研究者詳細 - 若泉　謙太

論文 - 若泉　謙太

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Exercise effect on pain is associated with negative and positive affective components: A large-scale internet-based cross-sectional study in Japan

Wakaizumi K., Shinohara Y., Kawate M., Matsudaira K., Oka H., Yamada K., Jabakhanji R., Baliki M.N.

Scientific Reports （Scientific Reports） 14 （ 1 ） 2024年12月

Pain is a global health problem that leads to sedentary behavior and tends to cause negative emotion. In contrast, exercise is widely recommended for a health promotion, while pain often worsens with physical activity. Although exercise therapy is often prescribed to people with pain, the mechanisms of exercise effect on pain remains unclear. In this study, we tried to identify a universal association factor between regular exercise and pain intensity utilizing a cross-sectional web-based survey involving 52,353 adult participants from a large national study conducted in Japan. Using principal component analysis, we uncovered a mediation model of exercise effect on pain through psychological components. Analyses were performed in half of the population with pain (n = 20,330) and validated in the other half (n = 20,330), and showed that high-frequency exercise had a significant association with reduction in pain intensity. We also found Negative Affect and Vigor, two psychological components, are fully associating the exercise effect on pain (indirect effect = − 0.032, p < 0.001; association proportion = 0.99) with a dose-dependent response corresponding to the frequency of exercise. These findings were successfully validated (indirect effect of high-frequency exercise = − 0.028, p < 0.001; association proportion = 0.85). Moreover, these findings were also identified in subpopulation analyses of people with low back, neck, knee pain, and the tendency of the exercise effect on pain was increased with older people. In conclusion, the effect of exercise on pain is associated with psychological components and these association effects increased in parallel with the frequency of exercise habit regardless pain location.

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Association between smoking and central sensitization pain: a web-based cross-sectional study

Chiba S., Yamada K., Kawai A., Hamaoka S., Ikemiya H., Hara A., Wakaizumi K., Tabuchi T., Yamaguchi K., Kawagoe I., Iseki M.

Journal of Anesthesia （Journal of Anesthesia） 38 （ 2 ） 198 - 205 2024年04月

ISSN 09138668

Purpose: This study aimed to investigate whether smoking is an independent risk factor for central sensitization syndrome (CSS) in individuals with pain as measured by the Central Sensitization Inventory (CSI). Methods: In 2020, we conducted an Internet survey targeting 2000 ordinary residents of Japan (aged 20–69 years) who had pain symptoms from October to November 2020. A multiple regression analysis was performed on the association between smoking status (nonsmokers and current smokers; Brinkman index) and CSI values. Moreover, compared to nonsmokers, the relative risk (RR) of the CSI cut-off score of 40 points or higher among current smokers was calculated using a modified Poisson regression model. Covariates included age, sex, body mass index, marital status, equivalized income, exercise habits, history of hypertension, history of hyperlipidemia, history of diabetes, pain chronicity, and Pain Catastrophizing Scale score. Results: This study analyzed 1,822 individuals (1,041 men and 781 women). Among those experiencing pain, current smoking was associated with the increase in CSI values (β = 0.07). The Brinkman index was also significantly associated with the increase in CSI values (β = 0.06). Current smoking also increased the risk of being over the CSI cut-off score, with a relative risk (RR) of 1.29 (95% confidence intervals, 1.04–1.60). Younger age, being women, experiencing chronic pain, and higher pain catastrophizing thinking were also significantly associated with increased CSS severity, independent of smoking status. Conclusion: Smoking is an independent risk factor for CSS. This indicates that smoking may be an important factor in the management of central pain disorders.

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Impact of continued mindfulness practice on resilience and well-being in mindfulness-based intervention graduates during the COVID-19 pandemic: A cross-sectional study

Tanaka C., Wakaizumi K., Ninomiya A., Tamura N., Kosugi S., Park S., Sado M., Mimura M., Fujisawa D.

