外傷性頸部症候群による慢性疼痛患者に対する目標に基づいた作業療法の有効性

Effectiveness of Goal-Based Occupational Therapy for a patient with chronic pain due to Whiplash associated disorders

事故後の外傷性頸部症候群による慢性疼痛，重度の中枢性感作症候群，心的外傷を呈し，日常生活に支障をきたした事例を経験した．Aid for Decision-making in Occupation Choiceを用いて目標を設定し，Goal Attainment Scalingにて段階的作業療法プログラムを実施した．結果，VASとPCS，PSEQの改善は認められなかったものの，GASの達成度が向上し，目標と関係するPDASの「腰を使う活動」に改善を認め，行動変容に繋がった．本事例を通して，外傷性頸部症候群による慢性疼痛患者に対する目標に基づいた作業療法が行動変容の促進に繋がる可能性が示唆された．

　A case of Whiplash associated disorders after an accident was treated with a graded occupational therapy program using the Aid for Decision-making in Occupation Choice to set goals and the Goal Attainment Scaling. The case had difficulty in daily living, and suffered from chronic pain, severe central sensitization syndrome, and psychological trauma. Although the treatment resulted in no improvement in VAS, PCS, or PSEQ, the achievement of GAS improved, and improvement was observed in "activities using the lower back" of PDAS, which was related to the goal, and lead to behavioral change. This case study suggests that goal-based occupational therapy for patients with chronic pain due to Whiplash associated disorders may promote behavioral change.