Intloko ze-Migraine zithathwa njengenye yezona zifo eziphazamisayo xa kuthelekiswa neminye imiba yempilo eqhelekileyo. Ngokuqhelekileyo kubangelwa ukuxinezeleka, iimpawu ze-migraines, kubandakanywa ubuhlungu beentloko ezidambisayo, ukuqonda ukukhanya nokuvakala kunye nesisongululo, sinokuchaphazela ngokuphawulekayo umgangatho wobomi wobomi. Nangona kunjalo, uphando olwenziwe uphando lufumene ukuba unyango lwe-chiropractic lunokunceda ukunciphisa ubukhulu kunye nobukhulu beentlungu zakho ze-migraine. Uninzi lweengcali zonyango luye lwabonisa ukuba ukuguqulwa kwamagqabi, okanye ukuxilongwa, kungabangela ukuba intlungu ibuhlungu. Injongo yendiqendu engezantsi kukubonisa imilinganiselo yempatho ye-chiropractic yonyango yokuguqula umlenze.

 

Unyango lwe-Chiropractic Spinal Manipulative Therapy for Migraine: aBathathu, abaXhobileyo, abangatshatanga? Abangaboniyo, i-Placebo, iTrone elawulwa ngokungaQhelekanga

 

Abstract

 

• Imvelaphi kunye nenjongo: Ukuphanda i-efficacy ye-chiropractic ye-spinal manipulative therapy (CSMT) ye-migraineurs.
• Iindlela: Le nto yayiza kubakho abathathu abaxhobileyo, abangatshatanga abangaboniyo, i-placebo, isilingo esilawulwa ngokungahleliwe (RCT) seenyanga ezili-17 ezibandakanya i-104 migraineurs kunye nokuhlaselwa okungenani kwe-migraine ngenyanga. I-RCT yaqhutywa kwisibhedlele iAkershus University, eOslo, eNorway. Unyango olusebenzayo lwalune-CSMT, ngelixa i-placebo yayisisinyanzelo sokuqhubela phambili komda we-scapula kunye / okanye nommandla wobukhazikhazi. Iqela lolawulo liqhubekile nolawulo lwazo oluqhelekileyo lweyeza. I-RCT ibandakanya inyanga enye ebalekayo? Kwi, iinyanga ezi-1 zongenelelo kunye namanyathelo esiphumo ekupheleni kongenelelo olo nakwiinyanga ezi-3, 3 ne-6 ezilandelelweyo. Indawo yokugqibela yayinani leentsuku ze-migraine ngenyanga, ngelixa amanqaku okuphela kwesibini yayilixesha le-migraine, amandla e-migraine kunye nesalathiso sentloko, kunye nokusetyenziswa kwamayeza.
• iziphumo: Iintsuku ze-Migraine zancitshiswa kakhulu kuwo omathathu amaqela ukusuka kwisiseko ukuya kwiposi yonyango (P <0.001). Iziphumo ziyaqhubeka kwiqela le-CSMT kunye ne-placebo kuwo onke amaxesha okulandela, ngelixa iqela lolawulo libuyela kwisiseko. Ukuncitshiswa kweentsuku ze-migraine kwakungahlukanga kangako phakathi kwamaqela (P> 0.025 yokunxibelelana). Ixesha le-Migraine kunye nesalathiso seentloko zancitshiswa kakhulu kwi-CSMT kuneqela lolawulo ukuya esiphelweni sokulandela? (P = 0.02 kunye P = 0.04 yokunxibelelana, ngokulandelanayo). Iziganeko ezimbi zazimbalwa, zincinci kwaye zidlulile. Ukumfama kwagcinwa ngamandla kwi-RCT.
• Izigqibo: Kuyenzeka ukuba uqhube i-RCT yonyango kunye ne-placebo efihliweyo. Iziphumo ze-CSMT eziqwalaselwe kwisifundo sethu mhlawumbi kungenxa yempendulo ye-placebo.
• Internet: i-chiropractic, i-headache, i-migraine, ilingo elilawulwa ngononophelo, unyango olusisigxina

 

Insight of Dr. Alex Jimenez

Intlungu yentlungu kunye neentloko ziyesithathu isizathu esivakalayo abantu bafuna unyango lwe-chiropractic. Uninzi lweengxelo zophando lubonise ukuba unyango lwe-chiropractic unyango olusisigxina lugqirha olukhuselekileyo nolunefuthe lwenyango ye-migraines. Ukunyamekela kwe-Chiropractic inokulungisa ngokuchanekileyo nayiphi na impazamo yokuguqulwa kwamagciwane, okanye i-subluxation, efunyenwe kunye nobude bomgudu, oboniswe ukuba ngumthombo wokubamba intloko. Ukongezelela, ukuguqulwa komgudu kunye nokusetyenziswa kwemigaqo kunokuncedisa ukunciphisa uxinzelelo noxinzelelo lwe-muscle ngokunciphisa inani loxinzelelo olubekwe kwiinkqubo eziyinkimbinkimbi zomgudu ngenxa yesiphumo sokuguqulwa kwamagqabi, okanye ukuxilongwa. Ngokuguqula umgudu kunye nokunciphisa uxinzelelo kunye nokuxhatshazwa kwemisipha, ukunakekelwa kwe-chiropractic kunokuphucula iimpawu zentsholongwane kunye nokunciphisa ixesha labo.

