研究者詳細 - 鉄永　倫子

Background. Various postoperative pain relief modalities, including continuous femoral nerve block (CFNB), local infiltration analgesia (LIA), and combination therapy, have been reported for total knee arthroplasty. However, no studies have compared CFNB with LIA for total hip arthroplasty (THA). The aim of this study was to compare the efficacy of CFNB versus LIA after THA. Methods. We retrospectively reviewed the postoperative outcomes of 93 THA patients (20 men, 73 women; mean age 69.2 years). Patients were divided into three groups according to postoperative analgesic technique: CFNB, LIA, or combined CFNB+LIA. We measured the following postoperative outcome parameters: visual analog scale (VAS) for pain at rest, supplemental analgesia, side effects, mobilization, length of hospital stay, and Harris Hip Score (HHS). Results. The CFNB+LIA group had significantly lower VAS pain scores than the CFNB and LIA groups on postoperative day 1. There were no significant differences among the three groups in use of supplemental analgesia, side effects, mobilization, length of hospital stay, or HHS at 3 months after THA. Conclusions. Although there were no clinically significant differences in outcomes among the three groups, combination therapy with CFNB and LIA provided better pain relief after THA than CFNB or LIA alone, with few side effects.

DOI： 10.1155/2016/1425201

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Microgeodic Disease Affecting the Fingers and Toes in Childhood: A Case Report. 国際誌

Tomonori Tetsunaga, Hirosuke Endo, Kazuo Fujiwara, Tomoko Tetsunaga, Toshifumi Ozaki

The open orthopaedics journal 10 500 - 504 2016年

記述言語：英語掲載種別：研究論文（学術雑誌）

Microgeodic disease is a disease of unknown etiology that affects the fingers and toes of children, with ≥ 90% of cases involving the fingers alone. We present a rare case of microgeodic disease affecting an index finger and two toes simultaneously in a 7-year-old girl. X-ray and magnetic resonance imaging (MRI) showed multiple small areas of osteolysis in the middle phalanges of the left index finger, hallux, and second toe. Microgeodic disease was diagnosed from X-ray and MRI findings, and conservative therapy involving rest and avoidance of cold stimuli was provided. Although pathological fractures occurred in the course of conservative treatment, the affected finger healed under splinting without any deformity of the finger.

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Effect of Tramadol/Acetaminophen on Motivation in Patients with Chronic Low Back Pain. 国際誌

Tomoko Tetsunaga, Tomonori Tetsunaga, Masato Tanaka, Keiichiro Nishida, Yoshitaka Takei, Toshifumi Ozaki

Pain research & management 2016 7458534 - 7458534 2016年

記述言語：英語掲載種別：研究論文（学術雑誌）

Background. The contribution of apathy, frequently recognized in individuals with neurodegenerative diseases, to chronic low back pain (LBP) remains unclear. Objectives. To investigate levels of apathy and clinical outcomes in patients with chronic LBP treated with tramadol-acetaminophen. Methods. A retrospective case-control study involving 73 patients with chronic LBP (23 male, 50 female; mean age 71 years) treated with tramadol-acetaminophen (n = 36) and celecoxib (n = 37) was performed. All patients were assessed using the self-reported questionnaires. A mediation model was constructed using a bootstrapping method to evaluate the mediating effects of pain relief after treatment. Results. A total of 35 (55.6%) patients met the criteria for apathy. A four-week treatment regimen in the tramadol group conferred significant improvements in the Apathy scale and numerical rating scale but not in the Rolland-Morris Disability Questionnaire, Pain Disability Assessment Scale, or Pain Catastrophizing Scale. The depression component of the Hospital Anxiety and Depression Scale was lower in the tramadol group than in the celecoxib group. The mediation analysis found that the impact of tramadol-acetaminophen on the change in apathy was not mediated by the pain relief. Conclusions. Tramadol-acetaminophen was effective at reducing chronic LBP and conferred a prophylactic motivational effect in patients with chronic LBP.

