Complaints Of Pain Research Articles

Pachydermoperiostosis Mimicking Acromegaly: a Rare Case Report in Sardjito General Hospital Yogyakarta Indonesia

Pachydermoperiostosis is a genetic disorder characterized by pachydermia and periostosis. The clinical and radiological features of pachydermoperiostosis are similar to acromegaly. The Prevalence of pachydermoperiostosis is estimated 0.16%. The ratio of male-to-female incidence is 7 to 1. We report a man 26 years old with complaints of pain and swelling in the wrist joints, fingers, knee joints and ankle joints bilaterally; seborrheic dermatitis, eyelid ptosis, and thickening of facial skin, which has been progressive since he was 17 years old. Manus, genu and pedis x-ray results showed a features of mixed connective tissue disease. Magnetic resonance imaging result of the pituitary gland with contrast was normal. Laboratory results for growth hormone (GH) and insulin growth factor-1 (IGF-1) were normal. Histopathology results of the facial skin biopsy showed grade 1 pachydermia in pachydermoperiostosis. In conclusion, the appearance of pachydermia on skin biopsy, with normal growth hormone and insulin growth factor-1 results can differentiate pachydermoperiostosis from acromegaly.

Pain Management with Ganglion Impar Block in Adenocarcinoma Recti

<strong>Background:</strong>Colorectal cancer is a type of malignant neoplasm that is often found with the third highest mortality rate in the world after breast cancer and lung cancer. Adenocarcinoma is the most common type of colorectal cancer which cause pain to the patient. The pain from this disease was described as chronic pain. Chronic pain can result from ongoing nerve inflammation and central sensitization. Inflammation begins with a mechanical injury which then turns into chronic inflammation. This situation changes the responsiveness of neurons to pain in the sympathetic ganglion. Sympathetic ganglia block is more effective in controlling visceral pain. This impar ganglion is the only sympathetic nervous system ganglion that is not attached to the sacrococcygeal. In this case report, the transsacrococcygeal joint approach was used to locate the ganglion accurately by injecting contrast and viewing the vertical dispersion called inverted commas along the ganglion laterally.<p><strong>Case Illustration:</strong> A 60-year-old female patient was admitted with complaints of pain around the anus. The patient has been diagnosed with Adenocarcinoma recti two years ago. Pain is felt like being stabbed and persists in the anal area. Pain intensity increases on sitting and defecation. The patient has undergone chemotherapy 12 times and is taking pain relievers that have been prescribed regularly. The patient's Numeric Rating Scale (NRS) score is 6-7, which is categorized as severe pain. This patient underwent ganglion impar block using the trans sacrococcygeal joint approach with the help of fluoroscopy to relieve the severe pain.</p><strong>Conclusion:</strong> Ganglion Impar Block (GIB) can be performed with significant results in reducing opioid use and reducing pain in patients with Adenocarcinoma recti. The technique of administering neurolysis agents with the help of fluoroscopy can be an option because it is very effective and simple

Description of JA Medical Skincare Medan Beautician’s Low Back Pain Based on Duration of Work

Introduction: Low Back Pain (LBP) is defined as pain and discomfort located below the costal margin to the inferior gluteal fold, with or without pain in the legs. LBP is a common condition that can occur in all age groups with acute or chronic episodes. Beauticians are more susceptible to musculoskeletal disorders. This line of work tends to involve limited positions, repetitive movements, standing for more than 8 hours or sitting in a bent position during activities. This study aims to determine the characteristics of low back pain based on work duration among beauticians of the JA Medical Skincare beauty clinic Medan. Method: The method used in this research was descriptive quantitative with a total sampling technique. The research population was 60 beauticians from the JA Medical Skincare Beauty Clinic Medan. The data were collected by having the respondents fill out a questionnaire. Results: The research results revealed that beauticians at the JA Medical Skincare beauty clinic who were at risk of experiencing low back pain were individuals aged under 30 years (51.8%), those with BMI > 27 or categorized as obese (60%), and those with a working duration of more than 8 hours (49,1%). These groups exhibited higher percentages of complaints related to low back pain. In general, almost all ages have the potential to experience low back pain. Beauticians who work long hours and do not pay attention to ergonomic factors would have caused continuous static loads on their back and are at risk of experiencing complaints of low back pain. Keywords: Beautician; Duration of work; Low back pain