 

intshayelelo

 

Iindleko zentlalo noqoqosho ze-migraine zikhulu kakhulu ngenxa yokuxhaphaka okuphezulu kunye nokukhubazeka ngexesha lokuhlaselwa [1, 2, 3]. Unyango olunamandla lwe-pharmacological luhlala lukhetho lokuqala kunyango lwe-migraine kubantu abadala. I-Migraineurs ngokuhlaselwa rhoqo, ukungonelanga kwesiphumo kunye / okanye ukuphikiswa kunyango olunamandla ngabagqatswa abanokubakho kunyango lweprophylactic. Unyango lwe-Migraine prophylactic ludla ngokuba yi-pharmacological, kodwa unyango olusesikweni aluyinto engaqhelekanga, ngakumbi ukuba unyango lwe-pharmacological luyasilela okanye ukuba isigulana sifuna ukunqanda amayeza [4]. Uphando lucebise ukuba unyango lwe-spinal manipulative unyango lunokukhuthaza iinkqubo ze-neural inhibitory kumanqanaba ahlukeneyo omqolo womqolo kuba inokuvula iindlela ezahlukeneyo zokuhla kumbindi [5, 6, 7, 8, 9, 10].

 

Izilingo ezilawulwa ngokungenamthetho ze-Pharmacological (RCTs) zihlala ziphindwe kabini, kodwa oku akunakwenzeka kwi-RCTs yonyango, njengoko ugqirha ongenelelayo engenakumfanyekiswa. Okwangoku akukho sivumelwano malunga nenkqubo ye-sham kwi-RCTs yonyango olingisa indawo ye-placebo kwii-RCTs ze-pharmacological [11]. Ukungabikho kwenkqubo efanelekileyo ye-sham ngumqobo omkhulu kuzo zonke i-RCTs zonyango zangaphambili [12, 13]. Kungekudala, senze inkqubo ye-sham chiropractic spinal manipulative therapy (CSMT), apho abathathi-nxaxheba abane-migraine bengakwazanga ukwahlula phakathi kwe-CSMT yokwenyani kunye ne-sham emva kovavanyo ngalunye lwe-12 kwisithuba senyanga esi-3 [14].

 

Iinjongo zokuqala zolu phononongo yayikukuqhuba incwadana yokunyanga emithathu, exhobileyo, engaboniyo, i-RCT ye-placebo ye-migraineurs enemigangatho yendlela efanayo naleyo ye-RCTs ye-pharmacological.

 

Injongo yesibini yayikuhlola ukuphumelela kwe-CSMT ngokubhekiselele ekutshatsheni kwe-sham (placebo) kunye ne-CSMT ngokuchasene nokulawula, okt abathathi-nxaxheba abaqhubeka nokuphathwa kwabo ngokuqhelekileyo kwemithi.

 

tindlela

 

IsiCwangciso soFundo

 

Uphononongo lwalunezixhobo ezithathu ezixhobileyo, ezingatshatanga, ezingaboniyo, i-placebo RCT ngaphezulu kweenyanga ezili-17. I-RCT ibandakanya isiseko senyanga enye ye-1, iiseshoni zonyango ze-12 ngaphezulu kweenyanga ze-3 ngamanyathelo okulandela emva kongenelelo, i-3, i-6 kunye ne-12 inyanga kamva.

 

Abathathi-nxaxheba babekho, phambi kokuba kusetyenziswe isiseko, ngokulandelelana ngokulinganayo kumaqela amathathu: i-CSMT, indawo ye-placebo (ukunyanzeliswa kwe-sham) kunye nokulawula (baqhubeka nokuphathwa kwabo ngokuqhelekileyo kwezemithi).

 

Uyilo lwesifundo luhambelana neziphakamiso ze-International Headache Society (IHS) kunye ne-CONSORT (iSithasiselo S1) [1, 15, 16]. IKomiti yesiFunda yaseNorway ye-Ethics Research Ethics kunye neNorway Social Science Data Services ivume le projekthi. I-RCT ibhaliswe kwiClinikiTrials.gov (i-ID engeyiyo: NCT01741714). Iprotocol epheleleyo yesilingo ishicilelwe ngaphambili [17].

 

nxaxheba

 

Abathathi-nxaxheba baqeshwe ukususela ngoJanuwari ukuya kuSeptemba 2013 ngokukodwa ngeSebe le-Neurology, kwisibhedlele sase-Akershus University. Abanye abathathi-nxaxheba baphinde baqeshwe ngabaSebenzi abaPhezulu baseAkershus nase-Oslo Counties okanye ntengiso yeendaba. Bonke abathathi-nxaxheba bafumene ulwazi oluposisiwe malunga neprojekthi elandelwa ngudliwano-ntanethi.

