• Journal of Hospice and Palliative Care
• /
• v.21 no.4
• /
• pp.152-157
• /
• 2018

Opioid aberrant behavior is an emerging problem as strong opioid is increasingly used to alleviate cancer pain in patients with cancer. Although the treatment of opioid addiction and physical dependence for non-cancer pain is well known, few studies have been conducted with cancer patients, particularly in the Korean population. Presented here are ten cases of cancer patients who were physically dependent on strong opioid and successfully treated with a partial mu-opioid receptor agonist, buprenorphine. This is the first report showing the efficacy of transdermal buprenorphine as a treatment for physical dependence on opioid medication in cancer patients.

• Journal of the Korean Orthopaedic Association
• /
• v.55 no.1
• /
• pp.1-8
• /
• 2020

The progression of aging and the increase in musculoskeletal diseases have led to an increase in invasive treatment methods, including various surgical methods, but conservative treatment should be attempted before surgical treatment in musculoskeletal diseases. Medication for pain control, such as acetaminophen, non-steroidal anti-inflammatory drugs, steroid, opioids, antidepressants, etc., is one of the most popular methods for pain control. If the pain receptors on peripheral organ are stimulated, pain is transmitted to the brain by the ascending pathway, and the brain then secretes endogenous opioids, such as endorphin, by the descending pathway for pain control. Opioids are substances that act on the opioid receptors, and there are three receptors for opioids. The affinity for each receptor varies according to the tissue and the patient's systemic status. Antidepressants work on the synapses in the central nervous system and its main mechanism is regulation of the ascending pathway. This is mainly effective in chronic pain and neuropathic pain, which is similar in effectiveness to opioids. This review focuses on the effectiveness, method of use, and side effects of opioids and antidepressants.

• Journal of Hospice and Palliative Care
• /
• v.17 no.3
• /
• pp.113-121
• /
• 2014

The major symptoms of terminally ill cancer patients are fatigue, loss of energy, feeling of helplessness, poor appetite and pain as well as general weakness, which are very similar to symptoms of adrenal insufficiency. Adrenal insufficiency-induced symptoms widely vary from mild symptoms to life-threatening conditions and may be resulted from variable medical causes. For terminally ill cancer patients who are hospitalized for palliative care, opioid agents are prescribed to control moderate to severe pain. The use of acute or chronic opioid agents is believed to negatively affect adrenal gland function. In most studies of opioid effects (preclinical/clinical with animal subjects or and patients suffering non-malignant pain, adrenal insufficiency and hormonal abnormalities were observed as side effects. However, opioid-induced adrenal insufficiency has been rarely reported in studies with patients with malignant cancer pain. Relationship between the type, treatment period, dosage of opioid agents and hormonal abnormalities can be examined by measuring the functional level of the adrenal glands. We hope to improve patient's quality of life by indicating hormone substitution to treat symptoms of adrenal insufficiency.

• Proceedings of the Korean Society of Applied Pharmacology
• /
• 1993.04a
• /
• pp.62-62
• /
• 1993

Morphine은 강력한 진통작용으로 약효를 나타내고 있고 이와 같은 진통작용은 대체로 크게 대별하여 두 가지 기전으로 설명이 된다. 그 첫째는 수의 opioid수용체에 작용하여 척수에서 상행으로 전달되는 통각정보를 차단하는 것이며 또 다른 하나는 뇌에 존재하는 opioid수용체에 작용하여 진통작용을 발현한다고 알려져 있다. 실지로 임상에서 morphine을 실내에 주입하여 강한 진통작용을 가진바가 많이 보고되었다. 그러나, 아직 마약성 진통제가 뇌를 통하여 진통작용을 가지는 그 기전에 대해선 잘 밝혀지지 않았다. 많은 연구가 마약성 진통제가 뇌에 주입되면 뇌에 존재하는 opioid수용체에 작용하고 이 수용체를 가진 신경세포가 하향성 억제를 함으로써 척수에서 통각정보를 차단하여 진통작용을 나타냄을 시사한다. 그러나 아직도 이의 정확한 기전이 명쾌히 밝혀지지 않고 있다. 즉, 뇌실내에 morphine을 주입하면 이것이 과연 척수세포를 억제할 것인가에 대한 답이 없기 때문이다. 그와는 반대로 뇌실내 morphine주입은 척수세포에 아무런 영향을 미치지 못한다는 보고가 있다. 이에 본 실험은 뇌실에 주입된 morphine이 척수세포를 어떤 영향을 미치는가를 확인하고자 하였다.

• Journal of Hospice and Palliative Care
• /
• v.18 no.2
• /
• pp.105-111
• /
• 2015

Purpose: Fatigue, energy loss, feeling of helplessness, poor appetite, pain besides general weakness are major symptoms presented to terminally ill cancer patients. These symptoms are similar to those that appeared with adrenal insufficiency. Also, for terminally ill cancer patients who are hospitalized for palliative care, opioid agents are prescribed to control moderate to severe pain. We studied the relationship of opioid agents and adrenal insufficiency. Methods: From November 2013 through June 2014, we monitored the serum level of cortisol and dehydroepiandrosterone sulfate (DHEAS, serum) in 55 cancer patients who were over 18 years old and were treated at a hospice center. We also checked the treatment period and dosage of opioid agents. Results: The DHEAS level, treatment period and dosage of opioid agents did not have significant correlation. Correlation between the serum cortisol level and the opioid agent treatment period was not significant either, but the serum cortisol level was positively correlated with the dosage of opioid agents (P value 0.0322). Conclusion: This study did not identify a novel link between treatment period, dosage of opioid agents and adrenal insufficiency. But, the DHEAS level was mostly below the normal level in patients who were treated with opioid agents.

