緩和ケアと医学

抽象的な

Pain Management for Urological Cancer Patients in Palliative Care

Hisaharu Oya, Masahiko Koike, Naoki Iwata, Daisuke Kobayashi, Motohiro Matoba, Satoshi Murakami, Takashi Kawahara, Tomohiko Hara, Takashi Maeda, Mitsuro Kanda, Chie Tanaka, Suguru Yamada, Tsutomu Fujii, Goro Nakayama, Hiroyuki Sugimoto, Shuji Nomoto, Michitaka Fujiwara and Yasuhiro Kodera

Pain mitigation and therapy is one of the most important medical tasks of the urologist, where patients benefit a lot from the basic concepts of analgesia. However, pain resulting from cancer can be more complex than the one after the surgery. Patients that are not receiving regional analgesia should be administered with intravenous or oral non-opioid analgesics in combination with titration. Slow-release of oral opioids is increasingly being used as part of systemic pain management despite little evidence of their efficacy. Continuous epidural infusion is recommended for pain resulting from extensive retroperitoneal and transperitoneal cancers because of its ability to enhance recovery. Additional pain relief-related approaches such as radiation, psychosocial and spiritual needs of the patients have to be considered. Therefore, a multidisciplinary team of experts is needed to administer etiology-specific pain management and therapeutics. Patients often benefit from multimodal, interdisciplinary pain management techniques comprising psychological and educational approaches, including physiotherapy. This article reviews the pain management techniques for the patients under palliative care. In addition, it presents the cases of urological cancer patients that approach palliative care department of our institution for pain management.