RÉSUMÉ
Postsurgical persistent pain, once entrenched, may be resistant to western medical treatments. A 39-year-old man who underwent thoracic repair with blood vessel prosthesis for dissecting aneurysm was presented to our pain clinic due to postoperative persistent pain. He complained his pain mainly around the sternum on which skin became keloid scar and presented tactile allodynia. Initially, we treated the patient with pregabalin, duloxetine and tramadol/acetaminophen fixed-dose combination tablets, leading to no pain relief. Then, we started the treatments with Kampo medicine as well as Yamamoto New Scalp Acupuncture and Unblocking acupuncture. We initially treated him with keishibukuryogan (TJ-23 ; Tsumura ®, Japan) and saikokeishito (TJ-10 ;Tsumura ®, Japan) based on the signs of blood stasis, hypochondrial resistance and pain, but no relief of pain was obtained. Thus, we administered ogikeishigomotsuto in addition to the above Kampo formulas. His pain was gradually decreased with increasing doses of ogi from 3 to 10 g/day and aconite tuber from 1.5 to 6 g/day due to cold sensation, and finally disappeared at 20 months since the start of Kampo treatments. The duration of effectiveness for relieving his pain with acupuncture was gradually increased in proportion to his pain relief. Our experiences suggest that ogikeishigomotsuto with aconite tuber as well as acupuncture may be optimal treatments for the patients with cold sensation suffering from postsurgical persistent pain.
RÉSUMÉ
We successfully treated 2 patients with ophthalmic symptoms due to post herpetic infection using chotosan. Case1was a 78-year-old woman who had been suffering from ophthalmic symptoms such as foreign body sensation and irritation pain due to post herpetic infection for almost 20 years, and had a history of hypertension. We treated her with stellate ganglion block every week and orally administered keishikajutsubuto, amitriptyline, and later mexiletine. Initially, stellate ganglion block was very effective, but its effect gradually decreased over about one month. Considering the same action of stellate ganglion block and chotosan, both of which might increase intracranial blood flow, we administered chotosan instead of keishikajutsubuto. Her ophthalmic symptoms subsided for 5 days, and had completely disappeared almost two and half months after initiating chotosan. Case 2 was a 65-year-old man who had also complained of foreign body sensation due to post herpetic infection for 11 months. He also had a history of hypertension. Initial stellate ganglion block was also effective for relieving his symptom, but the effect was transient as in Case 1. Taking into consideration of our experience in Case 1,we administered chotosan. His foreign body sensation gradually subsided for 2 weeks, and had almost disappeared 2 months after initiating chotosan. Our experiences suggest that chotosan may be an optimal formulation for the patients suffering from ophthalmic disorders due to post herpetic inflammation and hypertension.
RÉSUMÉ
We successfully treated 2 patients with ophthalmic symptoms due to post herpetic infection using chotosan. Case1was a 78-year-old woman who had been suffering from ophthalmic symptoms such as foreign body sensation and irritation pain due to post herpetic infection for almost 20 years, and had a history of hypertension. We treated her with stellate ganglion block every week and orally administered keishikajutsubuto, amitriptyline, and later mexiletine. Initially, stellate ganglion block was very effective, but its effect gradually decreased over about one month. Considering the same action of stellate ganglion block and chotosan, both of which might increase intracranial blood flow, we administered chotosan instead of keishikajutsubuto. Her ophthalmic symptoms subsided for 5 days, and had completely disappeared almost two and half months after initiating chotosan. Case 2 was a 65-year-old man who had also complained of foreign body sensation due to post herpetic infection for 11 months. He also had a history of hypertension. Initial stellate ganglion block was also effective for relieving his symptom, but the effect was transient as in Case 1. Taking into consideration of our experience in Case 1,we administered chotosan. His foreign body sensation gradually subsided for 2 weeks, and had almost disappeared 2 months after initiating chotosan. Our experiences suggest that chotosan may be an optimal formulation for the patients suffering from ophthalmic disorders due to post herpetic inflammation and hypertension.