Objective : This study was to examine the effects of a sleep pad, AlphaSlim^®, on patients with sleep disorders. Its physiological effects, the impact on sleep and the quality of life, and product safety were investigated.

Methods : Participants were divided into Active group and Dummy group (as a control) by envelop method. Both Active group and Dummy group were requested to sleep on AlphaSlim^® and ordinary sheets respectively for two months, and underwent objective as well as subjective assessments. The data collected from each group were compared.

Results : 20 subjects completed the experiment (9 belonged to Active group and 11 to Dummy group). Athens Insomnia Scale (AIS) : Sleep disorders in Active group significantly improved following the trial. Comprehensive Health Check for Workers (CHCW) : The results obtained from Active group showed a significant improvement after the trial while those from Dummy group remained unchanged. It follows that the quality of life of Active group improved. Sense of Coherence (SOC) Questionnaire : The results showed that there was a significant improvement in Active group after the trial while Dummy group reported no change. Blood test, Urinalysis, Chest X-P (used as a safety evaluation) : The clinical data obtained both prior to and subsequent to the experiment revealed that none of the participants had abnormalities. Head-up tilt test and heart rate variability (HRV) analysis : There was a significant improvement in high frequency components (HF amp) of the subjects in Active group following the experiment. Antioxidant defense system : Active group experienced a significant fall in the d-ROMs test after the experiment, which meant a positive change. The modified ratio of this group, which indicates the antioxidant potential, also improved significantly. Hemodynamics (head-up tilt test) : Systolic blood pressure (SBP) and the heart rate of Active group taken in a horizontal position dropped significantly following the experiment. There were increase tendency in stroke volume(SV), cardiac index(CI), but decrease tendency in total peripheral resistance (TPR) of this group. Cortisol, DHEA-S, Catecholamine, ADH, ACTH : A drop in the noradrenaline level was observed in Active group after the trial. There had been no significant difference of the DHEA-S level between Active and Dummy groups prior to the experiment, but the results obtained afterwards showed a significant increase in Active group.

Conclusions : AlphaSlim^® had favorable effects on people with sleep disorders. Without causing any harm, it enabled the participants to have better sleep and better quality of life. It even helped them to become confident about their life. The results of objective assessments were also supporting. HRV analysis revealed the improvement of the parasympathetic nervous system. The d-ROMs and the BAP tests showed the decrease of oxidative stress and the increase of the antioxidant potential. There were positive effects on the noradrenaline level and the DHEA-S level the way they could boost homeostasis. Thus, using a proper sleep tool like AlphaSlim^® not only helped to improve the quality of sleep. It also helped to normalize the homeostatic balance of the body that tended to be disrupted during the day when people were busy surviving a stressful life. It was evidenced that AlphaSlim^® had the ability to improve homeostasis.

95% of foot gangrene is caused by arteriosclerosis obliterans (ASO). More than 80% of ASO are attributed to diabetes, and more than 60% of patients with diabetes are on hemodialysis (HD). Another 10% of foot gangrene are led by collagen vascular diseases, such as rheumatoid arthritis and scleroderma, Buerger's disease, and shaggy aorta syndrome. These are accompanied by severe rest pain. The progression of foot gangrene results in major limb amputation. Recently, major limb amputation has most affected patients with diabetes and/or on HD.

Foot gangrene can be ischemic, neuropathic, and mixed (ischemic and neuropathic). Ischemic type is not common. Neuropathic type is accompanied by various sensory impairments, and increases the risk of deformities in toes and limbs and susceptibility to infection. Mixed type is most common (60%). The combination of ischemia and neuropathy accelerates the progression of infections and gangrene, which helps to prevent infection management and increase the risk of major amputation.

None of patients want major limb amputation. Loss of limbs in patients leads to deteriorating quality of life (QOL). Current comprehensive limb salvage treatment, including arterial reconstruction, wound management, and tissue transfer surgery for DM gangrene will acceptably achieve limb salvage rate by over 90% in 5 years. To standardize the treatment, it is urgent to establish a training program of limb salvage for physicians and surgeons.