Psychiatry and Clinical Neurosciences Reports （Psychiatry and Clinical Neurosciences Reports） 2 （ 3 ） 2023年09月

査読有り, ISSN 2769-2558

Aim: The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented stress. Mindfulness-based interventions (MBIs) are known to be effective in reducing stress. However, it is unclear how long-term outcomes differ between those who continue mindfulness practice after MBIs and those who do not. In this study, we hypothesized that those who continued mindfulness practice would have higher stress tolerance, and we examined this hypothesis through a survey of MBI graduates. In this study, we examined the association between the continuation of mindfulness practice among MBI completers and individual stress during the COVID-19 epidemic. Methods: A cross-sectional survey of MBI graduates was conducted. The physical and mental health states were compared between those who established a habit of mindfulness practice (practice group) and those who did not (no practice group). Results: The data were collected from 95 participants (response rate: 53.7%). Of the total respondents, 66 (69.5%) practiced mindfulness. Although the degree of perceived stress due to the COVID-19 pandemic was not statistically different between the practice and no practice groups, the practice group showed significantly lower levels of depression (p = 0.007), higher levels of resilience (p = 0.006), higher levels of overall health (p = 0.006), and higher levels of mental health (p = 0.039). The effect of mindfulness practice on reducing depression was fully mediated by resilience. Conclusion: Among MBI graduates, those who regularly practiced mindfulness had lower levels of depression and higher levels of physical and mental health. Thus, the continuation of mindfulness practice increases resilience, buffers against new stressors such as the COVID-19 pandemic, and has the potential to prevent depression.

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Effect of repeated transforaminal epidural low-dose dexamethasone injections on glucose profiles of diabetic and non-diabetic patients with low back pain

Hoshino R., Wakaizumi K., Otsuka Y., Morisaki H., Kosugi S.

Journal of Anesthesia （Journal of Anesthesia） 37 （ 2 ） 261 - 267 2023年04月

査読有り, ISSN 09138668

Purpose: We aimed to investigate the effect of repeated transforaminal epidural low-dose dexamethasone injections on glucose profiles and pituitary-adrenal axis functions of diabetic and non-diabetic patients with low back pain. Methods: A total of 28 patients (ten diabetic [DM group] and 18 non-diabetic patients [non-DM group]) with low back pain were followed-up. Transforaminal epidural low-dose dexamethasone (1.65 mg) injections were repeated every 7–14 days for 8 weeks. Fasting blood sugar (FBS), hemoglobin A1c (HbA1c), morning plasma adrenocorticotropin (ACTH), and cortisol levels were measured at baseline and during the 8-week follow-up period. Results: There were no significant changes in FBS and HbA1c levels between baseline and 8-week follow-up period in both DM and non-DM groups (difference in FBS [95% confidence Interval, CI]: − 0.6 mg/dL [− 6.4, 5.1], p = 0.83 in the non-DM group, − 0.2 mg/dL [− 26.2, 25.8], p = 0.99 in the DM group; difference in HbA1c [95% CI] − 0.02% [− 0.1, 0.1], p = 0.69 in the non-DM group, 0.04% [− 0.3, 0.4], p = 0.79 in the DM group). There were no significant longitudinal changes in ACTH and cortisol levels (ACTH, p = 0.38 [baseline vs. 8 week], p = 0.58 [non-DM vs. DM]; cortisol, p = 0.52 [baseline vs. 8 week], p = 0.90 [non-DM vs. DM]). Conclusions: Repeated transforaminal epidural low-dose dexamethasone injections provided no significant elevations in blood glucose or suppression of the pituitary-adrenal axis for two months from the first injection in both diabetic and non-diabetic patients. Our results indicate the intermediate-term safety of repeated transforaminal epidural low-dose dexamethasone injections with regard to the effect on glucose profile and pituitary-adrenal axis functions.

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Decreased Interoceptive Awareness as a Risk Factor for Moderate to Severe Pain in Japanese Full-Time Workers: A Longitudinal Cohort Study

Takaoka S., Wakaizumi K., Tanaka C., Tanaka S., Kawate M., Hoshino R., Matsudaira K., Fujisawa D., Morisaki H., Kosugi S.

