理学療法ジャーナル46巻2号

2012年02月発行

特集 慢性疼痛への包括的アプローチ

慢性疼痛への理学療法―切断

著者： 相澤純也¹ 森田定雄²

所属機関： ¹了德寺大学健康科学部理学療法学科 ²東京医科歯科大学大学院医歯学総合研究科リハビリテーション医学

ページ範囲：P.137 - P.144

はじめに

　切断者における断端痛や幻肢痛は切断後から数か月，数年にわたり，慢性的な経過をたどることが少なくない．断端痛とは切断肢の末端部に生じる痛みであり，程度や経過に差はあるが大半の切断者が経験する^1～4）．幻肢痛は幻肢に痛みが伴う感覚を意味する（図）．幻肢痛は切断者の59～90％が経験する^5～7）．なお，幻肢とは失った手足が残存しているような幻の感覚である．幻肢は固有受容感覚，触覚，視覚からの入力によるbody imageの発達に起因し，6～8歳頃より出現しやすい^8～11）．痛みを伴わない幻肢は，日常生活で問題となりにくく，自然に消失することが多いため経過観察が主体となる．しかし，幻肢痛に対しては適切にアプローチし，対症療法のみにとどまらないことが重要になる．

　断端痛と幻肢痛は，切断者の精神的・身体的な負担を増大させ，生活の質を低下させる^12）．リハビリテーションの臨床場面では，断端痛と幻肢痛は義肢の装着や適合を妨げ，義手操作や義足歩行を阻害する^13～16）．したがって，切断者のリハビリテーションに関わる専門職は，断端痛と幻肢痛の病態を正しく理解し，痛みの予防や軽減を目的とした評価や治療，患者教育を実践しなければならない．

　本稿では，理学療法アプローチの実践に役立つ情報として断端痛と幻肢痛の誘因や臨床症状を整理した上で，理学療法評価・治療の根拠と適用について述べる．

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