Ii-Biomarkers kunye neZiko loVavanyo loPhando

Oogqirha bachaza intlungu engapheliyo, njengokuba nayiphi na intlungu ehlala kwi-3 kwiinyanga ze-6 okanye ngaphezulu. I intlungu ichaphazela impilo yengqondo yomntu kunye nobomi bemihla ngemihla. Iintlungu zivela kuthotho lwemiyalezo ehamba nge-nervous system. Ukudakumba kubonakala kulandela intlungu. Ibangela iimpawu ezinzima ezichaphazela indlela umntu aziva ngayo, acinga ngayo, kunye nendlela yokuphatha imisebenzi yemihla ngemihla, oko kukuthi, ukulala, ukutya nokusebenza. I-Chiropractor, uDkt Alex Jimenez uhlolisisa kwiimpawu zezinto eziphilayo ezinokuthi zincede ekufumaneni nasekuphatheni iingcambu zentlungu kunye neentlungu ezingapheliyo.

• Isinyathelo sokuqala ekulawuleni iintlungu eziyimpumelelo luvavanyo olubanzi lwe-biopsychosocial.
• Ubungakanani be-pathology yezinto eziphilayo bungenakubonakaliswa ngokuchanekileyo kumava entlungu.
• Uvavanyo lokuqala lunokusetyenziswa ukuchonga iindawo ezifuna uvandlakanyo olunzulu.
• Uninzi lwezixhobo zokuzibika eziqinisekisiweyo ziyafumaneka ukuvavanya impembelelo yeentlungu ezingapheliyo.

Uvavanyo lwezigulane ezineentlungu ezingapheliyo

Iintlungu ezingapheliyo yinkxalabo yempilo yoluntu echaphazela i-20�30% yabemi bamazwe aseNtshona. Nangona kukho inkqubela phambili yenzululwazi ekuqondeni i-neurophysiology yentlungu, ukuvavanya ngokuchanekileyo kunye nokuxilongwa kwengxaki yentlungu engapheliyo yesigulane ayichanekanga okanye ichazwe kakuhle. Indlela intlungu engapheliyo ichazwa ngayo impembelelo kwindlela intlungu evavanywa ngayo kunye nezinto eziqwalaselwayo xa kusenziwa ukuxilongwa kweentlungu ezingapheliyo. Akukho budlelwane bomntu ukuya komnye phakathi kwesixa okanye uhlobo lwe-organic pathology kunye nobukhulu bentlungu, kodwa endaweni yoko, amava eentlungu ezingapheliyo abunjwa zizinto ezininzi ze-biomedical, psychosocial (umzekelo, iinkolelo zezigulane, izinto ezilindelekileyo, kunye neemvakalelo), kunye neendlela zokuziphatha (umz. umxholo, iimpendulo zabanye ababalulekileyo). Ukuvavanya nganye kwezi nkalo zintathu ngovavanyo olubanzi lomntu onobuhlungu obungapheliyo kubalulekile kwizigqibo zonyango kunye nokuququzelela iziphumo ezilungileyo. Olu vavanyo kufuneka lubandakanye imbali yesigulana ngokucokisekileyo kunye novavanyo lwezonyango kunye nodliwano-ndlebe olufutshane lovavanyo apho ukuziphatha kwesigulana kunokubonwa. Uvavanyo olongezelelweyo lokujongana nemibuzo echongiweyo ngexesha lovavanyo lokuqala luya kukhokela izigqibo malunga nokuba loluphi uvavanyo olongezelelweyo, ukuba lukhona, lunokufaneleka. Izixhobo ezisemgangathweni ezizimeleyo zokuvavanya ubunzima bentlungu yesigulane, amandla okusebenza, iinkolelo kunye nokulindela, kunye nokukhathazeka ngokomzwelo zikhoyo, kwaye zinokulawulwa ngugqirha, okanye ukuthunyelwa kovavanyo olunzulu kunokwenziwa ukuncedisa ekucwangcisweni kwonyango.

