Journal of Japan Society of Pain Clinicians
Online ISSN : 1884-1791
Print ISSN : 1340-4903
ISSN-L : 1340-4903
Volume 20, Issue 1
Displaying 1-15 of 15 articles from this issue
  • Mikio FUKUI
    2013 Volume 20 Issue 1 Pages 1-7
    Published: 2013
    Released on J-STAGE: March 22, 2013
    Advance online publication: February 26, 2013
    JOURNAL FREE ACCESS
    In recent years, pulsed radiofrequency (PRF) has evolved dramatically and has been applied as a safe and minimally invasive treatment of various types of pain. By intermittently energizing the high-frequency current, PRF is a means to obtain pain relief by raising the electric field to affect the nerves. It is set to keep the temperature below 42°C, to avoid possible spread of the surrounding temperature. PRF is less likely to cause muscle weakness, sensory disturbance, and motor paralysis, and it can be directed to the affected area of neuropathic pain and dorsal root ganglia. The objective of this review is to explain the physical as well as the biologic effects of PRF, and to show evidence of the efficacy of therapy of PRF treatment in chronic pain management in randomized clinical trials (RCTs) and well-designed observational studies.
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  • Hiromi FUJII, Toshio IWAKI, Yoshinori KOSOGABE, Hideki KAJIKI
    2013 Volume 20 Issue 1 Pages 8-11
    Published: 2013
    Released on J-STAGE: March 22, 2013
    Advance online publication: February 26, 2013
    JOURNAL FREE ACCESS
    Aim: Pregabalin (PGB) is the first-line agent for neuropathic pain. It has been reported that PGB at 150 mg daily is generally ineffective. We aimed to assess the efficacy of PGB using a low initial dose. Methods: The initial dose of PGB for neuropathic pain was 50 mg. Visual analogue scale (VAS) was assessed before administration and at 2 weeks, 4 weeks, 2 months, 3 months, and 6 months after administration. PGB was increased every 1 or 2 weeks until side effects developed or until patients expected no increase in quality. Results: We recruited 88 patients with a mean age of 71±10 years. At all measurement points, the dose of PGB was significantly increased, and VAS dosage was significantly decreased compared to that before administration. The dose of PGB at 2 weeks after administration was 75±34 mg. Conclusion: This study indicates that PGB at even less than 100 mg has a significant analgesic effect on patients with neuropathic pain.
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  • Shino NAKANISHI, Tatsuo YAMAMOTO, Yoichiro ABE, Kiyoshige OSETO, Keiic ...
    2013 Volume 20 Issue 1 Pages 12-16
    Published: 2013
    Released on J-STAGE: March 22, 2013
    Advance online publication: February 26, 2013
    JOURNAL FREE ACCESS
    Dekompressor® is a new device for the percutaneous lumbar discectomy. With Dekompressor®, the percutaneous lumbar discectomy for the treatment of radicular pain associated with disc herniation can be performed at minimum invasion level. We treated 43 patients using a Dekompressor® under fluoroscopic guidance. The intensity of pain and the level of physical functions were evaluated 7, 30, and 90 days after the procedure using visual analogue scale (VAS) and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), respectively. Follow-up data after 90 days were obtained from 33 patients. The reported average radicular pain VAS level was 64.8 mm before the procedure and 33.8 mm after 90 days. The effectiveness rate of low back pain, which was calculated by JOABPEQ was 74.2 %. None of patients reported procedure-related complications. Dekompressor® procedure can be a safe and efficient treatment of patients with radicular pain associated with disk herniation.
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  • Yukiko TABUCHI, Tetsuyuki YASUDA, Tetsuhiro KITAMURA, Michio OTSUKI, H ...
    2013 Volume 20 Issue 1 Pages 17-23
    Published: 2013
    Released on J-STAGE: March 22, 2013
    Advance online publication: February 26, 2013
    JOURNAL FREE ACCESS
    Opioids have been widely used for the management of acute and chronic pain, but they present several adverse effects such as fatigue, itching, nausea, and constipation. Recently it has been reported that chronic use of opioids has an influence on the endocrine system in humans. The most common endocrine dysfunction is hypogonadism, leading not only to a decrease in sexual function, but also to impaired physical and psychological conditions such as fatigue, muscle weakness, and depression. On the other hand, it has been reported that adrenal insufficiency and adult growth-hormone deficiency can also occur. These endocrine dysfunctions not only lead to impaired quality of life, metabolic abnormality, and organ damage, but they also may induce lethal conditions. Furthermore, these adverse effects can be avoided by either stopping or decreasing opioid treatment or by undertaking hormone replacement therapy. Taken together, it is very important for pain physicians to consider endocrine dysfunctions during long-term treatment with opioids.
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  • Dai GOKAN, Kaname UEDA, Yuko KONDO, Toru EHARA, Jitsu KATO, Setsuro OG ...
