• Journal of Hospice and Palliative Care
• /
• 제22권2호
• /
• pp.100-104
• /
• 2019

아편유사제는 중증의 암성통증 조절의 중요한 약제이며 천장효과가 없다. 그러나 의식저하, 인지기능 저하, 환각, 섬망, 호흡저하, 근간대경련, 발작, OIH 등의 합병증으로 인해 용량증량에 제한이 있다. 아편유사제 유발 OIH증은 아편유사제에 노출된 환자에서 역설적으로 통증이 증가하는 현상이다. 이 경우 아편유사제의 용량을 줄이거나, 중단하거나 다른 종류의 아편유사제로 변경하거나 NMDA 길항제를 추가하는 것이 조절에 도움이 된다. 아편 주사제에 노출된 이후 발생한 OIH를 조절한 증례를 보고하고자 한다.

• 한국임상약학회지
• /
• 제33권1호
• /
• pp.43-50
• /
• 2023

Background and Objective: With the advancement of cancer treatments and increased life expectancy, managing breakthrough cancer pain (BTcP) is essential to improve the quality of life for cancer patients. This study aimed to compare the major rapid onset opioids in Korea based on their characteristics and costs to determine the best option for each patient. Methods: Based on sales information from IQVIA-MIDAS, sublingual fentanyl tablet (SLF), fentanyl buccal tablet (FBT), and oral transmucosal fentanyl citrate (OTFC) were selected as the top three drugs for the treatment of BTcP in Korea, considering them the most comparable drugs. The cost and cost-pain relief ratio of the drugs for short-term (1 month) and long-term (1 year) treatment were compared and the ease of administration based on various factors, including pharmacokinetics, onset of action, and administration procedures were evaluated. Results: SLF was evaluated as the best overall in terms of rapid onset of action, ease of administration, and drug cost and also had the highest market share. SLF had the lowest cost pain relief ratio for both the initial and supplemental treatment for the 1-month pain intensity difference 15 (PID15) ratio. However, for the 1-month PID30 ratio, SLF was not superior to OTFC or FBT. The longer the breakthrough cancer pain duration, the more cost-effective the other rapid onset opioids. Conclusion: The rapid onset opioids that fit the patient's breakthrough cancer pain pattern have the best cost-effectiveness.

• The Korean Journal of Pain
• /
• 제33권2호
• /
• pp.108-120
• /
• 2020

From the perspective of the definition of pain, pain can be divided into emotional and sensory components, which originate from potential and actual tissue damage, respectively. The pharmacologic treatment of the emotional pain component includes antianxiety drugs, antidepressants, and antipsychotics. The anti-anxiety drugs have anti-anxious, sedative, and somnolent effects. The antipsychotics are effective in patients with positive symptoms of psychosis. On the other hand, the sensory pain component can be divided into nociceptive and neuropathic pain. Non-steroidal anti-inflammatory drugs (NSAIDs) and opioids are usually applied for somatic and visceral nociceptive pain, respectively; anticonvulsants and antidepressants are administered for the treatment of neuropathic pain with positive and negative symptoms, respectively. The NSAIDs, which inhibit the cyclo-oxygenase pathway, exhibit anti-inflammatory, antipyretic, and analgesic effects; however, they have a therapeutic ceiling. The adverse reactions (ADRs) of the NSAIDs include gastrointestinal problems, generalized edema, and increased bleeding tendency. The opioids, which bind to the opioid receptors, present an analgesic effect only, without anti-inflammatory, antipyretic, or ceiling effects. The ADRs of the opioids start from itching and nausea/vomiting to cardiovascular and respiratory depression, as well as constipation. The anticonvulsants include carbamazepine, related to sodium channel blockade, and gabapentin and pregabalin, related to calcium blockade. The antidepressants show their analgesic actions mainly through inhibiting the reuptake of serotonin or norepinephrine. Most drugs, except NSAIDs, need an updose titration period. The principle of polypharmacy for analgesia in case of mixed components of pain is increasing therapeutic effects while reducing ADRs, based on the origin of the pain.

• The Korean Journal of Pain
• /
• 제37권2호
• /
• pp.119-131
• /
• 2024

There are growing concerns regarding the safety of long-term treatment with opioids of patients with chronic non-cancer pain. In 2017, the Korean Pain Society (KPS) developed guidelines for opioid prescriptions for chronic non-cancer pain to guide physicians to prescribe opioids effectively and safely. Since then, investigations have provided updated data regarding opioid therapy for chronic non-cancer pain and have focused on initial dosing schedules, reassessment follow-ups, recommended dosage thresholds considering the risk-benefit ratio, dose-reducing schedules for tapering and discontinuation, adverse effects, and inadvertent problems resulting from inappropriate application of the previous guidelines. Herein, we have updated the previous KPS guidelines based on a comprehensive literature review and consensus development following discussions among experts affiliated with the Committee on Hospice and Palliative Care in the KPS. These guidelines may assist physicians in prescribing opioids for chronic non-cancer pain in adult outpatient settings, but should not to be regarded as an inflexible standard. Clinical judgements by the attending physician and patient-centered decisions should always be prioritized.

