モルヒネの大量投与による末期下顎歯肉癌患者の癌性疼痛管理の経験

  • 高木 純一郎
    Department of Dentistry and Oral Surgery, Ishikawa Prefectural Central Hospital
  • 宮田 勝
    Department of Dentistry and Oral Surgery, Ishikawa Prefectural Central Hospital
  • 岡部 孝一
    Department of Dentistry and Oral Surgery, Ishikawa Prefectural Central Hospital
  • 名倉 功
    Department of Dentistry and Oral Surgery, Ishikawa Prefectural Central Hospital
  • 坂下 英明
    Department of Diagnostic & Therapeutic Sciences, Second Division of Oral and Maxillofacial Surgery, Meikai University School of Dentistry

書誌事項

タイトル別名
  • Pain management by means of high dose morphine administration for terminal-stage mandibular cancer patient

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抄録

We herein report a case experience of a mandibular cancer patient to whom we administered high dose therapy for pain management.<BR>A 54-year-old male patient noticed a swelling in his right mandible five months before consulting a doctor. He complained of limited mouth-opening and bleeding in the oral cavity. He was referred to our department and diagnosis for mandibular gingival cancer was made. We performed a tracheotomy on the fifth day of his hospitalization. Although subsequent radiation therapy and chemotherapy contributed to a transient decrease in shrinkage of the tumors and shortly thereafter the tumors increased in size again and the patient suffered from cancer associated pain. Since the tumors could not be curatively treated, we shifted the focus of our treatment to pain management. The patient passed away died about 10 months after his initial visit.<BR>Our pain management was conducted in accordance with the WHO's “Narcotic Ladder” guidelines for pain management. During the end stage, we managed the patient's pain with morphine hydrochloride injections and a fentanyl patch, where an equivalent to 3600mg/day of morphine hydrochloride was required. Patients with head and neck cancer have mental distress in addition to physical disorders such as swelling and bleeding in the affect regions of the tumorous lesions, difficulties in eating and speaking. We should consider carefully what is best for these patients in terms of care, management and/or maximum attainment of a better QOL.

収録刊行物

  • 有病者歯科医療

    有病者歯科医療 15 (1), 43-48, 2006

    一般社団法人 日本有病者歯科医療学会

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