慢性術後痛の予防的観点から術後疼痛管理の未来を考える 継続的な疼痛管理とチーム医療の必要性
「はじめに」術後痛という用語は, 手術直後の痛みから遷延化した慢性の痛みまで, 広い範囲で使用されている. 一方で近年, 急性痛と慢性疼痛を全く別のものとして扱う風潮にあるが, 術後痛や外傷後痛, 帯状疱疹関連痛などに関しては, 同一患者がそれぞれの時期に経験する「不快な感覚と情動体験」である. そのため理想的には連続性のある治療やケアが望まれる. しかし, 現状では周術期の急性痛に対しても十分な疼痛緩和ができない環境に置かれている場合もあり, さらに本邦においては, 亜急性期痛が遷延し慢性化した状態でペインクリニックや痛みセンターを受診することも多い. 術後痛の多くが組織修復の過程で消失する...
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| Published in | PAIN RESEARCH Vol. 35; no. 1; pp. 1 - 9 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本疼痛学会
31.03.2020
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0915-8588 2187-4697 |
| DOI | 10.11154/pain.35.1 |
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| Abstract | 「はじめに」術後痛という用語は, 手術直後の痛みから遷延化した慢性の痛みまで, 広い範囲で使用されている. 一方で近年, 急性痛と慢性疼痛を全く別のものとして扱う風潮にあるが, 術後痛や外傷後痛, 帯状疱疹関連痛などに関しては, 同一患者がそれぞれの時期に経験する「不快な感覚と情動体験」である. そのため理想的には連続性のある治療やケアが望まれる. しかし, 現状では周術期の急性痛に対しても十分な疼痛緩和ができない環境に置かれている場合もあり, さらに本邦においては, 亜急性期痛が遷延し慢性化した状態でペインクリニックや痛みセンターを受診することも多い. 術後痛の多くが組織修復の過程で消失する疼痛であっても, 急性痛を速やかに軽減させることは, 患者に対する心身の苦痛を最低限にして周術期の生活の質を向上させることにつながり, 疼痛の遷延化の予防にも繋がる可能性がある. したがって今後は急性期から慢性期まで途切れのない心身のケアも含めた術後疼痛管理を, チーム医療で施行することが切望される. |
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| AbstractList | 「はじめに」術後痛という用語は, 手術直後の痛みから遷延化した慢性の痛みまで, 広い範囲で使用されている. 一方で近年, 急性痛と慢性疼痛を全く別のものとして扱う風潮にあるが, 術後痛や外傷後痛, 帯状疱疹関連痛などに関しては, 同一患者がそれぞれの時期に経験する「不快な感覚と情動体験」である. そのため理想的には連続性のある治療やケアが望まれる. しかし, 現状では周術期の急性痛に対しても十分な疼痛緩和ができない環境に置かれている場合もあり, さらに本邦においては, 亜急性期痛が遷延し慢性化した状態でペインクリニックや痛みセンターを受診することも多い. 術後痛の多くが組織修復の過程で消失する疼痛であっても, 急性痛を速やかに軽減させることは, 患者に対する心身の苦痛を最低限にして周術期の生活の質を向上させることにつながり, 疼痛の遷延化の予防にも繋がる可能性がある. したがって今後は急性期から慢性期まで途切れのない心身のケアも含めた術後疼痛管理を, チーム医療で施行することが切望される. |
| Author | 河合, 愛子 濱岡, 早枝子 井関, 雅子 山口, 敬介 千葉, 聡子 原, 厚子 |
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| References | 10) Johansen, A., Romundstad, L., Nielsen, C.S., Schirmer, H., Stubhaug, A., Persistent postsurgical pain in general population: Prevalence and predictors in Tromsø study, Pain, 153 (2012) 1390–1396. 19) 山本奈央, 牛山佳菜, 遠藤みどり, 仲田隆子, 梶原絢子, 国内の術後疼痛に関する看護研究の動向と課題, 山梨県立大学看護部研究ジャーナル, 3 (2017) 67–76. 2) Macrae, W.A., Chronic pain after surgery, Br. J. Anaesth., 87 (2001) 88–98. 15) Lavand'homme, P., The progression from acute to chronic pain, Curr. Opin. Anaesthesiol., 24 (2011) 545–550. 3) Breivik, H., Stubhang, A., Management of acute postoperative pain: still a long way to go, Pain, 137 (2008) 233–234. 4) Treede, R.D., Rief, W., Barke, A., Aziz, Q., Bennett, M.I, Benoliel, R., Cohen, M., Evers, S., Finnerup, N.B., First, M.B., Giamberardino, M.A., Kaasa, S., Korwisi, B., Kosek, E., Lavand’homme, P., Nicholas, M., Perro, S., Scholz, J., Schug, S., Smith, B.H., Svensson, P., Vlaeyen, J.W.S, Wang, S.J., Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD–11), Pain, 160 (2019) 9–27. 8) Sugiyama, Y., Iida, H., Amaya, F., Matsuo, K., Matsuoka, Y., Kojima, K., Matsuno, F., Hamaguchi, T., Iseki, M., Yamaguchi, K., Takahashi, Y., Hara, A., Sugasawa, Y., Kawamata, M., Tanaka, S., Inagaki, Y., Otsuki, A., Yamazaki, M., Ito, H., Prevalence of chronic postsurgical pain after thoracotomy and total knee arthroplasty: a retrospective multicenter study in Japan (Japanese Study Group of Subacute Postoperative Pain), J. Anesth., 32 (2018) 434–438. 