On January 1st, 2022, International Classification of Diseases 11th revision (ICD-11), which for the first time added codes for the classification of chronic pain, will come into effect. This systematic classification of chronic pain was developed by the task force of the International Association for the Study of Pain (IASP), where chronic pain is defined as pain that persists or recurs for more than three months and divided into chronic primary pain and chronic secondary pain. The latter chronic secondary pain is pain caused by underlying illness or tissue damage and is further divided into six categories according to the mechanisms and body parts. The IASP classification reflects pain concepts based on recent new scientific findings on chronic pain and is expected to bring about significant advances in the management of chronic pain. ICD-11 browser in the website of World Health Organization is also useful as a clinical tool for diagnosing chronic pain.
Objective: The study evaluated the efficacy, safety, and pharmacokinetics before and after a switchover from oxycodone hydrochloride controlled-release tablet to S-8117OTR in patients with moderate to severe chronic pain. Method: This study was a multicenter, non-randomized, open-label design that enrolled patients with moderate to severe non-cancerous chronic pain at 27 study sites nationwide. The primary endpoint was defined as the percentage of patients that maintained pain control during the switchover treatment phase. Results: A total of 81 patients were enrolled. Among them, 61 patients entered the switchover phase, and 44 patients completed the study. The primary endpoint, the percentage of patients that maintained pain control [95％ confidence interval] was 80.3％ [68.2, 89.4]. Treatment related adverse events reported ≧5％ were constipation, nausea, somnolence, and vomiting. None of the patients were considered as drug dependence. Conclusion: There was no significant difference in efficacy, safety and pharmacokinetics before and after switching from oxycodone hydrochloride controlled-release tablet to S-8117OTR.
Spinal muscular atrophy (SMA) is a genetic disease characterized by degeneration of the spinal cord, resulting in progressive muscle atrophy. Recently, nusinersen has been approved for treating SMA, which should be administered intrathecally. However, lumbar puncture is often technically challenging in patients with SMA because of young age, spinal deformity, scoliosis, and abnormal spinal rotation. Patient 1 was a 36-year-old woman with SMA type 2. Patients 2 was a 17-year-old girl with SMA type 1. We report two patients with SMA in whom intrathecal administration of nusinersen can be achieved safely using a transforaminal approach.
Perineal pain can be intractable; past study reported the effectiveness of blockade of ganglion impar, superior hypogastric plexus and inferior mesenteric plexus. In this paper, we report a case in which post-sigmoidectomy perineal pain and anastomotic ischemia were improved after ganglion impar block. 48-year-old man who had had perineal pain and anastomotic ischemia was consulted to our department. His perineal pain got worse when he defecated. Fluoroscopic ganglion impar block was performed; the perineal pain was completely cured five months after and colonoscopy revealed improvement of anastomotic ischemia. In this case, anastomotic ischemia may have caused perineal pain and bearing down possibly got ischemia worse by means of activation of sympathetic nerve.
Critical vascular disease and Raynaud's phenomenon are the typical insufficient blood supply disorders, and SCS (spinal cord stimulation) is said to be the good indication for these conditions. However, the majority of reports which show the effectiveness of SCS over the ischemic limbs are about critical vascular diseases, and few are about Raynaud's phenomenon. We experienced two Raynaud's phenomenon cases which were successfully treated with SCS, and measuring TcpO2 was useful in judgement of the therapeutic effect of SCS.