We conducted a questionnaire survey to clarify awareness regarding the usefulness of medication notebooks in disasters and the current status of disaster preparedness in migraine patients. The recovery rate was 67.5% (77/114 patients). Sixty-one percent of migraine patients did not know that a medication notebook was useful for doctors and pharmacists to select an alternate drug or prescription following the Great East Japan Earthquake. Although 66.2% of patients always had extra medication in preparedness for a disaster, the percentages of patients that always carried their medication notebooks or stored them in a location that can be accessed immediately in an emergency were 20.8% and 16.9%. Therefore patients need guidance regarding the management of drugs and preparation for disasters. Results of the survey revealed that awareness of crisis management by individual patients needs to increase.

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We experienced a case of extra-pleural hematoma after ultrasound-guided thoracic paravertebral block (TPVB) in a patient with no blood coagulation problems. An 85-year-old female developed postherpetic neuralgia and was treated with ultrasound-guided TPVB. After TPVB and a three-hour rest period, the patient was discharged; however, she returned to the clinic complaining of chest pain. A chest X-ray and contrast-enhanced computed tomography revealed a huge hematoma in the right hemithorax. The patient underwent an emergency removal of the hematoma and hemostasis, which might have developed following damage to the intercostal artery by the nerve-block needle. The postoperative course was uneventful, and the patient was discharged from the hospital on the fifth day after surgery. It is important to consider that bleeding complications can occur even during ultrasound-guided TPVB.

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The authors experienced a case of trigeminal neuralgia (TN) successfully treated with a nerve block, which incidentally led to the discovery of a meningioma. A 78-year-old male complaining of throbbing pain in the right nasal cavity underwent an otolaryngological examination, which revealed no abnormalities. Idiopathic TN was diagnosed, and the patient was prescribed carbamazepine (CBZ). Because the CBZ caused dizziness, he was referred to anesthesiology. The authors performed a single right infraorbital nerve block with high-concentration tetracaine, which successfully relieved his pain. Although the patient discontinued CBZ, his dizziness remained. A head CT scan revealed a meningioma at the cerebellopontine angle, which was then surgically removed. Since undergoing the infraorbital block, the patient's pain has not recurred even after one year. The “take-home” lessons of this case are twofold: (1) the importance of excluding the diagnosis of symptomatic TN even in a patient with typical idiopathic TN; (2) the importance of taking MRI into consideration when treating patients with TN.

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Cervical discitis (CD) is a critical infectious disease with inflammation and severe pain. A blood culture is performed to detect the primary causative factor because direct punctures of cervical abscesses using CT or fluoroscopy is difficult. Ultrasound-guided (USG) real-time puncture has been generalized for nerve blocks in pain medicine. We report two cases of CD treated by USG puncture drainage. Case 1: A 62-year-old man was admitted as a result of high fever and suspected peritonitis. CD on C6/7 with abscess was found by an MRI. We performed USG paracentesis using a microconvex probe. It provided drastic improvement to his symptoms and helped in the identification of causatives. Case 2: A 51-year-old woman was transferred with high fever and neck pain induced by C5/6 CD with abscess. A USG puncture drainage performed using linear probe resulted in an improvement of her symptoms, as in case 1. We conclude that USG real-time in-plane puncture drainage for a cervical abscess is useful for diagnosis, treatment, and pain relief in CD.

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The clinical presentations and pharmacologic management with valproic acid (VLA) for 3 zoster patients suffering from intolerable electric shock-like pain (ESP) were described. Case 1: A 60-year-old man affected by ophthalmic zoster 4 months after umbilical cord blood stem cell transplantation (UCBSCT) for malignant lymphoma. Because he was suffering from repeated episodes of intolerable ESP after 15 eruption days, treatment with VLA (800 mg/day) was initiated as an add-on to nortriptyline and gabapentin. The ESP was gradually reduced and resolved. Case 2: A 50-year-old woman with thoracic zoster 7 months after autologous peripheral blood stem cell transplantation for malignant lymphoma. ESP appeared in 54 eruption days and treatment with VLA (600 mg/day) as an add-on to nortriptyline resolved the ESP. Case 3: A 63-year-old man with cervical zoster 10 months after UCBSCT for myelodysplasia. Treatment with VLA (400 mg/day) resulted in resolution of the ESP, which occurred in 20 eruption days.

