Opioids are important drugs for the management of severe cancer pain without a ceiling effect. However, opioid administration leads to dose-limiting complications including drowsiness, hallucinations, delirium, respiratory depression, cognitive impairment, seizure, myoclonus, and hyperalgesia. Opioid-induced hyperalgesia (OIH) is a paradoxical phenomenon as opioid exposure increases pain sensitivity. Reducing or stopping opioids, opioid rotation, or co-administration of N-methyl-D-aspartate (NMDA) antagonists have been suggested for the management of OIH. In this study, we report two clinical cases of successful management of OIH in cancer pain patients that were treated with opioids.
Analgesics, Opioid ; Cognition Disorders ; Delirium ; Hallucinations ; Humans ; Hyperalgesia ; Myoclonus ; N-Methylaspartate ; Pain Management ; Respiratory Insufficiency ; Seizures ; Sleep Stages

OBJECTIVE: The purpose of this study was to develop a quality assessment domain and to determine its priority in Korea's Occupational Health Services. METHODS: We designed the study in a 3 phase approach. The first phase of the process encompasses making a list of measures for quality assessments by a thorough review of the literature. The second phase emcompassed the development of inclusion and priority criteria. The third phase of survey development was conducted during August 2008 and a questionnaire was administered to occupational health physicians covering 58 subjects. RESULTS: Finally we investigated 40 quality assessment measures, including 2 for structural domain, 17 for process domain, 21 for result domain in occupational health service. The 40 quality assessment measures divided into 2 parts. The early quality assessment part was 14 measures that including 8 measures for process domains and 5 measures for result domains. CONCLUSION: We investigate a quality assessment domain and determined the priorities of the occupational health service in Korea.
Humans ; Korea ; Occupational Health ; Occupational Health Physicians ; Occupational Health Services ; Questionnaires

OBJECTIVE: We investigated the differences among the patients who were diagnosed with carpal tunnel syndrome according to the frequency of exposure to wrist-burdening work by using carpal tunnel syndrome surveillance system. METHODS: The study subjects were a total of 855 patients from 1,017 patients who were diagnosed with carpal tunnel syndrome in 9 university hospitals from May, 2001 to October, 2004, and we excluded 161 patients who had no clear information for their occupational status. The subjects were classified into three groups according to four types of wrist-burdening work: 1) repetitive use of wrists, 2) inappropriate posture of the hand, 3) use of vibrating tools, and 4) overpressure work on the hand or palm, - as defined in the operational definition by the National Institute for Occupational Safety and Health (NIOSH). The subjects with two or more types of wrist-burdening work were classified as 'high risk group', the subjects with one type of wrist-burdening work were classified as 'intermediate risk group', and the subjects with none of the types of wrist-burdening work were classified as 'low risk group'. We used chi-square test, Fisher's exact test and ANOVA for comparing the characteristics according to the 3 subgroup. RESULTS: The mean age in the high risk group was the lowest(53 years), and there was a significant difference among the groups for the mean age(p<0.05). The high risk group included the most males with 39(22.0%). The subjects in the high risk group had significantly more jobs in agriculture.forestry.fisheries, factory work, and simple labor and less comorbidities, including diabetes and rheumatoid arthritis(p<0.05). The subjects in the intermediate risk group had a higher proportion of service workers. There were significant differences for the symptoms of carpal tunnel syndrome according to the frequency of exposure to wrist-burdening work. The subjects in the high risk group showed the highest proportion of work-related aggravation of symptoms with 88(76.5%) and the highest mean number of days absent from work(6 days) as related to carpal tunnel syndrome. CONCLUSION: Worker in agriculture.forestry.fisheries, factory work, and simple labor showed significantly more frequent carpal tunnel syndrome, and so management strategies are needed to prevent them from developing carpal tunnel syndrome.
Carpal Tunnel Syndrome ; Comorbidity ; Employment ; Hand ; Hospitals, University ; Humans ; Male ; National Institute for Occupational Safety and Health (U.S.) ; Occupations ; Posture ; Wrist