The incidence of cancer pain and improvement of pain management in Japan.

A nation-wide survey (1987) of cancer pain and analgesic methods showed that the incidence of pain in the terminal stage was in the range of 68 to 72% without any significant difference between hospital groups. Irrespective of the stage of illness, a certain analgesic effect was obtainable with oral/parenteral use of opioids. As a result of a year-to-year comparison of pain in cancer clinics, it was found that the rate of complete pain relief has increased for all stages of illness, especially in the terminal stage. Here the rate of complete pain relief steadily increased from 37.8% in 1986 to 42.7% in 1987 and 48.6% in 1988. Propagation of WHO-advocated cancer pain therapeutics has led to an improvement of the rate of pain relief in the terminal stage. Marketing of MS Contin tablets resulted in a dramatic increase in the consumption of morphine, but there was no increase in the rate of pain relief due to poor measures to counter adverse reactions, and to administration of morphine in insufficient doses. The consumption of morphine for medical use increased year by year, but a greater number of doctors experienced in the use of opioids would further improve the management of pain. To realize that, it would be necessary to incorporate terminal care into medical education programmes as soon as possible. Further efforts will be required for extensive research and propagation of analgesic methods in various fields including education in medicine, science of nursing and postgraduate education.