慢性疼痛の多面的評価 : 治療対象の明確化のために(シンポジウム:慢性疼痛の基礎と臨床,2008年,第49回日本心身医学会総会(札幌))  [in Japanese] Multiple Assessments for Chronic Pain : For Clarification of the Treatment Objects(Symposium/The Mechanism and Practice of Chronic Pain)  [in Japanese]

慢性疼痛は無効な医療の繰り返しになることが多く,不快情動が増大するため患者や家族のQOL(quality of life)を障害し,医療コミュニケーションの問題を起こし,社会医療経済学的にも大きな問題となっている.国際疼痛学会は,国際的な痛みの臨床研究評価のコンセンサスとして,2003年および2005年にIMMPACT recommendationを提起した.この評価軸を参考に,九州大学病院心療内科でも,多数の医療機関の診療を受けた後に来院される難治の慢性疼痛患者の心身医学的な治療対象を明確化するために,痛みの自覚的強度,生活障害,不安・抑うつ・破局化,失感情傾向,器質的および機能的病態,パーソナリティ傾向やパーソナリティ障害・発達障害,精神医学的障害,疼痛行動の分析,痛みに対する認知と対処法,家族や社会との交流不全(役割機能障害),医療不信といった観点で病態を評価する多面的な評価法を行っている.心身医学的治療法に結びつく慢性疼痛の評価法は発展途上であり,今後の発展が急務である.

Background: Clinical medicine on chronic pain conceives several important problems including invalid managements, disabled quality of life for patients and their families, dysfunctional medical communication, and raised medical socio-economical costs. The International Association for the Study of Pain has proposed the IMMPACT recommendations as an international consensus for clinical pain research in 2003 and 2005. Following this guideline, we overview the multiple assessments for chronic pain in Japan. Methods: We investigated and modified the IMMPACT recommendation for Japanese pain medicine. From the clinical experience for severe chronic pain patients in the Department of Psychosomatic Medicine in Kyushu University Hospital, we specified the several important treatment objects and multiple assessments for the psychosomatic treatment. Results: We introduce the original IMMPACT recommendation and proposed the eleven axes of multiple assessments for Japanese chronic pain patients (pain intensity, pain disability, anxiety・depression・catastrophizing, alexithymia, organic and functional disorder, personality trait・personality disorder・mental retardation, psychiatric disorder, pain behavior, cognition and coping for pain, dysfunctional communication with family or society, medical disbelief) for clarification of psychosomatic treatment objects such as medical disbelief, catastrophizing, pain behavior, alexithymia, pacing disorder and discommunication with significant others. Conclusions: We propose the importance of multiple assessments for clarification of psychosomatic treatment objects. However, the systematic assessments for chronic pain are still on the way to development and need more attention from psychosomatic clinicians and researchers for future development.