Neuropathic pain is now defined by the International Association for the Study of Pain as pain caused by a lesion or disease of the somatosensory nervous system. The guidelines recommend tricyclic antidepressants, gabapentin or pregabalin, and duloxetine, a serotonin noradrenaline reuptake inhibitor, as first line. Mirogabalin, which is a novel ligand for the α₂δ subunit of voltage-gated calcium channels, is being developed for treating neuropathic pain including diabetic peripheral neuropathy and postherpetic neuralgia. In this review, serendipitous discovery of pregabarin by Richard Silverman is discussed.

In this study, we examined the effectiveness and adverse events of pilocarpine hydrochloride (pilocarpine) gargle in the treatment of xerostomia in Sjogren's syndrome (SS). Dryness of the mouth, salivary flow rate, adverse events associated with oral administration or gargle method were compared before and after 4 weeks of administration in the eight SS patients enrolled in this study. Dryness of the mouth in seven patients was significantly improved by oral administration. Gargling also improved dryness of mouth but did not reach statistical significance. The salivary flow rate based on the gum test was significantly increased with the gargle method as well as with oral administration. The salivary flow rate by the Saxon test also increased with both oral administration and gargling but did not reach statistical significance. Increased rate of salivary flow was equally observed in both methods. An adverse event associated with oral administration was sweating, and one patient could not continue the study due to uncomfortable sweating and palpitation. In contrast, the gargle method induced slight sweating alone in six of seven patients. These results indicate that the gargle method, compared with oral administration improves xerostomia with equivalent efficacy without inducing excessive sweating.

Herpes zoster is a viral infection that is caused by the reactivation of the Varicella-zoster virus（VZV）which lies dormant in the sensory ganglia. After oral anticancer agent was prescribed in the elderly tongue cancer patient accompanied with uncontrolled diabetes mellitus, Ramsay Hunt syndrome occurred. Since the mental stress to malignant tumor treatment was also added, it was thought that the result of immunosuppressed state was VZV reactivation. Early intervention with antiviral drug could lead to planned operation under general anesthesia and prevention of post herpetic neuralgia.

In immunosuppressed patients when they received preoperative chemotherapy, we should take care of disturbing subsequent treatment due to the herpes zoster.