A case report on Sjogren syndrome with autoimmune liver disorder

Background: Primary Sjogren’s syndrome (pSS) is a chronic systemic and autoimmune disorder characterized by inflammation and dysfunction of exocrine glands. Liver involvement was the first extraglandular manifestations to be reported in patients with pSS. Tubulointerstitial nephritis (TIN) is the main renal involvement associated with pSS and manifest as distal renal tubular acidosis (RTA), and others, of which RTA is the main clinical presentation. RTA has been reported in 4.3 to 9% of pSS patients. In this case, patient experiences RTA. Case Presentation: A 19 year old female patient was presented with complaints of abdominal pain, fatigue for 2 months and loose stools. She had history of autoimmune hepatitis and decompensated liver cirrhosis with portal hypertension (autoimmune), bilateral peroneal axonal neuropathy, grade II hepatic encephalopathy resolved and recurrent pustular lesion for past 2 years which rupture spontaneously and heals with scary. She also presented with recurrent hypokalemia which was corrected. No history of similar complaints among the family members. Conclusion: This case explains the autoimmune liver disorder with newly diagnosed primary sjogren’s syndrome associated with recurrent hypokalemia.

Is Open Ureterolithotomy Finished? : A Case of Giant Ureteral Stone and Screening of the Literature

INTRODUCTION: Open surgery is an old method of urology in the treatment of ureteral stones. With the development of new technologies; Indications for open surgery in the treatment of stone disease have decreased to 1-5.4 %. In this case, we aimed to remove 4 stones with a diameter of 22 mm at the lower end of the left ureter by open ureterolithotomy and to report similar cases in the literature. CASE: In the direct urinary system X-ray and abdominal computed tomography of the patient who applied to us with the complaint of left flank pain, 4 stones with a diameter of 22 mm in the lower end of the left ureter, grade 4 hydroureteronephrosis in the left ureter and kidney were observed. Left open ureterolithotomy was planned. The patient's stones were removed using the left Gibson incision technique, and the ureteral incision area was sutured by placing a 6f double j catheter into the ureter. A drain was placed in the left ureteral tracing and the procedure was terminated by suturing the Gibson incision. The patient's foley catheter was removed on the 1st day and the drain was removed on the 2nd day, and he was discharged. No postoperative complications were encountered. Six weeks later, the patient's 6f double j catheter was removed and the surgical procedure was completed. DISCUSSION: Ureteral stones usually form in the primary kidney and then descend into the ureter. Ureteral stones usually pass spontaneously, but stones larger than 1 cm have fewer spontaneous passages. Ureteral stones are usually single and smaller than 2 cm. For stones larger than 5 cm, the term giant ureteral stone is used. Paik et al. reported a mean blood loss of 144 cc and a mean hospital stay of 6.5 days in seven patients with open ureterolithotomy. All patients in the series were stone-free and had no complications. In another study, open ureterolithotomy was performed in 56 patients, and 46.4% of the patients had stones in the distalureter. While the hospital stay was 4.2 days, no complications were encountered. CONCLUSION: Open ureterolithotomy has lost its status as the gold standard with the development of ureterorenoscopy, but as in our case, it is a surgical technique that should be considered in large ureteral stones.

Differences In The Effect Of Motor Control Exercise And William Flexion Exercise On Pain In Low Back Pain Miogenic Patients At Ambalat Sesko Tni Clinic, Bandung

Changes in the background needs and welfare of human life have led to a shift in modern lifestyle patterns. The growing population has resulted in increased work productivity, along with various types of work activities and a rise in complaints of symptoms like low back pain. Low back pain, or lower back pain, is a complaint where the pain can be local pain (inflammation) or radicular pain in the lower back. This pain can radiate to other areas, or the pain can be felt in the lower back, or it can be felt on a different side of the body from the center of the pain and can be felt in a variety of ways. Occupation is one of the factors causing LBP. Incorrect work postures, for example, sitting static for a long time and not using ergonomic sitting positions, are one of the factors in the occurrence of LBP (WHO, 2013). The purpose of this research is to find out if there is a comparison of the differences in the effect of motor control exercise and William flexion exercise on pain in myogenic low back pain patients at the Ambalat Sesko TNI Bandung clinic in 2023. The design in this study was a quasi-experiment with a control approach of two groups, pre-test and post-test, used to compare two independent groups, namely group I (motor control exercise) and group II (William flexion exercise). The research location was at the Ambalat clinic, Sesko TNI, with a total sample of 20 people. The research data was carried out using the normality test with the Shapiro-Wilk test. After the data was normally distributed, a hypothesis test was carried out using the independent paired sample t-test to obtain a p-value of 0.901 > (? = 0.05). The results of the analysis showed that the intervention of motor control exercise and William flexion exercise had the same effect on reducing pain, and there was no significant difference between giving myogenic low back pain at the Ambalat Sesko TNI Bandung clinic in 2023.

