Ubuhlungu be-Facetogenic, Intloko, Inhlungu ye-Neuropathic ne-Osteoarthritis

El Paso, TX. I-Chiropractor uDkt. Alexander Jimenez ukhangeleka kwiimeko ezahlukahlukeneyo ezinokubangela ubuhlungu obungapheliyo. Ezi ziquka:

• Osteoarthritis
• Ubuhlungu be-Facetogenic
• Intlungu ye-neuropathic
• Intloko

Abstract

Arthritis intlungu yinto enzima ebandakanya ukuqhutyelwa kwe-neurophysiological eyinkimbinkimbi kuwo onke amanqanaba endlela yeentlungu. Iinketho zonyango ezikhoyo zokunciphisa iintlungu ezidibeneyo zilinganiselwe, kwaye izigulane ezininzi ze-arthritis zichaza kuphela ukuthomalaliswa kweentlungu eziphantsi ngonyango lwangoku. Ukuqonda okungcono kweendlela ze-neural ezijongene nentlungu ye-musculoskelet kunye nokuchonga iithagethi ezintsha kuya kunceda ukuphuhlisa unyango lwe-pharmacological elizayo. Eli nqaku liphonononga uphando olutshanje kwizinto ezibangela intlungu edibeneyo kwaye igubungela iindawo ezifana ne-cannabinoids, i-proteinase-activated receptors, iziteshi ze-sodium, i-cytokines, kunye ne-transient receptor iziteshi ezinokubakho. I-hypothesis evelayo yokuba i-osteoarthritis inokuba ne-neuropathic component nayo iyaxoxwa.

intshayelelo

Intlangano yempilo yehlabathi ibangela iziphazamiso ze-musculoskelet njengesizathu esibangeleko sokukhubazeka kwihlabathi lanamhlanje, elichaphazela omnye kwabadala abathathu [1]. Okubhekisayo ngakumbi kukuba ukusabalaliswa kwezi zifo kukhula ngelixa ulwazi lwethu ngezizathu zabo ezisemgangathweni lugxeka ngokufanelekileyo.

Umzobo we-1 Isikimu esibonisa ezinye zeethagethi ezaziwa ukulungelelanisa intlungu edibeneyo. I-Neuromodulators inokukhutshwa kwii-terminals ze-nerve kunye neeseli ze-mast kunye ne-macrophages ukuguqula i-afferent mechanosensitivity. I-Endovanilloids, i-asidi, kunye nobushushu obunobungozi bunokusebenzisa i-receptor yexeshana enokubakho i-vanilloid uhlobo lwe-1 (TRPV1) i-ion channels ekhokelela ekukhululweni kwe-algogenic substance P (SP), ethi emva koko ibophe kwi-neurokinin-1 (NK1) receptors. Iiproteases zinokucanda kwaye zivuselele i-protease-activated receptors (PARs). Ukuza kuthi ga ngoku, i-PAR2 kunye ne-PAR4 zibonisiwe ukuba zinike amandla amaqabane aphambili. I-endocannabinoid anandamide (AE) iveliswa kwimfuno kwaye ihlanganiswe kwi-N-arachidonoyl phosphatidylethanolamine (NAPE) phantsi kwesenzo se-enzymatic se-phospholipases. Inxalenye ye-AE ke ibophelela kwi-cannabinoid-1 (CB1) i-receptors ekhokelela kwi-neuronal desensitization. I-AE engapheliyo ithathwa ngokukhawuleza yi-anandamide membrane transporter (AMT) ngaphambi kokuba iphulwe yi-fatty acid amide hydrolase (FAAH) kwi-ethanolamine (Et) kunye ne-arachidonic acid (AA). I-cytokines i-tumor necrosis factor-? Ekugqibeleni, i-tetrodotoxin (TTX) -iziteshi ze-sodium ezixhathisayo (Nav6) zibandakanyeka kwi-neuronal sensitization.

