A small pilot study suggests laughter therapy may be a simple adjunct for chronic head and neck pain—but not a replacement for standard care. 慢性の頭頸部痛に「笑い」は役立つのか。標準治療の代替ではなく、補助的なセルフケアとして考える視点です。 Source Cohen JR et al. Effect of laughter therapy on chronic head and neck pain. Cranio. 2026 Feb 23:1-10. PMID: 41730700. https://pubmed.ncbi.nlm.nih.gov/41730700/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

Can laughter help patients with chronic head and neck pain? In this video, I review the paper “Effect of laughter therapy on chronic head and neck pain” and discuss what this small 4-week pilot study may mean for clinicians managing persistent orofacial pain. The study evaluated a simple app-based laughter intervention in adults with chronic head and neck pain. Participants watched humorous videos for 10–15 minutes per day, and pain scores decreased over time across multiple self-reported pain measures. The findings are interesting because they suggest that a low-cost, low-risk, emotionally positive activity might have value as an adjunctive self-care strategy. At the same time, this was a small single-group study without randomization or a control group, so the results should be interpreted cautiously. This does not show that laughter is a cure, nor does it replace proper diagnosis or evidence-based treatment. But it does raise an important clinical question: could brief, accessible behavioral interventions help some patients cope better with chronic pain between visits? In this review, I discuss: - the study design - the main pain outcomes - compliance with the laughter app - possible mechanisms - major limitations - the practical relevance for orofacial pain care 笑いは慢性的な頭頸部痛の助けになるのでしょうか。 この動画では、“Effect of laughter therapy on chronic head and neck pain” という論文を取り上げ、4週間の小規模パイロット研究が、慢性口腔顔面痛を診る臨床にどのような示唆を与えるかを解説します。 この研究では、慢性的な頭頸部痛を有する成人を対象に、アプリを用いた笑い療法が検討されました。参加者は毎日10〜15分、ユーモアのある動画を視聴し、複数の自己記入式疼痛指標で痛みスコアの低下が報告されました。低コストで低リスク、しかも取り入れやすい前向きな介入が、補助的セルフケアとして役立つ可能性を示した点は興味深いところです。 一方で、この研究は単群・非ランダム化・対照群なしの小規模研究であり、結果の解釈には慎重さが必要です。笑いが慢性疼痛を治すと示したものではなく、適切な診断やエビデンスに基づく治療の代わりになるものでもありません。ただ、通院と通院のあいだに実践できる、短時間で取り組みやすい行動介入が、患者さんの対処を少し助ける可能性があるのではないか、という臨床的に重要な問いを投げかけています。 このレビューでは、以下の点を整理してお話しします。 - 研究デザイン - 主な疼痛アウトカム - アプリ使用の遵守状況 - 想定される作用機序 - 研究の限界 - 口腔顔面痛診療への実践的な示唆 Source Cohen JR et al. Effect of laughter therapy on chronic head and neck pain. Cranio. 2026 Feb 23:1-10. PMID: 41730700. https://pubmed.ncbi.nlm.nih.gov/41730700/ 本動画は教育・情報提供を目的としたものであり、個別の医療アドバイスではありません。 ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

For patients with partial but inadequate relief, OPTION-DM supports carefully monitored combination therapy as a rational next step—not automatically for everyone, but as part of a structured pathway. 単剤で少し効くけれど不十分な場合、慎重に管理された併用療法は合理的な選択肢になり得ます。すべての患者に早期併用を勧める話ではありません。 Source Tesfaye S et al; OPTION-DM trial group. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial. Lancet. 2022 Aug 27;400(10353):680-690. PMID: 36007534; PMCID: PMC9418415. https://pubmed.ncbi.nlm.nih.gov/36007534/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

In OPTION-DM, amitriptyline-, duloxetine-, and pregabalin-based pathways reduced pain similarly. The practical message is individualized treatment rather than searching for one universal best drug. OPTION-DM試験では、3つの第一選択薬ベースの治療経路に大きな差はありませんでした。重要なのは、患者ごとの個別化です。 Source Tesfaye S et al; OPTION-DM trial group. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial. Lancet. 2022 Aug 27;400(10353):680-690. PMID: 36007534; PMCID: PMC9418415. https://pubmed.ncbi.nlm.nih.gov/36007534/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

OPTION-DM addressed a common real-world problem: partial relief after first-line treatment for painful diabetic neuropathy. The key lesson is a structured, stepwise pathway. 痛み止めが「少し効くけれど不十分」なとき、次にどうするか。OPTION-DM試験は、実臨床に近い治療の流れを検証しました。 Source Tesfaye S et al; OPTION-DM trial group. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial. Lancet. 2022 Aug 27;400(10353):680-690. PMID: 36007534; PMCID: PMC9418415. https://pubmed.ncbi.nlm.nih.gov/36007534/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

