I-Fibromyalgia Imbali Nenkcazo

Fibromyalgia History

Fibromyalgia Umlando: Ngokwembali, i-fibromyalgia okanye iimeko ezifana nayo been zixelwe kangangamakhulu eminyaka, phantsi kwamagama amaninzi, kubandakanya nelona gama lingonelisiyo isffibrositis . Imbali ebangel 'umdla yento ngoku esiyibiza ngokuba yi-fibromyalgia syndrome (FMS) kunye ne-myofascial pain syndrome (i-MPS) iye yenziwa ikhathalogu ngoochwephesha beli xesha langoku abasebenza kwinqanaba leentlungu ezingapheliyo zemisipha, ekugqitywe umsebenzi wazo kushwankathelwe kwiBhokisi 1.1. Enkosi ngenxa yaba bantu (UPeter Baldry, uDavid Simons kunye noRichard van Kutheni ngakumbi) ngokutyhila okuninzi malunga nezifundo ezidlulileyo kwinto ebuhlungu bezihlunu ezingapheliyo. Into esinokuyifunda kolu lwazi kukuba kwakudala kangakanani (ngaphezulu kweminyaka eyi-150) kwaqatshelwa amanqaku athile, umzekelo, iipatheni zokudlulisa iintlungu kunye neempawu ezinje ngee-taut band kunye ne- nodules , kunye nokuqonda okuvela kubaphandi abaninzi abaziingcali kunye nakwezonyango. i-pathophysiology yezi meko.

Ikholeji yaseMerika yeRheumatology Inkcazo

Ukuchazwa ngokulula, isifo se-fibromyalgia (i-FMS) kunokuthiwa sisifo esiqobayo, esibonakaliswa ikakhulu yintlungu ye-musculoskeletal, ukudinwa, ukuphazamiseka kokulala, uxinzelelo kunye nokuqina (i-Yunus ne-Inanici 2002). Kwakungekho ngoo-1980s apho ukucaciswa ngokutsha kwenzeka kwento eyayifudula kwaye ididekile umfanekiso wesimo esiqhelekileyo. Ngo-1987, i-American Medical Association yamkela i-fibromyalgia njenge-syndrome ehlukileyo (i-Starlanyl kunye neCopeland 1996), nangona ngelo xesha ulwazi oluchanekileyo malunga nokuba i-syndrome yayiqulathe ntoni ingcaciso yangoku, eyamkelwa ngokubanzi yi-American College of Rheumatology (ACR), eyayiveliswe ngo-1990 (jonga iBhokisi 1.2 kunye neFig. 1.1). URussell (kwi-Mense & Simons 2001) uphawula ukuba ukuchaza imeko kwaba neziphumo ezibi kuluntu lwenzululwazi nakwezonyango:

Ekuvukeni kweempendulo eziyimpumelelo, ukunyuka kwamandla okuphanda kwi-1990 yakudala kwakhokelela kwinani lezinto ezibalulekileyo ezibalulekileyo. I-FMS ifumaneke ukuba iyinto evamile. Kwakukho malunga ne-2% yabemi abadala base-USA kwaye yabonisa ukuhanjiswa okufanayo kwamanye amazwe apho kwakuqhutywe khona izifundo eziphambili ze-epidemiological. Abasetyhini abadala bachaphazeleka ngokuphindwe ezintlanu ukuya kusixhenxe ngokuphindaphindiweyo ngaphezu kwamadoda. Kwabantwana ukuhanjiswa ngokwesini kwaba malunga nokulingana kwamakhwenkwe okanye amantombazana.

Xa iziganeko zengqondo kunye nezomzimba zabasebenzi abane-FMS zifaniswa nezo ntandathu ezihlukeneyo, iintlungu zesifo esiphambili, intlungu yomlomo wesibeleko, intlungu yesifo senzwa, intlungu yesifo somzimba, intlungu yesigxina kunye nentloko), kwafunyanwa ukuba iqela le-fibromyalgia bafumana ubunzima obuninzi, ngomgama obalulekileyo. Ngokubhekiselele ekuhanjisweni kwezesini kwezi zihlandlo ezisixhenxe zentlungwini, kwaqatshelwa ukuba i-fibromyalgia (kunye neentloko) zinamava amaninzi kunamadoda (Porter-Mofitt et al 2006).

Yintoni ekuthethwa ngokuqinisekileyo malunga ne-fibromyalgia syndrome kukuba:

Yimeko ye-rheumatic engeyiyo eyokukhubazeka, kwaye, ngokwenene, enye yeemeko eziqhelekileyo.

Yimeko yakudala, esanda kuchazwa (enempikiswano jonga ngezantsi) njengesifo esimbaxa okanye isifo.

Akukho sizathu sinye, okanye unyango, lweempawu zayo ezixhaphakileyo nezingapheliyo (nangona kunjalo, njengoko kuya kucaca, kubonakala ngathi kukho ii-subsets ezahlukileyo zabantu abanee-aetiologies ezahlukeneyo kwiimeko zabo, njengokungalingani kwe-thyroid kunye nokulimala kwe-whiplash).

Ubunzima bayo obunzima buhlala bubonakala bufuna ngaphezulu kwento enye ebalulekileyo ekufuneka isebenze, kwaye kukho iingcinga ezininzi malunga nokuba ingaba zeziphi (jonga uCh. 4).

Kubekho ukuqhuma kophando kwesi sifundo kule minyaka ilishumi idlulileyo (uphando olunye lwedatha kwi-intanethi luveze ngaphezulu kwama-20 000 amaphepha akhankanya i-fibromyalgia njengegama eliphambili).

Ngaphandle kwentsingiselo yayo yonyango yangaphambili, eyayicebisa ukubandakanyeka kokubini kwezakhiwo ze-articular kunye ne-non-articular, igama elithi rheumatic, ngokusetyenziswa okuqhelekileyo, lithetha ukuba yinto ebuhlungu kodwa engenziwanga yimilo ye-musculoskeletal), eyahlukileyo kwigama le-arthritic elibonisa ukuba kunye / okanye ukukhubazeka kweempawu (iBhlokhi 1993).

I-Fibromyalgia Controversy

Ngeenjongo zokusebenza ngokufanelekileyo le ncwadi iyamkela ukuba inkcazo ye-ACR esetyenziswa ngokubanzi yiyo ngcamango eguqukayo, kodwa ingaba iphosakele (jonga ngezantsi). Inkcazo njengoko iboniswe kwiBhokisi 1.2 ivumela ukuhlukaniswa kwabantu ngabanobuhlungu obungapheliyo kunye neempawu ezinxulumene neenkqutyana, kwaye unikezela ngamakliniki ithuba lokuba aqale ukucacisa iipateni ezididekayo zeempawu eziboniswe kwaye zichazwe ngabantu abaye babhalwe. Nangona kunjalo, akuzona zonke iingcali, kuquka nabaninzi abancedisayo kulo mbhalo, yamkela inkcazo ye-ACR. Nangona kunjalo, ekubeni ibeka isiseko sophando oluninzi oluchazwe kwincwadi, inkcazo yangoku kufuneka inikwe ingqalelo ngokufanelekileyo.

Ziziphi iiArguments Against the ACR Definition?

Schneider et al (2006) bahlalutye enye imbono ephezulu:

Idatha yakutshanje inokuxhasa inkcazo yokuba i-FMS yintlupheko yenkqubo ye-nervous system yokunyangwa kwentlungu, kwaye ayilona uhlobo oluthile lwe-auto-immune disorder of tissues. Kunokwenzeka ukuba i-FMS yexesha elikhethiweyo likhetha ukunyuka kwamagama, kuba oko kuthetha ukuba izigulane ezinezifo eziyinkimbinkimbi zinkxalabo zonke zifana nesifo okanye isifo.

Njengoko kuya kucaca kwizahluko ezilandelayo, lo ngumyalezo kanye oya kukhuthazwa yile ncwadi-ukuba zininzi iimpembelelo ze-aetiological ezinxulumene neqela leempawu ezimelwe ngabantu abanesifo se-FMS, kwaye kuloo manqwanqwa abemi anokuchongwa Ukuphathwa ngendlela eyahlukileyo yonyango, xa kuthelekiswa namanye amaqela angamaqela. Ukongezwa okunengqiqo kwale meko ye-multicausal yimodeli enikezela ngeendlela zongenelelo zonyango ezinokubakho, akukho nanye eya kuthi isebenze kwindalo iphela, kwaye uninzi lwayo luya kuthi lusebenze kakhulu kunyango lwamaqelana athile ngaphakathi kovavanyo lwe-FMS. Izahluko ezikule ncwadi zibonisa iindlela ezahlukeneyo zonyango zibandakanya ezo zivavanya kwaye zichaze ukusetyenziswa kwe-acupuncture, imiba ye-endocrine, iimpembelelo zengqondo, amanqaku e-myofascial trigger / needling eyomileyo, ukusetyenziswa kwe-microcurrent, i-hydrotherapy, i-therapeutic touch, i-manipulation, i-massage, ukuzilolonga , isondlo kunye nezinye iindlela zonyango. Imicimbi ejikeleze iseti esezantsi ye-FMS, kunye nokuchongwa okungaphaya (okanye okungalunganga) kwe-FMS, iphononongwa ngokupheleleyo kwisahluko 3, 4 no-5.

Iingxaki ezivela kwi-ACR Inkcazo

Uncedo njengoko kuchazwe le meko, kukho iingxaki ezicacileyo kwaye ezicacileyo ngencazelo njengento echanekileyo yenziwa yi-ACR:

Ukuba uxinzelelo lwahluka kancinane kuphela, ukuze “ngosuku olulungileyo” isiguli sinokuthi sichaze uvakalelo kunye nokuthantamisa endaweni yokuba "sibe buhlungu" xa kuvavanywa iindawo zethenda, isiguli ngoko ke asinakho ukufaneleka ; oku kunokuba nefuthe le-inshurensi yokwenyani, kunye nokushiya abantu abanxunguphele besafuna ukuxilongwa okunokubanceda baqonde ukubandezeleka kwabo.

Ukuba zonke ezinye iindlela zikhona, kwaye zingaphantsi kwe-11 kwezili-18 iziza ezinokubikwa njengezibuhlungu (yitsho kuphela i-9 okanye i-10), loluphi uxilongo olufanelekileyo?

