Migraine

I-Back Clinic Chiropractic kunye nePhysical Therapy Migraine Team. I-Migraine sisifo sofuzo se-neurological, esibonakaliswe ngeziqephu ezibizwa ngokuba yi-Migraine attack. Zahluke kakhulu kwiintloko ezibuhlungu eziqhelekileyo ezingeyo-migrainous. Ngokumalunga ne-100 yezigidi zabantu baphathwa yintloko e-US Kwaye i-37 yezigidi zaba bantu baphathwa yi-migraines. UMbutho wezeMpilo weHlabathi uqikelela ukuba i-18 ekhulwini yabasetyhini kunye neepesenti ze-7 zamadoda ase-US aphethwe yile ntloko. I-Migraines ibizwa ngokuba yi-primary headaches kuba iintlungu azibangelwa kukuphazamiseka okanye sisifo oko kukuthi ithumba ebuchotsheni okanye ukwenzakala entloko.

Ezinye zibangela intlungu kuphela kwicala lasekunene okanye kwicala lasekhohlo lentloko. Ngelixa abanye kubangela intlungu kuyo yonke indawo. Abantu abane-Migraine banokuba neentlungu eziphakathi okanye ezinzima kodwa kaninzi abakwazi ukuthatha inxaxheba kwimisebenzi yesiqhelo ngenxa yeentlungu. Xa i-migraine ibetha, igumbi elimnyama elizolileyo linokunceda ngeempawu. Zinokuhlala iiyure ezine okanye zinokuhlala iintsuku. Uluhlu lwexesha umntu ochaphazelekayo kuhlaselo ngokwenene lude kunentloko ngokwayo. Oku kungenxa yokuba kukho i-pre-monitory okanye ukwakhiwa, kunye ne-post-drome enokuhlala usuku olunye ukuya kwiintsuku ezimbini.

I-Psychology, Intloko, I-Back Pain, Ubuhlungu obungapheliyo kunye neChiropractic e-El Paso, TX

by iicrosoft | Umqolo obuhlungu, Chiropractic, Ubuhlungu obungapheliyo, Migraine, Ukubuyiswa komzimba, Uvavanyo oluLungeleleneyo oluLungisiweyo, istres, Unyango

Wonke umntu ufumana iintlungu ngexesha elide. Ubunzima bubuhlungu obungokwenyama obubangelwa kukulimala okanye ukugula. Xa udonsa umsizi okanye usike umnwe wakho, umzekelo, isignali ithunyelwa ngeengcambu zentsholongwane kwingqondo, ekutshengeni ukuba into ephosakeleyo emzimbeni. Ubuhlungu buyahlukahluka kuwo wonke umntu kwaye kukho iindlela ezininzi zokuvakalelwa nokuchaza intlungu. Emva kokulimala okanye ukugula kugula, intlungu iya kuphelisa, nangona kunjalo, kwenzeka ntoni ukuba intlungu iyaqhubeka nangemva kokuphilisa?

Ubuhlungu obungapheliyo ngokuqhelekileyo ichazwa njengaluphi na ubuhlungu obuhlala ngaphezu kweeveki ze-12. Ubuhlungu obungapheliyo bunokuvela kwi-mild to severe and can be the result of injuries before or surgery, migraine kunye nentloko, isifo samathambo, umonakalo wemisipha, ukusuleleka kunye ne-fibromyalgia. Ubuhlungu obungapheliyo buyakuchaphazela isimo sengqondo somntu kunye nengqondo, okwenza kube nzima ukukhupha iimpawu. Uphando lwaphando lubonise ukuba ukungenelela kwengqondo kunokuncedisa inkqubo yokubuyisela ubuhlungu obungapheliyo. Abasebenzi abaninzi bezempilo, njengogqirha we-chiropractic, banokubonelela ngononophelo lwe-chiropractic kunye nokungenelela kwengqondo ukunceda ukubuyisela impilo kunye nokuphila kakuhle kwezigulane zabo. Injongo yale nqaku ilandelayo kukubonisa inxaxheba yongenelelo lweengqondo ekulawuleni izigulane ezinentlungu engapheliyo, kuquka intloko yesifo kunye nentlungu.

