We investigated the effects of menatetrenone (vitamin K₂) on pain and bone mass in osteoporosis. We prescribed 30mg of oral vitamin K₂ per day to 12 female osteoporosis patients (age 64-77 years old) whose pain had not been relieved by 1.25 (OH)₂D₃ (vitamin D₃), Elcatonin, NSAIDs, and physical therapy. Pain scores decreased in 11 of 12 patients following, 2 to 4 weeks treatment. Bone mass measured with computed X-ray densitometer 4 and 8 months after administration of vitamin K₂ showed significant increase and improvement in pain score. The results indicate that vitamin K₂ may be useful in the treatment of pain and bone loss in osteoporosis patients.

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Objective pathophysiological study of low back pain, or lumbago, was conducted using thermography and deep body thermometry in conjunction with the subjective responses of 85 patients (29 males and 56 females, mean age: 64.7 years) and compared with similar parameters in 22 healthy subjects (6 males, 16 females, mean age: 52.3 years).
Active magnets and dummy magnets were randomly assigned to the patients under a double blind test. Active magnets were applied externally for the painful portion using the samarium-cobalt (Sm-Co) magnets (180m Tesla, 4.5mmφ×2.2mm in hight). Dummy magnets (10m Tesla) were also applied externally at random as placebo. All the patients wore 35-40 pieces of magnets for a 3-week period, after which the magnets were removed.
Before the treatment, in general, the lowest temperatures of the patients were lower than those of the healthy subjects.
Subjective and objective symptoms were observed to be improved significantly 1 week after the application of the active magnets. The lowest degrees of skin and deep body temperatures in the painful portion were significantly increased by exposure to the active magnets at 2 weeks and 3 weeks after the application. Until 1 week after removal of the active and dummy magnets, these temperatures indicated no significant difference between the active and the dummy groups, whereas the pain relief continued in the active magnets.
These findings suggest that the static magnetic fields might gradually increase the blood circulation in ischemic low back pain.

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Patients with metastatic tumor of the spine present with intense backache or intense pain radiating to the trunks or limbs, and the daily activities of these patients are markedly impaired because physical movements commonly aggravate the pain. The mechanism of backache is thought to be the excessive weight bearing on the facet joints caused by the instability of the spine. Therefore, blockage of the medial braches of the posterior ramus should be useful in the relief of backache. The source of the radiating pain is thought to be the compression of nerve roots by the collapsed vertebrae, and thus, radicular blockage should be useful in the relief of radicular pain.
Thirty-one patients (24 males and 7 females, mean age 60.5 years, range 45-77 year) with metastatic tumor of the spine were studied. Neural blocks were used to treat backache in 27 of the patients and radicular pain in 24 of the patients. Infiltrating blocks of the medial branches with local anesthetics relieved backache in 18 (67%) of the 27 patients for an average duration of 6.4 days. Percutaneous thermocoagulation of the medial branches (facet rhizotomy) provided relief in 24 (89%) of the 27 patients for an average duration of 14.7 weeks. Root blocks with local anesthetics relieved radicular pain in 14 (58%) of the 24 patients for an average duration of 10 weeks, and percutaneous thermocoagulation of the nerve roots (spinal rhizotomy) provided relief in 6 (75%) of the 8 patients for an average duration of 6.7 weeks. Improvement of daily activities was observed in 87% of all patients and in 8 of the 23 in-patients discharged from the hospital. There were no serious complications except slight motor weakness after spinal rhizotomy in 2 patients.
A medial branch block and a radicular block, including a facet rhizotomy and a spinal rhizotomy, were safer and easier to perform as repeat procedures than were intrathecal neurolytic block or percutaneous cordotomy for the reduction of pain due to metastatic tumor of the spine. Orthostatic jackets and other devices that stabilize the spine are necessary during the follow-up period because nerve blocks can provide pain relief but cannot stabilize the destroyed spine.

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To evaluate the roles of inflammatory cytokines in patients with herpes zoster (HZ) and postherpetic neuralgia (PHN), we investigated the levels of cytokines in sera and cerebrospinal fluids (CSF). Significantly higher levels of interleukin 8 (IL-8) was detected in CSF more than in sera collected within one-month from HZ patients (22 cases). IL-6 and tumor necrosis factor-α (TNF-α) were hardly detected in sera and CSF. Therefore, we further investigated and compared the IL-8 levels in CSF of patients who were cured without development of persistent pain (a cured group) and patients with PHN (a PHN group). Mean IL-8 (73.2pg/ml) in the cured group was higher than that of control subjects (mean: 21.1pg/ml), from whom CSF was collected during surgery of the lower extremity. IL-8 levels were correlated significantly with cell counts, protein contents, and α₁-protease inhibitor (API) levels. In the acute period (10+/-5 days of illness), mean IL-8 levels, cell counts, protein contents, and API levels in the cured group (n=26) were higher than those of the PHN group (n=7), although statistic significances were not observed in each parameter. One-month later, IL-8 levels and cell counts were significantly decreased in both groups. In the cured group, IL-8 levels and cell counts decreased to the control levels and were significantly lower than those of the PHN group. Thus, in patients who had persistent pain, IL-8 remained at high levels even one-month after illness. These results suggest that varicella zoster virus induces an inflammation in the medullary cavity and that IL-8 levels at one-month reflect the possible development of PHN.

