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A 40-year-old man visited our department because of chest and back pain. He had a history of diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) 20 years ago. He received immunosuppressive therapy and had no relapses after that. On Admission, MRI showed tuberous hypertrophy of the spinal roots, intercostal nerves, and brachial and lumbar plexuses. The genetic analysis showed no mutations in any of Charcot-Marie-Tooth related genes. He was finally diagnosed with CIDP and administration of high dose intravenous methylprednisolone relieved his chest and back pain within a few days. We present a rare case of CIDP in which showed marked enlarged spinal roots in long clinical course and have a relapse with radicular pain without sensorimotor symptoms.

An 81-year-old woman was admitted due to exacerbation of chronic back pain from a vertebral osteoporosis fracture. The lumbar MRI examination revealed compression fracture of Th12 and L1 bones. Initial treatment with roxoprofen, calcitonin, bupurenorfin, and morphine did not achieve pain reduction in the patient. Because her geriatric depression scale score was low, we next tried to treat the pain using an antidepressant. Although the pain was improved by amitriptyline, the side effects of dry mouth and urinary incontinence were occurred. Milnacipran, a serotonin and norepinephrine reuptake inhibitor (SNRI), was then tried for the treatment of the chronic pain instead of amitriptyline, but the pain was increased. Then, she was given amitriptyline again for treatment of the chronic back pain instead of SNRI. The second-time amitriptyline treatment was effective to reduce the pain, with minimal side-effects. Because chronic pain due to osteoporosis is often difficult to treat in elderly patients, the classic antidepressant, amitriptyline, may help pain control by narcotics and anti-inflammatory agents in some elderly patients.

A 74-year-old man with non-small cell lung cancer was referred to our hospital for chemotherapy. On admission, he suffered from high fever and left upper back pain. Laboratory data showed marked leukocytosis and increased CRP. He was treated with chemotherapy of weekly vinorelbine and gemcitabine. After the second cycle, the levels of leukocytes and CRP were remarkably decreased, and the severe back pain was also alleviated. He has been given an additional 4 cycles as an outpatient. He is now doing well. This regimen seems to be effective in alleviating symptoms and improving QOL.

A 60-year-old man was admitted to our hospital because of lumbago due to a metastatic bone tumor that originated from the prostate. Previously, he had been treated with 500 mg/kg of diethylstilbestrol diphosphate and 75 mg/day of chlormadinone acetate. At our hospital, he was given 470.1 mg/day of estramustine sodium phosphate and a bilateral orchiectomy was performed. However, he felt increased lumbago. Thus, a dose of 1200 mg/day of medroxyprogesterone acetate was started. Although the histology of his prostate and bone scintigram did not change, the patient no longer felt lumbago from about 2 weeks after the start of this treatment. Six months later, he remains free of lumbago. In this report, we describe the effect of high-dose medroxyprogesterone acetate on the clinical course, and the plasma and urine levels of the hormones.

Hochu-ekki-to was administered orally in 2.5 g doses thrice per day to 53 patients who complained of lumbago or lower abdominal discomfort. Its efficacy rate was 53.8% for the patients who complained of lumbago, and 32.3% for the patients who complained of lower abdominal discomfort. Total efficacy rate was 66.0%. Mild adverse effects were observed in 4 patients, but no severe untoward effects was observed.

Eleven patients with lumbago due to renal ptosis, and 23 patients with stress incontinence were treated with Tsumura Hotyuekkito (Buzhongyiqitang), an old Chinese prescription, 7.5 g, three times a day. The subjective symptoms were improved in 9 cases (82%) of lumbago and 18 cases (78%) of stress incontinence. No side effects were observed.