• 대한수의학회지
• /
• 제38권4호
• /
• pp.737-744
• /
• 1998

The rhizomes of the Acorus gramineus Soland have been used as sedatives, analgesics, stomachics and anthelmintics in chinese medicine. It is known that the rhizomes of the Acorus gramineus Soland contains the essential oil about 0.5~0.8% and this essential oil contains asarone about 86%. The asarone possess many pharmacological properties similar to those of reserpine and chlorpromazine. Sedative and analgesic effects of essential oil of Acorus gramineus Solaad in mouse was observed. The essential oil of Acorus gramineus Soland decreased the frequency of ambulation on mouse in proportion of concentration. ${\alpha}_2$ receptor antagonist(yohimbine hydrochloride) and opioids receptor antagonist(naloxone hydrochloride) were markedly decreased in frequency of ambulation. The essential oil of Acorus gramineus Soland decreased writhing syndrome in mouse and ${\alpha}_2$ receptor antagonist(yohimbine hydrochloride), opioids receptor antagonist(naloxone hydrochloride) were not increased above effects. In conclusion, these experimental results show that the essential oil of Acorus gramineus Soland have sedative and analgesic effects, but it did not antagonized ${\alpha}_2$ receptor antagonist(yohimbine hydrochloride) and opioids receptor antagonist(naloxone hydrochloride).

• The Korean Journal of Pain
• /
• 제32권2호
• /
• pp.69-78
• /
• 2019

Pain therapy often entails gastrointestinal adverse events. While opioids are effective drugs for pain relief, the incidence of opioid-induced constipation (OIC) varies greatly from 15% to as high as 81%. This can lead to a significant impairment in quality of life, often resulting in discontinuation of opioid therapy. In this regard, a good doctor-patient relationship is especially pivotal when initiating opioid therapy. In addition to a detailed history of bowel habits, patient education regarding the possible gastrointestinal side effects of the drugs is crucial. In addition, the bowel function must be regularly evaluated for the entire duration of treatment with opioids. Furthermore, if the patient has preexisting constipation that is well under control, continuation of that treatment is important. In the absence of such history, general recommendations should include sufficient fluid intake, physical activity, and regular intake of dietary fiber. In patients of OIC with ongoing opioid therapy, the necessity of opioid use should be critically reevaluated in terms of an with acceptable quality of life, particularly in cases of non-cancer pain. If opioids must be continued, lowering the dose may help, as well as changing the type of opioid. If these measures do not suffice, the next step for persistent OIC is the administration of laxatives. If these are ineffective as well, treatment with peripherally active ${\mu}$-opioid receptor antagonists should be considered. Enemas and irrigation are emergency measures, often used as a last resort.

• The Korean Journal of Pain
• /
• 제35권4호
• /
• pp.475-487
• /
• 2022

Background: Use of opioids for chronic intractable pain is increasing globally, and their proper use can improve patients' quality of life. In contrast, opioid use disorders, such as abuse or addiction, caused by prescribing opioids, are a worldwide issue. This study aimed to understand current opioid prescribing patterns and pain physicians' experiences with opioid use in South Korea. Methods: Pain physicians in 42 university hospitals in South Korea were asked to complete anonymous questionnaires regarding opioid prescriptions. Results: A total of 69 surveys were completed. Most pain physicians started prescribing opioids at a pain score of 7/10 and aimed to reduce pain by 50%. Most physicians (73.1%) actively explained the prescribed medications and possible side effects, and 61.2% of physicians preferred the prescription interval of 4 weeks. Immediate-release opioids were the most popular treatment for breakthrough pain (92.6%). The most common side effect encountered by physicians was constipation (43.3%), followed by nausea/vomiting (34.3%). Of the physicians, 56.5% replied that addiction and misuse prevalences were less than 5%. However, the most concerning side effect was addiction (33.0%). Conclusions: The survey results showed that the prescribing patterns of pain physicians generally followed Korean guidelines. Physicians were most interested in the safety and effectiveness of opioid prescriptions. They were most concerned about respiratory depression and abuse or addiction. A significant number of physicians agreed that the NHIS regulations needed improvement for patient convenience and safe and effective treatment, though there were pros and cons of the NHIS restrictions on prescription conditions.

• The Korean Journal of Pain
• /
• 제30권1호
• /
• pp.1-2
• /
• 2017

• 대한간호학회지
• /
• 제25권1호
• /
• pp.164-172
• /
• 1995

Pain management of postoperative patients or patients suffering from terminal cancer became one of the most important task of nurses in recent years. This study analyzed basic knowledge of 175 student nurses in Taegu on the pain assessment and management. The questionnaires included five areas : Assessment, pharmacological actions, medication, classification of opioids, and psychological dependence of analgesics. The results indicated that nursing students, in general, lacked knowledge on pain management : Correct responses on pain assessment varied between 9.7 and 100% , classification of opioids was in ranges of 61.7 to 95.4% ; Pharmacological actions was 16.6 to 80% : and medication was 14.9 to 85.7%. Less than 12.6% of students correctly identified the frequency of psychological dependence. These results suggested that the need of reinforcement on the pain management in formal nursing education.

• The Korean journal of internal medicine
• /
• 제33권6호
• /
• pp.1058-1069
• /
• 2018

Neuropathic cancer pain (NCP) is caused by nerve damage attributable to the cancer per se, and/or treatments including chemotherapy, radiotherapy, and surgery; the prevalence is reported to be as high as 40%. The etiologies of NCP include direct nerve invasion or nerve compression by the cancer, neural toxicity, chemotherapy, and radiotherapy. NCP is subdivided into plexopathy, radiculopathy, and peripheral neuropathies, among several other categories. The clinical characteristics of NCP differ from those of nociceptive pain in terms of both the hypersensitivity symptoms (burning, tingling, and an electrical sensation) and the hyposensitivity symptoms (numbness and muscle weakness). Recovery requires several months to years, even after recovery from injury. Management is complex; NCP does not usually respond to opioids, although treatments may feature both opioids and adjuvant drugs including antidepressants, anticonvulsants, and anti-arrhythmic agents, all of which improve the quality-of-life. This review addresses the pathophysiology, clinical characteristics and management of NCP, and factors rendering pain control difficult.