Departmental Bulletin Paper 腰痛の慢性化に対する2 点識別覚と胸郭拡張差測定の有用性
Usefulness of the two-point discrimination and measurement of thoracic expansion difference in patients with chronic low back pain

高間, 則昭  ,  西田, 裕介

 腰痛は日本人の多くが経験するが,その多くは原因が明らかでなく治療に苦慮する.その中で慢性化し医療費の高騰,就労困難による生産性低下など社会経済に与える損失が危惧されている.したがって,慢性腰痛における運動障害や疼痛の発現状態を詳細に評価し,慢性化を防ぐことが理学療法分野では必須の課題とされている.最近の研究では,心理的要因以外に慢性疼痛には脳・神経の可塑的変化が起こることや,腰部機能障害を有する患者では疼痛の有無に関わらず肋骨拡張が制限されることが明らかになってきたが,各要因の影響度や相関については明らかではないのが現状であり,使用者はこの測定についての意義を熟知し正しい評価を行う必要がある.そこで本稿では,慢性腰痛の概説し,心理的要因,神経の可塑的変化を反映する2 点識別覚,胸郭拡張差の文献を踏まえて臨床での有用性や展望を述べることを目的とした.
 Many Japanese experience lower back pain, but its etiology is unclear in most cases, making treatment difficult. In particular, a chronic-state related increase in health expenditure and reduction of productivity related to difficulty in working may affect the patients’ socioeconomic situation. Therefore, in the field of physical therapy, it is necessary to evaluate chronic lower back pain- related movement disorders and prevent a chronic condition. Recent studies have shown that chronic low back pain induces plastic changes of the brain/nerves in addition to changes in mental factors, and that costal bone dilation is restricted regardless of the presence or absence of pain in patients with low back dysfunction; however, clinically standardized efficacy assessment or interpretation of measurement remains controversial. Health care professionals must recognize the significance of the measurement and correctly evaluate the results. In this article, we introduce chronic low back pain based on previous articles, review the literature on mental factors, using a two-point discrimination, which reflects plastic changes of the nerves, and thoracic expansion differences. We also examine their clinical usefulness and development.

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