There Ukuba kukho iindawo ezili-11 ezibuhlungu kodwa ukusasazeka kwendalo yeentlungu ezingekhoyo (ngokwenkcazo kwiBhokisi 1.2), sesiphi isifo esichanekileyo esifanelekileyo? Ngokucacileyo, into ebonwayo kubantu abaneentlungu ezixhaphakileyo kwaye ababonisa ubuncinci i-11 ye-18 yamanqaku okuvavanya njengentlungu yimeko emele ukuphela kokude kokungasebenzi. Abanye abangafezekisi ngokufanelekileyo (ekufumanekeni kwe-FMS) inani lamanqaku ethenda anokuqhubela phambili ukuya kwimeko engonwabisiyo.

Njengoko bekuxeliwe ngaphambili, malunga ne-2% yabemi bayazifezekisa zonke iikhrayitheriya ze-ACR (Wolfe okqhubekayo 1993). Uninzi lwabantu abaninzi, nangona kunjalo, baya phambili kwelo cala, ngokophando lwaseBritane nolwaseMelika, olubonisa ukuba malunga neepesenti ezingama-20 zabemi bafumana iintlungu 'ezisasazeke' ezihambelana nenkcazo ye-ACR, nenani elifanayo, kodwa hayi kunyanzelekile ukuba babe ngabantu abafanayo, babonisa i-11 lamanqaku eethenda ali-18 njengentlungu kuvavanyo olufanelekileyo, nangokuhambelana nenkcazo ye-ACR. Abanye abantu baneentlungu ezixhaphakileyo kwaye azonelanga ngamanqaku abuhlungu, ngelixa abanye benamanqaku kodwa ukusasazwa kwabo kwintlungu ngokubanzi akukwanelanga ngokwaneleyo.

Ziyintoni Isimo Ukuba Sinayo i-FMS (Croft et al 1992)?

Ukuba zonke iikhrayitheriya azihambelani ngokupheleleyo, kwaye abantu abanokuthi, i-9 okanye i-10 iindawo (kunokuba i-11 ifunekayo) zinikezelwa ukuxilongwa kwe-FMS (kwaye ngoko iyakulungele ukuhlawula i-inshorensi okanye ukukhubazeka, okanye ifanelekile ukufakwa kuphando iiprojekthi), kuthekani ngomntu onokuphela kweengcambu ze-8 ezidibana nazo zonke ezinye iindlela?

Ngokwemigaqo yabantu, konke okukude nokufunda, kuba intlungu yeli nqanaba ixinzelele kwaye mhlawumbi ikhubaza, nokuba ingaba i-11 (okanye ngaphezulu) iyingqinamba. Kwizonyango, izigulane kufuneka zifumane ingqwalasela efanayo, nokuba ziphi na ezibonakalayo kwindawo yokukhubazeka, kwaye nayiphi na i-score point point, ukuba intlungu yabo inelungelo lokufuna ingcali.

Njengoko kuya kucaca njengoko kuvavanywa i-FMS kwesi sahluko nakwizahluko ezilandelayo, ukukhathazeka kwesigulana kuthelekiswa kakhulu nababoneleli bezempilo abazama ukuqonda nokunikezela unyango kwisigulana esine-FMS. Oku ikakhulu kungenxa yokuba akukho luhlobo lunye lwe-aetiological oluvele kwiinzame zophando ukuza kuthi ga ngoku. URussell (kwiMense & Simons 2001) uyishwankathela ngolu hlobo lulandelayo:

Isizathu se-FMS asaziwa, kodwa ubungqina obukhulayo bubonisa ukuba i-pathogenesis yayo ibandakanya ukuqhubekeka kwe-neurochemical ye-sensory signals kwi-CNS. Isiphumo sesiphumo sokunciphisa iintlungu zentlungu kunye nokwandiswa kweempawu eziqhelekileyo zengqondo kuze kube yilapho isigulane sifumana intlungu.

Njengoko kuya kucaca, iinqununu ze-pathogenesis yeemeko zibandakanya izixhobo ze-biochemical, psychological and biomechanical. Kwindawo ethile ekudibeneyo kwezinto kunye nezinto ezikhethekileyo zomntu unokuthi zenze amathuba okuphucula ukusebenza kunye nokunciphisa intlungu ephazamiseka rhoqo kunye nezinye iimpawu ezihambelana neFMS.

Izibonakaliso Eminye Kunokuba Buhlungu

Kwi-1992, kwi-Second World Congress kwi-Paincial Pain ne-Fibromyalgia e-Copenhagen, isaziso sokuvumelanisa nge-fibromyalgia sakhutshwa kwaye kamva sashicilelwa kwi-Lancet (i-Decenhagen Declaration 1992). Esi simemezelo samkela i-ACR i-fibromyalgia inkcazo njengesiseko sokuxilongwa, kwaye yongezelela inani leempawu kule nkcazo (ngaphandle kobuhlungu obubanzi kunye namanqaku amaninzi eethenda), kubandakanya ukukhathala okuqhubekayo, ukuqina kobungakanani bentsasa kunye nokulala okungaqabuliyo.

Uxwebhu lwaseCopenhagen luqaphele ukuba abantu abane-FMS ngamanye amaxesha banokubakho ngamanqaku angaphantsi kwe-11 abuhlungu - ebaluleke ngokucacileyo ukuba uninzi lweendlela zokuchonga ziyafezekiswa. Kwimeko enjalo, ukuxilongwa kwe-"FMS enokwenzeka "kucingelwa kufanelekile, kunye noviwo olulandelayo olucetyiswayo lokuvavanya imeko kwakhona.

Kukho impembelelo ebonakalayo kwinqanaba lokunqunyulwa (iimpawu okanye iinombolo zeenombolo zethenda, umzekelo) ekwenzeni ukuxilongwa: ezi zixhamle ngqo kwi-inshorensi kunye ne / okanye ukukhubazeka, kunye nokuthi, ngokuqinisekileyo, ukuxilongwa ngokuhlukileyo.

Uxwebhu lweCopenhagen luyabonisa ukuba i-FMS ibonakala iyinxalenye yenkqantosi enkulu ebandakanya iimpawu ezinjengentloko, isisindo esicasulayo, i-dysmenorrhoea, uvakalelo olugqithiseleyo kubanda, imilenze engenakuphumla, iimpawu ezingaqhelekiyo zokugubha kunye nokubetha, ukunyamezela ukuzisebenzisa, kunye nezinye iimpawu .

Imiba Yengqondo

Isibhengezo seCopenhagen (i-1992) yeempawu ezinxulumene ne-FMS (ngaphezu kweentlungu, ngokucacileyo into echazayo) idibanisa iipatheni zengqondo zixhomekeke kwi-FMS, oko kukuthi uxhalaba kunye / okanye ukuxinezeleka.

Icandelo lezengqondo elinokubakho kwi-FMS yindawo yokufunda enezinkolelo kunye neempendulo zokuzikhusela. Umbutho omkhulu wezimvo zonyango unika yonke into ye-FMS- kunye nesifo esinganyangekiyo sokudinwa (i-CFS) - kwibala lokugula kwengqondo / kwengqondo. Isikhundla esichazwe ngokulinganayo, esihlala kwiindawo ezininzi zononophelo lwempilo kunye nezigulana ezininzi, sigcina ukuba uxinzelelo kunye neempawu zokudakumba zixhaphakile, kunokuba zibangele, zentlungu kunye nokukhubazeka okufunyanwa kwi-FMS (McIntyre 1993a).

Iphepha lokuphononongwa lika-1994 lihlalutye lonke upapasho lwezonyango lwaseBritane ngesihloko seCFS ukusukela ngo-1980 ukubheka phambili kwaye kwafunyaniswa ukuba ama-49% akhetha izizathu ezingezozamvelo ngelixa ama-31% ethanda unobangela wezinto eziphilayo. Xa imithombo yeendaba ethandwayo yavavanywa ngendlela efanayo, phakathi kwe-70% (amaphephandaba) kunye ne-80% (iimagazini zabasetyhini) baxhasa inkcazo yezinto eziphilayo (McClean & Wesseley 1994).

Uhlobo oluqhelekileyo lwembono ebambelele ikakhulu kwi- psychological aetiology luphononongo lwezinto ezininzi olwenziwe ngu-Epstein kunye noogxa, olwapapashwa ngo-1999. Lwaqukumbela: “Kolu phononongo lwezinto ezininzi, abantu abane-FMS babonakalise ukungasebenzi kakuhle, amanqanaba aphezulu abanye Ixesha lokuphila kunye nokuphazamiseka kwengqondo okukhoyo ngoku, kunye noxinzelelo lwengqondo lwangoku. Izona ngxaki zixhaphakileyo kuqatshelwe yayiludandatheko olukhulu, idysthymia, ukuphazamiseka kovalo kunye ne-phobia elula.

Uninzi lwabaphandi abakhokelayo kwi-FMS ababambe kwinkcazo ye-organic - biochemical - ye-neurological yeempawu eziphambili, nangona kunjalo, bayazichasa iinkcazo zengqondo ngalo meko. UGqr.Jay Goldstein, ophando olunzulu kwaye lubalulekileyo kunye nolwazi lweklinikhi kukhathalelo lwezigulana ezine-CFS kunye ne-FMS ziya kuchazwa kamva kule ncwadi, usebenzisa igama elithi neurosomatic ukuchaza into ayibona njengokuphazamiseka kulwazi oluphambili. Uyasicacisa isikhundla sakhe ngokubhekisele kwisikolo sokucinga esingesiso esendalo, nesengqondo (uGoldstein 1996):

Uninzi lwezifo [i-CFS, i-FMS] ezanyangwa kusetyenziswa le modeli [i-neurosomatic] zisabizwa ngokuba yi- psychosomatic luluntu lwezonyango kwaye zinyangwa ngokwasemzimbeni ngengqondo, ngoochwephesha bemithambo-luvo kunye noogqirha ngokubanzi. I-anthropologists kwezentlalo zikwanazo iingcinga zazo ezichaza i-CFS njenge-urneurasthenia yee-1990s, kunye ne''culture bound syndrome '' ebeka ungquzulwano olucinezelweyo lwezigulana ezingakwaziyo ukuveza iimvakalelo zazo ( alexithymics ) kwisifo esamkelekileyo ngokwasentsholongwane okanye amajoni omzimba ukungasebenzi. Ukunyanga ngokunyanga kwengqondo kufanelekile ngakumbi, kuba ukumelana nokunyanga kwezigulo zabo, ezithi zithambe kwaye zihambe ngokungalindelekanga, yeyona ngxaki iphambili kuninzi lwabo babandezelekileyo. Bambalwa abaphandi kwizigulo zengqondo (ngaphandle kwabo baphanda ukuphazamiseka kwesoyikiso) abazixhalabeleyo malunga ne-pathophysiology yezigulana abazifundayo, kubonakala ngathi ngumxholo wokuchaza aba bantu ngokwemiqathango yengqondo yengqondo. Esi sikhundla siya singanyamezeleki njengoko inyani yomntu ophelayo inyamalala.

