[in Japanese]

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After “WHO method for relief of cancer pain” was adopted in clinical practice, morphine played major role in the treatment of cancer pain. Although new opioid analgesics (fentanyl-patch and slow-release oxycodone tablet) introduced recently, importance of morphine does not lessen at all. Almost all anxieties related to use of morphine (tolerance, addiction, respiratory depression, mental disorders, etc.) were resolved by the abundant clinical results and experimental studies in case of the treatment of pain. To provide satisfactory pain relief, it is essential to control unpleasant side effects thoroughly and to give “full” analgesic dose of the drug. Morphine is able to offer flexible remedies to various patient conditions with many forms of drug (fast-release tablet, slow-release tablet, liquid, suppository and many types of injectable solution). Still now morphine is the most reliable drug for pain relief, all “pain-clinician” must practice the proper use of it.

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Purpose: To explore the usefulness of the Hospital Anxiety and Depression Scale (HADS) for the cognitive behavioral approach to chronic pain by comparing it with the Profile of Mood States (POMS). Methods: 58 outpatients with chronic pain were studied. We treated them with psychological treatment, and their emotional state was measured with both the HADS and POMS before and after treatment. Pain was measured with the VAS. We studied the relationships among the results. Results: We found a correlation between the depression scale of the HADS and the depression-dejection scale of the POMS, and also between the anxiety scale of the HADS and the tension-anxiety scale of the POMS. The VAS was correlated with the depression scale and anxiety scale of the HADS and also with the depression-dejection scale and tension-anxiety scale of the POMS. Conclusion: We recommend the use of the HADS to evaluate the effect of treatment for chronic pain patients.

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Objective: The effectiveness of radiofrequency thermocoagulation of nerve roots was evaluated in 66 patients who were treated with selective radicular block using local anesthesia only, resulting in transient effects, and who were therefore diagnosed with intractable cervical spondylotic radiculopathy. Methods: After fluoroscopic radiculography using a needle electrode (non-insulated portion, 4mm), a local anesthetic was infused, followed by 90-second radiofrequency thermocoagluation at 40°C. One week later, the first evaluation was made. If the treatment was not effective and loss of muscular strength was not observed, the treatment was repeated at higher temperatures. The final evaluation was made 4 weeks after the last treatment. An evaluation of “effective” was given when the visual analogue scale pain score was decreased to half of the original value. Results: “Effective” results were found in 35 patients (effectiveness rate, 53.0%). A major adverse effect was loss of muscular strength which lasted for more than 1 week, which was noted in 19 patients (28.8%) but was recovered within 4 weeks in each patient Conclusion: Radiofrequency thermocoagulation for intractable cervical spondylotic radiculopathy is effective and worth trying under temperature control.

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A 83-year-old man had suffered severe from postherpetic neuralgia for 8 years. He received cervical dorsal rhizotomy in C2, C3, and C4 for unbearable allodynia. Although deep hypesthesia on all the skin of the right C2-C4 dermatomes was noted after the dorsal rhizotomy, cramping pain and brief recurrent shooting pain on the right cervical area were persistent Various therapies including C4 root block, topical capsaicin, dextromethorphan, ketamine, lidocaine and mexiletine could not attenuate his pain. We reexamined several drugs for his pain. Intravenous morphine at 5mg reduced his pain effectively. We decided to prescribe slow-release morphine at 60mg/day and amitriptyline at 10mg/day, orally. This painful condition was relieved with morphine in his last days.

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Although sympathetic blockade by stellate ganglion block (SGB) is a good indication for the treatment of sudden deafness, this therapy is still controversial for patients with bronchial asthma. We report a case of a patient suffering from sudden deafness with a complication of bronchial asthma who was successfully treated with repeated SGB.

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A 33-year-old woman presented with left jaw pain and was diagnosed as having a temporomandibular joint (TMJ) disorder. She was initially treated with nonsteroidal anti-inflammatory drugs and an oral orthopedic appliance. However, the pain in the left jaw persisted. Further examination revealed the presence of a trigger point in the ipsilateral trapezius muscle. The jaw pain relieved after a trigger point injection with 1ml of 1% procaine into the muscle as a diagnostic and therapeutic procedure. It is suggested that trigger point injection may be effective in the differential diagnosis of facial myofascial and TMJ pain.

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A 60-year-old man had herpes zoster on the left upper limbs during treatment with low-dose methotrexate (MTX) for rheumatoid arthritis (RA). He felt pain in the left upper limbs in the daytime the day after starting low-dose MTX therapy. Skin eruption appeared in the pain area in the evening. Intravenous aciclovir and continuous epidural block were started. His pain decreased to VAS values of 0mm.
MTX therapy so metimes causes immunosuppression, with may become critical when patients have herpes zoster. Therefore, aciclovir should be administered as early as possible in the case of herpes zoster with RA treated with low-dose MTX.

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We experienced a 76-year-old man with gastric ulcer who had right anterior chest pain diagnosed as intercostal neuralgia. He had had a right lobectomy 30 years ago and it was followed by right intercostal neuralgia. He had knotted pain without trigger at night. The pain continued for 2 to 8 hours but it responded temporarily to nonsteroidal anti-inflammatory drugs (NSAIDs) given orally. He did not have allodynia. Due to complaints of sleeplessness and poor appetite with loss of weight, he was admitted to our hospital and treated by continuous epidural block for pain. With continuous epidural analgesia the chest pain disappeared, but he still could not eat anything. Since his abdominal pain had intensified, he had a screening for abdomen disorder. A large gastric ulcer was found by endoscopic examination of upper gastrointestinal tract. The ulcer responded well to medical treatment and the abdominal pain disappeared. He was discharged from our hospital after 2 months. Gastric ulcer seldom solely shows chest pain, but pain clinicians should recognize it as one of the complications of NSAIDs.

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