Wonke umntu ufumana iintlungu ngexesha elide. Ubunzima bubuhlungu obungokwenyama obubangelwa kukulimala okanye ukugula. Xa udonsa umsizi okanye usike umnwe wakho, umzekelo, isignali ithunyelwa ngeengcambu zentsholongwane kwingqondo, ekutshengeni ukuba into ephosakeleyo emzimbeni. Ubuhlungu buyahlukahluka kuwo wonke umntu kwaye kukho iindlela ezininzi zokuvakalelwa nokuchaza intlungu. Emva kokulimala okanye ukugula kugula, intlungu iya kuphelisa, nangona kunjalo, kwenzeka ntoni ukuba intlungu iyaqhubeka nangemva kokuphilisa?

 

Ubuhlungu obungapheliyo ngokuqhelekileyo ichazwa njengaluphi na ubuhlungu obuhlala ngaphezu kweeveki ze-12. Ubuhlungu obungapheliyo bunokuvela kwi-mild to severe and can be the result of injuries before or surgery, migraine kunye nentloko, isifo samathambo, umonakalo wemisipha, ukusuleleka kunye ne-fibromyalgia. Ubuhlungu obungapheliyo buyakuchaphazela isimo sengqondo somntu kunye nengqondo, okwenza kube nzima ukukhupha iimpawu. Uphando lwaphando lubonise ukuba ukungenelela kwengqondo kunokuncedisa inkqubo yokubuyisela ubuhlungu obungapheliyo. Abasebenzi abaninzi bezempilo, njengogqirha we-chiropractic, banokubonelela ngononophelo lwe-chiropractic kunye nokungenelela kwengqondo ukunceda ukubuyisela impilo kunye nokuphila kakuhle kwezigulane zabo. Injongo yale nqaku ilandelayo kukubonisa inxaxheba yongenelelo lweengqondo ekulawuleni izigulane ezinentlungu engapheliyo, kuquka intloko yesifo kunye nentlungu.

 

 

Inxaxheba Yongenelelo lweengqondo kwi-Management of Patients with Pain Pain

 

Abstract

 

Intlungu engapheliyo inokuqondwa ngcono ngokwembono ye-biopsychosocial apho iintlungu zijongwa njengamava antsonkothileyo, anezinto ezininzi ezivela kulwalamano olunamandla lwesimo somzimba, iingcinga, iimvakalelo, isimilo, kunye nefuthe lenkcubeko. Umbono we-biopsychosocial ujolise ekujongeni iintlungu ezingapheliyo njengesifo kunesifo, ngenxa yoko ukuqonda ukuba ngamava aphantsi kwaye iindlela zonyango zijolise kulawulo, endaweni yokunyanga, kwentlungu engapheliyo. Iindlela zangoku zengqondo kulawulo lweentlungu ezingapheliyo zibandakanya ungenelelo olujolise ekufezekiseni ukwanda kolawulo lwakho, utshintsho kwindlela yokuziphatha, kunye notshintsho lwengqondo kunokuba ususe ngqo indawo ebuhlungu. Izibonelelo zokubandakanya unyango lwengqondo kwiindlela ezahlukeneyo zokulawula iintlungu ezingapheliyo zibandakanya, kodwa azikhawulelwanga, ukunyusa ukuzilawula kweentlungu, ukuphucula izixhobo zokujamelana neentlungu, ukunciphisa ukukhubazeka okunxulumene nentlungu, kunye nokunciphisa uxinzelelo lweemvakalelo ngeendlela ezahlukeneyo zokuzilawula, zokuziphatha, kunye neendlela zokuqonda. Ngokumiliselwa kolu tshintsho, iingcali zengqondo zinokunceda abaguli bazive ngaphezulu kumyalelo wolawulo lweentlungu zabo kwaye babenze bakwazi ukuhlala ubomi obuqhelekileyo kangangoko kunokwenzeka ngaphandle kwentlungu. Ngaphaya koko, izakhono ezifundwe ngongenelelo lwengqondo zixhobisa kwaye zenza ukuba izigulana zibe ngabathathi-nxaxheba abakhutheleyo kulawulo lokugula kwabo kwaye baxhokonxe izakhono ezixabisekileyo ezinokuqeshwa zizigulana kubomi babo bonke.

 

Internet: ukuphathwa kabuhlungu obungapheliyo, iingqondo zengqondo, unyango lweentlungu ezahlukeneyo, unyango lwezengqondo zokuziphatha

 

Insight of Dr. Alex Jimenez

Ubuhlungu obungapheliyo sele buzimisele ukuchaphazela impilo yengqondo yabantu abaneempawu eziqhubekayo, ekugqibeleni ukutshintsha isimo sabo sengqondo nesimo sengqondo. Ukongezelela, izigulane ezineemeko ezidityanisiweyo, kuquka ukuxinezeleka, uxinzelelo kunye nokudakumba, zingenza unyango lunzima. Indima yenkathalo ye-chiropractic kukubuyisela kunye nokugcina nokulungelelanisa ukulungelelaniswa kokuqala komgudu ngokusebenzisa ukuguqulwa komgudu kunye nokusetyenziswa kwamandla. Ukunyamekela kwe-Chiropractic kuvumela umzimba ukuba uphilise ngokwawo ngaphandle kwemfuno yeziyobisi / amachiza kunye nokungenelela okucwangcisiweyo, nangona oku kungathunyelwa kwi-chiroprarensi ukuba kuyimfuneko. Nangona kunjalo, ukunakekelwa kwe-chiropractic kugxile kumzimba ngokubanzi, kunokuba kubekho ukulimala omnye kunye / okanye imeko kunye neempawu zayo. Ukuguqulwa kwamagqabi kunye nokusetyenziswa kwamanyathelo, phakathi kwezinye iindlela zonyango kunye nezindlela eziqhelekileyo ezisetyenziselwa yicroperractor, zifuna ukuqonda ngesimo sengqondo nesimo sengqondo somguli ukwenzela ukuba ubonelele ngokufanelekileyo impilo nempilo. Izigulane ezityelela kwiklinikhi yam ngokuxinezeleka kwemizimba yazo zihlala zikwazi ukufumana iingxaki zengqondo ngenxa yoko. Ngako oko, ukunakekelwa kwe-chiropractic kungabangela ukungenelela kwengqondo kwindlela yokulawula ubuhlungu obungapheliyo, kunye nezo ziboniswe ngezantsi.

 

intshayelelo

 

Intlungu ngamava omntu okuyo yonke indawo. Kuqikelelwa ukuba malunga ne-20% 35% yabantu abadala abafumana iintlungu ezingapheliyo. [1,2] I-National Institute of Nursing Research inika ingxelo yokuba iintlungu zichaphazela abantu abaninzi baseMelika kunesifo seswekile, isifo sentliziyo, kunye nomhlaza zidityanisiwe. [3] Ubuhlungu bukhankanywe njengesona sizathu siphambili sokufuna unyango e-United States. [4] Ngapha koko, ukuthomalalisa iintlungu lolwesibini unyango olumiselweyo kwii-ofisi zoogqirha nakumagumbi angxamisekileyo. [5] Ukuqinisa ngakumbi ukubaluleka kovavanyo olwaneleyo lwentlungu, iKhomishini edibeneyo yokuVunywa kweMibutho yoKhathalelo lwezeMpilo ikhuphe umyalelo wokuba iintlungu zivavanywe njengophawu lwesihlanu olubalulekileyo ngexesha lotyelelo lwezonyango. [6]

 

