12 0 0 0 OA 麻酔科医として体験した3度の帝王切開
- 著者
- 中江 文
- 出版者
- 日本臨床麻酔学会
- 雑誌
- 日本臨床麻酔学会誌 (ISSN:02854945)
- 巻号頁・発行日
- vol.28, no.2, pp.259-265, 2008 (Released:2008-04-16)
- 参考文献数
- 10
- 被引用文献数
- 2 2
麻酔科医として勤務しながら3度の帝王切開を経験し, その実体験と, 女性麻酔科医の可能性について考察した. 私の仕事に対する考え方は, 実際に手術を体験し, 子育てにかかわるようになってから変化した. 実体験と想像の間にはかけ離れた世界があることを知り, 他の手術を担当する際も患者の様子を注意深く観察し, 訴えに謙虚に耳を傾け, できるだけ不快感を取り除くことが重要だと考えるようになった. 若手の先生に対する指導の仕方も変わった. 女性は上記のような体験, 子育てにかかわる可能性が高く, それらの経験がよい麻酔管理につながり, 女性麻酔科医の利点と考えられる. 私自身もそのことを念頭にさまざまな恩に報いたい.
- 著者
- 圓尾 知之 中江 文 前田 倫 高橋−成田 香代子 Morris Shayn 横江 勝 松崎 大河 柴田 政彦 齋藤 洋一
- 出版者
- 日本疼痛学会
- 雑誌
- PAIN RESEARCH (ISSN:09158588)
- 巻号頁・発行日
- vol.28, no.1, pp.43-53, 2013-03-10 (Released:2013-04-04)
- 参考文献数
- 15
- 被引用文献数
- 1 12
Background: The revised version of Short-Form McGill Pain Questionnaire (SF-MPQ-2) has been developed as a tool for measuring both neuropathic and non-neuropathic pain which can be used in studies of epidemiology, pathophysiologic mechanisms, and treatment response. SF-MPQ-2 was expanded and revised from the Short-Form McGill Pain Questionnaire (SF-MPQ-1) pain descriptors by adding symptoms relevant to neuropathic pain and by modifying the response format to a 0 - 10 numerical rating scale. In this study, we translated the SF-MPQ-2 into Japanese. The aim of this study was the validation of a Japanese version of the SF-MPQ-2 in patients with neuropathic pain. Materials and Methods: A total of 110 chronic pain patients from Osaka University Hospital and Nishinomiya Municipal Central Hospital were enrolled in this study, with 87 (47 males, 40 females) patients completing the study. Enrolled patients completed the SF-MPQ-2 which had been translated into Japanese. To evaluate the validity of the SF-MPQ-2 questionnaire, an exploratory factor analysis was performed. For assessment of reliability, we used internal consistency reliability coefficients (Cronbach's alpha coefficient) and the test-retest method test (Intraclass Correlation Coefficient; ICC) for the SF-MPQ-2 total and subscale scores. Validity was evaluated by examining the associations between the SF-MPQ-2 total and subscale scores and other measures. Results: The internal consistency (Cronbach's alpha coefficient; continuous pain; α=0.883, intermittent pain; α=0.856, predominantly neuropathic pain; α=0.905, affective descriptors; α=0.863, total score; α=0.906) and reproducibility coefficient (ICC; continuous pain; ρ=0.793, intermittent pain; ρ=0.750, predominantly neuropathic pain; ρ=0.819, affective descriptors; ρ=0.760, total score; ρ=0.830) were high. There were significant correlations between SF-MPQ-2 and other functional assessments. Conclusion: Our findings showed excellent reliability and validity for the Japanese version of the SF-MPQ-2 in pain patients, and the results of both exploratory and confirmatory factor analyses provided support for four readily interpretable subscales (continuous pain, intermittent pain, pre-dominantly neuropathic pain, and affective descriptors). These results provide a basis for use of the SF-MPQ-2 in future clinical research, including clinical trials of treatments for neuropathic and non-neuropathic pain conditions.