Iziguli zizilangazelela zabo Ubuhlungu obungapheliyo ukunyamalala; nangona kunjalo, i-analgesics emiselweyo okwangoku ayisebenzi kwaye ihamba kunye noluhlu olubanzi lweziphumo ebezingalindelekanga. Ngaloo ndlela, izigidi zabantu kwihlabathi jikelele zibandezeleka ngenxa yemiphumo ephazamisayo yeentlungu ezidibeneyo, apho kungekho unyango olwanelisayo [2].

Ngaphezu kwe-100 iintlobo ezahlukeneyo ze-arthritis zine-osteoarthritis (OA) eyona ixhaphakileyo. I-OA sisifo samalungu esiqhubela phambili esiwohlokayo esenza iintlungu ezingapheliyo kunye nokulahlekelwa ngumsebenzi. Ngokuqhelekileyo, i-OA kukungakwazi kokudibanisa ukulungisa umonakalo ngokufanelekileyo ekuphenduleni amandla amaninzi abekwe kuwo. Izinto zebhayoloji kunye nezengqondo ezibandakanya iintlungu ezingapheliyo ze-OA aziqondi kakuhle, nangona uphando oluqhubekayo lutyhila uhlobo olunzima lweempawu zesifo [2]. Unyango lwangoku, olufana ne-non-steroidal anti-inflammatory drugs (NSAIDs), lubonelela ngesiqabu seempawu, ukunciphisa iintlungu ixeshana elifutshane, kodwa azinciphisi iintlungu kubo bonke ubomi besigulane. Ngaphezu koko, i-NSAID yedosi ephezulu ayinakuthathwa ngokuphindaphindiweyo kwiminyaka emininzi, njengoko oku kunokukhokelela kwityhefu yezintso kunye nokopha kwesisu.

Ngokwesiko, uphando lwe-arthritis lugxininise kakhulu kwi-cartilage ye-articular njengeyona nto ijoliswe kuyo ekuphuhlisweni konyango lwamachiza e-OA anoveli yokuguqulwa kwesifo. Le ngqwalasela ye-chondrogenic iye yavelisa ukukhanya okutsha kwizinto eziyinkimbinkimbi ze-biochemical kunye ne-biomechanical ezichaphazela ukuziphatha kwe-chondrocyte kumalungu agulayo. Nangona kunjalo, njengoko i-articular cartilage i-aneural kunye ne-avascular, le thishu ayinakwenzeka ukuba ibe ngumthombo weentlungu ze-OA. Le nyaniso, idibene neziphumo zokufumanisa ukuba akukho kulungelelaniswa phakathi komonakalo we-articular cartilage kunye neentlungu kwizigulane ze-OA [3,4] okanye imodeli yangaphambili ye-OA [5], ibangele utshintsho ekugxininiseni ukuphuhlisa iziyobisi zokulawula iintlungu ezisebenzayo. . Eli nqaku liza kuphonononga iziphumo zakutsha zophando lwentlungu edibeneyo kwaye liqaqambise ezinye zeenjongo ezisakhulayo ezinokuthi zibe yikamva lolawulo lwentlungu ye-arthritis (isishwankathelo kwi-Fig. 1)