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We report on a case of pyogenic C1-C2 osteomyelitis that was diagnosed as occipital neuralgia. A 61-year-old man complained of occipital and neck pain with difficulty in rotating his head. Because his abnormal state was not observed and his pain did not diminish, he was referred to our outpatient clinic. His pain was not alleviated by various analgesics, superficial cervical plexus block, or greater occipital nerve block. Therefore we administered hydrocortisone intravenously for the purpose of diagnosing and treating potential systemic diseases, such as collagen disease. After administration of hydrocortisone, his pain disappeared dramatically. We immediately again performed an examination of his neck with X-ray and MRI, and we diagnosed his illness as pyogenic C1-C2 osteomyelitis. The patient received administration of antibiotics to reduce cervical infection and was provided with a neck collar. In conclusion, we should question C1-C2 osteomyelitis if nerve block or administration of analgesics is not effective for unidentified occipital pain.

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Chemotherapy-induced peripheral neuropathy (CIPN) causes pain and numbness in the hands and feet, which seriously disturbs the activity of daily living in severe cases. However, no effective treatments have been established for CIPN. Nine patients with CIPN were treated with oral Chinese herbal medicine and scalp acupuncture, and seven of them responded very well. Others, who did not respond well, continued or reinstituted the chemotherapy that induced their peripheral neuropathy. In most cases, an improvement of defi ciency, both in blood fl ow and static blood by the herbal medicine, lead to satisfactory relief of pain and numbness. Also, the use of Bushi was effective because the main cause of CIPN appeared to be neuronal sensitization. The mechanism of pain relief by scalp acupuncture is unclear, but one theory holds that the treatment affects the neuronal plasticity in brain. Therefore it is reasonable to treat CIPN with oral Chinese herbal medicine as well as neuronal sensitization, such as use of Bushi and scalp acupuncture.

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We report on a patient with phantom limb pain who was successfully treated with mirror therapy by use of a tablet-type terminal device （iPad^®）. A 33-year-old woman received an above-knee amputation resulting from a traffi c accident 13 years ago. Mirror therapy, using a mirror, was started on her phantom limb pain in October 2011. We changed to the iPad^® from the mirror for therapy in July 2012. Her phantom limb pain had gradually become relieved after introduction of the mirror therapy, but a large mirror was required for conventional mirror treatment. On the other hand, mirror treatment using iPad^® can be used without arranging for either a time or a place. Furthermore, because this case had a motor dysfunction in the nonamputated limb, there was a limit in enforcing the conventional mirror treatment.

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Continuous peripheral nerve blocks (CPNBs) have been used for postoperative analgesia following invasive surgery. It also improves rehabilitation after surgery. The long-term catheterization leads to a variety of problems, including accidental withdrawal of the catheter, displaced catheter, and leakage of the local anesthetic around the catheter. We experienced some issues when we performed CPNBs for rehabilitation. Improvement of catheter fi xation (the combination of securing with sutures, surgical adhesive, and occlusive dressing) enabled long-term catheterization. We must improve methods and positions of catheter insertions and methods of catheter fi xation when using CPNBs for rehabilitation.

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Background: Pregabalin has been shown to be effective against neuropathic pain, but is associated sometimes with adverse events such as dizziness, peripheral edema, and weight gain. It is primarily eliminated unchanged by renal excretion, but because plasma concentrations of pregabalin are higher, patients with reduced renal function are at increased risk of adverse events. The aim of this retrospective study was to assess risk factors for adverse effects of pregabalin administration. Methods: To identify factors associated with adverse effects of pregabalin administration, we carried out a retrospective study at our pain clinic by using a cohort of patients prescribed pregabalin. Results: Multivariate logistic regression analyses demonstrated increased plasma potassium (odds ratio: 6.668) as a significant independent risk factor for the appearance of adverse effects with pregabalin administration. Conclusion: This study demonstrated that the appearance of adverse effects of pregabalin administration is more frequent in patients with higher concentrations of serum potassium.

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