case_images: PMC10277465_01
case_images: White areas with high x-ray absorption indicate cast crowns and pontics. No dental abnormalities were found that could explain the patient's persistent oral dysesthesia.
case_images: fpain-04-1159134-g001.jpg
case_images: PMC10277465_01_fpain-04-1159134-g001.jpg
case_images: F1
case_images: A jaw x-ray image did not show any organic abnormality to explain the OD (Figure 1).
case_images: Course of treatment and objective/subjective parameters. (A) Pain NRS average; (B) EQ-5D; (C) HADS; and (D) PCS. ATX, atomoxetine; CAARS, Conners' adult ADHD rating scale; D, day; EQ-5D, euro QoL 5 Dimension; HADS-A/D, Hospital Anxiety and Depression Scale-Anxiety/Depression; MP, methylphenidate; NRS, numerical rating scale; PCS, Pain Catastrophizing Scale; PPX, pramipexole; and SPECT, single-photon emission computed tomography.
case_images: fpain-04-1159134-g002.jpg
case_images: PMC10277465_01_fpain-04-1159134-g002.jpg
case_images: F2
case_images: The patient's average NRS score for pain in the lower back at the first visit was 9/10, with an EQ-5D score of 0.233, a HADS-A score of 14/21, a HADS-D score of 15/21, and a PCS score of 49/52 (Figure 2).
case_images: Changes in CAARS scores along the course of treatment. (A) CAARS-S; (B) CAARS-O. ADHD, Attention-Deficit/Hyperactivity Disorder; CAARS-S/O, Conners' Adult ADHD Rating Scale Self-report/Observer rated; and DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, fourth edition.
case_images: fpain-04-1159134-g003.jpg
case_images: PMC10277465_01_fpain-04-1159134-g003.jpg
case_images: F3
case_images: The patient's CAARS results showed that his subscale scores exceeded 65 points and that his ADHD symptoms were at the clinical psychiatric level (Figure 3). All CAARS-S/O subscale scores also improved to below clinical levels (Figure 3). Day 2,169: CAARS and SPECT examinations were conducted for a third time; the CAARS-O scores (Figure 3) and cerebral blood flow in the prefrontal cortex showed further improvement (Figure 4).
case_images: Brain perfusion SPECT images obtained on day 524 (A), 762 (B) and 2,169 (C), respectively. From the left side: three axial views from the basal ganglia to the frontal-parietal level, and left- and right-side sagittal views. The voxel values are normalized by the average counts-per-voxel in the cerebellum being 50, then the color bars represent from 5-60. The bilateral prefrontal cortices show hypoperfusion (white dashed curves) (A,B) lower than the thalamus that gradually increases to almost the same level of the thalamus and parietal-occipital lobes (C). The mean normalized counts in the prefrontal cortices are 40.1, 40.1 and 42.0, respectively. In contrast, the precuneus and posterior cingulate gyrus (black dashed curves) show relatively high (black dashed curves) (A) and decreased with time (B,C). Their mean normalized counts are 47.8, 43.6, and 42.2, respectively. The voxel value normalization and calculation were performed using PMOD version 3.7 (PMOD Technologies Ltd., Zurich, Switzerland). SPECT, single-photon emission computed tomography.
case_images: fpain-04-1159134-g004.jpg
case_images: PMC10277465_01_fpain-04-1159134-g004.jpg
case_images: F4
case_images: Tochigi, Japan). The results showed hypoperfusion in the bilateral prefrontal cortex (Figure 4). Day 762: A second SPECT was performed, which showed a slight improvement in cerebral blood flow compared to that in the first image (Figure 4). Day 2,169: CAARS and SPECT examinations were conducted for a third time; the CAARS-O scores (Figure 3) and cerebral blood flow in the prefrontal cortex showed further improvement (Figure 4).