「マインドフルネス研究」2017年 第2巻 第2号 特集「マインドフルネス認知療法」 研究論文:原著論文(実践研究) pp. 91-108
Japanese Journal of Mindfulness, 2017, Vol. 2, No. 2 Special Issue: Mindfulness-Based Cognitive Therapy Original Article pp. 91-108

治療抵抗性慢性疼痛に対するマインドフルネス認知療法の試み

林 紀行 (大阪大学大学院医学系研究科統合医療学寄附講座,大阪大学大学院医学系研究科精神医学教室,ほうせんか病院)
家接 哲次 (名古屋経済大学大学院人間生活科学研究科・人間生活科学部,名古屋経済大学マインドフルネスセンター)
阪上 未紀 (大阪大学大学院医学系研究科統合医療学寄附講座)
坂本 淑子 (大阪大学大学院医学系研究科統合医療学寄附講座)
岩田 昌美 (大阪大学大学院医学系研究科統合医療学寄附講座)
大野 智 (大阪大学大学院医学系研究科統合医療学寄附講座)
柴田 政彦 (大阪大学大学院医学系研究科疼痛医学寄附講座)
伊藤 壽記 (大阪大学大学院医学系研究科統合医療学寄附講座)

発行:2018年7月14日,早期公開:2018年5月11日

A Pilot Study of Mindfulness-Based Cognitive Therapy for Refractory Chronic Pain

Noriyuki Hayashi Department of Integrative Medicine, Department of Psychiatry, Osaka University Graduate School of Medicine, Housenka Hospital
Tetsuji Ietsugu Graduate School of Human Life Sciences, Faculty of Human Life Sciences, Nagoya University of Economics, Meikei Mindfulness Center
Miki Sakaue Department of Integrative Medicine, Osaka University Graduate School of Medicine
Toshiko Sakamoto Department of Integrative Medicine, Osaka University Graduate School of Medicine
Masami Iwata Department of Integrative Medicine, Osaka University Graduate School of Medicine
Satoshi Ohno Department of Integrative Medicine, Osaka University Graduate School of Medicine
Masahiko Shibata Department of Pain Medicine, Osaka University Graduate School of Medicine
Toshinori Ito Department of Integrative Medicine, Osaka University Graduate School of Medicine

Published : July 14, 2018, Online first published : May 11, 2018

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https://mindfulness.jp.net/Journal/advance_vol2no2/jjm22hayashi180511/


キーワード:マインドフルネス認知療法,慢性疼痛,集学的治療,疼痛生活障害
Keywords: mindfulness-based cognitive therapy, chronic pain, multidisciplinary treatment, pain disability


要 約
パイロットスタディとして,マインドフルネス認知療法(Mindfulness-Based Cognitive Therapy:MBCT)を含む補完代替医療が安全,有効に実施可能であるか定量的および定性的に検証することを目的とした。治療抵抗性慢性疼痛患者5名に対して慢性疼痛用に修正したMBCTプログラム(8セッション:各2時間)を実施した結果,主要評価項目である有害事象や脱落を認めず,安全に実施可能であることが示唆された。副次評価項目では痛みの強さを0-10の11段階評価で示すNumerical Rating Scale(NRS)や痛みに関する日常生活動作を評価するPain Disability Assessment Scale(PDAS)で有意な改善を認め,MBCTを選択しなかった他の13例と比較すると有意にNRSの改善を認めた。著明な改善を認めた一例ではホームワークやエクササイズから多くの気づきが報告され,特に呼吸への気づきの大切さが繰り返し述べられた。

Abstract
This pilot study investigated quantitative and qualitative parameters to evaluate whether complementary alternative medicine, including the use of mindfulness-based cognitive therapy (MBCT) is feasibly safe and effective for the management of refractory chronic pain. We studied 5 patients who received a course of 8 weekly sessions (2 hours per session) of a modified MBCT program for chronic pain management. No adverse events or dropouts (which serve as primary endpoints) were reported suggesting that MBCT was a safe therapeutic option. In terms of the secondary endpoint, a statistically significant improvement was observed using the numerical rating scale (NRS) showing pain intensity assessed in terms of an 11-step evaluation (scale ranging between 0 and 10), as well as the pain disability assessment scale (PDAS), which evaluates the correlation between pain and the activities of daily living. The 4 patients we studied (1 patient did not achieve secondary outcomes but only received MBCT until the end of the study) showed a significant improvement when assessed using the NRS compared with the 13 patients who did not receive MBCT. Notably, one patient described completing a significant volume of homework and exercises and consequently reported a remarkable improvement. The importance of breath awareness has been particularly and repeatedly described in this context.