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Erythromelalgia is a rare neurovascular pain syndrome characterized by a triad of redness, increased temperature, and burning pain primarily in the extremities. Erythromelalgia can present as a primary or secondary form, and secondary erythromelalgia associated with a myeloproliferative disease such as essential thrombocythemia often responds dramatically to aspirin therapy, as in the present case. Herein, we describe a typical case of a 48-year-old woman with secondary erythromelalgia linked to essential thrombocythemia in the unilateral hand. As this case demonstrates, detecting and visualizing the hyperthermal area through infrared thermography of an erythromelalgic patient can assist in diagnosing the patient, assessing the therapeutic results, and understanding the disease course of erythromelalgia.

Trigeminal neuralgia (TN) is characterized by recurrent paroxysms of unilateral facial pain that typically is severe, lancinating, and activated with cutaneous stimulation. There are two types of TN, classical TN and atypical TN. The pain nature of classical TN are the same as those described above, whereas atypical TN is characterized by constant, burning pain. We describe the case of a 49-year-old male presenting with right-sided facial pain. The patient was diagnosed with temporomandibular joint disorder at a dental clinic and was on medical treatment, but his symptoms worsened gradually. He was referred to our pain clinic for further evaluation. Radiologic evaluation, including MRI, showed a parapharyngeal tumor. For the relief of TN, a right mandibular nerve (V3) root block was performed at our pain clinic, and then he was scheduled for radiation and chemotherapy.

Burning Mouth Syndrome (BMS) is defined as a chronic orofacial pain syndrome, without evidence of mucosal lesions and other clinical signs of disease or laboratory abnormalities. Patients with BMS complain of burning pain in the mouth, xerostomia and taste disturbances. It is more common among women and the median age of occurrence is about 60 years. BMS may be primary or secondary to other diseases. The mainstay in the treatment of BMS includes antidepressants, benzodiazepines, and anticonvulsants. A few cases of BMS caused due to medication have been reported. The causative drugs include angiotensin-converting enzyme inhibitors, anticoagulants, antipsychotics, antiretrovirals, and benzodiazepines. This is a case report of a patient on antidepressants who developed symptoms of BMS thereby causing a dilemma in management.

Fabry disease is an X-linked lysosomal disease caused by deficiency of α-galactosidase, in which early diagnosis may be missed due to the wide variety of clinical symptoms presenting during disease progression. A 13 year-old boy visited our pain clinic complaining of pricking and burning pain in the toe tips of both feet. Continuous epidural infusion for pain management was performed because of oral analgesics ineffectiveness. The patient underwent α-galactosidase A (GLA) enzyme analysis based on the clinical impression of Fabry disease from pain with a peripheral neuropathic component and history of anhidrosis. He was diagnosed with Fabry disease after confirming mutation of the GLA gene through a screening test of GLA activity. Enzyme replacement therapy was initiated and pain was tolerated with oral analgesics.

Primary erythromelalgia is a rare condition that's characterized by erythema, an increased skin temperature and burning pain in the extremities. The pain is often very severe, and treating erythromelalgia is frustrating and difficult. We report here on the case of a 12-year old girl with primary erythromelalgia in both lower extremities. The pain was refractory to medical treatment, but a bilateral sympathetic block with lidocaine and triamcinolone resulted in relief from the pain. Our experience with this disease demonstrates that sympathetic blocks are effective in improving the symptoms and they may be attempted on erythromelalgia patients who do not respond to other treatments, including medication and epidural blocks.

Herpes zoster (HZ), or shingles, is a common disease. For most patients skin healing and pain resolution occur within 3-4 weeks. However, pain can continue after the rash has healed. Herein, a case is presented in which acute urinary retention (AUR) occurred during post-herpetic neuralgia (PHN) treatment in an old aged patient. The patient was an 84-year-old man, who was evaluated due to reports of excruciating and burning pain secondary to HZ on the left thigh and knee area of 2 months duration. Initially, the symptoms of PHN were likely to respond well to the conventional combination of sympathetic blockade, anticonvulsants, antidepressants and opioids. However, after the administration of a mixed intravenous infusion of ketamine and midazolam, the patient experienced a sudden onset of AUR, with severe edema of both legs, which lasted 72 hours. Upon insertion of a Nelaton catheter, approximately 900 ml of clear, yellow urine were obtained, which resulted in a marked improvement of his discomfort. This case of acute transient urinary retention, associated with PHN management in old age, is reported.

Postherpetic neuralgia is sequelae to a herpes zoster infection. It represents with intractable burning pain, allodynia and paroxysmal lancinating pain. Although various therapeutic modalities have been applied to relieve these pains, no definite remedies have been established. Herein is report a patient with postherpetic neuralgia, treated with combination drug therapy; intravenous ketamine, oral dextromethorphan, anticonvulsant, antidepressant, opioid and nonsteroidal anti-inflammatory drugs. He developed sudden delirium after the third administration of intravenous ketamine, and required 5 days hospitalization to recover from his symptom. Furthermore, he was accidentally found to have an arterial aneurysm of his left middle cerebral artery, which had unruptured.