Toward Freedom from Cancer Pain in Japan

Abstract

Life expectancy in Japan is highest in the world. Cancer is the leading cause of mortality in Japan, accounting for about 30 percent of all deaths. Many Japanese cancer patients experience severe pain although they and their families hope to be pain free at the end of their lives. Toward that end, the consumption of morphine in Japan has increased markedly since 1989. The amount of morphine hydrochloride and morphine sulfate consumed in 2001 was 6.1 times that used in Japan in 1989. However, the amount of morphine consumed in Japan is still less than in other developed nations, and was only one-sixth of the amount used in Australia in 2001. As a result, many Japanese cancer patients experience potentially manageable cancer pain, largely because the amount of the drug used by doctors is insufficient for pain control. An increasing number of Japanese doctors now understand that their patients' quality of life is most important in end-of-life care and how to use the three step analgesic ladder of the World Health Organization (WHO). However, other doctors do not understand these issues sufficiently causing some patients to die without good pain control. Both the general population and some medical professionals misunderstand and have prejudice against the use of morphine. Patients often do not participate in decision making about medical treatment because of remaining paternalism in the relationship between Japanese doctors and patients. Thus, cancer pain management in Japan is not as effective as it can be and not all Japanese cancer patients receive appropriate management for their cancer pain. To improve outcomes for Japanese patients, it is necessary for health professional and social work students and practicing professionals to receive contemporary education including an introduction to palliative care ethics.

Key Words:

• Japan
• pain relief
• education
• health insurance
• end-of-life care
• patient rights
• opioids

Additional information

Notes on contributors

Kuniko Otsuka

Cherokee Layson-Wolf, PharmD, is Assistant Professor at the University of Maryland School of Pharmacy. At the time that this review was conducted, she was a Community Care Pharmacy Practice Resident at Virginia Commonwealth University.

Perry G. Fine, MD, is Professor of Anesthesiology, School of Medicine and Associate Medical Director, Pain Management Center at the University of Utah Health Sciences Center, Salt Lake City; and National Medical Director, VistaCare, based in Scottsdale, AZ. This commentary is based on an article in Dr. Fine's VistaCare Palliative Medicine Monitor.

Jonathan R. Gavrin, MD, is the Internet editor for the Journal. He is Associate Professor of Anesthesiology and Adjunct Associate Professor of Medicine at the University of Washington School of Medicine; Associate Member, Fred Hutchinson Cancer Research Center; and Associate Director for Clinical Anesthesia Services, Harborview Medical Center.

Perry G. Fine, MD, is Professor of Anesthesiology, School of Medicine and Associate Medical Director, Pain Management Center at the University of Utah Health Sciences Center, Salt Lake City; and National Medical Director, VistaCare, based in Scottsdale, AZ. This commentary is based on an article in Dr. Fine's VistaCare Palliative Medicine Monitor.

Philip J. Wiffen, is the Regional Pharmaceutical and Prescribing Adviser, Anglia & Oxford Region of the National Health Service Executive, a member of the Oxford Regional Pain Relief Unit and Coordinating Editor of the Cochrane Collaboration Pain Palliative and Supportive Care Collaborative Review Group.

Perry G. Fine, MD, is Professor of Anesthesiology, School of Medicine; Associate Medical Director, Pain Management Center at the University of Utah Health Sciences Center, Salt Lake City; and National Medical Director, VistaCare, based in Scottsdale, AZ. This commentary is based on an article in Dr. Fine's VistaCare Palliative Medicine Monitor.

Philip J. Wiffen, BPharm, MRPharmS, MFPHM (Hon) is Regional Pharmaceutical and Prescribing Adviser, Anglia & Oxford Region of the National Health Service Executive, a member of the Pain Relief Unit, Churchill Hospital, and Coordinating Editor, Cochrane Collaboration Pain Palliative and Supportive Care Collaborative Review Group.

Howard A. Heit, practices pain medicine and addiction medicine in Fairfax, Virginia, and is Assistant Clinical Professor of Medicine at Georgetown University, Washington, DC. Dr. Heit was a member of the Liaison Committee on Pain and Addiction.

Perry G. Fine, is Professor of Anesthesiology, School of Medicine and Associate Medical Director, Pain Management Center at the University of Utah Health Sciences Center, Salt Lake City; and National Medical Director, VistaCare, based in Scottsdale, AZ. This commentary is based on an article in Dr. Fine's VistaCare Palliative Medicine Monitor.

Philip J. Wiffen, is Regional Pharmaceutical and Prescribing Adviser, Anglia & Oxford Region of the National Health Service, a member of the Pain Relief Unit at Churchill Hospital and Coordinating Editor of the Cochrane Collaboration Pain Palliative and Supportive Care Collaborative Review Group.

