脊髄梗塞により神経障害性疼痛を呈した1症例 TENSによる鎮痛効果の検討
〔目的〕脊髄梗塞後の疼痛および痺れ感に対し，Transcutaneous Electrical Nerve Stimulation（以下，TENS）を用いて除痛効果を検討すること．〔対象と方法〕対象は，後脊髄動脈梗塞後に脊髄梗塞を発症し神経障害性疼痛を伴った1症例．方法はTENSを用い，電極配置部位を左L3，L5領域のデルマトーム上に配置し，周波数は変調周波数，刺激強度は対称性二相性パルス，50 μsec，感覚レベル刺激を用いて30分／日で3日間施行した．〔結果〕1日目TENS後，左L3，L5領域の疼痛，痺れ感ともに除痛効果が認められたが，2日目，3日目ともに即時効果，持続効果は認められなかっ...
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| Published in | Rigaku ryoho kagaku Vol. 32; no. 2; pp. 335 - 341 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
Tokyo
理学療法科学学会
01.01.2017
Japan Science and Technology Agency |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1341-1667 2434-2807 |
| DOI | 10.1589/rika.32.335 |
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| Abstract | 〔目的〕脊髄梗塞後の疼痛および痺れ感に対し，Transcutaneous Electrical Nerve Stimulation（以下，TENS）を用いて除痛効果を検討すること．〔対象と方法〕対象は，後脊髄動脈梗塞後に脊髄梗塞を発症し神経障害性疼痛を伴った1症例．方法はTENSを用い，電極配置部位を左L3，L5領域のデルマトーム上に配置し，周波数は変調周波数，刺激強度は対称性二相性パルス，50 μsec，感覚レベル刺激を用いて30分／日で3日間施行した．〔結果〕1日目TENS後，左L3，L5領域の疼痛，痺れ感ともに除痛効果が認められたが，2日目，3日目ともに即時効果，持続効果は認められなかった．〔結語〕TENSにより即時効果を得る一方でTENS後に神経の異常興奮を惹起する可能性がある． |
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| AbstractList | [Purpose] To investigate the effects of transcutaneous electrical nerve stimulation (TENS) on the pain and numbness experienced by a patient with spinal cord infarction. [Subjects and Methods] The subject was a single case exhibiting neuropathic pain due to spinal infarction after posterior spinal artery infarction. Electrodes were placed over dermatomes in the L3 and L5 regions, and TENS was delivered using a frequency modulated, 50-μs, symmetric, biphasic pulse at a perceived intensity for 30 min a day, at 3-day intervals. [Result] After the first treatment, pain and numbness in the L3 and L5 regions were alleviated; however, after the second and third treatments no immediate or lasting effects were observed. [Conclusion] Although TENS has an immediate effect, there is a possibility that it elicits abnormal neural excitation after treatment. 「要旨」: 〔目的〕脊髄梗塞後の疼痛および痺れ感に対し, Transcutaneous Electrical Nerve Stimulation(以下, TENS)を用いて除痛効果を検討すること. 〔対象と方法〕対象は, 後脊髄動脈梗塞後に脊髄梗塞を発症し神経障害性疼痛を伴った1症例. 方法はTENSを用い, 電極配置部位を左L3, L5領域のデルマトーム上に配置し, 周波数は変調周波数, 刺激強度は対称性二相性パルス, 50μsec, 感覚レベル刺激を用いて30分/日で3日間施行した. 〔結果〕1日目TENS後, 左L3, L5領域の疼痛, 痺れ感ともに除痛効果が認められたが, 2日目, 3日目ともに即時効果, 持続効果は認められなかった. 〔結語〕TENSにより即時効果を得る一方でTENS後に神経の異常興奮を惹起する可能性がある. 「I. はじめに」痛みについて国際疼痛学会(International Association for the Study of Pain: IASP)では, 「An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage(実際に組織損傷を伴うもの, または伴っている可能性のあるもの, あるいはそのような損傷があるような言葉を使って述べられる不快な感覚および情動的な経験)」と定義している. 〔目的〕脊髄梗塞後の疼痛および痺れ感に対し，Transcutaneous Electrical Nerve Stimulation（以下，TENS）を用いて除痛効果を検討すること．〔対象と方法〕対象は，後脊髄動脈梗塞後に脊髄梗塞を発症し神経障害性疼痛を伴った1症例．方法はTENSを用い，電極配置部位を左L3，L5領域のデルマトーム上に配置し，周波数は変調周波数，刺激強度は対称性二相性パルス，50 μsec，感覚レベル刺激を用いて30分／日で3日間施行した．〔結果〕1日目TENS後，左L3，L5領域の疼痛，痺れ感ともに除痛効果が認められたが，2日目，3日目ともに即時効果，持続効果は認められなかった．〔結語〕TENSにより即時効果を得る一方でTENS後に神経の異常興奮を惹起する可能性がある． |