UGoldstein uthi uthetha kuphela izigulane ze-psychotherapy ukuba zixinezelekile. Ugxininisa ukuqhelanisa (kusetyenziswa iindidi ezahlukeneyo zamachiza) wezinto eziphilayo ezinokwenziwa kwintsholongwane yee-neural, eyayigculiseleyo yimbangela yezizathu (kunye nezinye iimeko).

Xa Isizathu Asisona Isizathu?

Iindlela zeGoldstein ziya kuvavanywa kwizahluko ezilandelayo; Nangona kunjalo, kunokuba luncedo kweli nqanaba ukwenza ukuphambukisa kancinci ukucacisa ukubaluleka kokujonga ngaphaya kwezizathu ezibonakalayo zokuzama ukufumanisa imvelaphi yabo.

Njengokuba siqhubela phambili kwi-saga eyi-FMS (kunye ne-CFS) siza kudibana nenani lezikhundla ezichaziweyo ezigcina ukuba oyena nobangela ngu-X okanye u-Y okanye ngaphezulu kokudityaniswa kwe-X kunye no-Y (kwaye mhlawumbi nabanye). Inyani yile yokuba kwezinye iimeko ezibalulekileyo ezi zizathu ngokwazo zinezizathu ezingunobangela, ezinokuthi ngokuchanekileyo zisonjululwe kunyango.

Umzekelo oza kuvela ngokweenkcukacha kamva- sisindululo sokuba uninzi lweengxaki ezinxulumene ne-FMS (kunye neCFS) zinxulumene nokungezwani komzimba (iTuncer 1997). Oku kunokuba njalo ngengqondo yokuba ukutya okuthile okanye izinto ezithile zingaboniswa, kwiimeko ezinikiweyo, ukucaphukisa okanye ukonyusa iimpawu zentlungu nokudinwa. Kodwa yintoni evelisa oku kunyusa ukuphindaphinda / ubuntununtunu? Ngaba zikhona izizathu ezichongiweyo (zokutya zihlala) ukunganyamezelani (Ventura okqhubekayo 2006)?

Kwezinye iimeko le nto ingabonakaliswa ngenxa ye-malabsorption yamanqamuli amakhulu ngokusebenzisa udonga lwamathumbu, mhlawumbi ngenxa yomonakalo kwimimandla ye-gut (Tagesson 1983, iZar 2005). Kwezinye iimeko umonakalo we-mucosal ngokwawo ungabonakaliswa ukuba ubangelwe kwimvubelo engavumelekanga okanye i-bacterial overgrowth, ngenxa yokusetyenziswa kwangaphambili (okungenakulungelelwanga) kwee-antibiotics kunye nokuphazamiseka okubangelwa yi-flora eziqhelekileyo, kunye nokulawula kwabo kwizinto ezinobuncwane (Crissinger 1990). Okanye i-gut mucosa enokuphazamiseka inokudibaniswa ne-endotoxaemia equka isimo esichaphazelekayo se-bacterial status (McNaught et al 2005).

Iingqimba ze-anyanisi zinokuthi zihlanjululwe enye, ziveze izizathu eziqhubekayo ngokucacileyo. Intlungu iyancipha ngenxa yokungabikho komzimba, okubangelwa umonakalo we-bowel mucosa, okubangelwa yimvubelo ephezulu, ephumela ekusebenziseni ngokugqithisileyo okanye okungafanelekanga kwee-antibiotics ... njalo njalo. Ukungabikho komzimba kule mzekelo akusiyo imbangela yodwa kodwa kuyinto ebangela ingxaki, ikhonkco kwi-chain, kwaye ngelixa ukuphathwa ngayo kunokunciphisa imiqobo imimiselo, ayiyi kujongana nezizathu. Kwakungekho ukunyanga i-bacterium okanye imvubelo, nangona oku kunokunceda ekunciphiseni uxinzelelo lweempawu.

Uphi unobangela wale FS? Ngokunokwenzeka kuluhlu oluntsonkothileyo lweempawu zonxibelelaniso (ezihlala zihlala zembali), ekunokwenzeka ukuba kungabi lula ukuzikhulula. Ke ngoko, iindlela ezinje ngezi zihambisa ngokwabo kwi-allergies okanye ekwandeni kokuqina, ngelixa kunokwenzeka (kule meko) zisemthethweni kwaye ziluncedo, ayisiyiyo eyokujongana nezona zinto zibalulekileyo.

Ngaba oku kubalulekile? Kwimodeli yeGoldstein yeFMS kunye neCFS aetiology sijamelene nenethiwekhi ye-neural engasebenzi kakuhle. Uyavuma ukuba imeko yendalo enjalo ifuna izinto ezininzi zonxibelelwano:

Basic isisiseko esisisiseko esinokubangelwa yimfuza

Izinto ezithile zokukhula ebuntwaneni (ukuxhatshazwa ngokwasemzimbeni, ngokweemichiza okanye ngokwasemphefumlweni / ngokwenzakala, umzekelo)

Mhlawumbi inqanaba le-encephalopathy yentsholongwane (echaphazeleka kukuphazamiseka kwemeko yokuphendula komzimba)

Ukonyuka kokuchaphazeleka koxinzelelo lwendalo okususela kunciphiso lweplastiki ye-neural.

Ubunokwenzeka ukuba uqaliso olusisigxina okanye ukusetyenziswa kakubi kuluhlu luxhaswa ngophando. Ngokomzekelo, ingxelo ye-Weissbecker et al (2006) ithi:

Abantu abadala abane-fibromyalgia syndrome baxela amanqanaba aphezulu okonzakala komntwana. Ukuxhatshazwa kweNeuroendocrine kukhe kwaqatshelwa kolu luhlu. Iziphumo zibonisa ukuba amava abuhlungu ebuntwaneni anokuba yinto yabantu abadala abane-neuroendocrine dysregulation phakathi kwabanengxaki ye-fibromyalgia. Imbali yomothuko kufuneka ihlolwe kwaye ungenelelo lwengqondo lunokuchazwa njengecandelo lonyango lwe-fibromyalgia.

Izizathu ngaphakathi kwale modeli zinokubonakala ngathi zisasazeka ngokubanzi. I-Goldstein's (ebonakalayo iyimpumelelo) ukungenelela kujongana nento eyenzekayo ekupheleni kolu tshintsho luntsokothileyo lweziganeko xa uthungelwano lwe-neural luye, ngenxa yoko, lungasebenzi. Ngokusebenzisa i-biochemistry yelo xesha, uninzi (uGoldstein uthi uninzi) lweempawu zezigulana zakhe zibonakala ziphucuka ngokukhawuleza nangokukhawuleza.

Olu phuculo aluthethi ukuba izizathu zisonjululwe; ukuba ezi zisasebenza, iingxaki zempilo zexesha elizayo zinokulindeleka ukuba ekugqibeleni zivele. Ukumelwa kwesikim 'sendlela yokuya kwimpilo enkenenkene' (Ikhiwane. 1.2) ibonisa ezinye zeempawu ezinokubakho eziqhubekayo kwiipateni ezingasebenziyo ezinje nge-FMS, apho izixhobo ezilungelelanisiweyo zolulelwe kwimida yazo, kunye 'nqanaba lokuphelelwa ngamandla' Isifo se-selye's adaptation syndrome siye safikelelwa (Selye 1952). Jonga nengxoxo ye-allostasis kwiSahluko 3, ngakumbi iThebhile 3.2.

Iipatheni ezingasebenziyo ezifana ne-CFS kunye ne-FMS zibonakala zinemisebenzi emithathu ebonakalayo ehambelanayo kunye nohlobo oluthile lwabantu abathile kwaye bafumene iimpawu zabantu ngabanye ukuze banqunywe iqondo elilodwa lokungakhuselekanga kunye nokuthinteka kwabo (umzobo 1.3):

1. Izinto eziphilayo. Ezi ziquka ukutyhafaza, ukusilela, ukusasazeka, i-endocrine, i-allergic nezinye iimpawu (i-Wood 2006).

2. Izinto zeByomechanical. Ezi ziquka:

a. ulwakhiwo (ukuzalwa, okt ukuzalwa, okt umlenze omfutshane okanye iimpawu zokungahambi kakuhle emzimbeni, iimpawu zangasemva okanye ezothusayo) (UGedalia okqhubekayo ngo-1993, uGoldman 1991)

b. ukusebenza (iipatheni ezingasetyenziswayo, uxinzelelo lwe-hyperventilation kwiindlela zokuphefumula, njl.)

c. imithambo-luvo (uvakalelo, uvakalelo-phezulu wind-up ) (Staud okqhubekayo 2005).

3. Izinto zengqondo. Ezi zibandakanya ukuxinezeleka kunye / okanye iimpawu ezixhalabileyo, ukunyamezela ukunyamezela, ukukhathazeka kwangemva kokukhathazeka, njl njl. (Arguellesa et al 2006).

