Neurophysiology Yobuhlungu | El Paso, TX. | Icandelo II

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.

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

Neuroscience Purves et al.

• 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

1. Enkephalins
2. Endorphins
3. 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