Chronic pantalgia due to nociplastic pain managed with traditional Japanese medicine: A case report

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Nociplastic pain differs distinctively from nociceptive and neuropathic pain Fitzcharles et al., [1]. Recently, it has become increasingly evident that chronic physical and psychological stress can trigger and exacerbate pain, a phenomenon known as stress-induced pain (SIP) Johnson and Greenwood-Van Meerveld, [2]. SIP is characterized by a range of symptoms, including widespread persistent bodily pain and psychological symptoms such as anxiety and depression, and lacks clear clinical findings, such as tissue inflammation or nerve damage. Therefore, SIP can be considered as “nociplastic pain.” In this report, we present two cases of SIP that were successfully treated using traditional Japanese medicine. Case 1. A 70-year-old woman presented with a three-year history of generalized arthralgia with a visual analog scale (VAS) score for pain of 80 mm. Despite thorough diagnostic evaluation, no structural abnormalities correlating with her symptoms were identified. Additionally, her pain-catastrophizing scale (PCS) score was 47, with the pain being exacerbated by stress. Based on these findings, we diagnosed her with SIP. Treatment comprised of 7.5 g/day of hochuekkito and 7.5 g/day of yokukansankachimpihange, selected for their efficacy in addressing the symptoms of general malaise and hypervigilance. After five weeks, her VAS score decreased to 20 mm, and malaise and hypervigilance were significantly alleviated. Case 2. A 70-year-old woman presented with a seven-month history of severe bodily pain, mainly in the abdomen, with a VAS score of 70 mm. Despite a thorough diagnostic evaluation, no structural abnormalities correlating with her symptoms were identified. Additionally, her PCS score was 47 and she reported experiencing increased pain during stressful periods. The pain was diagnosed as SIP, and 7.5 g/day of hochuekkito and 15 g/day of shokenchuto were prescribed based on the symptoms of general malaise and abdominal pain. After two weeks, her VAS score decreased to 10 mm, and malaise was significantly alleviated. Pharmacological treatment options for nociplastic pain are limited. While pregabalin and tricyclic antidepressants have been shown to be effective in some reports Fitzcharles et al., [1], they carry a high risk of side effects, such as dizziness and drowsiness, making them particularly unsuitable for frail older patients. In this report, both patients presented with general malaise and severe pain. We prescribed hochuekkito, which has been reported to be effective for general malaise. Notably, ginseng, a constituent of hochuekkito, has shown efficacy against fatigue Arring et al., [3]. In Case 1, we also prescribed yokukansankachimpihange to prevent psychosocial stress-induced mental disorders. In Case 2, we prescribed shokenchuto to alleviate abdominal pain potentially associated with intestinal peristalsis and to enhance the function of the spleen and stomach. During the treatment, no adverse events indicative of medicine-related side effects were observed. The aim of nociplastic pain treatment is not to eliminate pain, but to improve the quality of life Fitzcharles et al., [1]. This report suggests that traditional Japanese medicine tailored to individual symptoms may improve pain-related symptoms, enhancing daily functionality and mobility. In patients with SIP, a combination of varying traditional Japanese medicine may represent a potential therapeutic option. We would like to thank Editage (www.editage.com) for English language editing. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors declare no conflicts of interest. N/A. Written informed consent was obtained from the patients for the publication of these case reports. N/A. N/A.

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