CyberKnife, an image-guided robotic radiosurgery, introduces advances in stereotactic radiosurgery for medically resistant trigeminal neuralgia. The frameless CyberKnife radiosurgery (CKR) can deliver either non-isocentric irradiation to an extended segment of the trigeminal nerve or isocentric irradiation to a pinpoint portion of trigeminal nerve. These characteristics of CKR are vastly different from the Gamma Knife radiosurgery (GKS). However, the differences between CKR and GKS regarding the ratio of pain relief to the number of treatments required to achieve it and the frequency of complications, such as hypoesthesia of the trigeminal nerve, were not significant. Radiosurgery does not have the concomitant risks of an open surgery; therefore, CKR should be evaluated as a minimally invasive technique for the management of recurrent trigeminal neuralgia with the goal of reducing nerve injury at the root entry zone or the retrogasserian region.

Ultrasound-guided nerve block has become popular as a safe and reliable technique. Ultrasound can help visualize the nerve, its surrounding tissues, and a block needle in real time. Ultrasound guidance is also used for performing sacroiliac joint blocks. A sacroiliac joint block can be classified into two types, intraarticular injection and periarticular injection. According to previous research, periarticular injection is recommended as a more effective method. The sacroiliac joint is innervated by a nerve plexus called the posterior sacral network (PSN). The PSN is often derived from the lateral branches of the dorsal rami of S1-S3. Therefore, an effective sacroiliac joint block can be performed if these branches are the targets. An ultrasound-guided sacroiliac joint block is strongly recommended for patients with lower back pain because it is a neural block procedure at a relatively shallow position where there are no tissues such as arteries and important organs.

Purpose: To ensure controlled dosage of Japanese herbal medicines given in small quantities of water, sedimentation must be minimized. When anorexia or nausea are present, medicinal-extract suspensions in cold water are consumed more easily; finding no reports on this, we examined how sedimentation of different medications varied in icy-cold to lukewarm water. Method: Into separate 20 ml syringes, each containing 15 ml of distilled water at either 0℃, 20℃ or 40℃, we dropped half a sachet of each of 24 types of herbal extract granules. At just after and 5 min after suspension, the samples were agitated for 1 min; at 10 min after suspension, sedimentation was measured. Results: At 0℃ and 20℃, nine formulations showed no more sedimentation than at 40℃; of these, one had no macroscopic sedimentation at any sampling temperature. Conclusion: Some Japanese herbal formulations may be effectively administered in cool and cold water.

Between 2015 and 2017, we examined 7,773 new patients in our medical offices. We diagnosed eight patients as having developed malignant tumors that had not been diagnosed as malignant before visiting our offices. The incidence of malignancy in patients presenting with any pain in the body is approximately 0.1％. We diagnosed these eight patients with an MRI exam after suspecting malignancy based on the patient's symptoms and the physical examination findings. There were six patients with low back pain that had two red flags for malignancy. Those were “patient over 50 years of age” and “back pain regardless of posture or movement”. In addition to these two red flags, the treatments of nerve block were not completely effective for these patients. “Pain regardless of posture or movement” was also an important sign to distinguish malignancy in two patients with pain other than low back pain.

Objectives: The purpose of this study was to examine the effect of nerve block for pain relief in the acute phase of herpes zoster (HZ). Study Design: A historical cohort study was conducted. Methods: We enrolled consecutive patients who visited Sendai Pain Clinic Center from January 2014 to December 2015 who were in acute phase of HZ, and less than 90 days from the onset of dermatomal rash. The exclusion criteria included patients without rash, patients on anticoagulant and antiplatelet treatment, or patients who visited our pain clinic only once. Outcome measurements included the difference between visual analogue scale (VAS) score at first visit, and at the visit three months after the appearance of a dermal rash. We used multiple linear regression models for the analysis. Results: After controlling for eight covariates, multiple linear regression found that a nerve block significantly reduced pain in the acute phase of HZ (P＝0.01). Conclusion: Comprehensive nerve block treatment can be one of the treatment options for pain in the acute phase of HZ.