痛みに対する非破壊的経皮電気刺激療法の臨床経験
除痛手術後の遺残痛・再発痛やその他の慢性痛および悪性腫瘍末期痛など29例に対して,国産の携帯用小型personal stimulatorを用いて,経皮的末梢神経電気刺激療法を試みた. その結果,Lテスト刺激では著効より多少とも効果を認めるものまで含むと,93%の患者で有効となり,たしかに鎮痛効果は認める. 2.患者に1週間より2年10カ月にわたる期間stimulatorを貸し出して,患者自身による経皮刺激を継続して行わせたもの22例中,86%の患者で鎮痛効果を見た. 3.しかし今後も痛みの治療として続けたいとする者は42%となった.悪性腫瘍末期痛患者全員脱落し,めまい・嘔気などを伴う頭部外傷後...
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| Published in | Neurologia medico-chirurgica Vol. 18pt2; no. 9; pp. 623 - 633 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English Japanese |
| Published |
一般社団法人 日本脳神経外科学会
1978
日本脳神経外科学会 |
| Online Access | Get full text |
| ISSN | 0470-8105 1349-8029 |
| DOI | 10.2176/nmc.18pt2.623 |
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| Abstract | 除痛手術後の遺残痛・再発痛やその他の慢性痛および悪性腫瘍末期痛など29例に対して,国産の携帯用小型personal stimulatorを用いて,経皮的末梢神経電気刺激療法を試みた. その結果,Lテスト刺激では著効より多少とも効果を認めるものまで含むと,93%の患者で有効となり,たしかに鎮痛効果は認める. 2.患者に1週間より2年10カ月にわたる期間stimulatorを貸し出して,患者自身による経皮刺激を継続して行わせたもの22例中,86%の患者で鎮痛効果を見た. 3.しかし今後も痛みの治療として続けたいとする者は42%となった.悪性腫瘍末期痛患者全員脱落し,めまい・嘔気などを伴う頭部外傷後遺症の慢性頭痛患者もほとんど脱落した. 4.本療法の実際,刺激効果,適応,限界などにつき考察した. 5.各種慢性痛患者に総合的な痛み対策の一つとして試みてよい方法と考える. |
|---|---|
| AbstractList | 除痛手術後の遺残痛・再発痛やその他の慢性痛および悪性腫瘍末期痛など29例に対して,国産の携帯用小型personal stimulatorを用いて,経皮的末梢神経電気刺激療法を試みた. その結果,Lテスト刺激では著効より多少とも効果を認めるものまで含むと,93%の患者で有効となり,たしかに鎮痛効果は認める. 2.患者に1週間より2年10カ月にわたる期間stimulatorを貸し出して,患者自身による経皮刺激を継続して行わせたもの22例中,86%の患者で鎮痛効果を見た. 3.しかし今後も痛みの治療として続けたいとする者は42%となった.悪性腫瘍末期痛患者全員脱落し,めまい・嘔気などを伴う頭部外傷後遺症の慢性頭痛患者もほとんど脱落した. 4.本療法の実際,刺激効果,適応,限界などにつき考察した. 5.各種慢性痛患者に総合的な痛み対策の一つとして試みてよい方法と考える. 癌末期頑痛や各種の治療に抗する慢性の痛みに対して, 末梢神経より中枢神経系にいたる痛覚伝導路の各高さにおける外科的遮断が行われてきた. しかしいわゆる痛覚伝導路も, 脊髄・脳幹・視床・大脳と上行するにつれdivergentなひろがりを示し3)12)13)14), どの部位の遮断でも永久的に除痛しうる理想的な手術標的は見出しがたい. 一方, 痛みの機構については従来よりspecificity theoryやpattern theoryが唱えられていたが, 臨床的事実との間に矛盾も多く, 両者の合成とも考えられるgate control theoryがMelzack and Wall20)により提唱された. これ以後痛みの外科も従来のdestructive treatmentに加えて, gate control systemのneuromodulationを応用した電気刺激による痛みの抑制-鎮痛というnondestructive treatmentの開発研究が盛んになり, 慢性電極埋込みによる末梢神経電気刺激4)31)32), 脊髄後索電気刺激23)28),が, アメリカのペースメーカー器機の進歩とともに実用段階に入ってきた. |
| Author | 田口, 薫 金井, 信博 渡部, 優 井奥, 匡彦 黒田, 良太郎 越野, 兼太郎 最上, 平太郎 赤井, 文治 |
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| References | 4) CAMPBELL, J. N. & TAUB, A.: Local analgesia from percutaneous electrical stimulation. A peripheral mechanism. Arch Neurol 28: 347-350, 1973 23) NASHOLD, B. S., JR. & FRIEDMAN, H.: Dorsal Column Stimulation for Control of Pain. J Neurosurg 36: 590-597, 1972 27) SATRAN, R. & GOLDSTEIN, M. N.: Pain Perception: Modification of Threshold of Intolerance and Cortical Potentials by Cutaneous Stimulation. Science 180: 1201-1202, 1973 15)久留勝:人体脊髄並に脳幹に於ける知覚伝導経路.pp429-673,日本学術会議(編):医学綜報,第2巻,第4冊,創元社,東京,1949 5) CHRISTENSEN, B. N. & PERL, E. R.: Spinal neurons specifically exited by noxious or thermal stimuli: Marginal zone of the dorsal horn. J Neurophysiol 33: 293-307, 1970 14) KURODA, R., et al.: Some efferent connections of the centromedian nucleus of the cat. Med J Osaka Univ 26: 1-25, 1975 28) SHEALY, C. N., MORTIMER, J. T. & HAGFORS, N. R.: Dorsal column electroanalgesia. J Neurosurg 32: 560-564, 1970 13) KURODA, R., MuRui, H. & MOGAMI, H.: Some efferent connections of the magnocellular nucleus of medial geniculate body in the cat. With special reference to