今日の朝一で来られた方は、重度の首痛が主訴でした。1年ぶりの来院です。
前回も慢性的な首の痛みで悩まされていらっしゃいましたが、今回はその数倍も症状が悪化していました。
1か月前に出産された後から、首の痛みが徐々に悪化し始め、何をやっても（痛み止めをのんでも）症状が収まらなかったようです。
首のどこを触っても鋭い圧痛があり、全可動域に制限があります。ぎっくり腰ならぬぎっくり首のような状態。
これほど酷い状態の首痛を診るのは、久しぶりです。もしかしたら、ぼくの臨床経験過去一酷い首痛かもしれません。
原因を特定するまでのこともありません。なぜなら、関節、神経、筋肉全てが原因となっているからです。ただ、これらの構造の中でも特に関節と神経の問題が、この方の首痛に大きく影響しているような気がしました。
頸椎の椎間関節を丁寧に診ていきます。その後、頸神経を中心に神経もしっかり治療。ただし、重度の症状のため治療の強度には十分留意します。
特に首の神経の中で皮膚に近いものは、慎重に治療する必要があります。刺激量が強すぎると悪化させてしまうリスクがあるからです。
治療後は半分程度の改善。ただし、この方の場合、これが今のベストと判断しました。数日予後経過を観察し、次回の治療タイミングを決めていく予定です。
English
A patient came in first thing this morning with a chief complaint of severe neck pain, her first visit in a year.
She had been suffering from chronic neck pain the last time, but this time her symptoms were several times worse.
After having a baby a month ago, her neck pain gradually began to worsen, and no matter what she did (even after taking painkillers), the symptoms did not stop.
There was sharp tenderness wherever she touched her neck, and her full range of motion was limited. It was like having a bad neck, not a bad back.
It has been a long time since I have seen a patient with such severe neck pain. It may be the worst neck pain I have ever seen in my clinical experience.
I don’t even want to go so far as to identify the cause. It is not necessary to identify the cause, because the joints, nerves, and muscles all contribute to the problem. However, among these structures, I felt that the joint and nerve problems in particular had a significant impact on this patient’s neck pain.
We carefully examine the intervertebral joints of the cervical spine. Then, we also treated the nerves well, focusing on the cervical nerves. However, due to the severity of the condition, we pay close attention to the intensity of the treatment.
In particular, the nerves in the neck that are close to the skin need to be treated carefully. There is a risk of aggravation if the amount of stimulation is too strong.
After treatment, the patient improves by about half. However, in this patient’s case, we determined that this is the best we could do now. We will observe the prognosis for a few days and decide the timing of the next treatment.