Iintlungu luphawu oluxhaphake kakhulu. Intlungu engapheliyo yodwa iqikelelwa ukuba ichaphazele i-30% yabantu abadala base-USA, ngaphezu kwe-100 yezigidi zabantu abadala.1

Nangona iindleko ezinyukayo zokunyanga abantu abaneentlungu ezingapheliyo, ukukhululeka kwabaninzi kuhlala kungenasiphelo kwaye ukupheliswa ngokupheleleyo kweentlungu kunqabile. Nangona kukho inkqubela phambili enkulu kulwazi lwe-neurophysiology yeentlungu, kunye nophuhliso lwamayeza anamandla e-analgesic kunye nezinye iindlela ezintsha zonyango kunye nonyango lotyando, ngokomyinge umlinganiselo wokunciphisa intlungu ngeenkqubo ezikhoyo yi-30�40% kwaye oku kwenzeka ngaphantsi kwesiqingatha sezigulane ezinyangweyo.

Indlela esicinga ngayo ngeentlungu ichaphazela indlela esihamba ngayo sivavanya iintlungu. Uvavanyo luqala ngembali kunye novavanyo lomzimba, lulandelwa, luvavanyo lwaselabhoratri kunye neenkqubo zokuxilonga kwinzame zokuchonga kunye / okanye ukuqinisekisa ubukho bayo nayiphi na i-pathology esisiseko ebangela iimpawu okanye intlungu generator.

Ukungabikho kwe-pathology yezinto eziphilayo ezichongiweyo, umboneleli wezempilo unokucinga ukuba ingxelo yeempawu zivela kwimiba yengqondo kwaye unokucela uvandlakanyo lwezengqondo ukufumanisa imiba yeemvakalelo ephantsi kwengxelo yesigulane. Kukho izinto ezimbini apho ingxelo yeempawu zibalelwa kuyo nayiphi na somatic or iindlela zengqondo.

Njengomzekelo, iziseko zendalo zezona zixhaphakileyo neziphindaphindanayo ezibuhlungu (umz. intloko ebuhlungu)3 kunye nezingapheliyo [umz. umqolo obuhlungu, I-fibromyalgia (FM)] iingxaki zentlungu ziyaziwa kakhulu, i-4,5 ngelixa ngakolunye uhlangothi, abantu abangabonakaliyo banokuba nezakhiwo ezingaqhelekanga ezifana neediski ze-herniated eziza kuchaza intlungu ukuba zikhona.6,7�Kukho ukunqongophala kweengcaciso ezifanelekileyo kwizigulana ezingenazo i-pathology echongiweyo ye-organic pathology ezixela iintlungu ezibukhali kunye nabantu abangenazintlungu kunye ne-pathology ebalulekileyo, enenjongo.

Iintlungu ezingapheliyo zichaphazela ngaphezu kwesigulana ngasinye, kodwa kunye nabanye ababalulekileyo (amaqabane, izalamane, abaqeshi kunye nabantu osebenza nabo kunye nabahlobo.), ukwenza unyango olufanelekileyo luyimfuneko. Unyango olwanelisayo lunokuvela kuphela kuvavanyo olubanzi lwe-aetiology yebhayoloji yeentlungu ezidityaniswe nenkcazo ethile yengqondo yengqondo kunye nokuziphatha kwesigulana, kubandakanya nemeko yeemvakalelo (umzekelo, ixhala, ukudakumba, kunye nomsindo), ukuqonda kunye nokuqonda iimpawu, kunye neempendulo kwezo. iimpawu ngabanye abalulekileyo.8,9 Isiseko esiphambili kukuba izinto ezininzi zichaphazela iimpawu kunye nokulinganiselwa okusebenzayo kwabantu abaneentlungu ezingapheliyo. Ngoko ke, uvavanyo olubanzi luyafuneka olujongene nemimandla ye-biomedical, psychosocial, kunye nokuziphatha, njengoko nganye igalelo kwiintlungu ezingapheliyo kunye nokukhubazeka okuhlobene.10,11

UVavanyo oluBanzi loMntu Onentlungu eziNgapheliyo

I-Turk kunye ne-Meichenbaum12 iphakamise ukuba imibuzo emithathu ephakathi kufuneka ikhokele uvavanyo lwabantu ababika intlungu:

