We investigated factors ameliorating pain in patients with zoster-associated pain (ZAP). We examined the characteristics and clinical courses of 130 ZAP patients. After 90 days from the start of pain management in our department, a reduction of 50％ in the numerical rating scale (NRS) was defined as very much improved, while less than 50％ was defined as pain non-improvement. Comparing the improvement and non-improvement groups revealed NRS at the initial visit to be significantly higher and the period from onset to visiting our department to be longer in the non-improvement group. Especially, the group that first visit more than 31days and had not previously received neuropathic pain treatment may be difficult to manage pain intensity. Therefore, the patients with intensive pain needed to be consult pain specialists until 30days from onset. If it cannot, neuropathic pain treatment would be better to start.

The efficacy of spinal cord stimulation (SCS) for pain after spinal cord injury (SCI) has not yet been determined. We experienced a case of chronic pain after SCI which was successfully treated with Burst-SCS. The patient suffered from paraplegia below the traumatic 12th thoracic spinal cord injury and severe pain in both lower limbs. She had been treated with a tricyclic antidepressant, but intolerable arrhythmia had appeared. Therefore, SCS was performed for reducing the dosage of medication. The high potency of tricyclic antidepressants indicates that they can activate the descending inhibitory system of the spinal cord. It was considered that the provability of the high efficacy of Burst-SCS also reflects the remaining function of the descending inhibitory system.

A 49-year-old man presented with left facial hot flush and burning sensation with left neck and upper extremity pain after hitting on his face in the traffic accident. We diagnosed cervical facet joint damage with left traumatic cervical sympathetic trunk injury, because of assessment of his symptoms related to sympathetic nervous disorder. His symptoms were alleviated with right stellate ganglion block (SGB) to reduce the left cervical sympathetic blockade condition such as left facial hot flash and rhino stenosis. Moreover, his facial thermo-graphical image after SGB showed an increase in skin temperature of right neck and a decrease in left cheek. His symptoms were alleviated by repeating the right SGB. We considered that SGB to the healthy side alleviated the symptoms of cervical sympathetic nerve blockade on the affected side, such as stimulation of the sympathetic activity via the transverse branch of the thoracic sympathetic nerve trunk or the sympathetic borrowing-lending phenomenon.

The case involved a teenage female with a history of spondylitis, hit on the head unexpectedly by a soccer ball during after-school activities. Subsequently, she developed an orthostatic headache, which made it difficult for her to attend school for several months. She visited more than four hospitals. Moreover, she underwent additional examinations, including some brain and spinal MRIs, which resulted in no remarkable change. She was subsequently referred to our hospital because she suspected leakage of cerebrospinal fluid (CSF). She underwent a whole spinal MRI and CT myelography. Since she had a CSF leakage in the thoracic spine consistent with the site of spinal deformity, she experienced one epidural autologous blood patch treatment. Her orthostatic headache improved rapidly. In this case, CSF leakage occurred due to sports trauma due to underlying structural changes in the spine. Delayed diagnosis has significant psycho-social consequences for the adolescent. Therefore, a further examination should need for precise diagnosis.