頸椎化膿性脊椎炎後の神経障害性疼痛に末梢性反復磁気刺激と作業療法の併用が及ぼす影響—事例報告

Effects of combined peripheral repetitive magnetic stimulation and occupational therapy on neuropathic pain after cervical pyogenic spondylitis: A case report

要旨：頸椎化膿性脊椎炎発症後に神経障害性疼痛（NP）が生じた70歳代女性を担当した．事例は，右上肢肩甲帯から手指にかけて自発痛やアロディニア，痺れが生じ，運動だけでなく他者からの身体接触に対しても恐怖心を抱いていた．その結果，痛みに伴う恐怖回避行動や患肢の学習性不使用など，慢性痛の機序である不活動が生じていた．そこで，NPや患肢の不活動の是正を目的に，末梢性反復磁気刺激（rPMS）と作業療法（OT）の併用を行ったところ，本人の心理状態や患肢の行動に変化が起こり，作業目標を達成することができた．上記の結果より，rPMSとOTの併用はNPに伴う患肢の不活動を是正し，生活行為の改善に寄与することが示唆された．

　We treated a woman in her 70s who developed neuropathic pain (NP) after the onset of cervical spondylitis pyogenicans. The patient had spontaneous pain, allodynia, and numbness in the right upper extremity from the shoulder girdle to the fingers and was fearful of movement and physical contact from others. As a result, fear avoidance behavior associated with pain and learned disuse of the affected limb occurred, which are mechanisms of chronic pain. When peripheral repetitive magnetic stimulation (rPMS) and occupational therapy (OT) were used to correct NP and inactivity of the affected limb, the patient's psychological state and behavior of the affected limb changed, and she was able to achieve her occupational goals. The results suggest that the combination of rPMS and OT corrects inactivity of the affected limb associated with NP and contributes to the improvement of Daily Life Performance.