著者

岡井 恒 古江 秀昌 吉村 恵

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.23, no.1, pp.11-18, 2008-02-20 (Released:2013-07-04)

参考文献数

16

被引用文献数

6 4

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Neurotropin®, a non protein extract from inflamed rabbit skin inoculated with vaccinia virus, is well known as an analgesic for chronic pain such as low back pain and postherpetic neuralgia, etc. In previous behavioral studies, we have shown that neurotropin activates the monoaminergic descending pain inhibitory system. In the present study, we examined the effects of neurotropin on serotonergic neurons in the nucleus raphe magnus (NRM, the origin of serotonergic descending pain inhibitory neuron) in the rostroventromedial medulla using whole-cell patch-clamp technique in brainstem slices. In some instances, recorded neurons were identified as NRM neurons with neurobiotin filled in the recording pipettes. NRM neurons had a resting membrane potential of about -60 mV. Bath application of neurotropin (1.0 NU/mL) depolarized NRM neurons, and it resulted in initiating an action potential under current-clamp conditions. Under voltage-clamp conditions at a holding potential of -70 mV, NRM neurons exhibited spontaneous excitatory postsynaptic currents (EPSCs). Neurotropin (0.2 - 1.0 NU/mL) did not change the frequency and amplitude of spontaneous EPSCs. However, neurotropin dose-dependently induced an inward current in approximately 60% of NRM neurons tested. The neurotropin-induced inward current was observed even in the presence of tetrodotoxin (1 µM). The reversal potential for the current was close to 0 mV, indicating that the neurotropin-induced current is mediated by the activation of non-selective cation channels. Neurotropin produced an inward current, in all neurons immunohistochemically stained for tryptophan hydroxylase (TPH), a marker for serotonergic neuron. These results indicate that neurotropin directly excites serotonergic NRM neurons without affecting the excitatory synaptic inputs to NRM neurons. This facilitatory action of neurotropin on serotonergic NRM neurons may have an important role for the neurotropin-induced analgesia.

著者

田口 徹

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.32, no.1, pp.19-24, 2017-03-31 (Released:2017-09-25)

参考文献数

20

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Fibromyalgia is characterized by systemic chronic pain. It accompanies a wide variety of symptoms, such as dysfunction in the autonomic nervous system, mental states, and locomotive activities. Fibromyalgia and related disorders are assumed to be heterogenous conditions with complicated pathologies driven by peripheral and central mechanisms. Using a reserpine–induced fibromyalgia model, a significant increase of mRNA expression in the dorsal root ganglion (DRG) was detected in the acid–sensing ion channel 3 (ASIC3) among several ion channels tested, which are responsible for pain, mechano–transduction, and the generation ⁄ propagation of action potentials. Behavioral mechanical hyperalgesia in this model was reversed by a selective blocker of ASIC3 (APETx2). Ex vivo single–fiber electrophysiological recordings revealed facilitation in the mechanical responses of mechano–responsive C–fibers both in the skin and muscle, whereas the proportion of mechanorespon sive C–nociceptors was paradoxically decreased. In the spinal dorsal horn microglial cells labeled with Iba1–immunoreactivity were obviously activated, especially in laminae I–II where the nociceptive input is mainly projected. Intraperitoneal injection of minocycline, which was applied preemptively and repeatedly for 4 consecutive days from 1 day before a series of reserpine injections, clearly suppressed the microglial activation and behavioral hyperalgesia. These results suggest that the increase in ASIC3 in the nociceptive afferents facili tated mechanical response of the remaining C–nociceptors,and that activated spinal microglia direct to intensify pain in this model. Pain may be further amplified by reserpine–induced dysfunction of the descending pain inhibi tory system, and by the decreased peripheral drive to this system resulting from a reduced proportion of mechano–responsive C–nociceptors.Persistent physical and psychological stress are associated with fibromyalgia. Changes in muscular nociceptors were systematically examined using two pain models induced by stress (repeated cold stress (RCS) and multiple continuous stress (MCS)). Mechanical response of C–nociceptors in RCS model was signifi cantly facilitated, whereas that in MCS model was unchanged. The result suggests that augmentation in the mechanical response of muscular C–nociceptors is involved in mechanical hyperalgesia in RCS, but not in MCS model. Different pathological mechanisms may underlie in pain induced by different type of stress.

