痛みの表現に基づく痛みの評価 - jpps.umin.jp

1 Jpn. J. Pharm. Palliat. Care Sci. 2 : 65_73 2009 65.. *1 *1 *1 *1. *2 *3 *1, *4 *1. *1.. *2.. *3.. *4. I. 2009 8 4 .. 66 . NSAIDs . 21 .. NSAIDs . APQ .. 2007 4 . 1-7 .. QOL .. Saunders .. 4 8 .. 468_8503 150 . I.. E-mail QOL Quality of Life NSAIDs . Nonsteroidal anti-inflammatory drugs . MPQ McGill Pain Questionnaire .. APQ Aichi Prefectural Society of Hospital Pharmacists Pain Questionnaire RCT Randomized . Controlled Trial . 66 .. 9, 10 .. 9 . APQ . NSAIDs . 2 .. 1 . NSAIDs .. 2 .. 3 .. 1 . 2004 1 2006 12 .. 66 1 . 1 . 66 . 51 15 34 81 . 4 36 15 3 2 1 1 2 . 1 . 1 . 5 . 38 14 12 10 7 4 3 2 1 62 . 28 . NSAIDs 4 NSAIDs 61 23 14 .. 66 23 .. 62 . 67. 0 5 6 0 10 2 APQ 78 . 11 1 APQ 3 APQ .. 2 APQ 4 . 2 .. 66 52 2 . 14.

2 APQ 78 3 APQ 5 .. 2 .. APQ . 4 APQ 7 .. 11 .. 3 . 4 78 19 4 . 1 3 8 APQ . 2 4 11 78 . APQ 3 . 5 4 . 5 .. 4 .. NSAIDs .. 4 . 4-1 . 9 . APQ .. 9 .. 4-2 . APQ 78 4-3 7. 11 .. 4-3 . 3 5 .. 4-4 5 .. 7 .. 1 . 66 . 34 26 . 21 17 . 68 . 15 5 4 6 . 3 2 2 . 64 50 70 .. 2 5 1 . 89 1 . 3 3 0 40 . 21 3 1 . APQ 1 3 1 . APQ 16 1 . APQ 4 3 . 5 . 35 . 52 80 . 22 31 . 4 5/8 3/4 . 7 3 3 100 3/3 .. 8 . 11 .. 3 . 3 21 80 3 . 17 3 . 4 .. 4 . 17 75 6/8 . 0 0/6 . 111 . 65 . 31 .. 26 . 13 17 . 10 .. 3 . 15 8 89 . 4 21 . 3 1 . 21 . 5 . 1 . 3 5 . 80 APQ .. 9 . 69. 3 66 .. 78 11 n 66 n 126 78 11 n 66 n 126 .. 1( ) . 6( ) 9( ) 3( ) . 0(0) 0(0) 0(0) . 1( ) 1( ) 0(0) . 12( ) 20( ) . 0(0) 0(0) 1 2( ) 2( ). 2( ) 5( ) 0(0) 0(0). 1( ) 4( ) 0(0) 0(0).

3 2( ) 2( ) 1( ) 3( ). 12( ) 17( ) 2 0(0) 0(0). 11( ) 15( ) 14( ) 18( ). 0(0) 0(0) 1( ) 1( ). 1( ) 4( ) 1( ) 4( ). 0(0) 0(0) 1( ) 1( ). 1( ) 4( ) 3 0(0) 0(0). 2( ) 2( ) 2( ) 2( ). 0(0) 0(0) 0(0) 0(0). 0(0) 0(0) 4 1( ) . 0(0) 0(0) 0(0) . 22( ) 31( ) 1( ) . 0(0) 0(0) 0(0) . 0(0) 0(0) 1( ) . 0(0) 0(0) APQ . 5( ) 6( ) 4( ) 7( ). 2( ) 2( ) 2( ) 2( ). 0(0) 0(0) 1( ) 1( ). 2( ) 3( ) 2( ) 2( ). 0(0) 0(0) 3( ) 3( ). 0(0) 0(0) 2( ) 3( ). 0(0) 0(0) 1( ) 2( ). 9( ) 13( ) 1( ) 1( ). 0(0) 0(0) 2( ) 2( ). 5( ) 6( ) 1( ) 1( ). 1( ) 1( ) 1( ) 1( ). 35( ) 52( ) 3 21 . 1( ) 1( ). 0(0) 0(0). 9( ) 11( ). 13( ) 22( ).. 9( ) 9( ). 14( ) 16( ) . 0(0) 0(0) . 1( ) 4( ).. 4( ) . 0(0) . 2( ) . 8( ) 11( ) RCT . 2( ) . American Society of 0(0) . 0(0) Clinical Oncology ASCO.

