Current Chronic Pain Management Programs in Japan

Special Article – Disability and Rehabilitation

Phys Med Rehabil Int. 2016; 3(4): 1091.

Current Chronic Pain Management Programs in Japan

Honda T¹*, Chikai M², Ohnishi T³, Honda K4, Ino S², Takahashi H and Kigawa H¹

¹Department of Rehabilitation Medicine, Hanno Seiwa Hospital, Japan

²Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Japan

³Department of Rehabilitation Medicine, Showa Inan General Hospital, Japan

4The Elders Cooperative Society Yasuoka, Japan

5Department of Rehabilitation Medicine, Saitama International Medical Center, Saitama Medical University, Japan

*Corresponding author: Tetsumi Honda, Department of Rehabilitation Medicine, Hanno Seiwa Hospital, 137-2 Shimokaji Hanno City, Saitama Pref. 357-0016, Japan

Received: June 22, 2016; Accepted: July 07, 2016; Published: July 11, 2016


Since the 1960s, a multidisciplinary-team approach based on cognitive behavioral therapy has been implemented worldwide in chronic pain rehabilitation. The chronic pain model was a multifaceted model at first, but later an altered nervous-system processing model was proposed, encompassing the idea of nervous system dysfunction. In recent years, the supersystem dysregulation model has been proposed from the standpoint of systems biology, in which chronic pain is understood in terms of chronic dysregulation of the body’s entire nervous, endocrine, and immune systems in response to excessive stress from the environment. In Japan, the multidisciplinary-team approach based on a multifaceted model started being applied in 1986. The use of brain single-photon emission computed tomography was introduced in this approach in 2003, and it led to a transformation of the approach into a cognitive brain-body-environment adjustment program based on the supersystem dysregulation model. The program involves correcting cognitive bias, tuning brain function abnormality, reconditioning physical disuse, and modifying environmental stress.

Keywords: Chronic pain; Rehabilitation; Multidisciplinary approach; Brain imaging; Cognitive behavioral therapy; Systems biology


CPP: Chronic Pain Patient; ALBP: Acute Low Back Pain; CLBP: Chronic Low Back Pain; VAS: Visual Analog Scale; MMPI: Minnesota Multiphasic Personality Inventory; SPECT: Single-photon Emission Computed Tomography: e-ZIS: easy Z-score Imaging System; PET: Positron Emission Tomography; MRI: Magnetic Resonance Imaging; MSW: Medical Social Worker; PT: Physical Therapy; OT: Occupational Therapy; CP: Clinical Psychology; ADL: Activities of Daily Living.


In Japan, the multidisciplinary-team approach for the management chronic pain was implemented for the first time in 1986 [1]. In this paper, we provide an overview of the evolution of the chronic pain model, and introduce our chronic pain management program.

Changes in the Chronic Pain Model that Formed the Basis of Chronic Pain Rehabilitation Programs.

From a multifaceted model to an altered nervous system processing model [2].

Loeser and Eagan [3] proposed “the multifaceted model of pain”, which involves 4 domains of pain phenomena, namely nociception, pain sensation, suffering, and pain behavior. This model served as the theoretical basis for cognitive behavioral therapy programs (pain management program with a multidisciplinary approach) implemented worldwide since the 1960s.

Furthermore, recent developments in brain function imaging techniques such as single-photon emission computed tomography (SPECT), positron emission tomography (PET), and magnetic resonance imaging (MRI) have brought about changes in the understanding of chronic pain. Using magnetic resonance imaging brain scan data Apkarian et al. [4] observed atrophy in the cortex of the frontal lobe in patients with chronic low back pain.

We introduced brain SPECT with technetium-99m ethyl cysteinate dimer in 2003, and performed a two-tailed view analysis by using the easy Z-score imaging system (e-ZIS, Fujifilm RI Pharma, Tokyo, Japan). A Z-score is a dimensionless quantity obtained by subtracting the population mean from an individual raw score and then dividing the difference by the standard deviation for that population. An e-ZIS two-tailed view analysis was used to assess the extent and degree of regional blood flow as a Z-score value, which was then presented as a graduation hue on the brain surface generated by the Talairach Daemon using vBSEE software (Fujifilm RI Phrma, Tokyo, Japan). Using such a representation, it was possible to observe a trend toward decreased blood flow to the prefrontal area and increased blood flow to the cerebellum and parietal lobe of patients with chronic pain (Figure 1) [5].