上肢の複合性局所疼痛症候群の治療の満足度 Degree of satisfaction for treatment of complex regional pain syndrome of the upper limb

複合性局所疼痛症候群(CRPS)に有効な治療法は確立されておらず，難治性の慢性痛となることが少なくない．上肢のCRPSでは痛みに加えて日常生活に支障をきたすことも多い．そこで，当科で過去10年間に，上肢のCRPSで治療を受けた44名に，痛みの状態と，これまでの治療に対する満足度を知るために，アンケート調査を実施した．44名のうち22名(50％)から回答を得た．痛みが寛解していたのは2名だけであり，多くは発症から長期間経過した調査時点でも痛みが持続していた．患者を治療満足群(満足群)と治療不満足群(不満足群)に分けて検討した．満足群と不満足群で，痛みや痛みによる身体的な生活の質(QOL)に違いはなかったが，満足群に比べ，不満足群は，年齢が有意に高く，SF-36の結果で精神的健康度が低値であった．難治性の痛みでは，われわれが実施可能な治療に対する満足度を高めることは重要であるが，高齢者の上肢のCRPSでは，治療の満足度が低く，高齢者に適した治療法に加え，支持的・精神的アプローチの必要性が示唆された．

There are no established treatments effective for complex regional pain syndrome (CRPS). The pain in CRPS is rather persistent. Patients with CRPS of the upper limbs tend to have persistent pain, with resultant impaired daily living. We assessed clinical courses and degree of patients satisfaction with treatments in 44 subjects with CRPS of the upper limb(s) who were treated at our department in the past 10 years. A questionnaire was sent to each patient who did not visit our department at the time of the present study. Patients who were being treated at the time of this study were directly evaluated. Twenty-two patients responded (response rate, 50%). Twenty patients still had pain, and two did not have pain. The patients were divided into two groups according to the level of satisfaction: satisfied and non-satisfied groups. Although there was no difference in the degree of pain or level of quality of life between the groups, the non-satisfied group was significantly older and more depressed. Supportive and psychological therapies should be adopted to improve patients satisfaction and reduce pain behaviors for the treatment of CRPS of the upper limbs in elderly patients.