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Purpose: This study evaluated the effects of thoracic facet rhizotomy (TFR) on thoracic zygapophyseal joint-induced pain (thoracic facet syndrome) and back pain induced by hypersensitivity of thoracic medial posterior branch of the spinal nerve.
Methods: Data were collected from all patients undergoing TFR at Nara Medical University between 1989-1996. Patients less than two years post-TFR were excluded from analysis, except those who died within two years after this procedure. The effects of TFR were evaluated by visual analog scale (VAS).
Results: TFR was performed in a total of 46 patients; 18 with spinal bone metastasis, 10 with spondyloarthrosis, 10 with compression fracture of the spine, 8 with referred pain of traumatic cervical syndrome. VAS was reduced from 5.6±1.2 to 2.0±1.4 after TFR, and 87% of patients showed desirable outcomes, which continued for 5.7±3.5 months. The duration of symptomatic improvement after the second TFR was longer than that after the first TFR. Those patients without neurosis had a longer duration of improvement than those with neurosis.
Conclusion: TFR was effective for both thoracic facet syndrome and back pain induced by hypersensitivity of thoracic medial posterior branch of the spinal nerve, especially for pain caused by compression fracture of the spine.

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Although the number of studies concerning the psychological characteristics of patients with chronic pain using the major scales of the Minnesota Multiphasic Personality Inventory (MMPI) are abundant, studies using the sub-scales of the MMPI are quite scarce. Infact, in Japan, no such study exists. It has been observed that the first 3 clinical scales of the MMPI are often elevated in chronic pain patients. Therefore, in addition to the major scales, we recruited the Harris and Lingoes sub-scales as the sub-scale for scale 2 and 3, in order to clarify further the psychological characteristics of chronic pain patients. Subjects for the study were limited to newcomers, who had no psychiatric disturbances, as judged by the diagnostic criteria of DSM-IV, and also with a pain duration of not less than 6 months. At initial consultation the subjects were administered the MMPI and other psychological tests. Since there is so much inter-correlation among the MMPI scales due to shared items, principal component analysis with oblique rotation was used for the analysis of the t-score of the MMPI. Four interpretable factors emerged and were labeled “Psychological lability (instability)”, “Physical complaints”, “Social isolation”, and “Social adaptability” to reflect significantly elevated factor loadings. It was suggested that the use of the four factors derived from the MMPI may help assess how severely chronic pain patients have been injured psychologically. Moreover, the use of the sub-scales of the MMPI major scales enables us to make a clearer interpretation of chronic pain patients' psychological characteristics.

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We report two cases of herpes zoster with the complicatin of liver dysfunction following intravenous administration of acyclovir.
The first case is a 44-year-ol d female, with herpes zoster on the right Th4 dermatome, who was admitted to our hospital for treatment with intravenous acyclovir, 500mg daily for 5 days, and continuous epidural block with bupivacaine. The herpetic pain disappeared quickly. However, general malaise and fever developed on the 22nd days after the start of treatment. Laboratory examination showed elevated serum GOT (269IU/l), GPT (503IU/l), and eosinophilia (12.5%), which returned to normal 4 weeks later.
The second case is a 57-year-old male, with herpes zoster of the right L3 dermatome, who was also admitted and treated with the same regimen as the first case. General malaise and fever developed on the 18th day. Laboratory examination showed elevated serum GOT (362IU/l), GPT (672IU/l), and eosinophilia (15.0%), which returned to normal 7 weeks later. In both patients, hepatitis A-IgM antibody, hepatitis B-surface antigen or antibodies to hepatitis C were not detected.
Elevated transaminases, fever, and eosinophilia, found in both cases strongly suggested that the dysfunction of the liver was caused by hypersensitivity reaction to acyclovir.

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A 48-year-old woman with recurrence of ovarian cancer had nausea, vomiting, and abdominal distention due to paralytic ileus. She was treated with intravenous hyperalimentation, hyperbaric oxygen, and nasogastric drainage. She became intolerant to the nasogastric tube, and it was removed. Haloperidol was given intravenously, which caused profound sedation, without relieving nausea, vomiting, or abdominal distention. Octreotide, an analogue of somatostatin, was given subcutaneously at a rate of 100μg/day for the first day and increased to 200μg/day for the ensuing seven days. Nausea and vomiting almost disappeared two days after administration of octreotide, when intravenous haloperidol was withdrawn. Nausea and vomiting did not recur for a month. Thereafter, she received three courses of continuous subcutaneous octreotide. Nausea and vomiting were relieved for approximately a month after each subcutaneous administration of octreotide. She could go back to home seven times and had a good time with her family. She died three and half months later. In conclusion, octreotide may relieve nausea and vomiting associated with paralytic ileus in some terminal cancer patients.

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Background: We report a case in which epidural bupivacaine relieved cancer pain in a patient who already was receiving 5.5g of morphine per day.
Patient, methods, and results: A 43-year-old man, who had undergone total gastrectomy three months previously, consulted us about intermittent somatic pain in the lower abdomen.
Even with 5g per day of intravenous morphine, abdominal pain persisted and increased to involve the entire abdomen. Additional epidural morphine, 0.5g per day, failed to alleviate the pain. The patient's pain was relieved for the first time only after administration of 4ml per hour of 0.125% bupivacine epidurally with morphine (50ml of 0.5g morphine solution+48ml of 0.25% bupivacine).
Conclusion: Epidural administration of morphine alone was ineffective in a patient receiving high dose systemic morphine. Epidural local anesthetic might be a useful adjunct for relief of cancer pain intractable to epidural and intravenouse morphine.

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