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

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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.

著者

歌 大介 田口 徹

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.32, no.4, pp.280-287, 2017-12-20 (Released:2018-05-31)

参考文献数

23

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Fibromyalgia (FM) is characterized by chronic widespread pain with mecha­nical allodynia and hyperalgesia. However, the neural mechanisms of nociception and pain are largely unknown. The aim of this study was to examine the responsiveness of peripheral nociceptive afferents and super­ficial dorsal horn (SDH) neurons by using a manifest rat model of FM, that was induced by reserpine (RES) injection. Repeated administration of RES (1 mg/kg, s.c., once daily for three consecutive days) caused a significant decrease in the mechanical withdrawal threshold of the plantar skin. Single–fiber electrophysiological recordings in vitro revealed that mechanical responses of mechano–responsive C–fibers were increased, although the proportion of mechano–responsive C–nociceptors was paradoxically de­creased. Next, we performed in vivo extracellular recordings of the SDH neurons. Although the SDH neurons showed mechanical stimulus intensity–dependent increases in the discharge rate both in the vehicle (VEH) and the RES–injected group, the response magnitude was significantly greater in the RES–injected group. Some SDH neurons in the RES–injected rats exhibited spontaneous firing with low frequencies, although those in the VEH–injected rats did not. These results suggest that increased mechanical sensitivity of the mechano–responsive C–fibers and the SDH neurons are involved in mechanical allodynia and hyperalgesia in a rat model of RES–induced pain. Similar mechanisms may underlie in patients with FM.

著者

奥野 祐次

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.29, no.4, pp.233-241, 2014-12-10 (Released:2014-12-29)

参考文献数

17

被引用文献数

1 2

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Purpose: Neovessels and accompanying nerves are possible sources of pain. Previous work demonstrated that transcatheter arterial micro−emboliza­tion (TAME) for patients with adhesive capsulitis resulted in excellent pain relief. We hypothesized that abnormal neovessels also play an important role in nighttime shoulder pain with other conditions as well as adhesive capsulitis and that TAME can relieve pain.   Material and Methods: TAME using imipenem ⁄ cilastatin sodium as an embolic agent proceeded to seventeen shoulders in sixteen patients, including adhesive capsulitis (n=6), subacromial impingement syndrome (n=7), rotator cuff tear without surgical indication (n=2), stiff shoulder (n=1), and chronic pain post scapula fracture (n=1). All patients had nighttime shoulder pain and previous conservative therapies applied for at least three months and persisted moderate−to−severe pain (Visual Analog Scale > 50 mm) before treatments. Adverse events, changes in Visual Analog Scale scores of night pain, and changes in self reporting sleep quality scores were assessed at 1 week and at 1, 3, and 6 months after the procedure.   Results: Abnormal neovessels were identified in all cases. No major adverse events were related to the procedures. Transcatheter arterial micro− embolization rapidly decreased nighttime pain visual analog scale scores from 72 ± 7 mm to 42 ± 26 mm at 1 week after the procedure, with further improvement at 1, 3 and 6 months (28 ± 22 mm, 19 ± 24 mm, and 16 ± 23 mm respectively). Self reporting sleep quality scores and nighttime pain frequency improved and maintained for 6 months.   Conclusion: Abnormal neovessels were observed in all patients. TAME of this lesion was feasible, effectively relieved unrelenting chronic night shoulder pain.

著者

重藤 隼人 田中 陽一 古賀 優之 大住 倫弘 森岡 周

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.35, no.3, pp.133-140, 2020-09-30 (Released:2020-09-30)

