Childhood maltreatment, which markedly increases risk of psychopathology, is associated with structural and functional brain abnormalities. Parental verbal abuse (PVA) or interparental violence during childhood is strongly associated with depression, PTSD, and reduced cognitive abilities. Other forms of childhood abuse have been associated with brain structure or developmental alteration. Our earlier studies elucidated the potential effects of PVA and domestic violence on the child's brain morphology, such as gray matter volume or cortical thickness. Subjects exposed to a single form of maltreatment might be particularly susceptible to the modification of brain regions that process and convey the adverse sensory input. Exposure to multiple types of maltreatment are more commonly associated with morphological alterations in the corticolimbic regions. These findings fit with preclinical studies that indicate the high plasticity of sensory cortices. Using tasks with high and low monetary rewards, while undergoing functional magnetic resonance imaging, we examined whether neural activity during reward processing was altered in children and adolescents with reactive attachment disorder (RAD). Significantly reduced activity in the caudate and nucleus accumbens was observed during a high monetary reward condition in the RAD group compared to the typically developed group while the striatal neural reward activity in the RAD group was markedly decreased. The present results suggest a dopaminergic dysfunction in the striatum of children and adolescents with RAD, potentially leading to a future risk of psychiatric disorders such as dependence.

For osteoarthritic pain, patients are often provided explanations like, “it hurts because the articular cartilage has peeled off and bare bone is rubbing together” or “it hurts because of osteophytes.” However, the reality is more complicated. While structural changes in the bone, cartilage, and tissue around the joints can cause pain, there are various other contributing factors such as synovitis, nerve sprouting in aneural regions such as the cartilage and meniscus, central or peripheral sensitization, and abnormality of the descending pain control system. Although these elements are closely related, each has its own pathogenesis. Therefore, each one could independently develop into an abnormality. Osteoarthritic pain is complicated, and the main cause varies depending on the stage of the disease and the individual patient, and hence, treatment according to the abnormality is required. In a super-aging society, doctors will clearly have more opportunities to see patients with osteoarthritis. To provide a tailor-made treatment protocol for osteoarthritic pain, it is important to understand the changes occurring during osteoarthritis and the exact cause of the pain.

Opioid misuse and addiction are a serious problem for public health and economy in the US. Since opioids is applied to chronic non-cancer pain as well as cancer pain, chronic opioid user is increasing according to the increase in life expectancy. However, Preoperative use of opioids is a risk factor for postoperative infection and reoperation because of their immune-suppressive effects. In addition, Perioperative use of opioids can lead to chronic opioid use and cancer recurrence after surgery. The immune-suppressive effects of opioids depend on type and dose of opioids. Recently, it has been reported that opioids can inhibit immune response through pattern-recognition receptors other than opioid receptors. Therefore, the binding of opioids to pattern-recognition receptors might directly change the recognition of foreign substance including pathogen and cancer cells.

Background: The zoster-associated pain (ZAP) is often prolonged with various treatments in older adults, but details of the cognitive function are still unclear. Methods: In this study, we retrospectively investigated the relationship between the treatment and cognitive function in older adults with ZAP. The cognitive function was evaluated with the Mini-Mental State Examination (MMSE) and Hasegawa's dementia scale-revised (HDS-R). Results: In 30 patients aged 79 (65–89) [median (range)], MMSE and HDS-R scores were 25 (17–30) and 25 (11–30), respectively, at the first visit. One month later, NRS, MMSE, HDS-R scores significantly improved (all p＜0.001). There was a significant positive correlation between HDS-R and disease duration (p＝0.022, rs＝0.418), and between MMSE or HDS-R and pregabalin consumption (MMSE; p＝0.021, rs＝0.458, HDS-R; p＜0.001, rs＝0.652). There was a negative correlation between MMSE scores and opioid consumption (p＝0.018, rs＝0.470), and no significant correlation in the nerve blocks. Conclusion: Our study suggests that the cognitive function in older adults with ZAP is impaired in the acute phase and with opioid treatment, and it is improved with pregabalin treatment.

