Objective: We conducted workshops across Japan to promote the dissemination of the Clinical Practice Guidelines for the Management of Chronic Pain developed by the Ministry of Health, Labour and Welfare's policy research team and evaluated their effectiveness. Methods: The workshops were held in a face-to-face format and consisted of two parts; lectures and group discussions focusing on case studies. A questionnaire was administered before and after the workshops to assess their impact. Results: Post-workshop assessments showed a significant increase in knowledge acquisition and regional collaboration scores across all evaluated items. Discussion: In addition to knowledge acquisition through lectures, group discussions facilitated a deeper understanding among different healthcare professions, suggesting a potential enhancement of regional collaboration. Conclusion: The continued implementation of workshops based on the Clinical Practice Guidelines for the Management of Chronic Pain may contribute to the standardization of chronic pain care.

Perioperative anaphylaxis caused by amide-type local anesthetics is rarely reported. We experienced a case of anaphylactic shock following wound infiltration anesthesia with an amide-type local anesthetic agent. The patient, a 46-year-old man, underwent an elective laparoscopic colectomy. Wound infiltration anesthesia with 40 ml of 0.33％ ropivacaine resulted in urticaria on the trunk and slight decrease in blood pressure. Despite suspecting an allergic reaction to ropivacaine, blood pressure was maintained with the administration of ephedrine. As there was no increase in airway pressure, tracheal extubation was successfully performed without administering adrenaline. However, 20 minutes later returning to the ward, the patient's blood pressure decreased, leading to a diagnosis of anaphylactic shock. An intramuscular injection of 0.3 mg of 0.1％ adrenaline was administered, and there was no recurrence of symptoms. A diagnosis of ropivacaine-induced anaphylaxis was made based on a positive skin test to ropivacaine performed later.

A 63-year-old man complained of numbness and pain all over his body since 6 years ago. He was referred to our department after receiving treatment at multiple facilities without any improvement. He had been taking benzodiazepine receptor agonists for 15 years as a sleeping pill. The pain worsened in the afternoon and was relieved by taking sleeping pills. Therefore, we thought that the symptoms were due to withdrawal symptoms from the sleeping pills, and replaced the sleeping pill with clonazepam 0.6 mg twice a day, which relieved various symptoms such as pain all over the body. The clonazepam was then gradually reduced in dosage and completely discontinued after 40 days. Long-term use of BZ receptor agonists may cause chronic pain and numbness throughout the body due to tolerance. Some patients who complain of indefinite and strong pain may have a drug dependency as an underlying cause, so it is important to keep this in mind.

Stellate ganglion block (SGB) is an effective treatment for refractory ventricular fibrillation and ventricular tachycardia that do not respond to antiarrhythmic medications. We present a case of successful management of defibrillation events through periodic SGB in a patient who experienced frequent activation of an implantable cardiac resynchronization therapy-defibrillator (CRT-D) due to intractable ventricular tachycardia. The patient was not a candidate for thoracic sympathectomy due to impaired cardiac function. However, continuous left and right SGB effectively suppressed defibrillator activations for an extended period. Since defibrillation can cause anxiety and fear in patients, reducing the frequency of these activations through SGB also lessens the psychological burden on the patient. However, it is unclear which SGB is more effective, left or right, how often treatment should be given, and the ideal interval between each block. Further research is needed to address these questions.