難治性疼痛、頑痛

WordNet

cause emotional anguish or make miserable; "It pains me to see my children not being taught well in school" (同)anguish, hurt
a symptom of some physical hurt or disorder; "the patient developed severe pain and distension" (同)hurting
a bothersome annoying person; "that kid is a terrible pain" (同)pain in the neck, nuisance
a somatic sensation of acute discomfort; "as the intensity increased the sensation changed from tickle to pain" (同)pain_sensation, painful sensation
emotional distress; a fundamental feeling that people try to avoid; "the pain of loneliness" (同)painfulness
not tractable; difficult to manage or mold; "an intractable disposition"; "intractable pain"; "the most intractable issue of our era"; "intractable metal"

PrepTutorEJDIC

〈C〉〈U〉(肉体のある部分の)『苦痛』,『痛み』 / 〈U〉(精神的な)『苦痛』,心痛 / 《複数形で》骨折り,苦労,努力 / 〈C〉不快感,いやな感じ;うんざりさせるもの,やっかい者 / (肉体的・精神的に)…‘に'苦痛を与える(受動態にできない)
(人・人の性質が)手に負えない,強情な / (物事が)処理しにくい,取り扱いにくい
《補語にのみ用いて》腹を立てて / 《補語にのみ用いて》(心が)鐘ついて / 不愉快な,気まずい
とうちゃん(papa)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/03/31 04:05:18」(JST)

wiki en

Intractable pain, also known as Intractable Pain Disease or IP, is a severe, constant pain that is not curable by any known means and which causes a bed or house-bound state and early death if not adequately treated, usually with opioids and/or interventional procedures. It is not relieved by ordinary medical, surgical, nursing, or pharmaceutical measures. Unlike the more common chronic pain, it causes adverse biologic effects on the body's cardiovascular, hormone, and neurologic systems. Patients experience changes in testosterone, estrogen, cortisol, thyroid hormones, and/or pituitary hormones. Both men and women require testosterone, however many doctors neglect to test women for low testosterone. Untreated Intractable Pain can cause death.^{[citation needed]}

Legal Definitions

The exact definition of intractable pain varies based on the source and is not generally agreed upon. Several states (California, Colorado, Florida, New Jersey, Texas, Virginia, and Washington^[1]) have passed intractable pain laws or guidelines. Texas, under their Intractable Pain Treatment Act, defines Intractable Pain as a state of pain for which the cause of the pain cannot be removed or otherwise treated and in the generally accepted course of medical practice, relief or cure of the cause of the pain is not possible or has not been found after reasonable efforts.^[2] Florida's Intractable Pain statue defines “intractable pain” as pain for which, in the generally accepted course of medical practice, the cause cannot be removed and otherwise treated.^[3]

Treatments

Although Intractable Pain is not curable, there are treatments. The aim of IP treatment is to appreciate the pain caused by the root condition in order to minimize or reverse the neurological, endocrine, and cardiac changes. The specific treatments depend on the cause of the pain, the physician's preference, and the patient's health and preferences. These treatments can be used on their own, but are commonly combined with one another. Not every patient will respond to every treatment, but some more common treatments include:

Surgical repair, such as spinal fusion for scoliosis
Opioid medications
Medical Marijuana
TENS Unit
Spinal cord stimulator (SCS) - utilizes the gate control theory to block painful signals by sending benign electrical signals along the nerve roots.^[4]
Intrathecal Pain Pump - delivers a very small amount of the chosen medication directly to the thecal space (next to the spinal cord, even closer than an epidural)^[5]
Epidural, nerve root, and/or trigger point corticosteroid injections
mu-Opioids - Depending on the specific drug, opioids can be oral, transdermal, IV, intramuscular, subcutaneous, transmucosal, sublingual, intranasal, epidural, or intrathecal. Examples include morphine, hydromorphone, oxymorphone, hydrocodone, oxycodone, codeine, buprenorphine
methadone - methadone is a mu-opioid, kappa-opioid, and NMDA receptor antagonist. It is especially useful for neuropathic pain, however it is also useful for other types of pain, such as bone pain, and musculoskeletal pain.

Some medications can be used to potentiate the primary treatment, this is most commonly done to boost the efficacy of opioids and minimize the dose of the opioid needed to alleviate the pain. Some of these treatments are also used on their own, examples include:^{[citation needed]}

Muscle Relaxants
Stimulants
Mood Stabilizers (anti-epileptics and antipsychotics), such as gabapentin (Neurontin/Gralise/Horizant), pregabalin (Lyrica), topiramate (Topamax), quetiapine (Seroquel), risperidone (Risperdal), aripiprazole (Abilify), paliperidone (Invega), iloperidone (Fanapt), ziprasidone (Geodon), lamotrigine (Lamictal), valproic acid (Depakene/Stavzor), or divalproex acid (Depakote).
SSRI antidepressants, such as fluoxetine (Prozac/Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), or escitalopram (Lexapro)
SNRI antidepressants, such as duloxetine (Cymbalta), venlafaxine (Effexor), desvenlafaxine (Pristiq, or milnacipran (Savella)
NSAIDs - Ibuprofen (Advil/Motrin), naproxen (Naprosyn/Aleve), celecoxib (Celebrex), diclofenac (Voltaren/Flector), or ketorolac (Toradol)
Physical Therapy

Causes

There are many painful conditions that can cause intractable pain disease. Not every patient with these conditions will develop intractable pain, but the following conditions are known to cause Intractable Pain in some patients:

Failed Back Syndrome
Scoliosis, Kyphosis, kyphoscoliosis
Degenerative Disk Disease
Rheumatoid Arthritis
Central Pain Syndrome (CPS)

Notable Figures

Although not recognized during their lifetimes, John F Kennedy^[6] and Howard Hughes^{[citation needed]} are both believe to have suffered from Intractable Pain.