IiCytokines

Izenzo zeecytokines ezahlukeneyo kwizifundo ze-neurophysiology ezidibeneyo ziye zabonakala kakhulu mva nje. I-Interleukin-6 (IL-6), umzekelo, i-cytokine ngokuqhelekileyo ibophelela kwi-membrane-bound IL-6 receptor (IL-6R). I-IL-6 ingabonakalisa kwakhona ngokubopha nge-soluble IL-6R (SIL-6R) ukuvelisa i-IL-6 / sIL-6R eyinkimbinkimbi. Le-IL-6 / sIL-6R eyinkimbinkimbi i-lybinds i-lybinds kwi-transmembrane glycoprotein subunit 130 (gp130), ngaloo ndlela ivumela i-IL-6 ukuba ibonise kwiiseli ezingabonisi i-membrane-bound bound IL-6R [25,26]. I-IL-6 kunye ne-SIL-6R ngabadlali abaphambili kwi-systemic inflammation kunye ne-arthritis, njengoko ukulawulwa kwazo zombini kufunyenwe kwi-serum yezigulane ze-RA kunye ne-synovial fluid. [27,29]. Kutshanje, uVazquez et al.observe ukuba ukulawulwa ngokubambisana kwe-IL-6 / sIL-6R emadolweni empuku kubangele iintlungu ezivusa ukuvuvukala, njengoko kutyhilwe ngokunyuka kwempendulo ye-spinal dorsal horn neurons ekuvuseleleni idolo kunye nezinye iindawo. yomqolo [30]. I-spinal neuron hyperexcitability nayo yabonwa xa i-IL-6 / sIL-6R isetyenziswe kwindawo kwintambo yomgogodla. Ukusetyenziswa komnqonqo we-gp130 enyibilikayo (eya kumophulela iikhompleksi ze-IL-6/sIL-6R, ngaloo ndlela inciphisa ukudluliselwa komqondiso) inhibited IL-6/sIL-6R-induced central sensitization. Nangona kunjalo, ukusetyenziswa ngokukhawuleza kwe-gp130 e-soluble yodwa akuzange kunciphise iimpendulo ze-neuronal esele zisekiwe ukudumba kwamalungu.

I-transient receptor potential (TRP) iziteshi azikhethiyo ze-cation channels ezisebenza njengabahlanganisi beenkqubo ezahlukeneyo ze-physiological and pathophysiological. Ukongeza kwi-thermosensation, i-chemosensation, kunye ne-mechanosensation, iziteshi ze-TRP zibandakanyeka kwi-modulation yentlungu kunye nokuvuvukala. Ngokomzekelo, i-TRP i-vanilloid-1 (i-TRPV1) iziteshi ze-ion ziye zaboniswa ukuba zibe negalelo kwintlungu edibeneyo yokuvuvukala njengoko i-thermal hyperalgesia ayizange ikhutshwe kwi-TRPV1 i-mono arthritic mice [31]. Ngokufanayo, i-TRP ankyrin-1 (TRPA1) iziteshi ze-ion zibandakanyeka kwi-arthritic mechano hypersensitivity njenge-blockade ye-receptor kunye nabachasi abakhethiweyo banciphisa intlungu yomatshini kwi-Freunds imodeli epheleleyo yokuvuvukala kwe-adjuvant [32,33]. Obunye ubungqina bokuba i-TRPV1 inokubandakanyeka kwi-neurotransmission ye-OA intlungu ivela kwizifundo apho i-neuronal TRPV1 ibonakaliso iphakanyisiwe kwi-sodium monoiodoacetate imodeli ye-OA [34]. Ukongeza, ulawulo olucwangcisiweyo lomchasi we-TRPV1 u-A-889425 unciphise umsebenzi okhutshiweyo kunye nozenzekelayo woluhlu oluguquguqukayo lwe-spinal-wide kunye ne-nociception-specific neurons kwimodeli ye-monoiodoacetate [35]. Ezi nkcukacha zibonisa ukuba i-endovanilloids inokubandakanyeka kwiinkqubo zokuvuselela i-central ehambelana neentlungu ze-OA.

Kukho okwangoku kwaziwa ukuba ubuncinane be-polymorphisms ezine kwi-gene efaka i-TRPV1, ekhokelela ekuguquleni kwisakhiwo somzila we-ion kunye nomsebenzi ophazamisekileyo. Enye i-polymorphism ethile (rs8065080) iguqula uvakalelo lwe-TRPV1 kwi-capsaicin, kwaye abantu abaphethe le polymorphism abavakalelwa kakhulu kwi-thermal hyperalgesia [36]. Uphononongo lwakutsha nje luvavanye ukuba ngaba izigulane ze-OA ezine-rs8065080 polymorphism ziye zafumana uluvo lweentlungu ezitshintshileyo ngokusekelwe kolu tshintsho lwemfuza. Iqela lophando lifumanise ukuba izigulana ezine-asymptomatic knee OA ziyakwazi ukuthwala i-RS8065080 gene kunezigulana ezinamalungu abuhlungu. [37]. Olu qwalaselo lubonisa ukuba izigulane ze-OA ezisebenza ngokuqhelekileyo; Iziteshi ze-TRPV1 zinomngcipheko onyukileyo weentlungu ezidibeneyo kwaye ziqinisekisa kwakhona ukubandakanyeka okunokwenzeka kwe-TRPV1 kwi-OA yokubona intlungu.

