1.Pain management of malignant psoas syndrome with tapentadol and lumbar plexus blockade:A case report
Tetsumi Sato ; Maya Ito ; Miwako Asari ; Keiko Shimada
Palliative Care Research 2015;10(1):510-514
Malignant psoas syndrome(MPS)is one of challenging cancer pain states, which is often refractory to conventional analgesic therapy. We report a case of a 67 years-old female patient suffering from left MPS caused by lumbar paravertebral malignant lymphoma. Tapentadol, a dual action analgesic, has relatively low affinity to mu-opioid receptor and provoke noradrenergic reuptake inhibition simultaneously. Neuropathic component is predominant in MPS. Tapentadol is reported to be a drug of choice for the treatment of neuropathic pain. Psoas compartment blockade is a choice of interventions to relieve severe thigh pain caused by a lesion of lumbar plexus which exists in a compartment between psoas and quadratus lumborum muscles. Pain and numbness in the affected left thigh region of the patient were well managed by opioid switching from oxycodone to tapentadol and supplemental psoas compartment blocks with a local anesthetic and dexamethasone. The activity of daily life and quality of life of the patient were dramatically improved. Tapentadol with psoas compartment blockade may be efficacious for the management of MPS.
2.Effective Treatment of Nightmare with Saikokaryukotsuboreito in a Patient with Advanced Cancer
Eri YANAGIHARA ; Tatsuya SUGIMOTO ; Tetsumi SATO
Palliative Care Research 2022;17(1):1-5
Nightmares are common in patients with advanced cancer. However, there are no standard treatment of nightmare in patients with cancer. We experienced a case with nightmares improved by Saikokaryukotsuboreito (SRBT). An 82-year-old man with malignant lymphoma experienced insomnia and nightmares. Antidepressants, orexin receptor antagonists, and atypical antipsychotics failed to improve the symptoms, but SRBT immediately eliminated his insomnia and nightmares. SRBT, an herbal medicine, has been used in a variety of clinical situations for treatment of stress-induced psychiatric symptoms, i.e., anxiety, depression, and insomnia, without serious adverse events. Several reports suggest that SRBT improves depression and anxiety with the effects on chronic stress-induced disruption of hypothalamo-pituitary-adrenal axis. The effects of SRBT might have improved nightmares in this case. SRBT may be a drug of choice in the treatment of nightmares in patients with cancer.
3.High-flow Nasal Cannula Oxygen Therapy in a Palliative Care Unit: Three Cases of Cancer Patients Suffering from Severe Dyspnea with Respiratory Failure
Yutaro SUZUKI ; Shigeki ONO ; Yurika ISHIKAWA ; Masayuki KANESHIMA ; Tetsumi SATO
Palliative Care Research 2024;19(1):1-5
High-flow nasal cannula oxygen therapy (HFNC) in palliative care is mentioned in several guidelines, however, the indication for this procedure has not been established yet. At our department, HFNC has increasingly been adopted for end-stage cancer patients when their dyspnea needs to be alleviated. This is a case report on three patients treated with this procedure at our department. Although they had severe dyspnea with respiratory failure, their daily activities, such as enjoying meals and conversation with their families, were improved with HFNC. It can be a treatment of choice to maintain and improve patients’ quality of life (QOL) in palliative setting, where benefits and risks should be considered for each patient.