Acute superior mesenteric artery thrombosis in a 34-year-old male with thrombophilia: a case report

Introduction: Thrombophilic state, marked by extensive formation of blood clots within the vascular system poses a formidable peril, leading to loss of circulatory integrity and systemic well-being. Superior mesenteric artery (SMA) thrombosis is a serious medical disorder characterized by the obstruction of the arterial blood flow to the gastrointestinal tract, which is associated with significant morbidity and mortality. The condition has a plethora of etiological causes. Vague abdominal pain is a common clinical manifestation, and there is a very high mortality rate.Case Presentation: A 34-year-old Pakistani male presented with rapidly worsening acute abdominal pain over a 10-hour period. Clinical examination revealed elevated blood pressure, while other vital signs remained within normal limits. Abdominal examination findings were inconclusive compared to the patient's severe abdominal pain complaint. Contrast-enhanced CT scan indicated a large thrombus in the superior mesenteric artery with radiological features suggestive of intestinal ischemia, extending from the duodeno-jejunal flexure to the mid-transverse colon. Subsequently, the patient underwent exploratory laparotomy with extensive bowel resection and received anticoagulant therapy. He subsequently experienced compensated right lower limb ischemia, treated conservatively with high-dose anticoagulant therapy. Within days, bowel anastomotic leak developed, requiring multiple surgeries. Eventually, the patient progressed to septic shock, followed by multiorgan failure, culminating in a fatal cardiac arrest.Conclusion: Acute mesenteric ischemia, a rare abdominal emergency with an incidence of 6 per 100,000, is associated with a substantial mortality rate, ranging from 58% to 93% among diagnosed cases. The challenges posed by SMA thrombosis include diagnostic complexities, as it frequently manifests with symptoms disproportionate to clinical signs, and results in catastrophic complications, necessitating high suspicion index and prompt intervention.

One year old misdiagnosed penetrating injury of sacrum with a retained knife: a case report and review of literature

Penetrating injuries to the spine, although less common than blunt trauma from motor vehicle accidents, are important causes of injury to the spinal cord. They are essentially of two varieties-gunshot or stab wounds. Gunshot injuries to the spine are more commonly described and are associated with a higher incidence of neurological damage. On the contrary, the prognosis is better in stab wounds where surgery plays a greater role. Here we report a case of a 31 year old male with a history of penetrating injury with knife in lower back 1 year ago comes with complaints of pain and pus discharge since 2 weeks. On detailed history taking, clinical examination and investigations it was found that knife was left in situ which was causing symptoms. Surgical exploration was done. Foreign body (knife) was removed keeping all the neurovascular complications in check. Post operatively patient is doing good with no neurological deficits. A timely intervention in removing foreign body is necessary for preventing for complications.

Zinner syndrome in a case of male infertility: a case report

Zinner syndrome is a rare congenital malformation formed by the developmental anomaly of distal portion of the wolffian duct. It is an unusual cause of infertility and dysuria among young males. It is associated with ipsilateral renal agenesis, seminal vesical cyst, and ejaculatory duct obstruction. We herein report a rare case of a Zinner syndrome, in a patient of primary infertility. He also presented with complaints of chronic pelvic pain and dysuria. Any young patients of male infertility or unspecified pelvic complaints should be evaluated for Zinner syndrome and surgical intervention is the mainstay treatment for symptomatic patients.

Acute cholestatic hepatitis due to infectious mononucleosis: A case report

Cholestatic hepatitis is a rare complication of acute Epstein-Barr virus (EBV) infection. Here, we presented a case of acute cholestatic hepatitis secondary to acute infectious mononucleosis, who presented with complaints of abdominal pain, yellowing of the eyes and body, itching, widespread body pain, fever, nausea and vomiting. It was emphasized that EBV infection should also be considered in the differential diagnosis of cholestatic hepatitis etiology.