Makhe siqwalasele ngokufutshane imodeli kaGqirha Goldstein yokungasebenzi kakuhle, ephakamisa ukungasebenzi kakuhle kwenethiwekhi njenge- cause ye-FMS, yona isisiphumo sokudityaniswa kweempawu ezichazwe apha ngasentla (iGoldstein 1996). Ukuba sisebenzisa ukhetho lweklinikhi olucetyisiweyo kuMzobo 1.2, siyabona ukuba kunokwenzeka ukuzama:

1. ukunciphisa umthwalo we-biochemical, biomechanical okanye psychogenic stress apho umntu ephendula khona

2. ukuphucula ukukhusela, ukulungiswa, imisebenzi yomzimba yomntu ukuze bakwazi ukujongana nale ngcinezelo ngempumelelo

3. i-palliate impawu, sinethemba ngaphandle kokuvelisa naluphi na ukwanda kweemfuno ezilungelelaniso kwinkqubo esele ikhululiwe.

Ngawaphi kula maqhinga aqeshwe kunyango lweGoldstein apho kuqhutywa khona ubuqhetseba be-biochemical, kwaye ngaba le dilesi ibangela okanye iimpawu, kwaye ngaba iyawenza lo nto, okoko nje kukho ukuphucuka ngokubanzi?

Umbono othile wefilosofi owamkelwe yingcali / ngugqirha uya kugweba isigwebo sakhe kulo mbuzo. Abanye banokubona ukukhululeka ngokukhawuleza kweempawu ezibanga uninzi lwezi zigulana njengokuthethelela indlela ethile yonyango. Abanye banokubona oku njengokubonelela ngezibonelelo zexeshana elifutshane, ungajongani nezizathu ezingunobangela, kwaye ushiye amathuba okubuya kweempawu zoqobo, okanye ezinye eziguqukayo, zinokwenzeka. Le micimbi iya kujongwa ngokunxulumene nale kunye nezinye iindlela zonyango lwe-FMS kwizahluko ezilandelayo.

Iimeko ezidibeneyo

Ininzi yeemeko eziyinkimbinkimbi ezikhoyo zineempatho zampawu ezilinganisa ezininzi zazo ziboniswe kwi-FMS, ngakumbi:

Isifo esingapheliyo se-myofascial pain syndrome (MPS) esibandakanya amanqaku amaninzi asebenzayo e-myofascial kunye neempembelelo zabo ezibuhlungu

Isifo sokudinwa esinganyangekiyo (i-CFS) esiphakathi kokudityaniswa kweempawu zayo phantse zonke ezo zichazwe kwi-FMS, kugxininiswa ngakumbi kwizinto zokudinwa, endaweni yeentlungu

Ubuntununtunu beekhemikhali ezininzi (i-MCS)

Uxinzelelo lwasemva koxinzelelo lwasemva kwesifo (PTSD). I-MPS, i-FMS, i-MCS (umzekelo, ngokunxulumene nento eyaziwa ngokuba yi-Gulf War syndrome) kunye ne-CFS-ukufana kwabo, kwaye ngamanye amaxesha inqanaba elikhulu lokudibana ekubonakalisweni kweempawu, kunye nolwahluko wabo- ziya kuvavanywa kamva izahluko. Inqaku elinye lazo zonke ezi meko ziye zaqaqanjiswa zisekwe kwi-hypothesis enetyhefu / ye-biochemical, ebandakanya amanqanaba aphezulu e-nitric oxide kunye nemveliso yayo enamandla, i-peroxynitrite (Pall 2001).

Ezinye iingcamango zeCausation

Iindidi zeengcamango malunga ne-Cafeation ye-FMS ziye zavela, zininzi zale ndawo kunye kunye nezinye zifana ncamanye nabanye, ngokungafani kancinci kuphela ekugxininiswe ngokubhekiselele kwi-aetiology, imbangela kunye nempembelelo. I-FMS icingelwa ngokucacileyo ukuba ifake nayiphi na inxalenye yentetho elandelayo (kunye nezinye) iimpawu zokubangela, eziphi na eziphakamisa imibuzo kunye nokucebisa iimpendulo kunye nemisebenzi yokwelapha:

I-FMS inokuba sisiphazamiso se-neuroendocrine, ngakumbi ebandakanya ukungalingani kwehomoni yedlala lengqondo (jonga uCh. 10) (IGarrison kunye nokuZala ngo-2003, uHoneyman 1997, uLowe 1997, uLowe kunye noHoneyman-Lowe 2006) kunye / okanye nokungalingani kokukhula kwehomoni (mhlawumbi ngokuthe ngqo Iziphumo zokuphazamiseka kokulala eyona nto iphambili ye-FMS, kunye / okanye ukunqongophala kwemithambo yomzimba) (UMoldofsky 1993). Umbuzo ekufuneka ubuzwe wona kukuba, yintoni evelisa ukuphazamiseka kwe-endocrine? Ngaba imiselwe ngokwemfuza njengoko abanye bekholelwa, okanye sisiphumo sokusilela, ubutyhefu, ukwaliwa, imeko yokuzimela komzimba okanye usulelo?

UDuna noWilke (1993) bacebisa ukuba ubuthongo obungalunganga bukhokelela ekunciphiseni imveliso ye-serotonin, kunye nesiphumo sokuncipha kwesiphumo sokumodareyitha kweentlungu ze-endorphins kunye nokwanda kwamanqanaba e-Pubsance P , kudityaniswe notshintsho lwenkqubo yemithambo-luvo ekhokelela kwimisipha ischaemia kunye nokunyusa uvakalelo Intlungu (iDuna kunye noWilke 1993). Le hypothesis iqala ngophawu, ukuphazamiseka kokulala, kwaye umbuzo osengqiqweni ngulo, yintoni evelisa oku?

I-Dysautonomia, ukungalingani okuzimeleyo okanye ukungasebenzi kakuhle, okubonakaliswa kukungakhathali kokungakhathali , oqaqambe kakhulu ebusuku (UMartinez-Lavin kunye neHermosillo 2005), ziye zacetyiswa njengezizathu ezisisiseko kwiqela labantu abane-FMS (kunye neCFS). Izigulana ezininzi ziye zabhalwa ngokugula okuhambelana neMfazwe yeGulf (UGeisser okqhubekayo ngo-2006, uHaley okqhubekayo ngo-2004, van der Borne 2004).

Micr Imisipha microtrauma inokuba sesona sizathu, mhlawumbi ngenxa yemeko yemfuza (kunye / okanye ukukhula kokungasebenzi kakuhle kwehomoni), ekhokelela ekuvuzaji kwecalcium, kunye nokonyusa ukuncipha kwemisipha kunye nokunciphisa ukuhanjiswa kweoksijini. Ukwehla okunxibeleleneyo kwimveliso yamandla e-mitochondrial kungakhokelela kukudinwa kwendawo kunye nokungakwazi ukuba ne-calcium engaphezulu ikhutshelwe ngaphandle kweeseli, kukhokelela kwi-hypertonia yendawo kunye nentlungu (Wolfe okqhubekayo 1992). Umbuzo wokuba kutheni i-muscle microtrauma yenzeka ngakumbi kwabanye abantu kunabanye, okanye kutheni ukulungiswa kuhamba kancinci, kufuna uphando.

I-FMS inokuba sisifo sokumodareyitha kwentlungu esiphumela ubuncinci kwinxalenye yenkqubo yobuchopho (ye-limbic system) kunye nokubandakanya ukuguqulelwa okungalunganga kwemiqondiso yeemvakalelo kunye nokunika ingxelo engeyiyo (iGoldstein 1996). Kutheni kwaye njani inkqubo ye-limbic kunye ne-neural network zingasebenzi kakuhle sisitshixo sale hypothesis (ekhuthazwe nguGoldstein, njengoko kuchaziwe apha ngasentla).

Kucetyisiwe ukuba oko kubizwa ngokuba kukuphazamiseka kwentlungu (i-IPD) - ezinje ngeengxaki zamalungu adibeneyo (i-TMJD), i-fibromyalgia syndrome (i-FMS), isifo sesifuba (i-IBS), iintloko ezingapheliyo, i-cystitis yangaphakathi, iintlungu ezingapheliyo zethambo, isifo esinganyangekiyo , iingxaki ezinxulumene ne-whiplash kunye ne-vulvar vestibulitis (VVS) zixolelaniswa ngokwahluka kwemfuzo, kunye nokuvezwa kweziganeko zokusingqongileyo. Iindlela eziphambili zokuba semngciphekweni ophantsi kophuhliso lweemeko ezinjalo zibonwa zibandakanya ukukhulisa iintlungu kunye noxinzelelo lwengqondo, oluguqulwe ngokwesini nangobuhlanga (UDiatchenko okqhubekayo 2006) (Ikhiwane. 1.4).

I-FMS inokuba sisifo esivela ngokuzalwa, ekunokwenzeka ukuba sihambelana nolawulo lwe-thyroid olungonelanga lokukhutshelwa kwemfuza, kunye nenqaku elibalulekileyo le-autosomal (Lowe okqhubekayo 1997, Pellegrino okqhubekayo 1989). Njengoko kuya kuchazwa, ezinye izifundo zophando zifumene ubungqina bento ehambelana nemfuza kwi-FMS. Ukungaqheleki kobume bokuzalwa, njengokuqaqanjelwa ligamentous (okt ukungahambelani komzimba (UKaraaslan okqhubekayo 2000)), kunye nokungasebenzi kakuhle kweChiari (jonga ingxoxo engaphezulu koku kwiCh. 3 (Kesler & Mandizabal 1999, Thimineur et al 2002)), ngokuqinisekileyo kubonakala ngathi ngokubhekisele kwi-FMS. Imibuzo ephakanyiswayo yile ibandakanya: zeziphi izinto ezenza mandundu ezi zinto zibekiweyo, kwaye ngaba akukho nto inokwenziwa ngazo?

