臨床整形外科46巻4号

2011年04月発行

誌上シンポジウム 運動器の慢性疼痛に対する薬物療法の新展開

筋骨格系の痛み―その慢性化のメカニズム

著者： 仙波恵美子¹

所属機関： ¹和歌山県立医科大学医学部第二解剖

ページ範囲：P.291 - P.298

　慢性疼痛の特徴として，1)筋骨格系の痛みが多い，2)痛みが全身性・両側性である，3)ストレスにより増強する，ということがある．筋骨格系の痛みが慢性化しやすいのは表在性の痛みと性質が異なり，より不快な情動を喚起するためと思われる．脳画像では，持続的な痛みにより前帯状回，島皮質などの血流が増加しており，これらの領域の過剰興奮は，下行性疼痛調節系を介して慢性疼痛の維持・増強に働く．さらに慢性的なストレス負荷が痛みを増強させるメカニズムにも下行性疼痛調節系が関与している．慢性疼痛では，脳をターゲットにした治療が必要である．

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