Nihon rinsho. Japanese journal of clinical medicine
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Cancer pain is usually treated by 1) pharmacotherapy, 2) nerve block, 3) radiation therapy, 4) cognitive therapy and 5) alternative medicine. Among these methods, pharmacotherapy is the simplest way to relieve cancer pain without special equipment or special settings. WHO cancer treatment guideline shows morphine is effective to most cancer pain. ⋯ Recently, many biological processes involved in the mechanism of neuropathic pain have been elucidated. Pharmacological treatment aimed at blocking such processes should produce specific effects on the pain. Such mechanism-based pharmacotherapy is the most effective way to treat difficult pain.
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In order to see the patients with low back pain and/or sciatica, it is most important to consider the pathophysiology of symptoms. We should know that the image findings such as X-ray and MRI do not always show the cause of symptom. Because degenerative changes in lumbar spine are common findings in asymptomatic group compared to symptomatic patients with low back pain and sciatica. According to pathophysiology (nerve root syndrome, cauda equina syndrome, facet syndrome, discogenic pain syndrome and intermittent claudication for low back pain), the treatment for low back pain and sciatica were described.
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The sequence of analgesic therapy for cancer pain should follow the WHO ladder regimen. Managing cancer pain with drug therapy provides the best results for the patients by using the combination of opioids, NSAIDs, and adjuvant analgesics. The selection or the combination of the drugs depends on the intensity, quality, and other characteristics of the pain. When the cancer pain is classified as neuropathic pain, we should use antidepressants, anticonvulsants, anxiolytics, or/and anti-arrhythmic drug.
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Weak opioids have been used as analgesics in cancer patients with moderate to severe chronic pain. Codeine is one of the weak opioids which is assigned as a representative analgesic of the 2nd ladder-drugs for the treatment of cancer pain by WHO cancer pain relief programme. ⋯ Clinical ceiling effect of codeine is seemed to be 200-300 mg/day, although it is described as 600 mg/day in some textbooks. Side effects of codeine are same as those of morphine, therefore, drugs for the side effects should be given to the patients simultaneously when codeine is administered.
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Non-opioid analgesics such as NSAIDs play a central role for patients with cancer pain as well as for those with acute pain. Pain management using non-opioid analgesics need to avoid potential side effects, and the analgesic action of NSAIDs, cyclooxygenase inhibitors, would synergistically potentiate opioids' effects via the activation of the periaquaductal grey of the midbrain. ⋯ Undertreatment of pain is a persistent clinical problem for patients with cancer. Although changing medical practice is difficult and improving pain management with the rational use of combination of drugs may especially difficult, supplementation of non-opioid analgesics for opioid treatment would provide a better quality of life of cancer patients.