著者

平田 幸一 鈴木 圭輔 春山 康夫 小橋 元 佐伯 吉規 細井 昌子 福土 審 柳原 万理子 井上 雄一 西原 真理 西須 大徳 森岡 周 西上 智彦 團野 大介 竹島 多賀夫 端詰 勝敬 橋本 和明

出版者

日本神経治療学会

雑誌

神経治療学 (ISSN:09168443)

巻号頁・発行日

vol.37, no.2, pp.166-179, 2020 (Released:2020-08-31)

参考文献数

51

被引用文献数

4

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難治性の疾患における持続中枢神経感作と言われる病態の疫学,基礎・臨床的な位置付けさらには患者のケアにむけての研究をまとめた.本総説は厚生労働研究班の各員の研究結果を示したものなので,必ずしもまとまりがない点に限界があるが,今までは疾患縦断的に診断治療がおこなわれてきた難治性疾患における中枢神経感作の役割を横断的にみたという意味でもわれわれの研究の結果は一部ではあるが解明したものといえる.結果として,中枢神経感作は種々の疾患,特に難治性のもので明らかに何らかの役割を呈していることが示せた.さらにその治療法の解明には至らぬまでも,患者ケアに繋がる方略を示せたものと考えられ,今後の研究の基盤となることが望まれる.

著者

水谷 みゆき 牛田 享宏 西原 真理

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.32, no.3, pp.191-202, 2017-09-15 (Released:2017-09-26)

参考文献数

30

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Chronic pain is a complex state that involves unpleasant emotion, autono­mic responses, helplessness against pain and movement disorder, as well as the sensation of pain itself. These memorized responses influence the present experience and behavior of the patient. A single treatment option is not enough to treat such a complex clinical state. Thus, our facility has several treatment programs to fit individual patients’ needs. We applied an individualized hypnotic approach to 161 patients who had not shown satisfactory improvement and were considered suitable subjects for psychotherapy.A hypnosis session consisted of the introduction stage, which prepared the therapeutic contexts accommodated to the change in chronic pain as well as each patient’s history, and the induction stage, which mainly targeted non–pain body sensations. Among the patients who tried hypnosis, 71.1% experienced in–session analgesia (ISA), and 46.3% experienced out–of–session analgesia (OSA). The most of the first ISA was experienced before approximately the 10th session, and the most of the first OSA was experienced by approximate­ly the 15th session after ISA.Based on the process and degree of analgesia, the number of sessions, the leaning rate of self–hypnosis, and the patients’ characteristics and experiences in the above process, we attempted to determine the conditions under which the patients were successfully engaged in hypnosis, the stage of changes in their chronic pain, and the inhibitory factors against analgesia. Despite clinical differences among the patients and their pain situations, their responses to the hypnosis implied the importance of achieving pain cessation through their own therapeutic efforts.

著者

木村 慎二 細井 昌子 松原 貴子 柴田 政彦 水野 泰行 西原 真理 村上 孝徳 大鶴 直史

出版者

公益社団法人 日本リハビリテーション医学会

雑誌

The Japanese Journal of Rehabilitation Medicine (ISSN:18813526)

巻号頁・発行日

vol.55, no.3, pp.206-214, 2018-03-16 (Released:2018-04-20)

参考文献数

29

被引用文献数

2

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2011年のNakamuraらの調査では,日本人の慢性疼痛の有症率は約15%で,その患者数は増加傾向である.慢性疼痛は急性痛と異なり,通常の薬物療法が効きにくい例があり,日本整形外科学会の2012年腰痛診療ガイドラインでは,運動療法,小冊子を用いた患者教育,さらには認知行動療法がGrade Aとして強く推奨されている.認知行動療法は,ある出来事に対する認知(考え方)と行動を変えることで,問題への効果的な対処の仕方を習得させる心理教育を踏まえた治療法である.慢性疼痛患者の生活および生きがいを獲得することを目的に,筆者は認知行動療法理論に基づき,「いきいきリハビリノート」を用いた運動促進法を開発し,普及に努めている.

