Nakamura Masaya, Nishiwaki Yuji, Sumitani Masahiko, Ushida Takahiro, Yamashita Toshihiko, Konno Shinichi, Taguchi Toshihiko, Toyama Yoshiaki
Department of Orthopaedic Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan,
J Orthop Sci. 2014 Jul;19(4):667-75. doi: 10.1007/s00776-014-0567-6. Epub 2014 Apr 16.
The previous epidemiological surveys conducted in Japan revealed that once the vicious cycle of chronic musculoskeletal pain begins, it is difficult to disrupt the cycle. This finding suggests the existence of problems with the conventional approaches to treatment of chronic musculoskeletal pain. The purpose of this study was to investigate the characteristics of patients with chronic musculoskeletal pain focusing on neuropathic and psychogenic pain.
The questionnaire was sent again to the 660 subjects found to have persistent chronic pain in the epidemiological surveys conducted in 2011. Responses were collected from 588 subjects (response rate 90%).
Of the 588 responders, 365 (62%) complained of persistent chronic pain. Among them, 128 (35%) were still receiving treatment and 193 (53%) had discontinued treatment. The degree of satisfaction with the treatment was low, and 66% of the patients had switched the medical facility that they visited to receive treatment. The cited reasons for the change in the medical facility visited and discontinuation of treatment were "treatment was ineffective," "I did not have sufficient time," "I thought I could take care of it myself," and "Treatment seemed to be unnecessary". Involvement of neuropathic pain was suggested in 20% of all the patients with chronic pain. As the PainDETECT Score rose, the Visual Analog Scale (VAS) score became higher and the change of medical facility for treatment also increased. The Pain Catastrophizing Scale score was correlated positively with the VAS score. The Hospital Anxiety and Depression Scale score was significantly correlated with the VAS score and the duration of pain.
The results of this survey indicated that the chronic course of musculoskeletal pain may be attributable to the following factors: (1) lack of appropriate treatment of neuropathic pain and psychogenic pain, and (2) insufficient awareness/knowledge among patients about chronic musculoskeletal pain.
此前在日本进行的流行病学调查显示，一旦慢性肌肉骨骼疼痛的恶性循环开始，就很难打破这个循环。这一发现表明，传统的慢性肌肉骨骼疼痛治疗方法存在问题。本研究的目的是调查以神经性疼痛和精神性疼痛为重点的慢性肌肉骨骼疼痛患者的特征。
对在2011年进行的流行病学调查中发现患有持续性慢性疼痛的660名受试者再次发送问卷。从588名受试者中收集了回复（回复率90%）。
在588名回复者中，365人（62%）抱怨存在持续性慢性疼痛。其中，128人（35%）仍在接受治疗，193人（53%）已停止治疗。对治疗的满意度较低，66%的患者更换了他们就诊接受治疗的医疗机构。更换就诊医疗机构和停止治疗的原因包括“治疗无效”、“我没有足够的时间”、“我认为我可以自己处理”以及“治疗似乎没有必要”。在所有慢性疼痛患者中，20%的患者提示存在神经性疼痛。随着疼痛检测量表（PainDETECT）评分升高，视觉模拟量表（VAS）评分升高，更换治疗医疗机构的情况也增加。疼痛灾难化量表评分与VAS评分呈正相关。医院焦虑抑郁量表评分与VAS评分和疼痛持续时间显著相关。
本次调查结果表明，肌肉骨骼疼痛的慢性病程可能归因于以下因素：（1）对神经性疼痛和精神性疼痛缺乏适当治疗，以及（2）患者对慢性肌肉骨骼疼痛的认识/知识不足。