| Author | 清水, 陽介 |
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| References | 1) Bonica JJ: Definitions and taxonomy of pain. In: Bonica JJ (ed): The Management of Pain, Lea and Febiger, Philadelphia, 1990, pp18-27. 22) Attal N, Cruccu G, Haanpää M, et al.: EFNS Task Force: EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol, 2006, 13: 1153-1169. 12) 徳田光紀，庄本康治，冨田恭治：肩関節術後症例に対する経皮的電気刺激治療の効果—電極設置部位に着目して—．理学療法科学，2012, 27: 565-570. 16) 齋藤昭彦：標準理学療法学 専門分野 物理療法学，第3版．網本 和（編），医学書院，東京，2008, pp146-154. 27) O’Connor AB: Neuropathic pain: quality-of-life impact, costs and cost effectiveness of therapy. Pharmacoeconomics, 2009, 27: 95-112. 11) 平井綾子，住谷昌彦，冨岡俊也・他：Neuropathic Pain Symptom Inventory 日本語版を用いて脊髄損傷後疼痛の治療効果を評価した1例．日本臨床麻酔学会誌，2011, 31: 685-688. 7) Rasmussen PV, Sindrup SH, Jensen TS, et al.: Symptoms and signs in patients with suspected neuropathic pain. Pain, 2004, 110: 461-469. 17) 冨田美佐緒，早津恵子，下地恒毅：疼痛に対する電気刺激療法．総合リハビリテーション，1996, 24: 231-235. 8) 小島 洋，花井謙次，荻久保修・他：腰痛の診断におけるPain drawingの有用性．日本腰痛会誌，1999, 5: 25-30. 25) 庄本康治：TENSの理学療法への応用．理学療法ジャーナル，2016, 50: 245-253. 23) 前島貞裕，片山容一：脊髄病変に起因する難治性疼痛．脊椎脊髄ジャーナル，2006, 19: 921-928. 10) 圓尾知之，中江 文，前田 倫・他:痛みの評価尺度・日本語版Short-Form McGill Pain Questionnaire 2（SF-MPQ-2）の作成とその信頼性と妥当性の検討．PAIN RESEARCH, 2013, 28: 43-53. 19) Woolf CJ, Shortland P, Coggeshall RE: Peripheral nerve injury triggers central sprouting of myelinated afferents. Nature, 1992, 355: 75-78. 21) Watkins LR, Milligan ED, Maier SF: Spinal cord glia: new players in pain. Pain, 2001, 93: 201-205. 24) Bloodworth DM, Nguyen BN, Garver W, et al.: Comparison of stochastic vs. conventional transcutaneous electrical stimulation for pain modulation in patients with electromyographically documented radiculopathy. Am J Phys Med Rehabil, 2004, 83: 584-591. 3) Benedetti F, Amanzio M, Casadio C, et al.: Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. Ann Thorac Surg, 1997, 63: 773-776. 14) Han JS, Chen XH, Sun SL, et al.: Effect of low- and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin A immunoreactivity in human lumbar CSF. Pain, 1991, 47: 295-298. 2) Defrin R, Ariel E, Peretz C: Segmental noxious versus innocuous electrical stimulation for chronic pain relief and the effect of fading sensation during treatment. Pain, 2005, 115: 152-160. 20) Eide PK: Pathophysiological mechanisms of central neuropathic pain after spinal cord injury. Spinal Cord, 1998, 36: 601-612. 