 

Abathathi-nxaxheba abafanelekileyo babengama-migraineurs aneminyaka eli-18 ukuya kwengama-70 ubudala benokuhlaselwa kube kanye ngenyanga kwaye bavunyelwa ukuba babenengxaki yokuchaphazeleka kwentloko kodwa kungabikho zintloko ziphambili. Bonke abathathi-nxaxheba bafunyaniswe ukuba ngugqirha wezonyango onamava okuxilongwa kwentloko ngexesha lodliwanondlebe kunye noHlulelo lwaMazwe ngaMazwe lweNgxaki zeNtloko? II (ICHD? II)

 

Iikhrayitheriya zokukhutshelwa ngaphandle zazichasene nonyango lomqolo, i-spinal radiculopathy, ukukhulelwa, uxinzelelo kunye ne-CSMT kwiinyanga ezili-12 ezidlulileyo. Abathathi-nxaxheba abafumana unyango olusebenzayo [18], batshintshe unyango lwabo lwe-migraine okanye bakhulelwa ngexesha le-RCT baxelelwa ukuba baya kurhoxiswa kuphononongo ngelo xesha kwaye bathathwe njengophumileyo. Abathathi-nxaxheba bavunyelwe ukuba baqhubeke kwaye batshintshe amayeza e-migraine abukhali ngalo lonke ixesha lokufunda.

 

Abathathi-nxaxheba abafanelekile bamenywa kwingxoxo-ndlebe kunye novavanyo lomzimba kuquka nophando olunzulu lomgca wecala lomhlaza (AC). Abathathi-nxaxheba abangabandakanyiyo kwi-CSMT okanye iqela le-placebo banombuzo opheleleyo weemviwo zengqondo.

 

Randomization kunye neMasking

 

Emva kokufunyanwa kwemvume ebhaliweyo, abathathi-nxaxheba babekwa ngokulinganayo kwesinye sezixhobo zokufunda ezintathu ngokuzoba iqashiso elinye. Amaqashiso atywinwe ngenani kunye neengalo ezintathu zokufunda zahlulwahlulwa zangamacandelwana amane ngokobudala kunye nesini, okt 18 39 okanye 40-70 iminyaka, kunye namadoda okanye abasetyhini.

 

Emva kweseshoni nganye yonyango, abathathi-nxaxheba kwi-CSMT kunye neqela le-placebo bagcwalisa iphepha lemibuzo malunga nokuba bakholelwa na ukuba unyango lwe-CSMT lufunyenwe, kwaye baqiniseke kangakanani ukuba unyango olusebenzayo lufunyenwe kwinqanaba le-0-10 yenani lamanani, apho i-10 imele ukuqiniseka okuqinisekileyo [14].

 

Zomibini i-randomization kunye ne-questionnaire eyimfama yenziwa kuphela yinkampani yangaphandle.

 

Ngoncedo

 

Iqela le-CSMT lafumana unyango lwe-spinal manipulative esebenzisa indlela kaGonstead, unxibelelwano oluthile, isantya esiphezulu, isantya esiphantsi, isinqe esifutshane somqolo ongenaso nesithuba sokulungiswa kohlengahlengiso olwalujolise kukungasebenzi kakuhle komqolo (indlela epheleleyo yomqolo) njengoko kufunyaniswe ngumgangatho Uvavanyo lwe-chiropractic kwiseshoni nganye yonyango nganye [19].

 

Iqela le-placebo lifumene ubuqhetseba be-sham, unxibelelwano olubanzi olungachazwanga ngokuthe ngqo, isantya esisezantsi, islow? Amplitude sham push maneuver in a non-mandional and non- therapeutic directional line of the lateral edge of the scapula and / or gluteal region [14 ]. Lonke unxibelelwano olunganyangiyo lwenziwa ngaphandle kwekholamu yomqolo kunye nokudibanisa okwaneleyo kunye nangaphandle kwethishu yethishu ethambileyo ukuze kungabikho mingxunya idibeneyo yenzekileyo. Ezinye iindlela zokusebenzisa ngobuqhetseba zazibekiwe ngaphambili kwaye zatshintshana ngokulinganayo phakathi kwabathathi-nxaxheba be-placebo ngokomgaqo olandelwayo ngexesha lokunyanga ngeveki le-12 ukomeleza ubunyani besifundo. Inkqubo ye-placebo ichazwe ngokweenkcukacha kwinkqubo yolingo ekhoyo [17].

 

Iseshoni ngasinye sokungenelela sagcina i-15 min kunye namaqela omabini anamava afanayo kunye novavanyo lokunyakaza ngaphambi kokuba emva kokungenelela. Ayikho enye ingenelelo okanye iingcebiso ezinikwe abathathi-nxaxheba ngexesha lokuvavanya. La mabini maqela athola ukungenelela kwisibhedlele saseAkershus kwiYunivesithi ye-chiropractor (one-experience).

