直腸がん術後骨転移のがん性疼痛に対しフェンタニル持続注入とジクロフェナク坐剤人工肛門内長期投与が有効であった1例

抄録

A 57 year-old male patient with rectal cancer was operated on and then a colostoma was constructed. Oral therapy with diclofenac (75 mg/day) for relief of pain due to the primary cancer invasion and thoracic vertebrae metastasis had to be discontinued due to worsening difficulty in oral ingestion. Also due to the increasing severity of cancer-related pain in the buttocks and the back, infusion of fentanyl was initiated due to morphine intolerance, and was effective for pain relief for the former, but not in the latter, at 1.056 mg/day. Thus, therapy with diclofenac suppositories was initiated via his colostoma based on informed consent, since his anus was not available for this purpose due to the rectal surgery. Based upon the patient's own pain evaluation, the back pain was well controlled by the intracolostomal administration of diclofenac suppositories at a dose of 75 mg/day, although plasma concentrations of diclofenac were approximately 50% of those achieved with intracolostomal administration in another study.
Though we can not clearly say why the intracolostomal administration of diclofenac suppositories was effective in spite of the low plasma concentrations of the drug, the combination of diclofenac and fentanyl may have produced a good analgesic action. The adminisration of Diclofenac via the colostoma was continued over 6 months, and there were no particular problems. These findings suggest that a colostoma is a useful alternative route for suppositories, when the rectum is unavailable.