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1 ) 2) 1) 1) 1) 1 2 VASNRSCPT Sugawara Masaaki, Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Hongo Bunkyou-ku Tokyo , Japan
2 International Association for the Study of PainIASP ) NSAID 2 underlying tissue pathology 3) QOL ) McGill pain questionnaire; MPQ 6) 102
3 ) 10 8) 2 VASVisual analog scale 8-10) 100 mm 0 mm 100mm mm 1 NRS Numerical rating scalevas VAS
4 ) VRSVerbal rating scale Face scale VAS NRS 3 Face visual analog scale Face scale VAS 2 Face scale 100 mm 10) 11,12) 3 CPT Current Perception ThresholdCPT Pain Tolerance Threshold PTT CPT PTTNeurometer TM Hz A250Hz A5Hz CPT Within SitebRatio Normal Ratio Range Sample Subject Ratio 2 Hz/5Hz / (normal) 2Hz/250Hz /120=2.42(normal) 250Hz/5Hz /22=5.45(abnormal)
5 542 C CPT PTT CPT Neurometer TM Katims PHNComplex Regional Pain SyndromeCRPS 13,14) NMDA
6 Drug challenge testdct 15-17) PHNCRPS ) GABA 18 C mg 1 5 VAS mg 1 Sympathetically Maintaimd PainSMP SMP SMP VAS 2 5mg 1 5 VAS VAS 05mg 3 15mg VAS ) AC ) AC 1mg/1 mg/30 VAS 23) 4 N-methy 1-D-aspartic acid NMDA 2 4) Wind up Central sensitization NMDA
7 542 25) Central sensitization Central sensitization 15mg VAS 0 315mg VAS () 26) 5 27) 28) 1 3mg VAS mg Saberski Kitahata 29) failed back syndrome, 1 30) 2 31) 610 TM ,33) failed back syndrome, 34-36) MRI
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11 542 He-Ne TM TM 2 TM 11 EXCEL-Xe TM ) % 3080% SGB 39-42) SGB SGB Homer SGB He-Ne SL SG Local Xe He-NeHe-Ne 1000mWSL SG Local Xe
12 ) 44-47) 42,48) ,50) ,52) electro-acupuncture therapyeat EAT He-Ne SL Xe SG Local CRPS
13 542 EAT PHN11 Complex Regional Pain Syndrome CRPS Bell Ramsay-Hunt PHN VAS PHN 5 6 CRPS CRPS PHN EAT
14 Department of AnesthesiologyPain Relief Center multidisciplinary ; 75(7): ; 1(3): ; 6(4): : ; 20: S 87-S 93 6Holroyd KA, Holm JE, Keefe FJ et al. A multi-center evaluation of the Mc Gill Pain Questionnaire: results from more than 1700 chronic pain patients. Pain1992; 48: Jensen MP, Miller L, Fisher LD. Assessment of pain during medical procedures :a comparison of three scales. Clin J Pain1998; 14: ; 19(4): ; 19(4): VAS 1998; 19(4): Katims JJ CPT PTT 1998; 19(4): CPT 1999; 20(7): Pain Res. 2001; 16: ; 19(4): ; 50(7): ; 17(4): ; 19(4): Cai Z, McCaslin PP. Acute, chronic and diffe rentia effects of several anesthetic barbiturate on glutamate receptor activation in neuronal culturebrain Res1993; 611: Nagase M, Hanaoka K, Tagami M et al. The effect of pentobarbital sodium on the dorsal horn of the spinal cord. J Anesth. 1994; 8: Cleland CL, Lim FY, Gebhart GF. Pentobarbital prevents the development of C fiber
15 542 induced hyperalgesia in the rat. Pain. 1994; 57: (neuropathic pain) 1995; 16: ; 207: Tanelien DL, Maclever MB. Analgesic concentrations of lidocaine suppress tonic A delta and C fiber discharges produced by acute injury Anesthesiology. 1991; 74: (L-740) 1992; 26: Coderre TJ, Katz J, Vaccarino AL et al. Contribution of central neuroplasticity to pathological painreview of clinical and experimental evidence. Pain. 1993; 52: Anis NA, Berry SC, Burton NR et al. The dissoiative anaesthetics ketamine and phencyclidine selectively reduce excitation of central mammalian neurons by N-methyl-D-aspartate. Br J Pharmacol. 1983; 79: ; 24(4): Hanaoka K, Ohtani M, Toyooka H et al. The relative contribution of direct and supraspinal descending effects upon spinal mechanisms of morphine analgesiaj Pharmacol Exp Ther. 1978; 207: : Saberski LR, Kitahata LM. Directvisualization of the lumbosacral epidural space through the sacral hiatus. Anesth Analg. 1995; 80: : ; 24(5): Richardson J, McGurgan P, Cheema S et al. Spinal endoscopy in chronic low back pain with radiculopathy. A prospective case series. Anaesthesia. 2001; 56: Saberski LR, Kitahata LM. Persistent radiculopathy diagnosed and treated with epidural endoscopy. J Anesth. 1996; 1 0: , 2001; 22(12): ,,,,. )2002: ; 25(1): ; ; 21(1): ; 13(3): ; 43(3): ; 44(4): ; 29(1): ;
16 ; 12(2): ; 7(6): ; 7(6): ; 7(4): ; 18: ; 39(1): ; 16(1): ; 57(2): ; 1(1): :
17 542 Review Assessment and Treatment of Chronic Pain SUGAWARA Masaaki 1), YOSHIKAWA Keishi 2), HAYASHIDA Masakazu 3), ARITA Hideko 3), HANAOKA Kazuo 3) 1) Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital 2) Sports Medicine, Graduate School of Comprehensive Human Science, The University of Tsukuba Abstract The definition of Pain, an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage(international Association for the Study of Pain: IASP, 1994), which is often used to explain its subjectivity. It is necessary to evaluate the pain objectively for diagnosis and effectiveness of therapy. As an evaluation method of chronic pain, Visual Analog Scale (VAS) and Numerical Rating Scale (NRS) are used. Recent years, face visual analog scale and Current Perception Threshold (CPT) testing are also used commonly. Drug challenge test draws attention as it combines an evaluation method and an effective therapy. Meanwhile as a therapy of chronic pain, the reports of epiduroscopy and phototherapy are increasing. The epiduroscopy is an endoscopic operation for patients with the chronic low back pain. In Japan the therapy is performed increasingly for patients with the low back pain of spinal canal stenosis, failed back syndrome and lumbar disc herniation. Regarding the phototherapy, the reports which show the effectiveness of linear polarized infrared raytherapy and xenon phototherapy are mainly observed. Though the nerve block is still the dominant therapy in pain clinics, acupuncture therapy and phototherapy are prospected to increase their demands in future. Zen Nippon Shinkyu Gakkai Zasshi (Journal of the Japan Society of Acupuncture and Moxibustion: JJSAM). 2004; 54(2): Key words: chronic pain, VAS, NRS, Current Perception Threshold (CPT), drug challenge test, epiduroscopy, phototherapy, electro-acupuncture therapy
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