Masui. The Japanese journal of anesthesiology
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Tramadol/acetaminophen fixed-dose combination tablets (Tramse) combine tramadol, a centrally acting week opioid analgesic, with low-dose acetaminophen. The action of tramadol may be described as a weak agonist at the mu-opioid receptor, inhibition of serotonin reuptake, and inhibition of noradrenaline reuptake. The second component in these tablets, acetaminophen mainly appears to act through central mechanism. ⋯ It is expected that Tramset is going to induce pain relief and to improve disturbance of daily life in patients with intractable chronic pain. However overuse of Tramset may induce severe adverse effects such as addiction, abuse and hepatotoxicity. Therefore clinician should continuously assess pain intensity, activity of daily life, mode of its consumption, and adverse effects after prescription.
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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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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.