Last Acts is a Robert Wood Johnson Foundation funded campaign to improve end-of-life care by a coalition of professional and consumer organizations. This coalition works to improve palliative care, focused on managing pain and making life better for individuals and families facing death. Last Acts envisions a world in which dying people and their loved ones receive excellent care and are honored and supported by their community.

S. R. Ghooi, MBBS, is a Medical Consultant in New Delhi.

Gustavo G. De Simone is Medical Oncologist (with Diploma in Palliative Medicine) and Pallium Latinoamérica Association Medical Director and Chief, Section on Palliative Care, Hospital Bonorino Udaondo, Bonpland 2287 (1425) Ciudad de Buenos Aires, Argentina ( [email protected].

The Reverend John S. Lunn, RN, MDiv, is Palliative Care and Hospice Consultant, Global Ministries for the Disciples of Christ and United Church of Christ, and former President, Board of Directors, Kauai Hospice, Hawaii.

Philip J. Wiffen, BPharm, MRPharmS, MFPHM (Hon), is Regional Pharmaceutical and Prescribing Adviser, Anglia & Oxford Region, National Health Service, a member of the Pain Relief Unit, Churchill Hospital and Coordinating Editor, Cochrane Collaboration Pain Palliative and Supportive Care Collaborative Review Group.

Jan Stjernswärd, MD, PhD, FRCP (Edin), is Former Chief, Cancer and Palliative Care, World Health Organization, Geneva, Switzerland, and International Director of the Oxford University International Centre for Palliative Care and World Health Organization Collaborating Centre for Palliative Care, Churchill Hospital, Oxford, UK. He also serves on the Steering Committee of the Diana Palliative Care Initiative, Diana Princess of Wales Memorial Fund in the UK, as a Consultant to the Open Society Institute in New York, and continues to serve as a World Health Organization advisor.

Barbara L. Kass-Bartelmes, MPH, CHES, and Ronda Hughes, PhD, wrote this report for the Agency for Health Care Research and Quality (AHRQ) of the U.S. Public Health Service.

Barbara L. Kass-Bartelmes, MPH, CHES, and Ronda Hughes, PhD, wrote this report for the Agency for Health Care Research and Quality (AHRQ) of the U.S. Public Health Service.

Robert J. Adams, PharmD, was at the time of this study Primary Care Resident, Pharmacy Service, Carl T. Hayden Veterans Affairs Medical Center, Phoenix, AZ.

Stephen P. Lordon, MD, was at the time of this study, Attending Physician in the Pain Management Center, University Hospitals and Clinics, and Clinical Assistant Professor of Anesthesiology, School of Medicine;

Arthur G. Lipman, PharmD, is Professor of Pharmacotherapy, College of Pharmacy, Adjunct Professor of Anesthesiology, School of Medicine and Director of Clinical Pharmacology, Pain Management Center, University Hospitals and Clinics; University of Utah Health Sciences Center.

Christopher Stock, PharmD, is Clinical Pharmacist, Substance Abuse Treatment Programs Pharmacist at the George E. Wahlen Veterans Affairs Salt Lake City Health Care System, and Clinical Associate Professor, College of Pharmacy, University of Utah

Perry G. Fine, MD, is Professor of Anesthesiology, School of Medicine, and Attending Physician at the Pain Management Center, University of Utah Health Sciences Center, Salt Lake City, UT; and Senior Medical Advisor, VistaCare, based in Scottsdale, AZ.

Phillip J. Wiffen, BPharm, MRPharmS, MFPHM(Hon), is Director of Training for the U.K. Cochrane Center, a member of the Oxford Regional Pain Relief Unit at Churchill Hospital, and Coordinating Editor of the Cochrane Collaboration Pain Palliative and Supportive Care Collaborative Review Group.

William J. Rusho, MS, RPh, is Professor (Clinical) of Pharmacotherapy, University of Utah College of Pharmacy and a former member of the FDA Advisory Committee on Pharmacy Compounding. He was clinical coordinator of sterile product compounding at the University of Utah Hospitals and Clinics for 32 years.

Jonathan R. Garvin, MD, is Director of Symptom Management and Palliative Care, Hospital of the University of Pennsylvania; Clinical Associate Professor of Anesthesia and Adjunct Associate Professor of Medicine, School of Medicine, University of Pennsylvania, Philadelphia.

Philip J. Wiffen, BPharm, MSc, MRPharmS, MFPHM (Hon), is a member of the Oxford Regional Pain Relief Unit, Churchill Hospital, Coordinating Editor, Cochrane Collaboration Pain Palliative and Supportive Care Collaborative Review Group, and Director of Training, U.K. Cochrane Center.

Dr. Fishman has developed this feature based on columns he has developed in collaboration with the American Pain Foundation Pain Monitor and Discovery Health. Dr. Fishman retains copyright for this material and has granted permission to the Journal of Pain & Palliative Care Pharmacotherapy to publish it.