isiphelo

Ngelixa umqobo wokunyanga iintlungu ze-arthritis ngokusebenzayo uhleli, imitsi emikhulu iyenziwa ekuqondeni kwethu iinkqubo ze-neurophysiological ezinoxanduva lokuvelisa iintlungu ezidibeneyo. Iithagethi ezintsha zifunyanwa rhoqo, ngelixa iindlela ezisemva kweendlela ezaziwayo zichazwa ngakumbi kwaye zilungiswa. Ukujolisa i-receptor ethile okanye i-ion channel ayinakwenzeka ukuba isisombululo sokunciphisa intlungu edibeneyo, kodwa kunoko indlela ye-polypharmacy iboniswa apho abalamli abahlukeneyo basetyenziswa ngokudibeneyo ngexesha lezigaba ezithile zesifo. Ukuqhawula isiphaluka esisebenzayo kwinqanaba ngalinye lendlela yeentlungu kuya kuphucula ulwazi lwethu malunga nendlela intlungu edibeneyo eyenziwa ngayo. Ngokomzekelo, ukuchonga abalamli be-peripheral bentlungu edibeneyo kuya kusivumela ukuba silawule i-nociception ngaphakathi kwendawo edibeneyo kwaye mhlawumbi siphephe imiphumo ephakathi ye-pharmacotherapeutics elawulwa ngokuqhelekileyo.

IPACETOGENIC PAIN

UKUQHUBEKA KWENKQUBO YOKUGQIBELA NENTLUNGU ENGAKUMANDLA

• I-facet syndrome yingxaki ye-articular ehambelana ne-lumbar facet joints kunye ne-innervations yazo kwaye ivelisa zombini iintlungu zendawo kunye ne-radiating facetogenic.
• Ukujikeleza ngokugqithiseleyo, ukwandiswa, okanye ukujikeleza komqolo (ukusetyenziswa ngokuphindaphindiweyo) kunokubangela utshintsho oluguquguqukayo kwi-cartilage edibeneyo. Ukongezelela, kunokubandakanya utshintsho oluphazamisayo kwezinye izakhiwo, kubandakanywa nediski ye-intervertebral.

ICANDELO LOKUXINANISWA KWENKCUBEKO YOMLOMO KUNYE NENTLUNGU YESIBONELELO

• Intlungu yentamo ye-Axial (enqabile igqithisa ngaphaya kwamagxa), ixhaphake i-unilaterally.
• Ubuhlungu kunye / okanye ukunciphisa ukwandiswa nokujikeleza
• Ukunyamezela ukubetha
• Ukuphuza ubuhlungu besimo sekhaya ngaphakathi okanye emagxeni okanye ngasentla, kwaye ngokungaqhelekanga kukhanya phambi okanye kwehla ingalo okanye kwiminwe njengokuba idiski ye-herniated inokwenzeka.

