外傷性頚部症候群に対するセロトニン・ノルアドレナリン再取り込み阻害剤（SNRI）の治療効果の検討―前向き無作為研究

Effects of Serotonin-noradrenaline Reuptake Inhibitor (SNRI) in the Treatment of a Whiplash-associated Disorder. : A Prospective Randomized Controlled Trial

　外傷性頚部症候群では，症状の遷延化にうつ状態が関与していると思われる症例が存在する．本研究の目的は，受傷後早期からうつ状態に対する治療を行うことにより，治療期間を短縮できるか否かを検討することである．対象は，交通事故による頚部愁訴で当科を初診した47名である．治療法は，ケベック・タスクフォースのガイドラインに準じた．対象を無作為にSNRI（セロトニン・ノルアドレナリン再取り込み阻害剤）投与群と非投与群に分け前向きに検討した．検討した項目は，症状軽快までに要した治療期間，Minnesota Multiphasic Personality Inventory（MMPI），および痛みのVASである．平均治療期間は，SNRI投与群で3.68±2.04週，非投与群では5.00±4.45週であった．SNRI投与群では治療期間が短い傾向にあった．SNRIの早期投与は，外傷性頚部症候群の治療期間を短縮できる可能性がある．

　Since depression may be related to the various symptoms in whiplash-associated disorder, we designed a prospective randomized controlled trial to determine whether a serotonin-noradrenaline reuptake inhibitor (SNRI) would be effective for the treatment of whiplash-associated disorder. Treatment was based on the guidelines of the Quebec Task Force. The subjects were 47 patients with neck symptoms related to traffic accidents, exclusive of infants, pregnant women, and patients with fractures and visceral injuries. The subjects were divided into a group treated with an SNRI and a control group. The responses of the groups to 11 questionnaires were compared. SNRIs are considered preferable to trycyclic antidepressants(TCAs)and selective serotonin reuptake inhibitors (SSRIs) because they have fewer side effects. The mean treatment period was 3.68±2.04 weeks in the SNRI group and 5.00±4.45 weeks in the control group. SNRI tended to reduce the duration of whiplash-associated disorder. In conclusion, early treatment with an SNRI may reduce the symptomatic period in whiplash-associated disorder.