Reports of Investigation Bone atrophy in complex regional pain syndrome patients measured by microdensitometryPurpose: To determine the usefulness of quantitative measurement of bone atrophy in the diagnosis and the longterm follow-up of patients with complex regional pain syndrome (CRPS). The bone-sparing effect of a 5-hydroxytriptamine (5-HT2) antagonist was also studied. Methods: Bone mass was measured by computerized micro-densitometry at the middle position of the second metacarpal. The effect of repeated stellate ganglion blocks (SGBs) three times per week with mepivacaine (n = I I), administration of a 5-l-IT 2 antagonist (sarpogrelate hydrochloride, 300 mg a day po) (n = 12), and combined therapy (n = 10) were compared by micro-densitometry and conventional visual analogue scale (VAS) for analgesia after three months of treatment. Results: In CRPS patients, metacarpal index (comical bone thickness), maximum bone density (cortical bone density), minimum bone density (trabecular bone density), and average bone density were reduced on the affected side (14. I%, 12. I%, 25.0% and 19.3% respectively). The rate of reduction in bone mass correlated with the duration of the disease (P < 0.05). Therapy with the 5-HT 2 receptor antagonist (with or without repeated SGBs) decreased pain intensity (from 6. I 0 to 3.81 with SGB, from 6.30 to 2.91 without SGB, respectively; P < 0.01 ) and bone atrophy evaluated by micro-densitometry (P < 0.05). In contrast, repeated SGBs alone reduced pain intensity (from 6.30 to 2.91; P < 0.01) but did not ameliorate bone atrophy. Conclusion: Bone micro-densitometry is useful in the assessment and follow-up of CRPS and for evaluation of treatment. The 5-HT 2 antagonist, sarpogrelate hydrochloride, is a promising treatment for CRPS patients.
A total of 20 chronic headache cases in which other Kampo medicines were ineffective or hardly effective were treated with Kumi-binro-to extract, and the effect of this medicine was investigated.At the start of administration, we investigated the following items : any deficiency or excess, presence or absence of stagnation of vital energy (facial erythema, ophthalmologic injection, bitter taste in the mouth, etc.) and disease caused by contaminated water (tendency of edema, sound of fluctuating liquid in the region of the stomach, decreased urine volume) as well as the presence or absence of grasping pain (pressure pain) in the gastrocnemius muscle which is a characteristic symptom as a target of this drug. The efficacy of Kumi-binroto was assessed by a pain score after weeks from the start of administration.Kumi-binro-to was markedly effective in 5 cases, effective in 11 cases and ineffective in 4 cases, indicating that the ratio of markedly effective and effective cases accounted for 80% of the patients treated. There was no adverse reaction. When the characteristics of 16 cases assessed as markedly effective or effective were investigated, disease caused by contaminated water and stagnation of vital energy was observed in 13 and 14 of the 16 cases respectively. The grasping pain in the gastrocnemius muscle that is a characteristic target of this drug was noted in only one case.The above result suggests that Kumi-binro-to promotes diuresis to eliminate wetness-evil and regulates vital energy, and is effective against chronic headache, especially when the disease caused by contaminated water is accompanied with stagnation of vital energy.
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