PAIN RESEARCH
Online ISSN : 2187-4697
Print ISSN : 0915-8588
ISSN-L : 0915-8588
28 巻, 1 号
日本疼痛学会誌
選択された号の論文の5件中1~5を表示しています
原著
  • 矢吹 省司, 菊地 臣一, 紺野 愼一
    2013 年 28 巻 1 号 p. 1-8
    発行日: 2013/03/10
    公開日: 2013/04/04
    ジャーナル フリー
     Cervical spondylotic myelopathy (CSM) is a disease showing various symptoms such as numbness of upper and lower extremities, disturbed fine motor skills, and gait disturbance due to spinal cord compression. CSM causes high degree of ADL (activities of daily living) disturbance due to these symptoms. Some patients show allodynia or hyperalgesia in upper and lower extremities. However, neuropathic pain in patients with CSM has not been paid attention as much as pain following spinal cord injury. The purpose of the current study was to determine the incidence of severe allodynia or hyperalgesia in upper and lower extremities in patients with CSM, and to clarify the characteristics of these patients. This study was approved by our IRB. A questionnaire was sent to 317 patients with CSM who were surgically treated in our hospital during the past 20 years. Data from 139 cases were available for analysis. Subjects were divided into two groups: Severe Pain group (NRS (numerical rating scale) of allodynia or hyperalgesia in upper and lower extremities was 5 and more than 5) and Light Pain group (NRS was less than 5). Age, gender, QOL (EQ-5D and SF-36), JOACMEQ (myelopathy evaluation questionnaire), McGill Pain Score, and the Neuropathic Pain Symptom Inventory were compared between these two groups. Non-parametric tests were used for statistical analysis. There were 57 cases (41%) in the Severe Pain group and 82 cases (59%) in the Light Pain group. There were no differences in age and gender between two groups. However, the EQ-5D was 0.560 ± 0.152 in the Severe Pain group and 0.698 ± 0.179 in the Light Pain group (p<0.001). On the SF-36, all 8 items showed lower scores in the Severe Pain group compared to the Light Pain group (p<0.005〜0.001). On the JOACMEQ, all 5 items showed worse scores in the Severe Pain group compared to the Light Pain group (p<0.05〜0.001). The McGill Pain Score was 8.10 ± 7.79 in the Severe Pain group and 2.47 ± 5.23 in the Light Pain group (p<0.001). The total score of the Neuropathic Pain Symptom Inventory was 22.92 ± 23.72 in the Severe Pain group and 8.03 ± 14.10 in the Light Pain group (p<0.001). There were 41% of patients showing severe allodynia or hyperalgesia in upper and lower extremities in CSM. These patients showed lower QOL and severe myelopathy. We should pay attention to allodynia or hyperalgesia in upper and lower extremities in patients with CSM.
  • 松下 晋大, 藤田 亜美, 水田 恒太郎, 大坪 瀬奈, 蒋 昌宇, 上村 裕平, 小杉 寿文, 熊本 栄一
    2013 年 28 巻 1 号 p. 9-21
    発行日: 2013/03/10
    公開日: 2013/04/04
    ジャーナル フリー
     Traditional Japanese medicine (Kampo medicine) is known to have a variety of pharmacological actions including antinociception. We have recently revealed that transient receptor potential (TRP) channel agonists such as capsaicin, zingerone [each TRP vanilloid-1 (TRPV1) agonist] and (-)-menthol [TRP melastatin-8 (TRPM8) agonist], which are contained in capsicum, ginger and peppermint, respectively, have an inhibitory action on nerve conduction without TRP channel activation. Taking into consideration that Kampo medicine contains many plant-derived chemicals, it is possible that this inhibits nerve conduction. The present study examined how several kinds of Kampo medicine and also its related chemicals affect compound action potentials (CAPs) recorded from the frog sciatic nerve by using the air-gap method. Daikenchuto, rikkosan, kikyoto and rikkunshito reduced the peak amplitude of the CAP in a concentration-dependent manner; daikenchuto had an IC50 value of 1.1 mg/ml. When examined at a concentration of 2 mg/ml, the extents of the reductions by daikenchuto, rikkosan, kikyoto and rikkunshito were 70, 30, 25 and 15%, respectively. Daikenchuto being the most effective in inhibiting CAPs is composed of three kinds of extract powder, ginseng, Japanese pepper and processed ginger, in which are contained not only TRPV1 but also TRP ankyrin-1 (TRPA1) agonists. When the actions of daikenchuto-related chemicals on frog CAPs were examined, a TRPV1 agonist piperine (in black pepper) at 70 µM reduced CAP peak amplitude by 20%, and TRPA1 agonists, allyl isothiocyanate (in wasabi) and cinnamaldehyde (in cinnamon), reduced the amplitude with the IC50 values of 1.4 mM and 1.2 mM, respectively. These results indicate that Kampo medicine has an ability to inhibit nerve conduction. It is suggested that this action of Kampo medicine, particularly daikenchuto, may be partly due to nerve conduction inhibition by plant-derived TRP agonists contained in Kampo medicine.