Umbutho waMazwe ngaMazwe woFundo lweNtlungu (IASP) uchaza iintlungu njenge- amava angathandekiyo eemvakalelo kunye neemvakalelo ezinxulunyaniswa nokwenzeka ngqo okanye ukubakho kwethishu, okanye kuchazwe ngokwaloo monakalo . Inkcazo ye-IASP igxininisa ubunjani obuninzi kunye nokuzithoba kwintlungu, amava anzima ahlukeneyo kumntu ngamnye. Ubuhlungu obungapheliyo buhlala buhlulwa kwintlungu ebuhlungu ngokusekwe kukunganyamezeleki okanye ukuzingisa, iindlela zayo zokulondolozwa komzimba, kunye / okanye nefuthe elibi kubomi bomntu. Ngokubanzi, kuyamkelwa ukuba iintlungu eziqhubeka ngaphezulu kwexesha elilindelweyo lokunyanga izicubu kulandela ukwenzakala okanye utyando kuthathwa njengentlungu engapheliyo. Nangona kunjalo, ixesha elibekiweyo elilindelweyo lokuphilisa liyahluka kwaye kuhlala kunzima ukuqiniseka ngalo. Ukulungiselela ukwahlulwahlulwa ngokulula, izikhokelo ezithile zibonisa ukuba iintlungu eziqhubayo ngaphaya kwenyanga ye-7 3 yexesha kuthathwa njengentlungu engapheliyo. [6] Nangona kunjalo, ukuhlelwa kwentlungu esekwe kuphela kubude kuyasebenza ngokungqongqo kwaye, kwezinye iimeko, inqobo yokuchasana. Ngokuqhelekileyo, izinto ezongezelelweyo ezifana ne-etiology, ubunzima beentlungu, kunye nefuthe ziqwalaselwa kunye nexesha lokuhlukanisa ubuhlungu obungapheliyo. Enye indlela yokubonakalisa ubuhlungu obungapheliyo isekelwe kwindlela yokugcinwa komzimba; Oko kukuthi, iintlungu ekucingelwa ukuba ziyavela ngenxa yolungelelwaniso kunye nolungelelwaniso oluphambili. Iimeko eziqhelekileyo zentlungu zibandakanya ukuphazamiseka kwemisipha, iimeko zentlungu ye-neuropathic, iintlungu zentloko, iintlungu zomhlaza kunye nentlungu yokubona. Ngokubanzi ngakumbi, iimeko zentlungu zinokuba ikakhulu zi-nociceptive (ukuvelisa iintlungu zoomatshini okanye zeekhemikhali), i-neuropathic (ebangelwa ngumonakalo wemithambo-luvo), okanye embindini (okubangelwa kukungasebenzi kakuhle kwii-neurons zenkqubo ye-nervous system). [7]

 

Ngelishwa, amava entlungu ahlala ebonakaliswa kukungaziphathi kakuhle ngokwasemzimbeni, ngokwasengqondweni, ngokwasentlalweni nakwezemali. Ubuhlungu obungapheliyo buye babonwa njengesona sizathu siphambili sokukhubazeka ixesha elide kubemi baseMelika abasebenzayo. [9] Ngenxa yokuba iintlungu ezingapheliyo zichaphazela umntu kwimimandla emininzi yobukho bakhe ikwangumthwalo omkhulu wemali kuluntu lwethu. Iindleko ezichanekileyo nezingangqalanga zentlungu ziqikelelwa ukuba zisuka kwi-125 yezigidigidi ukuya kwi-215 yezigidigidi, ngonyaka. [10,11] Iziphumo ezixhaphakileyo zentlungu engapheliyo zibandakanya ukwanda kweengxelo zoxinzelelo (umzekelo, ukudakumba, unxunguphalo, kunye nokudana), ukwanda kwamazinga okukhubazeka okunxulumene nentlungu, utshintsho olunxulumene nentlungu ekuqondeni, kunye nokunciphisa umgangatho wobomi. Ke, iintlungu ezingapheliyo zinokuqondwa ngcono ngokwembono ye-biopsychosocial apho iintlungu zijongwa njengamava antsonkothileyo, anezinto ezininzi ezivela kulwalamano olunamandla lwesimo somzimba, iingcinga, iimvakalelo, isimilo, kunye nefuthe lenkcubeko.

 

Ulawulo lwezinhlungu

 

Ngenxa yokuxhaphaka kweentlungu kunye nobukhulu bayo, i-regimen yolawulo lwentlungu efanelekileyo iya kubanzi, idibanise kunye neyodwa. Iindlela ezikhoyo zolawulo lweentlungu ezingapheliyo ziye zagqithisa ukunciphisa nokunciphisa ngokukhawuleza, ngokomzimba, okanye kwi-pharmacological unyango. Iindlela ezikhoyo ziyabona ukubaluleka kwesikhokelo sokhathazwa kwamanyathelo ahlukeneyo ekujoliswe kuzo ekujoliswe kwimiba yeentlungu kodwa kunye neengqinisiso zokuqonda, kunye nezizathu ezinokuthi zithintekayo kunye kunye neempembelelo ezifanayo. Ulawulo oluqhelekileyo lweentlungu ezingapheliyo ziquka ukunyangwa kwamaqela amaninzi afana nokuhlanganiswa kwama-analgesics, unyango lomzimba, unyango lwendlela yokuziphatha, kunye neyeza zengqondo. Indlela yokwenza i-multimodal ngokufanelekileyo ngokwaneleyo kwaye iqondise ngokufanelekileyo ulawulo lweentlungu kwiimodeli, ukuziphatha, ukuqonda, kunye namazinga asebenzayo. Ezi ndlela ziye zaboniswa ukuba zikhokele kwiziphumo eziphambili kunye nezihlala zihlala zihlala ziquka iingxelo zentlungu, imizwa, ukubuyiswa kwemisebenzi yansuku zonke, isimo somsebenzi, kunye neyeza okanye ukusetyenziswa kwezempilo; Iindlela zokwenziwa kweemimandla ziye zaboniswa ukuba zindleko ezininzi kuneendlela ezingenjalo. [12,13] Ugxininiso lwolu hlalutyo luya kubakho ngokucacileyo ukulungelelanisa iingenelo zengqondo kwindlela yokulawula intlungu engapheliyo.

 

 

Izigulana ziya kuthi ekuqaleni zibonise iofisi kagqirha ekunyangeni unyango okanye unyango lwezifo zabo / iintlungu ezibuhlungu. Kwizigulana ezininzi, kuxhomekeke kwi-etiology kunye ne-pathology yeentlungu zabo kunye neempembelelo ze-biopsychosocial kumava entlungu, iintlungu eziqaqambileyo ziya kusombulula ngokuhamba kwexesha, okanye ukulandela unyango olujolise ekujoliseni unobangela wentlungu okanye ukuhanjiswa kwayo. Nangona kunjalo, ezinye izigulana azizukufezekisa ukusonjululwa kwentlungu yabo ngaphandle kongenelelo oluninzi lwezonyango kunye nolongezelelo kwaye ziya kutshintsha zisuka kwintlungu ebuhlungu iye kwimeko yeentlungu ezinganyangekiyo. Umzekelo, uphando lubonakalisile ukuba malunga ne-30% yezigulana ezibonisa ugqirha wabo wokunyamekela kwizikhalazo ezinxulumene nentlungu ebuhlungu iya kuqhubeka nokufumana iintlungu kwaye, kwabanye abaninzi, ukusikelwa umda kwemisebenzi kunye nokubandezeleka kwiinyanga ezili-12 kamva. [14] Njengoko iintlungu kunye neziphumo zalo ziyaqhubeka nokukhula kwaye zibonakalise kwimiba eyahlukeneyo yobomi, iintlungu ezingapheliyo zinokuba ikakhulu yingxaki ye-biopsychosocial, apho uninzi lweempawu zebhayopsychosocial zinokuthi ziqhubele phambili kwaye zigcine iintlungu, oko ke kuqhubeka nefuthe elibi kubomi bomntu ochaphazelekayo. Kule ndawo apho irejimeni yonyango yoqobo inokwahluka ukubandakanya ezinye izinto zonyango, kubandakanya neendlela zengqondo zokulawula iintlungu.

