We have previously reported that acupuncture decreased the post-operative pain after abdominal surgery and significantly reduced the use of analgesic drugs, however, the mechanism of acupuncture analgesia is not completely elucidated. In this study, the effects of surgical invasion and acupuncture analgesia on serum β-endorphin, an endogenous opioid peptide that is involved in analgesic action, and adrenocorticotropic hormone (ACTH) levels were evaluated. Continuous electroacupuncture (EA; 3Hz) treatment was performed at Acupuncture point L14 (Hoku) and S36 (Tsusanli) for 3 hours from 3 hours after the operation in 11 patients (EA group). Another eleven patients not treated by EA served as controls. Peripheral blood (3ml) was collected before, during, immediately after surgery and at 3 hour intervals thereafter until 12 hours after operation, and serum β-endorphin and ACTH levels were measured by radioimmunoassay (RIA). During surgery, both β-endorphin and ACTH levels increased significantly. After operation, these levels tended to gradually decrease to preoperative values. The level of serum β-endorphin increased significantly again during the EA treatment but only in the EA group. Analgesic drugs for postoperative pain were used in 10 of the 11 cases in control group, but were used only in 1 of the 1 cases in the EA group. These results suggest that increased β-endorphin level induced by the EA reduced the postoperative pain, and even under the general anesthesia, the surgical invasions appear to be input into the central nervous system and activate stress-induced analgesia.

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Purpose: The mechanism of the effect of polarized infrared ray irradiation near the stellate ganglion (PIRISG) is unknown. The purpose of this study is to analyze peripheral sympathetic activity during PIRISG by quantitative measurment of perspiration and skin temperature. Methods: Irradiation was performed near the stellate ganglion of ten healthy adults for 20min using 80% maximum power output of 1, 800mW with cycles of 1 second on and 2 seconds off. The perspiration volume was measured for three minutes and was compared before irradiation, at 10 minutes, and at 20 minutes of irradiation. The skin temperature was recorded at one-minute intevals. Results: The baseline volume of perspiration was 1.000±0.202mg·3min^-1, at 10min of PIR irradiation was 0.931±0.238mg·3min^-1, and at 20min of PIR irradiation was 0.953±0.289mg·3min^-1. There were no significant differences in perspiration volume among control, at 10 and 20min of PIR irradiation. Skin temperature did not change during the study period. Conclusion: PIRISG does not show any inhibitory activity on peripheral sympathetic nerve activity in healthy adults during irradiation.

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In two cases of palmar hyperhidrosis, one had transient Mobitz type II atrioventricular block and the other had transient prolongation of PQ intervals after endoscopic thoracic sympathectomy. Both cases had first degree atrioventricular block preoperatively. In the first case, an 18-year-old female, Mobitz type II atrioventricular block occurred transiently ten hours after the T2, 3, 4 thoracic sympathectomy. However, no arrhythmia was observed on Holter electrocardiogram recorded throughout the first postoperative day. In the second case, a 25-year-old female, prolongation of PQ intervals was observed immediately after the T2, 3 thoracic sympathectomy and during the first postoperative day within one month, the PQ interval returned to preoperative state.

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Objective: The aim of this study was to evaluate whether 0.05% capsaicin cream could alleviate neuropathic pain that was unresponsive to conventional treatment. The changes of sleep, spirit, and activities of daily living, and side effects during capsaicin treatment were also studied.
Patients and methods: Capsaicin cream was applied to 12 patients: six with postherpetic neuralgia (PHN) and six with pain following nerve injury. The intensity of pain before, during, and after capsaicin treatment was measured by Visual Analogue Scale (VAS: 0=no pain, 100=severe pain).
Results: Median VAS scores before, during, and after treatment were 45, 10, and 10, respectively, for the PHN group, and 80, 40, and 50, respectively, for the nerve injury group. In both groups, median VAS scores were significantiy lower (p<0.05) during and after the treatment than those before treatment. Sleep, spirit, and activities of daily living were improved in 42%, 75%, and 58% of patients, respectively, during treatment. No severe side effects, except skin exfoliation in one patient, were observed. After capsaicin treatment, the pain recurred slowly but not significantly in the nerve injury group. No recurrence of pain was observed in the PHN group.
Conclusions: Our findings suggest that capsaicin cream is effective for treatment of neuropathic pain due to PHN and nerve injury.

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A19-year-old female underwent epidural anesthesia for appendectomy. A23 gauge needle was used for local anesthesia at L1-2. The patient moved accidentally when the needle was inserted to infiltrate local anesthetics, and had a sharp pain on her left lower limb. A spinal needle injury was suspected. After surgery, spontaneous pain developed at the area of L5-S2 in the left lower limb, followed by hypesthesia and allodynia at the same area. Because of the appearance of allodynia, we suspected neuropathic pain caused by the spinal needle injury and started intravenous ketamine infusion therapy. Spontaneous pain and allodynia were relieved dramatically, and the patient was able to function with no difficulty during daily life. Intravenous ketamine infusion might be good for neuropathic pain due to spinal injury during epidural anesthesia.

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