Journal of Clinical Medicine （Journal of Clinical Medicine） 12 （ 8 ） 2896 - 2896 2023年04月

責任著者, 査読有り

Interoceptive awareness, the conscious perception of internal bodily states, is a key construct of mind-body interaction. Decreases in interoceptive awareness, as measured by the Multidimensional Assessment of Interoceptive Awareness (MAIA), are found in chronic pain patients. In this study, we explored whether a specific aspect of interoceptive awareness is a risk for the onset and chronicity of pain. A longitudinal cohort study was conducted in 2018 and 2020 among a sample of full-time workers in an industrial manufacturing company in Japan. Participants completed a questionnaire on pain intensity, MAIA, exercise habits, kinesiophobia, psychological distress and work stress. Principal component analyses using the MAIA identified two principal components: self-control and emotional stability. Low emotional stability was associated with the prevalence of moderate to severe pain in 2020 among people with mild or no pain in 2018 (p < 0.01). Lack of exercise habits were associated with the prevalence of moderate to severe pain in 2020 among people with pain in 2018 (p < 0.01). Furthermore, exercise habits were associated with reduction in kinesiophobia among people with moderate to severe pain in 2018 (p = 0.047). Overall, these findings indicate that low emotional stability may be a risk for the onset of moderate to severe pain; lack of exercise habits may sustain kinesiophobia and be a risk for the chronicity of pain.

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Influence of exercise on pain is associated with resting-state functional connections: A cross-sectional functional brain imaging study

Wakaizumi K., Reckziegel D., Jabakhanji R., Apkarian A.V., Baliki M.N.

Neurobiology of Pain （Neurobiology of Pain） 13 100125 - 100125 2023年01月

査読有り

Exercise is associated with lower prevalence and severity of pain, and is widely recommended for pain management. However, the mechanisms the exercise effect on pain remain unclear. In this study, we examined the association of exercise with pain and aimed to identify its neurobiological mediators. We utilized a baseline data of a clinical trial for people with low back pain. Participants reported pain intensity and exercise habit, as well as pain-related psychological and emotional assessments. We also obtained brain imaging data using a resting-state functional MRI and performed mediation analyses to identify brain regions mediating the exercise effect on pain. Forty-five people with low back pain (mean pain intensity = 59.6 and mean duration = 9.9 weeks) were included in this study. Participants with an exercise habit (n = 29) showed significant less pain compared to those without an exercise habit (n = 16). Mediation analysis using resting-state functional connectivity identified the left thalamus, right amygdala, and medial prefrontal cortex as statistical mediators of the exercise effect on pain (indirect effect = −0.460, 95% confidence interval = −0.767 to −0.153). In conclusion, our findings suggest that brain function of the specific regions is probably a neuro-mechanism of exercise alleviating pain.

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A Cross-Sectional Study of the Impact of Pain Severity on Absenteeism and Presenteeism Among Japanese Full-Time Workers

Tanaka C., Wakaizumi K., Takaoka S., Matsudaira K., Mimura M., Fujisawa D., Kosugi S.