1. Ubungakanani besifo okanye ukwenzakala kwesigulane (ukukhubazeka emzimbeni)?
2. Bungakanani ubungakanani besigulo? Oko kukuthi, isigulana sibandezeleka ukusa kuwuphi umkhamo, sisiphene, kwaye singakwazi ukunandipha imisebenzi eqhelekileyo?
3. Ngaba indlela umntu aziphethe ngayo ibonakala ifanelekile kwisifo okanye ukwenzakala, okanye ngaba kukho nabuphi na ubungqina bokukhulisa iimpawu kuzo naziphi na izizathu ezahlukahlukeneyo ngokwasengqondweni okanye ngokwasentlalweni (umz. iinzuzo ezinjengokuhoya kakuhle, amayeza atshintsha isimo sengqondo, imbuyekezo yemali)?

Ukuphendula le mibuzo, ulwazi kufuneka luqokelelwe kwisigulane ngembali kunye nokuhlolwa komzimba, ngokudibanisa nodliwano-ndlebe lwekliniki, kunye nezixhobo zovavanyo olusemgangathweni. Ababoneleli ngezempilo kufuneka bafune naziphi na izizathu (ii) zentlungu ngovavanyo lomzimba kunye neemvavanyo zokuxilonga ngelixa bevavanya imo yesigulane, uloyiko, izinto ezilindelekileyo, iinzame zokuhlangabezana, izixhobo, iimpendulo zabanye ababalulekileyo, kunye nefuthe lentlungu kwizigulana. ubomi.11 Ngamafutshane, umboneleli wezempilo kufuneka avavanye �umntu wonke� hayi nje intlungu.

Iinjongo ngokubanzi zembali kunye novavanyo lwezonyango zezi:

(i) imisele imfuneko yovavanyo olongezelelweyo lokuxilonga

(ii) misela ukuba idatha yonyango inokuchaza iimpawu zesigulane, ubunzima beempawu, kunye nokunciphisa ukusebenza

(iii) enze uxilongo lukagqirha

(iv) ukuvavanya ukufumaneka konyango olufanelekileyo

(v) misela iinjongo zonyango

(vi) limisele ikhondo elifanelekileyo lolawulo lweempawu ukuba unyango olupheleleyo alunakwenzeka.

Amanani abalulekileyo ezigulane ezichaza intlungu engapheliyo ayibonakalisi isifo somzimba usebenzisa i-radiographs ecacileyo, i-axial tomography scans, okanye i-electromyography. (uncwadi olubanzi lufumaneka kuvavanyo lomzimba, iinkqubo zovavanyo lwe-radiographic kunye nebhubhoratri ukugqiba isiseko somzimba wentlungu), i-17 eyenza ukuxilongwa ngokuchanekileyo kwe-pathological nzima okanye akunakwenzeka.

Nangona le mida, imbali yesigulane kunye nokuhlolwa komzimba kuhlala kusisiseko sokuxilongwa kwezonyango, kunokubonelela ngokhuseleko malunga neziphumo zokutolika ngokugqithiseleyo kwi-imaging yokuxilonga ubukhulu becala, kwaye ingasetyenziselwa ukukhokela ulwalathiso lwemizamo yokuvavanya ngakumbi.

Ukongezelela, izigulane ezineengxaki zentlungu engapheliyo zihlala zisebenzisa amayeza ahlukeneyo.18 Kubalulekile ukuxoxa ngamayeza akhoyo esigulane ngexesha lodliwano-ndlebe, njengoko amaninzi amayeza eentlungu adibaniswa nemiphumo engathandekiyo enokubangela okanye ukulinganisa uxinzelelo lwengqondo.19 Ababoneleli bezempilo akufanele baqhelane kuphela namayeza asetyenziselwa intlungu engapheliyo, kodwa kunye nemiphumo emibi evela kula mayeza abangela ukudinwa, ubunzima bokulala, kunye nokutshintsha kwemizwelo ukuphepha ukuxilongwa kakubi kokudakumba.

