• The Korean Journal of Pain
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• 제27권2호
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• pp.139-144
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• 2014

Background: To manage intractable cancer pain, an alternative to systemic analgesics is neuraxial analgesia. In long-term treatment, intrathecal administration could provide a more satisfactory pain relief with lower doses of analgesics and fewer side-effects than that of epidural administration. However, implantable drug delivery systems using intrathecal pumps in Korea are very expensive. Considering cost-effectiveness, we performed epidural analgesia as an alternative to intrathecal analgesia. Methods: We retrospectively investigated the efficacy, side effects, and complications of epidural morphine and local anesthetic administration through epidural catheters connected to a subcutaneous injection port in 29 Korean terminal cancer patients. Patient demographic data, the duration of epidural administration, preoperative numerical pain rating scales (NRS), side effects and complications related to the epidural catheterization and the drugs, and the numerical pain rating scales on the 1st, 3rd, 7th and 30th postoperative days were determined from the medical records. Results: The average score for the numerical pain rating scales for the 29 patients decreased from $7{\pm}1.0$ at baseline to $3.6{\pm}1.4$ on postoperative day 1 (P < 0.001). A similar decrease in pain intensity was maintained for 30 days (P < 0.001). Nausea and vomiting were the most frequently reported side effects of the epidural analgesia and two patients (6.9%) experienced paresthesia. Conclusions: Epidural morphine and local anesthetic infusion with a subcutaneous pump seems to have an acceptable risk-benefit ratio and allows a high degree of autonomy to patients with cancer pain.

• The Korean Journal of Pain
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• 제26권1호
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• pp.32-38
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• 2013

Background: Intrathecal opioid administration has been used widely in patients suffering from severe cancer pain that is not managed with conventional modalities. However, the potential serious neurological complications from the procedure and the side effects of intrathecal opioids have made many clinicians reluctant to employ continuous intrathecal analgesia as a first-line therapeutic option despite its dramatic effect on intractable pain. We retrospectively investigated the efficacy, side effects, and complications of intrathecal morphine administration through intrathecal catheters connected to a subcutaneous injection port (ICSP) in 22 Korean terminal cancer patients with successful intrathecal morphine trials. Methods: Patient demographic data, the duration of intrathecal opioid administration, preoperative numerical pain rating scales (NRS) and doses of systemic opioids, side effects and complications related to intrathecal opioids and the procedure, and the numerical pain rating scales and doses of intrathecal and systemic opioids on the $1^{st}$, $3^{rd}$, $7^{th}$ and $30^{th}$ postoperative days were determined from medical records. Results: Intrathecal morphine administration for $46.0{\pm}61.3$ days significantly reduced NRS from baseline on all the postoperative days. A significant increase in intrathecal opioids with a nonsignificant decrease in systemic opioids was observed on the $7^{th}$ and $30^{th}$ postoperative days compared to the $1^{st}$ postoperative day. The most common side effects of intrathecal opioids were nausea/vomiting (31.8%) and urinary retention (38.9%), which were managed with conservative therapies. Conclusions: Intrathecal morphine administration using ICSP provided immediate and beneficial effects on pain scores with tolerable side effects in terminal cancer patients.

• 동서간호학연구지
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• 제11권2호
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• pp.146-154
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• 2005