Opioid induced constipation (OIC) is a prevalent issue among chronic noncancer patients because of the more prolonged use of opioids compared to that among cancer patients. We conducted a retrospective observational study to evaluate the efficacy and side effects of naldemedine. Thirty-three cases (92％) showed increased bowel movement and 26 showed (72％) reduced use of other laxatives. The adverse events included diarrhea (17％) and loose stools (8％). No severe adverse events were observed. The cost incurred due to OIC before prescription of naldemedine was 1,148 yen/month, but with naldemedine, the cost increased to 6,102 yen/month. Although naldemedine is expensive, it has few adverse effects. In addition, it reduces the use of other laxatives that can cause hypermagnesemia, kidney disfunction, and hypokalemia. Naldemedine is effective and safe for OIC treatment in patients with chronic noncancer pain. It is also an effective alternative to laxatives with adverse reactions.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most widely prescribed drugs all over the world. Several NSAIDs are being developed, however, it has been difficult to assess NSAIDs either objectively or relatively because pain is based on individual patient assessment. PainVision (PV) is a useful tool to measure the pain intensity using a painless electrical stimulation. In this study, 19 topical NSAIDs were assessed subjectively and relatively using visual analog scale (VAS) and PV, respectively. These scores after NSAIDs challenge were obtained from 33 healthy volunteers with informed consent. It was significant correlation between PD and VAS (r＝0.681: p＜0.01). We found that the analgesic effect of Mikametan, Teikoku and Yutoku were stronger than Inteban, significantly. Our data help revealed PV could be a useful tool for pain assessment. Our data helps pharmacists selecting NSAIDs drugs from generic name prescription.

Spinal cord stimulation (SCS) may cause cardiac pacemaker (PM) malfunction. We described a case of a 70-year-old female with arteriosclerosis obliterans where SCS was performed without interfering with the PM. Despite undergoing circulatory reconstructions seven times, SCS was requested as pain in the lower extremities persisted (NRS 7/10). The PM was needed for sick sinus syndrome. We confirmed an absence of interaction between SCS and PM by adjusting the electrode's position and stimulating the PM's intensity, frequency, and sensitivity with the VVI mode. The generator was implanted on the 7th day after placement of the electrodes. The pain decreased to NRS 4/10 when she was discharged on the 11th day without PM malfunction. Therefore, by carefully placing the stimulating electrodes and adjusting its parameters, SCS can be safely performed in the presence of a PM.

Psoas compartment block (PCB) for low-back or leg pain carries the risks of retroperitoneal hematoma or visceral injury. In order to evaluate the safety profile of PCB, we retrospectively assessed the anatomical position of the psoas muscle (PM) in patients that received a lumbar MRI. We measured the following distances at the level of the L4 spinal segment: 1) depth from 40 mm lateral to spinous process at the skin to PM, 2) distance from spinous process to the lateral border of PM. We also evaluated the location of the kidneys and the incidence of complications in relation to patient characteristics. A hundred patients were included in the study. The mean results were, 1) 63 mm, 2) 63 mm in males, and 53 mm in females. Both kidneys were located below L3 in most patients and there were no complications related to patient characteristics. The PM was found to be located deeper with increased body weight and tended to be located more laterally in males.

Following a constant orthostatic headache and nausea three weeks after undergoing a urological surgery, the patient, a 16-year-old male, was referred to our hospital. An initial epidural blood patch (EBP) was performed at level L4/5 where twenty milliliters of autologous blood was administered using an 18-G epidural needle; providing no improvement. Since a spinal computed tomography (CT) revealed an insufficient blood spread to the ventral lumbar epidural space, during the second EBP, a Racz catheter was inserted from the sacral fissure and placed at level L4/5 in the ventral epidural space. This was done while simultaneously performing an additional epidural puncture at level L3/4. Twenty milliliters of blood were administered in total. This time, spinal CT demonstrated sufficient spread of blood around the epidural space followed by the patient's prompt improvement. We conclude that the Racz catheter technique can efficiently administer blood to the cerebrospinal fluid leak sites and may be useful for intractable post dural puncture headache.

We report a patient who underwent radiofrequency thermocoagulation (RF) of the right mandibular nerve for symptomatic trigeminal neuralgia (TN) associated with multiple sclerosis (MS). Approximately twenty years prior, a 48-year-old woman developed muscle weakness in the left upper limb and double vision. She was diagnosed with MS by a neurologist. Despite administration of steroid and interferon therapy, she experienced a remitting-relapsing course. She experienced pain in the right mental region and on the ventral surface of the right tongue two years ago. She commenced treatment with pregabalin, but discontinued it because of gait disturbance even with a low dose. Treatment with carbamazepine, levetiracetam, and tramadol was also ineffective. She underwent RF of the right mandibular nerve resulting in relief of the intractable TN. Trigeminal nerve block for symptomatic TN associated with MS is considered to be less effective compared to its proven benefit in classical TN. However, it may be beneficial in cases refractory to pharmacotherapy.