Inxaxheba Yongenelelo lweengqondo kwi-Management of Patients with Pain Pain

Name: El Paso Back Clinic | Spine Specialists - El Paso, TX
Price range: $$

Abstract

Intlungu engapheliyo inokuqondwa ngcono ngokwembono ye-biopsychosocial apho iintlungu zijongwa njengamava antsonkothileyo, anezinto ezininzi ezivela kulwalamano olunamandla lwesimo somzimba, iingcinga, iimvakalelo, isimilo, kunye nefuthe lenkcubeko. Umbono we-biopsychosocial ujolise ekujongeni iintlungu ezingapheliyo njengesifo kunesifo, ngenxa yoko ukuqonda ukuba ngamava aphantsi kwaye iindlela zonyango zijolise kulawulo, endaweni yokunyanga, kwentlungu engapheliyo. Iindlela zangoku zengqondo kulawulo lweentlungu ezingapheliyo zibandakanya ungenelelo olujolise ekufezekiseni ukwanda kolawulo lwakho, utshintsho kwindlela yokuziphatha, kunye notshintsho lwengqondo kunokuba ususe ngqo indawo ebuhlungu. Izibonelelo zokubandakanya unyango lwengqondo kwiindlela ezahlukeneyo zokulawula iintlungu ezingapheliyo zibandakanya, kodwa azikhawulelwanga, ukunyusa ukuzilawula kweentlungu, ukuphucula izixhobo zokujamelana neentlungu, ukunciphisa ukukhubazeka okunxulumene nentlungu, kunye nokunciphisa uxinzelelo lweemvakalelo ngeendlela ezahlukeneyo zokuzilawula, zokuziphatha, kunye neendlela zokuqonda. Ngokumiliselwa kolu tshintsho, iingcali zengqondo zinokunceda abaguli bazive ngaphezulu kumyalelo wolawulo lweentlungu zabo kwaye babenze bakwazi ukuhlala ubomi obuqhelekileyo kangangoko kunokwenzeka ngaphandle kwentlungu. Ngaphaya koko, izakhono ezifundwe ngongenelelo lwengqondo zixhobisa kwaye zenza ukuba izigulana zibe ngabathathi-nxaxheba abakhutheleyo kulawulo lokugula kwabo kwaye baxhokonxe izakhono ezixabisekileyo ezinokuqeshwa zizigulana kubomi babo bonke.

Internet: ukuphathwa kabuhlungu obungapheliyo, iingqondo zengqondo, unyango lweentlungu ezahlukeneyo, unyango lwezengqondo zokuziphatha

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Ubuhlungu obungapheliyo sele buzimisele ukuchaphazela impilo yengqondo yabantu abaneempawu eziqhubekayo, ekugqibeleni ukutshintsha isimo sabo sengqondo nesimo sengqondo. Ukongezelela, izigulane ezineemeko ezidityanisiweyo, kuquka ukuxinezeleka, uxinzelelo kunye nokudakumba, zingenza unyango lunzima. Indima yenkathalo ye-chiropractic kukubuyisela kunye nokugcina nokulungelelanisa ukulungelelaniswa kokuqala komgudu ngokusebenzisa ukuguqulwa komgudu kunye nokusetyenziswa kwamandla. Ukunyamekela kwe-Chiropractic kuvumela umzimba ukuba uphilise ngokwawo ngaphandle kwemfuno yeziyobisi / amachiza kunye nokungenelela okucwangcisiweyo, nangona oku kungathunyelwa kwi-chiroprarensi ukuba kuyimfuneko. Nangona kunjalo, ukunakekelwa kwe-chiropractic kugxile kumzimba ngokubanzi, kunokuba kubekho ukulimala omnye kunye / okanye imeko kunye neempawu zayo. Ukuguqulwa kwamagqabi kunye nokusetyenziswa kwamanyathelo, phakathi kwezinye iindlela zonyango kunye nezindlela eziqhelekileyo ezisetyenziselwa yicroperractor, zifuna ukuqonda ngesimo sengqondo nesimo sengqondo somguli ukwenzela ukuba ubonelele ngokufanelekileyo impilo nempilo. Izigulane ezityelela kwiklinikhi yam ngokuxinezeleka kwemizimba yazo zihlala zikwazi ukufumana iingxaki zengqondo ngenxa yoko. Ngako oko, ukunakekelwa kwe-chiropractic kungabangela ukungenelela kwengqondo kwindlela yokulawula ubuhlungu obungapheliyo, kunye nezo ziboniswe ngezantsi.

