Pain Medication in Japan

[Gulliver]

I’m curious if other people out there have had trouble dealing with non-cancerous chronic/breakthrough pain in Japan, and if they have found any viable solutions.

In my experience, after having dealt with multitudes of doctors (both in primary care and hospital settings), pain medication indicated for SEVERE breakthrough pain Is not available unless you are on death’s door dying from cancer.

No matter how bad I tell them the pain is the strongest medicine they say they can give me is some form of NSAID like ibuprofen or loxoprofen and alternatively acetaminophen- both of which are indicated for mild to moderate pain (also these are all available OTC so I’m not sure what the point of going to the doctor is, besides maybe cost reduction).

So after gulping down large quantities of NSAIDs every day I’m starting to develop ulcers not to mention probably putting myself at high risk for stroke.

This is particularly frustrating because I know there are much safer and effective severe pain medications that I have taken for occasional breakthrough pain while living outside Japan. Oxycodone and hydrocodone are two examples.

Very recently, tramadol was approved in Japan for non-cancerous use. Unfortunately it has a component of SSRI which gave me a horrible case of serotonin sickness when I tried it.

I’m beginning to understand why depression and suicide are such a big problem here. Are so many other Japanese also suffering from insufficient pain management?

If you reply, please do not turn this into an addiction discussion. Those of us with chronic pain experience know full well that certain drugs are addictive but in some cases the pros outweigh the cons. And please don’t go on about an opioid epidemic. When I lived in Germany I was frequently prescribed severe pain opioid medications, and there is very little abuse in that country.

[RetireJapan]

Fortunately I have not had to deal with severe pain, so my experience is limited to taking 2-4x the recommended dose for ibuprofen or similar (due to my weight, on the advice of my doctor in Europe).

Anyone else?

[captainspoke]

Surgery for a broken pelvis, a year later a hip replacement. Once they pulled the komakugai off my back (2-3days?), it was NSAIDs from then on. Occasional 座薬, not sure what med that was. Same thing when I got a new heart valve (full open), and then when they went between my ribs to remove one lung lobe.

Probably not what you want to hear, but personally, I'm glad opioids are as restricted as they are here--inpatients only, and even then, sparingly. (Tho we have a friend, his wife was mostly at home, being eaten up by cancer, who had some very strong patches, he used gloves when handling them.)

[RetireJapan]

Actually come to think of it for my hip surgery last year I had a spinal stent(?) for the surgery itself and then something in a drip for 24 hours, but after that it was just normal painkillers. Don't remember it being too bad.

[Cracaphat]

I had two shoulder operations in the space of two years,five years ago. That first op had me in a world of pain and I basically had to sux it up.No cooling jacket,no more painkillers after it had worn off.Couldn't sleep and a nurse gave me a sleeping pill as if it'd work.I'll never forget that pain.The second time with a different doctor,I implored him to hook me up, because I didn't want to go through that level of pain again.He came through alright,though I was just waiting for the pain to come like the first time but thankfully it didn't.To me, Japan's pain attitude is to "gaman" at best.

[TJKansai]

I had two shoulder operations in the space of two years,five years ago. That first op had me in a world of pain and I basically had to sux it up.No cooling jacket,no more painkillers after it had worn off.Couldn't sleep and a nurse gave me a sleeping pill as if it'd work.I'll never forget that pain.The second time with a different doctor,I implored him to hook me up, because I didn't want to go through that level of pain again.He came through alright,though I was just waiting for the pain to come like the first time but thankfully it didn't.To me, Japan's pain attitude is to "gaman" at best.

I had an ankle sprain that made walking almost impossible. Doc didn't give me jack.

I've had dentists expect me to gaman. They quickly became my ex-dentists. One had N02, which I thought would be great, but he too expected too much gaman. My current one knows I want at least a single, if not double shot of anesthetic.

They generally don't give much in the way of pills to take home, though one guy (educated at Harvard and Todai) gave me something a bit stronger. Only 3 pills though. Not sure what it was, maybe something with codeine or the like.

[TJKansai]

Probably not what you want to hear, but personally, I'm glad opioids are as restricted as they are here--inpatients only, and even then, sparingly.