Purpose: This study was designed to identify the relationship between quality of life, perceived health status, perceived susceptibility severity to recurrence of cancer and character of object in cancer patients to provide the basic data of effective nursing interventions. Method: The subject of this study was randomly chosen from the patients diagnosed of cancer and being hospitalised or receiving chemotherapy as outpatients, at a Division of Hemato-Oncology, Department of Internal Medicine of a university hospital located in Seoul. The tool used in this study was a measurement tool for quality of life (${\alpha}=.829$), perceived health status (${\alpha}=.903$), and perceived susceptibility and severity for cancer recurrence (${\alpha}=.860$). The collected data were analysed using SPSS PC 12.0 Programme for real number, percentage, average, standard deviation, Pearson's Correlation, t-test and ANOVA, according to the purpose of this study. Result: 1) The score of quality of life in cancer patients was 3.64 point, perceived health status was 2.62 and perceived susceptibility severity to recurrence of cancer was 2.41. 2) There was a significant difference in the quality of life according to general characteristics, such as level of education, occupation, level of activity, pain, medication period, diagnosis, disease stage, purpose of medication, and recurrence. There was a significant difference in perceived health status according to age, level of activity, pain, diagnosis, purpose of medication, and recurrence. There was a significant difference in perceived susceptibility severity to recurrence of cancer according to age, level of education, and pain. 3) The cancer patients' quality of life showed significant correlation with perceived health status, perceived susceptibility severity to recurrence of cancer, pain, job, treatment purpose, relapse. The perceived health status showed significant correlation with perceived susceptibility severity to recurrence of cancer, pain, treatment purpose, relapse. The perceived susceptibility severity to recurrence of cancer showed significant correlation with pain. The relapse showed significant correlation with treatment purpose. The cancer patients' quality of life, perceived health status, and perceived susceptibility and severity for cancer recurrence, as confirmed above, showed differences according to the related factors of each subject, and it was also confirmed that those factors were significantly related with general characteristics. Upon these results, I suggest further studies on the factors that affect the cancer patients' quality of life.

• 한국산학기술학회논문지
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• 제21권8호
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• pp.75-86
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• 2020

본 연구에서는 이압요법을 적용하여 폐암 환자의 통증과 폐암 관련 삶의 질에 미치는 효과를 검증하고자 한다. 본 연구는 비동등성 대조군 전후 설계 유사 실험연구로 폐암 환자를 실험군, 대조군에 각각 22명씩 배정하였다. 실험군은 폐암 환자의 통증과 관련된 반응구역(점)에 이압요법을 실시하였고, 대조군은 폐암과 관련 없는 반응구역(점)에 이압요법을 실시하였다. 첩압 후 첩압 스티커는 5일 동안 유지하고 2일 휴식하는 과정을 6주 동안 진행하였다. 통증을 평가하기 위해 NRS(Numeric Rating Scale), 압통기를 이용하였다. 폐암 관련 삶의 질은 FACT-L(Functional Assessment of Cancer Therapy-Lung)의 한국어판을 사용하여 실험 전·후에 자가 설문 방법으로 평가하였다. 본 연구의 결과 통증 강도가 시간이 지남에 따라 통계적으로 유의한 차이가 있었으며(Z=-2.78, p=.006), 압통 역치도 그룹 간 통계적으로 유의한 차이가 있었다(Z=-2.69, p=.007). 폐암 관련 삶의 질 변화도 두 그룹 간 차이가 통계적으로 유의하게 나타났다(t=3.20, p=.003). 본 연구에서 시행한 6주간의 이압요법은 폐암 환자의 통증을 감소시키고 폐암 관련 삶의 질을 향상시키는데 효과가 있는 것으로 나타났다. 특히 대상자의 주관적인 통증뿐만 아니라 객관적인 통증 평가에도 효과가 있음을 확인하여 이압요법이 암 환자의 통증 조절에 효과적인 중재 방법으로 사용될 수 있을 것이다.

• 한국융합학회논문지
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• 제10권11호
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• pp.445-451
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• 2019

본 연구는 암성 통증에 대한 간호사와 의과대학 4학년을 대상으로 인식을 규명하고 체계적인 교육 프로그램 개발에 활용하고자 시도하였다. 연구 대상은 간호사 258명, 의과대학 4학년 211명이며, SPSS WIN 18.0을 이용하여 분석한 결과 두 직군 간 "암환자는 진통제를 자주 쓰면 쓸수록 중독되지 않는다.", "암성 통증은 나이와 상관없이 발생할 수 있다.", "암환자가 통증이 있을 때 주사나 신경치료는 일시적이지 않고 장기간으로 볼 때에 효과적이다", "암환자는 다른 환자에 비해 진통제에 쉽게 중독이 되지 않는다." 등의 문항에서 통계적으로 유의한 차이를 보였다. 따라서 두 집단 모두에게 체계적 암성 통증에 대한 이론 및 실무에 대한 교육 방향성을 설정하고 관련 교육 프로그램을 개발의 필요성을 시사한다.