    2013 Volume 20 Issue 1 Pages 24-27
    Published: 2013
    Released on J-STAGE: March 22, 2013
    Advance online publication: February 26, 2013
    JOURNAL FREE ACCESS
    We experienced four cases of pediatric patients with intractable pain: a male with scar pain and 3 females with complex regional pain syndrome. They were referred to our pain clinic by a pediatrician for appropriate pain management. Three of the 4 cases required a multidisciplinary approach to determine adequate pain management. All 4 cases were able to reduce pain by means of several pain treatments, including nerve blocks, medications, rehabilitation, and interviews based on personal symptoms over time.
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  • Masataka NOMURA, Masuji TANAKA, Kae NAKASUJI, Norie IMANAKA, Soon-Hak ...
    2013 Volume 20 Issue 1 Pages 28-31
    Published: 2013
    Released on J-STAGE: March 22, 2013
    Advance online publication: February 26, 2013
    JOURNAL FREE ACCESS
    We report a patient with polymyalgia rheumatica referred to our hospital as unexplained musculoskeletal pain and diagnosed when the symptom was exacerbated during continuation of treatment. A male in his 60s had experienced cervix, shoulder, and upper arm pain after the onset of herpes zoster in breast back. Although the symptom was prolonged for 17 years, blood tests and imaging findings showed no obvious abnormalities causing the pain, and diagnosis of causative disease was undetermined. Satellite ganglion block, trigger-point injection, and drug therapy had gradually diminished the symptom, but half a year later the pain was exacerbated. At that time, upper-arm grasping pain appeared, and C-reactive protein and erythrocyte sedimentation rate increased. We considered polymyalgia rheumatica and prescribed steroid; all symptoms disappeared quickly. In a pain clinic, when treating prolonged musculoskeletal pain, continuous clinical observation and detailed physical examinations are needed in consideration of the possibility of various rheumatic diseases.
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  • Shota SONOBE, Masahiro KURA, Chikahiko SUKENAGA, Toshiya HASHIMURA, Ya ...
    2013 Volume 20 Issue 1 Pages 32-35
    Published: 2013
    Released on J-STAGE: March 22, 2013
    Advance online publication: February 26, 2013
    JOURNAL FREE ACCESS
    A 74-year-old woman presented with a chief complaint of masticatory muscle disorders and pain in the second branch of the right trigeminal nerve. The diagnosis was right-jaw arthritis and right trigeminal neuralgia (second branch). Eperisone hydrochloride and carbamazepine were administered. After no improvement in the symptomatic state of masticatory muscle disorders, she was referred to us. In place of carbamazepine, pregabalin was administered, but her symptoms remained unchanged. A head MRI revealed a tumor mass in the right-cone italic part, and she underwent cranial nerve surgery. In future cases, if nonclassic symptoms are observed, the possibility of symptomatic trigeminal neuralgia should be explored. It is also highly recommended to incorporate an MRI.
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  • Kentaro KOJIMA, Hitoshi TAGUCHI, Midori NAKAO, Munehiro MASUZAWA, Koh ...
    2013 Volume 20 Issue 1 Pages 36-39
    Published: 2013
    Released on J-STAGE: March 22, 2013
    JOURNAL FREE ACCESS
    A 10-year-old boy with a left-leg joint sprain was referred to our pain clinic. Pain had spread to the entire left lower limb in 2 weeks, and gait-disturbance had appeared. Allodynia was present in the left lower limb, and the temperature in the left toes was lower than in the right toes. A diagnosis of complex regional pain syndrome (CRPS) was made. Because the patient continued screaming even when gently touched, we avoided nerve blocks and started an oral anticonvulsant clonazepam 0.5 mg/day. Four weeks later, at 1.2 mg/day of clonazepam, both allodynia and spontaneous pain had reduced markedly. The dose of clonazepam was reduced by 0.2 mg/day 3 weeks later. Neither allodynia nor pain recurred during the next week without medication. We judged that the patient was cured of CRPS 8 weeks after the first medical examination. We believe that clonazepam may be effective to treat pediatric CRPS.
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  • Tetsumi SATO, Masako EBINA, Ryuji TOSE, Keiko SHIMADA, Kazuyoshi HIROT ...
    2013 Volume 20 Issue 1 Pages 40-43
    Published: 2013
    Released on J-STAGE: March 22, 2013
    Advance online publication: February 26, 2013
    JOURNAL FREE ACCESS
    Churg-Strauss syndrome (CSS) is characterized as systemic allergic granular angitis that shows a variety of cardiovascular, neurological, renal, and gastrointestinal symptoms. A 10-year-old boy suffering from severe abdominal pain with bilateral foot pain, pyrexia, bronchial asthma, eosinophilia, elevated C-reactive protein, and cardiomegaly caused by CSS was referred to our pain clinic. His severe abdominal pain had been palliated successfully by patient-controlled analgesia (PCA), using mixed oxycodone/hydrocotarnine solution. An approximate 4-month therapy has successfully introduced complete remission of his CSS, which enabled normal oral intake to be recovered. The dose of oxycodone had been gradually reduced, and its administration was finally stopped with no withdrawal symptoms. Mixed oxycodone/hydrocotarnine solution by the PCA system is an effective method of choice to alleviate abdominal pain caused by CSS.