the pain conducting pathways. Med J Osaka Univ 21: 27-46, 1970 21) MELZACK, R., STILLWELL, D. M. & Fox, E. J.: Trigger Points and Acupuncture Points for Pain: Correlations and Implications. Pain 3: 3-23, 1977 11) IGNELZI, R. J. & STERNBACH, R. S.: Somatosensory changes during transcutaneous electrical analgesia (abstract). p 179, In Bonica, J. (ed) : In 1st World Congress on Pain, 1975 7) FOX, J. L.: Dorsal Column Stimulation for Relief of Intractable Pain: Problems Encoun tered with Neuropacemakers. Surg Neurol 2: 59-64, 1974 12)黒田良太郎他:ネコにおける三叉神経脊髄路核下核よりの上行性経路.とくに痛覚伝導路について.阪大医誌20:103-ll4,1968 33) WALL, P. D.: Dorsal Horn Electrophysiology. pp 253-270, In Iggo, A. (ed) : Handbook of Sensory Physiology, Vol. II, Springer-Verlag, Berlin, 1973 8) HIGGINS, J. D., TURSKY, B. & SCHWARTZ, G. E.: Shock-Elicited Pain and Its Reduction by Concurrent Tactile Stimulation. Science 21: 866-867,1971 31) SWEET, W. H. & WEPSIC, J. R.: Treatment of pain by chronic electrical stimulation of large axons. Excep Med Intern Congress Series 198: 81, 1969 29) SHEALY, C. N.: Transcutaneous Electrical Stimulation for Control of Pain. Clin Neurosurg 21: 269-277, 1974 24) NASHOLD, B. S., JR.: Electrical Stimulation of the Skin, Peripheral Nerves, or Dorsal Column for Pain Relief. pp 502-509, In Morley, T. P. (ed) : Current Controversies in Neurosurgery, W. B. Saunders Co., Philadelphia, 1976 16) LONG, D. M.: Electrical stimulation for relief of pain from chronic nerve injury. J Neurosurg 39: 718-722, 1973 6) EBERSOLD, M. J., LAWS, E. R., JR., STONNINGTON, H. & STILLWELL, G. K.: Transcutaneous Electrical Stimulation for Treatment of Chronic Pain : A Preliminary Report. Surg Neurol 4: 96-99, 1975 2) BATES, J. A. V.: Relief of chronic pain by transcutaneous stimulation. Analysis of 100 consecutive failures (abstract). p 178, In Bonica, J. (ed) : 1st World Congress on Pain, 1975 22) MUMFORD, J. M.: Influence of Transcutaneous Neural Stimulation on the Pain Threshold of Human Teeth (abstract). p 175, In Bonica, J. (ed) : 1st World Congress on Pain, 1975 18) LONG, D. M. & HAGFORS, N.: Electrical Stimulation in the Nervous System: The Current Status of Electrical Stimulation of the Nervous System for Relief of Pain. Pain 1: 109-123, 1975 20) MELZACK, R. & WALL, P. D.: Pain Mechanisms: A New Theory. Science 150: 971-979, 1965 32) WALL, P. D. & SWEET, W. H.: Temporary abolition of pain in man. Science 155: 108-109, 1967 30) SNYDER, S., et al.: Opiate recepter mechanisms. pp 329-360, In Iverson, L. L. & Iverson, S. D. (eds) : Handbook of Psychopharmacology Vol. 5, Plenum Press, New York, 1975 19) LONG, D. M.: Transcutaneous Electrical Stimulation in the Treatment of Chronic and Acute Pain. pp 54-64, In Lee, J. F. (ed) : Pain Management. Williams & Wilkins Co., Baltimore, 1977 1) ADAMS, J. E.: Stimulation of internal capsule for relief of chronic pain. J Neurosurg 41: 740-744, 1974 34) WALL, P. D.: Physiological mechanisms involved in the production and relief of pain. pp 36-63, In Bonica, J. J., Procacci, P. & Pagni, C. A. (eds) : Recent Advances on Pain. Pathophysiology and Clinical Aspects. C. C. Thomas, Springfield, 1974 17) LONG, D. M.: Cutaneous Afferent Stimulation for Relief of Chronic Pain. Clin Neurosurg 21: 257-268,1974 26) PICAZA, J. A., et