I-Neurophysiology: Kukho iindlela ezimbini apho ulwazi lwe-nociceptive lufikelela kwinkqubo ye-nervous central. Enye yi neospinothalamic iphecana intlungu ekhawulezayo kwaye ezimbini yi paleospinothalamic iphecana kwiintlungu ezicothayo ezinyukayo.
Contents
I-Neurophysiology yePain Icandelo le-II
Ubunzulu, Indawo kunye noMgangatho Weentlungu...
… bandakanya iSpinothalamic kunye neeNdlela zeTrigeminal
- Indlela ye-trigeminal izisa ulwazi oluvela kwindawo yobuso.
- Indlela ye-spinothalamic izisa ulwazi oluvela kuwo wonke umzimba.
- Zombini ezi ndlela ziprojekthi kwi-sensory cortex, ekwafumana ulwazi malunga nezivuseleli ezingenabungozi ezifana nokubamba, uxinzelelo kunye nobushushu ngendlela eyahlukileyo.
Iindlela ezi-2 zoThunyelo lweentlungu zoMgangatho woBunzulu beNdawo
- Indlela ye-Spinothalamic
- (Indlela esecaleni)
- Indlela ye-Trigeminal
Umgangatho ongemnandanga kunye ne-Autonomic Effectiveyo yeNkuthazo yeNzululwazi
IiNdawo zoBuchule eziBandakanyiweyo ekuCwangcisweni kweempawu zeNociceptive
I-Anterior Cingulate kunye ne-Insula Cortex iyasebenza kwiZifundo zabantu
… ngokunxulumene nemvakalelo yokutshisa emandla kulandela ukudibana kwesandla negrill eshushu.
Ithatyathwe kuCraig et al. 1994, 1996. Ukususela kwiMigaqo yeNzululwazi ye-Neural, uKandell et al.
Ukulawulwa kwePain Perception
- Kukho umahluko phakathi kwenjongo kunye nemiba ezimeleyo yokulimala kunye nentlungu.
- Phezu kwako nje ukwenzakala okufanayo, abantu banokwahluka kwindlela abavakalelwa ngayo.
- Ngokuxhomekeke kumxholo, iintlungu zisenokungaviwa naphezu kokwenzakala, umz. ukwenzakala kwindawo yedabi, ngexesha lemidlalo eqatha.
- Oku kuphakamisa ukuba kukho indlela ye-physiological elawula ukuhanjiswa kweempawu ze-nociceptive kwingqondo okanye ukuguqula ukuchazwa kweentlungu.
- Inkqubo yokulawula iintlungu inokuchaza isiphumo se-placebo.
Iintlungu Modulation Pathway
- Iimpawu zeNerve zithunyelwa zenza i-somatic sensory cortex kunye ne-hypothalamus ukuya iperiaqueductal grey matter (PAG).
- I-PAG ithumela imiqondiso kwi-nucleus ye-parabrachial, i-medullary reticular formation, i-locus coeruleus, kunye ne-Raphe neulei.
- Ezi ke ziyakwazi ukulawula ukuhanjiswa kweempawu ze-nociceptive ukusuka kwintambo yomgogodla ukuya kwingqondo.
- Oku kubandakanya ezahlukeneyo kubandakanya neurotransmitters ezahlukeneyo.
Oogoids Endogenous
Iimolekyuli eziveliswe ngaphakathi kunye nesenzo se-opioid esilawula ukuhanjiswa kweempawu ze-nociceptive.
Iindidi ezintathu zezi molekyuli zichongiwe. Zonke ziimolekyuli zepeptide
- Enkephalins
- Endorphins
- IiDynorphins
Nangona ezi zinamandla, i-endogenous modifiers yezibonakaliso ze-nociceptive, kuye kwaba nzima ukuvelisa nokulawula ngendlela enokusetyenziswa kwikliniki.
