We report a case of a 73-year-old man with intractable headache and facial pain, who was found to have an invasive sinus fungus infection on computed tomography. He underwent endoscopic intranasal surgery and was subsequently treated with antifungal drugs, but he had constant severe headaches. We treated him mainly with NSAIDs, acetaminophen, and pregabalin, but the effect became limited as the disease progressed. Finally, fentanyl patch was used to relieve the pain. Among sinusitis, sphenoidal sinus lesions tend to cause visual disturbance and headache with few nasal symptoms, which often leads to delay in diagnosis. Early diagnosis is often difficult and may lead to delay in antimicrobial therapy and worsening of the lesions by steroid administration. Periodic imaging evaluation is important for long-term persistent headache and facial pain.

Methadone is a highly effective opioid prescribed for severe cancer pain patients. However, opioid switching may be required because of side effects or poor pain control. We experienced a case of 56-year-old woman with retro-longitudinal primary malignant soft tissue sarcoma. She had received methadone 30 mg/day for refractory metastatic neuropathic pain of upper thoracic vertebras and nerves, but she had not obtained sufficient pain relief, suffering from side effects of nausea, drowsiness and malaise. Radiation therapy for thoracic vertebral lesions were started, considering switching from methadone to other opioids. We performed opioid switching by 2 steps of methadone reduction (each 15 mg) simultaneously with oxycodone replacement (90 mg) over 2 weeks. We successfully switched from methadone to oxycodone with combination of radiation therapy and other pharmacotherapy, and finally she could return to work.

We report two cases of Pancoast tumor where cervical root block at a site not directly affected by the tumor was effective in pain relief, which resulted in continuation of cancer treatment. In case 1, the patient complained about pain around the right scapula. Pancoast's syndrome was thought to be the cause, but direct nerve block to the site seemed to be difficult. Therefore, we performed right C5, 6 root block which can provide pain relief around the scapula, and he got pain relief. In case 2, the patient complained about left upper limb pain. Computed tomography showed C6–T2 vertebral compression fractures due to invasion of a right Pancoast tumor, which were considered to cause his complain. However, based on physical examination, we suspected that the cause was C5 radiculopathy. We performed a C5 root block diagnostically and he got pain relief. In both cases, pulsed radiofrequency was performed, and long-term analgesia was obtained. Continuation of cancer treatment was possible due to improved performance status after root block.

The first case was a 69-year-old woman who was undergoing chemotherapy for ovarian cancer and was hospitalized for herpes zoster centered on the left 8th thoracic nerve region. She developed headache, nausea, vomiting, and fever, and upon closer examination she was diagnosed with VZV meningitis. The second case was a 69-year-old man undergoing chemotherapy for non-Hodgkin's lymphoma who was hospitalized for herpes zoster in the right second to fourth lumbar nerve regions. motor weakness of his right lower limb occurred, and upon closer examination he was diagnosed with VZV meningitis. Considering the possibility of VZV meningitis, and Lumbar puncture should be considered.