腰痛：患者が手および指で示す疼痛領域の比較

Low Back Pain : Comparison of Pain Sites Indicated with the Hand and with the Finger

　抄録：腰痛の領域を患者に手および指で示させ，それぞれの領域（同定域）を比較した．腰痛患者のうち次の3条件を満たした45例を対象とした．1．立位前後屈または側屈で腰痛が誘発される．2．腰痛の領域が1カ所である．3．下肢痛がない．疼痛領域の同定は，腰痛を誘発し，患者に手および示指で疼痛領域を示させ，さらにその再現性を確認した後に，領域の輪郭を患者の皮膚に記入するという手順で行った．手と指による同定域について，面積を比較し，同定域の位置にズレがあるか否か，どちらがより正確に自覚する疼痛領域を示しているかを調べた．対象のうち，再現性をもって疼痛領域を示した40例を検討した．指による同定域の面積（1～147cm²，平均42cm²）が手による同定域（14～300cm²，平均63cm²）に比べて有意に小さかった．手と指による同定域の位置にズレのある例は40例中17例（42.5％）であった．検討した40例のうち，手と指による同定域が異なった34例中31例（91.2％）で，指による同定域がより正確に自覚する疼痛領域を示していた．腰痛の領域を正確に同定するには，患者に指で示させる必要があると考えられる．

　We compared sites of low back pain indicated with the patient's hand and with the patient's finger. The subjects of this study were 45 low-back-pain patients who met all three of the following criteria：（1）experiencing low back pain induced by lumbar flexion, extension, or lateral bending in the standing position,（2）having pain at only one site, and（3）not having leg pain. The subjects were asked to indicate the site of their pain with their hand and with their index finger immediatey after provoking the pain. After the reproducibility the sites they indicated was confirmed, the site was outlined on the subject's skin. The sites identified with their hand and with their finger were compared in terms of surface area, location discrepancies, and the accuracy of the site identified. The 40 patients who reproducibly indicated the site of their pain were included in the analysis. The surface area of the sites identified with the finger (1～147cm², mean：42cm²) was significantly smaller than the area of the sites identified with their hand (14～300cm², mean：63cm²). Location discrepancies were observed in 17 (43％) of the 40 patients. Among the 31 (91％) of the 34 patients with differences between the sites identified with their hand and with their finger, the site indicated with their finger more accurately identified the site of the pain than the site identified with their hand.

　We conclude that indication of the site of pain with the patient's finger results in more accurate identification of the site of low back pain.