Nerve block may be the most effective pain relief for acute herpetic pain. However, there are some cases in whom we cannot perform nerve block to avoid critical complications in spite of severe pain.
Therefore we attempted iontophoresis with local anesthetic and linear polarized infra-red ray local irradiation as alternative strategy in such cases. Iontophoresis is transdermal administration of anti-pain drug by applying an electric current. We investigated clinical courses of 8 patients with acute herpetic pain treated by iontophoresis and linear polarized infra-red ray local irradiation and discuss the efficacy of these treatments herein.
Nerve block was contraindicated in 6.2% (8/130 cases) of patients with acute herpetic pain referred to our clinic. By initial treatment, pain was reduced by 65.4% versus pretreatment pain. Average time to cure was 73.3 days at a mean of 32 aplications of treatment. There were no complications in all cases. The treatment worked well against aching pain and fulgurant pain, but was not affective against dull pain and numbness. All patients reported good therapeutic benefit of the treatment. The technique was very simple and safe and we could perform iontophoresis and linear polarized infra-red ray local irradiation many times without any complication.

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Though the Short-Form McGill Pain Questionnaire has been translated into several languages and validated, a Japanese version has not yet been developed. The Short-Form McGill Pain Questionnaire (SF-MPQ) has been translated into Japanese. Fifty-seven chronic pain patients in the department of psychosomatic medicine (PS), rheumatology (RA) or orthopedics (OP) filled out the SF-MPQ. Cronbach's alpha was 0.84, which indicated internal consistency of the 15 descriptors of the SF-MPQ. Concurrent validity of the SF-MPQ descriptors was supported by the result that the VAS values and the SF-MPQ descriptors total intensity scores were highly correlated using the scores of all patients (0.76) and of each group. We conclude that the Japanese version of the SF-MP is useful to analyze the quality as well as the quantity aspect of pain.

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We report a case of an elderly woman presenting with herpes zoster with motor nerve disorder of right upper extremity. Motor weakness of the right arm occurred with the onset of exanthema and pain. We administered antivirus medicine and effectively managed the patient's pain symptoms by analgesic. Although the patient underwent rehabilitation treatment, her recovery of motor nerve function was poor.

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We roport a 72-year-old female patient, who could not walk because of pain caused by calcaneotibial bone metastases from breast cancer. Since she had already undergone two courses of radiation therapy, we considered that additional radiation therapy would induce ankle contracture and skin ulceration. Therefore we injected bone cement into the metastatic lesions. The day after this therapy, the pain was relieved and the patient could walk by herself using a stick. Percutaneous cementoplasty, especially of the vertebra, has become an accepted procedure and the number of published cases is increasing. The rapid good clinical result observed in our patient is encouraging for the widespread application of this procedure.

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The authors report a case of malignant lymphoma presenting with clinical signs of Tolosa-Hunt Syndrome (THS) and pain in the ipsilateral upper limb. A 69-year-old male complained of acute pain in the left V1 and V2 trigeminal territories, left ptosis, and pain in the left upper limb. Magnetic resonance imaging (MRI) showed abnormal mass in the region of cavernous sinus and deformity of the cervical vertebra. We diagnosed his status as Tolosa-Hunt syndrome complicated by cervical spondylosis, and thus initiated steroid therapy and stellate ganglion block. The patient's symptoms however did not improve; furthermore, lower cranial nerve disorder appeared and enlargement of abnormal mass in the region of cavernous sinus was noted. Cranial biopsy for clearer diagnosis showed malignant lymphoma. The patient was placed on radiotherapy and chemotherapy, which resulted in an improvement of the symptoms. It is important to discriminate other diseases including malignant lymphoma patients showing THS-like symptoms especially when the patient has progressive symptoms other than ophthalmoplegia and pain in the V1 trigeminal territory.

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The author reports a delayed onset of pain in the lower limb after repeated gynecological pelvic surgery. Forty-nine-year-old woman who underwent laparoscopic assisted transvaginal hysterectomy for myoma uterin and laparoscopic removal of ovarian chocolate cyst within a 4-year period developed pain in the left lower limb. The pain developed three months after the last surgery and gradually worsened. The clinical course and imaging studies suggested that the cause of the pain was nerve damage caused by postoperative scar tissue around the left lumbosacral nerve trunk. She received repeated epidural blocks with a local anesthetic with methylprednisolone and amitriptyline, after which the pain gradually decreased.

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