Taro Minato, MD is an orthopedic surgeon in Yokohama, Japan. His areas of specialty are the upper extremities (shoulder, elbow, hand).
Simon R. Downes: Are opioids prescribed for patients with chronic back pain in Japan?
We seldom prescribe opioids for chronic back pain (or any chronic pain). This is because they have strong side effects and are likely to result in dependency. I would like to say that in general, patients in Japan are more likely to want to endure pain, rather than have medicines prescribed to handle the pain.
Is this also true for foreign patients?
Well, of course, it depends on the patient, but in general, we see that non-Japanese are more likely to request strong drugs to handle back pain - for example, opioids.
What do you commonly prescribe for chronic back pain?
We give NSAIDs. Or, drug plasters, which are sheets that contain medications. We apply these directly to the skin. They mostly contain NSAIDs.
In your practice, do you ever see drug-seeking patients complaining of back pain?
Very few compared to other countries. As I was saying, in Japan, opioids are seldom used. However, I have seen these type of patients before on the night shift who come to get opioids. They ask for a specific drug, saying that only that drug will work for them. I do not give it to them.
Can you tell me the name of an opioid that is prescribed for back pain, and under what circumstances you would prescribe it?
One example of an opioid we may give is Sosegon. The trade name Pentazocine. It may be given for patients with cancer pain. Otherwise, we generally do not give any opioids to patients. Even after back surgeries, we do not give opioids. Rather, we usually only give NSAIDs.
What type of patients come to you with cancer pain?
For example, managing pain for patients with bone metastasis. They have severe pain, and there are few choices for treatment...so we use opioids.
When would you perform surgery on a patient with bone metastasis?
If the surgery can be helpful, for example when a patient has one area of bone metastasis without any organ metastasis. However, it is often the case that patients have multiple areas of metastasis, in which case surgery is not recommended. In these cases, we would give drug treatments (chemotherapy), or perform radiotherapy.
Thank you, Dr. Minato.