U-Hudson okqhubekayo (2004) bacebise ukuba i-fibromyalgia lilungu elinye leqela le-14 yengqondo kunye nokuphazamiseka kwezonyango (ukunqongophala kwengqondo / ukuphazamiseka kwengqondo, i-bulimia nervosa, isifo se-dysthymic, ukuphazamiseka koxinzelelo ngokubanzi, uxinzelelo olukhulu lokudakumba, ukuphazamiseka okungafunekiyo , uxinzelelo lwasemva koxinzelelo, uxinzelelo lwangaphambi kokuya exesheni kunye ne-phobia yentlalontle- kunye neemeko zonyango ezine: i-fibromyalgia, isifo samathumbu esibuhlungu, i-migraine, kunye ne-cataplexy), ngokudibeneyo ekuthiwa kukungaboni kakuhle (ASD), kuthathwe into yokuba yabelane ngeempawu ezinokubakho zepathophysiological. Ukulandela uhlalutyo olunenkcukacha lwedatha evela kubantu abangama-800 abane-fibromyalgia nangaphandle kwayo (kunye neemeko ezongezelelweyo eziphantsi kovavanyo), u-Hudson et al uqukumbele ngelithi ulwazi olukhoyo longeze kubungqina bokuba ukuphazamiseka kwengqondo kunye nonyango, oluqokelelwe phantsi kwegama ASD, luhamba kunye kwiintsapho Ukuphakamisa ukuba kungenzeka ukuba ezi ngxaki zinokwabelana ngokungaqhelekanga komzimba.

Unobangela oyintloko we-FMS ubonwa ngabanye ukuba ubangelwe (kukuhlala kudityaniswa) ukubandakanyeka kokungabikho komzimba, usulelo, ityhefu kunye nokusilela kwesondlo okunokuthi kuvelise iimpawu eziphambili ze-FMS (kunye neCFS), njengokudinwa kunye nentlungu, okanye zinxulunyaniswa nokungalingani kwe-endocrine kunye neziphumo ezahlukeneyo ezichazwe apha ngasentla, ezinje ngehomoni yedlala yokungasebenzi kunye / okanye ukuphazamiseka kokulala (Abraham & Lubran 1981, Bland 1995, Cleveland et al 1992, Fibromyalgia Network Newsletters 1990-94, Pall 2001, Robinson 1981, Vorberg 1985). Uluhlu lwezinto ezinokunxibelelana ezinje ngezi, ezibonakala zihlala kunye nomntu one-FMS, zinika ithuba lokungenelela ngeendlela ezibonakala zigxile kwizizathu kunakwiziphumo. Umzekelo, i- excitotoxins ethile efana ne-monosodium glutamate (MSG) ichongiwe njengezinto ezibangela iimpawu ze-FMS (Smith et al 2001). Le neminye imizekelo iya kuqwalaselwa kwizahluko ezilandelayo.

I-hypothesis ye-sensitization esembindini iphakamisa ukuba iindlela eziphambili zentlungu ye-FMS zixhomekeke kwigalelo (s) elingaqhelekanga kuphuhliso nokugcinwa kwemeko (Vierck 2006). Uncwadi oluninzi luchaza umda CNS ukunxibelelana kwemida ebonakala ngathi iyahambelana nentlungu ye-fibromyalgia. Ubuninzi be-hypersensitivity ehambelana nemeko egxile kumdla ophakathi (CNS) weendlela zokuphazamiseka. Oku kubandakanya uvakalelo oluphakathi, ukubulala iintsholongwane kumbindi kunye ne-axis ye-hypothalamic pituitary adrenal (HPA) axis. Nangona kunjalo, kunyanzeliswa ukuba iimpembelelo eziphambili ezinxulunyaniswa ne-fibromyalgia zinokuveliswa yimithombo yentlungu yentlungu. Kule modeli, igalelo le-nociceptive engapheliyo likhuthaza uvakalelo oluphambili, ukukhulisa iintlungu kunye nokwenza i-axis ye-HPA kunye nenkqubo yemfesane yovelwano. Ukuvuselelwa kovelwano olungapheliyo emva koko ngokungathanga ngqo kukhuthaza ii-nociceptors zepheripher, kwaye kusete umjikelo okhohlakeleyo. (Jonga kwakhona amanqaku ngokuququzelelwa kamva kwesi sahluko, kunye nengxoxo ethe kratya malunga nolwazelelo lwangaphakathi kunye nolwembonakalo kwiCh. 4.)

Ukusetyenziswa kweMRI kunye nobunye ubuchwephesha bokuskena / iteknoloji yokucebisa ibonisa ukuba eyona nto iphambili yokukhuthaza ubuntununtunu inobungqina bokuyixhasa. Lo mbandela uxoxwa ngakumbi kwiSahluko 3 (jonga Isigulana esine-polysymptomatic ) kunye neSahluko 4 (jonga Ukukhuthaza uvakalelo lwecentral kunye nomzobo 3.1). Imizekelo emibini yobungqina bokucinga, ngokunxulumene nokutshintsha kwengqondo morphology kunye / okanye indlela yokuziphatha ngokunxulumene ne-FMS, ishwankathelwe kwiBhokisi 1.3.

Ngaphakathi kwesakhelo se- allergy kunye 'nokunganyamezelani' njengezinto ezibangela iimpawu ze-FMS kuxhomekeke kwingcinga ehlala iphikisana, kodwa kufanelekile ukuba ixoxwe. Oku kunxulumene nomxholo wohlobo oluthile lwegazi ukunganyamezelani okubangelwa kukunxibelelana phakathi kweelectins ezivela kukutya (iimolekyuli zeproteni) kunye neziphawuli ezithile zezicubu ezinxulumene nodidi lwegazi lomntu ngamnye. UD Adamo (2002), oye wenza okuninzi ukukhuthaza lo mbono, uthi (ngokunxulumene nabaguli beFMS abathi babe luhlobo O):

Kuye kwacaca ukuba abo bahlobo O kunye nabaphethwe yi-fibromyalgia banokubona iimpendulo ezimangalisayo xa benokubambelela kwicandelo elingenangqolowa ekutyeni ixesha elide. Uphononongo lwakutsha nje lubonisa ukuba ii-lectins zokutya ezinxibelelana ne-enterocytes (iiseli ezinamathumbu amathumbu) kunye nee-lymphocyte zinokuqhuba ukuhanjiswa kokubini kokutya kunye nokugaya i-antigen ye-pathogenic kwizicwili zomzimba, nezithi zibangele ukhuthazo lomzimba oluqhubekayo kumda womzimba, njenge amalungu kunye nezihlunu (Cordain okqhubekayo 2000). Oku, ngaphandle kwento yokuba uninzi lwegunya lokondla abasemagunyeni basabuza ukuba ii-lectins zingena na ekujikelezeni kwenkqubo! Kubantu abanokuchaphazeleka ngokwemfuza, oku kukhuthazeka kwe-lectin kunokubangela ukubonakaliswa kokuphazamiseka njenge-rheumatoid arthritis kunye ne-fibromyalgia ngokulinganisa imolekyuli, inkqubo apho iipeptides zangaphandle, ezifanayo kubume beepeptides ezingapheliyo, zinokubangela ii-antibodies okanye ii-T-lymphocyte ukuba zinqamleze kwaye ngokwenjenjalo kwaphula ukunyamezelana komzimba. Yiyo loo nto ngokususa u-O oqhelekileyo kunye nohlobo O lectins ekhethekileyo ekutyeni, sivumela amajoni omzimba ukuba avelise unyamezelo, ukudumba kuqala ukuncipha, kwaye ukuphilisa kungaqala.

Izigulana ezininzi ze-FMS zibonisa amanqanaba asezantsi e-carbon dioxide xa ephumla umqondiso wokubandakanyeka kwe-hyperventilation. Iimpawu ze-hyperventilation zijonga ngokusondeleyo ezo ze-FMS kunye ne-CFS, kunye nephethini yokuphefumla kwesifuba esiphakamileyo ebandakanya uxinzelelo olukhulu kwezihlunu zomzimba ongasentla ezichaphazeleka kakhulu kwi-FMS, kunye nokuvelisa ukusilela kweoksijini kwingqondo kunye nefuthe Ukucwangciswa kwayo kolwazi olufana nemiyalezo efunyenwe kwi-receptors yeentlungu (Chaitow okqhubekayo 2002, Janda 1988, King 1988, Lum 1981). Xa utyekelo lwe-hyperventilation lubakho, banokubonakala kwezinye iimeko ukuba babe yimpendulo kumanqanaba e-asidi aphakamileyo (ngenxa yokungasebenzi kakuhle komzimba mhlawumbi) okanye banokuba sisiphumo somkhwa omsulwa. Ukuphinda ufundise ukuphefumla, kwezinye izigulana ze-FMS, kubonelela ngeendlela zokuguqula iimpawu ngokukhawuleza (Readhead 1984).

I-Psychogenic (okanye i-psychosomatic) i-rheumatism ligama elinikwe i-FMS (kunye nezinye iingxaki zentlungu ezingapheliyo) ngabo bathandabuzayo ukubona imvelaphi yesifo. Kude kube ngawo-1960 kwakucetyiswa ukuba iimeko ezinjalo ziphathwe njenge-ychpsychoneurosis (Warner 1964). Kwi-FMS, njengazo zonke iindlela ezingapheliyo zempilo enkenenkene, ngokungathandabuzekiyo kukho izinto zokubandakanyeka ngokweemvakalelo, nokuba kungunobangela okanye njengesiphumo. Ezi mpembelelo ngokuthe ngqo ekuboneni iintlungu kunye nokusebenza kwamajoni omzimba, kwaye, nokuba kungunobangela okanye hayi, kuzuza kwingqwalaselo efanelekileyo, ukunceda kokubuyela kwimeko yesiqhelo kunye nokubuyiselwa kwimeko yesiqhelo (iMelzack kunye neWall 1988, uSolomon 1981).

I-FMS ibonwa ngabanye ukuba yinto egqithisileyo yesifo se-myofascial pain (MPS), apho uninzi lweempawu ezisebenzayo ze-myofascial zivelisa iintlungu apha ekhaya nakude (Thompson 1990). Abanye babona i-FMS kunye ne-MPS njengokwahlukileyo, kodwa bayaqonda ukuba isakuqhelekanga kwisigulana esineempawu zesifo esibuhlungu se-myofascial ukuqhubela phambili kunye nomfanekiso weklinikhi ofana nalowo we-FMS (Bennett 1986a). Phakathi kweyona ndlela ibaluleke kakhulu yokunciphisa iintlungu kwi-FMS iya kuba yimfuneko yokuchonga kunye nokwenza zingasebenzi amanqaku e-myofascial anokuba nefuthe kumthwalo wentlungu ngokubanzi. Inani leendlela ezahlukeneyo, ukusukela kwi-electroacupuncture ukuya kwiindlela zokwenza ngesandla, ziya kuchazwa (jonga i-Chs 6, 8 kunye ne-9 ngokukodwa).