al.: Pain Suppression by Peripheral Nerve Stimulation. Part I Observations with Transcutaneous Stimuli. Surg Neurol 4: 105-114, 1975 25) NATHAN, P. W. & WALL, P. D.: Treatment of Post-Herpetic Neuralgia by Prolonged Electric Stimulation. Br Med J 3: 645-647, 1974 3) BLOEDEL, J. R.: The Substrate for Integration in the Central Pain Pathways. Clin Neurosurg 21: 194-228, 1974 10) HOSOBUCHI, Y.: Chronic thalamic stimulation for the control of facial anesthesia dolorosa. Arch Neurol 29: 158-161, 1973 9) HONGO, T., JANKOWSKA, E. & LUNDBERG, A.: Postsynaptic exitation and inhibition from primary afferents in neurones in the spinocervical tract. J Physiol 199: 569-592, 1968 |
| References_xml | – reference: 23) NASHOLD, B. S., JR. & FRIEDMAN, H.: Dorsal Column Stimulation for Control of Pain. J Neurosurg 36: 590-597, 1972 – reference: 26) PICAZA, J. A., et al.: Pain Suppression by Peripheral Nerve Stimulation. Part I Observations with Transcutaneous Stimuli. Surg Neurol 4: 105-114, 1975 – reference: 30) SNYDER, S., et al.: Opiate recepter mechanisms. pp 329-360, In Iverson, L. L. & Iverson, S. D. (eds) : Handbook of Psychopharmacology Vol. 5, Plenum Press, New York, 1975 – reference: 5) CHRISTENSEN, B. N. & PERL, E. R.: Spinal neurons specifically exited by noxious or thermal stimuli: Marginal zone of the dorsal horn. J Neurophysiol 33: 293-307, 1970 – reference: 2) BATES, J. A. V.: Relief of chronic pain by transcutaneous stimulation. Analysis of 100 consecutive failures (abstract). p 178, In Bonica, J. (ed) : 1st World Congress on Pain, 1975 – reference: 34) WALL, P. D.: Physiological mechanisms involved in the production and relief of pain. pp 36-63, In Bonica, J. J., Procacci, P. & Pagni, C. A. (eds) : Recent Advances on Pain. Pathophysiology and Clinical Aspects. C. C. Thomas, Springfield, 1974 – reference: 18) LONG, D. M. & HAGFORS, N.: Electrical Stimulation in the Nervous System: The Current Status of Electrical Stimulation of the Nervous System for Relief of Pain. Pain 1: 109-123, 1975 – reference: 33) WALL, P. D.: Dorsal Horn Electrophysiology. pp 253-270, In Iggo, A. (ed) : Handbook of Sensory Physiology, Vol. II, Springer-Verlag, Berlin, 1973 – reference: 8) HIGGINS, J. D., TURSKY, B. & SCHWARTZ, G. E.: Shock-Elicited Pain and Its Reduction by Concurrent Tactile Stimulation. Science 21: 866-867,1971 – reference: 29) SHEALY, C. N.: Transcutaneous Electrical Stimulation for Control of Pain. Clin Neurosurg 21: 269-277, 1974 – reference: 4) CAMPBELL, J. N. & TAUB, A.: Local analgesia from percutaneous electrical stimulation. A peripheral mechanism. Arch Neurol 28: 347-350, 1973 – reference: 32) WALL, P. D. & SWEET, W. H.: Temporary abolition of pain in man. Science 155: 108-109, 1967 – reference: 25) NATHAN, P. W. & WALL, P. D.: Treatment of Post-Herpetic Neuralgia by Prolonged Electric Stimulation. Br Med J 3: 645-647, 1974 – reference: 19) LONG, D. M.: Transcutaneous Electrical Stimulation in the Treatment of Chronic and Acute Pain. pp 54-64, In Lee, J. F. (ed) : Pain Management. Williams & Wilkins Co., Baltimore, 1977 – reference: 28) SHEALY, C. N., MORTIMER, J. T. & HAGFORS, N. R.: Dorsal column electroanalgesia. J Neurosurg 32: 560-564, 1970 – reference: 6) EBERSOLD, M. J., LAWS, E. R., JR., STONNINGTON, H. & STILLWELL, G. K.: