慢性非特異的頚部痛症例における頚部身体イメージの変質と臨床症状との関係

Abstract

Several studies have demonstrated that perceived body image of pain region is distorted in patients with complex regional pain syndrome (CRPS), chronic non–specific lower back pain and phantom limb pain. Moreover, perceived body image was associated with abnormal pain sensation in patients with these conditions. However, it is not well known whether patients with chronic non–specific neck pain (CNSNP) have symptoms and distorted perceived body image like chronic non–specific lower back pain. The purpose of the present study was to examine based on body image drawings whether two point discrimination (TPD) and selected clinical findings are different in subgroups of individuals with CNSNP. Twenty patients with CNSNP and healthy volunteers were assessed through perceived body image, TPD. CNSNP patients were also assessed through clinical profiles (pain intensity, pain catastrophizing, and fear avoidance beliefs). Perceived body image of neck was assessed by drawing their own outline of neck as they feel in their mind. Of patients with CNSNP, 50% reported that they had distorted body image and significantly different to control group. This result suggested that pathological condition of CNSNP was associated with cortical dysfunction as well as CRPS, chronic non–specific lower back pain and phantom limb pain. In the secondary analysis, we divided patients with CNSNP into two groups by the presence or absence of distorted body image (normal image; NI group, distorted image; DI group) and compared TPD threshold and clinical symptoms in three group (NI , DI and control group). TPD threshold of NI–pain side and DI–pain side were significantly higher than control. All other clinical symptoms were not significantly different in three groups. We couldn’t find the factor that was specifically associated with distorted body image of patients with CNSNP in the present study. Further study is needed to elucidate the clinical factors associated with perceived body image.