診療ガイドライン，エビデンスを踏まえた慢性腰痛に対する患者主導型治療へ向けて─ Stratified approach（層化アプローチ）の重要性

抄録

A stratified approach for low back pain (LBP) involves targeted treatment for subgroups of patients classified according to their key characteristics such as prognostic psychological factors. This approach tailors therapeutic decisions in ways that maximize treatment benefit and reduce medical care costs. A stratified approach was known as the “Holy Grail” in back pain research over a decade ago.

Psychological factors strongly influence the chronicity of LBP. Evidence suggests that fear avoidance beliefs are prognostic for poor outcomes in subacute LBP. Thus, early treatment, including interventions aimed to reduce fear avoidance beliefs, may prevent delayed recovery and chronicity.

A recent development in the stratified approach is to use brief risk prediction tools such as the short–form Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) and the Keele STarT Back Screening Tool (SBST). These tools identify patients with an increased likelihood of delayed recovery, and facilitate intervention for these patients from day 1, rather than waiting for failure of the first–line care. These tools can also help clinicians to better understand the reasons for a potentially poor prognosis and to choose interventions accordingly. Both of these screening tools focus on assessment of key psychological factors such as fear avoidance beliefs.

Somatic symptom burden is used to evaluate the severity and course of illness. Co–existence of various somatic symptoms including multisite pain may be the core feature of central dysfunctional pain. The 8–item Somatic Symptom Scale (SSS–8) was recently developed as a brief, patient–reported measure of somatic symptom burden. We believe this tool to be useful for screening for functional somatic syndrome including chronic widespread pain.