A Case in Which Byakujutsubushito Responded to Extremity Pain / 日本東洋医学雑誌

The patient was an 84-­year-­old woman living in a nursing home. Her chief complaint was difficulty in mov­ing her body due to extreme pain. She could not lie down especially in a supine position because of severe un­identified somatic pain from left side of lower chest to flank. According to her family, she had been taking 2-­3 L of water daily at her nursing home to avoid dehydration even in the wintertime. Therefore she urinated fre­quently, but she also had constipation for several days. Since NSAIDs had been not effective, byakujutsu­bushito was administered from the first day of her hospitalization. Accordingly, her constipation improved and her pain quickly faded away. We inferred that her pain resulted from “fluid disturbance” caused by massive in­take of water in the wintertime in Aizu region. We believe that byakujutsubushito is a useful Kampo medicine for the treatment of pain resulting from “wind-­dampness” along with keishibushito and kanzobushito.

Use of stellate ganglion block for treatment of recurrent syncope followed by chest pain / 영남의대학술지

Syncope is defined as a transient loss of consciousness and postural tone, characterized by rapid onset, short duration, and spontaneous recovery. Stellate ganglion block (SGB) is a nerve block method that is used for treatment of neuropathic pain in the head, neck and upper extremities, especially trigeminal neuralgia, postherpetic neuralgia and complex regional pain syndrome. SGB can modulate and stabilize the sympathetic nervous system, which prevents it from overexcitation and improves symptoms of syncope. The authors report a patient who was treated for pain and edema of both upper extremities with SGB, then showed improvement in recurrent syncope followed by chest pain and overall quality of life.

Bone scintigraphy in patients with pain

Nuclear medicine imaging is widely used in pain medicine. Low back pain is commonly encountered by physicians, with its prevalence from 49% to 70%. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually used to evaluate the cause of low back pain, however, these findings from these scans could also be observed in asymptomatic patients. Bone scintigraphy has an additional value in patients with low back pain. Complex regional pain syndrome (CRPS) is defined as a painful disorder of the extremities, which is characterized by sensory, autonomic, vasomotor, and trophic disturbances. To assist the diagnosis of CRPS, three-phase bone scintigraphy is thought to be superior compared to other modalities, and could be used to rule out CRPS due to its high specificity. Studies regarding the effect of bone scintigraphy in patients with extremity pain have not been widely conducted. Ultrasound, CT and MRI are widely used imaging modalities for evaluating extremity pain. However, SPECT/CT has an additional role in assessing pain in the extremities.

Spinal Cauda Equina Stimulation for Alternative Location of Spinal Cord Stimulation in Intractable Phantom Limb Pain Syndrome: A Case Report

Phantom limb pain is a phenomenon in which patients experience pain in a part of the body that no longer exists. In several treatment modalities, spinal cord stimulation (SCS) has been introduced for the management of intractable post-amputation pain. A 46-year-old male patient complained of severe ankle and foot pain, following above-the-knee amputation surgery on the right side amputation surgery three years earlier. Despite undergoing treatment with multiple modalities for pain management involving numerous oral and intravenous medications, nerve blocks, and pulsed radiofrequency (RF) treatment, the effect duration was temporary and the decreases in the patient's pain score were not acceptable. Even the use of SCS did not provide completely satisfactory pain management. However, the trial lead positioning in the cauda equina was able to stimulate the site of the severe pain, and the patient's pain score was dramatically decreased. We report a case of successful pain management with spinal cauda equina stimulation following the failure of SCS in the treatment of intractable phantom limb pain.

Outcomes of Epiduroscopy Using Less Than 50 ml of Normal Saline in Low Back and Lower Extremity Pain Patients / 대한마취과학회지

BACKGROUND: Epidural adhesion can cause pain from compression and irritation of nerves. But a simple injection into the lumbar epidural space usually goes into the area of least resistance and cannot deliver the medication to the target area. Thus, the adhesiolysis of the affected area is sometimes mandatory. We performed an adhesiolysis, irrigating with normal saline, and targeted an injection of a local anesthetic and steroid mixture to the epidural space, using a flexible catheter-secured epiduroscopic unit in 15 patients with low back pain, and assessed the pain score changes. METHODS: With the patient in the prone position, the epidural space was entered with a 17-gauge Tuohy needle. A guide-wire was inserted through the needle and advanced under fluoroscopic guidance to the level of the suspected pathology. A catheter was then advanced over the guide-wire. After the removal of the guide-wire, an adapter was then attached to the proximal end of the catheter, and its side arm was connected to a syringe containing normal saline flush. The 0.9 mm diameter fiberoptic scope was introduced into the catheter via the adaptor, and a video camera was then attached. Gentle irrigation of normal saline less than 50 ml distended the epidural space. The catheter and fiberoptic scope were advanced to the adhesion area and adhesiolysis was done by moving the tip of the steering catheter. Assuming that original NRS (Numeric Rating Scale) before the procedure was 10, we asked the NRS at 1, 4, 8, 12, 16 weeks after the epiduroscope. RESULTS: NRS at 1, 4, 8, 12, 16 weeks after the epiduroscope showed significant decrease of both low back pain and radiating pain, compared with the original pain (P<0.05). CONCLUSIONS: The flexible catheter-secured epiduroscopic unit proved to be painless, safe, and more simple, than an operation, it is, thus, a practical method for pain relief using adhesiolysis and irrigation of epidural space under the direct visualization of the epidural space in patients with low back and lower extremity pain.