Purpose: From shortly after the fentanyl patch became commercially available, we have been using it as part of our armamentarium for cancer therapy to produce a reliable analgesic effect from the active treatment period to the terminal stage in patients who are expected to develop resistance to oral analgesics. To confirm the usefulness of fentanyl patch, a retrospective study was conducted to determine its efficacy and safety. Method: A survey was conducted of 28 cancer patients who were undergoing pharmacological pain control. The following parameters were recorded: opioids administered prior to fentanyl patch use, reasons for switching to fentanyl patch, duration of administration and dosage of fentanyl patch, pain score before switching to fentanyl patch, adverse effects (nausea, vomiting, constipation and drowsiness), and the results of clinical tests. Results: The major reasons for switching to fentanyl patch were: "pain control with oral agents was expected to become difficult in future" and "adverse effects of chemotherapy were noted or were likely to develop". The mean duration of fentanyl patch use was 133 days, during which time the pain score and the constipation symptom were significantly reduced. No significant difference was found with nausea, vomiting, drowsiness or the results of clinical tests. Conclusion: It is concluded that fentanyl patch is a highly useful opioid for analgesia when administered during chemotherapy for cancer and continued to the terminal stage.

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Purpose: The effectiveness of a flow chart of medication for cancer pain treatment was investigated. This flow chart was developed at Sasebo Chuo Hospital, and calls for the early introduction of controlled-release oxycodone tablets in combination with prescribing of a rescue dose and agents to prevent adverse reactions such as nausea, vomiting, and constipation. Method: The flow chart was used with a group of 29 patients (FC group), but not with a group of 35 patients (non-FC group). The rate of titration, which was adjustment of opioid dosage to achieve cancer pain control, and time required to achieve titration were compared between these two groups. Results: The titration rate of the FC group was 93.1% and that of the non-FC group was 80.0%. Medication was changed to another opioid for 4 patients in the non-FC group because of nausea and vomiting. The time required to achieve titration was 3.8±2.2 days in the FC group and 5.3±3.0 days in the non-FC group, and a significant difference was noted (p=0.048). Conclusion: The use of this flow chart with its early introduction of opioid controlled-release oxycodone tablets appears to be effective in achieving cancer pain control at an early stage.

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Purpose: Ketamine is effective on neuropathic pain that is difficult to respond to opioids among cancer pains, due to its N-methyl-D-aspartate (NMDA) receptor antagonism action. The purpose of this study was to evaluate the effect of oral ketamine on neuropathic pain. Methods: We retrospectively investigated the dosage and the administration period of oral ketamine in 31 patients for one year from December 2004. Results: Pain-relief was achieved in 22 of 31 patients, the average of initial dose was 107.3mg/day and the average administration period was 63 days. Seven patients discontinued oral ketamine within 7 days because of nausea/ vomiting (4 patients) or drowsiness (3 patients). Two patients had no sufficient pain-relief. Conclusion: This experience suggests that oral ketamine is effective on the management of neuropathic pain. Palliat Care Res 2008; 3(1): 216-220

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Objective: We experienced a case with recurring constipation and diarrhea caused by morphine for relieving cancer pain, who were well managed with oral administration of misoprostol. Subject: The patient was a male in his 70s with recurrent bladder cancer following primary surgery, developed bone metastasis to right side pelvis and exhibited cancer-related pain. To alleviate the resting pain, he underwent radiotherapy and received a sustained preparation of morphine sulfate, that lead to difficulty in bowel movements (repeated constipation and diarrhea) and abdominal distension which was intractable with routine administration of laxatives. Misoprostol, a prostaglandin E1 derivatives, which was reported to have an ability to control the bowel movement was administered at a dose of 800μg/day, and the patient subsequently achieved the improvement of bowel dysfunction and resumed regular self-defecation. Discussion: Misoprostol do not only accelerate small intestine movement but also inhibits water and sodium absorption. In this case, it is suggested that the pharmacological properties of misoprostol enabled to improve bowel movement. We consider that misoprostol is useful as one of the medications for refractory constipation caused by opioid administration. Palliat Care Res 2008:3(1);301-304

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Purpose: Since sustained cough causes great distress to cancer patients, it is important to palliate this symptom. Here, we report a case of intractable cough that could not be controlled by morphine but was successfully managed using continuous infusion of lidocaine for 1 year. Case: A female patient suffered from breast cancer in her fifties. Its lung metastasis invaded endobronchial space, causing frequent and sustained coughing. Further, coughing was often induced by her body motion, hampering the patient's quality of life. Morphine hydrochloride up to a dose of 480mg/day was ineffective in alleviating this symptom. Therefore, we started lidocaine administration via continuous infusion at a dose of 480mg/day. From the day administered, both frequency and duration of her coughing bouts were markedly reduced. Although its dose was increased to 960mg/day because of aggravated coughing in the course of her disease, the symptom was successively managed for 1 year with no side effects. Conclusion: Continuous and long-term infusion of lidocaine could be an alternative treatment for morphine-ineffective intractable cough. Palliat Care Res 2008;3(1):305-307

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A correction of a coauthor's name from Chigusa Nakamura to Chigusa Nakagawa on the author list and the abstract.

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