[Hospice care and the treatment of cancer pain].

The history of hospice care in Great Britain was first introduced, and the pioneer work carried out by the founder of the modern hospice care, Dame Cicely Saunders was briefly described. The first duty of the hospice to patients with terminal cancer is to eliminate physical pain, especially intractable severe pain, which may deteriorate the quality of the patient's life. For this purpose, morphine and its derivatives should be the panacea of choice, although it is of importance to initially determine the appropriate, i.e. completely analgesic level combined with euphoria and anxiolysis, then to maintain this level continuously without somnolence or other dysphoric effects. The dose differs quite markedly according to each patient and the severity of pain. To maintain the level of analgesia, the oral use of morphine at four-hour internals is required, or continuous hypodermic administration by means of a syringe driver is quite ideal. In Japan, the use of diamorphine (heroin) is strictly forbidden, and therefore, a non-narcotic and potent analgesic morphine antagonists, e.g. buprenorphine (Lepetan) has been used by continuous hypodermic administration with a syringe driver by Umeda et al. of Kyoto University Hospital, at a dose of 4-8 micrograms/kg of body weight/day with favorable results. Hospice care should now be considered to be a new concept of medical treatment or a new medical field which must include not only the patient himself with incurable malignant disease but also his family or relatives in considering the target of treatment and care, in order to improve the quality of the patient's life even though shortened by the malignancy.