 

Iindlela zengqondo zolawulo lweentlungu ezingapheliyo ekuqaleni zafumana ukuthandwa ekupheleni kweminyaka yama-1960 ngokuvela kweMelzack kunye neWall s gate-control theory of pain [15] kunye ne- neuromatrix theory of pain . [16] Ngokufutshane, ezi ngcamango zibonisa ukuba iinkqubo zengqondo nezomzimba ziyasebenzisana ukuze zichaphazele ukuqonda, ukuhambisa, kunye nokuvavanya iintlungu, kwaye ziyayiqonda impembelelo yezi nkqubo njengezinto zolondolozo ezichaphazelekayo kwimeko yeentlungu ezingapheliyo okanye ezinde. Ngokukwanjalo, ezi ngcamango zisebenza njengezinto eziphambili zokufaka utshintsho kwindlela ebalaseleyo nengalunganga kunyango lwentlungu, enye ilawulwa kakhulu ziimbono zebhayiloji ngokungqongqo. Iiklinikhi kunye nezigulana ngokufanayo zifumene ukwandiswa okwandayo kunye noxabiso ngobunzima bokulungiswa kwentlungu kunye nokugcinwa; Ngenxa yoko, ukwamkelwa kunye nokukhethwa kweembono ezahlukeneyo zemeko yentlungu kwasekwa. Okwangoku, imodeli ye-biopsychosocial yeentlungu, mhlawumbi, yeyona ndlela yamkelekileyo eyamkelekileyo yokuqonda iintlungu. [17] Umbono we-biopsychosocial ujolise ekujongeni iintlungu ezingapheliyo njengesifo kunesifo, ngaloo ndlela ukuqonda ukuba ngamava e-subjective kwaye iindlela zonyango zijolise kulawulo, endaweni yokunyanga, kwentlungu engapheliyo. [17] Njengoko ukusetyenziswa kwendlela ebanzi kunye neyona ndlela ibanzi yokulawula iintlungu ezingapheliyo kuye kwabonakala, ungenelelo olusekwe kwengqondo lubone ukunyuka okuphawulekayo ekuthandeni nasekuqondweni njengonyango olongezelelekileyo. Iindidi zongenelelo lwengqondo eziqeshwe njengenxalenye yenkqubo yonyango yeentlungu ezininzi ziyahluka ngokokuziqhelanisa nonyango, i-etiology yeentlungu, kunye neempawu zesigulana. Ngokufanayo, uphando malunga nokusebenza kwamanyathelo angenelelo lwengqondo kwiintlungu ezingapheliyo kubonise ukuhluka, nangona kuthembisa, iziphumo kwiimpawu eziphambili ezifundwayo. Olu gqabantshintshi luza kuchaza ngokufutshane iindlela zonyango ezisetyenziselwa unyango olusebenzayo kunye nokusebenza kwazo ngokufanelekileyo kwiziphumo eziphambili.

 

Izindlela zengqondo zangoku eziphathekayo ekulawuleni iintlungu ezingapheliyo ziquka ukungenelela okujolise ekuphumezeni ukulawulwa kwezinto ezizimeleyo, ukuguquka kokuziphatha, kunye nokuguqulwa kwengqondo kunokuba kupheliswe ngokuthe ngqo indawo yeentlungu. Ngaloo ndlela, bajolise kwizinto eziphathekayo zokuziphatha, iimvakalelo kunye neengcamango zentlungu engapheliyo kunye nezinto ezibangela ukugcinwa kwayo. Ukwaziswa kwesi sikhokelo esinikwe nguHoffman et al [18] kunye no-Kerns et al, [19] oku kulandelwa rhoqo kwiindawo zonyango ezisekelwe kwengqondo zihlaziywa: ubuchule be-psychophysiological, iindlela zokuziphatha zonyango, unyango lwendlela yokuziphatha kunye nokungenelela okusekelwe.

 

Iingcaphephe zengqondo

 

Biofeedback

 

I-Biofeedback yindlela yokufunda apho izigulane zifunda ukutolika impendulo (ngohlobo lwengcaciso yomzimba) malunga nemisebenzi ethile yempilo. Ngokomzekelo, isigulane sinokusebenzisa izixhobo ze-biofeedback ukufunda ukuqaphela iziganeko zomthambo emzimbeni wazo kwaye emva koko zifunde ukukhulula ezo ndawo ukunciphisa uxinzelelo lwe-muscular. Impendulo inikezwa ngezixhobo ezahlukeneyo zokulinganisela ezinokunika ulwazi malunga nomsebenzi wombane wengqondo, uxinzelelo lwegazi, ukuhamba kwegazi, ithoni ye-muscle, umsebenzi we-electrodermal, izinga leentliziyo, kunye nokushisa kwesikhumba, phakathi kweminye imisebenzi yomzimba ngokukhawuleza. Injongo ye-biofeedback iyayifumana isigulane ukuba ifunde indlela yokuqalisa inkqubo yokuzilawula ngokwasemzimbeni ngokuphumeza ukulawula ngokuzithandela malunga nezimpendulo ezithile zomzimba ekugqibeleni ukwandisa ukuguquguquka komzimba ngokuqonda ngokubanzi nokuqeqeshwa okuthe ngqo. Ngako oko isigulane siza kusebenzisa izakhono ezizodwa zokulawula ukuzama ukunciphisa umcimbi ongathandekiyo (umz., Intlungu) okanye ukuphendulwa kwemizimba engathandekiyo (umzekelo, ukuphendula uxinzelelo). Iingcali ezininzi zeengqondo ziqeqeshwe kwiinkqubo ze-biofeedback kwaye zibonelela ngeenkonzo njengenxalenye yonyango. I-Biofeedback iye yonyulwa njengomsebenzi onobungqina beentlungu ezinxulumene nentloko kunye ne-temporomandibular disorders (TMD). [20] Ukuhlalutya kwe-meta-uphando lwe-55 kuveze ukuba ukungenelela kwe-biofeedback (kubandakanya iindlela ezahlukeneyo ze-biofeedback) kwanikezela ukuphucula okubalulekileyo malunga nokuvama kokuhlaselwa kwe-migraine kunye nemibono yokulawulwa kwentloko ukuzinyameka xa kuqhathaniswa nezimo zolawulo. [I-21] Izifundo zinike inkxaso yenkxaso ye-biofeedback ye-TMD, nangona uphuculo oluthe xaxa malunga nentlungu kunye nokukhubazeka okuchaphazelekayo sele kufunyenwe kwiiprotokholi ezidibanisa i-biofeedback kunye nengqiqo ukuqeqeshwa kwezakhono zokuziphatha, phantsi kwengcinga yokuba indlela yokusebenzisana yonyango ngokubanzi ichaza i-gamut yeengxaki ze-biopsychosocial ezingadibana nazo ngenxa ye-TMD. [22]

 

Indlela yokuziphatha

 

Uqeqesho lokuphumula

 

Ngokuqhelekileyo yamkelwa ukuba uxinzelelo luyinto ebalulekileyo ekubandakanyekeni kunye nokugcinwa kweentlungu ezingapheliyo. [16,23] Ukuxinwa kwengxaki kunokuba yinto engqongileyo, ngokomzimba, okanye ngokwengqondo nangokwemvakalelo, nangona kunjalo ezi ndlela zihambelana ngokugqithiseleyo. Ukugxilwa koqeqesho lokuphumula kukunciphisa amanqanaba omgudu (ngokomzimba nangokwengqondo) ngokusebenza kwenkqubo ye-nervympathetic ne-nervous system kunye nokufumana ukuqonda okubanzi malunga namaziko kunye nokusebenza kwengqondo, ngaleyo ndlela kufezekiswe ukunciphisa intlungu kunye nokwandisa ukulawula iintlungu. Izigulane ziyakwazi ukufundiswa iindlela ezininzi zokuziphucula kwaye zizenzele ngokwazo okanye ngokubambisana, kunye nezixhobo ezixhasayo kwezinye iindlela zokuziphatha zobuhlungu nokuziphatha. Ezi zilandelayo zichazwe ngokufutshane iinkqubo zokuphumula eziqhelekileyo ezifundiswa ngabafundi beengqondo.