• Journal of Hospice and Palliative Care
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• 제21권4호
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• pp.158-162
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• 2018

유방암에 의한 림프부종은 유방암 수술 이후 생기는 치료하기 힘든 부작용 중 하나로 여겨져 왔다. 환자들은 림프부종에 의한 신체적인 기능저하뿐만 아니라 삶의 질 저하로 인한 정신적인 우울감을 호소한다. 최근의 연구에서는 봉와직염이 유방암에 의한 림프부종의 위험성을 현저히 높인다는 결과가 있었고, 봉와직염 자체가 유방암에 의한 림프부종을 일으키는 위험 인자로 제시되어 왔다. 본 증례에서는 1달간의 성상신경절 블록으로 유방암에 의한 염증성 림프부종 환자의 증상 완화 및 팔 둘레의 현저한 감소에 대해 기술 하고자 한다. 우리는 환자의 팔 둘레를 4군데에서 측정하였는데 각각 팔꿈치를 기준으로 위 아래 5 cm, 10 cm에서 측정이 이루어졌다. 또한 통증 점수(NRS) 와 breast cancer questionnaire (LBCQ) 점수를 외래 방문마다 측정하였다. 두 번의 연속적인 성상신경절 블록 이후 환자의 통증 점수 및 팔 둘레는 감소하였고, 치료 중간에 봉와직염이 재발하여 다시 입원하여 항생제 치료와 병행하여 연속적인 성상신경절 블록을 시행하였고 환자는 시술의 결과에 대해 매우 만족하였다. 특히 환자는 통증 및 붓기의 완화와 어깨 관절의 움직임 개선에 큰 만족을 보였고, 결과적으로 환자의 삶의 질을 높이는데 기여하였다. 본 증례는 유방암에 의한 염증성 림프부종에 대한 성상신경절 블록의 효과에 대한 연구로, 스테로이드를 사용하지 않는 성상신경절 블록이 치료하기 힘든 염증성 림프부종 환자의 대체적이면서 보조적인 치료 방법으로 제시 될 수 있다는 것을 보여준다.

• Journal of Hospice and Palliative Care
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• 제27권1호
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• pp.45-49
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• 2024

Purpose: This study investigated palliative care physicians' attitudes regarding social issues related to opioid use. Methods: An email survey was sent to 674 physicians who were members of the Korean Society for Hospice and Palliative Care (KSHPC). Results: Data from 66 physicians were analyzed (response rate, 9.8%). About 70% of participants stated that their prescribing patterns were not influenced by social issues related to opioid use, and 90% of participants thought that additional regulations should be limited to non-cancer pain. Under the current circumstances, pain education for physicians is urgently needed, as well as increased awareness among the public. Half of the respondents identified the KSHPC as the primary organization responsible for providing pain education. Conclusion: Palliative care physicians' prescribing patterns were not influenced by social issues related to opioid use, and these issues also should not affect cancer pain control.

• Journal of Korean Neurosurgical Society
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• 제30권4호
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• pp.456-462
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• 2001

Objective : Although cingulotomy has been applied to patients with affective disorders more frequently, there are numerous reports of its use for the control of severe pain. The goal of this study was to investigate the role of stereotactic bilateral anterior cingulotomy for intractable cancer pain. Method : Between January and June, 2000, we underwent stereotactic bilateral anterior cingulotomy in 6 patients for intractable cancer pain with poor response to opioids. The patients were suffering from widespread musculoskeletal or visceral pain. We made four lesions along the two tracks on either side of the cingulate cortex. Result : In all patients, pain reliefs after cingulotomy were dramatic and immediate. Five out of six patients did not require any opioids and one patient could reduce dose of opioids. There were no deaths or serious complications related to the procedure. Conclusion : These results suggested that a bilateral anterior cingulotomy might be useful method to control intractable cancer pain associated with the widespread metastatic disease. To provide rationale of bilateral anterior cingulotomy in intractable cancer pain, the theoretical mechanisms and role of bilateral anterior cingulotomy are discussed, along with our surgical techniques and the course of our patients.

