Cognitive behavioral therapy has been used as a treatment to improve pain, mood, and quality of life in chronic pain patients. Recently, internet-based interventions have increased due to the ease of access to treatment. We developed an online cognitive behavioral group therapy (CBGT) program, based on an existing face-to-face group CBGT program, and tested its effectiveness with 30 patients with chronic pain. The program consisted of 12 weekly sessions. We used the visual analogue scale (VAS) for pain intensity as a primary evaluation measure at three points in time: at entry (T0), before treatment (T1), and after treatment (T2). The results indicated that VAS scores at T2 significantly improved compared to both T0 and T1 [T0: 73.0 (22.1), T1: 73.9 (22.1), T2: 58.8 (27.3), mean (SD), p＜0.001]. These findings suggest that therapeutic effects are achieved through online CBGT interventions. However, a control group and the duration of post-treatment effects need to be assessed in future studies.

A 47-year-old man with bilateral multiple nephrolithiasis had been suffering from chronic back pain due to residual stones despite periodic transurethral ureterolithotripsy. Even under prescription opioids, he had dull pain in his back with numerical rating scale (NRS) 7 when resting, and sharp pain with NRS 8 when moving or putting pressure on his back. He was unable to work or sleep. Three days following an epidural block, his resting pain reduced to NRS 3, and we implanted the spinal cord stimulation (SCS). With SCS stimulation, his back pain at rest and back tenderness were reduced to NRS 1 and NRS 2, respectively. After that, he no longer needed opioids and returned to work or sleep. Both resting pain and incident pain were visceral with somatic, but SCS was significantly effective for both nociceptive types of pain. SCS may be a good indication for chronic pain caused by polynephrolithiasis. It can avoid long-term opioid use and improve ADL and QOL.

The patient was an 11-year-old boy. Two years earlier, he had experienced left anterior chest pain lasting 1–5 minutes, 1–4 times a month, and he was referred to our hospital. At the initial consultation, the patient had chest pain with a numerical rating scale 5–7 in the left Th5 region 3–4 times a month, and he sometimes missed school. Because he had sleep disorders, such as sudden loud crying while asleep and the oriental medical findings determined that he had deficiency pattern and urgency of symptoms, we administered Kanbakutaisoto extract granules (5 g twice a day) and acupuncture. As a result, the symptoms disappeared five months after the first consultation. These results suggest that oriental medical treatment is helpful when psychosocial factors are suspected to be involved in pediatric chest pain.

Polyarteritis nodosa (PAN) can cause multiple neuropathies due to ischemia of the vasa nervorum, sometimes resulting in neuropathic pain. Reports on treating PAN-related pain are limited as it is a rare condition. We report a case where spinal cord stimulation (SCS) was effective in managing refractory pain in a patient with PAN. The patient, a male in his 60s, achieved remission following immunosuppressive therapy, but severe limb pain persisted. While conservative treatments improved the pain in his hands, the pain in his feet remained intense (NRS 10/10), causing difficulty walking and frequent nighttime awakenings. SCS implantation provided immediate relief (NRS 10/10 to 2/10), improving his walking speed and eliminating pain-related sleep disturbances. Six months post-implantation, the patient remained free of complications, with sustained pain relief (NRS 2–3/10).

This report describes a case of ultrasound-guided fascia hydrorelease (US-FHR) used to treat persistent pain on walking of more than 20 years' duration. The patient, a man in his 80s, developed pain on walking in the right lateral femoral area after surgery for cervical spine disease more than 20 years earlier. Nerve blocks and other treatments were ineffective. He visited a pain clinic at Asahikawa Medical University Hospital and started taking pregabalin 50 mg/day, which decreased the pain, but caused side effects such as drowsiness. When the pain on walking worsened, we found muscle stiffness and pressure pain in the same area, and ultrasound showed a fascial overlap of the right vastus lateralis muscle. US-FHR with 20 ml of 0.025％ lidocaine around the overlap resulted in complete disappearance of the pain for a week. US-FHR was repeated and long-term pain improved. Finally, satisfactory pain control was achieved with only a low dose of mirogabalin.