intshayelelo

Intlungu ngamava omntu okuyo yonke indawo. Kuqikelelwa ukuba malunga ne-20% 35% yabantu abadala abafumana iintlungu ezingapheliyo. [1,2] I-National Institute of Nursing Research inika ingxelo yokuba iintlungu zichaphazela abantu abaninzi baseMelika kunesifo seswekile, isifo sentliziyo, kunye nomhlaza zidityanisiwe. [3] Ubuhlungu bukhankanywe njengesona sizathu siphambili sokufuna unyango e-United States. [4] Ngapha koko, ukuthomalalisa iintlungu lolwesibini unyango olumiselweyo kwii-ofisi zoogqirha nakumagumbi angxamisekileyo. [5] Ukuqinisa ngakumbi ukubaluleka kovavanyo olwaneleyo lwentlungu, iKhomishini edibeneyo yokuVunywa kweMibutho yoKhathalelo lwezeMpilo ikhuphe umyalelo wokuba iintlungu zivavanywe njengophawu lwesihlanu olubalulekileyo ngexesha lotyelelo lwezonyango. [6]

Umbutho waMazwe ngaMazwe woFundo lweNtlungu (IASP) uchaza iintlungu njenge- amava angathandekiyo eemvakalelo kunye neemvakalelo ezinxulunyaniswa nokwenzeka ngqo okanye ukubakho kwethishu, okanye kuchazwe ngokwaloo monakalo . Inkcazo ye-IASP igxininisa ubunjani obuninzi kunye nokuzithoba kwintlungu, amava anzima ahlukeneyo kumntu ngamnye. Ubuhlungu obungapheliyo buhlala buhlulwa kwintlungu ebuhlungu ngokusekwe kukunganyamezeleki okanye ukuzingisa, iindlela zayo zokulondolozwa komzimba, kunye / okanye nefuthe elibi kubomi bomntu. Ngokubanzi, kuyamkelwa ukuba iintlungu eziqhubeka ngaphezulu kwexesha elilindelweyo lokunyanga izicubu kulandela ukwenzakala okanye utyando kuthathwa njengentlungu engapheliyo. Nangona kunjalo, ixesha elibekiweyo elilindelweyo lokuphilisa liyahluka kwaye kuhlala kunzima ukuqiniseka ngalo. Ukulungiselela ukwahlulwahlulwa ngokulula, izikhokelo ezithile zibonisa ukuba iintlungu eziqhubayo ngaphaya kwenyanga ye-7 3 yexesha kuthathwa njengentlungu engapheliyo. [6] Nangona kunjalo, ukuhlelwa kwentlungu esekwe kuphela kubude kuyasebenza ngokungqongqo kwaye, kwezinye iimeko, inqobo yokuchasana. Ngokuqhelekileyo, izinto ezongezelelweyo ezifana ne-etiology, ubunzima beentlungu, kunye nefuthe ziqwalaselwa kunye nexesha lokuhlukanisa ubuhlungu obungapheliyo. Enye indlela yokubonakalisa ubuhlungu obungapheliyo isekelwe kwindlela yokugcinwa komzimba; Oko kukuthi, iintlungu ekucingelwa ukuba ziyavela ngenxa yolungelelwaniso kunye nolungelelwaniso oluphambili. Iimeko eziqhelekileyo zentlungu zibandakanya ukuphazamiseka kwemisipha, iimeko zentlungu ye-neuropathic, iintlungu zentloko, iintlungu zomhlaza kunye nentlungu yokubona. Ngokubanzi ngakumbi, iimeko zentlungu zinokuba ikakhulu zi-nociceptive (ukuvelisa iintlungu zoomatshini okanye zeekhemikhali), i-neuropathic (ebangelwa ngumonakalo wemithambo-luvo), okanye embindini (okubangelwa kukungasebenzi kakuhle kwii-neurons zenkqubo ye-nervous system). [7]