 

Ukuphefumla. Ukuphefumula ngokufayo kuyindlela yobomi bokuphucula apho izigulane ziyalwa ukuba zisebenzise izihlunu zesithsaba sazo ngokuchasene nezihlunu zesifuba saso ukuze zibandakanye ukuziloba. Ukuphefumula ngokuqhawula isithintelo kuvumela imiphunga ukuba yande (egqitywe ukwandiswa kwesisu ngexesha lokutshatyalaliswa) kwaye ngoko kwandisa ukondla kwe-oksijini. [24]

 

Ukuphumla kwemisipha yokuqhubekayo (PMR). I-PMR ibonakaliswe ngokubandakanya ukudibanisa kwemisipha kunye nokuzilalisa kwemisipha ethile okanye amaqela emisipha kuwo wonke umzimba. [25] Isigulane siyalwa ngokuqhelekileyo ukuba sihlanganyele ekusebenziseni uxhaphalo / ukuphumula ngendlela elandelanayo kude kube zonke iindawo zomzimba ziye zaqwalaselwa.

 

Uqeqesho lwe-Autogenic (AT). I-AT yindlela yokuzihlaziya ngokuzilawulayo apho isigulane siphinda ibinzana ngokubambisana nokubonisa ukukhupha isimo sokuphumla. [26,27] Le ndlela idibanisa ukuxilongo, ukubonakala, kunye nobuchule bokuphefumla.

 

Ukubonakalisa / ukujonga umfanekiso. Le ndlela ikhuthaza izigulane ukuba zisebenzise zonke iingqondo zabo ekucingeni indawo ecacileyo, ephilileyo kunye nekhuselekileyo ukuphumeza indlela yokuphumla kunye nokuphazamiseka kwiintlungu kunye neengcamango ezinxulumene nentlungu kunye nokuvakalelwa. [27]

 

Ngokudibeneyo, iindlela zokuphumla zifunyenwe ziluncedo kulawulo lweentlobo ngeentlobo zeemeko zentlungu engapheliyo kunye nolawulo lweentlungu ezibalulekileyo (umzekelo, umgangatho wobomi onxulumene nempilo). [28-31 ] Iindlela zokuphumla zihlala zenziwa ngokudibene nezinye iindlela zolawulo lwentlungu, kwaye kukho ukugqagqana okubonakalayo kwiindlela zokucinga zokuphumla kunye ne-biofeedback, umzekelo.

 

Unyango loPhatha

 

Unyango lokuziphatha olusebenzayo lwentlungu engapheliyo lukhokelwa yimigaqo-nkqubo yoqobo esebenzayo ecetyiswe nguSkinner [32] kwaye icokisiwe yiFordyce [33] ukuze isebenze kulawulo lweentlungu. Iimpawu eziphambili zomzekelo wokusebenza kwemeko yokusebenza njengoko inxulumene nentlungu ebambekayo yokuba isimilo sentlungu ekugqibeleni sinokuthi siguquke kwaye sigcinwe njengezibonakalisayo iintlungu ezingapheliyo ngenxa yokuqiniswa okuqinisekileyo okanye okungalunganga kwendlela yokuziphatha enikiweyo kunye nesohlwayo sokuziqhelanisa ngakumbi. Ukuziphatha kabuhlungu. Ukuba ukomeleza kunye neziphumo ezilandelayo zenzeka rhoqo, zinokubangela imeko yokuziphatha, oko ke kwandise ukubakho kokuphindaphinda indlela yokuziphatha kwixa elizayo. Ke ngoko, isimilo esimiselweyo senzeka njengemveliso yokufunda yeziphumo (zokwenyani okanye ezilindelweyo) zokuzibandakanya kwindlela oziphethe ngayo. Umzekelo wokuziphatha okuqhubekekayo kukuqhubeka nokusetyenziswa kwamayeza behavior indlela yokuziphatha ebangelwa kukufunda ngemibutho ephindaphindwayo ethatha amayeza ilandelwa kukususwa kwemvakalelo yokuvava (iintlungu). Ngokufanayo, iimpawu zokuziphatha zentlungu (umz., Intetho yomlomo wentlungu, amanqanaba omsebenzi asezantsi) unokuba yimeko yokuziphatha enokuthi iqhubekekise iintlungu ezingapheliyo kunye nokulandelelana kwayo. Unyango olukhokelwa yimigaqo yokuziphatha esebenzayo lujolise ekucimeni isimilo esibuhlungu ngokuziphatha okufanayo ngemigaqo yokufunda enokuthi isekwe yiyo. Ngokubanzi, izinto zonyango zonyango olusebenzayo zibandakanya ukwenziwa okuhleliweyo, iishedyuli zamayeza ezinamaxesha, kunye nokusetyenziswa kwemigaqo yokuqinisa ukonyusa isimilo esihle kunye nokunciphisa indlela yokuziphatha ebuhlungu.

 

Ukusebenza ngokusetyenzisiweyo. Iingcali zengqondo zikwazi ukuphumeza iinkqubo zengqesho ezidityanisiweyo zezigulane ezingapheliyo eziye zanciphisa amanqanaba omsebenzi wazo (ukwandisa amathuba okwenyuka komzimba) kwaye emva koko zifumana amanqanaba aphakamileyo entlungu xa eqhuba umsebenzi. Izigulane ziyalelwe ukuba ziphule ngokukhuselekileyo umjikelezo wokungahambi kunye nokuhlaziywa ngokubandakanyeka kwintsebenzo ngendlela elawulwayo kunye nexesha elingapheliyo. Ngale ndlela, izigulane zinokunyusa ngokukhawuleza ubude bexesha kunye nobukhulu bomsebenzi ukuphucula ukusebenza. Iingcali zengqondo zijongene nenkqubela phambili kwaye zibonelela ngokufanelekileyo ukuthotyelwa, ukulungiswa kweengcamango okanye ukuchazwa kakuhle kweentlungu ezibangelwa ngumsebenzi, apho kufanelekile, kunye neengxaki zokusombulula izithintelo zokuthobela. Le ndlela ihlala ihlanganiswe kwiinkqubo zonyango zolawulo lwentlungu.

 

Iishedyuli zamachiza ezithatha ixesha. Ingcali yeengqondo ingaba ngumboneleli obalulekileyo wokunakekelwa kwezempilo ekujongeni ulawulo lweemithi zentlungu. Kwezinye iimeko, oogqirha beengqondo banethuba lokuqhagamshelana ngokuthe rhoqo kunye nezigulane kunezigulane kunabanogqirha kwaye ngoko banokubambisana njengabalingani abalulekileyo beendlela zokwenza unyango oludibeneyo. Iingcali zengqondo ziza kuseka iishedyuli zamachiza ezithatha ixesha lokunciphisa amathuba okuxhomekeka kwimizi yeentlungu zokufumana ulawulo olufanelekileyo kwiintlungu. Ukongezelela, izazi zeengqondo zixhotyiswe ukubandakanya izigulane kwiingxoxo ezibalulekileyo malunga nokubaluleka kokunamathela ngokufanelekileyo kumachiza kunye neengcebiso zonyango kunye nokuxazulula iingxaki ezinokuthintela ukulandelwa ngokukhuselekileyo.