参考文献数

23

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Central sensitization (CS) and psychological factors are associated with pain intensity. However, it has remained unclear whether the effects of central sensitivity syndromes and cognitive ⁄ emotional factors differ depending on the severity of pain and the pain quality. Our purposes were to perform subgrouping based on central sensitivity syndromes and pain intensity, and to clarify the difference in central sensitization syndrome and pain intensity between subgroups.Fifty–nine patients with musculoskeletal pain were included in this cross–sectional study. Pain intensity and psychological problems were assessed with Central sensitization inventory (CSI–9), Short–Form McGill Pain Questionnaire 2 (SFMPQ2), Hospital Anxiety and Depression Scale (HADS), Pain Catastrophizing Scale (PCS–4). The cluster analysis with a ward method was used to divide patients into subgroups based on central sensitization syndrome and pain intensity. In addition, Kruskal–Wallis test, multiple comparison (Bonferroni method), and Fisher’s exact test were performed to compare clinical outcomes between subgroups. The level of significance was set at 5%.The cluster analysis classified into three subgroups. One subgroup of patients (n=11) was characterized by high level of central sensitivity syndromes, pain intensity and psychological problems. A second subgroup (n=19) was characterized by low level of central sensitivity syndromes, moderate level of pain intensity, high level of psychological problems. The third subgroup (n=29) was characterized by low level of central sensitivity syndromes, pain intensity and psychological problems. That is, one subgroup was mainly affected with central sensitivity syndromes, and another subgroup was affected psychological factors. These results indicated the differences in pain mechanism among subgroups.

著者

大住 倫弘 草場 正彦 中野 英樹 森岡 周

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.165-174, 2012-08-10 (Released:2013-02-19)

参考文献数

29

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Habituation to pain has been addressed in many recent studies. It is clear that patients with chronic pain do not become habituated to the pain; however, little is known about habituation to the inner experience of pain. We investigated the brain mechanisms underlying habituation to the inner experience of pain by using event-related potentials (ERPs), which provide superior temporal resolution, and low-resolution brain electromagnetic tomography (LORETA), which enables identification of regions of nervous activity. Fifteen healthy subjects participated in this study. The subjects were shown 4 sets of photographic images, with each set shown 30 times. The images included 15 images of a hand subjected to pain (painful condition). The subjects were instructed to imagine themselves in that condition and to imagine the pain they may experience in such a situation (inner experience of pain). Electroencephalography was continuously performed via 128 scalp electrodes mounted on an electrode cap. ERPs were recorded during the inner experience of pain; we also recorded N110 responses for emotional components and P3 responses for cognitive evaluation. To investigate habituation to the inner experience of pain, the mean amplitudes of P3 and N110 recordings were calculated for the first 2 (early sets) and last 2 (late sets) sets of trials for each painful condition; next, early sets were compared with late sets. We also analyzed the change in nervous activity after habituation to the inner experience of pain by LORETA analysis. The amplitude of central P3 responses was significantly lower for the late image sets than the early image sets of the painful condition. However, the mean amplitude of N110 responses did not significantly change. LORETA analysis of P3 responses showed reduced activity in the left secondary somatosensory area and left posterior insular cortex, indicating that the sensory component of the inner experience of pain was lower in the late sets than in the early sets. During habituation to the inner experience of pain, the P3 response, which is related to cognitive evaluation of this experience, changed, and brain activity, which reveals the sensory component of the inner experience of pain, reduced. Our study suggests that habituation to the inner experience of pain occurs at the point of recognition of the sensory component of pain. We hypothesize that pain recognition necessary for habituation to the inner experience of pain.

著者

郭 泰植

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.324-335, 2019-12-20 (Released:2020-03-14)

参考文献数

34

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Although migraine has been reported to have different inducing factors, changes in weather parameters such as atmospheric pressure, rain, humidity, temperature, wind, and lightning are well known important environmental factors. In recent years, reports of abnormal weather conditions such as heat waves in summer, heavy snow in winter, localized heavy rain, and abnormally light rain, as well as tropical cyclones are increasing. In today’s extreme weather conditions, the worsening, diver­sification, and chronicity of migraine symptoms is concerning, and a higher level of treatment for migraine is required than ever before. Drug therapy is used as the principal treatment for migraine. If the acute treatment alone interferes with daily life, the principle is to combine daily preventive therapies to reduce the frequency, severity, and duration of the migraine attacks. However, there are several cases wherein migraine is poorly controlled only with their combination. Several patients with migraine experience prodromal symptoms, including stiff neck and shoulder as well as sensitivity to light and sound, before migraine attacks. In recent years, it has been reported that sensors for detecting atmospheric pressure exist in the vestibular part of the inner ear, and it has been shown that changes in atmospheric pressure may activate the vestibular nerve activity. We reported that difenidol, a vestibular nerve modulator, was administered to prevent or alleviate migraine attacks during the prodromal phase caused by change in weather. Prevention during the prodromal phase and prevention based on weather prediction are new treatment strategies for migraine. In today’s extreme weather conditions, 3–P therapy that combines the three treatment strategies of prevention, prodrome, and prediction is useful.