Pain and Therapy （Pain and Therapy） 11 （ 4 ） 1179 - 1193 2022年12月

査読有り, ISSN 21938237

Introduction: Pain is known to have a high impact on work performance, but there are several confounding factors, such as stress and mental issues. Little is known about the impact of pain severity on work performance when adjusted for such confounding factors. The aim of this study was to identify the effect of pain severity on absence from work (absenteeism) and reduced performance (presenteeism). Methods: A cross-sectional study was conducted among full-time workers at an industrial manufacturing company in Japan. Participants were assessed using a self-reported questionnaire, including work performance evaluations, pain characteristics, pain-related fear, psychological distress, stress at the workplace and home, workaholism, and self-awareness. Principal component analysis was utilized to decrease the dimensions of the measures, and orthogonal rotation was performed on identified components with an eigenvalue > 1.0. Multivariable logistic regression analyses were performed to determine the association between pain severity and absenteeism and presenteeism, and were adjusted for confounding factors. We also analyzed the association between pain intensity and presenteeism using multivariable logistic regression analyses. Results: A total of 349 workers participated in the study. Six principal components were identified as confounding factors: work stress, regulation, mental instability, less support, home stress, and life dissatisfaction. Multivariable logistic regression analyses showed significant associations of moderate to severe pain with absenteeism (p = 0.02) and low and high presenteeism (p = 0.004 and 0.009, respectively), adjusted for age, sex, body mass index, short sleep, and the six principal components. Pain intensity was also significantly associated with low and high presenteeism (p = 0.002 and 0.014, respectively) in people with pain. Conclusions: Pain severity is a risk factor for absenteeism and presenteeism, even if workers have comorbid psychological stress or mental health problems.

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痛みとタバコ;ステートメントを超えて beyond the statement 日本の疫学研究からみえる喫煙と疼痛の関係

山田恵子, 千葉聡子, 若泉謙太, 井関雅子, 田淵貴大

PAIN RESEARCH （(一社)日本疼痛学会） 37 （ 4 ） 190 - 190 2022年12月

ISSN 0915-8588

集学的痛みセンターにおける慢性腰痛・頚部痛の治療反応性―ICD-11に基づく慢性痛分類による比較―

星野麗子, 本田あやか, 篠原佑太, 石川愛子, 田中智里, 辻収彦, 若泉謙太, 森崎浩, 小杉志都子

日本ペインクリニック学会誌（一般社団法人日本ペインクリニック学会） 29 （ 9 ） 187 - 192 2022年09月

査読有り, ISSN 1340-4903

【目的】本研究では，国際疾病分類（ICD-11）に基づいて慢性腰痛および慢性頚部痛を分類し，ICD-11の慢性痛分類コードと集学的治療下での疼痛改善との関連を調べた．【方法】当施設倫理委員会承認後，慢性腰痛および頚部痛を主訴に当院集学的痛み診療センターを受診した212人をICD-11に基づき一次性筋骨格系疼痛，二次性筋骨格系疼痛，および神経障害性疼痛に分類した．個々の症例は集学的評価に基づいて治療介入を行った．3カ月後の痛みの強さ（Brief Pain Inventory）が初診時の30％以上減少した場合を疼痛改善と定義した．多変量ロジスティック回帰分析を用いて，患者特性，治療因子，ならびにICD-11の慢性痛分類コードと疼痛改善の関連を調べた．【結果】神経障害性疼痛は，一次性筋骨格系疼痛と比較し，3カ月後の疼痛改善に対するオッズ比が有意に高かった［オッズ比（95％信頼区間）2.52（1.25～5.09），p＝0.02］．【結語】集学的治療下における慢性腰痛および頚部痛の疼痛改善に対して，ICD-11による慢性痛分類は重要な関連因子となりうる．

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Negative effect of anger on chronic pain intensity is modified by multiple mood states other than anger: A large population-based cross-sectional study in Japan

Yamada K., Fujii T., Kubota Y., Wakaizumi K., Oka H., Matsudaira K.

Modern Rheumatology （Modern Rheumatology） 32 （ 3 ） 650 - 657 2022年05月

査読有り, ISSN 14397595

Objectives: To investigate whether mood states other than anger can modify the association between anger and pain intensity in individuals with chronic pain. Methods: We analysed 22,059 participants with chronic pain, including 214 participants with rheumatoid arthritis (RA), who completed a questionnaire. The Profile of Mood States short form (POMS-SF) was used to assess six dimensions of mood states (anger-hostility, tension-anxiety, depression-dejection, confusion, fatigue, and vigour). A numerical rating scale (NRS) assessed pain intensity. We examined the association between anger-hostility and the NRS and the relationship between POMS-SF components. Moderation analyses were used to investigate whether the five mood states other than anger-hostility modified the effect of anger-hostility on the NRS. Results: Anger-hostility contributed to pain intensity. Although increased mood states other than vigour were associated with increased pain intensity, these increased mood states appeared to suppress the effect of anger-hostility on pain intensity. Increased vigour was associated with decreased pain intensity and increased the effect of anger-hostility on pain intensity. Conclusions: Mood states other than anger may influence the association between anger and pain intensity in individuals with chronic pain. It is important to focus on complicated mood states and anger in individuals with chronic pain, including RA.