DOI： 10.1155/2016/7458534

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The Effect of Guidance regarding Home Exercise and ADL on Adolescent Females Suffering from Adverse Effects after HPV Vaccination in Japanese Multidisciplinary Pain Centers 査読

Takahiro Ushida, Masahiko Shibata, Masaki Kitahara, Shoji Yabuki, Masahiko Sumitani, Takanori Murakami, Masako Iseki, Masako Hosoi, Hiroaki Shiokawa, Tomoko Tetsunaga, Hiroyuki Nishie, Sei Fukui, Motohiro Kawasaki, Sinsuke Inoue, Makoto Nishihara, Shuichi Aono, Tatunori Ikemoto, Takashi Kawai, Young-Chang Arai

Pain Research and Management 2016 1 - 6 2016年

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Hindawi Limited

<italic>Background</italic>. Two prophylactic papillomavirus (HPV) vaccines have been available for primary prevention of cervical cancer. Although serious adverse effects (AE) were rare, more than 230 women have been suffering from severe AEs such as persistent pain and headache in Japan. Our research group started to treat adolescent females suffering from the AEs.<italic>Objective</italic>. To survey the characteristics of and the effects of cognitive behavioral therapy on adolescent female suffering from the AEs in Japanese multidisciplinary pain centers.<italic>Methods</italic>. One hundred and forty-five patients suffering from the AEs were reviewed retrospectively and 105 patients of them were provided guidance on home exercise and activities of daily living based partially on a cognitive-behavioral approach. The intensity of pain was rated by the patients using a numerical rating scale (NRS). Furthermore, the Hospital Anxiety and Depression Scale (HADS) and the Pain Catastrophizing Scale (PCS) were used.<italic>Results</italic>. Eighty out of the 105 patients who received the guidance were followed up, 10 displayed a marked improvement, and 43 showed some improvement.<italic>Conclusions</italic>. Guidance on home exercise and activities of daily living based on a cognitive-behavioral approach alleviated the AEs that women suffered from after HPV vaccination in Japan.

DOI： 10.1155/2016/3689352

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その他リンク： http://downloads.hindawi.com/journals/prm/2016/3689352.xml

Four-Year Results of Summit Stems for Total Hip Arthroplasty in Japanese Patients 査読

Tomonori Tetsunaga, Toru Sato, Naofumi Shiota, Tomoko Tetsunaga, Yoshiki Okazaki, Kazuki Yamada

HIP International 25 ( 6 ) 553 - 556 2015年11月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：SAGE Publications

<sec><title>Purpose</title> A retrospective study to evaluate the clinical and radiographic outcome of the Summit primary total hip arthroplasty (THA) at a minimum follow-up of 4 years.

</sec><sec><title>Methods</title> 87 hips in 84 Japanese patients underwent THA using Summit stems. 3 patients were lost to follow-up, and 4 patients were excluded because a Summit stem was judged to be inappropriate for their narrow femoral canals. The remaining 80 hips in 77 patients were evaluated. Mean age was 66 years (range, 33-86 y). Mean postoperative follow-up period was 52 months (range, 48-66 m).

</sec><sec><title>Results</title> There was no early stem subsidence after surgery. Of the 80 hips, 60 (75%) showed radiographic signs of stem osseointegration including zones 3 and 5 at final follow-up. Stress shielding occurred in 50 hips (62.5%), and third-degree stress shielding was observed in 12 hips (15%). 3 patients experienced postoperative thigh pain due to distal fixation.

</sec><sec><title>Conclusions</title> These short-term results indicate that the Summit stem achieved good initial fixation, although there were some cases of distal fixation. Careful long-term follow-up and observation will be necessary for hips in which stress shielding occurs.

</sec>

DOI： 10.5301/hipint.5000287

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その他リンク： http://journals.sagepub.com/doi/full-xml/10.5301/hipint.5000287

岡山大学病院における難治性慢性痛に対する薬剤師の介入意義について

神崎浩孝, 北村佳久, 千堂年昭, 鉄永倫子, 鉄永智紀, 尾崎敏文, 西江宏行, 太田晴之, 井上真一郎, 小田幸治, 流王雄太, 宮脇卓也, 西田圭一郎

Journal of Musculoskeletal Pain Research 7 ( 3 ) S71 - S71 2015年11月

The effect of guidance for home exercise and activities of daily living on female adolescents experiencing adverse events after human papillomavirus vaccination in Japanese multidisciplinary pain centres. 国際誌

Pain research & management 2015年10月

Establishment of a liaison clinic for patients with intractable chronic pain.