Headache and Vision Loss as Initial Symptoms for an Acute Invasive Rhino-orbital-cerebral Mucormycosis

Background: Acute invasive rhino-orbital-cerebral mucormycosis (ROCM) is a rare fungal infection commonly caused by Rhizopus species. It occurs in immune- compromised individuals who have acquired immune deficiency syndrome (AIDS), leukemia, uncontrolled diabetes mellitus, or organ transplant patients who are on immunosuppressive therapy. Diagnosing invasive ROCM is challenging because its clinical presentation can be nonspecific, and it is not frequently observed in ophthalmic practices. Case Report: A 66-year-old Hispanic male with poorly controlled diabetes mellitus presented with the complaint of severe headache and retrobulbar pain in the right eye. An ophthalmic examination revealed normal ocular health in both eyes. Computerized tomography scan showed mild inflammatory mucosal thickening in the sinuses. Initially, he was diagnosed and treated for giant cell arteritis. The patient’s vision deteriorated to no light perception in the right eye with persistent 10 out of 10 headache and eye pain despite various treatments. Further evaluation revealed ROCM involving the sphenoid sinus. This was confirmed by a positive smear and culture of Rhizopus species from the sinus and from the patient’s symptoms improving with antifungal treatment. Conclusion: Sphenoid sinusitis is an unusual site of involvement with ROCM. The absence of nasal drainage adds to the difficulty of diagnosis without contrast imaging. Although rare, acute invasive ROCM should always be considered in any uncontrolled diabetic or immunosuppressed patient with acute headache and vision loss.

Chronic Pain Nursing Care for Elderly Gout Patients Using Warm Water Compress Therapy Combination Lemongrass and Ginger

Introduction: Uric acid is a normal substance found in the body and is the end result of purine metabolism, namely the result of the degradation of purine nucleotides which are important ingredients in the body as components of nucleic acids. The nursing problem that arises in elderly gout patients is chronic pain. The aim of this scientific work aims to explore nursing care for chronic pain in elderly gout patients with warm water compress therapy using lemongrass and ginger at RAAL Griya Asih Lawang.Methods: Using a case study design with nursing care. The subjects of this research were 3 elderly gout patients with chronic pain nursing problems for 3 days, with pain measurement using the Visual Analog Scale (VAS) and SLKI. and the targeted outcome criteria include the ability to complete activities, complaints of pain, protective attitudes, grimacing, restlessness and difficulty sleeping. The instrument used was the UNITRI gerontic nursing care format. Data was analyzed using the SMART method (Specific, Measurable, Achievable, Realistic, Time).Results: From the actions carried out on the three patients for 3 days, it was found that the chronic pain nursing problem in 3 patients was partially resolved with the following criteria: ability to complete activities increased, pain complaints decreased, protective attitude decreased, grimaces decreased, anxiety decreased, difficulty sleeping decreased.Conclusion: Due to limited time in conducting this research, which was only carried out for 3 days, it could affect the results of warm compresses using lemongrass and ginger which could only partially reduce pain complaints.Keywords: chronic pain, gout, warm water compress using lemongrass and ginger.

A splenic hydatid cyst in young female: a case report

Splenic hydatid disease is a rare kind of hydatid disease, accounting for less than 8% of cases in humans. Here we present a case of 23 years old female patient came to hospital with chief complaints of pain radiating to left quadrant in the last 2 years and cough with sputum and nausea and admitted in the hospital for further evaluation. CT chest shows cystic mass in the left hypochondrium lateral to the stomach compressing the stomach, later did CT abdomen which clearly indicates the spleen is enlarged in size with well-defined hypodense non enhancing unilocular cystic lesion measuring 13×13×11 cm (CC×AP×TR) in the upper and mid poles.

Sheehan’s syndrome of a 50 years old female with bipolar disorder: a case report

Empty Sella syndrome (ESS) pertains to a phenomenon in which the Turkish sale seems through radiography to be larger and perhaps partially or entirely filled with brain fluids. It can be major illness/ develop as a result of pituitary medical procedures, radiation therapy cerebral infarction/bleeding process. A 50 years old female patient was admitted in emergency medicine ward with chief complaint of pain in abdomen, weakness and vomiting. MRI scan of pituitary cerebrospinal fluid (CSF) signal intensity is seen in Sella with no visible anterior pituitary gland tissue noted-likely suggestive of secondary empty Sella (SES). Long-term steroid use is principal therapy for adrenocorticotropic hormone deficiency (IAD). In this instance, ESS, which can be primary/secondary, also noticed.