Yeah, I too am glad I missed 'the opportunity' to get addicted to them when I had surgery back in the 1980s stateside. Back then I had a morphine drip for 2 days, then codeine at home for a couple weeks. Nothing like Oxy from what I gather.

[Gulliver]

I think many of your posts are validating my point. Which is that there’s a large amount of misunderstanding as to the different types of pain. I am talking about chronic intractable pain which is pain that will never go away, cannot be easily managed and is just as bad, if not worse, than pain caused by cancer. So the main point is that Japan has a large gap in pain treatment protocols for this area. This might be my fault for not making it clear enough.

There was mention of a “ very strong patch” used by a cancer patient. This was probably the drug fentanyl which is 50 times stronger (literally) than heroin. The type of pain I am experiencing needs nowhere near that level of mitigation but it does need something stronger than the strongest NSAIDs on the market (which have minimal effect on my pain). This is where these intermediary drugs come in to play. The ones I was describing are 100 times less powerful than fentanyl but still work to make life livable for folks in my condition.

The type of pain most of the posts so far have been describing is postoperative acute transitory pain. This type of pain is intense at first but goes away over time. I’ve had a few major surgeries in Japan and while a week or two of severe pain medication would have been the compassionate and generally worldwide accepted treatment, not receiving them did not throw me into despair because I knew it would get better eventually.

Currently for someone like me who has fallen through this pain treatment gap in Japan, there is no respite other than maybe a stress related heart attack or something similar. That is why I ask the question: Has anybody been able to find a viable solutions to bridging this gap other than moving out of Japan? I’m so desperate that, I’m embarrassed to admit, I even tried acupuncture for a while.

A telling antidote, that may be of relevance, would be the time I received surgery for a broken ankle in Japan: After waking up from general anesthesia the first thing the surgeon asked me was, “Is your ankle in pain?” I thought this was a rather odd question considering I just had my ankle cut open, fragments of bone and tendon removed and a screw inserted into my fibula. It made me wonder how many Japanese simply answer “I’m OK” due to the grin-and-bear-it culture here. Looking back I should’ve said, “What do you think baca!” but I was still too out of it at the time.

The other thing that jumped out to me was the mention of suppositories. I recently had a doctor suggest I use NSAID suppositories because the oral ones were tearing up my stomach and intestines. “You can’t be serious,” I thought. So not only will I not get the proper level of pain mitigation but I also have to suffer the mental/ physical trauma of inserting the thing! A bit sadistic if you ask me .

This is all especially disheartening when I know there’s medication readily available that I know actually works for my pain, is fairly safe and does not cause ulcers and cardiovascular side effects like NSAIDs and acetaminophen do. The side effects of addiction and drowsiness do not bother me because I am retired and I do not own a car.

I think I agree with most of you when I say that I DO believe that opioids should be heavily regulated and you should be closely monitored by your doctor when they are taken (another difficulty Japanese doctors seem to have). I’m actually a bit alarmed as to the ease with which you can obtain benzodiazepines here (which are equally, if not more, addictive and mind bending as opioids). Not to mention prescription sleeping pills. The doctors here seem to give both of these out like candy. But I guess that’s another topic.

[captainspoke]

I'd have to look it up to get the list right, but there are 7-10 'routes of administration' for drugs, and yes, rectal is one of them. Heard of buccal? Or intrathecal? Of course oral, intramuscular, and intravenous are the most common, maybe also inhalation, and topical/transdermal. But both oral and inhalation generally take in so much unhealthy stuff that our bodies have set up some defenses for things coming in that way. Heparin can't be administered orally, or rather it can, and it won't hurt you, but the first pass effect destroys it before it can have any effect.

Rectal is fast onset, and direct, same with other mucous membrane paths (sublingual, buccal), and I still know the kanji for that, 粘膜 (I used to teach pharmacy students, and tried to use relevant materials for their english courses).

Blah, blah, blah...

**

Yes, the problem you're describing is different than post-op -- thanks for taking the time to write all that out.

[Bubblegun]

I think many of your posts are validating my point. Which is that there’s a large amount of misunderstanding as to the different types of pain. I am talking about chronic intractable pain which is pain that will never go away, cannot be easily managed and is just as bad, if not worse, than pain caused by cancer. So the main point is that Japan has a large gap in pain treatment protocols for this area. This might be my fault for not making it clear enough.

