Nihon rinsho. Japanese journal of clinical medicine
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The WHO guidelines have much improved cancer pain management in Japan. In 1987, the Ministry of Health established new policy on palliative care, revised narcotics control measures, and edited guidelines on palliative care. ⋯ In order to further achieve program implementation, educational approach should be much more strengthened. It is also emphasized that each health care professional should recognize the ethics in pain relief and each hospital should urgently has its policy to achieve freedom from cancer pain for all throughout Japan.
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This article presents the current management of acute pain(posttraumatic and postoperative pain). The management of acute pain, especially postoperative pain, makes a great advance in this twenty years. The discovery of physiology and pharmacology of pain mechanisms made a great contribution to the improvement of the patient care during postoperative period. ⋯ So these days postoperative pain, the major complaint during the postoperative period, is almost improved at the hospital that coordinates pain treatment strategies. The management of pain improves the quality of life for the postoperative patients and the prognosis of postoperative patients. We should take our warning to heart that the management of acute pain(postoperative, posttraumatic, and labor pain) is not only 'procedure' but also 'therapy' against the pain.
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Oral route morphine should be first choice for moderate or strong cancer pain. Morphine must be administered essentially at fixed interval. It is important to keep effective plasma morphine concentration. ⋯ Respiratory rate per minute of patients always must be measured during administration of morphine. Patients taking morphine have to take laxatives and antiemetics simultaneously. It is crucial to establish the cause of pain and choose other proper treatment when morphine is not effective.
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Local and regional analgesia, achieved by injecting a local anesthetic into tissues, or in proximity to certain parts of the peripheral nervous system, or into the epidural/subarachnoid space, to relieve pain has been used widely for many years. While nerve blocks no longer have the preeminent role as the pain management in cancer patients, they will remain useful tools in managing pain and increasing 'quality of life' of the cancer patients, only if they properly applied. The purpose of this chapter is to present an updated version of the regional analgesia in cancer pain management.
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Pain associated with herpes zoster arise from the virul neuritis of the suffered trigeminal or spinal dorsal ganglion. Prolonged neuritis makes an irreversible nerve injury and continuous pain impulse develops a central sensitization. A post-herpetic neuralgia is thought to be a neuropathic pain due to the irreversible nerve injury and sensitization. ⋯ It is also known that some sympathetic mechanisms relate to the development of the sensitization. A sensory nerve block reduces pain impulse to the dorsal horn, and may interfere the sensitization. A cortico-steroid administrated with a nerve block can reduce the neuritis, and may improve the nerve injury.