I-LUMBAR FACET SYNDROME NE-FACETOGENIC PAIN

• Intlungu okanye ububele kumqolo ongaphantsi.
• Ubumnandi bendawo / ubunzima bendawo ecaleni lomgudu ongaphantsi.
• Iintlungu, ukuqina, okanye ubunzima beentshukumo ezithile (ezifana nokuma nkqo okanye ukuphakama esitulweni.
• Ubuhlungu obuphezu kwe-hyperextension
• Iintlungu ezibhekiswe kwi-lumbar facet joints zingadlulela kwi-flank, i-hip, kunye nethanga eliphezulu.
• Iintlungu ezibhekiswe kwi-lumbar facet joints zingangena nzulu ethangeni, ecaleni kunye / okanye ngasemva.
• I-L4-L5 kunye ne-L5-S1 i-facet joints ingabhekisela kwintlungu eqhubekayo kwi-distal lateral leg, kwaye kwiimeko ezinqabileyo, ukuya ezinyaweni.

IMICIMBI YOKUSEBENZA

Ubufakazi obusekelwe kwiNtsholongwane yoPhando lweNtsholongwane ngokweNtsholongwane yeZifo

12. Ubuhlungu obuvela kwi-Lumbar Facet Joints

Abstract

Nangona ubukho be-facet syndrome kudala bubuzwa, ngoku yamkelwe ngokubanzi njengequmrhu leklinikhi. Ngokuxhomekeke kwiikhrayitheriya zokuxilonga, i-zygapophysial joints accounts phakathi kwe-5% kunye ne-15% yeemeko zentlungu engapheliyo, i-axial ephantsi. Ngokuqhelekileyo, iintlungu ze-facetogenic zibangelwa uxinzelelo oluphindaphindiweyo kunye / okanye ukwenzakala kwinqanaba eliphantsi, elikhokelela ekudumbeni kunye nokwelula kwe-capsule edibeneyo. Esona sikhalazo sixhaphakileyo ziintlungu ezisezantsi ze-axial kunye neentlungu ezigqithisiweyo ezibonwa kwiflank, isinqe, kunye nethanga. Akukho ziphumo zovavanyo lomzimba ziyi-pathognomonic yokuxilongwa. Isalathisi esinamandla sentlungu ye-facetogenic ye-lumbar kukunciphisa intlungu emva kweebhloko ze-anesthetic ze-rami mediales (amasebe aphakathi) e-rami dorsales angenayo i-facet joints. Ngenxa yokuba iziphumo ezingeyonyani kwaye, mhlawumbi, iziphumo ezingalunganga zinokuthi zenzeke, iziphumo kufuneka zitolikwe ngononophelo. Kwizigulane ezine-injection-confirmed zygapophysial joint pain, ukungenelela kwenkqubo kunokwenziwa kumxholo we-multidisciplinary, i-multimodal unyango lwe-regimen olubandakanya i-pharmacotherapy, unyango lomzimba, kunye nokuzivocavoca rhoqo, kwaye, ukuba kubonisiwe, unyango lwengqondo. Okwangoku, umgangatho wegolide wokunyanga intlungu ye-facetogenic yonyango lwe-radiofrequency (1 B +). Ubungqina obuxhasa i-intra-articular corticosteroids bulinganiselwe; ngenxa yoko, oku kufuneka kubekelwe abo bangaphenduliyo kunyango lwe-radiofrequency (2 B1).

I-Facetogenic Pain ephuma kwi-lumbar facet joints yimbangela eqhelekileyo yeentlungu ezisezantsi kubantu abadala. IGoldthwaite yaba ngowokuqala ukuchaza i-syndrome ngo-1911, kwaye iGhormley ngokuqhelekileyo kuthiwa yaqamba igama elithi �facet syndrome ngo-1933. , i-synovial membrane, i-hyaline cartilage, kunye nethambo.35