Dr. Fishman has developed this feature based on columns he has developed in collaboration with the American Pain Foundation Pain Monitor and Discovery Health. Dr. Fishman retains copyright for this material and has granted permission to the Journal of Pain & Palliative Care Pharmacotherapy to publish it.

Mark R. Collen is a self-taught artist and the creator of PAIN Exhibit and the on-line pain art exhibit PainExhibit.com. As a result of an injury and failed back surgery in 1995, Mr. Collen was left with neuropathic pain. He started the PAIN Exhibit in 2001 as a response to years of undertreatment that he endured.

Mr. Collen has created art pieces about his pain and concluded that art is far more effective at communicating the pain experience than are words. His desire to help end undertreatment of pain, coupled with his understanding of the power of art to educate were the seminal factors in the birth of the PAIN Exhibit and PainExhibit.com.

William M. Lamers, Jr., MD, is Medical Consultant to the Hospice Foundation of America. He has over thirty years of experience as a hospice medical director and consultant.

Dr. Fishman has developed this feature based on columns he developed in collaboration with the American Pain Foundation Pain Monitor and Discovery Health. Dr. Fishman retains copyright for this material and has granted the Journal of Pain & Palliative Care Pharmacotherapy permission to publish it to facilitate patient education.

Philip J. Wiffen, BPharm, MSc, MRPharmS, MFPHM (Hon), is a member of the Oxford Regional Pain Relief Unit at Churchill Hospital, Coordinating Editor of the Cochrane Collaboration Pain Palliative and Supportive Care Collaborative Review Group, and Director of Training for the U.K. Cochrane Center.

Dr. Fishman, a member of the Journal Editorial Board, has developed this feature based on columns he developed in collaboration with the American Pain Foundation Pain Monitor and Discovery Health and he has granted the Journal of Pain & Palliative Care Pharmacotherapy permission to publish it to facilitate patient education.

Paul M. Gahlinger, MD, PhD, MPH, FACOEM, is a practicing physician and author. He is Adjunct Professor in the Department of Family and Preventive Medicine, School of Medicine, University of Utah.

Medical Consultant to the Hospice Foundation of America. He has over thirty years of experience as a hospice medical director and consultant.

Angela Huskey, PharmD, was with the Interdisciplinary Pain and Palliative Care and Integrative Medicine Program at H. Lee Moffitt Cancer Center, Tampa, FL at the time she wrote the cannabinoid review. She is currently Clinical Pharmacist, Pain Management and Palliative Care, and Clinical Assistant Professor, Department of Pharmacy, University of Florida, Gainesville.

Dr. Fishman, a member of the Journal Editorial Board, has developed this feature based on columns he developed in collaboration with the American Pain Foundation Pain Monitor and Discovery Health and he has granted the Journal of Pain & Palliative Care Pharmacotherapy permission to publish it to facilitate patient education.

William M. Lamers, Jr., MD, is Medical Consultant to the Hospice Foundation of America. He has over thirty years of experience as a hospice medical director and consultant.

Philip J. Wiffen, BPharm, MSc, MRPharmS, MFPHM (Hon), is a member of the Oxford Regional Pain Relief Unit at Churchill Hospital, Coordinating Editor of the Cochrane Collaboration Pain Palliative and Supportive Care Collaborative Review Group, and Director of Training for the U.K. Cochrane Center.

This feature is adapted from PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care) which was published electronically by the American Academy of Hospice and Palliative Medicine and was edited by Amy Abernethy, Assistant Professor of Medicine and Nursing, Director of the Palliative Care Clinical Research Initiative, Duke University, Durham, NC.

William M. Lamers, Jr., MD, is Medical Consultant to the Hospice Foundation of America. He has over thirty years of experience as a hospice medical director and consultant.

Dr. Fishman, a member of the Journal Editorial Board, has developed this feature based on columns he developed in collaboration with the American Pain Foundation Pain Monitor and Discovery Health and he has granted the Journal of Pain & Palliative Care Pharmacotherapy permission to publish it to facilitate patient education.

Mark Collen is a person with chronic pain and a member of the Journal Editorial Board. He also is the founder and coordinator of http://PainExhibit.com See: Collen M. Life of pain, life of pleasure: Pain form the patients' perspective-The evolution of the PAIN exhibit. J Pain Palliât Care Pharmacother 2004;19(4):45-52

Scott M. Fishman, MD, is Chief, Division of Pain Medicine and Professor, Department of Anesthesiology and Pain Medicine, University of California at Davis.

Dr. Fishman, a member of the Journal Editorial Board, has developed this feature based on columns he developed in collaboration with the American Pain Foundation Pain Monitor and Discovery Health and he has granted the Journal of Pain & Palliative Care Pharmacotherapy permission to publish it to facilitate patient education.