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Effects of Thoracic Epidural Anesthesia on Systemic and Local Inflammatory Responses in Patients Undergoing Lung Cancer Surgery: A Randomized Controlled Trial

Okuda J., Suzuki T., Wakaizumi K., Kato J., Yamada T., Morisaki H.

Journal of Cardiothoracic and Vascular Anesthesia （Journal of Cardiothoracic and Vascular Anesthesia） 36 （ 5 ） 1380 - 1386 2022年05月

査読有り, ISSN 10530770

Objective: Inflammatory responses play major roles in the development of acute lung injury following lung cancer surgery. The authors tested the hypothesis that thoracic epidural anesthesia (TEA) during surgery could attenuate both systemic and local inflammatory cytokine productions in patients undergoing lung cancer surgery. Design: A prospective randomized controlled trial. Setting: At Keio University Hospital, Tokyo, Japan. Participants: Patients scheduled for lung cancer surgery. Interventions: Sixty patients were randomly allocated into two groups (n = 30 each group): the epidural group (group E), in which anesthesia was maintained with propofol, fentanyl, rocuronium, and epidural anesthesia with 0.25% levobupivacaine; or the remifentanil group (group R), in which a remifentanil infusion was used as a potent analgesia instead of epidural anesthesia. Measurements and Main Results: The lung epithelial lining fluid (ELF) and blood sampling were collected prior to one-lung ventilation (OLV) initiation (T1) and at 30 minutes after the end of OLV (T2). The concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 in the ELF at T2 were increased significantly compared with those at T1 in both groups. The ELF concentration of IL-6 in group E was significantly lower than that in group R at T2 (median [interquartile range]: 39.7 [13.8-80.2] versus 76.1 [44.9-138.2], p = 0.008). Plasma IL-6 concentrations at T2, which increased in comparison to that at T1, were not significantly different between the two groups. The plasma concentrations of TNF-α did not change in both groups. Conclusions: This randomized clinical trial suggested that TEA could attenuate local inflammatory responses in the lungs during lung cancer surgery.

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Improvement in Disability Mediates the Effect of Self-Efficacy on Pain Relief in Chronic Low Back Pain Patients with Exercise Therapy

Shinohara Y., Wakaizumi K., Ishikawa A., Ito M., Hoshino R., Tanaka C., Takaoka S., Kawakami M., Tsuji O., Fujisawa D., Fujiwara T., Tsuji T., Morisaki H., Kosugi S.

Pain Research and Management （Pain Research and Management） 2022 1 - 8 2022年

査読有り, ISSN 12036765

Background. The biopsychosocial mechanism by which exercise leads to improvement in chronic low back pain (CLBP) remains unstudied. This prospective cohort study was performed to examine the effectiveness of exercise on pain, disability, and psychological status for CLBP. We also tested path analytic models in which changes in these variables were included. Methods. CLBP patients who visited the Interdisciplinary Pain Center of Keio University Hospital from July 2018 to April 2020 were included. The propensity score matching was performed between patients who underwent exercise (the exercise group) and those who did not (the control group). At the first visit and at the 3-month follow-up, pain (Numerical Rating Scale (NRS)), disability (Pain Disability Assessment Scale (PDAS)), and psychological status (Pain Self-Efficacy Questionnaire (PSEQ), and Pain Catastrophizing Scale (PCS)) were assessed. Changes in pain and disability at the follow-up were compared between the groups. The relationships between changes in pain, disability, and psychological variables were examined using Pearson's correlation and mediation analysis. Results. A significantly larger decrease in the PDAS was observed in the exercise group (N = 49) than in the control (N = 49) (p<0.05). Increased PSEQ scores were significantly correlated with decreased NRS scores in both groups. In the exercise group, decreased PDAS fully mediated the relationship between increased PSEQ and decreased NRS (P<0.05). Conclusion. Exercise improved disability, and the improved disability by exercise mediated the effect of increased self-efficacy on pain relief in CLBP patients.

