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[in Japanese]

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Aim: We attempted to clarify symptoms that could predict pain relief with gabapentin in patients with neuropathic pain.
Methods: We performed a logistic regression analysis in patients with various neuropathic pain disorders who took gabapentin in a retrospective cohort study (n=53). Thereafter, we studied to confirm the effectiveness of gabapentin for neuropathic pain in patients with or without the selected symptoms from the retrospective cohort study in a prospective cohort study (n=24).
Results: The retrospective cohort study showed the presence of allodynia and dysesthesia were significant positive and negative factors, respectively, of pain relief with gabapentin. The adjusted odds ratio was 11.43 (95% confidence interval, 1.87-70.06) for allodynia and 0.08 (95% confidence interval, 0.01-0.74) for dysesthesia. Thus, allodynia and dysesthesia were selected as factors to predict the effectiveness of gabapentin. The prospective cohort study, however, showed that there were no statistically significant factors predicting pain relief with gabapentin. Pain in patients without dysesthesia tended to decrease with gabapentin.
Conclusions: We conclude that pain may be relieved with gabapentin in patients without dysesthesia.

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In this double-blind, placebo-controlled trial we evaluated the efficacy and tolerability of pregabalin for the relief of postherpetic neuralgia. Three hundred seventy-one patients whose pain persisted>3 months after healing of a herpes zoster skin rash were randomized to receive daily pregabalin 150, 300, 600 mg or placebo for 13 weeks. Pain was relieved as early as the first week after treatment in all pregabalin groups compared with the placebo group. Endpoint mean pain scores were significantly reduced with pregabalin 300 and 600 mg/day compared with placebo. Sleep disturbance, allodynia, and hyperalgesia improved in all three pregabalin groups. The most common adverse events were dizziness, somnolence, constipation, peripheral edema, and weight gain. Adverse events appeared dose related and were generally mild to moderate in intensity. We conclude that pregabalin is useful for the treatment of postherpetic neuralgia.

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We report a patient having palmar hyperhidrosis with panic disorder treated with endoscopic thoracic sympathectomy (ETS). A 17-year-old man had experienced palmar hyperhidrosis and panic attacks since attending elementary school. Although he received fluvoxamine and cognitive behavior therapy, the panic attacks frequently occurred. He visited our clinic and complained of hyperhidrosis. He underwent ETS, which improved the palmar hyperhidrosis and panic attacks, and thus discontinued fluvoxamine. One year later, he reported a good social life without recurrence of palmar hyperhidrosis and panic attacks.

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We report a patient with thoracic spinal cord granuloma whose initial symptoms were lumbago and inguinal pain. A 62-year-old woman had persistent lumbago and right inguinal pain. Thereafter, the patient developed sensory impairment of the right lower limb. Since the pain did not improve with medications, she was referred to us. The patient denied having intermittent claudication. Physical examination revealed bilateral exaggerated Achilles tendon reflexes. The motor impairment was progressive. MRI of the thoracic spinal cord disclosed intramedullary nodular lesion at the 10^th thoracic vertebral level that was enhanced by gadolinium. Pathology of the removed lesion was granuloma. Spinal cord lesions should be borne in mind when patients have pain and progressive neurologic impairment. Imaging studies such as MRI should be done to clarify the etiology.

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We report two patients with traumatic cervical syndrome who were treated with fluoroscopy-guided cervical facet block and rhizotomy. Case 1: A 32-year-old woman had a rear collision car accident when she was driving a car. Oral non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy did not improve the pain in the right posterior cervical region and face. The patient visited our clinic 1 year after the accident. Cervical facet blocks at C3/4 and C4/5 three times and cervical facet rhizotomy at C4 were performed under fluoroscopy. The pain in the posterior neck improved; however, pain in the face persisted. Stellate ganglion block (SGB) on the right was performed 10 times, which improved the facial pain. Case 2: A car hit a 61-year-old woman from behind when she was riding a bicycle. Pain in the right cervical region and tinnitus occurred thereafter. Oral NSAIDs and physical therapy did not improve the pain. The patient was referred to our clinic 6 months after the accident. Cervical facet blocks at C3/4 and C4/5 three times followed by SGB five times improved the pain and tinnitus. We conclude that repeated cervical facet blocks are effective for posterior cervical pain and that persistent pain despite repeated cervical facet blocks can be relieved by cervical rhizotomy in some patients with traumatic cervical symptoms.

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