 

Iqela lolawulo laqhubeka nokuphathwa kwabo ngokwemvelo ngaphandle kokufumana ukungenelela kwangoku kwincwadi yecandelo lophando.

 

Iziphumo

 

Abathathi-nxaxheba bazalise i-diary heading diagnosis heading kulo lonke uphando kwaye babuyisela rhoqo ngenyanga [20]. Kwimeko yeidayari ezingasetyenziswanga okanye idatha elahlekileyo, abathathi-nxaxheba baqhagamshelana ngefowuni ukukhusela ukuthotyelwa.

 

Isiphelo sokugqibela sasinani leentsuku ze-migraine ngenyanga (iintsuku ezingama-30 / inyanga). Ubuncinci i-25% yokuncitshiswa kweentsuku ze-migraine ukusuka kwisiseko ukuya esiphelweni songenelelo, kunye nenqanaba elifanayo eligcinwe kwi-3, 6 kunye ne-12 yeenyanga ezilandelwayo kulindeleke kwiqela le-CSMT.

 

Amanqaku okuphela kwesekondari yayilixesha le-migraine, amandla e-migraine kunye ne-index index (HI), kunye nokusetyenziswa kwamayeza. Ubuncinci i-25% yokuncitshiswa kwexesha, amandla kunye ne-HI, kwaye ubuncinci i-50% yokuncitshiswa kokusetyenziswa kwamayeza kulindeleke ukusuka kwisiseko ukuya esiphelweni songenelelo, kwinqanaba elifanayo eligcinwe kwi-3, 6 kunye ne-12 yeenyanga ezilandelelweyo kwiqela le-CSMT.

 

Akukho lutshintsho lwalulindelwe kwindawo yokuphela kunye neyesibini kwindawo ye-placebo kunye neqela lolawulo.

 

Usuku lwe-migraine luchazwe njengosuku apho i-migraine ene-aura, i-migraine ngaphandle kwe-aura okanye i-migraine enokwenzeka yenzekile. Uhlaselo lwe-Migraine oluhlala ixesha elide> i-24 h yabalwa njengolo hlaselo lunye ngaphandle kokuba iintlungu ziyekelele? Ukuba isiguli silele ngexesha lokuhlaselwa kwe-migraine kwaye savuka ngaphandle kwe-migraine, ngokungqinelana ne-ICHD? III?, Ixesha lokuhlaselwa lalibhalwa njengeqhubeka kude kube lixesha lokuvuka [48]. Ubuncinci bexesha lokuhlaselwa kwe-migraine yayiyi-21 h ngaphandle kokuba kwasetyenziswa i-triptan okanye ichiza eliqukethe i-ergotamine, kwimeko apho sachaza ubuncinci bexesha. I-HI ibalwe njengentsingiselo yeentsuku ze-migraine ngenyanga (iintsuku ezingama-22) - kuthetha ubude be-migraine (h / ngosuku) - kuthetha ukuba namandla (4 30 amanani okulinganisa amanani).

 

Indawo zokugqibela kunye nezesekondari amanqaku akhethwe ngokusekwe kwiQela loMsebenzi le-IHS Clinical Trial Subcommittee's trial trial guidelines [1, 15]. Ngokusekwe kuphononongo lwangaphambili kwi-migraine, ukuncitshiswa kwe-25% kwathathelwa ingqalelo njengoluqikelelo lokugcina [12, 13].

 

Uhlalutyo lweziphumo lubalwe ngeentsuku ezingama-30 emva kweseshoni yokungenelela yokugqibela kunye neentsuku ezingama-30 emva kwexesha lokulandela, okt i-3, 6 kunye ne-12 inyanga ngokwahlukeneyo.

 

Zonke iziganeko ezimbi (ii-AEs) zarekhodwa emva kokungenelela nganye ngokuhambelana neengcebiso ze-CONSORT kunye ne-IHS Task Force kwi-AE kwimvavanyo ye-migraine [16, 23].

 

Uhlalutyo lweSatisati

 

Sisekelwe ekubaleni kwamandla kwiphando olutshanje lwe-topiramate kwi-migraineurs [24]. Sifumanisa umlinganiselo ophakathi kokunciphisa inani le-migraine ngeentsuku phakathi kwendawo esebenzayo kunye ne-placebo, kunye phakathi kwamaqela asebenzayo kunye nolawulo lweentsuku ze-2.5, kunye ne-SD ye-2.5 yokunciphisa iqela ngalinye. Njengoko uhlalutyo oluphambili lubandakanya ukuqhathaniswa kweqela ezimbini, izinga lokubaluleka libekwe kwi-0.025. Ngenxa yamandla e-80%, ubungakanani beesampuli zezigulane ze-20 zafuneka kwiqela ngalinye ukuba zibone ukuhlukana okukhulu ekunciphiseni iintsuku ze-2.5.

 

Iimpawu zesigulana kwisiseko zaziswa njengeendlela kunye ne-SD okanye ii-frequency kunye neepesenti kwiqela ngalinye kwaye kuthelekiswa neesampulu ezizimeleyo zovavanyo kunye? Uvavanyo lwe-2.