Analysis of the effectiveness and efficiency of the Indonesian metastatic bone disease of unknown origin algorithm (INA-MBD): time to diagnosis and cost to diagnosis : Quasi-experimental study

Background Patients with Metastatic Bone Disease (MBD) often presenting with complaints of pain and multiple osteolytic lesions findings. Remarkably, 30% of these cases exhibit an undetected primary lesion. Hence, categorizing them as MBD of unknown origin. The diagnostic processes of patients with MBD of unknown origin typically takes up to four months, rendering it as a catastrophic disease with the second-highest financial burden. Given its urgency, it is necessary to develop a systematic and evidence-based consensus for managing cases of MBD with an unknown origin. Purpose This study aimed to enhance the effectiveness and efficiency of treating patients with MBD of unknown origin through the application of the INA-MBD algorithm. Research method A quasi-experimental study with a pretest and post-test design was conducted with a total of 128 patients who met the inclusion and exclusion criteria. The patients were consecutively enrolled and categorized into two groups: the intervention group with the INA-MBD algorithm and the non-intervention group without the INA-MBD algorithm. The primary outcomes were the cost and time to diagnose MBD of unknown origin. The proposed measuring tool was the INA-MBD algorithm. Furthermore, for the cost-to-diagnosis variable, an extra measurement tool was used, which were summaries of the patient’s medical bill including hospital stays and medical procedures. The analysis of data related to the time-to-diagnosis variable was conducted using the Log Rank regression test, and cost-to-diagnosis variable was carried out using co-variance test.

Spontaneous isolated gastric intramural hematoma combined with spontaneous superior mesenteric artery intermural hematoma: a rare case

BackgroundGastric intramural hematoma is a rare disease. Here we report a case of spontaneous isolated gastric intramural hematoma combined with spontaneous superior mesenteric artery intermural hematoma.Case presentationA 75-years-old man was admitted to our department with complaints of abdominal pain. He underwent a whole abdominal computed tomography (CT) scan in the emergency department, which showed extensive thickening of the gastric wall in the gastric body and sinus region with enlarged surrounding lymph nodes, localized thickening of the intestinal wall in the transverse colon, localized indistinct demarcation between the stomach and transverse colon, and a small amount of fluid accumulation in the abdominal cavity. Immediately afterwards, he was admitted to our department, and then we arranged a computed tomography with intravenously administered contrast agent showed a spontaneous isolated gastric intramural hematoma combined with spontaneous superior mesenteric artery intermural hematoma. Therefore, we treated him with anticoagulation and conservative observation. During his stay in the hospital, he was given low-molecular heparin by subcutaneous injection for anticoagulation therapy, and after discharge, he was given oral anticoagulation therapy with rivaroxaban. At the follow-up of more than 4 months, most of the intramural hematoma was absorbed and became significantly smaller, and the intermural hematoma of the superior mesenteric artery was basically absorbed, which also confirmed that the intramural mass was an intramural hematoma.ConclusionA gastric intramural hematoma should be considered, when an intra-abdominal mass was found to be attached to the gastric wall. Proper recognition of gastric intramural hematoma can reduce the misdiagnosis rate of confusion with gastric cancer.

Poorly differentiated mucinous carcinoma of the ascending colon complicated by bilateral ovarian mature cystic teratomas in a 17-year-old female patient: a case report

BackgroundColorectal cancer (CRC) is one of the most common cancers worldwide, and screening colonoscopy has led to a decreasing incidence rate. However, the incidence of CRC is increasing among young people, especially adolescents and young adults (AYAs) who are not routinely screened. Although CRC is the fourth most common cancer among AYAs, it is extremely rare. In younger patients, CRC is often diagnosed later, and the proportion of patients with advanced CRC is higher than that in older patients. We herein present a case of poorly differentiated mucinous carcinoma of the ascending colon complicated by bilateral ovarian mature cystic teratomas (MCTs) in an AYA.Case presentationA 17-year-old female patient presented with a chief complaint of abdominal pain and diarrhea that had persisted for more than 3 years. Colonoscopy revealed circumferential wall thickening of the ascending colon, and colonic biopsy revealed a mucous mass and findings of adenocarcinoma, predominantly signet ring cell carcinoma. Abdominal computed tomography (CT) and pelvic magnetic resonance imaging (MRI) showed bilateral ovarian tumors. Laparoscopic right hemicolectomy and enucleation of bilateral ovarian tumors were performed. Although the ascending colon cancer formed a large mass, there were no signs of peritoneal dissemination or direct invasion to the surrounding organs. Microscopically, the ascending colon was a poorly differentiated mucinous carcinoma with signet ring cell carcinoma and lymph node metastasis (9/42). The ovarian tumors were diagnosed as MCTs without any malignant components. The pathological diagnosis was ascending colon cancer (pT4aN2bM0, pStage IIIC) and bilateral ovarian MCTs. Microsatellite instability (MSI) testing was negative, and there were no gene mutations in either RAS or BRAF. Postoperative adjuvant chemotherapy with oxaliplatin and 5-FU was started.ConclusionsWe presented a case of locally advanced ascending colon cancer in a 17-year-old female patient. CRC rarely occurs in AYAs. However, the incidence has gradually increased in recent years. It should be considered as a differential diagnosis for young patients with long-term abdominal symptoms of unknown cause.

