運動器疾患における疼痛のマネージメント

Pain Management in Locomotive Disorder

はじめに

　運動器は骨格とともに身体を支え，筋肉・関節の協調・分離的な働きによって意思を具現化するために不可欠な器官である．痛みは外傷，炎症などトラブルを報せるシグナルであると同時に痛み刺激は運動器に対し筋力低下，筋萎縮，関節運動制限，筋痙縮・スパズム，浮腫を伴い効果的な働きを阻害する大きな要因となる．

　運動器における痛みは効果的な身体の働きを阻害するため，包括的に日常生活動作（ADL）障害をきたし生活の質（QOL）低下に陥りやすい．初期治療に反応せず長期・難治化すると全身的な廃用性障害を呈するようになり，さらに心理・社会的な要因も病態形成に加わることでいわゆる慢性疼痛に至る危険がある（図1）．

Abstract : Patients suffering from locomotive disorder often become anxious about their initial symptoms due to the inappropriate explanation about their condition and the treatment that they receive. Consequently, they then start criticizing people around them due to the irritation caused by not being able to see any improvement in their symptoms. This in turn causes depression, social withdrawal, and decreased self-appraisal, followed by a fixation on their status as chronic pain patients. It is easily conceivable that the onset of physical disuse atrophy along with the patients' inappropriate psychological state will further exacerbate the decline in their social functionality and self-appraisal. Thus, treatments aimed simply at relieving pain are usually ineffective. Care providers are therefore required to perform an exclusion diagnosis of all organic symptoms, an evaluation of the patient's physical functionality including activities of daily living, an ergonomic assessment of activities specific to certain occupations, and a psychological assessment. In order to deal with each issue in a concrete fashion, we suggest that a multidisciplinary treatment based on collaboration among a wide array of professionals such as doctors (physicians), psychiatrists, physical therapists, psychotherapists, and certified social workers can be effective.