4 0(0) 12 . 3( ) . 0(0) . 0(0) 9 . 2( ) . 2( ) . 2 . 0(0) 100 .. 3 . 4( ) . 1 . 70 . 4 . 3 . 17 n 126 . 9 4 0 3 0 1 1 0 0 0. 20 5 3 4 4 1 0 1 2 0. 17 7 2 5 0 3 0 0 0 0. 15 6 3 3 0 2 0 0 1 0. 31 14 6 2 2 5 1 0 1 0. 6 2 1 1 1 0 1 0 0 0. 13 5 1 4 0 3 0 0 0 0. 6 0 2 3 1 0 0 0 0 0. 52 15 9 7 10 5 3 1 1 1. 11 3 0 4 0 0 2 0 1 1. 22 5 6 0 5 2 1 1 2 0. 9 5 0 1 1 1 1 0 0 0. 16 3 3 4 2 2 2 0 0 0. 11 7 2 0 1 1 0 0 0 0. 18 3 1 11 2 1 0 0 0 0. 7 2 2 2 0 0 1 0 0 0. 3 0 0 0 3 0 0 0 0 0. 1 . 3 . p vs.. 1 9 . 2 10 . 3 11 . 4 12 . 5 13 . 6 14 . 7 15 . 8 16 . 71.. 14 .. 16 .. 13 .. 14 . 15 . 80 . 50 70 . 0 40 3 APQ Melzack McGill 17 . Pain Questionnaire MPQ MPQ. MPQ. The . short-form McGill Pain Question- 18 . naire SF-MPQ APQ . MPQ SF-MPQ.

5 72 . pain quality descriptors in cancer patients with nociceptive and neuropathic pain. In Vivo 2007; 21: 93-97.. 8 . 2006 p. 168-169 . 9 . 1 . 2006 32 776-787 . 10 . 2 . 1 .. Boureau F, Doubrere JF, and Luu M. Study of verbal de- APQ . scription in neuropathic pain. Pain 1990; 42: 145-152. 2006 32 788-804 . 2 Wilkie DJ, Huang H-Y, Reilly N, et al. Nociceptive and 11 . neuropathic pain in patients with lung cancer: A compari- 2002 30 114-115 . son of pain quality descriptors. J. Pain Symptom Manag. 12 . 2001; 22: 899-910. 2005 p. 1-12 . 3 Bennett M. The LANSS Pain Scale: The Leeds assess . 13 1978 . ment of neuropathic symptoms and signs. Pain 2001; 92: 14 . 147-157. 2000 p. 251-266 . 4 Krause SJ and Backonja M-M.

6 Development of a Neu . 15 NEW . ropathic Pain Questionnaire. Clin. J. Pain 2003; 19: 306- 4 2002 p. 354-365 . 314. 16 . 5 .. Backonja M-M and Krause SJ. Neuropathic Pain Ques- 2005 7 351-358 . tionnaire Short Form. Clin. J. Pain 2003; 19: 315-316. 17 .. Melzack R. The Mcgill Pain Questionnaire . : Major . proper- 6 Bouhassira D, Attal N, Alchaar H, et al. Comparison of ties and scoring methods. Pain 1975; 1: 277-299. pain syndromes associated with nervous or somatic lesions 18 Melzack R. The short-form McGill Pain Questionnaire. and development of a new neuropathic pain diagnostic Pain 1987; 30: 191-197. questionnaire DN4 . Pain 2005; 114: 29-36. 7 Mystakidou K, Parpa E, Tsilika E, et al. Comparison of 73. Pain Assessment for Lung Cancer Patients Research on the Relationship between Words Describing Pain and Pain Pathogenesis.

7 Satomi INAGAKI*1, Masayuki MIYAZAKI*1, Katsuyoshi KATO*1, Tomoko TEZUKA*1, Yoshinori HASEGAWA*2, Toshitaka NABESHIMA*3, Yukihiro NODA*1, *4, and Kiyofumi YAMADA*1. *1 . Department of Neuropsychopharmacology and Hospital Pharmacy, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8560, Japan *2 . Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8560, Japan *3 . Department of Chemical Pharmacology, Meijo University Graduate School of Pharmaceutical Sciences, 150 Yagotoyama, Tenpaku-ku, Nagoya 468-8503, Japan *4 . Division of Clinical Sciences and Neuropsychopharmacology, Meijo University Graduate School of Pharmaceutical Sciences, 150 Yagotoyama, Tenpaku-ku, Nagoya 468-8503, Japan Abstract: Cancer pain is complicated due to the existence of many types of pain, such as nociceptive pain and neuropathic pain.

8 It is important to assess and classify pain quality based on patients' complaints, in order to provide appropriate pain relief. To examine the relationship between pain quality descriptions and pain pathogenesis based on the site of pain and the response to analgesics (opioids and/or NSAIDs), 66 lung cancer patients were assessed using the Aichi Prefectural Society of Hospital Pharmacists Pain Questionnaire (APQ). This tool used the McGill Pain Questionnaire (MPQ), which has been shown to be assessing pain, based on patients' descriptions of pain quality. More than half of the patients included in this study had pain located at the chest, back and arms, and 21 words were used by the patients to describe the pain quality.

9 Dull was the word most frequently used to describe pain, and was used for pain at all reported sites. For patients with bone metastases, lung cancer and pancoast lung cancer, patients with pain described as dull, throbbing and pressing demonstrated a high response rate (more than 80 ) to analgesic treatment. Pain described as shooting, tender, heavy and pricking showed a moderate response rate (50-70 ), suggesting that these descriptions of pain indicate the existence of analgesic sensitive and insensitive components. These findings suggest that a comprehensive analysis of pain quality descriptions would be clinically useful for determining pain pathogenesis and optimizing drug treatment for cancer pain. Further studies are needed to validate the usefulness of pain quality descriptions in a clinical setting.

10 Key words: p ain assessment, pain quality descriptors, pain pathogenesis, analgesics (opioids and/or NSAIDs). response, Aichi Prefectural Society of Hospital Pharmacists Pain Questionnaire APQ.