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  • Tetsuro KIMURA, Hiroshi IGARASHI, Mizuki TANIGUCHI, Shigehito SATO
    2013 Volume 20 Issue 1 Pages 44-47
    Published: 2013
    Released on J-STAGE: March 22, 2013
    Advance online publication: February 26, 2013
    JOURNAL FREE ACCESS
    We report our experience in making a difficult diagnosis for a patient who developed deep paresthesia after insertion of an epidural catheter. The case was a 78-year-old male patient who received treatment for herpes zoster in the right-upper extremity. When an epidural catheter was inserted from C6/7 to begin continuous administration, the pain was completely eliminated. After 1 hour of rest, the patient complained of discomfort in his left-lower extremity. Since he continued to have difficulty in standing up, the continuous administration was discontinued. The catheter was removed, and cervical MRI was performed. As a result, intervertebral disc herniation compressing the right C7 nerve root was confirmed. Immediately after removal of the catheter, the symptom was improved. It was considered that deep paresthesia was caused when the epidural catheter compressed the dorsal column of the spinal cord, which was shifted in a posterolateral direction by cervical disc herniation compressing the nerve root similar to that of the herpes zoster.
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  • Junken KOH, Mahito KAWABATA, Masataka OISHI, Hiromi ARAKI, Yui UENO, M ...
    2013 Volume 20 Issue 1 Pages 48-51
    Published: 2013
    Released on J-STAGE: March 22, 2013
    Advance online publication: February 26, 2013
    JOURNAL FREE ACCESS
    We report a case of chronic postoperative pain that was alleviated by cognitive behavioral therapy at our pain clinic, which also removed the patient's dependence on large doses of an antianxiety drug. The patient was a 47-year-old woman who had undergone cholecystectomy for cholelithiasis 5 years before and had been experiencing abdominal pain since then. The pain was persistent and worsened spasmodically. Therefore besides receiving treatment at another pain clinic, she had often visited the emergency department of another hospital. When she consulted our department, she had taken up to 12 tablets per day of etizolam (0.5 mg), an antianxiety drug. At first we treated her with continuous epidural block and local irradiation with linear-polarized near-infrared rays, which could hardly alleviate the pain. We diagnosed the case as etizolam dependence accompanying chronic pain and introduced cognitive behavioral therapy 6 months after the first examination. As a result, the etizolam dose could be decreased gradually, and the patient restored bright expressions on her face. Six months after introduction of the therapy, the pain was alleviated and the patient could stop taking large doses of etizolam.
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  • Shintaro ABE, Kazunori HIROTA, Kazuhiko HIRATA, Koichiro TAKEMOTO, Tor ...
    2013 Volume 20 Issue 1 Pages 52-55
    Published: 2013
    Released on J-STAGE: March 22, 2013
    Advance online publication: February 26, 2013
    JOURNAL FREE ACCESS
    We report a patient with traumatic intracranial hypotension who needed epidural blood patches at three spinal levels. A 44-year-old man developed orthostatic headache the next day after he received a massage to the neck and higher back. The magnetic resonance images (MRI) of the head and neck, MRI myelography, radionuclide cisternography, and low pressure of the cerebrospinal fluid (CSF) indicated that he had traumatic intracranial hypotension. Intravenous hydration and bed rest failed to lessen the headache. An epidural patch with 13 ml of autologous blood was done via the C7/T1 interspace. The headache persisted. The MRI and MRI-myelography indicated the presence of CSF in the lower thoracic to the upper lumbar epidural space. The second epidural patch with 16 ml of autologous blood was performed via the L3/4 interspace; however, the headache remained. The third epidural patch with 12 ml of autologous blood via the T9/10 interspace was done. The headache disappeared two hours after the procedure.
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  • Megumi KAGEYAMA, Shinsuke HAMAGUCHI, Rie MATSUZAWA, Naoko HIGASHI, Tom ...
    2013 Volume 20 Issue 1 Pages 56-59
    Published: 2013
    Released on J-STAGE: March 22, 2013
    Advance online publication: February 26, 2013
    JOURNAL FREE ACCESS
    A 42-year-old male had continuous pain in his back, hip, and bilateral lower extremities. A lumbar MRI showed a small subdural extramedullary tumor behind the L3 vertebral body. However, removal of the tumor was not adopted because the doctors determined that it was not the cause of his neurological findings. Before his visit to our outpatient service, he had been treated with various antidepressants, anticonvulsants, and analgesics, including opioid alone or in combination. However, previous treatments were ineffective. We diagnosed his pain as neuropathic and prescribed a combined 400 mg of gabapentin and 60 mg of duloxetine a day after confirmation of his past medication history. Four weeks after daily administration of these drugs, his pain had decreased to 5/10, from 10/10, determined by use of a pain scale. We concluded that the combined administration of various adjuvant analgesics can be useful for neuropathic pain relief when analgesic administration with no combined administration was ineffective treatment for intractable pain.
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