なぜわが国において術後痛の診療・研究が必要なのか？

Why are Postoperative Pain Management and Research Necessary in Japan?

はじめに

　術後痛の診療・研究は，患者の生活の質（quality of life：QOL）向上，慢性術後痛（chronic postsurgical pain：CPSP）の予防，高齢化社会への対応，国際基準との整合性，医療経済の効率化のために重要である。術後痛の適切な管理が行われなければ，運動制限や睡眠障害を引き起こし，回復の遅延や再入院リスクを高める。特に急性術後痛が適切に管理されないと，CPSPへ移行し，長期的な健康被害につながる。また，高齢化が進むなか，高齢患者では認知機能低下や合併症を考慮した個別化管理が必要であるが，標準化が進まず，多職種連携の術後疼痛管理チームの普及も限定的である。さらに，術後痛管理のガイドライン策定の遅れや，海外で標準的に使用される鎮痛薬の未承認（ドラッグロス）も課題となっている。本論文では，術後痛管理の歴史と現状を整理し，今後の展望を考察する。適切な術後痛管理の確立は，患者の健康のみならず，医療費削減や労働損失の軽減にも寄与するため，診療と研究の推進が急務である。

　Postoperative pain management and research are crucial in Japan for enhancing patients’ quality of life（QOL）, preventing the development of chronic postsurgical pain（CPSP）, improving the efficiency of healthcare, addressing Japan’s aging society, and aligning with international standards. Inadequate postoperative pain management can lead to movement restrictions and sleep disturbances, delaying patients’ recoveries and increasing the risk of their readmission. The insufficient management of acute postoperative pain in particular may result in the pain’s transition to CPSP, causing long-term health issues.

　As Japan’s population continues to age, personalized pain management that considers the possibility of cognitive decline and comorbidities in elderly patients becomes essential. However, the standardization of personalized pain management is lacking in Japan, and the country’s dissemination of multidisciplinary Acute Pain Service（APS）programs remains limited. Delays in the establishment of postoperative pain management guidelines and the unapproved status（i.e., drug loss）of analgesics that are commonly used internationally present further challenges.

　This paper reviews the history and current state of postoperative pain management in Japan and discusses future perspectives. Establishing appropriate postoperative pain management is an urgent task that not only benefits patient health but also contributes to reducing medical costs and healthcare labor losses.