 

Uloyiko lokuphepha. Umzekelo wokugwema ukwesaba okungapheliyo ukusetyenziswa kwentlungu yintlungu engapheliyo (i-LBP). [34] Lo mzekelo uthatha kakhulu kwimigaqo yokuziphatha esebenzayo ichazwe ngaphambili. Ngokwenene, imodeli yokugwema ukwesaba ithi xa ubuhlungu obukhulu buchazwa ngokuphindaphindiweyo njengengozi yengozi okanye iimpawu zokulimala kabuhlungu, izigulane zingasengozini yokuzibandakanya ekukhuseleni ukuziphatha okukhuselekayo kunye neengcamango ezomeleza ngakumbi inkolelo yokuba intlungu uphawu lweengozi kunye nokuqhubela phambili ukuhlaziywa komzimba. Njengoko umjikelezo uyaqhubeka, ukuphepha kungadala kwiintlobo zeentlobo zomsebenzi kwaye kubangele ukungathandabuzeki kwemvakalelo ebonakalayo ebonakaliswe ngokuchazwa ngokukrakra kweengqondo zomzimba. Uphando luye lwabonisa ukuba inqanaba eliphezulu leentlungu elixhatshazwayo lidibene nokugcinwa komjikelezo. [35] Unyango olujoliswe ekugqibeleni umjikelezo wokugwema ukwesaba uqeshe imisebenzi eyoyikisayo ekuqinisekiseni ukuba ukwesaba, okubangelwa yimingcipheko yokuthatha inxaxheba kwimisebenzi . Ukubhengezwa ngokubanzi kuqhutyelwa nge-psychoeducation malunga neentlungu kunye neengcamango zokuhlaziywa kwengqondo ezijolise kwiingcamango eziphathekayo kunye nokulindela ngemisebenzi kunye nentlungu. Iingcali zengqondo zisesimweni esihle kakhulu sokwenza ezi ntlobo zongenelelo ezilinganisa ngokugqithiseleyo unyango oluqhelekileyo elisetyenziselwa unyango lweengxaki ezithile zokuxhalabisa.

 

Nangona unyango olusondeleyo lwezonyango luye lwaboniswa ukuba luncedo ekwenzeni unyango lweengxaki zesifo seengingqi i-CR (i-CRPS-1) [i-36] kunye ne-LBP [37] kwimilo yecala elilodwa, isilingo esiphezulu esilinganiselwe ngokulandelanayo esilinganiselwe unyango lwamayeza kunye neenkqubo ezahlukeneyo zonyango lwenkqubo kunye neenkqubo ezahlukeneyo zonyango lwenkqubo yodwa kunye neqela lokulawula uluhlu lubone ukuba ezi zimbini zonyango zenzeke ekuphuculeni okubonakalayo kwimilinganiselo yempatho yentlungu, ukwesaba ukunyakaza / ukulimala, intlungu, Ukudakumba, kunye nomgangatho womsebenzi. [I-38] Iziphumo ezivela kulolu vavanyo zibonisa ukuba ukungenelela kokubambisana kwakunxulumene nokusebenza ngonyango olubalulekileyo kangangokuthi unyango olungabonakaliyo olubonakalayo aluzange lubonakale lubangele ukufumana unyango olongezelelweyo. [38] Inqaku elisixwayisayo ekuchazeni kwezi Iziphumo zigqamisa ukuba ilingo elilawulwa ngokungahleliwe (RCT) libandakanya iintlobo ezahlukeneyo zentlungu engapheliyo e ixutywe ngaphaya kwe-LBP kunye ne-CRPS-1 kwaye ayizange ibandakanye kuphela izigulane ezinamaqondo aphakamileyo enkwantya-ntlungu; ukungenelela kwaziswa kwakhona kwiifom zeqela kunokuba zifomathi zomntu ngamnye. Nangona unyango lwe-in-vivo lungcono kakhulu ekunciphiseni ubuhlungu obuyingozi kunye nemibono yokulimala kwemisebenzi, ukunyangwa kwezinto ezibonakalayo kubonakala ngathi kusebenza njengongenelelo lokusebenza okuphuculweyo ekuphuculeni ukukhubazeka okusebenzayo kunye nezikhalazo eziphambili. [39] Olunye uvavanyo lweklinikhi lufanisa ukuphumelela kwonyango- Ulwahlulo olusekelweyo (TBC) lonyango lonyango kuphela kwi-TBC longezwe ngemisebenzi eyenziwe ngokucwangcisiweyo okanye ukubonakaliswa ngokubaluleka kwezigulane ezine-LBP ezinobunzima kunye nobunzima. [Iziphumo ze-40] zibonise ukuba akukho ntohluko kwi-4-iveki kunye neziphumo zeenyanga ze-6 zokunciphisa ukukhubazeka , ubunzima beentlungu, ukukhathazeka kwentlungu, kunye nokuphazamiseka komzimba phakathi kwamacandelo enyango, nangona ukunyanzeliswa kwamagunya kunye ne-TBC kwenza ukuba kuncitshiswe kuninzi kwiinkonzo zokugwema ukwesaba ukwenziwa kwiinyanga ze-6. alukho kwiziphumo eziphuculweyo malunga namanyathelo afana nokuphuhliswa kwe-chr I-LBP ye-oni ngaphaya kophuculo olwenziwe ngeTBC yedwa. [40]

 

Iindlela zokuziphatha

 

Ungenelelo ngononophelo lweendlela zokuziphatha (i-CBT) zongenelelo lweentlungu ezingapheliyo zisebenzisa imigaqo-nkqubo yengqondo ukwenza utshintsho olusebenzayo kwizimo zezigulana, ukuqonda okanye kuvavanyo, kunye neemvakalelo. Olu ngenelelo luhlala luqulathe imfundo esisiseko yengqondo malunga nentlungu kunye nesigulo esithile seempawu zesigulana, izinto ezininzi zokuziphatha, uqeqesho lwezakhono, iindlela zokusombulula iingxaki, kunye necandelo lokuhlengahlengisa ukuqonda, nangona olona nyango lonyango luhluka ngokoklinikhi. Izinto zokuziphatha zinokubandakanya izakhono ezahlukeneyo zokuphumla (njengoko zijongwa kwicandelo lendlela yokuziphatha), imiyalelo yokuhamba ngenqanaba / ukwenziwa okuhleliweyo, iindlela zokuziphatha, kunye nokukhuthaza ukuqala kwakhona kwemisebenzi yomzimba ukuba kukho imbali ebalulekileyo yokuthintela umsebenzi kunye nokubekwa kwimeko yesiqhelo emva koko. Eyona njongo iphambili kuqeqesho lwezakhono kukuchonga izicwangciso zokuziphatha gwenxa (umz., Ukonakalisa, ukuthintela) isigulana esisebenzisana naso ekusebenziseni iindlela zokuguqula imeko (umzekelo, ukusetyenziswa kweengxelo ezizezakho, inkxaso yezentlalo). Njengenqaku lesilumkiso, inqanaba apho isicwangciso-buchule silungelelanisa okanye singalunganga kwaye ukusebenza okuqondakalayo kwezicwangciso ezithile zokulwa ziyahluka ukusuka komnye umntu ukuya komnye. [41] Ngalo lonke unyango, iindlela zokusombulula iingxaki ziyahlonitshwa ukunceda abaguli kwiinzame zabo zokunamathela kunye nokubanceda ukuba bandise ukusebenza kwabo. Uhlengahlengiso lwengqondo lubandakanya ukwamkelwa kokungalunganga okwenziwayo sisigulana, ukwenza umngeni kukuchongwa okungalunganga okuchongiweyo, kunye nohlengahlengiso lweengcinga ukuze zivelise ezinye. Ngokuziqhelanisa nohlengahlengiso lokuqonda, abaguli baya bekwazi ngakumbi ukuqonda indlela iimvakalelo zabo, ukuqonda, kunye nokutolika okuzilungisa ngayo iintlungu zabo kwicala elilungileyo nelingalunganga. Ngenxa yoko, kucingelwa ukuba abaguli baya kufumana umbono omkhulu wokulawula iintlungu zabo, babe nakho ukulawula indlela abaziphethe ngayo kunye neengcinga zabo njengoko zinxulumene nentlungu, kwaye babe nakho ukuvavanya ngokuchanekileyo intsingiselo abayinikezela kwintlungu yabo. . Izinto ezongezelelweyo ngamanye amaxesha zibandakanyiwe kungenelelo lwe-CBT lubandakanya uqeqesho lwezakhono zentlalo, uqeqesho kunxibelelwano, kunye neendlela ezibanzi kulawulo loxinzelelo. Ukuhamba ngongenelelo lwe-CBT ejolise kwintlungu, uninzi lwezigulana ziyaxhamla kuphuculo ngokubhekisele kwimpilo yabo yeemvakalelo kunye nokusebenza, kwaye ekugqibeleni umgangatho wabo wobomi onxulumene nempilo.