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痛みによる報酬行動の変化と脳科学的メカニズム

若泉謙太

慢性疼痛（日本慢性疼痛学会） 40 （ 1 ） 68 - 75 2021年12月

筆頭著者, 最終著者, 責任著者, 査読有り, ISSN 1340-2331

「痛み」と「報酬」は、我々の脳で相反する刺激として認知され、その関係性を理解することは痛み医療において重要である。しかしながら、脳内報酬系には様々な役割があり、痛みとの関連性を理解することは簡単ではない。本稿では報酬系の機能を報酬認知、鎮痛効果、報酬予測、強化学習の4つに分類し、それぞれの役割における痛みとの関連性について概説する。痛みは報酬認知を歪め、慢性痛患者では報酬系の機能低下が生じている。報酬系の活性化は鎮痛効果を惹起できるが、痛みにより衝動性が高まっている状態では不適切な学習により痛みの悪循環に陥りやすいと考えられる。慢性痛医療においては、認知の歪みや報酬系の機能低下を患者個人のレベルで評価し、持続的な報酬系の活性化につながるような適切な医療を段階的に提供していく姿勢が求められる。今後、慢性痛医療にとって重要な「痛みと報酬系の関係」について臨床的な研究が進むことが期待される。(著者抄録)

Loneliness, social isolation, and pain following the COVID-19 outbreak: data from a nationwide internet survey in Japan

Yamada K., Wakaizumi K., Kubota Y., Murayama H., Tabuchi T.

Scientific Reports （Scientific Reports） 11 （ 1 ） 18643 - 18643 2021年12月

査読有り

The aim of cross-sectional study was to investigate the association between loneliness, increased social isolation, and pain following the COVID-19 outbreak. A total of 25,482 participants, aged 15–79 years, were assessed using an internet survey; the University of California, Los Angeles Loneliness Scale (Version 3), Short Form 3-item (UCLA-LS3-SF3) was used to assess loneliness, and a modified item of the UCLA-LS3-SF3 was used to measure the perception of increased social isolation during the pandemic. The outcome measures included the prevalence/incidence of pain (i.e., headache, neck or shoulder pain, upper limb pain, low back pain, and leg pain), pain intensity, and the prevalence of past/present chronic pain. Pain intensity was measured by the pain/discomfort item of the 5-level version of the EuroQol 5 Dimension scale. Odds ratios of pain prevalence/incidence and past/present chronic pain prevalence according to the UCLA-LS3-SF3 scoring groups (tertiles) and the frequency of the perceived increase in social isolation (categories 1–5) were calculated using multinomial logistic regression analysis. The mean pain intensity values among different loneliness and social isolation levels were tested using an analysis of covariance. Increased loneliness and the severity of the perceived social isolation were positively associated with the prevalence/incidence of pain, pain intensity, and the prevalence of past/present chronic pain.

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新型コロナウイルスの蔓延と仕事のパフォーマンスの変化 JACSIS研究より

若泉謙太, 山田恵子, 島津明人, 田淵貴大

臨床麻酔（真興交易(株)医書出版部） 45 （ 12 ） 1565 - 1572 2021年12月

筆頭著者, 責任著者, ISSN 0387-3668

Sex-Specific Pharmacotherapy for Back Pain: A Proof-of-Concept Randomized Trial

Reckziegel D., Tétreault P., Ghantous M., Wakaizumi K., Petre B., Huang L., Jabakhanji R., Abdullah T., Vachon-Presseau E., Berger S., Baria A., Griffith J.W., Baliki M.N., Schnitzer T.J., Apkarian A.V.

