MilnacipranによりQOLの改善をみた慢性疼痛の事例 : 鎮痛補助剤としてのSNRIの有用性について  [in Japanese] Utilizing Milnacipran for Improving QOL of Case with Neuropathic Pain : SNRI as Algetic Adjuvant  [in Japanese]

神経性疼痛は,その重症度,慢性性,鎮痛剤への抵抗性により患者および医師を悩ませている.慢性疼痛は,患者のQOLを低下させ,主治医との関係にも影響を及ぼす.今回筆者は,三環系抗うつ薬より安全性が高いmilnacipranを使用し,慢性疼痛により自室にこもり日常生活に介助を要していた高齢女性のQOLが疼痛の改善に伴い向上した症例を3例経験したので報告する.慢性疼痛の評価は,自覚所見だけでなくQOLを含めた包括的評価を行う必要があること,介護者らの他覚的評価がQOLの改善に重要な役割を果たすことを示した.Serotonine norepinephrine reuptake inhibitorは,鎮痛補助領域における有用性が独立しているとされ,精神科医はもちろんプライマリ・ケア医が,鎮痛補助剤としてmilnacipranを日常臨床で活用することにより,慢性疼痛患者のQOLが著しく改善する可能性について指摘した.

Neuropathic pain (NP) is a bother to both patient and doctor, related to severity, chronicity and resistance to licensed analgesics. It damages the quality of life (QOL) of people with NP and the relationship with their therapists. Author reported 3 elder female cases whose lower QOL caused by NP improved with its remission, using milnacipran, which is the only serotonin norepinephrine reuptake inhibitor (SNRI) in Japan and recognized as safer than tricyclic antidepressants. Possible antinociceptive mechanisms of them include direct effect, activation of descending inhibition pain system and, psychosomatic which is effect considered as main effect by most clinicians in Japan. There are lots of reports indicating antidepressants as the gold standard treatment for NP, suggesting that SNRIs may work as analgesics, independent of antidepressants. These cases indicated that primary care physicians as well as psychiatrists must recognize the analgesic efficacy of milnacipran and facilitate to use it in daily practice also in Japan, and it may significantly improve QOL of people with NP, especially elderly.