著者

柴田 政彦 寒 重之 大迫 正一 三木 健司 栁澤 琢史 助永 憲比古 恒遠 剛示 新田 一仁 岩下 成人 福井 聖 黒崎 弘倫 中野 直樹 若泉 謙太 上嶋 江利 本山 泰士 高雄 由美子 溝渕 知司

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.31, no.4, pp.189-196, 2016-11-26 (Released:2017-01-27)

参考文献数

37

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The review was performed to investigate the functional brain alterations in patients with various kinds of chronic pain including fibromyalgia, chronic low back pain, migraine and the other chronic pain conditions. In these patients functional connectivity was different not only in the sensory–motor system but also in the affective and reward system. New technology have allowed us to identify and understand the neural mechanisms contributing to chronic pain, which provides us novel targets for future research and treatment.

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

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

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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

岡井 恒 岡﨑 良平 吉田 広幸 難波 宏好 田口 一貴 山本 任 三浦 智士 河村 稔

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.25, no.3, pp.179-188, 2010-08-10 (Released:2013-06-22)

参考文献数

22

被引用文献数

1

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Neurotropin® (NTP), a non protein extract from inflamed rabbit skin inoculated with vaccinia virus, is well known as an analgesic for chronic pain such as low back pain and postherpetic pain. In previous study, we revealed that NTP activated monoaminergic descending pain inhibitory system in SART (specific alternation of rhythm in temperature) stressed animals. To clarify the details of antinociceptive mechanisms of NTP, we investigated the influence of chemical denervation of monoaminergic neurons on the antinociceptive effect of NTP in SART-stressed rats. First, serotonergic neurons of nucleus raphe magnus (NRM) were chemically denervated by injection of 5,7-dihydroxytryptamine (50 nmol / 1 µL / site). Chemical denervation of NRM serotonergic neurons decreased the contents of spinal serotonin but not noradrenaline and dopamine, and decreased nociceptive threshold in rats. SART stress decreased nociceptive threshold in non-denervated rats but not in denervated rats whose threshold was already decreased. NTP (200 NU/kg, p.o.) showed an antinociceptive effect in non-denervated rats exposed to SART stress but had no effect in NRM-denervated rats exposed to SART stress. Next, we denervated spinal noradrenergic terminals by intrathecal injection of 6-hydroxydopamine (1 µmol / 10 µL / site) because some noradrenergic neurons are descending from some supraspinal noradrenergic nucleus to spinal cord. Chemical denervation of spinal noradrenergic neurons decreased the contents of spinal nor adrenaline but not serotonin and dopamine in rats. Similar to denervation of NRM serotonergic neurons, nociceptive threshold was decreased by chemical denervation of spinal noradrenergic neurons. SART stress decreased the nociceptive threshold in non-denervated rats, and that was improved by NTP (200 NU/kg, p.o.). SART stress did not affect the decreased threshold in denervated rats and NTP (200 NU/kg, p.o.) had no effect in denervated rats exposed to SART stress. These results suggest that antinociceptive effects of NTP in SART-stressed rats involve the activation of monoaminergic descending inhibitory neurons.

著者

植田 弘師

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.32, no.4, pp.239-245, 2017-12-20 (Released:2018-05-31)

参考文献数

30

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We have firstly demonstrated that LPA1 receptor signaling initiates the neuropathic pain and underlying mechanisms including dorsal root (DR) demyelination and up–regulation of Cavα2δ1 in dorsal root ganglion (DRG), which are supposedly related to allodynia and hyperalgesia, respectively. Since this report, we have accumulated the findings supporting this discovery. They are the findings that LPA is produced in the spinal dorsal root upon the partial ligation of sciatic nerves of mice, the LPA production is self–amplified through activations of LPA1 ⁄ 3 receptors and microglia. Thus produced LPA may go back to DR and DRG and cause abnormal pain behavior. All these mechanisms may develop the feed–forward amplification of abnormal pain mechanisms, or pain memory. On the analogy of this neuropathic pain, we tested the involvement of LPA1 receptor signaling in experimental fibromyalgia–like mouse models, such as intermittent psychological stress (IPS)–, intermittent cold stress– and repeated intramuscular injection of acid saline–induced models. The deficiency of LPA1 receptor completely lost the hyperalgesia in all these models. The repeated treatments with LPA1 antagonist AM966 completely cured the established pain in the IPS model. All these findings demonstrate that LPA1 signaling plays key roles in the development and maintenance of chronic pain.

