Pain Clinic, Particularly related with the Management of Intractable Pain

• Published in: Japanese Journal of National Medical Services Vol. 21; no. 10; pp. 1160 - 1164
• Main Authors: ONO, Kazuhiro, BANBA, Toshiyuki, UEMURA, Tomoya, KATSUME, Michihito
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society of National Medical Services 20.10.1967
• ISSN: 0021-1699; 1884-8729
• DOI: 10.11261/iryo1946.21.1160

About the pain clinic, this report is particularly concerned with management of the pain caused by terminal cancer. The patients who were placed on the treatment at the pain clinic, had been suffering from severe pain secondary to cancer, involving fairly various part of the body. Nerve blocks of different kinds are utilized, but occasionally combined with drug therapy. The majority of patients were at first undergone to the nerve block, using ordinary local anesthetic agents, and the following points were observed during this procedure 1) To check the effect of nerve block. 2) To decide the region to be blocked. 3) To observe anyy possibility of alteration of the general condition. Among various kinds of nerve block with local anesthetics, epidural lumbal continuous block did play the larger part. Intermittent infusion of 1% xylocain with epinephrin was applied via polyethylen catheter. Patients, who did not have difficulty of urination or bowel movement, were subjected to have continuous epidural block. Besides blocks with local anesthetics, neurosclerotic agents gave the great advantage to treat intractable pain from distal to lower chest. Mainly applied neruosclerotic drug was absolute alcohol, while 5% phenol in glycerin was also injected to some cases. From view point of effect, absolute alcohol was assumed to be more powerful in comparison with phenol in glycerin. Despite of this event, burning type of pain at the time of injection and in following few days, was recognized as disadvantage of absolute alcohol. Also troublesome in keeping of the body position could be counted as hesitation in selecting absolute alcohol. From the practical point at pain clinic, judgement of the effect is largely depends upon patient's subjective statments. And relatively many cases gave the impression of addiction to analgetics.