4) 川村博文，鶴見隆正，辻下守弘・他：反射性交感神経ジストロフィーを含む慢性疼痛患者に対するTranscutaneous Electrical Nerve Stimulationの検討．理学療法学，1993, 20(Suppl 1): 365. 26) 山本晋史：脊髄損傷患者の疼痛を理解する．理学療法ジャーナル，2013, 47: 847-851. 6) Nardone R, Pikija S, Mutzenbach JS, et al.: Current and emerging treatment options for spinal cord ischemia. Drug Discov Today, 2016, 21: 1632-1641. 13) Sluka KA, Deacon M, Stibal A, et al.: Spinal blockade of opioid receptors prevents the analgesia produced by TENS in arthritic rats. J Pharmacol Exp Ther, 1999, 289: 840-846. 15) Cheng GA, 富澤一夫：物理療法学テキスト，改訂第2版．木村貞治・他（編），南江堂，東京，2013, pp207-224. 5) Cruccu G, Aziz TZ, Garcia-Larrea L, et al.: EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol, 2007, 14: 952-970. 18) Mendell LM, Wall PD: Responses of single dorsal cord cells to peripheral cutaneous unmyelinated fibres. Nature, 1965, 206: 97-99. 9) Dworkin RH, Turk DC, Revicki DA, et al.: Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2). Pain, 2009, 144: 35-42. |
| References_xml | – reference: 7) Rasmussen PV, Sindrup SH, Jensen TS, et al.: Symptoms and signs in patients with suspected neuropathic pain. Pain, 2004, 110: 461-469. – reference: 15) Cheng GA, 富澤一夫：物理療法学テキスト，改訂第2版．木村貞治・他（編），南江堂，東京，2013, pp207-224. – reference: 1) Bonica JJ: Definitions and taxonomy of pain. In: Bonica JJ (ed): The Management of Pain, Lea and Febiger, Philadelphia, 1990, pp18-27. – reference: 12) 徳田光紀，庄本康治，冨田恭治：肩関節術後症例に対する経皮的電気刺激治療の効果—電極設置部位に着目して—．理学療法科学，2012, 27: 565-570. – reference: 26) 山本晋史：脊髄損傷患者の疼痛を理解する．理学療法ジャーナル，2013, 47: 847-851. – reference: 8) 小島 洋，花井謙次，荻久保修・他：腰痛の診断におけるPain drawingの有用性．日本腰痛会誌，1999, 5: 25-30. – reference: 16) 齋藤昭彦：標準理学療法学 専門分野 物理療法学，第3版．網本 和（編），医学書院，東京，2008, pp146-154. – reference: 18) Mendell LM, Wall PD: Responses of single dorsal cord cells to peripheral cutaneous unmyelinated fibres. Nature, 1965, 206: 97-99. – reference: 25) 庄本康治：TENSの理学療法への応用．理学療法ジャーナル，2016, 50: 245-253. – reference: 27) O’Connor AB: Neuropathic pain: quality-of-life impact, costs and cost effectiveness of therapy. Pharmacoeconomics, 2009, 27: 95-112. – reference: 3) Benedetti F, Amanzio M, Casadio C, et al.: Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. Ann Thorac Surg, 1997, 63: 773-776. – reference: 22) Attal N, Cruccu G, Haanpää M, et al.: EFNS Task Force: EFNS guidelines on pharmacological treatment of neuropathic pain. Eur J Neurol, 2006, 13: 1153-1169. – reference: 21) Watkins LR, Milligan ED, Maier SF: Spinal cord glia: new players in pain. Pain, 2001, 93: 201-205. – reference: 19) Woolf CJ, Shortland P, Coggeshall RE: Peripheral nerve injury triggers central sprouting of myelinated afferents. Nature, 1992, 355: 75-78. – reference: 4) 川村博文，鶴見隆正，辻下守弘・他：反射性交感神経ジストロフィーを含む慢性疼痛患者に対するTranscutaneous Electrical Nerve Stimulationの検討．