Earticle

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.

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.

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.

We report a case of sternoclavicular joint infection with chest wall abscess in a 54-year-old female with right shoulder pain for one month. The patient had hypertension and newly diagnosed diabetes. Laboratory findings showed elevated inflammatory markers. Chest MRI confirmed infectious arthritis with abscess, and blood cultures isolated Methicillin-sensitive Staphylococcus aureus. After surgical drainage and 7-week antibiotic therapy, the patient improved. This case emphasizes considering sternoclavicular joint infection in persistent shoulder pain, especially with risk factors like diabetes.

Chronic back pain is a prevalent condition often refractory to conventional medical therapies, prompting the use of spinal cord stimulation (SCS) for intractable cases such as chronic pain after spinal surgery. Traditional SCS, however, demonstrates limitations, including inconsistent relief for axial back pain and potential loss of efficacy over time. This narrative review synthesizes the conceptual foundations, neurophysiological mechanisms, and emerging clinical evidence supporting differential target multiplexed (DTM) SCS in chronic back pain management. DTM SCS employs multiplexed electrical stimulation, integrating a low-frequency base signal with multiple high-frequency prime signals to concurrently target neurons and glial cells—whose dysregulated interplay drives chronic pain persistence and neuroinflammation—unlike conventional SCS, which predominantly modulates neuronal activity. Preclinical investigations reveal DTM’s superiority over traditional and high-frequency SCS in altering neural cell-specific transcriptomes and enhancing mechanical withdrawal thresholds in neuropathic pain models. Clinically, DTM SCS yields substantially greater therapeutic efficacy, offering a promising advancement for refractory back pain.

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.

Spinal pain is frequently encountered in pain clinics and is often attributed to benign musculoskeletal conditions; however, serious underlying diseases may present with similar symptoms, leading to diagnostic challenges. We report two cases that illustrate clinical pitfalls in interpreting spinal magnetic resonance imaging (MRI) in patients with cervicothoracic pain. The first case involved a 60-year-old man presented with persistent posterior neck and upper back pain accompanied by weight loss and sleep disturbance. On the outside cervical spine MRI, the lesion was overlooked because it was located beyond the primary region of interest on the far lateral sagittal images; subsequent chest computed tomography (CT) revealed a Pancoast tumor. In the second case, a 64-year-old man was referred for a bone biopsy after multifocal signal alterations on spinal MRI were interpreted as suspicious for malignancy at a primary clinic. However, the biopsy revealed only reactive marrow changes, and his symptoms improved after a cervical epidural block. These cases demonstrate that while MRI is indispensable in the evaluation of spinal pain, it should not be considered definitive without careful clinical correlation. Thorough history-taking, vigilance regarding red flags, and careful review of all imaging planes and adjacent anatomical structures are essential to avoid delayed diagnosis or unnecessary invasive intervention in pain clinic practice.

Failed back surgery syndrome has been defined as persistent low back pain with or without radiating pain despite previous spine surgery, and it has various etiologies. Given the high probability that the pain would be chronic and intractable, it is essential to employ a broad range of therapeutic strategies. Radiofrequency ablation (RFA) may serve as one of the treatment options. A 64-year-old woman who had undergone lumbar fixation (L4–5) surgery five years ago visited our multidisciplinary pain center, complaining of back pain with radiating pain to both lower extremities (NRS 8) despite receiving medications at a local clinic. Following a positive diagnostic medial branch block, we decided to perform RFA using a novel multitined (Diros TridentTM) radiofrequency needle device, which has been reported to be more effective than conventional single-tined needles. Heat RFA was conducted on the right L3, L4, and L5 medial branches of the patient after nerve stimulation for localization. One month after the procedure, the patient reported a reduction in pain intensity (NRS 5 from 8). The patient is being followed up to evaluate the long-term effects. Additional comparative research is required to validate the therapeutic and side effects of multitined needles.

Lumbar percutaneous epidural neuroplasty (L-PEN) may be an effective treatment for lumbar disc herniation (LDH) symptoms such as ongoing neuropathic pain brought on by spinal root compression and spinal canal stenosis. L-PEN is a minimally invasive therapy that involves inserting a specially made catheter right into the pathological spinal canal site in order to both manually remove soft tissue adhesions and effectively administer medication to the desired region. We use a mixture of various medication including local anesthetics for reducing the pain during L-PEN. However, unexpected intrathecal or intravascular uptake of local anesthetics can happen occasionally and this may cause adverse reactions. In this report, we would like to share our experience concerning the occurrence of systemic toxicity of local anesthetics during L-PEN.

Buttock pain is a common complaint of patients in the pain clinic. However, assessment of fractures can be difficult if there is no trauma history. A 65-year-old woman with rheumatoid arthritis complained of bilateral pains in the buttocks for a month. She didn’t have a history of falls or other traumas and no fracture line was visible in plain lumbar X-rays. Although the patient had taken analgesics for two weeks, her pain persisted even with newly developed severe pain in the left groin. Magnetic resonance imaging of the pelvis revealed fragility fractures of the left parasymphyseal area and bilateral sacral ala. In addition, previously unrecognized osteoporosis was detected. Fragility fracture of the pelvis are rare, but we recommend that clinicians may consider these problems when an elderly patient complains of the motion-related sacrum or groin pain.