Elucidation of the mechanism of pain induced by rotator cuff tear and examination of treatment for pain

2020 Fiscal Year Final Research Report

• Project/Area Number: 18K16633
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 56020:Orthopedics-related
• Research Institution: Kitasato University
• Principal Investigator: KENMOKU Tomonori 北里大学, 医学部, 助教 (00533324)
• Project Period (FY): 2018-04-01 – 2021-03-31
• Keywords: 腱板断裂 / 運動器疼痛 / 神経成長因子 / シクロオキシゲナーゼ / 疼痛コントロール / 神経ペプチド

Outline of Final Research Achievements

We investigated the mechanism of chronic pain in rotator cuff tears. Synovial tissue was obtained from the subacromial bursa and rotator interval during arthroscopic rotator cuff repair, and NGF, Apelin, and COX-2 were examined using PCR. The control uses synovial tissue from patients with recurrent shoulder dislocation.Although there was no difference in expression of COX-2 compared to the control, NGF was significantly higher. NGF was significantly higher than that in the dislocated group even when Western blot was used. Apelin was also significantly elevated in the human subacromial sac. These are consistent with the results of animal experiments. Therefore, NGF and Apelin could be therapeutic targets for the pain induced by rotator cuff tear.

Free Research Field

運動器疼痛、肩関節

Academic Significance and Societal Importance of the Research Achievements

腱板断裂は主に変性断裂であり、70代以上の半数以上は腱板断裂を認める。しかし、症候性腱板断裂の割合は36％と言われ、その主訴は疼痛がメインである。そのため疼痛コントロールは治療上重要である。しかし、一般的なNSAIDsは無効であることが多い。今回NSAIDsが無効である理由としてCOX-2が疼痛のメインでないことがわかった。そのため、NSAIDsの漫然とした処方の注意喚起となる。そして、新たな疼痛コントロールのターゲットとしてNGF,Apelinが挙がった。抗NGF抗体は現在腰痛や変形性関節症にも適応がある。腱板断裂に対しても有効性が示唆され、効果があれば手術件数の減少が期待できる。