Umothuko (umzekelo, i-whiplash) ibonakala iyinto ephambili yokuqalisa kwimeko ezininzi ze-FMS, ngakumbi ukulimala komlomo wesibeleko, ngakumbi ezo zibandakanya i-suboccipital musculature (Bennett 1986b, Curatolo okqhubekayo 2001, Hallgren okqhubekayo ngo-1993). Ukwamkelwa kwemeko yoomatshini, eyakhiweyo ivumela ungenelelo olujongana neziphumo zalo, kunye neziphumo zengqondo yomothuko. Kwisahluko 9 UCarolyn McMakin uveza ubungqina obunyanzelisayo bokusetyenziswa kwee-microcurrents kunyango lwe-FMS yoxinzelelo (ngakumbi ingingqi yomlomo wesibeleko) imvelaphi.

Kukho imodeli ye- immune dysfunction ye-myalgic encephalomyelitis (ME) eli gama libodwa lase-Bhritane kwinto ebonakala ngathi iyi-amalgam yesifo esinganyangekiyo sokudinwa kunye ne-fibromyalgia. Oku kuphakamisa intsholongwane okanye enye (ukugonywa, ukwenzakala, njl. Njl.) Isiphumo sokuqala esinokukhokelela ekusebenzeni okungaphaya kwenkqubo yomzimba yokuzikhusela (ukuveliswa kakhulu kwee cytokines). Inxulunyaniswa noku kunokubakho imichiza kunye / okanye i-aleji yokutya, ukuphazamiseka kwe-hypothalamic, ukungalingani kwehomoni kunye neendawo ezithile zobuchopho (umzekelo inkqubo ye-limbic) ukungasebenzi kakuhle. Eyona nto iphambili kule modeli kukusebenza komzimba okungaginyisi mathe, uninzi lwezinye izinto, ezinjengokungalingani kwe-endocrine kunye nokungasebenzi kwengqondo, okulandelayo (Macintyre 1993b). Kuphando lwakutsha nje, ubukho benkqubo yebacteria, ye-mycoplasmal kunye neentsholongwane kwizigulana ezininzi ezine-CFS kunye ne-FMS ibe yinto (UNicolson okqhubekayo 2002).

I-Musculoskeletal Terrain ye-FMS

Uphando lwangoku kunye nemvumelwano yeklinikhi kubonakala ngathi ibonisa ukuba i-FMS ayisiyiyo ingxaki ye-musculoskeletal, nangona ikwiiseli zale nkqubo apho iimpawu zayo eziphambili zibonakalisa: I-Fibromyalgia sisifo esinganyangekiyo, esibuhlungu, se-musculo-skeletal esibonakaliswa kukuqaqamba kwamanqaku kunye namanqaku ithenda enxulunyaniswa: 1) ukutshintsha imbono yentlungu, iipateni zokulala ezingaqhelekanga kunye nokuncipha kwengqondo kwe-serotonin; kunye ne-2) ukungaqheleki kwe-microcirculation kunye ne-metabolism yamandla kwi-muscle (Eisinger okqhubekayo 1994).

Ezi mpawu, zibandakanya ukusasazeka okungagunyaziswanga kwemitha kunye nokusilela kwamandla, zezona zinto zifuneka kuqala ukuze kuvele indawo ezinesifo se-myofascial kunye ne-neural hyper-reactivity (okt amanqaku okubangela). Njengoko kubonisiwe, omnye wemibuzo ephambili ekufuneka iphendulwe nakweyiphi na imeko linqanaba apho iintlungu zomntu zivela khona kumanqaku e-myofascial trigger points, okanye eminye imithombo ye-musculoskeletal, kuba ezi zinokulungiswa ngokulula kunokungalingani okuntsonkothileyo ezivelisa, ezinegalelo, okanye zokugcina imeko ephambili ye-FMS.

I-Fibromyalgia Imbali: Uphando lwakuqala

Uninzi lophando kwi-FMS (phantsi kwamagama ahlukeneyo jonga iBhokisi 1.1), kunye neendlela zomzimba ezonyusa ukuqonda kwethu imeko ye-FMS, iqhutywa kule nkulungwane iphelileyo (nangaphambili) kwaye kufanelekile ukuba iphononongwe. Uphando olongezelelekileyo ngokuhambelana nolo lujolise kwintlungu engapheliyo yemisipha inokucacisa iinkqubo zomsebenzi kule meko inzima.

Umsebenzi weKorr s kuQuquzelelo

Phakathi kwabaphandi ababalulekileyo kwiindawo zesifo se-musculoskelet and the pain over the half half past past has been Professor Irwin Korr, umsebenzi wakhe ekuchazeni inkqubela yokuququzelela inika ulwazi olubalulekileyo kwezinye zeemeko ezenzeka kwi-FMS kwaye, ngokukodwa, kwintlungu izicwangciso. Akufuneki ukuthetha, ezi zihlala zihamba. Njengoko kuphakanyiswe ngasentla, kumxholo wekliniki kubalulekile ukwazi ukuba yiyiphi ixabiso lentlungu ekhoyo kwi-FMS yiphumo leentlungu ze-myofascial, kuba le nxalenye yentlungu yeentlungu ingaba lula ukuguqulwa okanye isuswe (jonga i-Chs 8 ne-9) .

Izakhiwo ze-Neural zinokuthi zisebenze ngamandla kwi-tissue yomgogodla kunye neparaspinal okanye phantse naziphi na ezinye izicubu ezithambileyo. Xa zifunyenwe kufutshane nomqolo le nto yaziwa ngokuba luncedo kwicandelo. Xa olo tshintsho lwenzeka kwimisipha, imisipha okanye izicwili zeperiosteal, zibizwa njengeendawo zokuqala; ukuba zibekwe kwimisipha okanye kwi-fascia zibizwa ngokuba zii-ofmyofascial point trigger. Kwizifundo zokuqala ngoyena mphandi ubalulekileyo kuququzelelo, u-Irwin Korr (1970, 1976), ubonakalisile ukuba uphawu lokuququzelelwa kwamacandelo ngamacala mabini kukuba icala elinye liza kuvavanya njengokuxhathisa kwesikhumba okuqhelekileyo kumbane xa kuthelekiswa necala eliphikisayo, indawo eququzelelweyo , apho ukuncitshiswa okuphawulekayo kokuchasana bekukho. Xa stress ngohlobo lokudinga okanye ubushushu sasetyenziswa kwenye indawo emzimbeni, kwaye iindawo ezimbini zomqolo zajongwa, indawo yokuququzelela yabonisa ukunyuka okumandla kwimisebenzi yombane (okt ye-neurological). Kwilinge elinye lamavolontiya afaka izikhonkwane kwimisipha yamathole ukuze kubonwe isiphumo kwimisipha ye-paraspinal, eyajongwa ngomsebenzi wombane. Ngelixa phantse kungekho kunyuka kwenzekile kwingingqi yesiqhelo, indawo eququzelelweyo ibonise ukwanda kakhulu kwemisebenzi ye-neurological emva kwemizuzwana ye-60 (Korr 1977) (Ikhiwane. 1.5). Olu phononongo kunye nezifundo ezininzi ezifanayo ziye zaqinisekisa ukuba naluphi na uhlobo loxinzelelo oluchaphazela umntu-inokuba yimozulu, ityhefu, imvakalelo, umzimba okanye nantoni na eyenye-iya kuvelisa ukwanda kwimveliso ye-neurological evela kwiindawo eziququzelelweyo.

KwiSahluko 9, uCarol Mc McKakin uchaza indlela ezinye iintlobo zentlungu, ikakhulukazi ezichaphazela izakhiwo zomlomo wesibeleko, zingakhokelela ekuncediseni indawo engapheliyo, okubangelwa intlungu efana neFMS. Ubika ukuba unyango olusebenzisa i-microcurrent, iindlela zokuziphatha kunye nenkxaso yokuncedisa okunokutya kunokusoloko kulula, okanye kususe, iimpawu ezinjalo.

UNjingalwazi uMichael Patterson (1976) uchaza ingcamango yecandelo elithile (ugcino) ukulungiselela kanje:

Umxholo wecandelo eliququzelelweyo uthi ngenxa yokuchaphazeleka okungafaniyo okanye uluvo lwendawo ethile yomnqonqo, loo ndawo igcinwa ikwimeko yokonyuka okuqhubekayo. Olu ncediso luvumela ukungasebenzi kakuhle okanye ukungasebenzi kakuhle ukuze kusebenze ekuveliseni imveliso evela kwicandelo eliququzelelweyo, kubangele ukuba amalungu omzimba kunye namalungu e-visceral angagcinwanga kwicandelo elichaphazelekayo ukuba ligcinwe likwimeko yokusebenza. Kungenzeka ukuba ukungasebenzi kakuhle kwecandelo eliququzelelweyo kunxibelelene, sisiphumo esithe ngqo somsebenzi wecandelo elingaqhelekanga kunye nokuba noxanduva ngokuyinxalenye lokuququzelelwa.

Umoya-up kunye noKuququzelela

Inkqubo eyaziwa ngokuba yi-wind-up (Fig. 1.6) isekela iingcamango zokuququzelela, ngeendlela ezahlukeneyo. U-Staud (2006) uchaze ubudlelwane phakathi kweentlungu zengxowankulu ekhokelela ekukhunjweni okuphakathi kwendlela elandelayo:

Ubungqina obandayo bubhekisela kwizicubu zomhlaba njengengenelo echaphazelekayo yegalelo elinokubangela impembelelo enokuthi iqalise okanye igcine ukuqonda, okanye zombini. Kuyaziwa ukuba i-nociception eqhubekayo okanye enamandla ingakhokelela ekutshintsheni kwe-neuroplastic kwintambo yomgogodla kunye nengqondo, okubangele ukukhathazeka phakathi kunye nentlungu. Le ndlela ibonisa uphawu lwe-FM kunye nezinye ezininzi izifo zentlungu ezingapheliyo, eziquka isifo sofuba esiswini, i-temporomandibular disorder, i-migraine, kunye neentlungu ezisezantsi. Kubaluleke kakhulu, emva kokuvalelwa kwentsebenziswano olusekuqaleni lusekwe kuphela okokufakelwa kwenkxaso ye-nociceptive yokugcinwa kwimeko yesifo esingapheliyo. Iinkalo ezongezelelweyo, kubandakanywa iintlungu ezichaphazelekayo kunye nokulala ebuthathaka baye baboniswa ukuba banegalelo elikhulu kwiintlungu ze-FM.