Transcutaneous Electrical Stimulation for Treatment of Chronic Pain : A Preliminary Report. Surg Neurol 4: 96-99, 1975 – reference: 17) LONG, D. M.: Cutaneous Afferent Stimulation for Relief of Chronic Pain. Clin Neurosurg 21: 257-268,1974 – reference: 14) KURODA, R., et al.: Some efferent connections of the centromedian nucleus of the cat. Med J Osaka Univ 26: 1-25, 1975 – reference: 22) MUMFORD, J. M.: Influence of Transcutaneous Neural Stimulation on the Pain Threshold of Human Teeth (abstract). p 175, In Bonica, J. (ed) : 1st World Congress on Pain, 1975 – reference: 11) IGNELZI, R. J. & STERNBACH, R. S.: Somatosensory changes during transcutaneous electrical analgesia (abstract). p 179, In Bonica, J. (ed) : In 1st World Congress on Pain, 1975 – reference: 9) HONGO, T., JANKOWSKA, E. & LUNDBERG, A.: Postsynaptic exitation and inhibition from primary afferents in neurones in the spinocervical tract. J Physiol 199: 569-592, 1968 – reference: 10) HOSOBUCHI, Y.: Chronic thalamic stimulation for the control of facial anesthesia dolorosa. Arch Neurol 29: 158-161, 1973 – reference: 21) MELZACK, R., STILLWELL, D. M. & Fox, E. J.: Trigger Points and Acupuncture Points for Pain: Correlations and Implications. Pain 3: 3-23, 1977 – reference: 1) ADAMS, J. E.: Stimulation of internal capsule for relief of chronic pain. J Neurosurg 41: 740-744, 1974 – reference: 15)久留勝:人体脊髄並に脳幹に於ける知覚伝導経路.pp429-673,日本学術会議(編):医学綜報,第2巻,第4冊,創元社,東京,1949 – reference: 20) MELZACK, R. & WALL, P. D.: Pain Mechanisms: A New Theory. Science 150: 971-979, 1965 – reference: 24) NASHOLD, B. S., JR.: Electrical Stimulation of the Skin, Peripheral Nerves, or Dorsal Column for Pain Relief. pp 502-509, In Morley, T. P. (ed) : Current Controversies in Neurosurgery, W. B. Saunders Co., Philadelphia, 1976 – reference: 27) SATRAN, R. & GOLDSTEIN, M. N.: Pain Perception: Modification of Threshold of Intolerance and Cortical Potentials by Cutaneous Stimulation. Science 180: 1201-1202, 1973 – reference: 12)黒田良太郎他:ネコにおける三叉神経脊髄路核下核よりの上行性経路.とくに痛覚伝導路について.阪大医誌20:103-ll4,1968 – reference: 31) SWEET, W. H. & WEPSIC, J. R.: Treatment of pain by chronic electrical stimulation of large axons. Excep Med Intern Congress Series 198: 81, 1969 – reference: 7) FOX, J. L.: Dorsal Column Stimulation for Relief of Intractable Pain: Problems Encoun tered with Neuropacemakers. Surg Neurol 2: 59-64, 1974 – reference: 3) BLOEDEL, J. R.: The Substrate for Integration in the Central Pain Pathways. Clin Neurosurg 21: 194-228, 1974 – reference: 13) KURODA, R., MuRui, H. & MOGAMI, H.: Some efferent connections of the magnocellular nucleus of medial geniculate body in the cat. With special reference to the pain conducting pathways. Med J Osaka Univ 21: 27-46, 1970 – reference: 16) LONG, D. M.: Electrical stimulation for relief of pain from chronic nerve injury. J Neurosurg 39: 718-722, 1973 |
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| Snippet | 除痛手術後の遺残痛・再発痛やその他の慢性痛および悪性腫瘍末期痛など29例に対して,国産の携帯用小型personal stimulatorを用いて,経皮的末梢神経電気刺激療法を試みた.... 癌末期頑痛や各種の治療に抗する慢性の痛みに対して, 末梢神経より中枢神経系にいたる痛覚伝導路の各高さにおける外科的遮断が行われてきた. しかしいわゆる痛覚伝導路も,... |
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| Title | 痛みに対する非破壊的経皮電気刺激療法の臨床経験 |
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