In this video, I review the OPTION-DM trial and what it means for the treatment of painful diabetic peripheral neuropathy. This study addressed a very practical clinical question: what should we do when a first-line neuropathic pain medication helps only partially? The trial compared three realistic treatment pathways: amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin. The key takeaway is that these pathways produced broadly similar pain relief overall, with no clear winner among them. Importantly, for patients whose pain remained inadequately controlled on monotherapy, adding a second first-line agent provided additional benefit. This is clinically relevant not only for diabetic neuropathy, but also for neuropathic pain management more broadly. The study supports an individualized, stepwise approach: start with a first-line medication, titrate carefully, reassess response and tolerability, and consider combination therapy when monotherapy provides partial but insufficient relief. In this review, I discuss: the clinical rationale behind the OPTION-DM design, the main efficacy findings, the role of combination therapy, common adverse effects, and how these results may inform real-world neuropathic pain management. この動画では、痛みを伴う糖尿病性末梢神経障害に対する治療を考えるうえで重要なOPTION-DM試験を解説します。特に、第一選択薬で痛みが一部しか改善しない場合に、次にどうするべきかという臨床的に非常に実践的な問題を取り上げています。 この試験では、以下の3つの現実的な治療経路が比較されました。 アミトリプチリン開始後、必要に応じてプレガバリンを追加する方法 プレガバリン開始後、必要に応じてアミトリプチリンを追加する方法 デュロキセチン開始後、必要に応じてプレガバリンを追加する方法 主な結論は、これら3つの治療経路の鎮痛効果は全体としてほぼ同等であり、明確に優れた経路は示されなかったという点です。一方で、単剤治療で十分な改善が得られなかった患者では、第二の第一選択薬を追加することでさらなる改善が期待できることが示されました。 この結果は、糖尿病性ニューロパチーに限らず、慢性神経障害性疼痛全般の治療戦略を考えるうえでも参考になります。第一選択薬を開始し、忍容性をみながら増量し、効果と副作用を再評価したうえで、部分反応にとどまる場合には併用療法を検討するという段階的なアプローチを支持する内容です。 この動画では、 OPTION-DM試験の臨床的意義 主要な有効性の結果 併用療法の位置づけ 主な有害事象 実臨床への応用 について解説します。 Source Tesfaye S et al; OPTION-DM trial group. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial. Lancet. 2022 Aug 27;400(10353):680-690. PMID: 36007534; PMCID: PMC9418415. https://pubmed.ncbi.nlm.nih.gov/36007534/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

The key clinical takeaway: multiple medications may be reasonable options, but response and tolerability vary from patient to patient. 有痛性糖尿病性ニューロパチーでは、「唯一の正解」となる薬を探すより、患者ごとの反応性と忍容性を見極めることが大切です。 Source Quilici S, Chancellor J, Löthgren M, Simon D, Said G, Le TK, Garcia-Cebrian A, Monz B. Meta-analysis of duloxetine vs. pregabalin and gabapentin in the treatment of diabetic peripheral neuropathic pain. BMC Neurol. 2009 Feb 10;9:6. PMID: 19208243; PMCID: PMC2663537. https://pubmed.ncbi.nlm.nih.gov/19208243/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

In this meta-analysis, duloxetine, pregabalin, and gabapentin all showed benefit over placebo—but the point estimates should not be over-interpreted as head-to-head results. このメタ解析では、デュロキセチン、プレガバリン、ガバペンチンはいずれもプラセボより有効性を示しました。ただし直接比較ではない点に注意が必要です。 Source Quilici S, Chancellor J, Löthgren M, Simon D, Said G, Le TK, Garcia-Cebrian A, Monz B. Meta-analysis of duloxetine vs. pregabalin and gabapentin in the treatment of diabetic peripheral neuropathic pain. BMC Neurol. 2009 Feb 10;9:6. PMID: 19208243; PMCID: PMC2663537. https://pubmed.ncbi.nlm.nih.gov/19208243/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

Choosing medication for painful diabetic neuropathy is not only about pain reduction. Tolerability and staying on treatment matter just as much. 有痛性糖尿病性ニューロパチーの薬剤選択では、効果だけでなく、副作用や継続しやすさも重要です。 Source Quilici S, Chancellor J, Löthgren M, Simon D, Said G, Le TK, Garcia-Cebrian A, Monz B. Meta-analysis of duloxetine vs. pregabalin and gabapentin in the treatment of diabetic peripheral neuropathic pain. BMC Neurol. 2009 Feb 10;9:6. PMID: 19208243; PMCID: PMC2663537. https://pubmed.ncbi.nlm.nih.gov/19208243/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