There was mention of a “ very strong patch” used by a cancer patient. This was probably the drug fentanyl which is 50 times stronger (literally) than heroin. The type of pain I am experiencing needs nowhere near that level of mitigation but it does need something stronger than the strongest NSAIDs on the market (which have minimal effect on my pain). This is where these intermediary drugs come in to play. The ones I was describing are 100 times less powerful than fentanyl but still work to make life livable for folks in my condition.

The type of pain most of the posts so far have been describing is postoperative acute transitory pain. This type of pain is intense at first but goes away over time. I’ve had a few major surgeries in Japan and while a week or two of severe pain medication would have been the compassionate and generally worldwide accepted treatment, not receiving them did not throw me into despair because I knew it would get better eventually.

Currently for someone like me who has fallen through this pain treatment gap in Japan, there is no respite other than maybe a stress related heart attack or something similar. That is why I ask the question: Has anybody been able to find a viable solutions to bridging this gap other than moving out of Japan? I’m so desperate that, I’m embarrassed to admit, I even tried acupuncture for a while.

A telling antidote, that may be of relevance, would be the time I received surgery for a broken ankle in Japan: After waking up from general anesthesia the first thing the surgeon asked me was, “Is your ankle in pain?” I thought this was a rather odd question considering I just had my ankle cut open, fragments of bone and tendon removed and a screw inserted into my fibula. It made me wonder how many Japanese simply answer “I’m OK” due to the grin-and-bear-it culture here. Looking back I should’ve said, “What do you think baca!” but I was still too out of it at the time.

The other thing that jumped out to me was the mention of suppositories. I recently had a doctor suggest I use NSAID suppositories because the oral ones were tearing up my stomach and intestines. “You can’t be serious,” I thought. So not only will I not get the proper level of pain mitigation but I also have to suffer the mental/ physical trauma of inserting the thing! A bit sadistic if you ask me .

This is all especially disheartening when I know there’s medication readily available that I know actually works for my pain, is fairly safe and does not cause ulcers and cardiovascular side effects like NSAIDs and acetaminophen do. The side effects of addiction and drowsiness do not bother me because I am retired and I do not own a car.

I think I agree with most of you when I say that I DO believe that opioids should be heavily regulated and you should be closely monitored by your doctor when they are taken (another difficulty Japanese doctors seem to have). I’m actually a bit alarmed as to the ease with which you can obtain benzodiazepines here (which are equally, if not more, addictive and mind bending as opioids). Not to mention prescription sleeping pills. The doctors here seem to give both of these out like candy. But I guess that’s another topic.

So I was an NHS nurse, and there are some questions that really need to be asked before we can really make an real comment on what type of pain killers might be suitable. Most above are discussing acute pain which will resolve itself.

1.What type of pain is it? Nerve, muscular or bone? Depending on the type the the doc can best prescribe some meds. Nerve pain is very hard to treat and control however there have been some excellent results with specific anti-depressants, which block pain.

2. what is the diagnosis? ( important) and Where is your pain specifically? Is Weight an issue? As that can have an impact too.

3. How is the pain being measured? Do you have a pain chart. eg 0.no pain .......... up to 10 unbearable? track it. Show the doc.best thing about a chart is it is objective, measurable, and can be used to review treatment.

4, What type of route is best? To be honest rectal is the fastest route into the blood stream, due to the large bowels large vascular system. and will stop any stomach side effects. Its one of the reason we use it with kids.

5 Have you found a pain specialist? Most docs don't have "expertise" in pain management, because their speciality is in another field, however there has been an increase is pain specialists now. This wasn't something I saw 20 years ago here. if I was you, ask for a referral or look around for a pain management specialist.

6) I am going to suggest that there could be cultural misconception (doctors) on how patients express pain. Maybe Japanese can games, while the rest of the world expresses their pain in an over loud way.
One experience we had was froma young Ethiopian man who continually groaned, and even though we tried to manage his pain and there was no obvious reason for his pain, we thought he was expressing it in the way he would do back home. Anyway, it turned out the consultant recommended a colonoscopy (nice). and they found a massive tape worm inside his intestines. So while, it may be ignored, cultural bias maybe there.( it may not)


I suffered chronic pain for 25 years and I'm basically pain free 2 years now. NO NSAID and no muscle relaxants, which I used for years and years.