著者

吉野 敦雄 岡本 泰昌 神人 蘭 森 麻子 山脇 成人

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.32, no.4, pp.260-266, 2017-12-20 (Released:2018-05-31)

参考文献数

17

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Chronic pain affects many people and decreases their physical or emotional functioning and their quality of life, and impairs their ability to work. Psychological factors such as depression and less activities lead to chronicity of pain, and multidimensional treatments including psychotherapy for chronic pain patients are required. Cognitive behavioral therapy (CBT) is one of the psychotherapy treatments, and is required positive attitude that patients objectively monitor one’s own emotion, sensation, and social environments and that they continuously modify these maladaptive behavior and cognition, rather than negative attitude. By using acquired skills, they can learn to be able to control their symptoms by themselves. Many meta–analyses show that CBT is more useful for pain experiences, mental health, and social functioning than only drug medication. We have also developed a CBT program for patients with chronic pain since 2011 and have confirmed the improvement of subjective pain perception, depression, anxiety, and QOL after CBT. In this manuscript, we report the concrete program. Furthermore, clinical effects of our program were variable, and lastly, psychosocial or neuroscientific considerations were given to make this program more effective in the near future.

著者

松平 浩 藤井 朋子

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.32, no.4, pp.252-259, 2017-12-20 (Released:2018-05-31)

参考文献数

22

被引用文献数

1

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A stratified approach for low back pain (LBP) involves targeted treatment for subgroups of patients classified according to their key characteristics such as prognostic psychological factors. This approach tailors therapeutic decisions in ways that maximize treatment benefit and reduce medical care costs. A stratified approach was known as the “Holy Grail” in back pain research over a decade ago.Psychological factors strongly influence the chronicity of LBP. Evidence suggests that fear avoidance beliefs are prognostic for poor outcomes in subacute LBP. Thus, early treatment, including interventions aimed to reduce fear avoidance beliefs, may prevent delayed recovery and chronicity.A recent development in the stratified approach is to use brief risk prediction tools such as the short–form Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) and the Keele STarT Back Screening Tool (SBST). These tools identify patients with an increased likelihood of delayed recovery, and facilitate intervention for these patients from day 1, rather than waiting for failure of the first–line care. These tools can also help clinicians to better understand the reasons for a potentially poor prognosis and to choose interventions accordingly. Both of these screening tools focus on assessment of key psychological factors such as fear avoidance beliefs.Somatic symptom burden is used to evaluate the severity and course of illness. Co–existence of various somatic symptoms including multisite pain may be the core feature of central dysfunctional pain. The 8–item Somatic Symptom Scale (SSS–8) was recently developed as a brief, patient–reported measure of somatic symptom burden. We believe this tool to be useful for screening for functional somatic syndrome including chronic widespread pain.

著者

坪川 孝志

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.7, no.1, pp.1-8, 1992-03-31 (Released:2014-06-19)

著者

山田 恵子 壬生 彰 向後 響 井関 雅子 西上 智彦

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.36, no.1, pp.1-14, 2021-04-30 (Released:2021-06-18)

参考文献数

9

被引用文献数

1

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The Pain Disability Index (PDI) is a self–reported outcome measure initially developed in English to assess disability caused by pain in seven dimensions of daily life activity, including family ⁄ home responsibilities, recreation, social activity, occupation, sexual behavior, self–care, and life–support activity. This study aimed to develop a linguistical­ly valid Japanese version of the PDI (PDI–J) according to the guidelines for the translation and cultural adaptation of patient–reported outcome measures establish­ed by the task force of the International Society for Pharmacoeconomics and Outcomes Research. A draft of the PDI–J was developed through a forward translation of the original PDI from English to Japanese, reconciliation of the translation, back–translation from Japanese to English, and harmonization. We subsequently conducted a cognitive debriefing in five patients using the PDI–J draft and reviewed it before finaliz­ing a linguistically valid PDI–J. We also considered a five–item version of the PDI (PDI–5–J), which excluded two items (sexual behavior and life–support activity) from the original version. This consideration was made for brevity and because sexual behavior is a considerably personal parameter that some patients may be reluctant to answer and life–support activity because it was considered ambiguous in Japanese. Therefore, we were able to develop a linguistically valid PDI–J and PDI–5–J through this process. Further study is warranted to confirm the psychometric validity and reliabili­ty of the two indices (PDI–J and PDI–5–J).