Indawo yeeSeli zeNerve ezine-Endogenous Opioid Receptors
- Umnqonqo, iMedulla, iPeriaqueductal grey matter (PAG)
- Kwintambo yomgogodla, i-opioids engapheliyo inokuthintela ukuhanjiswa phakathi kweeseli ze-nerve ze-1 zomyalelo (ukuzisa iimpawu ezivela kwi-periphery) kunye ne-2nd order cell nerve cells ezihambisa izibonakaliso kwingqondo.
- Kwakhona kunokuthintela ukwanda kokusebenza kakuhle kwe-synaptic, edlala indima kwi-hyperalgesia.
(Iziko loPhando lweBrain, e-Uni Vienna)
Ukumodareyithwa kwePain Signal Transmission kwiSpinal Cord
Ukudibanisa kwintambo yomgogodla apho i-opiates isebenza.
I-Neurotransmitters � serotonin (5-HT) kunye ne-norephinephrine (noradrenaline) � kwintambo yomgogodla inokuthintela usulelo lwentsholongwane. intlungu imiqondiso engqondweni.
Isobho esivuthayo - Hyperalgesia
- Umonakalo wezicubu ukhokelela ekukhululweni kweekhemikhali ezininzi.
- Ezi zandisa i-nociceptors 'impendulo kwi-stimulus (=hyperalgesia) kunye nokuvelisa ukuvuvukala.
- Hyperalgesia = xa ubukhulu bempendulo kwi-nociceptive stimulus iphezulu kunesiqhelo.
UJulius-D & Basbaum-AI, Indalo 2001;413:203
Isicelo seKliniki
- Ukwazi iimolekyuli ezibandakanyekayo kwi-�isuphu evuthayo� kunye nendlela ezidityaniswe ngayo zibonelela ngeethagethi ezinokubakho zokunciphisa iintlungu.
- umz. iiprostaglandins ziveliswa yi-COX enzyme. Umsebenzi wale enzyme uvalwe ngamachiza angeyo-steroidal achasene nokudumba (NSAIDs) njenge-ibuprofen, diclofenac.
Allodynia
- Imeko apho ngokuqhelekileyo izivuseleli ezingenabuhlungu zibangela iintlungu, umzekelo, ukubamba, uxinzelelo olulula, ingqele.
- Ibandakanya utshintsho kwi-synaptic sensitivity ye-nociceptive neurons kwintambo yomgogodla (uvuselelo oluphakathi).
- Iziyobisi ezifana ne-ketamine, i-block NMDA receptors kwaye ngoko ukunciphisa ukuhanjiswa kwe-nociceptive stimuli.
Ithiyori yoLawulo lweSango leeNtlungu
- Umama uthi emntwaneni, �Yiza ndikuhlikihle indawo ebuhlungu kwaye oku kuya kuyenza ibe ngcono.
- Emva kokukhuhla uzwane, ngokwethuku siphulula loo ndawo; oku kunciphisa ukuva intlungu.
- URonald Melzack noPatrick Wall ngowe-1962 banikela ingcaciso enokwenzeka yesi siphumo.
Amaphecana anyukayo | Ukuguqulwa kweentlungu: Ithiyori yoLawulo lweSango
Ithiyori yeSango
Ukuhlikihla indawo eyenza ubuhlungu kuvuselela i-receptors ye-stimuli engenabungozi njengokuchukumisa, uxinzelelo kunye nokungcangcazela.
Ezi mechano-receptors zithumela imiqondiso ecaleni kwe-A? imithambo-luvo ukuba:
(1) vuselela imithambo yomqolo (i-inhibitory inter-neurons) ethi yona inqanda ukubonakaliswa kwe-2nd order neurons (projection neuron) kunye (2) inqanda ngokuthe ngqo i-2nd order neuron ukunciphisa okanye ukuyeka umqondiso wentlungu ekuthunyelwe kwingqondo
wikidoc.org/images/f/fe/Gate_control_A_firing.png
Isicelo seKliniki
I-Transcutaneous Nerve Stimulation (TENS) isekelwe kwiTheory yoLawulo lweSango. Iinerves zenkqubo ye-sensory ezingenacala zivuselelwe kwaye zibuye zithintele ukuhanjiswa kwe-nociceptive stimuli umqolo.