著者

櫻井 博紀 佐藤 純一 青野 修一 新井 健一 井上 真輔 西原 真理 畠山 登 尾張 慶子 西須 大徳 牧野 泉 牛田 享宏

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.34, no.4, pp.336-341, 2019-12-20 (Released:2020-03-14)

参考文献数

19

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Patients who complain of chronic pain have various symptoms and complicated pathologies, and there are often cases in which the symptoms worsen due to weather changes. However, few studies have examined the nature of pain affected by weather changes. In this time, we investigated the characteristics of patients with weather–related pain. As results, their pain intensity is moderate and they can maintain moderate daily activity. But in psychosocial factors, they have low self–efficacy and high catastrophic thinking. As treatment for chronic pain, exercise therapy managed by a therapist is highly recommended in non–drug therapy. Patients with weather–related pain often complain at head and neck shoulders. Evidences on the effects of exercise therapy for these body parts have also been reported. We hope that capturing the characteristics of patients with weather–related pain will lead to more appropriate treatments tailored to the pathological condition of the patients.

著者

水谷 みゆき 鈴木 千春 大道 裕介 櫻井 博紀 森元 温子 西原 真理 牛田 亨宏 新井 健一 佐藤 純

雑誌

Pain research : the journal of the Japanese Society for the Study of Pain = 日本疼痛学会誌 (ISSN:09158588)

巻号頁・発行日

vol.27, no.3, pp.175-188, 2012-08-10

参考文献数

44

著者

西原 真理 新井 健一 牛田 享宏

出版者

愛知医科大学

雑誌

基盤研究(C)

巻号頁・発行日

2016-04-01

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感覚過敏は中枢神経感作とも重なる概念であるが、その評価は主観的なものに限られ、他覚的に定量化する試みは成功していない。治療法として弁別能力を向上させることが有効であると推測されるが、その生理学的評価を中心に研究を継続している。これまでは聴覚刺激による皮質反応を検討してきたが、触覚による評価も追加した。一連の研究から、触覚でも聴覚と同様の抑制が見られること、その抑制は情報の階層処理が進むほど強くなること、個体内で聴覚、触覚の抑制率に一定の傾向があることなどが分かっている。新しい生理指標として期待できるものであった。また異なる方法として、音圧変化の程度に応じて反応する聴覚誘発反応変化率(loudness dependence of auditory evoked potentials:LDAEP)についても検討し、それらが不安や特定の性格傾向と関連があるかどうかについて調べている。また、更に感覚過敏を社会関係性の視点から検討するために動物実験を追加している。このために高社会性げっ歯類であるハタネズミを用いた。これまで既に、絆が形成されたペアーを短期間離して飼育すると、機械刺激、熱刺激に対する反応性が増強すること、この過敏性は不安と関連していることを報告している。現在は感覚過敏の治療に応用するための正確な生理学的評価である聴覚、触覚刺激による脳内抑制機構の定量化の成果は得られているが、直接的に治療に結びつけ、論文発表に結びつけ、一定の成果を上げるにはさらに追加実験が必要であると考えたため、研究を1年延長した。

著者

水谷 みゆき 鈴木 千春 大道 裕介 櫻井 博紀 森元 温子 西原 真理 牛田 亨宏 新井 健一 佐藤 純

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.27, no.3, pp.175-188, 2012-08-10 (Released:2013-02-19)

参考文献数

44

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The effect of hypnotic intervention for the refractory chronic pain patients was examined along with the process of patients' selection and their psychological characteristics. The total 596 visit patients in the first year were statistically examined concerning duration of pain, scores of psychological distress (Hospital Anxiety and Depression Scale) and disability (Pain Disability Assessment Scale) at the initial visit and the treatment outcome at the end of the first year. The duration of chronic pain was significantly related to disability but not to psychological distress at the initial visit. At the end of the first year of multidisciplinary pain treatment, 44% of total patients were under treatment, 19% finished treatment (10% evidently improved and 9% accepted their pain), 12% were referred and 25% dropped out. The group of patients who were evidently improved was not different concerning the duration of pain, but significantly less anxious, less depressed and less disabled at the initial visit than the other groups. Among the 261 patients under treatment, 33 patients (5.6% of total patients) were introduced into individual psychological interventions in consideration of 1) poor outcome in pharmacological and physical treatments, 2) unstable treatment relationship and marked pain behaviors, 3) obvious psychological distress, 4) event-related fluctuations in pain. They were significantly more anxious and depressed at the initial visit, than those who were not introduced to psychological intervention. Multiple bio-psycho-social factors were identified; tender points in 21 patients (by physiotherapist), stressful life events around the onset of pain in 26, serious daily conflicts at present in 30, catastrophizing thinking in 21, repressive thinking in 12, avoidance in 2 and perseverative coping in 6. Many of them did not or partly perceive their somatic tension / discomfort. Multiple factors were considered to inhibit the effect of treatment in those patients. In individual hypnosis, therapeutic conversation, permissive induction and indirect suggestions were employed. Direct suggestions for analgesia were not applied. Among 33 patients, 25 patients experienced hypnotic analgesia during sessions, 14 of whom finished their sessions with the decreased daily pain level or the enhanced effect of medication until the end of the 3rd year. Among them, 5 patients evidently improved (one phantom limb pain and 4 other chronic pain). Hypnosis successfully helped 42% of the patients who had failed to respond to multi disciplinary treatment. The psychosomatic resources in patients need to be more attended and utilized in chronic pain treatment.

