Masui. The Japanese journal of anesthesiology
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Opioids are available for patients with chronic non-cancer pain. At the start of treatment, side effects such as nausea and vomiting may occur. As these symptoms appear at a dose lower than that at which analgesic actions are achieved, preventive strategies are important. ⋯ It is also effective to use opioid rotation or change the administration route from oral to continuous subcutaneous administration. However, concerning chronic, non-cancer pain, the opioid rotation regimen is limited to a combination of codeine preparations, morphine preparations, and fentanyl patches. For long-term administration, the continuous intravenous/subcutaneous injection of opioids is not indicated.
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The purpose of the treatment of chronic non-cancer pain is the improvement of the patient's quality of life, not the complete alleviation of pain. In Japan transdermal fentanyl patch can be used for the treatment of chronic intractable pain including cancer pain and chronic non-cancer pain. In prescribing transdermal fentanyl patch for patients with chronic non-cancer pain, cares should be focused on the selection of the patients and the periodic and continuous observation of analgesic effect and side effects. ⋯ However, respiratory suppression or over sedation would also occur and such side effects can sometimes be fatal. Furthermore, long term effects on endocrine and immune systems have not been clarified yet. Proper prescription of opioids during a limited period of time is definitely the primary concern of medical professionals.
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Pregabalin has been available in Japan since June 2010 for neuropathic pain. The adverse effects of pregabalin might be serious, and one must start at minimal doses and increase gradually to effective doses with enough explanation to patients. Pregabalin is a derivative of y-aminobutyric acid (GABA), but it has no effects on GABA receptors. ⋯ The effects of pregabalin is to bind alpha2delta-1 subunit and normalize the numbers of VGCCs at neuron surface and decreases neurotransmission, especially by excitatory amino acid. The descending facilitating serotonergic system from rostral ventromedial medulla may have effects on the occurrence and maintenance for the chronic pain. New drugs with less adverse effects may be developed.