心身医学からみた慢性腹痛(慢性疼痛の心身医学第22回日本心身医学会総会シンポジウム)

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  • Chronic Abdominal Pain : From the psychosomatic medicai point of view(Psychosomatic Aspect of Chronic Pain : Introduction : the Symposium at the 22 nd Annual Congress of the Japanese Psychosomatic Society)

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Pathophysiologically, abdominal pain can be grouped into two categories : visceral pain and somatic pain. However, both afferent fibers, that is visceral afferent fibers (C-fiber) and somatic afferent fibers (A-fiber), which transmit pain impulses, enter the dorsal root of the spinal cord. The impulse of visceral pain is said to be induced by alteration in tone and motility of the alimentary canal, particular]y by spasm. Abdominal pains requiring psychosomatic treatment probably result from the same mechanism. In the last 5 years, there were 1933 paticnts who complained of abdominal pains in our department. The highest frequent location of abdominal pains in these patients was the central epigastric region, which was 50% of all the pains. The second highest was diffuse abdominal pain, which was 38%. Organic diseases were discovered by clinical examinations in 769 patients or 40% of the total subjects. The major final diagnoses included gastric ulcer, chronic gastritis, duodenal ulcer, gastric cancer and gall stone in the central epigastrium and right upper abdomen. However, in the left upper abdomen and left lower abdomen, irritable colon syndrome, which is a functional disturbance of the bowel, was found most frequently. During the same period, 106 patients visited our psychosomatic clinic, complaining abdominal pain. These abdominal pain were located mainly in the central epigastrium and diffuse abdomen. The most frequent diagnosis was irritable colon syndrome, which was followed by hysteria. Then there were patients with anxiety neurosis, depression or depressive state. From the etiological standpoint, patients had anxiety and tension most frequently, which was 42% of all the subjects. The second highest incidence was conversion reaction, namely psychogenic abdominal pain or hysterical pain, which was 35%. Finally, we measured the colonic intraluminal pressure in the patients with irritable colon syndrome. To measure the intraluminal pressure of the ascending colon and sigmoid colon at same time, we have divised a new method, an endoscopic retrograde bowel insertion method (ERBI). In the patients with spastic colon, intraluminal pressure of the sigmoid colon was much higher than that of the ascending colon, especially after prostigmine was injected.

収録刊行物

  • 心身医学

    心身医学 21 (5), 421-426, 1981

    一般社団法人 日本心身医学会

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