 

 

Ungenelelo lwe-CBT luhanjiswa ngaphakathi kwenkxaso kunye novelwano oluzama ukuqonda iintlungu zesigulana ngokwembono ye-biopsychosocial kwaye ngendlela edibeneyo. Oochwephesha babona indima yabo 'njengabafundisi-ntsapho' okanye 'abaqeqeshi'kwaye umyalezo odluliselwe kwizigulana kukufunda ukulawula ngcono iintlungu zabo nokuphucula ukusebenza kwabo kwemihla ngemihla kunye nomgangatho wobomi ngokuchasene nokujolisa okanye ukuphelisa iintlungu. Injongo ephambili kukunyusa ukuqonda kwezigulana ngeentlungu zabo kunye neenzame zabo zokulawula iintlungu kunye nokulandelelana kwazo ngendlela ekhuselekileyo neguqukayo; Ke ngoko, ukufundisa abaguli ukuba babeke esweni indlela abaziphethe ngayo, iingcinga zabo, kunye neemvakalelo yinto ebalulekileyo kunyango kunye nesicwangciso esiliqili sokwenza ukusebenza ngempumelelo. Ukongeza, i-Therapist izama ukukhuthaza indawo enethemba, enyanisekileyo nenokhuthazo apho isigulana sinokuba nobuchule ngakumbi ekuqondeni nasekufundeni kwimpumelelo yabo nasekufundeni nasekuphuculeni kwimizamo engaphumelelanga. Ngale ndlela, abanyangi kunye nezigulana basebenza kunye ekuchongeni impumelelo yesigulana, izithintelo ekubambeleleni kunyango, kunye nokuphuhlisa ulondolozo kunye nokubuyela kwisicwangciso sokuthintela kwimeko eyakhayo, yokusebenzisana kunye nokuthembeka. Inqaku elinomtsalane kwindlela yokuziphatha kwengqondo kukuxhasa isigulana njengomthathi-nxaxheba okhutheleyo ekuvuseleleni iintlungu okanye kwinkqubo yolawulo.

 

Uphando lufumene ukuba i-CBT ibe yonyango olusebenzayo lwentlungu engapheliyo kunye ne-sequelae yayo njengoko ibonakaliswe ngenguqu ebonakalayo kwimimandla eyahlukeneyo (oko kukuthi, amanyathelo okuvalelwa kwintlungu, ukukhathazeka / ukuchaphazeleka, ukuphathwa kwengqondo kunye nokuhlola, ukuziphatha kweentlungu kunye nenqanaba lomsebenzi kunye nomsebenzi wendima yentlalo ) xa kuthelekiswa neemeko zokulawula uluhlu lokulinda. [42] Xa kuthelekiswa namanye amachiza asebenzayo okanye izimo zokulawula, i-CBT ibangele ukuphucula okuphawulekayo, kunye nemiphumo encinci (ubungakanani bomzimba ~ 0.50), ngokubhekisele kumava obuhlungu, ukuxilongwa kwengqondo kunye nokuhlolwa , kunye nomsebenzi wendima yentlalontle. [42] Uhlalutyo olutshanje lwe-meta-uphando lweziphumo ze-52 eziqhathaniswa nophatho lwezonyango (BT) kunye ne-CBT malunga nokuphathwa njengemiqathango yokulawula yesiqhelo kunye neemeko zolawulo olusebenzayo kumaxesha athile ahlukeneyo. [43] Le meta-analysis bagqiba ukuba idatha yabo ayizange iboleke inkxaso ye-BT ngaphaya kokuphuculwa kwintlungu ngokukhawuleza emva kokonyango xa kuthelekiswa nonyango njengeemeko zolawulo eziqhelekileyo. [43] Ngokubhekiselele kwi-CB T, baqukumbele ukuba i-CBT inciphise imiphumo emihle yintlungu yokukhubazeka, kunye nomoya; Nangona kunjalo, akukho idatha ekhoyo ekhoyo ukuphanda impembelelo ethile yenkcazo yonyango kwiziphumo ezikhethiweyo. [43] Ngokubanzi, kubonakala ukuba ii-CBT kunye ne-BT zindlela zokwenza unyango olufanelekileyo ukuphucula imizwa; iziphumo ezihlala zizinzileyo kwiindawo zokulandelela iinkcukacha. Nangona kunjalo, njengoko kuboniswe ngophando oluthile kunye nokuhlaziywa kweemeta, into ebalulekileyo ekuqwalaseleni ukuphumelela kwe-CBT yokulawulwa kwentlungu engapheliyo ijoliswe kwimibandela yokubonelela ngokufanelekileyo, ukungabikho kwamacandelo okunyanga ofanayo, ukungafani kokunikezelwa kwamanyango kunye nokunyango abantu kunye nokuhlukahluka kwimiba yeziphumo zentshisekelo kuzo zonke izilingo zophando. [13] Ukugqithisa ngakumbi ukuchazwa kokufunyaniswa kwempumelelo yimimiselo yesigulane kunye neenguqu ezongezelelweyo ezingasichaphazela ngokuzimeleyo iziphumo zonyango.

 

Izindlela eziMkelweyo

 