5 0 0 0 OA オピオイドによる内分泌機能異常
- 著者
- 田渕 優希子 安田 哲行 北村 哲宏 大月 道夫 金藤 秀明 井上 隆弥 中江 文 松田 陽一 植松 弘進 真下 節 下村 伊一郎 柴田 政彦
- 出版者
- 一般社団法人 日本ペインクリニック学会
- 雑誌
- 日本ペインクリニック学会誌 (ISSN:13404903)
- 巻号頁・発行日
- vol.20, no.1, pp.17-23, 2013 (Released:2013-03-22)
- 参考文献数
- 38
近年,非がん性慢性痛に対するオピオイド処方の選択肢が広がったことにより,オピオイドによる内分泌機能異常発症に留意する必要性がある.内分泌機能異常としては性腺機能低下症が最も多いが,副腎機能低下症や成人GH(成長ホルモン)分泌不全症の報告例も散見される.これらの内分泌機能異常は単に患者のQOLを低下させるのみならず,さまざまな代謝異常,臓器障害を呈し,時に生命の危機にかかわる病態へと進展することもある.現時点で,これらの内分泌機能異常がどのような患者に惹起されやすいかは明らかではなく,また内分泌異常の診断も必ずしも容易ではない.しかし,これらの内分泌機能異常はオピオイドの減量,中止,あるいは非オピオイド系鎮痛薬への変更,ホルモン補充療法により改善可能な病態であることから,オピオイド投与中の患者において決して見逃してはならない副作用の一つと考えられる.オピオイドによる内分泌機能異常について基礎医学的および臨床医学的見地から解説する.
4 0 0 0 OA 痛みと情動
- 著者
- 中江 文 眞下 節
- 出版者
- 日本疼痛学会
- 雑誌
- PAIN RESEARCH (ISSN:09158588)
- 巻号頁・発行日
- vol.25, no.4, pp.199-209, 2010-12-10 (Released:2013-06-06)
- 参考文献数
- 38
- 被引用文献数
- 1
Pain is a subjective experience comprised of physiological and affective components. Previous decades of research have placed an emphasis on pain “sensation″, which involves assessing location and intensity of noxious stimuli. However, somatosensory localization and intensity coding are not necessarily linked with emotional responses, as indicated by the IASP (International Association for the Study of Pain) definition, “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage″. Therefore, it is important to consider that not only the sensory, but also the emotional, perspective of pain plays an important role in pain suffering. Our group previously demonstrated, for the first time, that long-term persistent pain in an animal model of neuropathic pain, resulted in anxiety and depression related behavior. The many human emotions are all capable of altering pain sensitivity, as demonstrated by experimental and clinical studies focused on the associations between pain sensation and various emotions in human imaging studies. Negative emotions, such as anger, sadness, and anxiety, result in increased pain intensity. In contrast, positive emotion can regulate various pain sensations. Patients with certain psychiatric disorders, such as schizophrenia and borderline personality disorder, are less sensitive to pain. However, one of the main symptoms of depressive patients is “pain″. Although many of the neurobiological mechanisms of these diseases remain unclear, psychiatric disorders could reflect brain mechanisms of pain processing, because patients with psychiatric disorders exhibit varying reactions to experimental and clinical pain. Certain psychiatric disorders, in particular schizophrenia, could be considered to be human diseases that exhibit symptoms completely opposite to chronic pain. As stated by Prof. Loeser, “It is not pain, but suffering, that brings patients into doctor's offices in hopes of finding relief". Doctors of modern medicine tend to believe that it is more important to remove the cause of pain through methods such as nerve blockade. However, injuries, and the diseases that cause pain, might only be the trigger. The most important problem for these patients could be the change in social environment triggered by the injuries and diseases. In other words, affective components of pain are the main problems for these patients. Although it is difficult to distinguish whether patient pain is influenced by the affective components of pain, it is recommended to attempt to simultaneously treat patients according to sensory and emotional perspectives. It is expected that studies focused on the affective components of pain will make great advancements, and drug discovery will likely aim at specifically reducing suffering from pain, with an eventual paradigm shift in pain treatment.
- 著者
- 中江 文
- 出版者
- メディカル・サイエンス・インターナショナル
- 巻号頁・発行日
- pp.725-732, 2021-07-01
はじめに筆者が麻酔の臨床を学んだ当時,プロポフォールは眠らせる薬,つまり鎮静のための薬,フェンタニルは痛みをとる薬,つまり鎮痛のための薬と教わった。だから,麻酔中は鎮静度が足りないのか鎮痛が足りないのかを,血圧や心拍数といった限られたモニター上の数値から想像し,それぞれの薬の投与量を調節してきた。今思えば,そこに確固たる根拠があったわけではなく,その時一緒に仕事をするベテラン麻酔科医の嗜好に左右されていた。ある医師は「もっと寝かせないとだめだろう!」と言い,ある医師は「これは,侵害刺激がブロックできていない状態なので痛み止めだ!」と,それぞれの持論を展開していた。ここで不思議なのは,どちらのやり方を選択しても,それなりのゴールに到達できたということである。 なぜだろう?