理学療法ジャーナル56巻4号

2022年04月発行

特集 臨床に活かすニューロリハビリテーション

臨床に活かすニューロリハビリテーション　疼痛

著者： 壹岐伸弥¹

所属機関： ¹川口脳神経外科リハビリクリニック

ページ範囲：P.429 - P.433

Point

●中枢性脳卒中後疼痛に対する神経リハビリテーションの科学的根拠は乏しい

●中枢性脳卒中後疼痛のさまざまな病態メカニズムに基づいた臨床観察が重要となる

●感覚識別課題，両側性動作，温冷覚刺激，ミラーセラピー，ラバーハンド錯覚を用いた神経リハビリテーションを紹介する

参考文献

1）日本脳卒中学会脳卒中ガイドライン委員会（編）：脳卒中治療ガイドライン2021．pp271-272，協和企画，2021

2）慢性疼痛診療ガイドライン作成ワーキンググループ（編）：慢性疼痛診療ガイドライン．pp130-131，真興交易医書出版部，2021

3）Klit H, et al：Central post-stroke pain：clinical characteristics, pathophysiology, and management. Lancet Neurol 2009；8：857-568

4）Andersen G, et al：Incidence of central post-stroke pain. Pain 1995；61：187-193

5）Paolucci S, et al：Prevalence and time course of post-stroke pain：a multicenter prospective hospital-based study. Pain Med 2016；17：924-930

6）Boivie J, et al：Central post-stroke pain—a study of the mechanisms through analyses of the sensory abnormalities. Pain 1989；37：173-185

7）Misra UK, et al：A study of clinical, magnetic resonance imaging, and somatosensory-evoked potential in central post-stroke pain. J Pain 2008；9：1116-1122

8）Krause T, et al：Chronic sensory stroke with and without central pain is associated with bilaterally distributed sensory abnormalities as detected by quantitative sensory testing. Pain 2016；157：194-202

9）Tang SC, et al：pathophysiology of central poststroke pain：motor cortex disinhibition and its clinical and sensory correlates. Stroke 2019；50：2851-2857

10）Morishita T, et al：Brain stimulation therapy for central post-stroke pain from a perspective of interhemispheric neural network remodeling. Front Hum Neurosci 2016；10：166. doi：10.3389/fnhum.2016.00166

11）Harris AJ：Cortical origin of pathological pain. Lancet 1999；354：1464-1466

12）Perfetti C：リハビリテーションの問題としての疼痛．認知神経リハビリテーション；2013；13：5-19

13）Perfetti C，et al（編著），江草典政，他（監訳）：疼痛の認知神経リハビリテーション．pp139-264，協同医書出版社，2020

14）壹岐伸弥，他：中枢性脳卒中後疼痛患者の両手動作に着目したリハビリテーション介入の試み．認知神リハ2020；19：81-86

15）Swinnen SP, et al：Two hands, one brain：cognitive neuroscience of bimanual skill. Trends Cogn Sci 2004；8：18-25

16）Heitger MH, et al：Cortical regions involved in the observation of bimanual actions. J Neurophysiol 2012；108：2594-2611

17）Szameitat, AJ, et al：Neural activation and functional connectivity during motor imagery of bimanual everyday actions. PLoS One 2012；7：e38506. doi：10.1371/journal.pone.0038506

18）Ohtsuka, H, et al：Longitudinal follow-up of mirror movements after stroke：a case study. Case Rep Neurol Med 2015；15：1-4

19）Hayashi T, et al：Improving a bimanual motor skill through unimanual training. Front Integr Neurosci 2016；10：25. doi：10.3389/fnint.2016.00025

20）細見晃一，他：中枢性脳卒中後疼痛の神経画像研究と非侵襲脳刺激療法．PAIN RES 2018；33：282-293

21）Boivie J, et al：Central post-stroke pain—a study of the mechanisms through analyses of the sensory abnormalities. Pain 1989；37：173-185

22）Reimer M, et al：Sensory bedside testing：A simple stratification approach for sensory phenotyping. Pain Reports 2020；5：e820. doi：10.1097/PR9.0000000000000820

23）Chen JC, et al：Facilitation of sensory and motor recovery by thermal intervention for the hemiplegic upper limb in acute stroke patients：a single-blind randomized clinical trial. Stroke 2005；36：2665-2669

24）Chen SCJ, et al：Immediate effects of noxious and innocuous thermal stimulation on brain activation in patients with stroke. Medicine 2020；99：e19386. doi：10.1097/MD.0000000000019386

25）Ramachandran VS, et al：Touching the phantom limb. Nature 1995；377：489-490

26）Moseley GL, et al：Graded motor imagery for pathologic pain：a randomized controlled trial. Neurology 2006；67：2129-2134

27）Corbetta D, et al：Mirror therapy for an adult with central post-stroke pain：a case report. Arch Physiother 2018；8：4. doi：10.1186/s40945-018-0047-y

28）Schmalz L, et al：An alternative to traditional mirror therapy：illusory touch can reduce phantom pain when illusory movement does not. Clin J Pain 2013；29：e10-18

29）Botvinick M, et al：Rubber hands ‘feel’ touch that eyes see. Nature 1998；391：756. doi：10.1038/35784

30）Lenggenhager B, et al：Restoring tactile awareness through the rubber hand illusion in cervical spinal cord injury. Neurorehabilitation Neural Repair 2013；27：704-708

31）Ramger, BC, et al：Effects of non-invasive brain stimulation on clinical pain intensity and experimental pain sensitivity among individuals with central post-stroke pain：a systematic review. J Pain Res 2019；12：3319-3329