Ngokuqhelekileyo, sisiphumo soxinzelelo oluphinda-phindayo kunye/okanye umonzakalo okwinqanaba elisezantsi elongezelekayo. Oku kukhokelela ekudumbeni, oku kunokubangela ukuba i-facet joint izaliswe ngamanzi kwaye idumbe, okukhokelela ekoluleni kwe-capsule edibeneyo kunye nesizukulwana sentlungu esilandelayo.I-27 iyatshintsha utshintsho malunga nomdibaniso we-facet inokucaphukisa umlenze womgogodla nge-diminiti ye-foraminal, okubangele i-sciatica. Ukongeza, Igarashi et al.28 yafumanisa ukuba ii-cytokines ezivuthayo ezikhutshwe kwi-capsu joint capsule kwizigulane ezine-zygapophysial eziye zahlukana ngokutsha zingabangela uxanduva lwezonyango ezingenayo i-neuropathic kubantu ngabanye abane-spinal stenosis. Izidalwa zengxube ye-zygapophysial intlungu edibeneyo zibandakanya i-spondylolisthesis / irisysi, isifo se-diserative degenerative kunye nobudala obude.5

IIMVIWO ZEMIBUZO EZIQHELEKILEYO

Ireyithi yokuxhaphaka kweenguqu ze-pathological kwi-facet joints kuvavanyo lweradiyoloji ixhomekeke kwiminyaka ephakathi kwezifundo, ubuchule beradiyoloji obusetyenzisiweyo, kunye nenkcazo yokungaqhelekanga. Izihlanganisi ezinobungakanani bezinto ezinokuthi ziboniswe ngokugqithiseleyo zingabonakaliswa ngokugqithiseleyo nge-computed tomography (CT).49

I-PAUROPATHIC PAIN

• Ubunzima buqaliswe okanye bubangelwa lilonda eliphambili okanye ukungasebenzi kwiinkqubo ze-nervosensory system.
• Intlungu ye-neuropathic idla ngokungapheliyo, kunzima ukuyinyanga, kwaye ihlala ixhathisa kulawulo oluqhelekileyo lwe-analgesic.

Abstract

Ubuhlungu be-neuropathic bubangelwa yi-lesion okanye isifo se-somatosensory system, kubandakanywa ne-peripheral fibers (A?, A? kunye ne-C fibers) kunye ne-neurons ephakathi, kwaye ichaphazela i-7-10% yabantu bonke. Izizathu ezininzi zeentlungu ze-neuropathic zichazwe. Izehlo zayo zinokunyuka ngenxa yokuguga kwabantu behlabathi, ukwanda kwesifo seswekile, kunye nokuphuculwa kokusinda kumhlaza emva kwechemotherapy. Enyanisweni, ukungalingani phakathi kwe-excitatory kunye ne-inhibitory somatosensory signaling, ukuguqulwa kweendlela ze-ion, kunye nokuguquguquka kwindlela imiyalezo yeentlungu ehlengahlengiswa ngayo kwinkqubo ye-nervous central zonke ziye zabandakanyeka kwiintlungu ze-neuropathic. Ngaphezu koko, umthwalo wentlungu engapheliyo ye-neuropathic ibonakala ihambelana nobunzima beempawu ze-neuropathic, iziphumo ezibi, kunye nezigqibo ezinzima zonyango. Okubalulekileyo, umgangatho wobomi uphazamiseka kwizigulane ezineentlungu ze-neuropathic ngenxa yokunyuka kwemimiselo yeziyobisi kunye nokutyelela ababoneleli bezempilo kunye nokugula okuvela kwintlungu ngokwayo kunye nesifo esikhuthazayo. Nangona imingeni, inkqubela phambili ekuqondeni i-pathophysiology yeentlungu ze-neuropathic ikhuthaza ukuphuhliswa kweenkqubo ezintsha zokuxilonga kunye nokungenelela komntu, okugxininisa imfuno yeendlela ezininzi zokulawula intlungu ye-neuropathic.

I-PATHOGENESIS YENKQUBO YENKQUBO

• AMANCHANISMS OKUSEBENZA

• Emva kwe-peripheral nerve lesion, i-neuron iba novelwano ngakumbi kwaye iphuhlise ukonwaba okungaqhelekanga kunye novakalelo oluphakamileyo lokuvuselela.
• Oku kwaziwa ngokuba ... Ukwaziswa kwe-Peripheral Sensitization!