  • 平川 善之, 原 道也, 藤原 明, 花田 弘文, 森岡 周
    2013 年 28 巻 1 号 p. 23-32
    発行日: 2013/03/10
    公開日: 2013/04/04
    ジャーナル フリー
     Total knee arthroplasty (TKA) is a surgical treatment for conditions such as knee osteoarthritis; the treatment aims to relieve knee pain and improve quality of life. Treatment outcomes are stable; however, it has been reported that postoperative pain becomes chronic in 15 - 20% of cases. The aim of this study was to examine the factors involved in the chronicity of postoperative pain by investigating the effects of cognitive and psychological factors on postoperative pain at 3 weeks, 5 weeks, and 4 months post-operation. Subjects were 50 patients who underwent TKA (8 men and 42 women, mean age: 74.8 ± 6.5 years). Cognitive factors in this study comprised an assessment of neglect-like symptoms; such symptoms included decreased “cognitive function regarding the existence of one's own limbs" or “cognitive function regarding the motion perception of one's own limbs." The severity of these symptoms was assessed using the method described by Galar et al. Psychological factors comprised assessments of anxiety and catastrophic thinking about pain. Anxiety was assessed using the state-trait anxiety inventory, while catastrophic thinking about pain was assessed using the pain catastrophizing scale (comprises categories of helplessness, magnification, and rumination). Postoperative pain was assessed using a visual analog scale (VAS). Multiple regression analysis by using VAS as the dependent variable and all other factors as independent variables showed the following factors to be significantly correlated with VAS: neglect-like symptoms at 3 weeks, 5 weeks, and 4 months post-operation and rumination at 3 weeks and 4 months post-operation. Sensory integration becomes difficult because of decreased sensory function in neglect-like symptoms; this is thought to be caused by body image becoming inaccurate. On the basis of these findings, it is considered necessary to approach for the improvement of sensory function in postoperative rehabilitation. In addition, rumination is persistent in pain, which is believed to result in a prognosis of a psychological state of severe anxiety. Therefore, methods for dealing with postoperative pain and giving patients a prognosis that is as precise as possible are thought to be necessary. These measures are thought to be factors in relieving postoperative pain and preventing it from becoming chronic.
  • 岡田 明子, 鈴木 郁子, 中谷 有香, 小林 真之, 鰕原 賀子, 今村 佳樹, 岩田 幸一
    2013 年 28 巻 1 号 p. 33-41
    発行日: 2013/03/10
    公開日: 2013/04/04
    ジャーナル フリー
     It is well known that the trigeminal nerve injury such as tooth extraction or pulpectomy sometime causes severe pain (neuropathic pain) in the orofacial regions. The orofacial neuropathic pain caused by trigeminal nerve injury is difficult to diagnose and treat because of the complexity of its neuronal mechanism. It is very important to evaluate the neuronal mechanisms underlying orofacial neuropathic pain, in order to develop the appropriate approaches to treat neuropathic pain patients. For this purpose, we developed the rats model with trigeminal nerve injury (inferior alveolar transection: IANX) in which mechanical allodynia and hyperalgesia occurred in the whisker pad skin. Recently, it has been reported that the sciatic nerve injury causes a down-regulation of potassium-chloride exporter KCC2 in the spinal dorsal horn neurons, contributing to the development of neuropathic pain in the foot.
     We hypothesized that down-regulation of GABA transporter might be involved in an increase in the excitability of the trigeminal subnucleus caudalis (Vc) neurons after IANX, involving in the development of orofacial neuropathic pain in the whisker pad skin. For this purpose we introduced, VGAT-Venus A (VA) expressing rats which coexpressed fluorescent protein and the vesicular GABA transporter in the Vc neurons to analyze the functional changes in GABAergic neurons in the Vc, and mechanical nocifensive behavior, KCC2 immunohistochemistry and single neuron activity were precisely analyzed in the rats with IANX at 21 days after IAN transection.
     Head-withdrawal threshold to mechanical stimulation of the whisker pad skin significantly decreased in IANX-rats 7 and 21 days after IAN transection. Majority of KCC2 positive VA neurons was significantly decreased in IANX rats 21 days after IAN transection. The neuronal excitability of Vc nociceptive neurons was enhanced after intrathecal administration of R-DIOA in the Sham rats.
     These findings revealed that the functional change from inhibitory to excitatory might be induced in GABAergic interneurons after IANX, suggesting that the neuroplastic change in the GABAergic neuronal network in the Vc is involved in the trigeminal neuropathic pain after IANX.
  • 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
    2013 年 28 巻 1 号 p. 43-53
    発行日: 2013/03/10
    公開日: 2013/04/04
    ジャーナル フリー
     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.
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