Large-scale research has documented that rigorous blood glucose control contributes to the prevention of diabetic neuropathy, especially in patients with type 1 diabetes mellitus. Although the latest guidance for diabetic therapies in Japan (2020–2021) emphasizes strict blood glucose control, little detail is provided about treatment-induced neuropathy of diabetes (TIND), nor does it elaborate on its prevention or treatment. We report a case of intractable pain in the lower back and bilateral legs, later diagnosed as TIND. It is important to understand the pathophysiology of TIND and prepare effective therapeutic strategies because TIND may be more frequent than previously estimated. Incremental treatment with a single neuropathic agent, amitriptyline, was effective in our case. As such, treatment with a strong opioid (morphine) was discontinued.

The brain-gut interaction plays an important role in the pathophysiology of irritable bowel syndrome (IBS). As stress is highly involved in the onset and exacerbation of IBS, a psychosomatic approach is considered effective. We report the case of a 49-year-old woman with IBS that was effectively treated with the combination of psychotherapy and Kampo medicine. She was referred to our pain center because of numbness appearing throughout her body and severe abdominal pain interfering with her daily life. At her first visit, our clinical psychologist discovered her experiences of maltreatment in childhood and spousal violence and paternal verbal abuse in adulthood. We considered that these experiences were related to her symptoms and started psychotherapy. Her numbness disappeared and she became more active, but her abdominal pain persisted. Therefore, we added Keishikaryukotsuboreito, which has an antianxiety effect, and Shakuyakukanzoto. Her quality of life, daily living activities, and abdominal symptoms improved.