• AMANCHANISMS EMFUNDO

• Njengesiphumo somsebenzi oqhubekayo ozenzekelayo kwi-periphery, i-neurons iphuhlisa umsebenzi owandisiweyo ongasemva, imimandla eyandisiweyo yokwamkela, kunye nokunyuka kweempendulo kwiimpembelelo ezithintekayo, kubandakanywa ne-tactile stimuli eqhelekileyo.
  Oku kwaziwa ngokuba ... Ukwazisa okuphakathi!

Intlungu engapheliyo ye-neuropathic ixhaphake kakhulu kubasetyhini (i-8% ngokubhekiselele kwi-5.7% kumadoda) kunye nezigulane> iminyaka yobudala be-50 (i-8.9% kunye ne-5.6% kulawo <iminyaka eyi-49 ubudala), kwaye idla ngokuchaphazela umqolo ophantsi kunye nemilenze ephantsi. , intamo namalungu aphezulu24. I-Lumbar kunye ne-cervical painful radiculopathies mhlawumbi iyona nto ibangela intlungu engapheliyo ye-neuropathic. Ngokuhambelana nale datha, uphando lwe> izigulane ze-12,000 ezineentlungu ezingapheliyo kunye neentlobo zentlungu ye-nociceptive kunye ne-neuropathic, ezibhekiswe kwiingcali zentlungu eJamani, zibonise ukuba i-40% yazo zonke izigulane zifumana ubuncinane iimpawu zentlungu ye-neuropathic (ezifana nokuvutha komsindo, ukubetha, kunye nokubetha); izigulane ezineentlungu ezibuhlungu ezingapheliyo kunye ne-radiculopathy zachaphazeleka ngokukodwa25.

Igalelo le-neurophysiology yeklinikhi ukuya ekuqondeni iinkqubo zokubandezeleka kwentloko.

Abstract

Ukuza kuthi ga ngoku, izifundo zeklinikhi ze-neurophysiological kwi-tension-type headache (TTH) zenziwe ngeenjongo ezimbini eziphambili: (1) ukufumanisa ukuba ezinye iiparamitha ze-neurophysiological zingasebenza njengabamakishi be-TTH, kunye (2) nokuphanda i-physiopathology ye-TTH. Ngokumalunga nenqaku lokuqala, iziphumo zangoku ziyadanisa kuba ezinye izinto ezingaqhelekanga ezifunyenwe kwizigulane ze-TTH zinokubonwa rhoqo kwii-migraineurs. Ngakolunye uhlangothi, i-neurophysiology yeklinikhi idlale indima ebalulekileyo kwingxoxo malunga ne-pathogenesis ye-TTH. Izifundo malunga nokunyanzeliswa okungaqhelekanga kokunyanzeliswa kwemisipha yesikhashana ziye zafumanisa ukungasebenzi kwe-brainstem excitability kunye nolawulo lwe-suprasegmental. Isigqibo esifanayo sifikelelwe kusetyenziswa i-trigeminocervical reflexes, engaqhelekanga kwi-TTH iphakamise umsebenzi wokunciphisa inhibitory we-brainstem interneurons, ebonisa iindlela ezingaqhelekanga zokulawula iintlungu ezingapheliyo. Okubangela umdla kukuba, i-neural excitability abnormality kwi-TTH ibonakala iyinto eqhelekileyo, engaphelelanga kwizithili ze-cranial. Iinkqubo ezifana ne-DNIC ezineziphene ziye zangqinwa kwakhona kwizithili ze-somatic ngezifundo ze-nociceptive flexion reflex. Ngelishwa, uninzi lwezifundo ze-neurophysiological kwi-TTH zonakaliswe ziziphene ezinzulu zemethodological, ekufuneka ziphetshwe kuphando lwexesha elizayo ukucacisa iindlela ze-TTH ngcono.

Iingxelo:

I-neurophysiology yeentlungu ze-arthritis. McDougall JJ¹ Linton P.

www.researchgate.net/publication/232231610_Neurophysiology_of_Arthritis_Pain

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