高齢者慢性腰痛症に対する薬物療法—プレガバリンとオピオイドの比較

Pharmacological Management of Chronic Low Back Pain in Older Patients—Effectiveness of Pregabalin and an Opioid

　背景：慢性腰痛症の薬物療法ではプレガバリンやオピオイドの有効性が報告される一方，副作用も少なくなく高齢者に対する投与は慎重に行われるべきである．

　対象と方法：非ステロイド性抗炎症薬(NSAIDs)無効例の65歳以上の慢性腰痛症65例に対するプレガバリンとオピオイドの効果を評価した．

　結果：両薬剤の効果には差がなかったが，効果発現時期はプレガバリン10.2日，オピオイド6.1日で有意差を認めた．プレガバリンは神経障害性疼痛に，オピオイドは非神経障害性疼痛に有効であった．

　まとめ：神経障害性疼痛を評価することにより，プレガバリンとオピオイドの使い分けが可能である．

　Methods：The effectiveness of pregabalin and an opioid in the treatment of chronic low back pain in older adults was investigated.　A total of 65 patients aged over 65 years were recruited, and the agents were administered.

　Results：Pregabalin was effective in 73.3% and the opioid in 83.3%, and the difference was not significant.　The average interval before effectiveness was noted was 10.2 days for pregabalin and 6.1 days for the opioid.　While pregabalin was more effective against chronic low back pain accompanied by neuropathic pain than non-neuropathic pain, the opioid was more effective against non-neuropathic pain.　There was greater improvement in activities of daily living with the opioid than with pregabalin.

　Conclusion：It is better to choose a medication that is effective against neuropathic pain, for elderly patients with chronic low back pain, and symptoms in the lower extremities may be an integral part of chronic low back pain as well as serve as a screening test.