1996 年 8 巻 2 号 p. 155-158
A 59 year-old woman fell accidentally, and sustained bruising to her shoulder and left cheek two years before presenting at our pain clinic. She suffered from episodes of intermittent, sharp pain of the left cheek for three months after the accident, and this was then augmented by a continuous dull pain seven months after the accident. The usual diagnostic cranial examinations revealed no anatomically abnormal findings. As medication with antidepressants did not effectively attenuate the pain, she was referred to our clinic. We suspected that she was suffering from neuropathic pain secondary to her trauma, and we treated her with diode laser low reactive-level laser therapy (LLLT) using a GaAlAs 830 nm continuous wave system with an output power of 150 mW. Because the therapy was not effective, trigger point injection of an anesthetic (bupivacaine) was applied, which suceessfully attenuated the sharp pain, Subsequent combined treatment of conventional stellate ganglion block and antidepressant medication (desipramine) gave her a warm sensation on the pain region following LLLT. Three months after her admission, the intractable pain was successfully attenuated by the combination of diode LLLT and stellate ganglion block. As neuropathic pain is related to various mechanisms of neurotransmission and neuromodulation, a combination of treatment methods is recommended for successful attenuation of this type of intractable and difficult to treat pain.
