In general, intrathecal opioid administration is considered for intractable cancer pain management. We would like to report a case of carcinomatous meningitis that was successfully treated by using an intrathecal catheter with subcutaneous port. A female in her fifties with carcinomatous meningitis secondary to invasive ductal breast cancer was suffering multiple neurological symptoms including headache. Intrathecal catheterization with subcutaneous port was considered as an alternative to Ommaya reservoir placement to continue intrathecal antineoplastic treatment. The port was used for collection of CSF, antineoplastic drug administration and opioid delivery. Neoplastic cells in the CSF disappeared within one month and the headache and other neurological symptoms improved. The patient died five months post diagnosis (four months after initiation treatment via intrathecal catheter) without recurrence of significant headache, before developing coma seven days prior to death. This case suggests an intrathecal catheter with subcutaneous port may be used effectively for both symptom management and the administration of antineoplastic drugs. However, further study is necessary.

Objective: To introduce a successful experience of tapering high-dose opioids using spinal analgesia. Case: A 53-year-old man suffering from buttock-pain due to sacral metastasis of rectal cancer, was referred to our hospital for specialized cancer pain treatment and opioid reduction. At the time of admission, he was taking 5040 mg/day of oral morphine equivalent dose of opioids and NRS was still 10/10. Although the dosage was too high, an illicit transactions, diversion or psychological dependence were ruled out. Exacerbation of pain and tolerance formation due to the rapid increase of opioid dose seemed to be a vital factor. After admission, the high-dose opioid was gradually reduced while epidural and intrathecal analgesia were introduced. After 30 days of adjustment, the dose of systemic opioid was finally reduced to 120 mg/day (oral morphine equivalent) with 24 mg/day of intrathecal morphine at the time of transfer to his primary hospital. Conclusion: Cancer pain can result in high-dose opioids administration. Specialized pain treatment may be useful in weaning patients from high-dose opioids, but early concomitant use is recommended to avoid becoming high-dose opioid.

Mouthwash is used to support brushing because it is distributed throughout the oral cavity. In this study, we examined the efficacy of a mixture of three hot water extracts (from Hordeum vulgare L, Apocynum venetum L, and Brasenia schreberi J. F. Gmel) for the purpose of developing an effective mouthwash. The mixture suppressed enhanced tumor necrosis factor α and matrix metalloproteinase 3 gene expression by Porphyromonas gingivalis lipopolysaccharide stimulation in human gingival fibroblasts. Furthermore, human studies using a mouthwash containing the plant extracts (MW) improved gingival index and bleeding on probing in the gum, and reduced the concentration of methyl mercaptan, which causes bad breath, in the mouth. These findings suggest that continued use of MW has positive effects on gingival inflammation and halitosis, and is useful for maintaining oral health.