理学療法学，1993, 20(Suppl 1): 365. – reference: 9) Dworkin RH, Turk DC, Revicki DA, et al.: Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2). Pain, 2009, 144: 35-42. – reference: 10) 圓尾知之，中江 文，前田 倫・他:痛みの評価尺度・日本語版Short-Form McGill Pain Questionnaire 2（SF-MPQ-2）の作成とその信頼性と妥当性の検討．PAIN RESEARCH, 2013, 28: 43-53. – reference: 24) Bloodworth DM, Nguyen BN, Garver W, et al.: Comparison of stochastic vs. conventional transcutaneous electrical stimulation for pain modulation in patients with electromyographically documented radiculopathy. Am J Phys Med Rehabil, 2004, 83: 584-591. – reference: 14) Han JS, Chen XH, Sun SL, et al.: Effect of low- and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin A immunoreactivity in human lumbar CSF. Pain, 1991, 47: 295-298. – reference: 13) Sluka KA, Deacon M, Stibal A, et al.: Spinal blockade of opioid receptors prevents the analgesia produced by TENS in arthritic rats. J Pharmacol Exp Ther, 1999, 289: 840-846. – reference: 23) 前島貞裕，片山容一：脊髄病変に起因する難治性疼痛．脊椎脊髄ジャーナル，2006, 19: 921-928. – reference: 20) Eide PK: Pathophysiological mechanisms of central neuropathic pain after spinal cord injury. Spinal Cord, 1998, 36: 601-612. – reference: 5) Cruccu G, Aziz TZ, Garcia-Larrea L, et al.: EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol, 2007, 14: 952-970. – reference: 6) Nardone R, Pikija S, Mutzenbach JS, et al.: Current and emerging treatment options for spinal cord ischemia. Drug Discov Today, 2016, 21: 1632-1641. – reference: 2) Defrin R, Ariel E, Peretz C: Segmental noxious versus innocuous electrical stimulation for chronic pain relief and the effect of fading sensation during treatment. Pain, 2005, 115: 152-160. – reference: 11) 平井綾子，住谷昌彦，冨岡俊也・他：Neuropathic Pain Symptom Inventory 日本語版を用いて脊髄損傷後疼痛の治療効果を評価した1例．日本臨床麻酔学会誌，2011, 31: 685-688. – reference: 17) 冨田美佐緒，早津恵子，下地恒毅：疼痛に対する電気刺激療法．総合リハビリテーション，1996, 24: 231-235. |
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| Snippet | 〔目的〕脊髄梗塞後の疼痛および痺れ感に対し，Transcutaneous Electrical Nerve... 「要旨」: 〔目的〕脊髄梗塞後の疼痛および痺れ感に対し, Transcutaneous Electrical Nerve Stimulation(以下, TENS)を用いて除痛効果を検討すること. 〔対象と方法〕対象は, 後脊髄動脈梗塞後に脊髄梗塞を発症し神経障害性疼痛を伴った1症例. 方法はTENSを用い,... [Purpose] To investigate the effects of transcutaneous electrical nerve stimulation (TENS) on the pain and numbness experienced by a patient with spinal cord... |
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| SubjectTerms | Pain TENS Transcutaneous electrical nerve stimulation-TENS 神経障害性疼痛 脊髄梗塞 |
| Subtitle | TENSによる鎮痛効果の検討 |
| Title | 脊髄梗塞により神経障害性疼痛を呈した1症例 |
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