Masui. The Japanese journal of anesthesiology
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The salivary enzyme alpha-amylase is an established non-invasive marker of psychological and physiological stress. Since there are positive correlations between salivary alpha-amylase secretion and sympathetic parameter increment during stress, salivary alpha-amylase might be an indicator of sympathetic-adrenal-medullary (SAM) system and central sympathetic activity In contrast, it is well known that sympathetic neural activity is significantly involved in development and deterioration of pain symptoms as a part of pain disorders. ⋯ Furthermore, a hand-held device, which is able to measure the activity of salivary alpha-amylase easily and quickly, was developed recently, and we can try to evaluate the condition of pain at the outpatient clinic and the bedside. Though the actual utility of this measuring device for clinical use is unclear, it is hoped that the measuring device of salivary alpha-amylase is one of helpful methods for pain assessment in the future.
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For more than 20 years morphine for spinal analgesia in patients with refractory cancer pain has been one of the cornerstones for the management of chronic, medically intractable pain. In general, most types of cancer pain are treatable following the guideline of Cancer Pain Relief well established by the WHO. However, some patient are unable to tolerate pain only following the guideline and often suffer with side-effects from high doses of opioid and from prescribed multiple adjuvant drugs. ⋯ Intrathecal drug application is cost effective and can significantly improve the quality of life in selected patients with limited life expectancy. However, an intensive training of physicians, careful patient selection, awareness of specific complications, and arrangement of social back-up medical system are essential to commence intrathecal morphine application using implantable access port. This article introduces the basic idea of intrathecal morphine therapy with implantable access port (not pumps) as cost effective, alternative therapy for cancer patient suffering from intractable pain.
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Spinal cord stimulation (SCS) is an established treatment for intractable neuropathic pain. SCS is performed using an implantable pulse generator connected to leads with electrodes positioned in the dorsal epidural space, which are then used to stimulate the ascending and descending dorsal column fibres to achieve paresthesia covering the area of pain. ⋯ The clinical indications for SCS are mainly peripheral vascular diseases (PVD), refractory angina, failed back surgery syndrome (FBSS), complex regional pain syndrome (CRPS) type 1 and type 2, spinal cord stenosis and neuropathic pain. The new puncture trial method is less invasive and can reduce psychological resistance of the patient for SCS manipulation.
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Continuous infusion of fentanyl for postoperative pain management is performed commonly. But the usage of traditional syringe pump or infusion pump sometimes makes medical staff confusing for its difficulties of handling. We have simplified the postoperative pain management system using the single-use continuous infusion device and the protocol for administration of fentanyl. ⋯ It is concluded that good postoperative pain management is possible with single use infusion device safely.
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Two types of new electrical infusion pumps (pump) scheduled to be introduced to the Japanese market in this autumn, were featured focusing on patient controlled analgesia (PCA). For the successful introduction of PCA pumps into clinical practice, initial investments including both finance and manpower may be required. The clinical application of these PCA pumps should benefit both patients and medical staffs and gain more than the initial investment eventually.