Pharmacological classification, based on a so-called drug challenge test (DCT), is one method to evaluate intractable pain following experimental administration of medicines. In this scenario, the appropriate medicine is prescribed for a patient with intractable pain based on the result of the DCT. A 61-year-old man was healthy until 2003, when he sustained a brachial plexus injury caused by a gas explosion. He had experienced fulgurant pain in his left upper limb since 2006, and had undergone stellate ganglion blocks, and treatment with amitriptyline. He was admitted for further treatment in 2010 because these treatments did not alleviate his fulgurant pain. He could not move his shoulder, elbow, wrist and fingers because of severe paralysis and arthrodesis of his left shoulder joint, and complained of fulgurant pain and persistent dullness in his left upper limb. He was diagnosed to have complex regional pain syndrome (CRPS) due to the brachial plexus injury, and electromyographic examinations showed evidence of a partial regrowth after sural nerve transplantation. Gabapentin was prescribed for the patient's CRPS based on the remarkable effect of thiamilal on this fulgurant pain. The frequency of the fulgurant pain decreased following the initiation of gabapentin therapy, and the persistent dullness disappeared. DCT is recommended for patients with intractable pain such as CRPS, in addition to neurological and electromyographic examinations, in order to elucidate the details of the pain and select the appropriate medication.

Although the Trail Making Test (TMT) Part A, B, Wisconsin Card Sorting Test-KFS version (WCST-KFS) and Miyake's Verbal Paired-Associate Learning Test (MVPLT) are simple tools to evaluate cognitive dysfunction in patients with traumatic brain injury, there is very little normative data for young persons available in Japan. Therefore, we evaluated 124 healthy persons who were from 15 to 30 years old with the three assessment tools. Median numbers of TMT Part A and Part B were 23.8 seconds and 49.0 seconds, respectively. Median numbers of achieved categories, perseverative errors of the Nelson type, and difficulties of maintaining set in the WCST-KFS were 5, 2 and 0, respectively. Median numbers of correct answers for related and unrelated pairs of MVPLT were 10 and 9 at the third trial, respectively. TMT Part B and perseverative errors of the Nelson type had a negative and weak correlation with age. And related pairs of MVPLT at the first trial had a positive and weak correlation with age. The normative values obtained in this study would be a useful standard for clinical assessments and acknowledgment of disabilities.

Small group training, that is “A rehabilitation class to prepare patients for their return to society,” was created for 5 patients with higher brain dysfunction who had not yet returned to normal daily life after undergoing individual cognitive training, in order to provide them with a better insight into their disease, and to improve their communication abilities and interpersonal skills. The class consisted of 10 sessions (each session lasting 2 hours and 30 minutes) over a 4-month period, which consisted of an opening address, a short lecture, social skills training, tea time, and recreation. Before and after the class, the patients and their families were asked to complete the Dysexecutive Questionnaire, and any decrease in the difference in the scores between the patients and families suggested that the class had enhanced the patients' self awareness. The Baum test showed the patients having an increased interest in the outside world and a tendency to also have more internal energy. The Clinical Global Impression, as evaluated by the patients' families, indicated an improvement in all patients. We therefore consider this rehabilitation class to help prepare patients for their return to society to be useful as one step to encourage an increased social participation in patients suffering from a higher brain dysfunction.