Local anesthetic agents were injected in the skin using a needleless jet injection device (MadaJet^®) in 10 cases of thoracic and 20 cases of lumbar epidural anesthesia. At the time of injection using MadaJet^®, 20 of 30 patients had no pain, and 8 patients had slight pain. The remaining 2 had moderate pain.
In 4 of 10 patients receiving thoracic epidural anesthesia, the anesthetic effect by MadaJet^® was not adequate for freedom of pain, and conventional infiltration anesthesia was necessary at the time. In contrast, in 19 of cases of lumbar epidural anesthesia, patients were free from pain using only MadaJet^®.
From our experience, it was concluded that MadaJet^® was effective for topical anesthesia before puncture of Touhy needle especially for lumbar epidural anesthesia.

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We studied 69 children with herpes zoster (HZ) during the years 1988-1993. Most patients were 7 years of age or older. Of 69 patients, 32 (46%) were males and 37 (54%) were females. The largest cluster of patients, 11 (19%), was found in August. On the other hand, the smallest clusters, one patient (2%), were found in January and in May.
Of 69 patients, 38 (55%) had lesions on the right side and 31 (45%) had lesions on the left side. Of 50 patients (71%) with lesions on thoracic dermatomes, 10 (14%) had lesions on the T4 dermatome.
Of 13 patients (19%) with basal diseases, five had malignant diseases. Of 56 patients without basal diseases, 16 were inpatients and 40 were outpatients. Of 16 inpatients, 12 were treated with continuous epidural blocks for 6 to 19 days (mean 11 days). Four patients of 16 inpatients had good pain relief with non steroidal antiinflammatory drugs (NSAIDs) and were discharged within 7 days. Of 40 outpatients, all patients completed the therapy with several clinic visits and eight obtained total analgesia in the affected skin.
Patients with basal diseases were administered antiviral agents. Complement fixing (CF) antibody titer elevated about two weeks after the onset of HZ. Of 69 patients, only one patient with acute lymphatic leukemia (ALL) had facial nerve paralysis as a complication with the lesion on the ipsilateral C2 dermatome.
This study demonstrates as follows: 1) Severe pain is not frequently experienced. 2) Post-herpetic neuralgia (PHN) is rare. 3) The largest cluster of patients was found in Summer.

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The McGill Pain Questionnaire (MPQ) is one of the most widely used instruments throghout the world for the evaluation for chronic pain patients. The difference in language and cultural background have hindered us from its standardization in Japan. We examined the reliability and validity of a Japanese version of the MPQ (JMPQ) translated by Sato et al., which was written in a format parallel to the original MPQ. One hundred and five consecutive chronic pain patients completed the JMPQ, other pain rating scales (Visual Analogue Scale, Verbal Rating Scale, Numerical Rating Scale) and a psychometrical test (STAI: State-Trait Anxiety Inventory). Subset of these patients (n=30) were re-tested again 2 weeks. The results showed acceptable level of reliability and validity of the JMPQ. But the chronic pain patients did not show remarkable anxiety as might have been expected.

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Aim of investigation: The purpose of this study was to determine the efficacy of a Kampo formula consisted of Sho-saiko-to and Keishi-ka-syakuyaku-to to trigeminal neuralgia.
Materials and methods: Extract preparations of Sho-saiko-to and Keishi-ka-syakuyaku-to were simultaneously prescribed to 13 patients with idiopathic trigeminal neuralgia for two weeks. Intensity of pain was measured with visual analogue scale. The degree of daily-activity restriction in terms of eating and washing the face was graded into four ranks. These parameters were measured before and two weeks after the commencement of the formula and analyzed with Wilcoxon's signed rank test. Frequency of paroxysms and severity of entire symptoms at the end of administration were expressed in numerical scores where initial status was represented as 10.
Results: Intensity of subjective pain was significantly reduced (P=0.0030) after two-week administration of the Kampo formula. Restriction of eating and washing the face was also significantly improved (P=0.0158 and 0.0021 respectively). Frequency of paroxysms decreased from 10 to 2.8 (mean). Severity of entire symptoms also decreased to 3.6.
Conclusion: The formula of Sho-saiko-to and Keishi-ka-syakuyaku-to was thought to be an effective option for the treatment of trigeminal neuralgia.

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Three patients with intractable cancer pain due to spinal-epidural metastasis were treated with continuous intrathecal administration of lidocaine and morphine. Excellent transient pain relief was obtained in all patients. However, in two of the three cases, the catheters for continuous subarachnoid administration had to be removed because of side effects: one case in infection and the other in hyperalgia with myoclonic seizure induced by high dose morphine. To maintain an intrathecal catheter for a long time, we should pay much attention to adverse effects followed by continuous intrathecal opioid administration. Nevertheless, when continuous epidural analgesia and radiation therapy fail to decrease the pain, continuous subarachnoid analgesia in thought to be a useful method for the treatment of intractable cancer pain induced by bone metastasis.

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A 50-year-old female patient came to our hospital with a chief complain of right foot pain. Her right leg was slightly thinner than the left leg and the right foot was deformed by a navicular bone and matatarsal bone rotaion. We performed lumbar sympathetic ganglion block reducing her pain score to about a half of pretreatment levels.

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A patient with Meniere's disease, who had been treated with medication without effect, was successfully treated with stellate ganglion block, but the patient had a relapse of Meniere's disease on pregnancy.
We presume Meniere's disease recurs on pregnancy, due to the increase of blood volume during pregnancy. Although mepibacaine easily flow through the placenta, it is not retained in the fetal tissue. Therefore we may treat with stellate ganglion block even throughout pregnancy, if it is necessary.

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