Ukufana phakathi kokujongwa kwemithambo-luvo kwale mihla kunye nomsebenzi wokuqala kaKorr kucacile.

I-Arousal kunye noQoqosho

Ukuvuswa komzwelo kunako ukuphazamisa ukukhwabanisa kweendlela zokungena kwi-neural to sensitization. Ukunyuka kweempembelelo ezihlayo ukusuka kwisifundo esivusa umzwelo kunokubangela ukwanda kwenzondelelo enobungozi endleleni kunye nokuvumela iziphumo ezongezelelweyo ukuvelisa ukukhuphaza ngamandla. Oku kuthetha ukuba abantu abanomdla kakhulu, okanye abo baxhomekeka kakhulu, kuya kulindeleke ukuba babonise iimeko eziphezulu zokuququzelelwa kwendlela yokugaya umgudu okanye iindawo zendawo zoxinzelelo lwe-myofascial (Baldry 1993).

Oku kunokubaluleka ngokukodwa kwi-fibromyalgia, apho ukuphakama kuphakanyisiwe (ngenxa yezizathu ezahlukeneyo ezinokubakho, njengoko kuya kucaca), ukongeza ekusebenzeni kwenkqubo ye-limbic, kukhokelela kwiimpembelelo ezinkulu ezivela kumaziko aphezulu (iGoldstein 1996). Kuba amaziko obuchopho aphakamileyo anempembelelo kumanqanaba e-tonic yendlela yomqolo, kunokulindeleka ukuba uqeqesho lomzimba kunye nesimo sengqondo sinokuthambekisa ukutshintsha ukonwaba kwethoni, ukunciphisa ukuthambekela komntu kukhuthazo kuxinzelelo lwemihla ngemihla. Yiyo loo nto imbaleki kulindeleke ukuba imelane nenqanaba eliphezulu lokuthelekisa ngaphambi kokufumana iziphumo eziqhubela phambili zokukhuthaza. Nale, inokubaluleka kwe-fibromyalgia, apho kukho ubungqina obaneleyo beempembelelo eziluncedo zeenkqubo zoqeqesho lwe-aerobic (McCain 1986, Richards & Scott 2002).

Ukukhethwa kweeMoto zoTywala

Abaphandi babonakalisile ukuba inani elincinci leemoto, ezikwiimisipha ezithile, zinokubonisa phantse umsebenzi oqhubekayo okanye ophindaphindiweyo xa zichaphazeleka ngokwasemzimbeni. Umsebenzi we-amplitude ephantsi (usebenzisa umphezulu we-EMG) wawucacile naxa izihlunu bezingasebenzi, ukuba kukho inqanaba lokuvusa imvakalelo. PoolIdama elincinci leemoto ezisezantsi linokuba phantsi komthwalo omkhulu kangangexesha elide ... iiyunithi zeemoto ezinohlobo lwe-1 [postural] fibers zezona ziphambili kwezi. Ukuba isifundo siphinda-phinda sisebenzisa iimoto ezifanayo, ukulayishwa okungaphezulu kunokubangela ingxaki ye-metabolic. (Waersted okqhubekayo 1993). Iziphumo zolu phando zinzulu kuba zinxibelelana namanqanaba asezantsi oxinzelelo lweemvakalelo phantse uvakalelo rhoqo lwezakhiwo ezithile ze-myofascial, kunye nefuthe elinxulunyaniswa nokuququzelelwa kunye nokuveliswa kwentlungu. Le thetiology ingqinelana nokuvela okucetywayo kwamanqaku e-myofascial trigger points, njengoko kucetyisiwe nguSimons okqhubekayo (1999).

Akunjalo kuphela amaFibers aMaelinated

Uphando olwenziwe nguRonald Kramis lubonakalisile ukuba, kwizimo zentlungu engapheliyo, ii-neurons ezingezizo ezokukhulisa ingqondo zinokukhuthazwa ukuba zithwale iintlungu (Kramis 1996). I-Hypersensitization ye-spinal neurons inokuthi ibandakanye i-non-nociceptive neurons eguqula i-phenotype yabo ukuze baqale ukukhupha into P. Oku, kucingelwa ukuba, kungadlala indima ebalulekileyo ekuboneni iintlungu ze-FMS, njengoko amanqanaba okwanda kwezinto P kwi-cerebrospinal fluid egcina ukuphakamisa ukuphakanyiswa kwezinto eziqhelekileyo zibhaliswe njengeempembelelo ezinobungozi. Uphando lubonisa ukuba iimpembelelo ezivela kwiimeko ezinxulumene nezinto ezinje ngokuqhubeka kwentsholongwane, i- muscularxinzelelo okanye isilonda esinokucaphuka sinokwanela ukugcina imbonakalo yentlungu esembindini.

UkuKhuthazwa kweNgingqi

Ngaphandle kwezicubu ze-paraspinal, apho ukulungelelaniswa kwamacandelo, njengoko kuchazwe ngasentla, kubonakalisa, iindawo ezikufutshane zendawo yokucwangcisa i-neural ziyakwenzeka phantse zonke izicubu ezintle: ezi zibizwa ngokuba yi-myofascial trigger points.

Uninzi lophando olusisiseko kunye nomsebenzi weklinikhi kulo mbandela wokuququzelelwa wenziwe ngoogqirha uJanet Travell noDavid Simons (Simons okqhubekayo ngo-1999; iTravell 1957; iTravell kunye neSimons 1986, 1992; jonga ne-Chs 6 kunye ne-8). I-Travell kunye ne-Simons zirekhodi njengoko zichaza ukuba ukuba iintlungu zinobunzima obaneleyo bokubangela ukuba isigulana sifune ingcebiso kubuchwephesha (xa singekho isifo se-organic), ihlala ibandakanya iintlungu ezithunyelwayo, yiyo loo nto indawo enokubangela inokuba sesona sizathu. Basikhumbuza ukuba iipateni zentlungu ekubhekiswa kuyo zihlala zisasazwa kubo bonke abantu, kwaye kuphela kukuqina kweempawu / iintlungu ekubhekiswa kuzo ziya kwahluka.

Intsingiselo yesigulana se-fibromyalgia yinto enokwenzeka (ngokweTravell naseSimon oku kuqinisekisiwe) ukuba iintlungu zabo ziyinxalenye yenxalenye yokuzibandakanya kokubandakanyeka kwamanqaku e-myofascial, nawo ngokwawo ziindawo zokuququzelela (jonga uCh. 8. nguDommerholt kunye noIssa). Oku kuphakamisa ukuba amanqaku abangela iintlungu, kunye nentlungu (kunye nokutswina, ukuba ndindisholo, njl.njl. UTravell uqinisekisile ukuba uphando lwakhe lubonisa ukuba ezi zinto zilandelayo zinokukunceda ukugcina kunye nokwenza ngcono umsebenzi wenqaku le-myofascial:

Ukuswela ukutya (ngakumbi iivithamini C kunye no-B, kunye nentsimbi)

Ukungalingani kwehomoni (ukuveliswa kwehomoni ephantsi ye-thyroid, ukungasebenzi komzimba okanye ukungasebenzi kwangaphambili)

usulelo (iintsholongwane, iintsholongwane okanye igwele)

i-allergies (ingqolowa kunye nobisi ngokukodwa)

Oxygen i-oxygenation ephantsi yezihlunu (ezixinzelelekileyo ngoxinzelelo, uxinzelelo, ukungasebenzi, ukuphefumla okungalunganga) (USimon et al 1999, Travell & Simons 1986, 1992).

Olu luhlu luhambelana ngokusondeleyo kunye nezinto ezizezona zibangela ukuba abantu abaninzi (uninzi) babe ne-fibromyalgia, becebisa ukuba unxibelelwano phakathi kokuququzelela (ukuqala kwenqaku lomsebenzi) kunye ne-FMS kusondele (I-Starlanyl kunye neCopeland 1996). Amanqaku e-Myofascial trigger, nangona kunjalo, ayingonobangela we-fibromyalgia, kwaye i-myofascial pain syndrome ayisiyi-FMS, nangona zinokuhlala kumntu omnye ngaxeshanye. Amanqaku okubangela iMyofascial ngokungathandabuzekiyo ahlala enegalelo kwinto ebuhlungu ye-FMS, kwaye ngenxa yoko kufanelekile ukuba iqatshelwe.

Njengoko kuya kuchazwa kwizahluko ezizayo, kukho iindlela ezininzi apho kungasetyenziswanga okanye kuguqulwe amanqaku e-myofascial trigger points. Abanye oochwephesha bakhetha iindlela ezijongana nabo ngesandla, ngelixa abanye bekhetha ii-microcurrents okanye iindlela ze-electro-acupuncture okanye umahluko kule mixholo, ukanti abanye bacebisa ukunciphisa inani kunye nokuqina koxinzelelo - nokuba loluphi na uhlobo unika indlela ekhuselekileyo ukunciphisa impembelelo yokuququzelela kwintlungu.

Ukulandela olu ngqungquthela kumbono wempembelelo echaphazelekayo, ekhuthazwayo (eququzelelweyo) izakhiwo ze-neural, kuya kulungele ukubuza malunga nokuba kungenjalo okwenzekayo kwingqondo nakwintanethi ye-neural, njengoko kuchazwe nguGoldstein, akusikho nje ukuququzelela kwizinga elikhulu. Uludwe lweminye yeengcinga ezikhoyo ezikhoyo ezikhoyo ezikhoyo ngokuphathelele kwi-FMA kwiSahluko 4 sinokukhanyisa oku kwenzeka.