Pain and Therapy （Pain and Therapy） 10 （ 2 ） 1375 - 1400 2021年12月

査読有り, ISSN 21938237

Background: Preventing transition to chronic back pain (CBP) is a long-sought strategy that could rescue patients from prolonged suffering. Recent rodent and human brain imaging studies suggest involvement of sexually dimorphic, dopaminergic-motivational, mesolimbic circuits in the transition to chronic pain (tCBP), and hint that the combination of carbidopa/levodopa and naproxen (LDP + NPX) may block tCBP. Here we evaluated, in people with recent-onset back pain, whether a 3-month treatment with LDP + NPX is safe, blocks tCBP, and whether its efficacy is sex-dependent. Methods: A total of 72 participants were enrolled and stratified by risk for tCBP using brain-imaging biomarkers. Low-risk participants entered a no-treatment arm. Others were randomized to placebo + naproxen or LDP + NPX for 3 months. Results: Both treatments resulted in more than 50% pain relief for approximately 75% of participants. A strong sex by treatment interaction was observed for daily pain intensity (phone NRS, P = 0.007), replicated on 4-week average pain (Pain/4w, P = 0.00001), and in intent-to-treat analysis (Pain/4w, P = 0.000004). Nucleus accumbens functional connectivity with medial prefrontal cortex, a predefined objective biomarker, showed sex dependence at baseline (P = 0.03) and sex-by-treatment interaction effect 3 months after treatment cessation (P = 0.031). Treatment modified the psychological profile of participants, and disrupted brain modeling-based predicted back pain intensity trajectories. Forty participants were queried 3.3 years from trial start; back pain ratings were similar between end of treatment and at 3.3 years (P = 0.62), indicating persistence of relief for this duration. Conclusions: These results provide the first evidence for preventing transition to chronic back pain using sex-specific pharmacotherapy. These provocative observations require confirmation in a larger study. ClinicalTrials.gov identifier: NCT01951105.

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脊椎由来疼痛の保存的治療における疼痛関連アウトカムに影響する因子の検討

本田あやか, 星野麗子, 篠原佑太, 石川愛子, 田中智里, 高岡早紀, 辻収彦, 西村大輔, 若泉謙太, 森崎浩, 小杉志都子

日本ペインクリニック学会誌（(一社)日本ペインクリニック学会） 28 （ 9 ） 183 - 189 2021年09月

査読有り, ISSN 1340-4903

脊椎疾患の保存的治療における疼痛および障害の改善に影響する因子を縦断的に調査した.施設倫理委員会承認後,2018年7月〜2019年12月に当センターを受診した18歳以上の脊椎疾患患者185名を解析した.患者背景(年齢・性別・body mass index・罹患期間・罹患高位・脊椎手術歴),治療因子(内服・神経ブロック・運動療法),および初診時・3ヵ月後の簡易疼痛質問票(BPI),疼痛生活障害尺度(PDAS),不安抑うつ尺度(HADS),痛みの破局化思考(PCS)を調査した.3ヵ月後の疼痛および障害の改善は,BPI減少率≧50%およびPDAS減少率≧30%と定義した.短い罹患期間および神経ブロック治療が疼痛改善と有意に関連した(p<0.05).若年齢,短い罹患期間,および脊椎手術歴がないことが障害改善と有意に関連した(p<0.05).3ヵ月間のHADSおよびPCSの変化量は,BPIおよびPDASの変化量と有意に相関した(p<0.001).脊椎疾患の保存的治療では,早期介入や局所鎮痛がアウトカム改善に寄与するが,高齢者や脊椎手術既往者では治療反応性は乏しく,治療内容の再考を要する.(著者抄録)

Psychosocial, Functional, and Emotional Correlates of Long-Term Opioid Use in Patients with Chronic Back Pain: A Cross-Sectional Case–Control Study

Wakaizumi K., Vigotsky A.D., Jabakhanji R., Abdallah M., Barroso J., Schnitzer T.J., Apkarian A.V., Baliki M.N.