 

Iiprofayili zexesha lokuphela kwamanqaku athelekiswa phakathi kwamaqela. Ngenxa yokuphindaphindwa kwemilinganiselo kwisigulana ngasinye, iimodeli ezixubeneyo ezixubeneyo ezenza ukwahluka ngaphakathi kuye kwaqikelelwa kuwo onke amanqaku. Iziphumo ezizinzileyo zexesha (elingelolayini), ulwabiwo lweqela kunye nokunxibelelana phakathi kwezi zimbini zibandakanyiwe. Iziphumo ezingaqhelekanga kwizigulana kunye namathambeka angenisiwe kwimodeli. Njengoko iintsalela bezitsaliwe, i-bootstrap inference isekwe kwiisampulu ezili-1000 ezisebenzisanayo. Ukuthelekisa ngababini kwenziwa ngokufumana ixesha elichaseneyo lamaqela kwiqela ngalinye ngexesha ngalinye elinamaxabiso ahambelana ne-P kunye nama-95% amaxesha okuzithemba. Ukusetyenziswa kwamayeza phakathi kwamaqela kwaxelwa ngeedosi ezithetha nge-SD, kwaye amaqela athelekiswa novavanyo oluzimeleyo lweesampulu. Idosi ichazwe njengolawulo olunye lwe-triptan okanye i-ergotamine; Iparacetamol 1000 mg codeine; iziyobisi ezichasayo ezingasebenziyo (tolfenamic acid, 200 mg; diclofenac, 50 mg; aspirin, 1000 mg; ibuprofen, 600 mg; naproxen, 500 mg); kunye ne-morphinomimetics (tramadol, 50 mg). Akukho namnye kwizigulana otshintshe ingalo yokufunda kwaye akukho namnye ophumayo oye wazaliswa kwidayari zentloko emva kokurhoxa kufundo. Yiyo loo nto, kuphela kuvavanyo lomgaqo olandelwayo olufanelekileyo.

 

Uhlalutyo lwalumfanyekisiwe kulwabiwo lonyango kwaye lwenziwa kwi-SPSS v22 (IBM Corporation, Armonk, NY, USA) kunye ne-STATA v14 (JSB) (StataCorp LP, Station Station, TX, USA). Inqanaba elibalulekileyo le-0.025 lisetyenziselwe indawo yokugqibela, ngelixa kwenye indawo inqanaba le-0.05 lalisetyenziswa.

 

Zokuziphatha

 

Izikhokelo zeeklinikhi ezilungileyo zalandelwa [25]. Ulwazi olumlomo nolwabhaliweyo malunga neprojekthi lunikeziwe kwangaphambili kokufakwa kunye nokwabiwa kweqela. Imvume ebhaliweyo yafunyanwa kubo bonke abathathi-nxaxheba. Abathathi-nxaxheba kwi-placebo kunye neqela lolawulo bathenjiswe unyango lwe-CSMT emva kwe-RCT, ukuba ingenelelo elisebenzayo lufunyenwe lusebenza. I-inshurensi yanikezwa ngeNorway System of Compensation kwaMagulane (Isiguliso seMpilo esiLawulayo), umzimba ozimeleyo wesizwe ohlawula izigulane ezenzakaliswe ngonyango olunikezelwa inkonzo yezempilo yaseNorway. Umgaqo wokumisa uchazwe ukuba uhoxise abathathi-nxaxheba beli phofu ngokuhambelana neengcebiso kwiNTSHONO YOKUKHUTSHELWA kweNgxelo yoLungiso lweHarms [26]. Zonke ii-AE zajongwa ngexesha lokungenelela kwaye zenzeke njengoko zenzeke ngokulandela iziphakamiso ze-CONSORT kunye ne-IHS Task Force kwi-AE kwimvavanyo ye-migraine [16, 23]. Kwimeko enzima ye-AE, umntu othabatha inxaxheba uza kuhoxiswa ekufundeni aze abhekiswe kwiSebe eliPhezulu okanye kwisibhedlele esiphuthumayo ngokubhekiselele kumcimbi. Umphenyi (AC) wayefumaneka ngefowuni ephathekayo nanini na ixesha kulo lonke ixesha lokunyanga.

 

iziphumo

 

Umzobo 1 bonisa itshathi yokuhamba ye-104 migraineurs ebandakanyiwe kufundo. Isiseko kunye neempawu zedemografi zazifana ngokwamaqela amathathu (1 Table).

 

 

 

Izisiphumo

 

Iziphumo kuwo onke amanqaku okuphela zinikezelwe ku Ikhiwane. 2a d kunye neeTheyibhile 2, 3, 4.