Oriental medicine incorporates holistic approaches that is beneficial to the treatment of chronic pain.

1. Patients suffering from chronic pain tend to be vulnerable to external atmospheric stimulant such as air pressure and weather changes and therefore protection from these exasperation factors are important. In this approach, sensitivity to the external stimulant is countered from within the body.

2. There is a process in Oriental Medicine by which mental symptoms are dealt naturally through treatment of physical symptoms. Based on the notion that the physical and the mental are of a similar figure, it has a method to approach the physical through the mental and vise a versa. It is effective when patient experience difficulty coming to terms with their issues.

3. Integrating the perspective that the physical and the mental is of one body, reconstruction of body image should be encouraged to clinicians in that they develop a redefined sense of well-being within the context of the modern materialistic times.

4. The ideal treatment for Oriental Medicine is where a patient's awareness of self takes the lead in the cure of the self. This suggests that the deeper consciousness and the presence of being are related.

Temporomandibular disorders (TMD) are fundamentally physical disease. However, they are better understood when biopsychosocial model is applied. Thus, TMD can be considered as psychosomatic disorders, which is influenced by the psychological and social factors with varying degrees of severity.

Accordingly, it is necessary to assess patients in their physical aspect (Axis I) and psychosocial aspect (Axis Ⅱ) in making a diagnosis of TMD. If psychosocial factors (AxisⅡ) are dominant, which is peculiar to a subgroup of patients suffering from the chronic form of TMD pain, psychosomatic approach should be central to the treatment. In order to provide proper treatment, the assessment of TMD patients includes medical interviews, psychological tests and the distinction of patients based upon the MW classification criteria.

This is where cooperation with psychiatrists and other specialists as in consultation-liaison psychiatry is of crucial importance.

It is a treatment called YNSA which is one of my main treatments at the present time. YNSA is a treatment that Dr. Toshikatsu Yamamoto of Miyazaki devised since 1967. YNSA is a treatment method to prick the needles into the head and has shown high curative effects for the diseases such as the pain, central nerve system diseases, the mental disorder and so on. YNSA has spread through many countries around the world now including Germany, Hungary, Brazil, United States, Australia and so on. I examined the treatment effect of 39 rheumatic patients who visited our clinic for two years from May, 2013 to May, 2015. The results are as follows :

・Continued treatment not possible(less than 5 times) : 12 cases

・Aggravation or no improvement : 5 cases

・Positive effect : 22 cases

The results in detail, possibility and problems of YNSA will be discussed in the presentation.

Are there ways to live without excessive interference of pain? Without experiencing it, people are incapable of understanding how pain interferes with life. The lack of understanding causes pain patients to struggle so greatly that death seems the only way out. How can they live without being influenced by pain?

When pain becomes worse, there are reasonable causes. However, physicians as well as people around pain patients tend to think it is difficult to understand what patients tell them about pain. Thus, some patients are pushed into providing ‘too many explanations,' hoping to be understood. But such an attempt is rarely successful and they end up in hopelessness. On the other hand, there are patients who complain less of their pain. While living their social life, they may cope with their pain by ‘normalisation,' ‘pacing,' ‘tolerance,' and ‘exercises to improve physique.' The author thinks that they might even go so far as to ‘reshape the perception and interpretation of pain'. How do silent patients manage their pain?

It is encouraging that a new approach to pain patients has started. This approach is expected to facilitate the understanding of pain experience and underlying causes, and give all patients hope for recovery.

In this paper, the author attempts to describe aggravated pain and distress of patients from our filed cases, and invites all to consider what can be done to find a way of helping patients to be least affected by their pain experience.

The patients suffering both mentally and physically have recently increased, and these patients are also encounterd in dental office. A case of a patient with chronic and idiopathic oral pain, who had been unsuccessfully treated at several hospitals is presented here with some discussion.

