Living a Life with LDS (September 12, 2020) E3 Summit
1:18:18-1:23:47
Q:
Just I guess thoughts on ways to manage chronic pain in LDS at different ages and I think particularly as people age and, and start getting into arthritis and things like that as well.
LDSにおける慢性痛の対処法を教えて下さい。
A:
You want to take that one, Bart?
Loeys先生お願いできますか？
Yeah, well, I, I try to especially in the young children to, to motivate them to start doing the right exercises and the right type of exercises at a young age in order to reinforce the muscles that might compensate for some of the laxity that's present in the joints and by laxity they might have increased frequency of joint damage later on in life.
特に幼いお子さんの場合には、正しい方法に基づいた運動を始めることを勧めます。幼い頃から始めることで、筋肉が強化され、関節の緩みをカバーできる可能性があるからです。関節が緩むことで、今後の生活で関節の怪我が増えることもあります。
So one of the things that we almost always recommend start doing at young ages is swimming because during swimming you do reinforce your muscles and you don't put too much pressure on, on your joints so that's trying to work in a preventive way.
私は幼いお子さんには、ほぼ確実に水泳を勧めています。筋肉を強化できますし、関節にそれほど負荷がかからないので、怪我の予防になります。
Similarly when they do running we try to stimulate to do that running on a rather soft surface rather than on a hard court.
同様に、ランニングをする場合には、硬い地面よりも柔らかい地面の方をおすすめします。
So I think if the diagnosis is made early on trying to, to try to do the right exercises on in the right circumstances might prevent a lot of the joint issues and pain issues later on in life.
LDSの診断が付いたら、正しい運動を正しい環境で行うことで、今後起きうる関節の怪我や痛みの問題などを防ぐことができる可能性があります。
I think later on in life it can be, it can be challenging and usually it is a combination of doing additional physical therapy, pain medication, additional joint support things like, how do you call them, splints that help to, to manage daily life activities.
運動は後になってから始めてもあまり効果が期待できない可能性があります。運動の他に、理学療法や痛み止めの薬、関節を保護してくれるのようなもの、例えば、日常生活をサポートしてくれる装具などを組み合わせることが重要です。
Yeah, I'm, I, I think it's important for people to have their experiences with pain validated by the people who are caring for them. You know, in connective tissue disorders in general pain can be a prominent issue, sometimes in fact often there's no obvious overt reason for the pain but you have to make sure that you're working with a doctor that is not dismissive of your experience of pain.
そうですね。痛みに関しては原因を医師に調べてもらうことが重要です。結合組織疾患では一般に痛みが大きな問題となります。原因がはっきりとしない場合もあるのですが、そうだとしても真剣に痛みと向き合ってくれる医師と協力する必要があります。
Every effort should be made to get to the bottom of why pain is present, you know, there are lots of reasons for back pain including disc problems, including other bone problems, including dural ectasia, which can cause impingement on nerves in the spine.
痛みの原因を突き止めるためには、あらゆる可能性を検討しなければなりません。背中の痛みの多くは、椎間板や骨の異常、硬膜拡張が原因です。硬膜拡張では、拡張した硬膜が背骨の神経に当たっている可能性もあります。
So, you know, everything should be done to try to understand why someone has pain and to see if there's something that can be done about it.
痛みに関しては、原因の追求とその対策が重要になります。
With regard to interventions my general recommendation is not to rush to surgery, to try all the kinds of interventions that Bart was mentioning to see if something can be, some intervention can be found that provides relief.
痛みの対処法についてですが、私は一般に早急に外科手術に飛びつくことはおすすめしていません。Loeys先生からあったような全ての対処法を試すことで、効果のある方法が見つかる可能性があります。
But sometimes surgery is needed. Make sure you're seeing someone who's experienced with that problem and with that surgery in connective tissue disorders that can be challenging because sometimes the surgical approach is different or the expectations for recovery are different.
時には手術が避けられない場合もあります。その場合は、その症例の経験を積んだ外科医にかかるようにしてください。結合組織疾患の外科手術は手術アプローチが異なったり、回復までの予測がしにくいなど、困難を伴うこともあります。
With pain medications try to use the mildest and least frequent medications that work for you. Again don't jump directly to opioids, for example, that have their own obvious sets of problems.
痛み止めの薬については、効果が穏やかで服薬回数が少なくて済むものを選ぶようにしてください。大事なことは、すぐにオピオイド（医療用麻薬）を使わないということです。オピオイドには様々な問題があることがはっきりしています。
We do now often turn to colleagues that are pain specialists to help come up with the best program that, you know, can include sometimes medications plus physical therapy plus biofeedback plus a number of other potential alternative modalities that can be helpful.
痛みを訴える患者さんの治療にあたって、我々は痛みの専門医に相談し、最適な治療法を提示してもらっています。薬+理学療法+バイオフィードバックの他にいくつか他の方法を加えることで効果が期待できる可能性があります。
So, you know, my bottom line is don't just decide that you need to live with pain, don't settle for doctors that are dismissive of your pain and, you know, be open-minded about the types of things that might help you get to a better place.
大事なことは、痛みと共存しようと思わないこと、痛みと真剣に向き合わない医師にかかり続けないこと、今の状況を改善できる方法を探し続けることです。
The Marfan Foundation did not participate in the translation of these materials and does not in any way endorse them. If you are interested in this topic, please refer to our website, Marfan.org, for materials approved by our Professional Advisory Board.
The Marfan Foundation は、当翻訳には関与しておらず、翻訳内容に関してはいかなる承認も行っておりません。このトピックに興味をお持ちの方は、Marfan.org にアクセスし、当協会の専門家から成る諮問委員会が承認した内容をご参照ください。