Here we report two patients with persistent postoperative pain (PPP) whose symptoms and activities of daily living (ADL) improved following nerve root pulsed radiofrequency (PRF). Case 1: A 68-year-old male felt discomfort and pain in the inguinal region for five years after a total prostatectomy. Various drug therapies did not work, and peripheral nerve blocks had transient effect. The pain disappeared for several months after performing nerve root PRF, and the patient could later resume playing golf. Case 2: A 52-year-old female presented with chronic abdominal pain experienced for three years after abdominal surgery due to pancreaticobiliary duct abnormalities. Intercostal nerve block and drug therapy allowed slight pain relief; but subjective symptoms and ADL greatly improved by performing thoracic nerve root PRF. These results suggest nerve root PRF could be a promising treatment for intractable PPP.

We report the outcome of pain clinic treatment in 8 patients diagnosed with somatoform disorder. Three patients reported pain reduction. Their pain was caused by undiagnosed medical dysfunctions. Another three patients who had non-severe dysfunctions learned to cope with their pain. One patient was later diagnosed with dissociative disorder, and remaining 1 patient showed no improvement.

A 60-year-old women with rheumatoid arthritis strained her left elbow, which was diagnosed as a tear in the medial collateral ligament. She was treated with medication and physiotherapy, which exacerbated the elbow joint pain. The following year, she developed severe left elbow pain due to overuse, and the pain had spread to both upper extremities. She was referred to our clinic 2 years after the initial injury. On her first visit, she not only had movement pain but also severe resting pain on both upper extremities and was unable to move her shoulders, elbows, and wrists on both sides. Severe muscle and bone atrophy of the upper extremities were also noted. Collateral meridian therapy was administered once in 1–2 weeks, which eliminated her resting pain. In addition, she was able to make full movement of the left elbow joint and 90 degrees flexion of the right elbow joint after 2 months of treatment.

Percutaneous vertebral drilling (PVD) for acute lumbar compression fractures ameliorates back pain and promotes rehabilitation. However, its effect on spinal construction and function has not been sufficiently evaluated. We report a case involving a newly developed radiculopathy after PVD. A 67-year-old woman presented with back pain and right fourth-lumbar (L4) radiculopathy. Magnetic resonance imaging (MRI) revealed vertebral compression fractures at L2 and L3. The patient was hospitalized immediately, and continuous epidural block was initiated. Despite treatment, severe back pain persisted, and hence, PVD on L2 and L3 was performed. The patient was able to ambulate more easily while wearing a lumbosacral corset after the operation; however, she reported pain in the right leg. This was diagnosed as a newly developed radiculopathy. Although we could not definitively determine when the new radiculopathy developed during the continuous epidural block, PVD may have influenced this development. It is, therefore, important to evaluate the chronological progression of fractures and radiculopathies via radiography and MRI.

Lumbar canal stenosis (LCS) causes characteristic symptoms of lower limb pain possibly due to oppression or ischemia of the spinal cord and the cauda equina nerve. The symptom is often relieved at rest, therefore the assessment of spinal cord stimulation (SCS) using pain scores can be unclear during hospitalization. We used motor function tests as the evaluation of SCS trial in addition to pain scores in four LCS patients aged 57–85 years. The motor function tests included Time Up & Go test, 10 m walking time and walking distance measurement. The SCS trial improved the motor function tests in all patients, however, the improvement of pain scores were uneven. It is suggested that motor function tests may be useful as an objective tool for evaluation of SCS trial in addition to the subjective pain scores during hospitalization.

In recent years, the ultrasound-guided maxillary and mandibular nerve block technique has received increasing attention. A 21-year-old woman underwent orthognathic surgery of the maxilla and mandible for distortion of the face. Ultrasound-guided maxillary and mandibular bilateral nerve blocks were performed under general anesthesia. At the time of wound closure, intravenous acetaminophen and intravenous patient-controlled analgesia (IV-PCA) were administered. During the surgery, there were no significant changes in the blood pressure or pulse rate. After surgery, the patient did not complain of pain for 32 hours under continuous IV-PCA alone. In this technique, the anatomy of the temporal region can be visualized with ultrasound, and the local anesthetic is infiltrated into the nerve with a lateral pterygoid plate approach. Therefore, there're reports that the use of ultrasonic devices is safer and more accurate than the landmark method. We considered that this patient was a good candidate for analgesia using this technique, and we were able to achieve adequate perioperative analgesia.