Iindlela ezisekwe ekwamkelweni zihlala zichongwa njengonyango lwesithathu lwendlela yokuziphatha ngokuziphatha. Ukwamkelwa kunye nokuzibophelela kunyango (UMTHETHO) yeyona nto ixhaphakileyo kwizonyango zengqondo ezamkelweyo. UMTHETHO ugxininisa ukubaluleka kokuququzelela inkqubela yomthengi ekufikeleleni kubomi obuxabiseke ngakumbi nobonelisayo ngokwandisa ukuguquguquka kwengqondo kunokugxila ngokungqongqo kulwakhiwo ngokutsha lokuqonda. [44] Kwimeko yeentlungu ezingapheliyo, i-ACT ijolise kwiindlela zokulawula ezingasebenziyo kunye nokuthintelwa kwamava ngokukhuthaza ubuchule obumisela ukuguquguquka kwengqondo. Ezi nkqubo zintandathu zingumthetho zibandakanya: ukwamkelwa, ukuqonda okungalunganga, ukubakho, ubuqu bakho njengomxholo, amaxabiso kunye nokuzimisela. [45] Ngokufutshane, ukwamkelwa kukhuthaza izigulana ezinganyangekiyo ukuba zamkele iintlungu kunye nokulandelelana kwazo kunokuba zizame ukuyitshintsha, ngokwenza njalo ukukhuthaza isigulana ukuba siyeke umlo olilize ojolise ekuphelisweni kwentlungu yabo. Ukuchaphazeleka kwengqondo (deliteralization) yeendlela zokuqesha ziqeshelwe ukuguqula ukusebenza kweengcinga endaweni yokunciphisa ukuhamba kwabo okanye ukulungisa umxholo wabo. Ngale ndlela, ukuchasana kwengqondo kunokutshintsha nje intsingiselo engathandekiyo okanye ukusebenza kweengcinga ezingalunganga kwaye ngaloo ndlela kunciphise ukunamathela kunye nokuphendula okulandelayo kokuziphatha kunye nokuziphatha kwezi ngcinga. Inkqubo engundoqo yokubakho igxininisa ukusebenzisana okungagwebanga phakathi kweengcinga zakho kunye nezizimeleyo kunye neziganeko. Amaxabiso asetyenziswa njengezikhokelo zokukhetha isimilo kunye nokutolikwa okubonakaliswa ngala maxabiso umntu azabalazela ukuwenza kubomi bemihla ngemihla. Okokugqibela, ngokwenza isenzo sokuzibophelela, abaguli banokuqonda utshintsho kwindlela yokuziphatha elungelelaniswe nexabiso lomntu ngamnye. Ke, UMTHETHO usebenzisa imigaqo-siseko emithandathu ngokudibeneyo kunye nomnye ukuthatha indlela ebanzi yokwandisa ukuguquguquka kwengqondo kunye nokunciphisa ukubandezeleka. Izigulana ziyakhuthazwa ukuba zijonge iintlungu ngokungaphephekiyo kwaye zamkelwe ngendlela engagwetywanga ukuze ziqhubeke nokufumana intsingiselo ebomini ngaphandle kobukho beentlungu. Iinkqubo ezingundoqo ezinxulumeneyo zibonisa umzekelo wokuqonda nokwamkela iinkqubo nokuzinikela kunye neenkqubo zokutshintsha indlela yokuziphatha. [45]

 

Iziphumo zophando malunga nokusebenza kweendlela ezisekelwe kwi-ACT zokulawula ubuhlungu obungapheliyo zi thembisa, nangona kunjalo zifunwa ukuhlolwa okuqhubekayo. I-RCT ngokuthelekisa UMTHETHO nomqathango wokulawula uluhlu kubhengeze ukuphuculwa okukhulu kwiintlungu ezonakalisa ukukhubazeka, ukunyaniseka kweentlungu, ukwaneliseka komphefumlo, ukwesaba ukunyakaza, kunye noxinzelelo lwengqondo olugcinwe kwi-7 inyanga yokulandelelana. [46] Ilingo elikhulu lichazwe Ukuphucula intlungu, ukuxinezeleka, ukuxhalaba, ukukhubazeka, ukutyelela, unyango lwezempilo, isimo somsebenzi kunye nokusebenza ngokomzimba. [47] Ukuhlaziywa kwe-meta-uphendlo yakutshanje ekuphononongeni ukungenelela okusukeleyo (UMTHETHO nokunciphisa uxinzelelo lwengqondo) kwizigulane ezinentlungu engapheliyo yafumanisa ukuba, ngokuqhelekileyo, iindlela zokubamkela ezisekelweyo zikhokelela kwiziphumo ezilungileyo kwizigulane ezinentlungu engapheliyo. [48] Ngokukodwa, ukuhlalutya kweemeta kubonakalise ubuncinci kumgangatho ophakathi kwintlungu, ukuxinezeleka, ukuxhalaba, ukukhathazeka ngokwenyama kunye nomgangatho wobomi , kunye nemiphumo emincinci efunyenweyo xa ukuhlolwa kweeklinikhi ezilawulwayo kwakungabandakanywa kwaye i-RCT kuphela ifakiwe kwi-analysis. [48] Ezinye iindlela zokunikwa uphando lweengcamango zengqondo-yokuziphatha kunye nokunyangwa kwengqondo ngokusekelwe kwengqondo, nangona uphando lwezobugcisa ekusebenzeni kwezi zonyango zokulawulwa kweentlungu ezingapheliyo zisencinane.

 

Lindele

 

Into ebalulekileyo engahoywanga ngokubanzi exhaphakileyo kuzo zonke iindlela zonyango kukuqwalaselwa kokulindelwe sisigulana kwimpumelelo yonyango. Ngaphandle kwenkqubela phambili ekwakhiweni nasekuhanjisweni kwonyango olusebenzayo oluninzi lweentlungu ezingapheliyo, kugxininiswe kancinci ekubonakaliseni ukubaluleka kokulindelwa kwimpumelelo nasekugxileni kwimizamo yokuphucula okulindelwe zizigulana. Ukwamkelwa ukuba i-placebo yeentlungu ibonakaliswa ziipropathi ezisebenzayo ezikhokelela kuthembeko olunokuthenjwa, olubonakalayo, kunye nolunokulinganiswa kunye nemixhaso ye-neurobiological okwangoku okwangoku kuphando lwentlungu. Izifundo ezininzi ziye zaqinisekisa ukuba, xa inyanzeliswa ngendlela eyonyusa ulindelo (ngokusebenzisa ubuqili bolindelo olucacileyo kunye / okanye imeko), i-analgesic placebos inokubangela utshintsho olubonakalayo nolulinganisekayo kwimbono yeentlungu kwinqanaba lokuzixela kunye ne-neurological inqanaba lokulungisa iintlungu. [49,50] I-analgesic placebos ichazwe ngokubanzi njengonyango olulinganisiweyo okanye iinkqubo ezenzeka kwimeko yengqondo kunye nefuthe kumava omntu kunye / okanye kwi-physiology. [51] Ukuqondwa kwangoku kwe-placebo kugxininisa ukubaluleka kwemeko yengqondo kunye ne-placebos efakwe ngaphakathi. Isiseko semeko yengqondo kunye nesiko lonyango kulindelwe zizigulana. Ke ngoko, ayimangalisi into yokuba isiphumo se-placebo sibetheleleke phantse kulo lonke unyango; Kananjalo, oogqirha kunye nezigulana ngokufanayo ziya kuthi zixhamle ekuqapheleni ukuba kukho indawo eyongezelelweyo apho unyango lwangoku lusondela kwiintlungu ezinokuphuculwa.

 

