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.

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.

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.

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.

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.

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.

Percutaneous epidural neuroplasty (PEN) is an interventional treatment option for chronic low back and lower extremity radicular pain that is refractory to conservative management or conventional epidural steroid injection. Traditional caudal PEN using a Racz catheter has been widely used; however, catheter manipulation can be difficult when the target lesion is located above L5/S1 or when severe spinal stenosis, postoperative adhesion, or degenerative anatomical changes are present. The retrodiscal approach allows more direct access to the disc–nerve interface and may provide targeted treatment around the affected nerve root while avoiding the vascular risk associated with the conventional safe triangle approach. The Whip catheter® is a steerable catheter system designed for retrodiscal approach PEN. Its unidirectional steerable tip, stylet-assisted stiffness, and blunt-tip side-hole needle may facilitate selective catheter placement, local drug delivery, and hydrostatic or chemical adhesiolysis near the target lesion. However, because the retrodiscal approach is performed close to the intervertebral disc and nerve root, careful fluoroscopic guidance, contrast confirmation, and monitoring for intradiscal or intravascular injection are essential. This review summarizes the anatomical rationale, technical considerations, potential advantages, limitations, and safety issues of retrodiscal approach PEN using the Whip catheter.

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 clinical diagnosis and may be difficult to differentiate from other conditions, particularly in the early stage. We report the case of a 17-year-old male who presented with right ankle pain two months after a ligament injury. At presentation, he exhibited hyperalgesia, allodynia, asymmetry in skin temperature and color, edema, and increased uptake on three-phase bone scintigraphy, findings raising concern for early-stage CRPS. A lumbar sympathetic ganglion block was performed, and transient improvement in pain and swelling was observed. However, four days after the procedure, the patient developed progressive erythema, swelling, and bullae formation in the affected ankle. Although laboratory evaluation revealed only mild leukocytosis without other significant abnormalities, a soft tissue infection was suspected. Empirical antibiotic therapy was initiated, resulting in marked improvement in both pain and swelling. This case highlights that early CRPS and soft tissue infection such as cellulitis may present with overlapping clinical features, leading to diagnostic confusion, and may also coexist. It underscores the importance of ongoing reassessment and careful differential diagnosis when new inflammatory signs emerge during follow-up.

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.