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The Global Burden of Disease Study highlighted a 113.3% increase in osteoarthritis (OA) cases globally, with Korea showing notably high prevalence rates, especially for knee OA. Herbal symptomatic slowacting drugs in OA (SYSADOA), such as JOINS® which contains extracts from Clematis mandshurica, Trichosanthes kirilowii, and Prunella vulgaris, have emerged as effective treatments. JOINS® has demonstrated significant anti-inflammatory and cartilage-protective effects through inhibiting key inflammatory cytokines and enzymes involved in cartilage degradation. Clinical trials comparing JOINS® to conventional NSAIDs and SYSADOAs revealed similar efficacy in pain management and functional improvement with lower incidences of gastrointestinal issues and no significant cardiovascular risks, positioning it as a viable long-term treatment option for OA. This evidence supports the potential of herbal SYSADOAs, particularly JOINS®, as safe and effective alternatives for OA management, emphasizing the need for comprehensive treatment strategies in the face of rising OA prevalence.

The causes of complications and failure of spinal cord stimulator (SCS) include migration, breakage, disconnection of the lead, fibrosis, effluence of cerebrospinal fluid, and infection-induced meningitis. Here, we report an unusual case of leakage of implantable pulse generator (IPG) batteries during SCS removal. A 76-year-old woman diagnosed with complex regional pain syndrome type 1 underwent SCS implantation 13 years ago to treat her arm pain. She visited the hospital for SCS removal as it was nonfunctional. Upon incision at the IPG pocket site, a clear milky pus-like liquid discharge was observed. An abscess was suspected. However, white corroded areas were observed around the IPG after the completion of the drainage. Although battery leakage from the IPG had occurred, the patient had no symptoms because the granulation tissue had prevented the absorption of the leaked products from the battery into the systemic circulation. Therefore, we recommend replacing the IPG after 9–10 years or as the product manufacturer recommends.

Fabry disease is an X-linked recessive disorder of glycosphingolipid metabolism resulting from the deficient activity of the lysosomal enzyme, α-galactosidase A. It leads to the systemic accumulation of glycosphingolipids including globotriaosylceramide (GL3) in the plasma and tissue lysosomes. Classically affected hemizygous males, with no residual α-galactosidase Aactivity may display all the characteristic sign, including neurological (pain), cutaneous (angiokeratoma), renal (proteinuria, kidney failure), cardiovascular (cardiomyopathy, arrhythmia), cochleo-vestibular and cerebrovascular (transient ischemic attacks, strokes) features of the disease. While, heterozygous females have symptoms ranging from very mild to severe. Thus, it is not easy to diagnose Fabry disease in female patients, because of the variable clinical features. This case is a patient who was considered to have an ordinary fibromyalgia but was found to have a Fabry disease by detailed history taking and examination. We herein report a case of chronic somatic pain due to Fabry disease without other systematic manifestations.

A 69-year-old man visited multidisciplinary pain center as an out-patient, complaining of back pain (NRS 9) after trauma 15 days ago. The pain was exacerbated by position change and cough. Percussion tenderness was present at mid-thoracic level, but neurologic exam was normal. T-spine image revealed compression fracture at T6 and 7. Ultrasound-guided paravertebral block at right T7 level was performed in a prone position. The patient coughed during injection, and presented severe chest pain and shortness of breath. The patient was transferred to ER under doubt of pneumothorax. Initial vital sign at ER was BP 172/84mmHg, HR 155/min. Chest X-ray revealed tension pneumothorax at right upper lung field. 16G needle was inserted Right 5~6th rib and simultaneously thoracic surgeon was called. After needle insertion, chest pain and shortness of breath were improved and vital sign was improved to BP 136/68mmHg, HR 92/min. Atelectasis of right lung was improved after chest tube drainage by thoracic surgeon. After admission, osteoporotic compression fracture was diagnosed based on MRI and DXA finding. The patient presented worsened back pain (NRS 10) and epidural steroid injection at T6-7 had no effectiveness. Percutaneous balloon kyphoplasty was done at T6 and T7 using extrapedicular approach. After kyphoplasty, back pain was improved to NRS 2/10, and no other complication was seen. Eight days after, chest tube was removed after confirmation of no drainage. The patient was discharged the next day. After 2 weeks, patient visited multidisciplinary pain center, no pain remained and CXR was normal.

Percutaneous epidural neuroplasty (PEN) is one of the most widely used alternatives for treating lumbar spinal stenosis (LSS). PEN may be a good option, if conservative treatments such as medical treatment, epidural steroid injection, or physical therapy fails to relieve patients’ symptoms. Especially, PEN using balloon catheter can improve patients’ outcome more successfully through the dilation of stenotic area and the lysis of epidural adhesion. Although PEN is a relatively safe procedure, several complications including transient pain aggravation, dural puncture, subdural, intradiscal, and intravasucular injection have been reported. In this case report, the authors share our encounter with a rare complication of intervertebral disc herniation following PEN using balloon catheter.

Ventricular electrical storms (VES) caused by ventricular tachycardia (VT) or ventricular fibrillation (VF) are life-threatening. Because increased sympathetic activity is common cause, cardiac autonomic modulation can offer potential VT/VF prevention and treatment. We herein present two cases of a successful control of cardiac rhythm after stellate ganglion block (SGB) to inhibit cardiac sympathetic activity in patients with intractable ventricular arrhythmias. A 41-year-old male patient with coronary stents presented with chest pain. After admission VT was developed. Despite receiving medical treatment with antiarrhythmic drugs, implantable cardioverter defibrillator shocks, and radiofrequency catheter ablation, VT was not effectively controlled. Ultrasound-guided SGB was performed on the left side. After the procedure, the patient's cardiac rhythm was stabilized. Another 60-year-old male patient with heart failure (EF 21%) presented with dyspnea. After hospitalization, he experienced refractory ventricular arrhythmias even after left ventricular assist device implantation. Following ultrasound-guided SGB unilaterally at 2-day intervals, his frequent VT was resolved. In conclusion, SGB in patients with VES can be an effective treatment for patients with refractory ventricular arrhythmias.

Percutaneous epidural neuroplasty carries the risk of life-threatening accidents if there is a misidentification of a myelogram as an epidurogram. If the contrast image demonstrates symmetrical and well-defined boundaries, smoothly extending both upwards and downwards, and exhibits rapid dilution upon subsequent imaging, it may indicate the presence of a myelogram. While a myelogram typically exhibits a certain pattern, it may vary among patients. Particularly in cases of severe spinal stenosis and epidural adhesions, distinguishing between myelogram and epidurogram may be ambiguous and requires great caution.

Following the COVID-19 pandemic in 2020, encounters with patients experiencing post-vaccination pain have become increasingly common in outpatient settings. This case report highlights a 47-year-old male, initially devoid of any underlying conditions, presenting with persistent lower back and bilateral thigh pain following his third COVID-19 vaccination. Despite analgesics, his pain intensified, prompting further investigation. Lumbar MRI revealed mild disc protrusion at L4-L5 and widespread signal intensity abnormalities in the vertebrae and pelvis, suggesting a hematogenous disorder. Subsequent blood tests showed decreased platelets and atypical leukocytes, leading to a final diagnosis of acute myeloblastic leukemia after being transferred to the department of hematology. This case underscores the importance of comprehensive assessment in patients with post-vaccination symptoms, where seemingly routine pain may indicate underlying severe conditions. It highlights the necessity for pain physicians to consider a broad differential diagnosis, including serious hematological diseases, when evaluating post-vaccination complaints.