Objective: To examine the clinical significance of an opioid, tapentadol, for cancer pain relief including its analgesic effects and indications based on our clinical experience. Methods: We retrospectively studied 31 patients receiving tapentadol in our hospital. Results: In 19 successfully treated patients, the numerical rating scale (NRS) scores showed a significant decrease in pain, and the doses at the start and completion of administration were 73.7±25.6 mg (morphine equivalent dose: 30 mg or less) and 125±49.3 mg, respectively. Six successfully treated patients showed improvement of gastrointestinal symptoms. The results of the comparison between successfully and unsuccessfully treated patients suggested titration to be difficult in patients with mixture of somatic pain and neuropathic pain. Conclusion: Based on our clinical experience, we consider tapentadol to be easy to use during the introductory period after treatment with non-opioids or low-dose opioids.

Introduction: The opioid-to-methadone conversion ratio is not constant. Thus, exacerbation of pain associated with switching of these drugs is a concern. We report two cases in which methadone was introduced in combination with epidural block. Case 1: The patient was a 55-year-old man who complained of perineal pain due to recurrent colorectal cancer. Diagnostic imaging could not be performed because of severe persistent pain and breakthrough pain even under treatment with oral oxycodone 600 mg/day. Methadone administration (starting dose, 45 mg/day) was started in combination with continuous lumbar epidural block. The persistent pain mostly dissipated after an approximately 2-week treatment period with methadone 75 mg/day, making magnetic resonance imaging measurement possible. Case 2: The patient was a 62-year-old man who complained of pain in both lower limbs due to spinal metastasis of prostate cancer. Pain impairing body movement persisted even during treatment with oral oxycodone 300 mg/day. The pain was reduced by combination treatment with continuous lumbar epidural block and methadone (starting dose, 30 mg/day), making it possible to perform radiotherapy. At the time of discharge from the hospital while being treated with methadone 45 mg/day, the patient complained minimally of pain. Conclusion: Owing to epidural block, switching to methadone was achieved smoothly without exacerbation of pain.

Cough-variant asthma is the most common cause of chronic cough. It may progress to classic asthma and therefore requires adequate treatment intervention. We experienced two cases of cough-variant asthma that was refractory to standard drug therapy but improved after additional administration of kumibinroto. In Case 1, the patient was a 46-year-old woman receiving hormone therapy after breast cancer surgery. She developed cough-variant asthma 5 years ago, and though she has received drug therapy, the symptoms aggravated. Cough continued to appear at night without improvement of asthma symptoms. However, the symptoms improved with subsequent administration of kumibinroto. In Case 2, the patient was a 47-year-old woman who developed cough-variant asthma after childbirth, which repeatedly worsened and improved. The cough-variant asthma aggravated after change of workplace and did not improve with drug therapy. However, asthma symptoms improved with oral administration of kumibinroto and hangekobokuto, and subsequent administration of kumibinroto alone. In both patients, the asthma was seasonal. These cases suggest that kumibinroto administration may contribute to the improvement of cough-variant asthma.

Rectal tenesmus is a very uncomfortable symptom. Though antiarrhythmic drugs and nerve blocks have been proposed as a treatment for rectal tenesmus, none is well-established. We report a 68-year-old female who undertook surgery for uterine cervical cancer and underwent chemotherapy. She got a bilateral nephrostomy and bowel obstruction during the chemotherapy because of recurrence. She decided to stop chemotherapy and to receive palliative care. She had a symptom of rectal tenesmus, which was refractory to medications. The clinical sign was severe and uncomfortable, making her very nervous. We planned to treat the rectal tenesmus with a nerve block. A ganglion impar block was insufficient to remove the symptom, and the saddle block failed due to epidural lipomatosis. We finally succeeded in alleviating the sign with a neurolytic caudal epidural block. Relief of tenesmus made her hope to spend her final period at home. She could stay at home with her family for seven days before death without recurrence of the symptom. Though there is no report about the effectiveness of neurolytic caudal epidural block for rectal tenesmus, we consider the block appropriate for the symptom.

We prospectively studied the effectiveness of byakkokaninjinto added gypsum powder for the treatment of atopic dermatitis (AD) by using the skin disease severity score, visual analogue scale (VAS) score for assessing itch severity, and Skindex-16 for assessing the quality of life (QOL) in 12 patients who were refractory to conventional treatments including steroid repellents. In addition, we retrospectively investigated for what types of “sho” (Kampo diagnosis) and eruptions this treatment was more effective. The results showed that the skin disease severity score and Skindex-16 significantly improved in 4 weeks. There was no significant improvement in eosinophil counts, IgE antibody levels, thymus and activation-regulated chemokine levels. Byakkokaninjinto added gypsum powder was found to be effective for the “sho” of “sensitive to heat” and “excessive sweating.” Thus, it can be one of the options in oral medicine for treating patients with intractable AD including steroid repellents because the rash improved in a short period of 4 weeks in our patients.