Uphando olongezelelweyo lwe-FMS

Uphando lwe-FMS lwasekuqaleni lufakwe kwifom yesifom kwiBhokisi 1.1. Iimpawu zoluphando, kunye nokuba ezinye zazo zihambelana njani nokufunyanwa kwezinto zakutshanje, zichazwe ngezantsi.

R. Gutstein, ugqirha wasePoland owafudukela e-UK ngaphambi kweMfazwe Yehlabathi yesiBini, wayengumphandi ophawulekayo owakhupha amaphepha phantsi kwamagama ahlukeneyo (MG Good, umzekelo) ngaphambili, ngexesha kunye nokulandela imfazwe. Phakathi kwabo uchaze ngokucacileyo inkcazo ye-myofascial trigger point, kunye nento eyaziwa ngokuba yi-fibromyalgia, kunye neyona mininzi yemigqaliselo yayo yokugcina nokugcina.

I-Gutstein (1956) ibonakalise ukuba iimeko ezinje nge-ametropia (impazamo kwiliso lokujonga amandla elenzeka kwi-myopia, hypermetropia kunye ne-astigmatism) zinokubangelwa lutshintsho kwicandelo le-neuromuscular lommandla we-craniocervical, kunye neemeko ezikude kakhulu ezibandakanya isinqe. okanye umbhinqo wamagxa. Uye wathi: yI-Myopia sisiphumo sexesha elide soxinzelelo kwimisipha engaphezulu kwe-ocular kumzamo wokudibana kwendawo yokuhlala kubandakanya ukubola kwemisipha ye-ciliary, kunye nomphumo wokudakumba kwamehlo. Ubudlelwane obulandelelanayo buye baboniswa phakathi kwaloo meko kunye nokuqaqanjelwa yimisipha yentamo

U-Gutstein ubize indawo ye-reflex wachonga i-odmyodysneuria kwaye wacebisa ukuba imeko ekubhekiswa kuyo yamabala anje okanye i-igtriggers ingabandakanya iintlungu, ukuguqulwa kwentlungu, ukurhawuzelela, ukuxhalaba komzimba kukhuthazo lomzimba, ispasm, ukujija, ubuthathaka kunye nokungcangcazela kwemisipha ebethelekileyo. okanye i-hypotonus yezihlunu ezigudileyo zemithambo yegazi kunye nezitho zangaphakathi, kunye / okanye i-hyper- okanye i-hyposecretion ye-visceral, sebaceous kunye ne-sudatory glands. Ukubonakaliswa kweSomatic kwathiwa kuyenzeka xa kuphendulwa inkuthazo ye-visceral yenqanaba lomqolo elihambelanayo (Gutstein 1944). Kuzo zonke ezi ngcebiso uGutstein ubonakala ngathi uyafana nomsebenzi kaKorr.

Indlela yonyango ka-Gutstein / ye-Goods ibandakanya inaliti yesisombululo se-anesthetic kwindawo yokuqala. Ucacisile, nangona kunjalo, ukuba apho kufikeleleka (umz. Ukufakwa kwezihlunu kwindawo yomlomo wesibeleko) ukuphola kwezi ndawo kudityaniswe noxinzelelo kuya kuvelisa iziphumo ezilungileyo.

Kule nto kwaye uninzi lwezinto azichazileyo ngoo-1940 noo-1950 uGutstein wayevumelana kakhulu neziphumo zophando zikaJohn Mennell (1952) kunye neTravell & Simons, njengoko kuchaziwe kwizicatshulwa zabo eziphambili ngalo mbandela (iTravell & Simons 1986 Ngo-1992). Uxele ukuba ukupheliswa kwezinto ezigqithileyo kunye nezifihlakeleyo kwindawo ye-occipital, yomlomo wesibeleko, ye-interscapular, ye-sternal kunye ne-epigastric ikhatshwa yiminyaka yokuncitshiswa kwe-premenopausal, menopausal kunye neempawu zokugqibela ze-menopausal (ezilungileyo 1951). Ucaphula inani leengcali eziphumelele ekunyangeni ukungasebenzi kakuhle kwamathumbu ngokususa indawo ezingasebenziyo. Ezinye zazo ziye zaphathwa ngokuthengwa, ezinye ngoxinzelelo loxinzelelo kunye nokusikwa (uCornelius 1903). Uye waxela uluhlu olubanzi lweempawu kunye neempawu zakudala ze-fibromyalgia, ecebisa igama elithi myodysneuria ngesi sifo, ekwabiza ngokuba yi-onnonarticular rheumatism (Gutstein 1955). Ekuchazeni i-myodysneuria (FMS), uGutstein ubonakalise ukusebenza kwendawo kunye / okanye ukungaqheleki kwemoto kwizicubu zemisipha kwaye wabona izizathu zolu tshintsho zininzi (Gutstein 1955). Uninzi lwezi zinto zifunyanisiweyo ziqinisekisiwe emva koko, ngakumbi ngumsebenzi weTravell kunye neSimon. Ziquka:

Infections usulelo olubi kunye nolunganyangekiyo, athe walwenza lwakhuthaza uvelwano lomsebenzi we-nerve ngokusebenzisa ityhefu

Heat ubushushu obugqithisileyo okanye ingqele, utshintsho kuxinzelelo lomoya kunye noyilo

Ukulimala ngoomatshini, kokubini okuphindaphindwayo okuncinci okuphindaphindayo okuqinisekisiweyo kuphando lwamva nje lukaNjingalwazi uPhilip Greenman weYunivesithi yaseMichigan State (Hallgren okqhubekayo ngo-1993)

Stra ubunzima bangasemva, ukuzivocavoca ngendlela engaqhelekanga, njl.njl., Enokuthi ibeke phambili kutshintsho lwexa elizayo ngokunciphisa umda wexesha elizayo (kule nto wayevumelana neendlela zokuqhuba njengoko kuchaziwe apha ngasentla)

Izinto ezinobungozi kunye / okanye i-endocrine ezinokubangela ukungalingani kwinkqubo ye-autonomic nervous

Izinto zokuzalwa ezenza ukuba ukuziqhelanisa noxinzelelo lwendalo kube nzima

Utshintsho lwe-arthritic olunokuthi lubangele iimfuno ezithile kwinkqubo ye-musculoskeletal's adaptation capacity

Izifo ze-visceral ezinokuqinisa kunye nokuthintela iimpawu ezithile kusasazo lomqolo kunye namacandelo akufutshane.

Sinokubona kule mizekelo yokucinga okuqinisekileyo kukaGutstein koququzelelo lwe-hypothesis kunyango lwe-osteopathic.

Ukuchongwa kukaGutstein kwe-myodysneuria kwenziwa ngokwezi nqobo zilandelayo:

inqanaba lokwahlukahlukana koxinzelelo lwezihlunu kunye nokuncipha kuhlala kubakho, nangona ngamanye amaxesha kufutshane, izicubu ezibonakala ngathi azichaphazeleki kubuhlungu

ubuntununtunu koxinzelelo okanye ukucofa imisipha echaphazelekayo kunye nezihlanganisi zazo

I-hypertonicity ephawulweyo inokufuna ukusetyenziswa koxinzelelo olunzulu ukubonisa intlungu.

Ngo-1947 iTravell neBigelow bavelisa ubungqina obuxhasa uninzi lwezinto ebezixeliwe nguGutstein (1944). Bakhombise ukuba amandla aphakamileyo okuphuma kwiindawo ezinamandla avelisayo avelisa, nge-reflex, i-vasoconstriction eyandisiweyo ene-ischaemia ekhethekileyo kwiindawo ezinobuchopho, intambo yomqolo, okanye izakhiwo zemithambo-luvo.

Umzekelo oxhaphakileyo wokungasebenzi kakuhle unokubangela, uchaphazele phantse naliphi na ilungu lomzimba. Iziphumo zophando zokuqala zinxibelelana kakuhle ne-fibromyalgia yale mihla kunye nophando lokudinwa okungapheliyo kunye noqikelelo lwe- neural network disorders njengoko kuchaziwe nguGoldstein (1996), nakuphando lwaseBritane nolweMelika olusebenzisa i-SPECT scan, ebonisa ngokucacileyo ukuba ukusilela kakhulu i-brainstem kunye nakwezinye iindawo zobuchopho babantu abaninzi abane-CFS kunye ne-FMS (Costa 1992).

Ukuphakanyiswa kwePathophysiology ye-Fibromyalgia / Fibrositis / Myodysneuria ephakanyisiweyo

Utshintsho olwenzeka kwizicubu ezibandakanyekayo ekuqaleni kwe-myodysneuria /fibromyalgia, ngokutsho kweG Gutstein, kucatshangelwa ukuba iqaliswe yi-predominance ehambelanayo, ehambelana neenguqu kwi-concentration ye-hydrogen ion kunye ne-calcium kunye ne-sodium balance in the water fluids (Petersen 1934). Oku kudibene ne-vasoconstriction kunye ne-hypoxia / ischaemia. Ubuhlungu bubekhokelela, wacinga, ngaba utshintsho oluchaphazela abaveleli beentlungu kunye nabanikazi bempahla.

Ukuqaqanjelwa yimisipha kunye nobunzima, i-nodular, i-tetanic contractions eyenzelwe indawo yezihlunu zemisipha, kunye ne-vasomotor kunye ne-musculomotor stimulation, zomelezelana, zenza umjikelo okhohlakeleyo wokuziqhubela phambili (iBayer 1950). Iipateni ezahlukeneyo nezintsonkothileyo zeempawu ezithunyelwayo zinokubangelwa zezi ndawo ze-igtrigger , kunye neentlungu zalapha kunye nokuphazamiseka okuncinci. Iimvakalelo ezinje ngokuqaqanjelwa, ukuba buhlungu, ukuthamba, ubunzima kunye nokudinwa kunokubonakala konke, njengokulungiswa kwemisipha ngenxa yokuncipha, okukhokelela kuxinzelelo, ukuqina, ukudumba njalo njalo.

Kucacile kwesi shwa nkathelo somsebenzi wakhe uG Gutstein wayechaza fibromyalgia, kunye nezinto ezininzi ezinokwenza izinto ezinokubangela.

Isahluko 2 sivavanya oko i-FMS, kunye noko kungenjalo, kunye neziphakamiso zokuxilongwa ngokuhlukileyo.