【大分市・坐骨神経痛】大分坐骨神経痛太腿神経痛下肢痛足の神経痛注射の効果

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【大分市・坐骨神経痛】大分坐骨神経痛太腿神経痛下肢痛足の神経痛注射の効果

2010/11/21

　下肢（足）の神経痛はつらいものです。それは主に３つの神経痛、①坐骨神経痛（臀部、おしりから太もも,ひざの裏、ふくらはぎの外側、足先へかけての痛みやしびれ）、②大腿神経痛（太ももの前面の痛みやしびれ、患者さんは股関節が痛いと感じる場合があります）、③外側大腿皮神経痛（太ももの外側の痛み、大腿神経の枝で両方同時に痛むことが多い）が大部分で、同時に２つの神経痛を生じることもよくあります。
　その原因はほとんどが腰椎疾患からです。まず高齢者では圧倒的に腰部脊柱管狭窄症が多いです。その症状の特徴はじっとしていると症状はないが、歩くと腰、足のしびれや痛みがひどくなりついには歩けなくなる（間欠性跛行と呼びます。歩ける距離が短いほど重症です）、前かがみの姿勢は楽だが後ろに反らすと痛い、朝より夕方の方が痛みとしびれが強い、これらの症状は腰部脊柱管狭窄症に特徴的なものです。また若年者から壮年者に多いのは腰椎椎間板ヘルニアです。また腰椎すべり症、腰椎不安定症などでもおこります。
　これらの疾患により、下肢に通じる神経が腰椎から出る部分(神経根といいます）で圧迫を受けて痛みがでます。大腿神経痛、外側大腿皮神経痛は腰椎(腰骨は５個あります）の２、３、４番目から出る神経（腰神経叢といいます）、また坐骨神経痛は腰椎の４，５番目とその下部の仙骨から出る神経（仙骨神経叢といいます）が上記した様な疾患により圧迫を受けて生じます。下肢の神経痛としては、坐骨神経痛が有名ですが、大腿神経痛、外側大腿皮神経痛も多いです。診断はMRI検査でわかりますが、必ずしもMRIで神経の圧迫像がなくてもこれらの痛みが生じる場合も結構あります。おそらくＭＲＩでは見つけにくいような小さな突起物が神経を圧迫しているものと考えられます。　
　当院のペインクリニック治療では、腰部硬膜外ブロックをまず行います（大腿神経痛、外側大腿皮神経痛の場合は腰椎２番、３番の間から、坐骨神経痛の場合は腰椎４番、５番の間、または５番と仙骨１番のあいだからアプローチします。）。硬膜外ブロックは漫然と行うのではなく、局麻薬など薬剤の種類（メピバカイン、ネオビタカイン、アナペイン等）を変えたり、投与濃度、投与量を変えたりして行います。また、神経根の炎症が強い場合はステロイドホルモンを必要最小限使用する場合もあります。腰部硬膜外ブロックを何回か繰り返すと痛みが、急速にあるいは徐々に軽減して行く場合が多いです。
　また、硬膜外ブロックで効果が少ない場合は、神経根ブロックを行うと有効なことがあります。
　さらに、リリカ（プレガバリン）という神経痛治療内服薬、トラムセット配合錠（トラマドールとアセトアミノフェンの混合錠）というこれも新しいオピオイド系鎮痛薬があります。ただしリリカは、ふらつき、めまい、眠気など、トラムセットは投与初期に吐き気、また慢性的には便秘がおこることがありますのでこれらの薬の作用に精通した医師に患者さん個々人に合った量を処方してもらうことが肝心だと思います。
　
　

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