14) Althaus, A., Arránz Becker, O., Moser, K.H., Lux, E.A., Weber, F., Neugebauer, E., Simanski, C., Postoperative Pain Trajectories and Pain Chronification —an Empirical Typology of Pain Patients, Pain Med., 19 (2018) 2536–2545. 6) Richebé, P., Capdevila, X., Rivat, C., Persistent Postsurgical Pain: Pathophysiology and Preventative Pharmacologic Considerations, Anesthesiology, 129 (2018) 590–607. 9) Fletcher, D., Stamer, U.M., Pogatzki–Zahn, E., Zaslansky, R., Tanase, N.V., Perruchoud, C., Kranke, P., Komann, M., Lehman, T., Meissner, W.; euCPSP group for the Clinical Trial Network group of the European Society of Anaesthesiology, Chronic postsurgical pain in Europe: An observational study, Eur. J. Anaesthesiol., 32 (2015) 725–734. 18) Huang, C.C., Sun, W.Z., Wong, C.S., Prevention of Chronic Postsurgical Pain: The Effect of Preventive and Multimodal Analgesia, Asian J. Anesthesiol., 56 (2018) 74–82. 20) Kash, B.A., Zhang, Y., Cline, K.M., Menser, T., Miller, T.R., The perioperative surgical home (PSH): a comprehensive review of US and non–US studies shows predominantly positive quality and cost outcomes, Milbank Q., 92 (2014) 796–821. 12) Beswick, A.D., Wylde, V., Gooberman–Hill, R., Blom, A., Dieppe, P., What proportion of patients report long–term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients, BMJ, 2 (2012) e000435. 7) Chapman, C.R., Viercky, C.J., The transition of acute postoperative pain to chronic pain; An integrative overview of reseach on mechanisms, J. Pain,18 (2017) 359.e1–359.e38 11) www.iasp–pain.org/globalyear（水枝谷一仁, 住谷昌彦 翻訳） 13) Balduyck, B., Sardari Nia, P., Cogen, A., Meulemans, E., Lauwers, P., Nia, P.S., Hendriks, J.M., Van Schil, P.E., The effect of smoking cessation on quality of life after lung cancer surgery, Eur. J. Cardiothorac. Surg., 40 (2011) 1432–1438. 22) Tiippana, E., Hamunen, K., Heiskanen, T., Nieminen, T., Kalso, E., Kontinen, V.K., New approach for treatment of prolonged postoperative pain: APS Out–Patient Clinic, Scand. J. Pain, 12 (2016) 19–24. 1) Macrae, W.A., Davies, H.T.O., Chronic postsurgical pain, In: Crombie I.K. (ed.), Epidemiology of Pain, IASP Press, Seattle, 1999, pp125–142. 21) Katz, J., Weinrib, A., Fashler, S., Katznelzon, R., Shah, B., Ladak, S., Jiang, J., Li, Q., McMillan, K., Santa Mina, D., Wentlandt, K., McRae, K., Tamir, D., Lyn, S., de Perrot, M., Rao, V., Grant, D., Roche–Nagle, G., Cleary, S., Hofer, S., Gilbert, R., Wijeysundera, D., Ritvo, P., Janmohamed, T., O'Leary, G., Clarke, H., The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain, J. Pain Res., 8 (2015) 695–702. 17) Weinstein, E.J., Levene, J.L., Cohen, M.S., Andreae, D.A., Chao, J.Y., Johnson, M., Hall, C.B., Andreae, M.H., Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. Version 2, Cochrane Database Syst. Rev., 6 (2018) CD007105. 5) Schug, S.A., Lavand’homme, P., Barke, A., Korwisi, B., Rief, W., Treede, R.D.; The IASP classification of chronic pain for ICD–11: chronic postsurgical or posttraumatic pain, Pain, 160 (2019) 45–52. 16) Chou, R., Gordon, D.B., de Leon–Casasola, O.A., Rosenberg, J.M., Bickler, S., Brennan, T., Carter, T., Cassidy, C.L., Chittenden, E.H., Degenhardt, E., Griffith, S., Manworren, R., McCarberg, B., Montgomery, R., Murphy, J., Perkal, M.F., Suresh, S., Sluka, K., Strassels, S., Thirlby, R., Viscusi, E., Walco, G.A., Warner, L., Weisman, S.J., Wu, C.L., Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council, J. Pain, 17 (2016) 131–157. |