Utilization of Biopsy-Guided CT Scan in Diagnosing Liver Cancer: A Case Study

Introduction: Liver cancer is one of the most common types of cancer in Indonesia and has a high mortality rate. Early diagnosis of liver cancer is very important to increase the patient's chances of recovery. Biopsy-guided CT scan is an effective method for diagnosing liver cancer.
 Case presentation: We report the case of a 55 year old man with a history of chronic hepatitis B who presented with complaints of right upper abdominal pain and weight loss. Physical examination revealed hepatomegaly and ascites. Investigations, including abdominal ultrasound and liver function tests, showed a mass in the liver. CT scan of the abdomen with contrast showed a hypodense mass in the right hepatic lobe. A CT-guided liver biopsy was performed and the histopathological diagnosis was hepatocellular carcinoma (HCC). The patient then underwent partial resection hepatectomy and chemotherapy.
 Conclusion: Biopsy-guided CT scan is a valuable tool for the diagnosis of HCC in patients with chronic hepatitis B.

COMBINATION OF REGENERATIVE THERAPY AND FREE GINGIVAL GRAFT IN STAGE IV PERIODONTITIS: CASE REPORT

Introduction: Periodontal regenerative therapy can be used to repair damaged periodontal tissues caused by periodontitis. The combination of regenerative periodontal surgery and FGG (Free Gingival Graft) is expected to accelerate the regeneration of periodontal tissue. Case : A 37-year-old woman came with complaints of loose lower front teeth, frequent bleeding and pain when eating and drinking. The complaint was felt since 1 year ago. Clinical examination obtained an average pocket depth of 6 mm and an average second degree of tooth mobility. On radiographic examination found bone damage horizontally. Case Management: The patient received root planing scaling and occlusion adjustment, followed by dental periodontal surgery 42,41,31,32. Stage II surgery for recession closure therapy with FGG was carried out three months after stage 1 surgery was performed. Discussion: Regenerative periodontal surgery is performed to produce new periodontal tissue growth and restore connective tissue attachment to the teeth. Free Gingival Graft is performed to increase gingival keratinization and improve patient esthetics. Conclusion and Suggestions: The combination of regenerative periodontal surgery and FGG for the treatment of periodontitis cases involving severe bone destruction gives good results of periodontal tissue healing by alveolar bone healing and regeneration and quite good aesthetics.

FIXED DOSE COMBINATION OF MECOBALAMIN AND PREGABALIN IN THE TREATMENT OF OROFACIAL NEUROPATHIC PAIN

Introduction: orofacial neuropathic pain is extraordinary disease in character with its complicated management. Mecobalamin has been used to provide regeneration of traumatized nerves. Pregabalin with its analgesic activities relieves the clinical signs of neuropathic pain. The aim of this case report is to explain fixed dose combination of Mecobalamin and Pregabalin as the treatment of neuropathic pain caused by inferior alveolar nerve and facial nerve neuropathy. Case: First case was an inferior alveolar nerve neuropathy experienced by 63 years old female with complaints of persistent pain and numbness around the left chin and left lower lip the day following the procedure of surgery for the treatment of dentoalveolar abscess on left second premolar of mandibula. Second case was facial nerve neuropathy experienced by 54 years old female had persistent pain and numbness of the anterior two-thirds of the tongue after total thyroidectomy and 1,100 MBq (30 mCi) activity of Radioactive iodine (RAI) therapy, followed with two 131I whole body scans. Case Management: Mecobalamin 500 µg and Pregabalin 75 mg twice daily for 5 weeks were given with tolerable side effects and improvement symptoms. Discussion: Pregabalin combined with Mecobalamin can reduce orofacial neuropathic pain. Pregabalin possess analgesic property and reduce neuropathy-related pain symptoms while Mecobalamin facilitates myelinogenesis and nerve regeneration. Conclusion: Fixed Dose Combination of Mecobalamin and Pregabalin has the potential analgesic effect, reduced neuropathic orofacial pain at a below than determined dosage in case of inferior alveolar and facial nerve neuropathic pain.