Ukusetyenziswa kweedayari zemihla ngemihla kukholelwa ukuba kuchaneka ngakumbi njengoko zisekelwe kwixesha langempela kunokuba ukhumbule. Izigulane zinokucelwa ukuba zigcine iidayari eziqhelekileyo zokuqina kweentlungu kunye namanqaku arekhodiweyo amaxesha amaninzi ngosuku ngalunye (umzekelo, ukutya kunye nexesha lokulala) iintsuku eziliqela okanye iiveki kunye neentlungu ezininzi zokulinganisa zinokulinganisa ixesha lonke.

Enye ingxaki ephawulwe ngokusetyenziswa kweedayari zephepha kunye neepensile kukuba izigulane azikwazi ukulandela umyalelo wokubonelela ngemilinganiselo ngexesha elithile. Endaweni yoko, izigulane zinokuzalisa iidayari kwangaphambili (�zigcwalise) okanye kamsinya phambi kokuba zibone ugqirha (�zigcwalise ngasemva), 24 zijongela phantsi ukuqinisekiswa kokuqinisekiswa kweedayari. Iidayari ze-elektroniki ziye zafumana ukwamkelwa kwezinye izifundo zophando ukuphepha ezi ngxaki.

Uphando luye lwabonisa ukubaluleka kokuvavanya umgangatho wobomi obunxulumene nempilo (HRQOL) kwizigulane ezibuhlungu ezingapheliyo ngaphezu komsebenzi.31,32 Kukho inani lemilinganiselo ye-HRQOL esekelwe kakuhle, exhaswa yi-psychometrically [IziPhumo zonyango eziFundiweyo zoPhando lwezeMpilo olufutshane. (SF-36)], imilinganiselo ye-33 jikelele yokusebenza komzimba [umz. I-Pain Disability Index (PDI)], i-34 kunye nemilinganiselo yesifo esithile [umzekelo, i-Western Ontario MacMaster Osteoarthritis Index (WOMAC); i-35 Roland-Morris Back Pain Disability Questionnaire (RDQ) )]36 ukuvavanya umsebenzi kunye nomgangatho wobomi.

Amanyathelo ajongene nezifo ayilelwe ukuvavanya impembelelo yemeko ethile (umzekelo, iintlungu kunye nokuqina kwabantu abane-osteoarthritis), ngelixa amanyathelo afanayo enza kube lula ukuthelekisa ukusebenza komzimba okuhambelana nesifo esinikiweyo kunye nonyango lwaso kunye nezinye iimeko ezahlukeneyo. Imiphumo ethile yokuphazamiseka ayinakubonwa xa usebenzisa umlinganiselo wegeneric; ngoko ke, amanyathelo ajongene nesifo anokuthi abonakalise ukuphuculwa okubalulekileyo kwezonyango okanye ukuwohloka kwemisebenzi ethile ngenxa yonyango. Imilinganiselo eqhelekileyo yokusebenza ingaba luncedo ukuthelekisa izigulane ezineentlobo ezahlukeneyo zeemeko ezibuhlungu. Ukusetyenziswa okudityanisiweyo kwemilinganiselo yesifo kunye namayeza afana nalawo aqhelekileyo kunceda ukufezekiswa kweenjongo zombini.

Ubukho boxinzelelo lweemvakalelo kubantu abaneentlungu ezingapheliyo kunika umngeni xa kuhlolwa iimpawu ezinjengokukhathala, ukunciphisa izinga lomsebenzi, ukunciphisa i-libido, utshintsho lokutya, ukuphazamiseka kokulala, ukufumana ubunzima okanye ukulahleka, kunye nokusilela kwenkumbulo kunye nokuxinana, njengoko ezi zimpawu zinokuba yingxaki. Isiphumo seentlungu, uxinzelelo lweemvakalelo, okanye amayeza onyango amiselwe ukulawula intlungu.

