Purpose: The purpose of this investigation was to evaluate a suite of factors that may influence the use of gabapentin for the treatment of cancer pain in our hospital. Methods: We carried out a retrospective investigation of 52 patients hospitalized in our department with cancer-related neuropathic pain and under gabapentin treatment. Patients were divided into two groups: high dose (≥1,800mg gabapentin daily) and low dose (≤1,600mg gabapentin daily). The two groups were compared in terms of a suite of factors including patient background, type of neuropathic pain, dose of adjuvant analgesic drugs, period of administration, and the incidence of adverse effects. Results: Of the total number of patients involved in the study, 52% were in the high dose group. Patient age was significantly lower in the high dose group. There were no significant differences between the two groups in the dose of opioid analgesics, the number of adjuvant analgesic drugs, or the duration of administration. The incidence of adverse effects did not increase in the high dose group. Conclusion: In this retrospective investigation, we conclude that approximately half of our patient study population with cancer-related neuropathic pain may require daily gabapentin dose of 1,800mg or more. In addition, we observed that larger doses of opioid analgesics were used in the high dose group but without risk of increased adverse effects. This phenomenon may have been influenced by the lower patient age in the high dose group. Palliat Care Res 2010; 5(2): 219-226

In palliative care setting, betamethasone is commonly used to relieve various symptoms such as general malaise, loss of appetite, fatigue and pain. In patients administered steroids, the psychic adverse effects should be cared as well as the physical adverse effects. Profile of Mood States (POMS) is a tool to evaluate a temporary mood and an affective state of a patient. The contracted version of POMS shortens intervention time by reducing question items. We administered betamethasone 3mg/day to the patient with digestive symptoms by bowel obstruction and the symptoms improved. Four months later, as the patient complained anxiety, irritation and insomnia, we prescribe predonisolone switching from equivalent dose of betamethasone. In this case we experienced that psychic symptoms improved without worsening digestive symptom since three days after the drug change. We evaluated a mood and an affective state before and after the drug change by using POMS contracted version. Palliat Care Res 2010; 5(2): 332-337

Introduction: This report describes a case of hyperactive delirium induced by tapenatadol whose symptoms were successfully managed with opioid-switching to oxycodon. Case: A 67-year-old female, who had been treated with chemotherapy for malignant thymoma, had to stop chemotherapy because of her carcinomatous pericarditis. Tapentadol 200 mg per day was administrated for her unbearable chest wall tumor invasion-related somatic pain. After a while, insomnia, visual hallucination, thought disturbance, and attention disturbance were appeared. We diagnosed as hyperactive delirium. Because her somatic pain was favorably controlled by tapentadol, we additionally administered quetiapine 50 mg per day instead of replacing tapentadol. Unfortunately, quetiapine was not effective for the delirium. We therefore switched opioids from tapentadol to oxycodon. The delirium was remitted soon after the switching without relapsing of the pain. Conclusion: Tapentadaol reportedly induce hyperactive delirium via its noradrenaline reuptake inhibitory action. This case suggests that switching tapenatadol to other opioid could be an effective option for opioid induced delirium.