마약성 진통제를 이용한 암성 통증의 효율적 관리에 대한 약사의 임상업무 개발

Abstract

Patients with cancer have diverse symptoms, impairments in physical and psychological functioning, and other difficulties that can undermine their quality of life. Generally, oral and transdermal morphine has been recognized as the analgesic of first choice in the management of increasing or persisting cancer pain. In this study, we evaluated the adequacy of pain control using opioid analgesics in terminal cancer patients in this hospital, and considered the pharmacist's role in the cancer pain management process. From August to October 2005, we conducted medication counseling of opioid analgesics in cancer patients, and gave them questionnaires to evaluate the efficacy of the opioid analgesics and occurring complications. Also, we investigated the ratio of pharmacist's intervention in using opioid analgesics. On the cancer pain intensity, 83 percent of patients experienced moderate to severe pain. 60 percent of patients satisfied opioid's analgesic effects, but 28.5 percents complained inadequate pain management. 62.8% of patients experienced adverse effects by opioid analgesics, and the list of common adverse effects includes constipation (40.6%), drowsiness (27.5%), dry mouth (20.3%), nausea and vomiting (8.7%). The rationale of the clinical pharmacist's intervention in using opioid analgesics was 35.7 percent, including alteration of the prescription about opioid analgesics (35.2%), relief from the adverse effects (26.5%), improvement of the patient's recognition about using opioids (26.5%). The results showed most patients administrated opioid analgesics had severe pain, and some of them experienced inadequate pain control or adverse effects. In conclusion, the pharmacists should be clinically well experienced and evaluate administrating opioid analgesic's efficacy. In addition, they should induce modification of the inappropriate prescription as the communication mediators between the doctor and the patients. Then, cancer pain management service could be more effective and patient's quality of life would be more improved.