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中枢性感作票はプライマリーケアにおける筋骨格系障害の疼痛関連能力障害を予測する

Tanaka, Katsuyoshi 田中, 克宜 タナカ, カツヨシ 神戸大学

2020.03.25

概要

【はじめに】筋骨格系障害 (MSK) 患者において疼痛関連能力障客は重要なアウトカムの一つで,プライマリケアにおける適切な評価,治療は重要である。中枢性感作 (CentralSensitization: CS)は, MSK患者の疼痛関連能力障害を含む臨床症状への影得が報告されており, CSが関与する包括的な疾患概念として中枢性感作症候群 (CentralSensitivity Syndrome: CSS)が提唱されている。 CSおよび CSSの評価票として中枢性感作票 (Central Sensitization Inventory: CSI)が開発され,臨床有用性が報告されている。本研究の目的は,プライマリケアにおいて, CS関連症状の重症度と MSK患者の患者特性との関係性および, CS関連症状と疼痛関連能力障害の縦断的関連を, CSIを用いて調査することとした。

【方法】対象は外来 MSK障害患者 553名である。初期評価として, CS関連症状は CSI,健康関連 QOLは EroQol-5dimension, 疼痛評価(疼痛強度,疼痛関連能力障害)は BriefPain Inventoryを用いて評価した。 553名のうち 150名 は 3ヶ月後に再評価を行った。また,対象者を初期評価時の CSIscoreで 3つの重症度に分類した (subclinica]: 0・29点,mild: 30・39点, moderateto higher: :>40点)。統計解析は,初期評価時の CSI重症度と臨床症状の関連を Jonckheere・Tepstatestにて検討した。また,初期評価の CSI重症度が 3ヶ月後の疼痛関連能力障害を予測するかどうかを,目的変数に 3 ヶ月後の疼痛関連能力障害,説明変数に初期評価時の CSI重症度,調整変数に忠者背景,権患期間,初期評価での疼痛強度,疼痛関連能力障害,治療回数, CSS診断歴を投入した重回帰分析を用いて検討した。また, CSI重症度間 (subclinicalvs. mildまたは moderateto higher) での疼痛関連能力障害の差の効果呈を算出した。

【結果】初期評価時の CSI重症度が重症なほど,疼痛関連能力障害,疼痛強度が有意に強く,健康閑連 QOLが有意に低かった (p<0.05)。また,重回帰分析により交絡因子の調整を行った後も,初期評価時の CSI重症度が moderateto higherであると 3ヶ月後の疼痛関連能力障害が有意に裔かった (beta=1.647, 95% confidence interval= 0.852 to 2.442,p < 0.001)。さらに, subclinical と比べた疼痛関連能力障害への効果はは, mildで 中 (d=0.41), moderate to higherで 大 (d=l.57) であった。しかし, CSI重症度間での罹患期間の差はなかった。

【結論】プライマリケアにおける筋骨格系障害患者で CSI重症度がより高いことは,より高い疼痛関連能力障害を予測した。 CSIは筋骨格系障害患者の予測ツールとして,罹患期間に関わらず臨床的有用性を有する。術前に CS関連症状が強い患者は予後不良であることも報告されているが,本研究の結果よりプライマリケアから CS関連症状の評価を行い,適切な治療選択をしていくべきである。

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