Tomoko Tetsunaga, Tomonori Tetsunaga, Hiroyuki Nishie, Toshifumi Ozaki

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 20 ( 5 ) 907 - 13 2015年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: A multidisciplinary approach has been shown to be effective for the treatment of intractable pain. However, few hospitals in Japan have established liaison clinics for such patients. In this study, we investigated the short-term results of a liaison clinic for patients with intractable chronic pain. METHODS: Study participants comprised 53 outpatients (20 men, 33 women) with intractable chronic pain who visited our hospital between April 2012 and March 2013. At baseline, patients completed a self-reported questionnaire and provided demographic and clinical information. Experts in various fields (anesthesia, orthopedic surgery, psychiatry, physical therapy, and nursing) conducted examinations of patients and attended a weekly conference during which patients' physical, psychological, and social problems were discussed and courses of treatment were determined. All patients were assessed using the Numerical Rating Scale (NRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Pain Disability Assessment Scale (PDAS). Eligibility for the pain liaison outpatient clinic was evaluated using multiple logistic regression analysis. RESULTS: After a 6-month follow-up period, no significant changes were seen in scores for the NRS, PDAS, or HADS for depression. In contrast, scores for both the PCS and HADS for anxiety were significantly reduced after 6 months of treatment (p < 0.05). HADS for anxiety was identified as a factor related to patient resistance to attending the pain liaison outpatient clinic (p < 0.05). CONCLUSIONS: This liaison clinic for patients with intractable chronic pain was able to improve patient anxiety. Severe anxiety at the initial visit represented a risk factor for dropout from the clinic.

DOI： 10.1007/s00776-015-0748-y

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神経線維腫症1型に合併した頸髄髄内腫瘍の1例

渡邉典行, 荒瀧慎也, 小田孔明, 魚谷弘二, 篠原健介, 鉄永倫子, 瀧川朋亨, 杉本佳久, 田中雅人, 尾崎敏文

中国・四国整形外科学会雑誌 27 ( 3 ) 446 - 446 2015年9月

Apathy scaleを用いた変形性股関節症患者と慢性腰痛患者の意欲低下の比較検討

鉄永智紀, 佐藤徹, 塩田直史, 鉄永倫子

Hip Joint 41 65 - 68 2015年8月

記述言語：日本語出版者・発行元：日本股関節学会

当院整形外科を受診した慢性腰痛患者63例(以下A群)と末期変股症患者25例(B群)および健常対照群30例(C群)についてApathy scaleの測定を行い、群間比較した。また、疼痛の程度をNumerical rating scale(NRS)で測定するとともに、神経障害性疼痛スクリーニング質問票による調査、疼痛生活障害評価(Pain disability assessment scale:PDAS)、不安抑うつ評価(Hospital anxiety and depression scale:HADS)、破局的思考評価(Pain catastrophizing scale:PCS)を行い、群間比較した。結果、Apathy scaleの点数はA群とB群がC群に比べて有意に高く、A群とB群の間に有意差はなかった。NRSはA群>B群>C群の順に高く各群間に有意差を認め、神経障害性疼痛も同様であった。PDAS、HADS、PCSはA群とB群がC群に比べて有意に高値で、A群とB群の間に有意差はなかった。

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処方エキスパートへの道(第2回) プレガバリン

鉄永智紀, 鉄永倫子

Loco Cure 1 ( 2 ) 150 - 154 2015年8月

Comparison of Continuous Epidural Analgesia, Patient-Controlled Analgesia with Morphine, and Continuous Three-in-One Femoral Nerve Block on Postoperative Outcomes after Total Hip Arthroplasty. 国際誌

Tomonori Tetsunaga, Toru Sato, Naofumi Shiota, Tomoko Tetsunaga, Masahiro Yoshida, Yoshiki Okazaki, Kazuki Yamada

Clinics in orthopedic surgery 7 ( 2 ) 164 - 70 2015年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Postoperative pain relief can be achieved with various modalities. However, there are only few reports that have analyzed postoperative analgesic techniques in total hip arthroplasty patients. The aim of this retrospective study was to compare the postoperative outcomes of three different analgesic techniques after total hip arthroplasty. METHODS: We retrospectively reviewed the influence of three analgesic techniques on postoperative rehabilitation after total hip arthroplasty in 90 patients divided into three groups (n = 30 patients per group). Postoperative analgesia consisted of continuous epidural analgesia (Epi group), patient-controlled analgesia with morphine (PCA group), or a continuous femoral nerve block (CFNB group). We measured the following parameters relating to postoperative outcome: visual analog scale scores, the use of supplemental analgesia, side effects, length of the hospital stay, plasma D-dimer levels, and the Harris hip score. RESULTS: Each group had low pain scores with no significant differences between the groups. The PCA group had a lower frequency of supplemental analgesia use compared to the Epi and CFNB groups. Side effects (nausea/vomiting, inappetence) and day 7 D-dimer levels were significantly lower in the CFNB group (p < 0.05). There were no significant differences between the groups in terms of the length of the hospital stay or the Harris hip score. CONCLUSIONS: Although there were no clinically significant differences in outcomes between the three groups, the CFNB provided good pain relief which was equal to that of the other analgesics with fewer side effects and lower D-dimer levels in hospitalized patients following total hip arthroplasty.

DOI： 10.4055/cios.2015.7.2.164

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