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Hoshu HASHIMOTO, Kiyofumi OYA, Tomonao OKAMURA, Hideyuki KASHIWAGI, Ya ...
2020 Volume 27 Issue 4 Pages
296-299
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
Advance online publication: July 28, 2020
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Somatic symptom disorder is characterized by physical symptoms, abnormal thoughts, feelings, and behaviors that affect the patient's daily living. In general, pharmacotherapy alone is insufficient; various types of psychotherapy are often required. Herein, we report a case in which supportive psychotherapy was effective for somatic symptom disorder with burning sensation in the feet. A 74-year-old woman with gastric cancer and metastatic liver cancer was admitted to a hospital because of worsening burning sensation in bilateral legs 10 days after chemotherapy. A series of laboratory tests showed no abnormal results. We diagnosed the patient's physical symptoms based on the diagnostic criteria in DSM-V. We delivered supportive psychotherapy, which consisted of reassurance and emotional support from the palliative care team. After she felt accepted, the symptoms ameliorated. Her symptoms were a relatively rare phenotype of somatic symptom disorder, and supportive psychotherapy seemed to be effective. Supportive psychotherapy may be useful in building good relationships with patients and reducing their pain.
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Hiroki AOYAMA, Yuka AOYAMA, Hideaki MATSUI, Eriko OTA
2020 Volume 27 Issue 4 Pages
300-303
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
Advance online publication: September 15, 2020
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Although psychological interventions are well established in the treatment of chronic pain, their importance in acute pain is not documented. We report a pediatric case of acute pain in the bilateral legs, which was later diagnosed as somatic symptom and related disorders. A 10-year-old girl presented with acute bilateral leg pain; she could not ambulate without physical support. She visited our hospital on a wheelchair with extended knees and was admitted. Despite examination by expert doctors, the cause of her acute pain could not be identified. Her class teacher visited her on the fifth day of hospital stay; subsequently, her pain disappeared and she began to walk. She was diagnosed with brief somatic symptom disorder, which belongs to the group of somatic symptom and related disorders. Resolution of socio-psychological concerns can occasionally ameliorate severe acute pain. Psychological approach can be effective in the management of pediatric cases of acute pain.
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Tomoyuki MATSUMOTO, Toru SHIRAI, Masahiro MORIMOTO, Keiji UEHARA, Tats ...
2020 Volume 27 Issue 4 Pages
304-307
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
Advance online publication: September 15, 2020
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Herein, we report a case in which radiofrequency thermocoagulation (RFTC) as a nerve root block was extremely effective for leg spasticity caused by thoracic spinal cord injury. The patient was a 13-year-old girl who developed involuntary movement of her lower limbs, accompanied by intractable pain around her knees. She previously underwent bilateral Achilles tendon and hamstring tendon surgeries several times to treat these symptoms, but without any resolution; moreover, her activity of daily living (ADL) progressively deteriorated. After providing sufficient explanations about the risks and benefits of RFTC, and obtaining consent from both the patient and her family, we performed bilateral RFTC (90℃ for 180 seconds each) of the lumbar 2–4 nerve roots under general anesthesia. Fortunately, the technique was extremely effective, and her involuntary movement and pain disappeared completely. Presently, the patient's ADL has remarkably improved, and she can go to school.
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Mariko SHIBUYA, Yutaka TAIRA, Yasutoshi HIGA
2020 Volume 27 Issue 4 Pages
308-313
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
Advance online publication: September 15, 2020
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We encountered 3 cases of lumbar facet joint cyst, which were successfully treated by facet joint arthrography and subsequent steroid injection. On magnetic resonance imaging (MRI), we observed nerve root compression due to the cysts. The area of the pain and the nerve root compression findings on MRI were neurologically consistent. Arthrography confirmed the inflow of contrast medium from the facet joint to the cyst. In all the cases, lower limb pain was induced at the time of pressure injection into the facet joint. In 2 cases, the cyst ruptured on contrast medium injection, following which, steroid was injected; in 1 case, the cysts did not rupture following contrast medium injection. However, the pain improved dramatically in all patients. No patient presented with cyst recurrence even after 6 months. Facet joint arthrography followed by steroid injection appears to be an effective alternative to surgery in the treatment of facet joint cysts.
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Sayaka SUGIBE, Aiko MAEDA, Chiaki SAIGANO, Shouko NAKAYAMA, Midoriko H ...
2020 Volume 27 Issue 4 Pages
314-317
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
Advance online publication: September 15, 2020
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Background: Peripheral nerve injury is a significant perioperative complication. We report a case of a patient with intraoperative position-related brachial plexus injury, whose symptoms were improved by brachial plexus block. Case: A 23-year-old man underwent thoracoscopic resection for an anterior mediastinal tumor. The surgery lasted 8 hours under the right prone position with his left arm fixed at the shoulder height, and his neck-slightly extended. Immediately after the surgery, the patient complained of severe pain, with paralysis and numbness of the left upper extremity. Magnetic resonance neurography revealed a swollen brachial plexus. He was referred to our pain clinic because his symptoms did not improve with conservative treatment. We decided to perform ultrasound-guided branchial plexus block (1% mepivacaine+dexamethasone [3.3 mg]) to control pain and inflammation. After five blocks, although numbness remained, his pain improved considerably. Conclusion: The brachial plexus block could ameliorate acute neuropathic pain with inflammation.
