慢性疼痛の内科治療

Medical Treatment of Chronic Pain

神経障害性慢性疼痛に対して国内10学会が協力した『慢性疼痛診療ガイドライン』が2021年に発表された。Ca^2＋チャネルα2δリガンド（プレガバリン・ガバペンチン・ミロガバリン）とデュロキセチンが使用を強く推奨される。三環系抗うつ薬を加えた3薬剤クラスは有痛性糖尿病性神経障害で鎮痛効果が同等であり，併用でさらに強い効果が期待できる。副作用や患者個別の状況を理解したうえでの治療戦略が重要である。

Abstract

Antinociceptive therapy for chronic neuropathic pain is anecdotal in nature based on a physician's preference. However, evidence-based therapy is expected, following the chronic pain guideline established in 2021, supported by 10 pain-associated Japanese medical societies. The guideline strongly recommends the use of Ca²⁺-channel α2δ ligands (pregabalin, gabapentin, and mirogabalin) and duloxetine for pain relief. International guidelines also recommend administration of tricyclic antidepressants as first-line agents. Recent studies have described three classes of medicines that show comparable antinociceptive effects in painful diabetic neuropathy. Furthermore, a combination of first-line agents can improve efficacy. Antinociceptive medical therapy should be individualized based on the patient's condition and adverse effect profile of each medication.