Izixhobo ziye zaphuhliswa ngokukodwa kwizigulane ezibuhlungu ukuba zihlole ukuxinezeleka kwengqondo, impembelelo yentlungu kubomi bezigulane, imvakalelo yokulawula, indlela yokuziphatha, kunye nesimo sengqondo malunga nesifo, intlungu, kunye nababoneleli bezempilo.17

Ngokomzekelo, i-Beck Depression Inventory (BDI) 39 kunye neProfayili ye-Mood States (POMS) i-40 isandi se-psychometrically ukuvavanya iimpawu zokudakumba, ukudandatheka, kunye nokuphazamiseka kwengqondo, kwaye ziye zacetyiswa ukuba zisetyenziswe kuzo zonke iimvavanyo zeklinikhi. intlungu engapheliyo;I-41 nangona kunjalo, amanqaku kufuneka atolikwe ngokuqaphela kwaye imilinganiselo yamanqanaba okukhathazeka ngokomzwelo inokufuna ukuguqulwa ukuze kuthintelwe iimpembelelo zobuxoki.42

ILab Biomarkers Yeentlungu

Iimpawu zebhayoloji ziimpawu zebhayoloji ezingasetyenziselwa ukubonisa impilo okanye izifo. Eli phepha liphonononga izifundo kwii-biomarkers zeentlungu ezisezantsi (LBP) kwizifundo zabantu. I-LBP iyona nto ibangela ukukhubazeka, okubangelwa yiziphazamiso ezahlukeneyo ezinxulumene nomqolo, kubandakanywa ne-intervertebral disc degeneration, i-disc herniation, i-spinal stenosis, kunye ne-facet arthritis. Ingqwalasela yezi zifundo ngabalamli abavuthayo, kuba ukuvuvukala kunegalelo kwi-pathogenesis ye-disc degeneration kunye neendlela ezihambelana neentlungu. Ukwandisa, uphando lubonisa ukuba ubukho babalamli abavuthayo bunokulinganiswa ngokwenkqubo egazini. Ezi biomarkers zinokusebenza njengezixhobo ezintsha zokwalathisa ukhathalelo lwesigulana. Okwangoku, impendulo yesigulane kunyango ayinakuqikelelwa ngesantya esibalulekileyo sokuphindaphinda, kwaye, ngelixa unyango lotyando lunokubonelela ngolungiso lwe-anatomical kunye nokunciphisa intlungu, zihlasela kwaye zibiza. Uphononongo lubandakanya izifundo ezenziwa ngabantu abanezifo ezithile kunye nemvelaphi engachazwanga ye-LBP. Ekubeni imbali yendalo ye-LBP iqhubela phambili, ubume bexeshana bezifundo luhlelwe ngokwexesha leempawu / isifo. Izifundo eziyeleleneyo malunga notshintsho kwii-biomarkers ngonyango zikwajongwa kwakhona. Ekugqibeleni, ii-biomarkers zokuxilonga ze-LBP kunye nokuguqulwa komgogodla ziyakwazi ukwalusa ixesha leyeza lomntu ngamnye lonyango lomntu kunyango lwe-LBP.

I-Biomarkers ye-Chronic Neuropathic Pain kunye nesicelo esinokwenzeka kwi-Spinal Cord Stimulation

Olu phononongo lwalugxile ekuqondeni ukuba zeziphi izinto ezingaphakathi emzimbeni womntu zonyuka kwaye ziyancipha ngokunyuka kweentlungu ze-neuropathic. Siye saphonononga izifundo ezahlukeneyo, kwaye sabona ulungelelwaniso phakathi kweentlungu ze-neuropathic kunye namacandelo e-immune system (le nkqubo ikhusela umzimba kwizifo kunye nosulelo). Iziphumo zethu ziya kuba luncedo ngakumbi ekuqondeni iindlela zokunciphisa okanye ukuphelisa ukungahambi kakuhle, intlungu engapheliyo ye-neuropathic iza nayo. Inkqubo yokuvuselela i-Spinal cord (SCS) yenye yeendlela ezimbalwa zonyango olusebenzayo lokulungisa iintlungu. Uphononongo olulandelayo luya kusebenzisa iziphumo zethu kolu hlaziyo kwi-SCS, ukuze siqonde indlela yokusebenza, kunye nokwandisa ukusebenza kakuhle.