著者

河合 隆志 牛田 享宏 井上 真輔 池本 竜則 新井 健一 西原 真理

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.29, no.3, pp.181-189, 2014-08-30 (Released:2014-09-16)

参考文献数

20

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Many patients have neck and back pain, and their standing posture (spinal alignment) is sometimes considered to be one of the factors that contributes to such pain. Thus, it would be useful to evaluate spinal loads in that posture. A method to evaluate individual spinal loads using link segment models made from body mass distributions using DXA (dual–energy X–ray absorptiometry) was developed.   An element was defined as 1.30 × 1.22 cm, and a detailed body mass distribution consisting of 7473 elements was constructed using DXA equipment (QDR4500). The subjects' bodies were divided into cervicofacial (vertex–C7 ⁄ T1), thoracic (C7 ⁄ T1 – T12 ⁄ L1), and lumbar (T12 ⁄ L1 – L4 ⁄ 5) segments. Each mass, M1, M2, and M3, and the center of the masses were calculated. With these parameters and DXA images, each torque, TC7/T1, TT12/L1, and TL4/5, was calculated from the following formulas: TC7/T1 = M1gr1cosθ1, TT12/L1 = M1g (l2cosθ2 + r1cosθ1) + M2gr2cosθ2, and TL4/5 = M1g (l3cosθ3 + l2cosθ2 + r1cosθ1) + M2g (l3cosθ3 + r2cosθ2) + M3gr3cosθ3 (r1, r2, and r3: lengths from the rotation center to each center of mass; l2 and l3: lengths of C7 ⁄ T1 – T12 ⁄ L1 and T12 ⁄ L1 – L4 ⁄ 5; θ1, θ2, and θ3: angles formed between a horizontal line and r1, r2, and r3). In order to reproduce the standing posture on DXA, the standing side was formed by a vacuum cushion for operative position in advance.   The parameters from DXA in the lateral view were as follows. In case 1 (38–year–old man, healthy, 164.0 cm and 55.5 kg), they were M1 = 4.50, M2 = 13.24, M3 = 6.92 kg, TC7/T1 = –0.28, TT12/L1 = –3.80, and TL4/5 = –6.42 Nm (facing right, clockwise: positive). In case 2 (76–year–old man, lumbar spondylosis, 156.9 cm and 59.6 kg), they were M1 = 4.83, M2 = 14.27, M3 = 10.34 kg, TC7/T1 = –1.69, TT12/L1 = –16.1, and TL4/5 = –44.3 Nm. In case 3 (71–year–old woman, lumbar spondylosis, scoliosis, 147.2 cm and 49.0 kg), they were M1 = 4.63, M2 = 11.42, M3 = 5.36 kg, TC7/T1 = –2.53, TT12/L1 = –16.0, and TL4/5 = –27.0 Nm. Torques at L4/5 were 6.9 and 4.2 times greater in cases 2 and 3 than in case 1. Total masses calculated from DXA were 54.5, 59.0, and 47.6 kg, and errors between these and actual weights were –1.8, –1.0, and –2.9%, respectively.   A method for evaluating spinal loads as torques was developed using DXA. In the future, it will be possible to use this method to evaluate factors such as pain and the effect of rehabilitation. The relationships between torques and various scales (such as pain, depression, ADL, and QOL) need to be examined, taking into account age, sex, muscular strength, etc.