緒言とまとめ

Current Status and Future Perspectives of Postoperative Pain Management and Research：Preface and Comments

　厚生労働省保健局が管理しているレセプト情報・特定健診等情報データベース〔National Database of Health Insurance Claims and Specific Health Checkups of Japan（NDB）オープンデータ〕のL008算定回数をもとに，わが国で実施されている全身麻酔管理手術件数を概算すると，2014年度の約326万件から2023年度には437万件へと右肩上がりに増加している^1）。程度の差はあれ，ほぼすべての症例で術後痛が生じていることを考えると，年間400万件を超える術後痛が発生している計算になる。術後痛は，予後や術後の回復，日常生活動作（activities of daily living：ADL）やquality of life（QOL）に直接影響するのみならず，急性期痛の強さが慢性術後痛の発症に関与していることも指摘されており^2），術後急性期痛管理の重要性は周知のとおりである。

　According to Japan’s National Database of Health Insurance Claims and Specific Health Checkups（NDB）, the annual number of surgeries performed under general anesthesia in Japan increased from 3.26 million in 2014 to 4.37 million in 2023. Since nearly all surgical patients experience some degree of postoperative pain, this represents an annual total of over four million cases involving postoperative pain. Postoperative pain not only affects patients’ recovery, activities of daily living, and quality of life but is also implicated in the development of chronic postsurgical pain, highlighting the importance of the optimal management of acute pain.

　In recent years, multidisciplinary postoperative pain management teams have rapidly expanded in Japan, particularly following the 2022 introduction of financial incentives for Acute Pain Service（APS）-type care. APS interventions have been shown to reduce patients’pain intensity, perioperative complications, analgesia-related adverse events, and the length of hospital stays while improving patient satisfaction. Japan’s first evidence-based guideline on postoperative pain was published in March 2025, promoting standardized, team-based care across institutions.

　Despite advances, the analgesics that are currently in use, i.e., opioids, NSAIDs, and acetaminophen have remained largely unchanged for decades, underscoring the need for both clinical studies optimizing multimodal analgesia and basic research to clarify analgesic mechanisms of action and identify new therapeutic targets. This special issue reviews current practices, challenges, and future directions in postoperative pain management in Japan.