Pain and Therapy （Pain and Therapy） 10 （ 1 ） 691 - 709 2021年06月

査読有り, ISSN 21938237

Introduction: The opiate epidemic has severe medical and social consequences. Opioids are commonly prescribed in patients with chronic pain, and are a main contributor to the opiate epidemic. The adverse effects of long-term opioid usage have been studied primarily in dependence/addiction disorders, but not in chronic pain. Here, we examine the added iatrogenic effects, psychology, and brain morphology of long-term opioid use in matched patients with chronic pain with and without opioid use (case–controlled design). Methods: We compared psychosocial, functional, and psychological measures between patients with chronic back pain (CBP) who were managing their pain with or without opioids, thereby controlling for the effect of pain on these outcomes. In addition, we investigated brain morphological differences associated with long-term opioid usage. We recruited 58 patients with CBP, 29 of them on long-term opioids and 29 who did not use opioids, and who were matched in terms of age, sex, pain intensity, and pain duration. Questionnaires were used to assess pain quality, pain psychology, negative and positive emotions, physical, cognitive, sensory, and motor functions, quality of life, and personality traits. Results: Patients with CBP on opioids displayed more negative emotion, poorer physical function, and more pain interference (p < 0.001), whereas there were no statistical differences in cognitive and motor functions and personality traits. Voxel-based morphometry using structural brain imaging data identified decreased gray matter density of the dorsal paracingulate cortex (family-wise error-corrected p < 0.05) in patients with opioids, which was associated with negative emotion (p = 0.03). Finally, a volumetric analysis of hippocampal subfields identified lower volume of the left presubiculum in patients on opioids (p < 0.001). Conclusion: Long-term opioid use in chronic pain is associated with adverse negative emotion and disabilities, as well as decreased gray matter volumes of specific brain regions.

Access to Document (DOI)

【頭痛・めまい・しびれ・疼痛-慢性化のメカニズムと治療】しびれ・疼痛しびれ・疼痛の一般的病態と慢性化のメカニズム大脳の変化

若泉謙太

内科（(株)南江堂） 127 （ 6 ） 1287 - 1292 2021年06月

筆頭著者, 最終著者, 責任著者, ISSN 0022-1961

＜文献概要＞▼国際疾病分類に慢性痛の項目が新設され,原因の特定できない慢性痛に対して「一次性慢性痛」という診断ができるようになった.▼中枢感作の病態を示唆する"nociplastic pain"という用語もつくられた.このような動きの背景には,脳神経の可塑的な変化が痛みの慢性化や重症化に関与することを示す研究成果がある.▼脳画像研究の発展に伴って慢性痛患者ではペイン・マトリックスやデフォルト・モード・ネットワークとよばれる脳部位や神経ネットワークにさまざまな変化が起こっていることがわかってきた.▼脳内報酬系ネットワークは痛みの慢性化の素因となっている可能性が指摘されている.▼慢性痛に対しては,このような大脳の変化を念頭に置いた治療的介入が必要であると考えられる.

【高齢者の疼痛管理を考える】学際的痛み医療と脳機能の改善

若泉謙太

ペインクリニック（真興交易(株)医書出版部） 42 （ 6 ） 722 - 730 2021年06月

筆頭著者, 最終著者, 責任著者, ISSN 0388-4171

著者の所属していた施設(米国シカゴ)で行われていた学際的痛み医療(ペイン・マネジメント・プログラム)について概説する。このプログラムで参加者は、マインドフルネスを含めた様々なリラクゼーション法や運動療法、認知の修正法などを学び、自分の痛みをマネジメントするスキルを獲得する。プログラムの前後を比較すると、参加者は痛みの改善だけでなく、情動面の改善やコーピング・スキルの獲得といった効果を得ることができる。また、脳画像解析において有意な変化も検出でき、脳機能の改善も示唆される。(著者抄録)

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