Nihon rinsho. Japanese journal of clinical medicine
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Adjuvant analgesics are drugs that have primary indications other than pain but are analgesic in selected circumstances. Antidepressants, anticonvulsants, local anesthetics, and NMDA receptor antagonists are drugs used in the treatment of neuropathic cancer pain. Assessment of pain is very important in selecting appropriate adjuvant analgesics. ⋯ Another problem is that morphine is the only rescue drug available for the assessment of opioid responsiveness since morphine is the only opioid with an immediately release form among the strong opioids available in Japan which are morphine, oxycodone, and fentanyl. Adjuvant analgesics also have side effects such as constipation and sleepiness, which may augment the side effects of morphine and may impair the QOL of cancer patients with neuropathic pain. There is a need to improve the systems of development and importation of adjuvant analgesics.
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'Dyspnea' is a subjective symptom defined as "an uncomfortable sensation of breathing". It should be distinguished from 'respiratory failure' defined as hypoxia. ⋯ The important points of management of dyspnea are described here; (1)Treat the underlying causes (e.g. antibiotics for pneumonia, blood transfusion for anemia), (2) pharmacological interventions such as morphine and anxiolytics, (3) non-pharmacological interventions such as oxygen, respiratory rehabilitation and relaxation. Since dyspnea in cancer patients has multidimensional aspects, interdisciplinary team approach for the symptom management is important.
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With the development of the medical oncology, the progress of the diagnosis and the treatment for cancer patients have provided the improvement of overall survival rates. Furthermore, the importance of the palliative care, which give the relief of the pain and maintain or improve quality of life in cancer patients, has become to be recognized recently. ⋯ Therefore, an interdisciplinary collaboration with a variety of experts is required for palliative care. Although there is a lot of problem to be solved for palliative care in Japan, each expert should investigate his own speciality but also collaborate with another.
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Opioids are main drugs in pain management for terminal cancer patients. In these days, we have to choice suitable opioids for the terminal cancer patients with severe pain by opioids rotation. Morphine is a basic drug in opioids. ⋯ For example, timing for administrating opioids, titration, rescue dose, and side effects were included in this article. We don't have to remember the aim of pain management. Pain control is not a purpose, but a way for keeping QOL of the terminal cancer patients.
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Recent advances in cancer pain management resulted with rapid spread of variety of opioids in Japan. During these two decades, many controlled release morphines for cancer pain management have been released in the Japanese market. ⋯ In this article, the feature and direction of each controlled release morphine are described. Moreover, the target and method of cancer pain treatment are also described.