 

 

 

 

 

Inqaku lokuphela kweprayimari. Iintsuku ze-Migraine zancitshiswa kakhulu kuwo onke amaqela ukusuka kwisiseko ukuya kwiposi yonyango (P <0.001). Iziphumo zaqhubeka kwi-CSMT kunye namaqela e-placebo kwi-3, 6 kunye ne-12 iinyanga zilandelelana, ngelixa iintsuku ze-migraine zibuyiselwe kwinqanaba lokuqala kwiqela lolawulo (Ikhiwane. 2a). Imodeli exubeneyo emxinwa ayibonisanga umahluko opheleleyo otshintsho kwiintsuku ze-migraine phakathi kwe-CSMT kunye namaqela e-placebo (P = 0.04) okanye phakathi kwe-CSMT kunye neqela lolawulo (P = 0.06; 2 Table). Nangona kunjalo, ukuthelekiswa kwamacala amabini ngamaxesha athile kubonise umahluko obonakalayo phakathi kwe-CSMT kunye neqela lolawulo ngawo onke amaxesha amanqaku aqala ngeposi? Unyango (3 Table).

 

Amanqaku okuphela kwesekondari. Kwakukho ukuncitshiswa okubonakalayo ukusuka kwisiseko ukuya kuposi? Kunyango kubude bemigraine, amandla kunye ne-HI kwi-CSMT (P = 0.003, P = 0.002 kunye neP <0.001, ngokwahlukeneyo) kunye ne-placebo (P <0.001, P = 0.001 kunye neP < 0.001, ngokwahlukeneyo) amaqela, kwaye isiphumo saqhubeka kwi-3, 6 kunye ne-12 iinyanga zilandela?

 

Ukwahlukana okubalulekileyo phakathi kwe-CSMT kunye namaqela okulawula kwakutshintsho kwisigidi semigraine (P = 0.02) nakwi-HI (P = 0.04; Ithebula 2).

 

Kwiinyanga ezili-12 ezilandelwayo, utshintsho ekusebenziseni iparacetamol lwalusezantsi kakhulu kwiqela le-CSMT xa kuthelekiswa ne-placebo (P = 0.04) kunye nolawulo (P = 0.03) amaqela (4 Table).

 

Ukufumba. Emva kweseshoni nganye yokungenelela eyi-12,> i-80% yabathathi-nxaxheba bakholelwa ukuba bayifumene i-CSMT ngaphandle kokunikezelwa kweqela. Umlinganiso wobungakanani bokukholelwa ukuba unyango lwe-CSMT lwafunyanwa yayiyi-10 kuzo zonke iiseshoni zonyango kuwo omabini amaqela (yonke i-P <0.001).

 

Imiphumo emibi. Inani elipheleleyo lama-703 eeseshoni zongenelelo ezingama-770 zavavanywa kwii-AEs (355 kwiqela le-CSMT kunye ne-348 kwiqela le-placebo). Izizathu zovavanyo lwe-AE oluphosakeleyo ziye zayekwa okanye zaphoswa ziiseshoni zongenelelo. Ii-AEs beziphindaphindeka rhoqo kwi-CSMT kuneeseshoni zongenelelo lwe-placebo (83/355 vs. 32/348; P <0.001). Ithenda yengingqi yayiyeyona i-AE ixhaphakileyo exelwe yi-11.3% (95% CI, 8.4-15.0) kwiqela le-CSMT kunye ne-6.9% (95% CI, 4.7-10.1) kwiqela le-placebo, ngelixa ukudinwa kusuku lokungenelela nentlungu yentamo. zichazwe nge-8.5% kunye ne-2.0% (95% CI, 6.0-11.8 kunye ne-1.0 4.0), kunye ne-1.4% kunye ne-0.3% (95% CI, 0.6 3.3 kunye ne-0.1 1.9) ngokwahlukeneyo. Zonke ezinye ii-AEs (iintlungu ezisezantsi, ubuso obungenanjongo, isicaphucaphu, ukuhlaselwa kwe-migraine kunye nokudinwa kwiingalo) zazinqabile (<1%). Akukho zi-AE zinzima okanye zinobungozi ezichaziweyo.

 

ingxoxo

 

Kulwazi lwethu, le yincwadi yokuqala yonyango i-RCT enempumelelo ebhalwe ngamehlo. I-RCT ye-placebo ivavanye ukusebenza kwe-CSMT kunyango lwe-migraine ngokuchasene ne-placebo (sham chiropractic) kunye nolawulo (unyango lwe-pharmacological yesiqhelo). Iziphumo zabonisa ukuba iintsuku ze-migraine zancitshiswa kakhulu kuwo omathathu amaqela ukusuka kwisiseko ukuya kunyango? Iziphumo ziyaqhubeka kwi-CSMT kunye neqela le-placebo kuwo onke amaxesha alandelayo, ngelixa iqela lolawulo libuyela kwisiseko. Ii-AEs zazithambile kwaye zidlulile, ngokuhambelana nezifundo zangaphambili.

