In January 2013, the Committee on Safety of the Japan Society of Pain Clinicians sent a questionnaire on adverse events (AEs) of pain management to all 307 board-certifi cated training facilities in Japan. Responses were received from 202 facilities (response rate, 66%). The survey asked about prescribed analgesic/adjunctive agents, nerve blocks/interventional therapy, rehabilitation therapy, physiotherapy, medical instruments/devices, and medical imaging systems used in the preceding year. AEs were reported by 99 of the 202 respondents in the year of 2012. Most reported AEs were classifi ed as side effects resulting from analgesics/additives or complications because of nerve blocks/interventional therapy. The survey of 2012 warned of the following issues: inappropriate use of strong opioids; side effects of neuropathic analgesics for geriatric patients; the risk of car accidents in patients using analgesics; the lack of Japanese guidelines for the management of antithrombotic therapy in pain medicine; hematoma and infection after interventional therapy; pneumothorax resulting from blocks on the trunk; and complications of peripheral nerve blocks under ultrasonographic guide. Taken as a whole, the number of reported AEs increased with the frequency of the prescription or procedure. This paper reports details of the background leading to manifestation of some AEs, which should prove useful for raising awareness among members of the Japan Society of Pain Clinicians and therefore prevent AEs in the future.

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The author reviews epidural block up-to-date. He focuses on controversial articles based on recent evidence and mentions the following; 1) epidural block technique: the medium for loss of resistance, intermittent epidural bolus compared with continuous epidural infusions, and the extent of blockade during epidural anesthesia; 2) severe complications after epidural block; 3) effects of epidural block on postoperative outcomes: postoperative analgesia, postoperative complications, and postoperative outcome; 4) effects of epidural block on clinical immunity： postoperative infection and postoperative cancer recurrence; 5) epidural steroids; 6) preventive effects of epidural block on chronic pain.

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Osteoporosis patients are known to total 12,800,000 in Japan, a result of an increasing aged population. However, only 20-30% of them are appropriately treated. Now there are numerous osteoporosis drugs, which cause the confusion among doctors. This comprehensive review will summarize characteristics of each drug, and support the use of proper drugs for proper patients.

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To compare the short-term effectiveness of nerve-root blocks between three clinical groups of lumber radiculopathy patients classified under the painDETECT Questionnaire (PDQ). The patients included in this study were suffering from lumber radiculopathy with the visual analogue scale (VAS) scores of 40 mm or higher, but drug therapies and epidural steroid injections were not effective. Each nerve-root block was considered “effective” if the patient's VAS score improved 50 % or higher 2 to 3 weeks after treatment. The average frequencies were then compared between the PDQ groups. Among the 91 patients, all of whom obtained statistically signifi - cant VAS improvements, the average frequencies of effective results were 62% for the nociceptive, 41 % for the mixed, and 28 % for the neuropathic groups. In the effectiveness of nerve-root blocks to the lumber radiculopathy patients, no statistically signifi cant difference was observed in a comparison of the three PDQ groups.

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We investigated to determine the utility of enhanced MRI as a prognostic examination for peripheral facial nerve palsy retrospectively. Fifty-five patients with that disease were classified into two groups. Group A was found with positive enhanced effect along facial nerve (n=35); group B was not found with that effect (n=20). The clinical course of patients was compared between the groups, and relevance between rates of complete healing and concomitant symptoms (pain, eruption of herpes zoster, taste disturbance, hyperacusis, secretory disturbance of tear, and enhanced effect of MRI) were researched. The frequencies of hospitalization and cervical sympathetic nerve block were more in group A. The lowest facial palsy score and the value of an electroneurography within 1 week after the onset were higher in group B. The rate of complete cure was 71.4% in group A; in group B it was 100%. Only those found with enhanced MRI were correlated with a rate of complete cure. We concluded that enhanced MRI is useful for prognostic evaluation of peripheral facial nerve palsy.

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Interstitial cystitis is characterized intractable pain. We report successful pain treatments of superior hypogastric plexus (SHP) block for 3 interstitial cystitis patients. Drug therapy and bladder hydrodistention therapy did not improve pain and nocturia of an 80-year-old woman. Epidural block was used in her treatment, and transient reduction of her symptoms was achieved. Subsequently, SHP block using neurolytic agent improved the symptoms without complication. SHP block was also made effective for 2 other patients. We could fi nd no reports of interstitial cystitis treatment using SHP block. Our report suggests effi cacy of SHP block for interstitial cystitis treatment.

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A 26-year-old woman patient, previously healthy, is an airline stewardess. On a recent fl ight, after lifting some heavy passenger baggage in her duties to the overhead shelf by using the power of her whole body, she felt nausea and headache. They both increased that evening and in a standing position, but improved in a supine position. Spinal fluid leakage was observed by her computed tomography (CT) -myelography, and she was diagnosed with cerebrospinal fluid hypovolemia (CFH). We performed a continuous epidural saline infusion as treatment to her, and her symptoms and activities of daily living improved. It was then possible for us to treat CFH safely and effectively without epidural autologous blood infusion, which is well-known and can have many complications. Also, though the pathogenesis of CFH in a nontraumatic case is unknown, stretching exercises such as lifting heavy baggage overhead possibly caused CFH in this case.

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A 72-year-old woman with bipolar disorder visited our department with a complaining of a persistent stinging pain in the right cheek, as well as a stabbing pain in the right cheek and maxilla when brushing her teeth or drinking water. We diagnosed her as having right trigeminal neuralgia and immediately began administration of 300 mg/day carbamazepine. Because of similarities between the patient's psychiatric symptoms and the side effects of the antinociceptive drugs used to treat trigeminal neuralgia, selecting appropriate drugs or determineing their efficacy was difficult. Although the patient had strong resistance to and mental rejection of trigeminal nerve block, considering it a last-treatment option, she eventually consented to undergo alcohol nerve block, which improved her symptoms significantly.

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We conducted treatment with a combination of exercise therapy and educational approach supervised by a physical therapist with chronic-pain patients who had suffered for a long time and were inactive. The results of treatment were that activity, pain behavior, pain cognition, and the symptoms were improved dramatically in chronic-pain patients. This treatment was considered one of the most effective methods for chronic pain.

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Serotonin syndrome is an adverse reaction caused by the therapeutic use or overdose of serotonergic drugs, alone or in combination, that results from postsynaptic hyperstimulation of 5-hydroxytryptamine (5-HT) 2A and 1A serotonin receptors in the central and peripheral nervous systems. Serotonin syndrome presents as a constellation of symptoms that include changes in mental status, neuromuscular overactivity, and autonomic instability. We report a case of serotonin syndrome primarily caused by duloxetine, a serotonin-norepinephrine reuptake inhibitor, which was administered to treat zoster-associated pain. We administered tramadol to the patient as treatment at the same time, and this coadministration may have induced serotonin syndrome. Many opioids, such as tramadol, oxycodone, fentanyl, codeine, buprenorphine, and dextromethorphan, which are reported to be serotonergic, are implicated in causing serotonin syndrome in combination with other serotonergic agents. Serotonin syndrome is a rare, but potentially life-threatening, iatrogenic complication, and physician awareness needs to be directed toward this syndrome.

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