著者

福井 晴偉 大瀬戸 清茂 塩谷 正弘 有村 聡美 大野 健次 唐澤 秀武 長沼 芳和 湯田 康正 羽尻 裕美 小澤 みどり

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.11, no.1, pp.29-34, 1996-03-31 (Released:2014-06-19)

著者

山下 敏彦

出版者

日本疼痛学会

雑誌

PAIN RESEARCH (ISSN:09158588)

巻号頁・発行日

vol.30, no.4, pp.199-207, 2015-12-10 (Released:2016-01-06)

参考文献数

20

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The incidence of chronic pain among the adult Japanese population has been reported to be around 23%. In the majority of cases, the site of chronic pain is located in the musculoskeletal system, such as the lumbar spine, neck and shoulder joint. Based on the pain mechanism, musculoskeletal chronic pain is classified as chronic nociceptive pain, neuropathic pain or mixed pain. Psycho–social factors often affect clinical symptoms in chronic pain cases.   The first choice of medication for chronic nociceptive pain, resulting from conditions such as inflammation or degeneration of joints or spine, is nonsteroidal anti–inflammatory drugs (NSAIDs). Cox 2 selective inhibitors should be used in cases of long–term use to avoid gastrointestinal problems. Although opioids may be applied in cases in which NSAIDs have no effect, attention should be paid to potential side effects such as nausea and consti-pation, abuse and addiction. Physical therapy including muscle stretching and strengthening is a very important therapeutic modality for chronic noci-ceptive pain. Surgical treatment, such as arthroplasty and spinal fusion, may also be applied in cases in which conservative treatments fail.   As NSAIDs are not effective for neuropathic pain caused by disorders and diseases of nervous system, pregabalin (Ca2+ channel blocker), anti–depressant s and opioids may be applied. Surgery intervention, including laminectomy, discectomy or neurolysis for the purpose of nerve decompres-sion, may be applied in cases in which conservative treatment fail or nerve palsy is observed. For difficult chronic pain cases with psycho–social factors, a multidisciplinary approach including cognitive behavioral therapy should be considered.

著者

池本 竜則 中田 昌敏 梶浦 弘明 宮川 博文 長谷川 共美 井上 雅之 下 和弘 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.29, no.1, pp.31-40, 2014-03-10 (Released:2014-03-29)

参考文献数

19

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Musculoskeletal pain and other clinical complaints are known to increase with age, however its relationship to these symptoms remains unclear. In this study, we investigated the correlation between musculoskeletal pain and other clinical complaints. Questionnaires containing self–reported complaints collected from 3891 people over 30 years old were used for our study. Serf–reported complaints comprised of 33 items including three musculo­skeletal disorders (knee, low back, neck) and another thirty complaints. Firstly, we divided subjects into the following eight different categories by their musculoskeletal condition; a group without musculoskeletal disorder (Control), a group with knee pain alone, a group with low back pain alone, a group with neck stiffness alone, three groups which had overlapping pain in above two regions and a group with overlapping pain in all regions. Secondly, we investigated the epidemiological background and analyzed the number of other complaints in each group.   In terms of epidemiological background, the ages in groups with any musculoskeletal disorders were significantly higher than those in control. Moreover, groups with musculoskeletal disorders except low back pain alone were significantly more prevalent in women. Groups with any musculo­skeletal disorders had significantly greater numbers of other complaints compared to control. Comparing the three groups with mono–regional pain, we discovered the number of other complaints was more significant in the group with neck stiffness than in the other two groups. The theoretical number of other complaints in a group with pain in all regions was significantly greater than the sum in each group with mono–regional pain.   These findings suggest that musculoskeletal disorders are not only a regional problem but also affect other organs in the human body, followed by an increase of other unidentified complaints.