• The Korean Journal of Pain
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• 제28권4호
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• pp.236-243
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• 2015

Background: Chemotherapy-induced peripheral neuropathy is a major side effect of anti-cancer drugs, and our knowledge of its mechanisms is lacking. Several models for chemotherapy-induced neuropathy have been introduced. However, the outcomes of these models differ significantly among laboratories. Our object was to create a model of chemotherapy-induced neuropathy in rats with cancer. Methods: Female Sprague-Dawley rats were used. Mammary rat metastasis tumor (MRMT-1) cells were implanted subcutaneously in rats. Chemotherapy-induced peripheral neuropathy was induced by injection of cisplatin once a day for four days. The responses to mechanical and thermal stimuli were examined using von Frey filaments, acetone, and radiant heat. Results: Cisplatin (2 mg/kg/day) produced mechanical allodynia, while it did not induce cold allodynia or thermal hyperalgesia. This dose of cisplatin could work successfully against cancer. Body weight loss was not observed in cisplatin-treated rats, nor were other abnormal behaviors noted in the same rats. Conclusions: Repeated injection of intraperitoneal cisplatin induced peripheral neuropathic pain in rats. Thus, this type of rat model has broad applicability in studies related to searching for the mechanism of cisplatin-induced mechanical allodynia and agents for the treatment of neuropathic pain.

• 지역사회간호학회지
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• 제13권3호
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• pp.541-555
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• 2002

Objectives: This study is aimed to analyze the trend of research on nutrition, pain and fatigue of cancer patients in Korea, suggest direction for future research of nutrition, pain and fatigue of cancer patients. Methods: 74 studies published from 1991 to 2001 were examined according to the year of publication, types of journal, research design, types of disease, care methods, major concepts, tool and research findings. Results: 1) The number of studies related nutrition, pain and fatigue of cancer patients had increased rapidly since the 1996's(78.4%). 2) 42 nutrition, pain and fatigue of cancer patients studies(56.1%) were done for a thesis for a degree and 32 were nondegree research studies(43.9%). 3) 70 studies(94.7%) were quantitative study, which included in 40 descriptive studies(54.1%), 22 experimental studies (29.75), 5 correlative studies(6.8%), 2 comparative studies(2.7%) and 1 case study(1.4%), and 4 studies(5.3%) were qualitative study, which included in 3 content analysis studies(3.9%) and 1 phenomenological study(1.4%). 4) Researches about cancer more than 2 were the most by 48 studies (66.1%), following leukemia researches were 8 studies(10.8%), breast cancer researches were 7 studies(9.5%), gastric cancer researches were 4 studies(5.4%), pediatric cancer researches were 3 studies(4.1%), uterine cancer researches were 2 studies(2.7%). 5) Researches about chemotherapy were the most by 39 studies(52.6%), following analgesic researches were 14 studies(18.9%), researches that do not present treatment method were 9 studies(12.2%), radiation researches were 7 studies(9.5%). 6) In 22 experimental studies, the effects of 13 types of nursing interventions were tested. Research findings were effective almost but muscle relaxation therapy to decrease nausea and vomiting was no effect. Conclusion: We need more researches about research of nutrition, pain and fatigue of cancer patients, especially need to prove the effect of intervention or program for nutrition, pain and fatigue of cancer patients by experimental research designs and need more qualitative researches to identify indepth the meaning of nutrition, pain and fatigue of cancer patients.