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There is a report that 7.6% of patients worldwide suffer from osteoarthritis, and a study conducted in Korea indicates that 8.27% of Koreans are affected by this condition. Osteoarthritis not only causes pain but can also lead to swelling and joint stiffness. In Korea, nonsteroidal anti-inflammatory drugs (NSAIDs) and SYSADOA are often prescribed together for osteoarthritis patients. Recently, Duojoin®, a combination of these two types of medication, has become commercially available for treatment. The drug consists of celecoxib and PG201, both of which can reduce pain and improve function in osteoarthritis patients. Celecoxib is known to have fewer gastrointestinal side effects compared to other NSAIDs. Study suggests that Duojoin® can be more effective in reducing pain and improving function than celecoxib alone, making it a promising option for the treatment of osteoarthritis.

Case 1. An 82-year-old male patient visited with neck pain and right upper extremity pain 6 months after the onset of symptoms. The pain was aching, and right 4th and 5th fingers were cold and numbness. Past history was gastric cancer surgery and chemotherapy 7 years ago. On MRI, central canal stenosis of C5/6 and C6/7, as well as foramen stenosis, were observed. Radiculopathy caused by a cervical disc was initially diagnosed. trigger point injections, cervical epidural injections were done, but no effect. During follow-up, patient couldn’t dorsiflex the right wrist gradually. Nerve conduction studies found right C7-8-T1 radiculopathy. In the meantime, a mass was accidentally found in the lower lobes of both lungs on the patient's yearly abdominal CT. And additional chest CT showed a 5 cm mass in the apex of the right lung and lymph metastasis. Case 2. A 62-year-old male patient visited our hospital complaining of tingling in right hands. This patient was diagnosed with C6/7 disc herniation. After cervical 7th foraminal nerve root injection, and pulsed RF, symptoms improved by 30-40%. About one year later, new symptoms appeared: numbness and paresthesia in the right medial arm. On physical exam, motor power of the 7th, 8th cervical level was reduced to Grade III/V. Nerve conduction test showed right C7-8-T1 radiculopathy. No MRI findings explained the patient's symptoms. Chest PA and chest CT were performed, and lung cancer with lymph node and pleural metastasis were found in the right lung apex.

Complex regional pain syndrome (CRPS) is a challenging disease, and various combined treatments are being attempted. A variety of drug, sympathetic ganglion block and pain control devices, such as a spinal cord stimulator (SCS) or an intrathecal drug pump (ITP) can be used to relieve pain. However, even with these treatments, pain relief may be difficult and take a significant amount of time to resolve. Lumbar sympathetic ganglion block (LSGB) is used to diagnose and treat pain associated with sympathetic nerves in the lower extremities. There are several ways to check whether sympathetic block is effective, body temperature measurement is a noninvasive and effective way to check skin blood flow change. Since nerve block using local anesthetics is temporary, radiofrequency thermocoagulation and chemical neurolysis using alcohol or botulinum toxin type A can be used to prolong the effect of nerve block. In this case report, we would like to share a case of a patient with complex regional pain syndrome at left ankle who underwent left lumbar sympathetic ganglion block and experienced an increase in right lower extremity body temperature. 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

Complex Regional Pain Syndrome (CRPS) is a chronic neuropathic condition with unclear etiology and pathophysiology, characterized by heightened pain sensitivity and various autonomic disturbances. Due to the lack of a definitive treatment, a multidisciplinary approach is essential for managing symptoms and improving patients’ quality of life. Managing CRPS in pregnant patients presents additional challenges, as many conventional pharmacological treatments and interventional procedures carry risks to maternal and fetal health. This limits therapeutic options, necessitating safer and non-invasive alternatives. Transcutaneous Electrical Nerve Stimulation (TENS) is a proven safe and effective therapy for pregnancy-related low back pain, making it a promising option for managing CRPS in pregnant patients. In our case, TENS provided significant pain relief, demonstrating its potential as a viable, non-invasive modality for CRPS treatment during pregnancy without compromising safety.

This case report discusses a 63-year-old male with chronic refractory musculoskeletal pain and muscle cramps in both calves, persisting for 20 years despite various treatments like nerve blocks and trigger point injections. Initial evaluations showed no specific findings. After ineffective management with vitaminmagnesium therapy, pramipexole, tizanidine, and transcutaneous electrical nerve stimulation, the patient underwent intramuscular collagen injections in the gastrocnemius and soleus muscles. Following a total of eight injections, there was a significant improvement in muscle spasm and pain. The report suggests that type 1 collagen may be a promising treatment for refractory chronic musculoskeletal pain by promoting tissue recovery, serving as a scaffold for repair, or directly reducing inflammation.

