Pain Medicine and Palliative Care Division

Introduction
The Pain Medicine and Palliative Care Division was established in June 1, 1999. Our goal is to relieve cancer pain and to manage other symptoms in cancer patients such as dyspnea, nausea, itching, and hiccups. Treatments for cancer pain follow the WHO anal-gesic ladder. Morphine and adjuvant analgesics are the main pharmacological treatments. We also use nerve blocks with local anesthetics for transient analgesia and those with neurolytic agents for permanent analgesia. Regarding non-pharmacological means, we use transcutaneous electrical stimulation (TENS), acupuncture, low power laser and superlizer. Our themes are 1) patient care, 2) patient education, and 3) research in palliative medicine.We are part of the palliative care team, which started its operation on July 1, 1999. Members of the palliative care team include 3 oncologists, 5 pharmacists, two psychiatrists and one social worker.

Routine Activities
Pain and palliative care division consists of one staff, one senior resident and one resident. Daily patients round is conducted to about 40 inpatients to treat pain and other sufferings due to cancer itself or cancer treatment in the hospital. Most of the patients are referred to us by their oncologists. Since Oct. 2000, our division has one to two beds specialized for palliative care patients. These specialized beds will be increased in the future and will become part of the new palliative care system in NCCH. We also see out patients with cancer pain and/or other symptoms due to cancer every afternoon.We occasionally give second opinions to patients and families from other hospitals. We also accept questions from other hospitals through e-mail and phone. Our specialty is treating neuropathic pain due to cancer itself, cacer chemotherapy and operation. We are also engaged in basic and clinical researches on neuro-pathic pain.
In our palliative care team activities, we have 1) case conference every Friday, 2) e-mail conference everyday, 3) combined visit to pain patients with pharmacists and social worker, 4) special conference in the ward for patients with a lot of palliative issues. We have started to give lectures every Wednesday to health care personnel on palliative care.

Research Activities
Clinical Research: We have developed an analgesic ladder for neuropathic cancer pain using anitconvulsants, anti-depressant, anti-arrhythmic drugs and N-methyl-D-Aspartate (NMDA) receptor antagonist, with which doctors who do not specialize in pain treatment can treat neuropathic cancer pain. Research on the effect of inhalational furosemide on cancer dypnea is also underway (Shimoyama N., in press ).
Basic Research: We collaborate in basic research with the Department of Physiology of Chiba University Medical Graduate School, Department of Pharmacology of Cornell University Medical College in U.S.A., and Laboratory of Chemical Biology and Peptide Research of Clinical Research Institute of Montreal. We are developing novel opioids as candidates for clinical use such as [DMT1] DALDA. (Shimoyama M et al., 2001) We have deve-loped a novel mouse model of neuropathic cancer pain by tumor implantation, which mimics human neuropathic cancer pain.

Clinical Trials
We finished Phase 2 trial of Tramadol and a study on a new morphine slow release capsule with immediately release morphine. We have started Phase 2 trial on buprenorphine oral patch and Strontium 89. We will start Phase 3 trial on the new morphine slow release capsule and Phase 3 trial on Tramadol. We have launched a project on the use of virtual reality for cancer symptom management such as dyspnea, weak pain and anxiety before chemo-therapy. This will be carried through the next few years. We also have launched a study of supportive care for both cancer patients and their families. We successfully hosted the 14th International Symposium of the Foundation for Promotion of Cancer Research: Pain Control, Palliative Medicine and Psycho-oncology (Collins J et al. 2001).

N. SHOMOYAMA

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