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Mihoko USHIYAMA, Jitsu KATO, Wakako SAKATA, Kouju YAMADA
2020 Volume 27 Issue 4 Pages
318-322
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
Advance online publication: September 15, 2020
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A housewife in her 30s referred to our multidisciplinary pain center with a 10-year history of right chest pain. Initial consultation by a nurse revealed the following: 1) she was a perfectionist and had a serious disposition; 2) she took care so that she was not deserted by her mother and husband; 3) she had experienced several emotionally traumatic episodes and 4) she believed that she would die because of the pain. Nurses interviewed her mother to investigate the relationship between them and to get further information about her daughter's previous negative experiences. The investigation revealed that she was highly anxious in nature and was extremely fearful following an experience of encountering the dead body of her friend on the way to school and being bullied in school age. The nurse's consultation at the multidisciplinary pain center might have facilitated the identification of the psychosocial element of her pain.
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Akiko HAGIWARA, Koji ODA, Aya MAKINO, Yukiko GODA, Sigeko MATSUYAMA, T ...
2020 Volume 27 Issue 4 Pages
323-326
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
Advance online publication: September 15, 2020
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A woman in her 20s underwent a radical surgery for peritoneal metastasis of appendix cancer; there was no apparent sign of recurrence at postoperative 28-month follow-up. She was prescribed oral fentanyl (OF), but the frequency of its administration eventually increased to eight or more times a day. Since an excessive demand for the drug and suicidal tendencies were observed in the patient, the drug dosage was reduced to 1,800 µg/day. However, her demand for OF made it difficult to further reduce the dosage, and she was referred to our hospital. After admission to the psychiatric ward, the OF was replaced with 10 mg/day of methadone. Although she continued to demand OF initially, the demand decreased gradually. Thereafter, methadone was replaced with buprenorphine patches on the 15th day of hospitalization, and opioid use was completely discontinued on the 25th day. No physical withdrawal symptoms were observed. To achieve discontinuation of OF, the switch to methadone and buprenorphine was effective.
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Miho MATSUMURA, Mai KINOSHITA, Mayumi IKEDA, Hiroshi TANIGUCHI, Junich ...
2020 Volume 27 Issue 4 Pages
327-330
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
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We encountered a case involving a 69-year-old man with stage IV small cell lung cancer suffering from severe epigastralgia and systemic fatigue, who was later diagnosed with esophageal candidiasis. His epigastralgia was initially thought to be derived from mediastinum lymph node metastasis. However, the use of opioid or analgesic adjuvant did not reduce his complaints, and antipsychotics were needed for unbearable pain. The pain was accompanied by heartburn and nausea that worsened when the patient was on an empty stomach. We suspected upper gastrointestinal disease. Therefore, an endoscopic examination was performed, which led to the diagnosis of esophageal candidiasis. Antifungal therapy relieved the patient's pain and improved his general condition, leading to a reduction in his opioid dose and termination of antipsychotics. The cause of painful symptoms in cancer patients may not necessarily be associated with their cancer, and thus, the actual cause of the pain should be thoroughly assessed. Early detection of any treatable cause may benefit patients with cancer even in the terminal phase.
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Atsushi ITO, Akio MASUDA, Hiroto YAMAMOTO, Kazuaki YOKOYAMA, Tokujiro ...
2020 Volume 27 Issue 4 Pages
331-334
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
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Abdominal angina is a postprandial abdominal pain that is often difficult to control. The conventional therapy for its treatment is pharmacotherapy or revascularization by surgery. However, these are not often effective. Spinal cord stimulation therapy (SCS) is effective for pain control of ischemic limbs, such as Buerger's disease. The authors report a case of a patient with severe abdominal angina whose abdominal symptoms were improved by implantation of an SCS. SCS may be an effective treatment for ischemic pain caused by peripheral blood flow disorders not only in the extremities but also in the torso of a patient.
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Yosuke FUJITA, Takahisa NISHIYAMA, Ryoji MAEDA, Mikiko TOMINO, Naoto I ...
2020 Volume 27 Issue 4 Pages
335-339
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
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We report a patient who underwent stellate ganglion block (SGB) for refractory dialysis access-associated steal syndrome (DASS). A 50s-year-old man who had an internal shunt placed in his left forearm 10 years ago due to chronic kidney failure. Two months ago, he noticed a color change in his left hand fingers that worsened during dialysis, as well as cold and painful sensations. He was diagnosed with DASS, and vasodilators and analgesics were prescribed for these symptoms, and arteriovenous fistula removal was performed, but they did not provide relief. Then, we changed analgesics and performed SGB, which resulted in symptom relief at the first attempt. DASS is caused by a peripheral circulatory disturbance due to steal phenomenon in radiocephalic arteriovenous fistula. Therefore, the effect of additional SGB on blood flow may be efficacious in treating ischemic symptoms in refractory DASS.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
2020 Volume 27 Issue 4 Pages
340-342
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
Advance online publication: July 28, 2020
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
2020 Volume 27 Issue 4 Pages
343-344
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
Advance online publication: September 15, 2020
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[in Japanese], [in Japanese], [in Japanese]
2020 Volume 27 Issue 4 Pages
345-346
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
Advance online publication: September 15, 2020
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[in Japanese], [in Japanese], [in Japanese]
2020 Volume 27 Issue 4 Pages
347-349
Published: October 25, 2020
Released on J-STAGE: October 28, 2020
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