A case is a 27-year-old woman. Open discectomy was performed for L3/4 and L4/5 herniation in X−7 year. X−1 year, She visited our department with low back pain and right lower limb pain. MRI confirmed recurrence of huge herniation occupying 70％ of the spinal canal in the L4/5 and disc degeneration. She complained severe pain of low back and L5 nerve root area, NRS was 10 and SLRT was 30 degrees. NRS decreased to 7 in drug therapies and nerve root block etc., but she was difficult to maintain the same posture and walking. We considered intervertebral disc therapy (Disc-FX^®). We performed nucleus decompression, nucleus ablation, and annulus modulation using Disc-FX^®. Lower extremity pain disappeared on day 2, SLRT improved to 80 degrees. Back pain gradually improved and decreased to NRS 1–3. Even in the recurrent huge herniation, Disc-FX^® was considered as one of the options to try.

Ulnar nerve dysfunction causes pain and numbness in the ring and little fingers. We report a case of ulnar neuritis with only elbow pain. A 79-year-old man with left elbow pain for nine years was treated with a combination of pregabalin and tramadol/acetaminophen. He visited our department because his symptoms worsened with increased nocturnal awakenings due to pain. He complained of resting pain (numerical rating scale score: 8/10) at a point inside his left pulled elbow. No psychosocial problems, symptoms in his hand, or abnormal radiographic findings of the elbow were observed. A left ulnar nerve block was performed under ultrasound guidance as the tender point coincided with the left elbow canal; an improvement in the elbow pain indicated a dysfunction of the left ulnar nerve. Nerve conduction and sensory examinations of the ulnar nerve revealed no abnormalities; however, edema-like changes on magnetic resonance imaging indicated an ulnar neuritis. The symptoms improved with a nerve block and administration of duloxetine.

Intercostal hematoma is a rare complication of thoracic epidural anesthesia. However, it can have serious outcomes. We encountered a case of intercostal hematoma, which we believe developed by thoracic epidural procedure that damaged an intercostal blood vessel. The patient was a 50-year-old woman with a pulmonary tumor. Epidural anesthesia combined with general anesthesia was planned for partial resection of left upper lung by video-assisted thoracic surgery. An epidural puncture was made via the paramedian approach. Backflow of blood was observed when the catheter was inserted; hence, it was withdrawn. After changing the punctured level, catheter was successfully placed. At the end of the surgery, an intercostal hematoma was discovered by thoracoscopy. Although this is a rare complication, it can have serious outcomes. Physicians must take care of the direction of needle, when performing thoracic epidural anesthesia via the paramedian approach.

Chronic low back pain is often intractable. We report a case of chronic low back pain which was responsible for erector spine plane block (ESP block). A 58-year-old male patient was diagnosed with L3 vertebral compression fracture. Although, lumbar nerve root block, epidural block and sympathetic nerve ganglion block were not effective enough, fluoroscopic guided ESP block could ameliorate his symptoms. We consider the procedure of a fluoroscopic guided ESP block has more advantages than ultrasound-guided block. Usage of contrast medium prevent us from puncturing blood vessels. At computed tomography scan after the procedures, we recognized contrast medium spread only within the erector spinae muscles. This suggests that fluoroscopic guided ESP block leads to block dorsal lateral branch widely, and contributes to ameliorate a myofascial pain. ESP block would be a safer and more effective technique for chronic low back pain from myofascial membrane.

We report the case of a patient with lower leg compartment syndrome after acute lower limb arterial occlusion who was treated with peripheral nerve block after relaxing incision. A 56-year-old man developed paleness in the left leg on the day before he was diagnosed with acute left common femoral arterial occlusion and underwent emergency thrombectomy. He developed left lower leg compartment syndrome after the surgery. Therefore, relaxing incision was performed twice. Fentanyl did not control pain; therefore, peripheral nerve block (left sciatic and saphenous nerve) was administered under ultrasound guidance. After the administration of peripheral nerve block, the pain was controlled, and the dose of fentanyl was decreased, and finally stopped. We should consider administering peripheral nerve block to stabilize the general condition in cases of pain uncontrolled with medication in an intensive care unit.