Abstract
The patient consulted another institution with a two-year history of pain radiating from the precordial and scapular regions to the axilla. However, despite thorough investigations, the cause of the pain could not be identified. The patient was subsequently referred to our department for the management of intractable pain, and was undergoing nerve block and drug therapy. While on these treatments, the patient began to complain of unilaterally reduced facial and palmar sweating associated with a warm sensation, and diagnostic imaging (CT and MRI) performed at this time detected apical lung cancer. In this patient, clear signs of sympathetic blockade including reduced sweating and increased skin temperature were seen, although Horner syndrome was not observed. When treating cryptogenic radiating pain in the shoulder and the upper arm, therapy such as stellate ganglion block is often performed, but medical inquiry and diagnostic imaging are important when considering the treatment of patients with this type of intractable pain. Since it is particularly difficult to detect subjective and objective symptoms associated with autonomic nerve abnormalities, autonomic activity must be assessed.