 

Uyilo lokufunda lubambelele kwizindululo ze-RCTs ze-pharmacological njengoko zinikezwe yi-IHS kunye ne-CONSORT [1, 15, 16]. Unyango? Unyango lwe-RCTs lunemiqobo emithathu xa kuthelekiswa nee-RCTs zeekhemesti. Okokuqala, akunakwenzeka ukumfamekisa umphandi ngokunxulumene nonyango olusetyenzisiweyo. Okwesibini, imvumelwano yonyango lwe-inert placebo iyasilela [11]. Okwesithathu, iinzame zangaphambili zokubandakanya iqela le-placebo lishiye ukuqinisekisa ukungaboni, ngenxa yoko, kuhlala kungaziwa nokuba unyango olusebenzayo kunye ne-placebo lwalufihliwe [27]. Ngenxa yale mingeni sagqiba ekubeni siqhube i-RCT exhobileyo, engatshatanga, eyayibandakanya iqela elilawulayo eliqhubeka nonyango oluqhelekileyo lonyango ukuze sifumane umqondiso wobukhulu bempendulo ye-placebo.

 

Kucetyisiwe ukuba, kwii-RCTs ze-placebo ezingaboniyo kabini, yi-50% kuphela eya kukholelwa ukuba ifumana unyango olusebenzayo kwiqela ngalinye, ukuba ukungaboni kakuhle kulungile. Nangona kunjalo, oku akunakuba yinyani kwi-RCTs yonyango, kuba amandla asebenzayo kunye ne-placebo ashukumisayo anokubakho ngakumbi kunethebhulethi [28]. Umphandi omnye unciphisa ukungafani komphenyi ngokunika ulwazi olufanayo kubo bonke abathathi-nxaxheba kwaye kuyacetyiswa ngokubanzi ukuba ungenelelo lwe-placebo kufuneka lufane nonyango olusebenzayo ngokwenkqubo, ixesha lokunyanga kunye nexesha elichithwe nomphenyi ukuvumela ulindelo olufanayo kuwo omabini amaqela [28]. Ukubaluleka kokumfamekisa ngempumelelo kuyagxininiswa yinto yokuba zonke i-RCTs zonyango zangaphambili kwi-headache zine-placebo. Ke, siyakholelwa ukuba iziphumo zethu ezixoxwe ngezantsi zisebenza kwinqanaba elifanayo ne-RCT ye-pharmacological [14].

 

Idatha enokuthenjwa ithembeke ngakumbi kunedatha ebuyayo ngokubhekisele ekukhetheni ukukhumbula; nangona kunjalo, ukungathobeli kunokuba ngumceli mngeni, ngakumbi ekupheleni kwesifundo. Siyakholelwa ekubeni unxibelelwano rhoqo phakathi kwabathathi-nxaxheba kunye nomphenyi, kubandakanya unxibelelwano lwenyanga nenyanga kwixesha lokulandela, mhlawumbi kugcinwe ukuthotyelwa okuphezulu kwisifundo sethu sonke.

 

Nangona isampulu yethu yokufunda yaphela ngabathathi-nxaxheba abangama-104 kula maqela mathathu, ukubalwa kwamandla kunye nenqanaba eliphezulu lokugqitywa kwenkxaso yedatha ephunyeziweyo isemthethweni kubemi abaphandiweyo. Indlela yeGonstead isetyenziswa yi-59% ye-chiropractors [19] kwaye, ngenxa yoko, iziphumo ziyafumaneka ngokubanzi kulo msebenzi. Ukuqinisekiswa kwesifo sesinye sezona zinto zisomeleleyo njengoko phantse bonke abathathi-nxaxheba babesele befunyaniswe yi-neurologist ngokwe-ICHD? II [2]. Ngokuchasene ne-RCTs yangaphambili ye-chiropractic migraine ebithathe abathathi-nxaxheba ngamajelo eendaba njengamaphephandaba kunye nentengiso kanomathotholo [12], uninzi lwabathathi-nxaxheba bethu baqeshwa kwiSebe le-Neurology, kwisibhedlele i-Akershus University, bebonisa ukuba i-migraineurs inokuhlaselwa rhoqo kunzima ukunyanga kunabantu ngokubanzi, njengoko babethunyelwe nguGqirha Jikelele kunye / okanye noqheliso lweeurologist. Ke ngoko, isifundo sethu simele ikakhulu iklinikhi yenqanaba labemi, kwaye isiphumo sinokuba sahlukile ukuba abathathi-nxaxheba babebanjiwe kubemi ngokubanzi. Ipesenti yentlungu yentamo ifunyenwe iphezulu kwizigulana ezine-migraine [29] kwaye, ke, ipesenti ephezulu yeentlungu zomqolo ezingafunekiyo kwisifundo sethu inokuba yinto ephikisayo ebonwe kwiintsuku ze-migraine.

