中枢性脳卒中後疼痛の多面的評価

抄録

Objective: The goal of treating chronic pain is becoming more focused on improving ADL and QOL than on pain itself. In this study, we evaluated patients with central post–stroke pain (CPSP) by a multifaceted evaluation and examined factors related to ADL and QOL.

Methods: Patient background, stroke information, motor and sensory disturbance, pain site and duration, pain scales (VAS and Short–form McGill Pain Questionnaire 2; SF–MPQ2), Pain Catastrophizing Scale, Hospital Anxiety and Depression Scale (HADS), Pain Disability Assessment Scale (PDAS), EQ–5D–5L were obtained from 41 patients with CPSP. The factors related to PDAS and EQ–5D–5L were investigated by univariate and multivariate analyses.

Results: The univariate analysis showed that the PDAS was associated with motor disturbance scale (SIAS–motor: r=−0.67, p<0.01) and pain scales (VAS: r=0.32, p=0.04; SF–MPQ2: r=0.31; p=0.04), while the QOL value (EQ–5D–5L) was associated with motor disturbance scale (SIAS–motor: r=0.55, p<0.01), pain scales (SF–MPQ2: r=−0.54, p<0.01; VAS: r=−0.48, p<0.01), degree of sensory disturbance (p<0.01), and mood status (HADS depression item: r=−0.56, p<0.01; HADS anxiety item: r=−0.37, p<0.01). In multivariate analysis, the PDAS was largely affected by SIAS–motor and SF–MPQ2, and the QOL value was affected by multiple factors such as the SIAS–motor, SF–MPQ2, degree of sensory disturbance and HADS depression item.

Conclusions: The ADL and QOL in patients with CPSP reflect not only pain, but also motor and sensory impairments, and mood status, which should be noted when assessing.