星総合病院での入院型ペインマネジメントプログラム

抄録

A biopsychosocial model of well–being is a very important concept in the multidisciplinary pain clinic. This model is a general model or approach stating that biological, psychological, and social factors play a significant role in human functioning in the context of disease or illness. There are few facilities in Japan that administer a multidisciplinary pain clinic, especially an inpatient pain management program. In Hoshi General Hospital we are implementing a multi disciplinary pain management program based on the biopsychosocial model, guided by IASP recommendations. The aim of this report is to describe our initial efforts in creating an inpatient pain management program using the biopsychosocial method of self–pain management. The pain management center started with a team consisting of orthopaedic surgeons, psychiatrists,physical therapists, clinical psychologists, nurses, pharmacists, and nutritionists. Our 3–week inpatient pain management program is indicated for patients who find it hard to work or go to school due to chronic pain, and/or are confined to life at home but want to return to work or school. The program consists of 1) measurements of physical fitness, and training with a physical therapist, 2) assertion and relaxation training, role–playing to increase healthy behavior and to decrease painful behavior led by a psychologist, and 3) a lecture ⁄ discussion by each specialist. The goals of the program are to return to a functional daily life habit, education to acquire coping methods for chronic pain, and to get into the habit of exercise. Finally, participation in lectures and psychotherapy programs is to include not only patients but also their family members or significant others. Using this program, our inpatients with chronic pain were evaluated using a numerical rating scale, a pain catastrophizing scale (rumination, magnification, and helplessness), a pain disability assessment scale, a hospital anxiety and depression scale, a pain self–efficacy questionnaire, the EQ–5D, and assessment of physical functions before and after treatment. Three patients have been treated during the first 8 months. The average change of outcomes among these patients before and after 3–week program were: 7.0 to 6.8 in numerical rating scale; 16.7 to 8.0, 15.7 to 10.3, 7.3 to 3.3 in each pain catastro phizing scale (rumination, magnification, and helplessness); 12.0 to 7.0, 14.3 to 8.3in the hospital anxiety and depression scale (anxiety and depression); 31.0 to 21.3 in the pain disability assessment scale; 16.0 to 32.0 in the pain self–efficacy questionnaire; 0.399 to 0.612 in the EQ–5D; and 25.3 cm to 33.7 cm in the static flexibility test. Thus, most outcomes were improved after the 3–week inpatient program. The results suggest that we may be able to improve the coping mechanisms of our patients for dealing with chronic pain, and that the program can improve their quality of life and flexibility. Our inpatient pain management program may be expanded to better serve chronic pain patients.