I-cytokines e-pro-inflammatory efana ne-IL-1 ?, i-IL-6, i-IL-2, i-IL-33, i-CCL3, i-CXCL1, i-CCR5, kunye ne-TNF-?, zifunyenwe zidlala indima ebalulekileyo ekukhuliseni iintlungu ezingapheliyo.

Emva kokuphononongwa kwezifundo ezahlukeneyo eziphathelele kwii-biomarkers zentlungu, sifumene ukuba amanqanaba e-serum e-pro-inflammatory cytokines kunye ne-chemokines, njenge-IL-1?, IL-6, IL-2, IL-33, CCL3, CXCL1, CCR5, kunye ne-TNF -?, Ziye zalawulwa kakhulu ngexesha leentlungu ezingapheliyo. Ngakolunye uhlangothi, ii-cytokines ezichasayo ezifana ne-IL-10 kunye ne-IL-4 zifunyenwe zibonisa ukulawulwa okubalulekileyo ngexesha leentlungu ezingapheliyo.

Biomarkers For Depression

Uphando oluninzi luye lwachaphazela amakhulu ee-biomarkers zokudakumba, kodwa ayikacacisi ngokupheleleyo indima yabo kwisigulo soxinzelelo okanye iseke into engaqhelekanga apho izigulana kunye nokuba ulwazi lwebhayoloji lunokusetyenziswa njani ukuqinisa ukuxilongwa, unyango kunye noxilongo. Oku kunqongophala kwenkqubela phambili kungenxa yendalo kunye ne-heterogeneity yoxinzelelo, ngokubambisana ne-methodological heterogeneity ngaphakathi koncwadi lophando kunye noluhlu olukhulu lwee-biomarkers ezinamandla, ukubonakaliswa kwazo okuhlala kuhluka ngokwezinto ezininzi. Sihlaziya uncwadi olukhoyo, olubonisa ukuba abamakishi ababandakanyekayo kwiinkqubo ezivuthayo, i-neurotrophic kunye ne-metabolic, kunye ne-neurotransmitter kunye ne-neuroendocrine system components, bamele abaviwa abathembisayo kakhulu. Ezi zinokulinganiswa ngofuzo kunye ne-epigenetic, i-transcriptomic kunye neproteomic, i-metabolomic kunye ne-neuroimaging assessments. Ukusetyenziswa kweendlela zenoveli kunye neenkqubo zophando ezicwangcisiweyo ngoku ziyafuneka ukugqiba ukuba, kwaye yeyiphi, i-biomarkers ingasetyenziselwa ukuqikelela impendulo kunyango, stratify izigulane kunyango oluthile kunye nokuphuhlisa iithagethi zongenelelo olutsha. Siphetha ngelithi kukho izithembiso ezininzi zokunciphisa umthwalo wokudakumba ngokuphuhlisa ngakumbi nokwandisa ezi ndlela zophando.

Iingxelo:

• Uvavanyo lwezigulane ezineentlungu ezingapheliyo�EJ Dansiet kunye no-DC Turk*t�

• Iimpawu ze-biomarkers ezivuthayo zentlungu ephantsi kunye ne-disc degeneration: uphononongo.
  Khan AN1, Jacobsen HE2, Khan J1, Filippi CG3, Levine M3, Lehman RA Jr2,4, Riew KD2,4, Lenke LG2,4, Chahine NO2,5.
• I-Biomarkers ye-Chronic Neuropathic Pain kunye nesicelo sabo esinokubakho kwi-Spinal Cord Stimulation: Uphononongo
  Chibueze D. Nwagwu,1 Christina Sarris, MD,3 Yuan-Xiang Tao, Ph.D., MD,2 kunye no-Antonio Mammis, MD1,2
• Iimpawu zeBiomarkers zoxinzelelo: ukuqonda kwamva nje, imiceli mngeni yangoku kunye nethemba elizayo. Strawbridge R1, Young AH1,2, Sula AJ1,2.