Ukungaqhelekanga kweNkqubo yeentlungu
Iintlungu zePhantom
- Izigulana ezinqunyulwe amalungu zisoloko zinentlungu etshisayo okanye erhabaxa kwilungu lomzimba elisusiweyo.
- Omnye unobangela kukuba imicu yemithambo-luvo kwisiphunzi iyavuselelwa kwaye ingqondo itolika imiqondiso njengesuka kwindawo eshunquliweyo.
- Olunye luhlengahlengiso ngaphakathi kwe iindawo zecortical ke loo ndawo ithi isandla ngoku siphendula imiqondiso evela kwamanye amalungu omzimba kodwa isazitolika njengeza kwisandla esinqunyulweyo.
Sensitization
- I-peripheral sensitization imele ukunciphisa umda kunye / okanye ukwanda kobukhulu bokuphendula kwiipheripheral ze-sensory nerve fibers.
- Oku kwenzeka ngokuphendula abalamli beekhemikhali ezikhutshwe ngama-nociceptors kunye neeseli ezingenayo i-neuronal (umz. iiseli ze-mast, i-basophils, iiplatelet, i-macrophages, i-neutrophils, iiseli ze-endothelial, i-keratinocytes kunye ne-fibroblasts) kwindawo yokulimala kwezicubu okanye ukuvuvukala.
- Ngokusisiseko, kukwanda kovakalelo kwi-afferent nerve stimuli.
Sensitization ephakathi
I-peripheral & Central uvakalelo
- Imeko ye-nervous system ehambelana nophuhliso kunye nokugcinwa kwe Ubuhlungu obungapheliyo.
- Kwaziwa �njengokuvuthuza � okanye ukusebenza ngokuqhubekayo okuphezulu.
- �Iplastiticity kwiindlela zeentlungu� okanye ukuzingisa kweentlungu nasemva kokuba ukwenzakala kupholile.
- Ngaba le plastikhi engalunganga okanye entle?
Uvakaliso oluphakathi kunye neeFayibha zeC
Iimpawu ezimbini eziphambili zoKwazisa okuseMbindini:
Allodynia � kwenzeka xa umntu esiva iintlungu ngezinto eziqhele ukuba azibuhlungu, oko kukuthi, ukubamba okuthambileyo kubangela intlungu.
Hyperalgesia � kwenzeka xa umvuselelo oqhele ukuba buhlungu ubonwa njengobuhlungu ngakumbi ukuba kufanele ukuba ubenjalo, oko kukuthi, iqhuma elilula.
Zombini zibangelwa yi-hyperreactivity ye-nervous system.
Umbutho weSomatosensory Cortex
Uhlengahlengiso lweCortical
I-Neuroscience. Uhlelo lwe-2. Purves D, Augustine GJ, Fitzpatrick D, et al., Abahleli. Isazobe 25.14
Ubunzima obubhekiselelweyo
- Idla ngokusuka kwilungu le-visceral.
- Isenokuvakala kwinxalenye yomzimba ekude nendawo ye-pathology.
- Iinkqubo zinokuba kukuguqulwa komgogodla we-visceral kunye ne-somatic afferent fibers kwi-spinothalamic neurons.
- Ukubonakaliswa okuqhelekileyo: i-cutaneous kunye ne-hyperalgesia enzulu, i-tenderness, i-contraction ye-muscular.
Ukuva Iingqaqambo eziBoniswa Kumalungu eVisceral ...
... ukuya kwelinye ilungu lomphezulu womzimba
Iindlela zePain Hypersensitivity kwi-Glance
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