Spinal arteriovenous malformation (AVM) is a clinical disorder that can cause radiculopathy on rare occasions. We report a case of successful pain management using carbamazepine for radicular pain due to a spinal AVM. A 20-year-old woman presented with a posterior right leg pain. Angiography revealed an intramedullary AVM with a drainer descending through the right S1 foramen. After partial embolization of the AVM, dilation of the remaining drainer was observed, followed by a paroxysmal lancinating pain on the right S1 region. Intensity and frequency of the pain increased despite the use of pregabalin, tramadol and duloxetine, and the patient was emergently hospitalized due to the intense pain attacks that made her unable to walk. Considering the clinical resemblance to trigeminal neuralgia, a severe paroxysmal lancinating facial pain due to neurovascular compression, carbamazepine 300 mg/day was applied. After taking carbamazepine, the pain subsided within a day. Carbamazepine may be an effective nonsurgical therapeutic option for radicular pain caused by a spinal AVM.

Genicular nerve-radiofrequency ablation (GN-RFA) is reportedly effective in treating chronic knee arthralgia. Although an analgesic effect is also expected for chronic post-surgical pain (CPSP) after knee arthroplasty, such a case has not been reported. We report two cases of CPSP after knee arthroplasty treated with GN-RFA. Case 1 is a 50-year-old woman. She underwent multiple ultrasound-guided GN-RFA for CPSP after total knee arthroplasty. Adding saphenous nerve RFA to GN-RFA provided better analgesia than ultrasound-guided GN-RFA only. Case 2 is a 69-year-old woman. She underwent multiple ultrasound-guided GN-RFA for CPSP after left unicompartmental knee arthroplasty. The patient had an excellent analgesic effect with fluoroscopy-guided GN-RFA. GN-RFA is effective for CPSP after knee arthroplasty. However, the ultrasound-guided GN-RFA might lead to inaccurate determination of the puncture site due to anatomical changes and angiogenesis associated with surgery. Additional treatments, including fluoroscopy-guided or other nerve blocks, could be needed in such cases.

Complications of varicella-zoster virus (VZV) infection include postherpetic neuralgia, myelitis, and meningitis. The typical symptom of myelitis is spastic paraplegia and hemiplegia is rare. We experienced a case in which myelitis was suspected to be the cause of upper limb pain associated with hemiplegia secondary to herpes zoster in the trigeminal nerve region. After the onset of herpes zoster, the patient developed symptoms such as numbness and muscle weakness in the left upper and lower limbs, and experienced burning pain and allodynia throughout the left upper limb. No significant findings were obtained on cerebrospinal fluid VZV polymerase chain reaction or magnetic resonance imaging, however, from the clinical findings it was thought that VZV spread from the trigeminal ganglion to the trigeminal spinal tract nucleus and reached the dorsal horn of the cervical spinal cord, and spread to the ventral horn and root. Central neuropathic pain is treatment resistance, but epidural block and drug treatment were effective in this case.

A 48-year-old man was admitted to the hospital for pain control. The CT imaging revealed multiple bone metastasis including right 6^th rib, ilium and spine caused by angiosarcoma. Tapentadol 200 mg/day was started on Day 1. The pain was relieved and the sleep disturbance was disappeared on Day 2. Immediate-release hydromorphone 2 mg/dose was prescribed from Day 6 as a rescue medication for tingling breakthrough pain when moving. Tapentadol was increased to 300 mg/day from Day 7. On Day 8, the pain was relieved and he became able to walk. The patient was discharged on Day 10 after pain relief was obtained following 400 mg/day of tapentadol and 4 mg/dose of immediate-release hydromorphone. Recently, the efficacy of tapentadol for the neuropathic pain caused by bone metastasis has been reported. Tapentadol may be a treatment of choice for the neuropathic pain caused by multiple bone metastasis of angiosarcoma.