Acupuncture and moxibustion for palliative care / 全日本鍼灸学会雑誌

Cancer is the leading cause of death in Japan, which boasts one of the longest life expectancies in the world. Some types of cancer cause excruciating pain. Measures are actively being taken to establish palliative care units as specialized facilities to mitigate pain and set up palliative care teams in core hospitals for cancer care. In accordance with the guidelines of the WHO, a method using narcotic drugs as a means of pain relief has been established in Japan, but for patients at the middle to late stages of cancer, sufficient pain control cannot be ensured for many cases. Although various alternative therapies, including acupuncture, moxibustion, and haut care (hand and foot massages) are used to alleviate pain, the effectiveness of these methods is still unclear. Accordingly, we examined the actual conditions of palliative care together with evidence of acupuncture and moxibustion therapies and haut care as a means of pain relief.

Both switching from a winged needle to a small plastic intravenous catheter and adding dexamethasone to continuous subcutaneous infusion (CSCI) successfully treated inflammatory skin changes caused by CSCI

<b>Purpose</b>: The continuous subcutaneous infusion (CSCI) is one of the most popular methods to reduce cancer pain. Inflammatory skin changes such as redness and induration are sometimes observed around the infusion site of the skin. Although dexamethasone is empirically added to a CSCI regimen to reduce such skin changes, little evidence on this practice has been available. We aimed to demonstrate the effectiveness of the CSCI protocol that we have been using for the treatment of skin changes. <b>Methods</b>: We prospectively observed the incidence of skin changes. When redness or induration at the injected site appeared, a winged needle was switched to a plastic intravenous catheter. When the redness or induration did not resolve with this needle change, dexamethasone was added to CSCI. <b>Result</b>: Sixty-six patients with cancer pain who underwent CSCI using a winged needle were enrolled in this study. The CSCI needles were switched from a winged needle to a plastic intravenous catheter in 20 out of 66 patients who revealed redness at a size of greater than 10 mm in diameter during CSCI. After this needle switch, the skin changes resolved in 15 out of 20 patients. Among the five patients who did not respond to the needle change, the skin changes resolved in three patients by dexamethasone (0.5∼1 mg/day) added to CSCI. <b>Conclusion</b>: These findings suggest that both switching from a winged needle to a small plastic intravenous catheter and adding dexamethasone to a CSCI regimen are effective in the treatment of inflammatory skin changes caused by CSCI.