How should we choose between duloxetine, pregabalin, and gabapentin for painful diabetic peripheral neuropathy? In this video, Dr. Akihiro Ando reviews a 2009 meta-analysis published in BMC Neurology that examined indirect comparisons among duloxetine, pregabalin, and gabapentin for diabetic peripheral neuropathic pain (DPNP). Because direct head-to-head trials were limited, the authors compared these medications through placebo-controlled trial data to explore differences in efficacy and tolerability. The paper suggests that all three medications showed benefit over placebo for painful diabetic neuropathy. In the indirect comparison, duloxetine appeared broadly comparable to pregabalin and gabapentin for overall pain reduction, although pregabalin was favored on patient global impression outcomes and duloxetine was favored on dizziness. The study also highlights an essential clinical reality: treatment choice is not only about pain relief, but also about adverse effects, discontinuation, comorbidities, and whether a patient can remain on therapy long enough to benefit. This review also discusses the important limitations of indirect meta-analysis, including small study numbers, limited gabapentin data, differences across trial populations, and the fact that indirect comparisons are not a substitute for true head-to-head randomized trials. This is a practical paper for clinicians managing neuropathic pain, because it supports multiple evidence-based options rather than a single “best” drug. 有痛性糖尿病性末梢神経障害に対して、duloxetine、pregabalin、gabapentinのどれを選ぶべきでしょうか。 この動画では、Dr. Akihiro Andoが、BMC Neurology に2009年に掲載されたメタアナリシスをもとに、糖尿病性末梢神経障害性疼痛（DPNP）に対する duloxetine、pregabalin、gabapentin の比較を解説します。直接比較試験が限られている中で、この論文はプラセボ対照試験を共通比較対象として用いた間接比較により、有効性と忍容性を検討しています。 論文の結果からは、3剤はいずれもプラセボより疼痛改善効果を示しました。間接比較では、主な疼痛アウトカムにおいて duloxetine は pregabalin や gabapentin と概ね同等と考えられました。一方で、患者全体評価では pregabalin がやや有利であり、めまいに関しては duloxetine が有利でした。つまり、薬剤選択は単純に「どれが一番効くか」ではなく、副作用、治療中止率、併存症、継続しやすさなどを含めて考える必要があることを示しています。 またこのレビューでは、間接メタアナリシスの限界についても詳しく取り上げます。特に、対象試験数の少なさ、gabapentin に関するデータの限界、試験間の患者背景の違い、そして間接比較は真の直接比較試験を置き換えるものではないという点は重要です。 臨床的には、「唯一の勝者」を決める論文というより、複数の妥当な治療選択肢をどう患者ごとに使い分けるかを考えるうえで参考になる論文です。 Source Quilici S, Chancellor J, Löthgren M, Simon D, Said G, Le TK, Garcia-Cebrian A, Monz B. Meta-analysis of duloxetine vs. pregabalin and gabapentin in the treatment of diabetic peripheral neuropathic pain. BMC Neurol. 2009 Feb 10;9:6. PMID: 19208243; PMCID: PMC2663537. https://pubmed.ncbi.nlm.nih.gov/19208243/ #糖尿病性神経障害 #神経障害性疼痛 #デュロキセチン #プレガバリン #ガバペンチン #痛み治療 #EBM #DiabeticNeuropathy #NeuropathicPain #Duloxetine #Pregabalin #Gabapentin #PainManagement #EvidenceBasedMedicine ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

This paper frames neuropathic pain as more than excess nociceptive input—it may also reflect impaired endogenous inhibition. 神経障害性疼痛は入力の増加だけでなく、内因性の抑制機構がうまく働かない状態としても捉えられます。 Source Giancotti LA, Squillace S, Chen Z, Lauro F, Li Y, Salvemini D. Ozanimod, a functional sphingosine-1-phosphate receptor 1 antagonist, restores brainstem descending pain pathways in murine models of neuropathic pain. Pain. 2025 Nov 1;166(11):2510-2518. PMID: 40758546. https://pubmed.ncbi.nlm.nih.gov/40758546/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical

In rodent models of traumatic and chemotherapy-induced neuropathic pain, systemic ozanimod showed broad antinociceptive effects. 外傷性神経障害性疼痛と化学療法誘発性ニューロパチーのモデルで、ozanimodは広い鎮痛効果を示しました。 Source Giancotti LA, Squillace S, Chen Z, Lauro F, Li Y, Salvemini D. Ozanimod, a functional sphingosine-1-phosphate receptor 1 antagonist, restores brainstem descending pain pathways in murine models of neuropathic pain. Pain. 2025 Nov 1;166(11):2510-2518. PMID: 40758546. https://pubmed.ncbi.nlm.nih.gov/40758546/ ⸻ Websites Akihiro Ando Portal: https://www.akihiroando.com Ando Orofacial Pain & Oral Medicine Clinic: https://www.ando-pain.jp TED Talk: https://www.ted.com/talks/akihiro_ando_this_thing_called_pain ⸻ Facebook Spark Medical: https://www.facebook.com/sparkmeds/ Ando Orofacial Pain & Oral Medicine: https://www.facebook.com/andoofpom/ Spark Medical Presentation Workshop: https://www.facebook.com/groups/joinsparkmedical