In Japan, opioid crisis became widely known by President Trump's declaration of a state of emergency in public health. The opioid crisis began with good intentions for patients suffering from pain against the backdrop of a social environment left behind by globalization, and expanded with a strategy that downplayed the risks of opioids by pharmaceutical companies that misused the practice and policy shifts. The opioid crisis has not yet occurred in Japan, but we should not be optimistic. Also, as cancer treatment improves, the number of cancer survivors is increasing, so we must be vigilant. Once an opioid crisis occurs, it is difficult to resolve. Therefore, all healthcare professionals involved in opioid therapy are required to work together for appropriate use.

We report two patients with crowned dens syndrome (CDS) who improved dramatically following treatment with oral nonsteroidal anti-inflammatory drugs (NSAIDs). Case1: A 70-year-old woman presented with acute neck pain, neck stiffness and fever for five days. Blood test revealed elevated WBC and CRP. Computed tomography (CT) of the cervical spine (C-spine) showed calcium deposits encircling the dens. The patient was treated with oral NSAIDs and the symptoms improved in a week. Case 2: An 84-year-old woman underwent the lumbar peritoneal shunt for idiopathic normal pressure hydrocephalus. Four days after the operation, the patient complained of fever, headache, nausea, neck pain and stiffness. Blood test revealed elevated inflammatory biomarkers and CT of the C-spine showed the peri-odontoid calcium deposits. Her symptoms improved with use of NSAIDs in a week. CDS should be considered in the differential diagnosis in patients who present with acute neck pain.

We report two patients with herpes zoster-associated pain (ZAP) in the subacute phase that responded to intravenous drip infusion of lidocaine. Patient 1 was a 70-year-old man who presented with herpes zoster on the right Th4 region. He was not responding to pregabalin 150 mg/day for electric shock-like pain and sleep disturbance, then he visited our hospital a month after the onset. He presented with a VAS of 80 mm and allodynia. Because he was on antithrombotic therapy for cerebral infarction, nerve block could not be performed. Patient 2 was a 69-year-old man with left Th5 herpes zoster. He presented with a VAS of 70 mm and allodynia. Allodynia disappeared immediately after intercostal nerve block and intravenous lidocaine infusion of 100 mg. Lidocaine infusion is a simple and effective adjunctive therapy for ZAP with allodynia in the sub-acute phase when nerve block cannot be performed, such as during antithrombotic therapy.