The patient was sixty two years female (152cm, 42kg). Her main complaint was unbearable pain in the right mandible. The infected root canal in the area had been treated by a dentist several years ago. The patient's medical history included various systemic and mental diseases. The patient visited several hospitals and took twenty kinds of medicines.

The diagnosis at our hospital was chronic apical periodontitis due to the infected root canal of the right mandibular second molar. We provided endodontic retreatment and tooth crown restoration, and her symptoms were ameliorated. As the patient had still other complaints, PEG also employed base on salutogenesis. The comprehensive evaluation with an emphasis on Sense of Coherence (SOC) and resorse extraction was performed to reveal her physical. mental, social and existential problems. In addition,

In addition, her standardized score for health performance on “Comprehensive Health Check for Workers” (CHCW) was 41 points, which was a poor result for all dimensions on average.

Therefore, in order to treat those problems comprehensively, the comprehensive therapy by focusing on the problems such as her understanding ability, management capacity, and significance among resources. As a result, her symptoms decreased gradually.

Since the oral symptoms due to increased mental stress were observed, the treatment based on salutogenesis was introduced and finally her healthy daily lifestyle was resumed.

We provided comprehensive treatment for a 41-year-old female patient, who complained of pain and numbness on her upper and lower jaws. Her medical history showed that she was prescribed for anxiety disorders and irritable bowel syndrome at the age of 41.

After the third molar extraction, her upper and lower jaws began to hurt, accompanied by numbness on her cheeks, elbows and finger-tips. She tried acupuncture and Kampo treatment (Chinese herbal treatment), which had no effect on her symptoms. A month after the tooth extraction, she came to our clinic. We prescribed her pregabalin (25mg daily) and mecobalamin (1500μg daily). In addition, she underwent Xenon light therapy and logo-based psychotherapy. While we took a logotherapeutic approach and tried to listen to her with attention and acknowledgment, she came to realize that her pain was intensified when she had anxieties. Her symptoms were fluctuating for a while. Seven months later, her pain measured 2 out of 10 on Numerical Rating Scale (NRS). Since her pain seemed to be greatly influenced by psychological factors, active listening together with drug and Xenon light therapies played a key role in alleviating her symptoms.

Thanks to the advancement of science and technology, pain treatment in modern medicine has improved. Accordingly, various kinds of pains have now been treatable. However, there are still many patients suffering from pain ; postoperative pain and cancer pain affect a large number of patients. In addition, chronic pain prevails in our society.

Pain not only has destructive effects on humans, but also helps them to realize what is meaningfully valuable. All the human activities such as science, philosophy, psychology, religion, and literature offer useful tips on how to deal with pain. Just as medicine provides scientific solutions for pain, human history and the great achievements of our ancestors teach us humanistic ways of treating pain.

Pain is associated with tissue damage. Tissue damage leads to deformation of pain maps in the brain, and may even cause detrimental changes in the mind. If central sensitization is developed, pain will not only persist but worsen. Then, a vicious circle is created. Although neuroplasticity works when the brain restores damaged areas to normal conditions, the vicious circle of pain prevents it and over-sensitivities to pain is maintained.

In order to treat chronic pain patients who suffer from reactivity in the nervous system, it is important to improve brain plasticity, especially at the prefrontal cortex where pain is recognized and the insular cortex where internal conditions and emotions are monitored. By so doing, it becomes possible to change their perception of pain and relax their emotions. In addition, the adjustment of the motor cortex is useful to treat a certain types of neuropathic pain because the region lies next to the sensory cortex.

In summary, to deal with persistent pain, we should utilize not only the latest advance and accumulated wisdom of medicine, but also the healing powers of the brain and the mind which can be enhanced by mindfulness and meditation. Brain should not be the single focus of the treatment ; holistic treatment will relieve persistent pain, offer a benevolent approach to pain, and enable pain patients to empathize others suffering from intractable pain.