Recent developments in the management of cancer pain in Japan: education, clinical guidelines and basic research.

The Cancer Control Act of Japan came into effect in 2007. Most physicians, however, have not yet had sufficient opportunity to learn about pain management and other clinical palliative care practices. In an attempt to rectify this situation, the Japanese Society for Palliative Medicine has initiated the Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education project. The two major roles of this project are to establish a faculty development program in palliative care, and to provide support for conducting workshops about basic palliative care throughout Japan. Another important movement is the development of a clinical guideline for the management of cancer pain. The Japanese Society for Palliative Medicine developed a clinical guideline for the pharmacological management of cancer pain in 2010. On the other hand, although clinical experience has demonstrated that psychological dependence is not a major concern when morphine is used to control pain in cancer patients, undue anxiety about psychological dependence on morphine in cancer patients has led physicians and patients to use inadequate doses of opioids. In an attempt to remedy this situation, therefore, Japanese basic researchers are cooperatively involved in conducting high-quality basic research to answer clinical questions in palliative care. They have demonstrated to the world, for the first time, that (i) chronic pain dramatically attenuates the reward effects of opioids and that (ii) atypical antipsychotics, such as olanzapine, can suppress morphine-induced emesis and alleviate the sleep dysregulation associated with neuropathic pain in animals. Thus, we are working in close collaboration to establish new strategies for palliative care in Japan.