Dialysis patients’ views on withdrawal from dialysis and palliative care are unclear. We conducted a survey of hemodialysis outpatients in Tochigi prefecture regarding withdrawal from dialysis and palliative care. Among a total of 2170 questionnaires sent, 481 (22.2%) valid responses were obtained. The results showed that 160 (33.3%) answered yes to the question whether they would like to withdraw from dialysis if it becomes too difficult to continue dialysis treatment. Of these, 118 (73.8%) answered they would make that decision by themselves, 107 (22.2%) were currently in some kinds of suffering. In terms of awareness of palliative care, only 60 (12.5%) responded that they knew about palliative care, which was clearly less than in the survey on awareness of palliative care for cancer among the general Japanese population. These results suggested the necessity to promote awareness of palliative care among dialysis patients.

[Objective] Postherpetic neuralgia (PHN) is commonly associated with allodynia in around 90% of patients, which is related to both physical and psychosocial distress. In this report, we report two cases in which surrounding needling with electroacupuncture (EA) at 2Hz was performed for allodynia in the thorax and upper limb, resulting in a reduction of the allodynic area. [Case 1] A 67-year-old male with right-sided anterior thoracic pain. He experienced the initial symptoms in December of a certain year and was diagnosed with herpes zoster the following day. Despite receiving antiviral medication, the pain persisted, leading to a referral to our Saitama Medical University in June of the following year. [Case 2] An 80-year-old female complained of left upper limb pain because of herpes zoster following chemotherapy for multiple myeloma in February of a certain year. In September of the same year, she was referred to our department due to persistent pain and allodynia, despite receiving analgesic medication for PHN since June. [Evaluation] The allodynic areas were calculated as the ratio of the allodynic area to the total area of the anterior thorax and upper limb using Image J. Pain intensity was assessed using the Visual Analogue Scale (VAS). [Treatment] We applied surrounding needling with electro-acupuncture for two cases. Acupuncture needles in the specification of 0.18 × 50 mm (Seirin Co., Ltd, Japan) were inserted transversely as like surrounding the allodynic region and connected to the EA apparatus (Zeniryou Co., Ltd, Japan). EA parameter was selected as dilatational wave. [Time course 1] The ratio of allodynic area was 20.0% at the first session, with a VAS of 28mm. After 8 months, the ratio decreased to 1.7%, and the VAS reduced to 18mm. The analgesics that were being taken at the first session were discontinued by the end of the session. [Time course 2] The ratio of allodynic area was 66.1%, with a VAS of 82mm at the first session. After 6 months, the ratio decreased to 24.1%, and the VAS reduced to 48mm. The analgesics were unchanged, while there was a reduction in the rescue medication. [Discussion] In two cases of intractable PHN with allodynia, EA reduced pain intensity and improved quality of life, with Image J serving as a useful assessment tool. [Conclusion] Surrounding needling with EA at 2Hz may be effective for two cases of PHN with allodynia.

[Objective] We report a successfully treated case by a combined therapy of acupuncture and Kampo medicine for a patient with lower limb pain associated with Guillain-Barre syndrome (GBS).[Case] The patient was a 74-year-old man whose chief complaints were severe lower limb pain, gait difficulty, and hyposthenia. Clinical history: In late September in X year, the patient had a cold infection. On October 14, he became aware of weakness in his lower limbs on both sides, difficulty in walking, and severe pain in his lower limbs. He visited our hospital's general internal medicine department and was diagnosed with GBS. The patient was hospitalized and started to receive intravenous immunoglobulin therapy for GBS. Since pain in the lower limbs continued after treatment, he received analgesics, which was not effective. Therefore, acupuncture treatment was started on October 30 aiming to alleviate lower limb pain. Evaluation: Pain and burning sensation were evaluated using a numerical rating scale (NRS), and Hughes' function grade scale (FG) as an objective evaluation. [Acupuncture treatment] The acupuncture treatment was based on Chinese medicine. The basic combination of meridian points for treatment of the case were LR3 (Taichong), LI4 (Hegu), KI6 (Zhaohai), KI3 (Taixi), ST36 (Zusanli), PC6 (Neiguan), and SI8 (Xiaohai). The patient received acupuncture treatments once a day for 12 weeks.[Progress] The first evaluation of the patient's pain in his lower limbs on both sides was 10 points in NRS and 4 units in FG. Pain was alleviated immediately after acupuncture treatment was started, and a significant improvement in pain was observed by the seventh acupuncture treatment. However, the　patient started to complain of burning sensation on his soles. Therefore, the combined use of Kampo medicine (Choutousan, Rokumijiougan) were introduced in addition to the acupuncture treatment, and his burning sensation disappeared. Since then, rehabilitation was enhanced, and after three months from the start of acupuncture treatment, he was discharged since the FG was improved to 2 units. [Discussion] Lower limb pain and burning sensation in this case were considered to be neuropathic pain associated with GBS, and conventional analgesics were only temporarily effective. In contrast, the combined use of acupuncture and Kampo medicine alleviated the pain and burning sensation, and ADL was improved. Acupuncture and Kampo medicine were effective for lower limb pain and burning sensation from GBS.