Kucetyisiwe ukuba iziphumo ezilindelweyo zezona mpembelelo ziphambili zokuqhuba utshintsho olufunyenweyo ngeendlela ezahlukeneyo zoqeqesho lokuphumla, i-hypnosis, unyango lokuvezwa, kunye neendlela ezininzi zonyango ezijolise kukuqonda. Ngaloo ndlela, indlela efanelekileyo yokulawulwa kweentlungu ezingapheliyo zixhomekeke kumandla okulindela izigulane kwimpumelelo. Ngelishwa, amaxesha amaninzi, ababoneleli ngezempilo bayakhathala ukujongana ngqo nokugxininisa ukubaluleka kokulindelwa zizigulana njengezinto ezibandakanyekayo ezinegalelo kulawulo oluyimpumelelo lweentlungu ezingapheliyo. I-zeitgeist kuluntu lwethu kukuba ukunyanga ukunyanga kwezifo ezenza ukuba ulindelo ngokubanzi lokuba iintlungu (nokuba zintlungu ezingapheliyo) kufuneka zisuswe ngenkqubela phambili kwezonyango. Konke oku kulindelwe ngokuqhelekileyo kushiya abaguli abaninzi bedidekile ziziphumo zonyango ezikhoyo kwaye banegalelo kuphando olungapheliyo lwe- cure . Ukufumana i- cure ngaphandle kokulawula ngokubhekisele kwiimeko zeentlungu ezingapheliyo. Kwimeko-bume yethu yangoku, apho iintlungu ezinganyangekiyo zixhaphaza izigidi zabantu baseMelika minyaka le, inomdla wethu ukubethelela kwaye siqhubeke nokukhuthaza ukutshintsha kwengcinga endaweni yoko kugxile kulawulo olusebenzayo lweentlungu ezingapheliyo. Indlela esebenzayo nethembisayo yokufezekisa oku kukwenza uninzi lwezinto ezilindelwe zizigulana (ezizizo) kunye nokufundisa abaguli abaziintlungu kunye noluntu ngokubanzi (iipesenti ezingama-20 zabo baya kuthi babe zizigulana eziqaqanjelwa) kwixesha elizayo ngokubhekisele kulawulo lwentlungu. Mhlawumbi oku kunokwenzeka ekuqaleni ngoku, ngemfundo esekwe kubungqina ngokubhekisele kwi-placebo kunye neziphumo zonyango ezingacacanga ezinokuthi izigulana zikwazi ukulungisa iinkolelo ezingachazwanga ngaphambili. Emva koko oogqirha banokujolisa ekuphuculeni okulindelweyo kwizigulana ngaphakathi kwimeko zonyango (ngendlela eyiyo) kunye nokunciphisa ukulindela okungenathemba okuthintela impumelelo yonyango, ke ngoko, ukufunda ukuphucula unyango lwabo lwangoku ngeendlela ezininzi ezikhokelwa kukongamela ekuphuculeni indawo ye-placebo inokuvelisa, nkqu kunyango olusebenzayo . Iingcali zengqondo ziyakwazi ukujongana nale micimbi kunye nezigulana zabo kwaye zibancede babe ngabameli bempumelelo yabo yonyango.

 

Abaququzeleli Bemizwelo Yobunzima

 

Umba osoloko ulucelomngeni kulawulo lweentlungu ezingapheliyo kukuxhaphaka ngokungathandabuzekiyo koxinzelelo lweemvakalelo. Uphando lubonakalisile ukuba uxinzelelo kunye noxinzelelo lokuphazamiseka lonyuka laphindaphindeka kathathu phakathi kwezigulana ezinganyangekiyo kunabantu ngokubanzi. [52,53] Rhoqo, izigulana eziqaqanjelwa zizifo zengqondo zibizwa ngokuba "zizigulana ezinzima" ngababoneleli bezempilo, mhlawumbi kunciphisa ukhathalelo abalulufumanayo. Izigulana ezinedepression zineziphumo ezibi zokudakumba kunye nonyango lwentlungu, xa kuthelekiswa nezigulana ezinesifo esisodwa okanye uxinzelelo. [54,55] Iingcali zengqondo zikulungele ngokumangalisayo ukujongana uninzi lwezifo zengqondo ezidla ngokudibana nabantu abaziintlungu ezingapheliyo kwaye ke ngoko ziphucula iintlungu. Iziphumo zonyango kunye nokunciphisa ukubandezeleka ngokweemvakalelo kwezigulana. Iingcali zengqondo zinokujongana neempawu eziphambili (umzekelo, i-anhedonia, inkuthazo ephantsi, izithintelo ekusombululeni iingxaki) zoxinzelelo eziphazamisa ukuthatha inxaxheba kunyango kunye noxinzelelo lweemvakalelo. Ngapha koko, ngaphandle kokuphazamiseka kwengqondo, iingcali zengqondo zinokunceda izigulana ezinganyangekiyo ziqhubele phambili kwindima ebalulekileyo abanokuthi bayenze (umzekelo, ukuphulukana nomsebenzi, ukukhubazeka), ubunzima phakathi kwabantu abanokudibana nabo (umz., Umbono wokuzahlula oziswa yintlungu), kunye Ukubandezeleka ngokweemvakalelo (umzekelo, ixhala, umsindo, usizi, ukuphoxeka) kuyanyanzeleka kumava abo. Ke, iingcali zengqondo zinokuchaphazela ngokuqinisekileyo ikhosi yonyango ngokunciphisa ifuthe lokudibana neemvakalelo ekujongwa kuzo njengenxalenye yonyango.

 

isiphelo

 

Izinzuzo zokubandakanya unyango lweengqondo kwiindlela ezahlukeneyo zokulawula ubuhlungu obungapheliyo zininzi. Ezi zibandakanya, kodwa azikhawulelwanga, ukunyusa ukuphathwa kweentlungu, ukuphucula izixhobo ezinokubangela iintlungu, ukukhubazeka okunxulumene nentlungu, kunye nokunciphisa uxinzelelo lwengqondo olwenziwe ngeendlela ezahlukeneyo zokuzilawula, ukuziphatha, nokuqonda ubuchule. Ngokuphunyezwa kwezi nguqu, isazi sengqondo singakwazi ukunceda ngokuphumelelayo izigulane zivakale ngakumbi kumyalelo wokulawulwa kweentlungu kwaye zenze ukuba baphile ngokuqhelekileyo ubomi ngokusemandleni nangona kukho intlungu. Ngaphezu koko, izakhono ezifunyenwe ngongenelelo lwangokwengqondo nokuxhobisa izigulane ukuba zibe ngabathathi-nxaxheba ekulawuleni izifo zabo kwaye zibandakanye izakhono ezibalulekileyo izigulane ezingasebenzisa ubomi babo bonke. Iinkonzo ezongezelelweyo zeendlela ezidibeneyo kunye neendlela ezipheleleyo ekulawuleni ubuhlungu obungapheliyo zingabandakanya ukunyuka kwamazinga okubuyela emsebenzini, ukunciphisa iindleko zonyango lwempilo, kunye nokukhula komgangatho wokuphila kwezilwanyana kwizigulane kwihlabathi lonke.

 

 

Imihlathi

 

Ukwazisa: Akukho zintlukwano zomdla zavakaliswa ngokumalunga kweli phepha.

 

Ukuququmbela, ukungenelela kwengqondo kungasetyenziswa ngokufanelekileyo ekuncediseni iimpawu zentlungu engapheliyo kunye nokusetyenziswa kwamanyathelo enyango, njengokhathalelo lwe-chiropractic. Ukongezelela, uphando olusentla lubonise indlela iindlela ezithile zokungenelela kwengqondo ezinokuphucula iziphumo zempatho yokuphathwa kabuhlungu obungapheliyo. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kwakunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

 

Ikhutshwe nguDkt. Alex Jimenez

 

 

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

 

Ngokwezibalo, malunga ne-80% yabantu baya kuba neempawu zentlungu emva koko kanye ngexesha lokuphila kwabo. Umqolo obuhlungu isikhalazo esiqhelekileyo esinokubangelwa ngenxa yeemeko ezahlukeneyo kunye / okanye iimeko. Ngokuphindaphindiweyo amaxesha, ukuguqulwa kwemvelo komgudu kunye nomdala kunokubangela intlungu emva. Iidiski zeHerniated kwenzeka xa i-disc, i-gel-like centre ye-disc intervertebral iqhubezela ngeengqungquthela kwijikelezo zayo zangaphandle, ukuxilisa nokucaphukisa izimpande zentliziyo. Iingxoxo ze-Disc zivame ukuqhutyelwa kwi-back back, okanye i-lumbar spine, kodwa nazo zingenzeka kunye nomlenze womlomo wesibeleko okanye intamo. Ukufakelwa kwamathambo afunyenwe kwinqanaba eliphantsi ngenxa yokulimala kunye / okanye imeko ehlaseleyo ingakhokelela kwimpawu ze-sciatica.

 

ISIHLOKO ESIBALULEKILEYO: Ukulawula uxinzelelo lomsebenzi

 

 

IINGCUKACHA EZIBALULEKILEYO: UKUPHATHA KWE-EXTRA: I-Car Accident Injury Treatment El Paso, TX I-Chiropractor