Case: A 59-year-old woman. Venous stasis ulcer starting from small ulcers on the right first and second toes. Despite treatments such as varicose vein surgery and skin grafting, the ulcer enlarged. She was referred to our department for treatment of wound related pain. Symptoms: Extensive ulcers were found in the lower third of both lower legs. Hyperalgesia and allodynia were observed in the ulcer and its surroundings. By placing epidural catheter with subcutaneous injection port (epidural port), it was possible to wash the ulcer area and remove defective tissue under analgesia, and allodynia was improved by using spinal cord stimulation (SCS). More than 5 years have passed since the start of pain treatment with epidural port and SCS, but no infection or functional problems have been observed. Summary: The combination of epidural port and SCS was effective for long-term analgesic management of chronic venous ulcers. Complications such as infection and epidural fibrosis require regular scrutiny and preparation.

Supraclavicular nerve injury is a common complication after plate fixation of a midshaft clavicular fracture. We herein report a case of chronic postsurgical pain (CPSP) after plate fixation of midshaft clavicular fracture successfully treated with pulsed radiofrequency (PRF) of the supraclavicular nerve. A 46-year-old man sustained a midshaft clavicular fracture and underwent plate fixation 2 years ago. After surgery, the pain around the left clavicle worsened and persisted. Implant removal did not improve the pain. On referral to our hospital, he was suffering from stabbing pain around the left precordia, clavicle, and shoulder. Superficial cervical plexus block decreased the pain, but the effect was temporary. For this reason, we performed PRF treatment of the supraclavicular nerve for a possible long-lasting effect. After two treatments with PRF, the pain had been relieved to a numerical rating scale of 2–3 at the next visit. PRF of the peripheral nerve may be a promising treatment for intractable CPSP involving peripheral nerve injury.

Neuralgic amyotrophy (NA) usually causes severe pain in the shoulder and upper extremities, followed by paralysis when the pain subsides. We experienced a case of NA in which severe pain in the shoulder and upper extremities improved with nerve block therapy and duloxetine. Administration of DEX to the brachial plexus of the supraclavicular region improved subacute shoulder and upper extremity pain but had no effect on recurrent pain. Epidural block and oral duloxetine were significantly effective in recurrent pain. Pain with various mechanisms may be mixed in NA, and it is necessary to accumulate multiple treatment strategies including nerve blocks.