 

Incwadana yesithathu ye-pragmatic chiropractic? Unyango lwe-RCTs kusetyenziswa ubuchule obahlukileyo obenziwe ngaphambili kwimigraineurs [12, 30, 31, 32]. I-RCT yase-Australia ibonakalise ngaphakathi kweqela ukunciphisa i-migraine frequency, ubude kunye namandla e-40%, 43% kunye ne-36%, ngokwahlukeneyo, kwiinyanga ezi-2 ezilandelwayo [30]. Uphononongo lwaseMelika lufumene imvama ye-migraine kunye namandla okunciphisa ngaphakathi kweqela nge-33% kunye ne-42%, ngokwahlukeneyo, kwinyanga eyi-1 yokulandela [31]. Olunye uphando lwase-Australia, eyayikukuphela kwe-RCT yokubandakanya iqela elilawulayo, okt i-ultrasound efumanekileyo, yafumana ngaphakathi ukunciphisa iqela lokuphindaphindeka kwemigraine kunye nobude be-35% kunye ne-40%, ngokwahlukeneyo, kwiinyanga ezi-2 ezilandelelanayo kwiqela le-CSMT, xa kuthelekiswa nokuncitshiswa kweqela ngaphakathi kwe-17% kunye ne-20% kwiqela lolawulo, ngokwahlukeneyo [32]. Ukuncitshiswa kweentsuku ze-migraine kwakufana nokwethu (i-40%) kwiqela le-CSMT ukusuka kwisiseko ukuya kwiinyanga ezi-3 ezilandelelweyo, ngelixa ubude be-migraine kunye nokuqina bekuncitshisiwe kwiinyanga ezi-3 zokulandela, okt i-21% kunye ne-14%, ngokwahlukeneyo. Ukuthelekiswa kwexesha elide akunakwenzeka njengoko kungekho kwizifundo zangaphambili ezibandakanya ixesha elilandelelweyo lokulandela. Uyilo lwethu lwesifundo kubandakanya ukusebenza okuqinisekileyo kwangaphakathi kusivumela ukuba sitolike isiphumo esibonwe njengempendulo ye-placebo.

 

I-RCT yethu yayinee-AE ezimbalwa xa kuthelekiswa nezifundo zonyango zangaphambili, kodwa ezinje ngokuhamba kancinci kunye nobumnene [33, 34, 35, 36, 37, 38, 39]. Nangona kunjalo, yayingaxhotyiswanga ngokwaneleyo ukufumana i-AEs ezinqabileyo. Xa kuthelekiswa, ii-AEs kwi-pharmacological migraine prophylactic placebo RCTs zixhaphakile kubandakanya ii-AEs ezingezozobulali nezingezizo [40, 41].

 

isiphelo

 

Ukumfamekisa kwaqiniswa ngamandla kuyo yonke i-RCT, ii-AE zazimbalwa kwaye zinobulali, kwaye isiphumo kwiqela le-CSMT kunye ne-placebo mhlawumbi yayiyimpendulo ye-placebo. Ngenxa yokuba abanye abantu abanganyamezeliyo abanyamezeli amayeza ngenxa ye-AEs okanye ukuphazamiseka kwengqondo, i-CSMT inokuqwalaselwa kwiimeko apho ezinye iindlela zonyango zingasebenzi okanye zinganyamezelwa kakuhle.

 

Ukuchazwa kweengxabano zomdla

 

Bonke abalobi baye bagqiba iKomidi yeSizwe ye-Medical Journal Abahleli befomu yokubhengeza ifom kunye nokuvakalisa akukho mali okanye ezinye iimbambano zomdla.

 

Ukuxhasa ulwazi

 

Ncbi.nlm.nih.gov/pmc/articles/PMC5214068/#ene13166-tbl-0001

 

Imibulelo

 

Ababhali bafuna ukuvakalisa umbulelo ongazenzisiyo kwisibhedlele iAkershus University, esibonelele ngobubele ngezixhobo zophando, kunye neKliniki yeChiropractor 1, eOslo, eNorway, neyenze lonke uvavanyo lwe-x ray. Olu phononongo luxhaswe zizibonelelo ezivela kwi-Extrastiftelsen, i-Norwegian Chiropractic Association, i-Akershus University Hospital kunye neYunivesithi yase-Oslo eNorway.

 

Ukuququmbela, Iimpawu ezityhafisayo ze-migraines, kubandakanya iintlungu zentloko kunye nobuntununtunu bokukhanya kunye nesandi kunye nesicaphucaphu, kunokuchaphazela umgangatho wobomi bomntu, ngethamsanqa, ukhathalelo lwe-chiropractic lubonakalisiwe lukhetho olukhuselekileyo nolusebenzayo kunyango lwentloko. intlungu. Ngaphaya koko, inqaku elingentla libonakalisile ukuba i-migraineurs ifumene iimpawu ezincitshisiweyo kunye neentsuku ze-migraine ngenxa yokhathalelo lwe-chiropractic. Ingcaciso ebhekiswe kwiZiko leLizwe leNgcaciso yeBiotechnology Information (NCBI). Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nokulimala komqolo kunye neemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukubuza uGqirha Jimenez okanye unxibelelane nathi ku 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.

 

ISIQENDU ESIBALULEKILEYO ESIBALULEKILEYO: Unyango lweNhlungu zobuhlungu kwi-El Paso, TX

 

 

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