BRAIN and NERVE－神経研究の進歩60巻5号

2008年05月発行

特集 「痛み」の研究と治療の最前線

プログラマブルポンプによる髄腔内薬物慢性投与による疼痛コントロール

著者： 平孝臣¹

所属機関： ¹東京女子医科大学脳神経外科学講座

ページ範囲：P.509 - P.517

文献概要

はじめに

　本邦では2005年春から，脊髄損傷や脳性麻痺などに起因する重症の痙縮に対して，体内に植え込んだプログラマブルポンプによるバクロフェン髄腔内投与を行う治療が健康保険治療の適応となり，従来有効な治療法のなかった重度の痙縮に対する治療として普及しつつある。一方，難治性の疼痛に対しても，同様の方法で痛みをコントロールする治療は，欧米ではモルヒネをはじめとし，さまざまな薬剤が古くから実際の臨床に応用され，さらにいくつかの新薬の開発も考えられている^1）。しかし本邦ではさまざまな理由から，疼痛を対象とした慢性的治療に，髄腔内薬物投与ポンプを使用できる状況にはほど遠いのが実情である。本稿では髄腔内薬物投与による難治性疼痛のコントロールに関して，筆者のバクロフェン投与治療の経験^2，3）をもとに，現状を紹介したい。

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