Ngelishwa, amava entlungu ahlala ebonakaliswa kukungaziphathi kakuhle ngokwasemzimbeni, ngokwasengqondweni, ngokwasentlalweni nakwezemali. Ubuhlungu obungapheliyo buye babonwa njengesona sizathu siphambili sokukhubazeka ixesha elide kubemi baseMelika abasebenzayo. [9] Ngenxa yokuba iintlungu ezingapheliyo zichaphazela umntu kwimimandla emininzi yobukho bakhe ikwangumthwalo omkhulu wemali kuluntu lwethu. Iindleko ezichanekileyo nezingangqalanga zentlungu ziqikelelwa ukuba zisuka kwi-125 yezigidigidi ukuya kwi-215 yezigidigidi, ngonyaka. [10,11] Iziphumo ezixhaphakileyo zentlungu engapheliyo zibandakanya ukwanda kweengxelo zoxinzelelo (umzekelo, ukudakumba, unxunguphalo, kunye nokudana), ukwanda kwamazinga okukhubazeka okunxulumene nentlungu, utshintsho olunxulumene nentlungu ekuqondeni, kunye nokunciphisa umgangatho wobomi. Ke, iintlungu ezingapheliyo zinokuqondwa ngcono ngokwembono ye-biopsychosocial apho iintlungu zijongwa njengamava antsonkothileyo, anezinto ezininzi ezivela kulwalamano olunamandla lwesimo somzimba, iingcinga, iimvakalelo, isimilo, kunye nefuthe lenkcubeko.

Ulawulo lwezinhlungu

Ngenxa yokuxhaphaka kweentlungu kunye nobukhulu bayo, i-regimen yolawulo lwentlungu efanelekileyo iya kubanzi, idibanise kunye neyodwa. Iindlela ezikhoyo zolawulo lweentlungu ezingapheliyo ziye zagqithisa ukunciphisa nokunciphisa ngokukhawuleza, ngokomzimba, okanye kwi-pharmacological unyango. Iindlela ezikhoyo ziyabona ukubaluleka kwesikhokelo sokhathazwa kwamanyathelo ahlukeneyo ekujoliswe kuzo ekujoliswe kwimiba yeentlungu kodwa kunye neengqinisiso zokuqonda, kunye nezizathu ezinokuthi zithintekayo kunye kunye neempembelelo ezifanayo. Ulawulo oluqhelekileyo lweentlungu ezingapheliyo ziquka ukunyangwa kwamaqela amaninzi afana nokuhlanganiswa kwama-analgesics, unyango lomzimba, unyango lwendlela yokuziphatha, kunye neyeza zengqondo. Indlela yokwenza i-multimodal ngokufanelekileyo ngokwaneleyo kwaye iqondise ngokufanelekileyo ulawulo lweentlungu kwiimodeli, ukuziphatha, ukuqonda, kunye namazinga asebenzayo. Ezi ndlela ziye zaboniswa ukuba zikhokele kwiziphumo eziphambili kunye nezihlala zihlala zihlala ziquka iingxelo zentlungu, imizwa, ukubuyiswa kwemisebenzi yansuku zonke, isimo somsebenzi, kunye neyeza okanye ukusetyenziswa kwezempilo; Iindlela zokwenziwa kweemimandla ziye zaboniswa ukuba zindleko ezininzi kuneendlela ezingenjalo. [12,13] Ugxininiso lwolu hlalutyo luya kubakho ngokucacileyo ukulungelelanisa iingenelo zengqondo kwindlela yokulawula intlungu engapheliyo.

UDkt. Jimenez wenza unyango lomzimba kwisigulane.