| References_xml | – reference: 11) www.iasp–pain.org/globalyear（水枝谷一仁, 住谷昌彦 翻訳） – reference: 3) Breivik, H., Stubhang, A., Management of acute postoperative pain: still a long way to go, Pain, 137 (2008) 233–234. – reference: 13) Balduyck, B., Sardari Nia, P., Cogen, A., Meulemans, E., Lauwers, P., Nia, P.S., Hendriks, J.M., Van Schil, P.E., The effect of smoking cessation on quality of life after lung cancer surgery, Eur. J. Cardiothorac. Surg., 40 (2011) 1432–1438. – reference: 7) Chapman, C.R., Viercky, C.J., The transition of acute postoperative pain to chronic pain; An integrative overview of reseach on mechanisms, J. Pain,18 (2017) 359.e1–359.e38 – reference: 9) Fletcher, D., Stamer, U.M., Pogatzki–Zahn, E., Zaslansky, R., Tanase, N.V., Perruchoud, C., Kranke, P., Komann, M., Lehman, T., Meissner, W.; euCPSP group for the Clinical Trial Network group of the European Society of Anaesthesiology, Chronic postsurgical pain in Europe: An observational study, Eur. J. Anaesthesiol., 32 (2015) 725–734. – reference: 16) Chou, R., Gordon, D.B., de Leon–Casasola, O.A., Rosenberg, J.M., Bickler, S., Brennan, T., Carter, T., Cassidy, C.L., Chittenden, E.H., Degenhardt, E., Griffith, S., Manworren, R., McCarberg, B., Montgomery, R., Murphy, J., Perkal, M.F., Suresh, S., Sluka, K., Strassels, S., Thirlby, R., Viscusi, E., Walco, G.A., Warner, L., Weisman, S.J., Wu, C.L., Management of Postoperative Pain: A Clinical Practice Guideline From the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council, J. Pain, 17 (2016) 131–157. – reference: 17) Weinstein, E.J., Levene, J.L., Cohen, M.S., Andreae, D.A., Chao, J.Y., Johnson, M., Hall, C.B., Andreae, M.H., Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children. Version 2, Cochrane Database Syst. Rev., 6 (2018) CD007105. – reference: 21) Katz, J., Weinrib, A., Fashler, S., Katznelzon, R., Shah, B., Ladak, S., Jiang, J., Li, Q., McMillan, K., Santa Mina, D., Wentlandt, K., McRae, K., Tamir, D., Lyn, S., de Perrot, M., Rao, V., Grant, D., Roche–Nagle, G., Cleary, S., Hofer, S., Gilbert, R., Wijeysundera, D., Ritvo, P., Janmohamed, T., O'Leary, G., Clarke, H., The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain, J. Pain Res., 8 (2015) 695–702. – reference: 2) Macrae, W.A., Chronic pain after surgery, Br. J. Anaesth., 87 (2001) 88–98. – reference: 6) Richebé, P., Capdevila, X., Rivat, C., Persistent Postsurgical Pain: Pathophysiology and Preventative Pharmacologic Considerations, Anesthesiology, 129 (2018) 590–607. – reference: 