Although percutaneous epidural neuroplasty (PEN) is generally safe, rare complications such as catheter breakage can occur during the procedure. In this report, we present a case of epidural catheter breakage with a retained fragment in the epidural space during lumbar PEN. A 61-year-old male with a history of lumbar posterior decompression presented to the pain clinic. He complained with low back and left leg pain. A PEN targeting left L5 was planned. In the prone position, a Tuohy 18G needle was inserted via the transforaminal approach at the left L5-S1 level. Following needle placement, an epidural catheter (Perifix®) was advanced through the needle. However, advancing the catheter was challenging. Consequently, repositioning of the Tuohy needle was attempted. During the withdrawal of the catheter through the needle, an unintentional breakage of the epidural catheter occurred. After stopping the procedure, an immediate ultrasound examination, a CT scan, and a contrast-enhanced MRI were conducted. However, these tests also failed to identify the residual catheter. After hospitalization, a conservative management was performed. During the hospital stay, no complications arose. Three months after discharge, a follow-up CT scan revealed an epidural linear opacification of the remnant catheter at the L4 level. Up to 1-year follow-up periods, the patient remained asymptomatic. In conclusion, the risk of epidural catheter breakage during PEN should always be considered.

A perineural cyst is a cyst filled with CSF that occurs between the perineurium and endoneurium. As perineural cyst expands, it can exert pressure on the surrounding nerve fibers, potentially leading to neurological symptoms. Cervical perineural cysts are rare condition with a low prevalence, and there is a lack of systematic research on the disorder. Most individuals with these cysts are asymptomatic. In symptomatic case, there is no established treatment protocol. However, there have been reported cases of symptom improvement through nerve block procedures. In this case, patient presented with brachial plexopathy due to multiple perineural cysts, and was successfully treated by nerve root block and epidural block.

Chronic postsurgical pain (CPSP) is a significant complication that can severely affect quality of life, particularly in cases involving facial fractures due to the complex neural anatomy. This case involves a 70-year-old female with persistent facial pain, dysesthesia, and nasal discomfort for 2.5 years after orbital and zygomatic complex fracture repair. Despite more than six months of pharmacological treatment, symptoms persisted; therefore, we performed an ultrasound-guided infraorbital nerve block (IONB). After six sessions, the patient experienced a 70% reduction in pain and sustained improvement in symptoms, including decreased nasal sensation as if having a runny nose. This case demonstrates the efficacy of IONB as a safe and effective treatment for managing CPSP and neuropathic symptoms associated with infraorbital nerve injury, even in cases with prolonged symptom duration.

Diagnosis and treatment of complex regional pain syndromes (CRPS) continue to generate controversy among clinicians and frustration and suffering for patients. As a result, the clinical features of pediatric CRPS remain poorly understood. We report a case of CRPS in a 15- year -old girl after minor trauma. She was consulted from pediatrics with right arm pain and edema that occurred 6 months ago. After blood test for school health checkup, a bruise appeared at the puncture site, followed by swelling and tenderness. She complained of a pain with a numerical rating scale (0 = no pain, 10 = worst pain imaginable) 5 when rest and 7 in motion. The MR angiography and ultrasound were performed, revealed swelling of subcutaneous layer of upper arm. She showed a temporary response to steroid therapy under suspicion of cellulitis or panniculitis, however, the lesion recurred. After a multidisciplinary evaluation, the possibility of other diagnosis was ruled out. CRPS type 1 was diagnosed. She received intermittent steroid therapy, and exercise for range of motion. Medications were not effective, except for combination of codeine, ibuprofen and acetaminophen. We will register her for bio-data genome testing and plan sympathetic block or intravenous infusion. CRPS in children and adolescents is still underdiagnosed. The management by an experienced multidisciplinary team is recommended.

Spinal cord stimulator (SCS) is a treatment that can be applied to chronic refractory pain, including complex regional pain syndrome (CRPS). SCS related dermatitis is very rare, and in most of the cases, it occurs around the generator. Here, we report a patient who experienced dermatitis in his left leg after SCS implantation.