A most common type of diabetic neuropathy is distal symmetric polyneuropathy, of which 15–20％ is painful. Other painful types exist, including treatment induced neuropathy of diabetes. Pregabalin and duloxetine are generally used for drug treatment of painful diabetic neuropathy, but nerve block therapy is considered when sufficient efficacy is not obtained. Although there is no nerve block therapy with established evidence, the lumbar sympathetic ganglion block is a treatment option when peripheral blood flow disorders are suspected to be involved in the pathology. We report a case of bilateral lower extremity pain associated with distal symmetric polyneuropathy and treatment-induced diabetic neuropathy, in which a lumbar sympathetic ganglion block using radiofrequency thermocoagulation and absolute ethanol was effective.

The case is a 56-year-old man. The patient had headache symptoms and underwent bilateral perforation hematoma removal with a diagnosis of chronic subdural hematoma, but his symptoms did not improve and he was referred to our hospital because cerebrospinal fluid leak was suspected. Immediately prior to transfer to our hospital, a sudden loss of consciousness due to herniation of the cerebellar tonsils was observed. We urgently performed the epidural autologous blood patch (EBP), and the patient's conscious state improved immediately after the patch. Five days after EBP, he again showed consciousness impairment due to central tentorotid hernia and underwent perforator hematoma removal, which improved his consciousness. About the therapy of consciousness disturbance by the cerebrospinal fluid leak with subdural hematoma, whether to prioritize the EBP or removing hematoma operation is discussed. In the present case, the treatment strategy was determined by head CT, resulting in improvement of impaired consciousness and headache.

Pulsed radiofrequency (PRF) is a safe, minimally invasive, and effective procedure for chronic pain management. We performed parasternal intercostal nerve (PSI)–PRF for anterior chest pain in a patient who underwent thoracic intramedullary tumorectomy. The patient was a 45-year-old man who underwent dura mater closure surgery after thoracic intramedullary tumor (Th2–4) resection. After the surgery, he complained of prolonged left anterior chest pain along the same nerve region. We diagnosed chronic postsurgical neuropathic pain. We performed a PSI block with a single bolus dose, and the patient achieved a pain-free state for several days. We subsequently performed PSI-PRF, and the analgesic effect was sustained for several weeks. Before performing dura mater adhesion surgery, we performed PSI–PRF 20 times every 3–5 weeks for 15 months; there were no associated complications.