case_images: PMC11371746_01
case_images: Course of treatment and subjective parameters. Additional MP and VFX interventions that may have contributed to the improvement in the patient's nociplastic pain status are highlighted in red underlined font. Subsequent changes in MP and VFX doses are shown in black bold underlined font. (A) Average pain NRS score. (B) EQ-5D score. (C) HADS score. (D) PCS score. ATX, atomoxetine; CAARS, Conners' adult ADHD rating scale; CSI-9, central sensitization inventory-9; D, day; df, difference; EQ-5D, EuroQoL-5 dimension; GF, guanfacine; HADS-A/D, hospital anxiety and depression scale-anxiety/depression; MIRT, mirtazapine; MP, methylphenidate; MPI, multidimensional pain inventory; NRS, numerical rating scale; OLZ, olanzapine; PCS, pain catastrophizing Scale; SPECT, single-photon emission computed tomography; VFX, venlafaxine.
case_images: fpain-05-1394131-g001.jpg
case_images: PMC11371746_01_fpain-05-1394131-g001.jpg
case_images: F1
case_images: The classification was DYS type (Figures 1, 2).
case_images: Changes in the CSI-9 and MPI scores along the course of treatment. CSI-9, central sensitization inventory-9; MPI, multidimensional pain inventory.
case_images: fpain-05-1394131-g002.jpg
case_images: PMC11371746_01_fpain-05-1394131-g002.jpg
case_images: F2
case_images: The classification was DYS type (Figures 1, 2).
case_images: Changes in the CAARS scores during treatment. Changes in the CAARS scores over the course of treatment. (A) CAARS-S and (B) CAARS-O. ADHD, attention deficit hyperactivity disorder; CAARS-S/O, Conners' Adult ADHD Rating Scale Self-report/Observer-rated; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
case_images: fpain-05-1394131-g003.jpg
case_images: PMC11371746_01_fpain-05-1394131-g003.jpg
case_images: F3
case_images: The patient's CAARS results showed that her CAARS-O subscale score was >65, and her ADHD symptoms were rated at the clinical psychiatric level by her husband (Figure 3).
case_images: Changes in cerebral blood flow during treatment. Brain perfusion SPECT images. The figure shows four axial images from left to right: basal frontal to upper frontoparietal levels (A-C), and axial and sagittal images of the anterior to middle cingulate cortices level (D-F). The SPECT images were acquired at three different time points: before treatment initiation (A,D), day 1,002 (B,E), and day 1,394 (C,F). The voxel values were normalized using the average counts per voxel, with the cerebellum set at 50. The color bar represents a range from 0 to 60. Mild hypoperfusion of the bilateral prefrontal and lateral parietal cortices (A) improved slightly in (B) and was maintained in (C) (white dashed curves). The mean normalized voxel values for each image from (A) to (C) are 38.7, 40.0, and 39.4 in the frontal lobe, and 40.9, 42.5, and 43.0 in the lateral parietal cortices. The anterior and middle cingulate cortices are identified in (D) (arrows), and the blood flow was increased in (E) and (F) The mean normalized voxel values for each image from (D) to (F) are 43.6, 45.1, and 45.8 in the anterior and middle cingulate cortices. Voxel value normalization and calculations were performed using PMOD, version 3.7 (PMOD Technologies Ltd., Zurich, Switzerland). SPECT, single-photon emission computed tomography.
case_images: fpain-05-1394131-g004.jpg
case_images: PMC11371746_01_fpain-05-1394131-g004.jpg
case_images: F4
case_images: Before treatment, she underwent single-photon emission computed tomography (SPECT) which showed mild hypoperfusion in the bilateral prefrontal and lateral parietal cortices (Figure 4).