4) Treede, R.D., Rief, W., Barke, A., Aziz, Q., Bennett, M.I, Benoliel, R., Cohen, M., Evers, S., Finnerup, N.B., First, M.B., Giamberardino, M.A., Kaasa, S., Korwisi, B., Kosek, E., Lavand’homme, P., Nicholas, M., Perro, S., Scholz, J., Schug, S., Smith, B.H., Svensson, P., Vlaeyen, J.W.S, Wang, S.J., Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD–11), Pain, 160 (2019) 9–27. – reference: 18) Huang, C.C., Sun, W.Z., Wong, C.S., Prevention of Chronic Postsurgical Pain: The Effect of Preventive and Multimodal Analgesia, Asian J. Anesthesiol., 56 (2018) 74–82. – reference: 8) Sugiyama, Y., Iida, H., Amaya, F., Matsuo, K., Matsuoka, Y., Kojima, K., Matsuno, F., Hamaguchi, T., Iseki, M., Yamaguchi, K., Takahashi, Y., Hara, A., Sugasawa, Y., Kawamata, M., Tanaka, S., Inagaki, Y., Otsuki, A., Yamazaki, M., Ito, H., Prevalence of chronic postsurgical pain after thoracotomy and total knee arthroplasty: a retrospective multicenter study in Japan (Japanese Study Group of Subacute Postoperative Pain), J. Anesth., 32 (2018) 434–438. – reference: 20) Kash, B.A., Zhang, Y., Cline, K.M., Menser, T., Miller, T.R., The perioperative surgical home (PSH): a comprehensive review of US and non–US studies shows predominantly positive quality and cost outcomes, Milbank Q., 92 (2014) 796–821. – reference: 12) Beswick, A.D., Wylde, V., Gooberman–Hill, R., Blom, A., Dieppe, P., What proportion of patients report long–term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients, BMJ, 2 (2012) e000435. – reference: 14) Althaus, A., Arránz Becker, O., Moser, K.H., Lux, E.A., Weber, F., Neugebauer, E., Simanski, C., Postoperative Pain Trajectories and Pain Chronification —an Empirical Typology of Pain Patients, Pain Med., 19 (2018) 2536–2545. – reference: 5) Schug, S.A., Lavand’homme, P., Barke, A., Korwisi, B., Rief, W., Treede, R.D.; The IASP classification of chronic pain for ICD–11: chronic postsurgical or posttraumatic pain, Pain, 160 (2019) 45–52. – reference: 1) Macrae, W.A., Davies, H.T.O., Chronic postsurgical pain, In: Crombie I.K. (ed.), Epidemiology of Pain, IASP Press, Seattle, 1999, pp125–142. – reference: 10) Johansen, A., Romundstad, L., Nielsen, C.S., Schirmer, H., Stubhaug, A., Persistent postsurgical pain in general population: Prevalence and predictors in Tromsø study, Pain, 153 (2012) 1390–1396. – reference: 19) 山本奈央, 牛山佳菜, 遠藤みどり, 仲田隆子, 梶原絢子, 国内の術後疼痛に関する看護研究の動向と課題, 山梨県立大学看護部研究ジャーナル, 3 (2017) 67–76. – reference: 15) Lavand'homme, P., The progression from acute to chronic pain, Curr. Opin. Anaesthesiol., 24 (2011) 545–550. – reference: 22) Tiippana, E., Hamunen, K., Heiskanen, T., Nieminen, T., Kalso, E., Kontinen, V.K., New approach for treatment of prolonged postoperative pain: APS Out–Patient Clinic, Scand. J. Pain, 12 (2016) 19–24. |
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| Snippet | 「はじめに」術後痛という用語は, 手術直後の痛みから遷延化した慢性の痛みまで, 広い範囲で使用されている. 一方で近年, 急性痛と慢性疼痛を全く別のものとして扱う風... |
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| SubjectTerms | Chronic postsurgical pain (CPSP) Maltimodal analgesia (MMA) Neuropathic pain Perioperative surgical home (PSH) Transitional pain service (TPS) |
| Subtitle | 継続的な疼痛管理とチーム医療の必要性 |
| Title | 慢性術後痛の予防的観点から術後疼痛管理の未来を考える |
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