Introduction: The analysis of hair cortisol concentrations (HCC) is a relatively new strategy to measure long-term cumulative cortisol level, which is increasingly used in psychoneuroendocrinological research. We measured hair cortisol levels in patients with chronic pain and in a group of control subjects. Methods: Patients with severe chronic pain, aged 20 years or older were recruited in this study. Controls were healthy adults with no pain. We compared HCC and perceived stress scale (PSS) between groups. Results: There were 30 women in each group. Median age was 72.5 years old in patient group, and 43.5 years old in control group. Regarding HCC and PSS, there was no significant difference between groups. Pearson correlation coefficient test showed no correlation between HCC and PSS. Conclusion: HCC was not higher in patients with chronic pain than controls.
A 72-year-old woman who had undergone an ileocecal resection 13 years ago had pain in her scar of abdominal wall for 7 years. At the first examination, she revealed a tender point at the top of her scar; Carnett's sign was present, confirming a diagnosis of anterior cutaneous nerve entrapment syndrome (ACNES). An ultrasound-guided rectus sheath block was performed, resulting in effective pain relief. However, a new tender point was found at the bottom of her scar. She underwent the same procedure, which resulted in temporary pain relief. The procedure was repeated for 20 months. However, the pain relapsed after a short period of relief bought about by nerve blocks. She did not experience a satisfactory reduction in pain, but her quality of life gradually improved.
Saddle block is effective for perineal cancer pain. However, there is substantial risk of relative opioid overdose and opioid withdrawal syndrome following sudden relief of pain. We report a case of successful management of saddle block for intractable anal pain in a patient who required high-dose opioids. A patient in his forties was referred to our hospital due to intractable anal pain. 40 mg/day of transdermal fentanyl was administrated, but numerical rating scale (NRS) rated 8–10/10. Saddle block was scheduled because of insufficient pain relief. To avoid relative opioid overdose and opioid withdrawal syndrome, we switched from transdermal fentanyl to oxycodone injection. We performed saddle block while reducing oxycodone injection. NRS rated 0/10 just after saddle block without any adverse effects. Although we performed saddle block with tetracaine or phenol glycerin several times during the hospitalization, no significant block-related adverse effects were encountered.