総合診療30巻10号

2020年10月発行

特集 —ポリファーマシーを回避する—エビデンスに基づく非薬物療法のススメ 【症状編】

慢性疼痛

著者： 上田剛士¹

所属機関： ¹洛和会 丸太町病院 救急・総合診療科

ページ範囲：P.1184 - P.1190

はじめに
　ここでは特異的な根治療法のない慢性疼痛を対象とする。さまざまな慢性疼痛のなかでも最もよく研究されている慢性腰痛症や変形性膝関節症に対する非薬物療法の位置付けについて解説する。

参考文献

1）Chou R, et al : Systemic pharmacologic therapies for low back pain ; a systematic review for an American College of physicians clinical practice guideline. Ann Intern Med 166（7） : 480-492, 2017. PMID 28192790

2）Skelly AC, et al : Noninvasive nonpharmacological treatment for chronic pain ; a systematic review. AHRQ Comparative Effectiveness Reviews 18-EHC013-EF, 2018. PMID 30179389

3）Herling SF, et al : Interventions for preventing intensive care unit delirium in adults. Cochrane Database Syst Rev 11（1） : CD009783. pub 2, 2018. PMID 30484283

4）Yousefi-Nooraie R, et al : Low level laser therapy for nonspecific low-back pain. Cochrane Database Syst Rev 18（2） : CD005107, 2007. PMID 17443572

5）van Duijvenbode ICD, et al : Lumbar supports for prevention and treatment of low back pain. Cochrane Database Syst Rev （2） : CD001823, 2008. PMID 18425875

6）Aleksiev AR : Ten-year follow-up of strengthening versus flexibility exercises with or without abdominal bracing in recurrent low back pain. Spine （Phila Pa 1976） 39（13） : 997-1003, 2014. PMID 24732860

7）Shiri R, et al : The association between smoking and low back pain ; a meta-analysis. Am J Med 123（1） : 87. e7-35, 2010. PMID 20102998

8）Straube A, et al : Headache in school children ; prevalence and risk factors. Dtsch Arztebl Int 110（48） : 811-818, 2013. PMID 24333367

9）Machado-Oliveira L, et al : Effects of different exercise intensities on headache ; a systematic review. Am J Phys Med Rehabil 99（5） : 390-396, 2020. PMID 31725018

10）Arakawa A, et al : An investigation of factors contributing to higher levels of placebo response in clinical trials in neuropathic pain ; a systematic review and meta-analysis. Clin Drug Investig 35（2） : 67-81, 2015. PMID 25559268

11）Meske DS, et al : Efficacy of opioids versus placebo in chronic pain ; a systematic review and meta-analysis of enriched enrollment randomized withdrawal trials. J Pain Res 11 : 923-934, 2018. PMID 29765246

12）Charlesworth JEG, et al : Effects of placebos without deception compared with no treatment ; a systematic review and meta-analysis. J Evid Based Med 10（2） : 97-107, 2017. PMID 28452193

13）Espay AJ, et al : Placebo effect of medication cost in Parkinson disease ; a randomized double-blind study. Neurology 84（8） : 794-802, 2015. PMID 25632091

14）Linde K, et al : Acupuncture for the prevention of tension-type headache. Cochrane Database Syst Rev （4） : CD007587, 2016. PMID 27092807

15）Jain TK, et al : The effectiveness of physiotherapeutic interventions in treatment of frozen shoulder/adhesive capsulitis ; a systematic review. J Back Musculoskelet Rehabil 27（3） : 247-273, 2014. PMID 24284277

16）Diercks RL, et al : Gentle thawing of the frozen shoulder ; a prospective study of supervised neglect versus intensive physical therapy in seventy-seven patients with frozen shoulder syndrome followed up for two years. J Shoulder Elbow Surg 13（5） : 499-502, 2004. PMID 15383804

17）Huang MH, et al : A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis. Semin Arthritis Rheum 32（6） : 398-406, 2003. PMID 12833248

18）Hislop AC, et al : Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? ; a systematic review and meta-analysis. Br J Sports Med 54（5） : 263-271, 2020. PMID 30728126

19）Dong R, et al : Is aquatic exercise more effective than land-based exercise for knee osteoarthritis? Medicine（Baltimore） 97（52） : e13823, 2018. PMID 30593178

20）Chu IJH, et al : Effects of meaningful weight loss beyond symptomatic relief in adults with knee osteoarthritis and obesity ; a systematic review and meta-analysis. Obes Rev 19（11） : 1597-1607, 2018. PMID 30051952

21）Moyer RF, et al : Valgus bracing for knee osteoarthritis ; a meta-analysis of randomized trials. Arthritis Care Res（Hoboken） 67（4） : 493-501, 2015. PMID 25201520

22）Gohal C, et al : Effectiveness of valgus offloading knee braces in the treatment of medial compartment knee osteoarthritis ; a systematic review. Sports Health 10（6） : 500-514, 2018. PMID 29543576

23）Cudejko T, et al : Effect of soft braces on pain and physical function in patients with knee osteoarthritis ; systematic review with meta-analysis. Arch Phys Med Rehabil 99（1） : 153-163, 2018. PMID 28687317

24）Gijon-Nogueron G, et al : Effectiveness of foot orthoses in patients with rheumatoid arthritis related to disability and pain ; a systematic review and meta-analysis. Qual Life Res 27（12） : 3059-3069, 2018. PMID 29922913

25）Arias-Martín I, et al : Effectiveness of custom-made foot orthoses for treating forefoot pain ; a systematic review. Int Orthop 42（8） : 1865-1875, 2018. PMID 29423640

26）Zhang J, et al : Ineffectiveness of lateral-wedge insoles on the improvement of pain and function for medial knee osteoarthritis ; a meta-analysis of controlled randomized trials. Arch Orthop Trauma Surg 138（10） : 1453-1462, 2018. PMID 30030612

27）Boomershine CS, et al : A blinded, randomized, placebo-controlled study to investigate the efficacy and safety of ferric carboxymaltose in iron-deficient patients with fibromyalgia. Rheumatol Ther 5（1） : 271-281, 2017. PMID 29149437

28）Kim J, et al : Comparing verum and sham acupuncture in fibromyalgia syndrome ; a systematic review and meta-analysis. Evid Based Complement Alternat Med eCollection 2019 : 8757685, 2019. PMID 31534469

29）Zhang XC, et al : Acupuncture therapy for fibromyalgia ; a systematic review and meta-analysis of randomized controlled trials. J Pain Res 12 : 527-542, 2019. PMID 30787631

30）Xu S, et al : Adverse events of acupuncture ; a systematic review of case reports. Evid Based Complement Alternat Med 2013 : 581203, 2013. PMID 23573135