References

^ Joranson, David E. (1995). "Intractable Pain Treatment Laws and Regulations". Archives of the Bulletin of the American Physical Society. American Physical Society. 5 (2): 1–3, 15–17. Retrieved January 12, 2014.
^ http://www.statutes.legis.state.tx.us/Docs/OC/htm/OC.107.htm
^ http://www.flsenate.gov/laws/statutes/2011/458.326
^ http://TameThePain.com
^ http://TameThePain.com
^ http://foresttennant.com/foresttennant/wp-content/uploads/2016/12/905-Feature-JFK-Tennant.pdf

UpToDate Contents

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1. Overview of the treatment of chronic non-cancer pain
2. 癌性疼痛症候群の概要 overview of cancer pain syndromes
3. 癌疼痛のマネージメント：鎮痛補助剤（鎮痛剤） cancer pain management adjuvant analgesics coanalgesics
4. 頭蓋顔面痛の概要 overview of craniofacial pain
5. 経膣メッシュ曝露と骨盤手術後の疼痛のマネージメント management of transvaginal mesh exposure and pain following pelvic surgery

English Journal

Gene therapy for the treatment of chronic peripheral nervous system pain.

Goins WF, Cohen JB, Glorioso JC.SourceDept of Microbiology & Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh PA 15219, USA. goins@pitt.edu
Neurobiology of disease.Neurobiol Dis.2012 Nov;48(2):255-70. Epub 2012 Jun 2.
Chronic pain is a major health concern affecting 80 million Americans at some time in their lives with significant associated morbidity and effects on individual quality of life. Chronic pain can result from a variety of inflammatory and nerve damaging events that include cancer, infectious diseases
PMID 22668775

Rabbit Notochordal Cells Modulate the Expression of Inflammatory Mediators by Human Annulus Fibrosus Cells Cocultured With Activated Macrophage-Like THP-1 Cells.

Kim JH, Moon HJ, Lee JH, Kim JH, Kwon TH, Park YK.SourceFrom the Department of Neurosurgery, Guro Hospital, College of Medicine, Korea University, Seoul, South Korea.
Spine.Spine (Phila Pa 1976).2012 Oct 15;37(22):1856-64. doi: 10.1097/BRS.0b013e3182579434.
STUDY DESIGN.: We evaluated the influence of rabbit notochordal cells on the expression of inflammatory mediators by human annulus fibrosus (AF) cells cocultured with macrophage-like cells. OBJECTIVE.: To identify the protective effect of rabbit notochordal cells on AF during in vitro inflammation.
PMID 22472811

Japanese Journal

福島県立医科大学附属病院における運動器の慢性疼痛患者に対するリエゾン診療(シンポジウム:チーム医療における心身医学的アプローチ,2010年,第51回日本心身医学会総会ならびに学術講演会(仙台))

大谷晃司
心身医学 51(8), 709-714, 2011-08-01
まず,運動器の慢性疼痛を訴えている患者に対して,器質的疾患の関与と精神医学的問題の関与を整形外科で見極める.後者のスクリーニングには,BS-POPを使用している.患者の承諾が得られ,心身医療科とのリエゾン診療が始まった患者に対して,リエゾンカンファレンスを開催して,コメディカルを含めた医療チームの情報を共有し,一貫した治療方針で治療が行われている.最近のリエゾン診療症例32例の治療成績は,有効15 …
NAID 110008686793

疼痛に対する歯内療法 : 難治症例において

上林融
福岡歯科大学学会雑誌 37(2), 60-65, 2011-06-30
… Many of such cases become intractable. … Here, we discuss how to treat the biofilms and what should be cared when treating the biofilms that are formed in the root canals or outside the apical dental foramen and are related with intractable cases of apical periodontal diseases. … gingivalis, are present in many intractable cases. …
NAID 110008733456

A Case of Surgery for Kyphosis of the Thoracolumbar Spine in an Elderly Patient with Dysphagia

Nakanishi Kazuo,Yamane Kentarou,Tanaka Masato,Misawa Haruo,Saiga Kenta,Ozaki Toshifumi
Acta Medica Okayama 65(3), 211-214, 2011-06
… Here we report a case of surgery for kyphosis of the thoracolumbar spine in an elderly patient, in whom surgery was performed because the patient had developed intractable digestive symptoms. … The case was that of a 76-year-old female with complaints of back pain and dysphagia. … After the surgery, the kyphosis angle was improved to 27°, the patient's back pain was alleviated, and it became easier for the patient to swallow food. …
NAID 80021815246