• Journal of Hospice and Palliative Care
• /
• v.9 no.2
• /
• pp.106-111
• /
• 2006

Purpose: In terminal cancer patients, pain control with narcotic analgesics and supportive care by hospice are very useful treatment modality. However, many patients and their caregivers are poorly compliant in using narcotic analgesics for fear of addiction and tolerance. And also many patients and family caregivers are reluctant to accept hospice, presuming that hospice means patient's condition is no longer reversible and progressively deteriorating. The purpose of this study was to evaluate and analyze the perception of using narcotic analgesics and hospice by family caregivers of terminal cancer patients who play a critical role in health care in Korean culture. Methods: A total of 54 terminal ranter patient's family caregivers participated in this study. Questionnaire consisted of 15 questions about narcotic analgesics and hospice. Results: The study revealed following results. 1) family caregivers who are not aware of hospice are more than half (56.7%). 2) 81.8% of family caregivers agreed that hospice care is beneficial to terminal cancer patients. 3) 85.1% of family caregivers were under financial burden. 4) 83.2% of patient complained pain in 24 hours. 3) while 88.5% of family caregivers believed that narcotic analgesics can control pair, 79.1% and 79.6% of them also believed that use of narcotic analgesics would result in addiction and tolerance, respectively. Conclusion: There still exist barriers to family caregivers in using narcotic analgesics for pain control. And also, terminal cancer patient's family caregivers have poor information about hospice. Therefore, educational intervention about narcotic analgesics by pharmacist and doctors are needed for proper pain control for terminal ranter patients. In addition, more precise information about hospice care should be provided for terminal cancer patients and their family caregivers.

• Journal of Hospice and Palliative Care
• /
• v.19 no.3
• /
• pp.249-255
• /
• 2016

Purpose: Up to 90% of pancreatic cancer patients suffer from neuropathic pain. In a palliative care setting, pain control in pancreatic cancer patient is one of the major goals. Ketamine is a N-methyl-D-aspartate (NMDA) receptor antagonist, effective in neuropathic pain. Additionally, there have been studies about the opioid sparing effect of ketamine. This study was held in the palliative care unit among pancreatic cancer patients to determine the factors related to ketamine use and the opioid sparing effect. Methods: The medical records of pancreatic cancer patients admitted to St. Mary's hospital palliative care unit between January, 2013 and December, 2014 were reviewed. Patients were divided into 2 categories according to ketamine use. Also, opioid use before and after ketamine use was compared in the ketamine group. Results: Compared to the non-ketamine use group, patients in the ketamine group required a higher dose of opioid. The total opioid dose, daily opioid dose, number of daily rescue medications, and daily average rescue dose were statistically significantly higher in the ketamine group. The opioid requirement was increased after ketamine administration. Conclusion: In this retrospective study, ketamine was frequently considered in patients with severe pain, requiring higher amount of opioid. Studies about palliative use of ketamine in a larger number of patients with diverse types of cancer pain are required in the future.

• The Science & Technology
• /
• v.32 no.8 s.363
• /
• pp.28-29
• /
• 1999

한림대 의대 약리학교실 서홍원교수는 마약성분이 없고 부작용도 적은 강력한 진통제 개발에 땀을 흘리고 있다. 신경약리 및 신경과학 분야가 주 전공인 서교수는 마약과 같은 성분으로 우리 몸 안에서 통증을 없애주는 엔도르핀의 진통작용과 엔도르핀을 생성시키는 Opioid peptide유전자 발현 조절기전에 대한 연구를 발표하여 학계의 관심을 모으고 있다. 마약성 성분을 보유하고 있지 않은 강력한 진통제의 탄생을 기대한다.

• Journal of Korean Critical Care Nursing
• /
• v.11 no.3
• /
• pp.35-44
• /
• 2018

Purpose : This study investigates pediatric nurses' knowledge and attitudes regarding iatrogenic narcotic analgesic withdrawal symptoms management (INAWSM). Methods : In this cross-sectional study, 253 pediatric nurses working at a tertiary hospital in Seoul participated. Instruments were the inventory consisting questionnaires on 35 items knowledge and 12 items attitude for INAWSM. Further, descriptive statistics, t-test, and analysis of variance were used to evaluate the nurses' knowledge and attitudes. Results : The correct answers rate of knowledge toward INAWSM was 44.9%. With respect to the pediatric nurses' attitudes, the participants scored an average value of $2.83{\pm}0.25$ out of 4 points. The factor related to the knowledge and attitude level was age, pediatric nursing experience, educational experience, and educational needs. Conclusions : Results revealed that pediatric nurses had inadequate knowledge and attitude on INAWSM despite a compulsory education. Therefore, it is necessary to develop an efficient INAWSM educational program.

• 한국임상약학회:학술대회논문집
• /
• 2007.12a
• /
• pp.183-183
• /
• 2007