Izigulana ziya kuthi ekuqaleni zibonise iofisi kagqirha ekunyangeni unyango okanye unyango lwezifo zabo / iintlungu ezibuhlungu. Kwizigulana ezininzi, kuxhomekeke kwi-etiology kunye ne-pathology yeentlungu zabo kunye neempembelelo ze-biopsychosocial kumava entlungu, iintlungu eziqaqambileyo ziya kusombulula ngokuhamba kwexesha, okanye ukulandela unyango olujolise ekujoliseni unobangela wentlungu okanye ukuhanjiswa kwayo. Nangona kunjalo, ezinye izigulana azizukufezekisa ukusonjululwa kwentlungu yabo ngaphandle kongenelelo oluninzi lwezonyango kunye nolongezelelo kwaye ziya kutshintsha zisuka kwintlungu ebuhlungu iye kwimeko yeentlungu ezinganyangekiyo. Umzekelo, uphando lubonakalisile ukuba malunga ne-30% yezigulana ezibonisa ugqirha wabo wokunyamekela kwizikhalazo ezinxulumene nentlungu ebuhlungu iya kuqhubeka nokufumana iintlungu kwaye, kwabanye abaninzi, ukusikelwa umda kwemisebenzi kunye nokubandezeleka kwiinyanga ezili-12 kamva. [14] Njengoko iintlungu kunye neziphumo zalo ziyaqhubeka nokukhula kwaye zibonakalise kwimiba eyahlukeneyo yobomi, iintlungu ezingapheliyo zinokuba ikakhulu yingxaki ye-biopsychosocial, apho uninzi lweempawu zebhayopsychosocial zinokuthi ziqhubele phambili kwaye zigcine iintlungu, oko ke kuqhubeka nefuthe elibi kubomi bomntu ochaphazelekayo. Kule ndawo apho irejimeni yonyango yoqobo inokwahluka ukubandakanya ezinye izinto zonyango, kubandakanya neendlela zengqondo zokulawula iintlungu.

Iindlela zengqondo zolawulo lweentlungu ezingapheliyo ekuqaleni zafumana ukuthandwa ekupheleni kweminyaka yama-1960 ngokuvela kweMelzack kunye neWall s gate-control theory of pain [15] kunye ne- neuromatrix theory of pain . [16] Ngokufutshane, ezi ngcamango zibonisa ukuba iinkqubo zengqondo nezomzimba ziyasebenzisana ukuze zichaphazele ukuqonda, ukuhambisa, kunye nokuvavanya iintlungu, kwaye ziyayiqonda impembelelo yezi nkqubo njengezinto zolondolozo ezichaphazelekayo kwimeko yeentlungu ezingapheliyo okanye ezinde. Ngokukwanjalo, ezi ngcamango zisebenza njengezinto eziphambili zokufaka utshintsho kwindlela ebalaseleyo nengalunganga kunyango lwentlungu, enye ilawulwa kakhulu ziimbono zebhayiloji ngokungqongqo. Iiklinikhi kunye nezigulana ngokufanayo zifumene ukwandiswa okwandayo kunye noxabiso ngobunzima bokulungiswa kwentlungu kunye nokugcinwa; Ngenxa yoko, ukwamkelwa kunye nokukhethwa kweembono ezahlukeneyo zemeko yentlungu kwasekwa. Okwangoku, imodeli ye-biopsychosocial yeentlungu, mhlawumbi, yeyona ndlela yamkelekileyo eyamkelekileyo yokuqonda iintlungu. [17] Umbono we-biopsychosocial ujolise ekujongeni iintlungu ezingapheliyo njengesifo kunesifo, ngaloo ndlela ukuqonda ukuba ngamava e-subjective kwaye iindlela zonyango zijolise kulawulo, endaweni yokunyanga, kwentlungu engapheliyo. [17] Njengoko ukusetyenziswa kwendlela ebanzi kunye neyona ndlela ibanzi yokulawula iintlungu ezingapheliyo kuye kwabonakala, ungenelelo olusekwe kwengqondo lubone ukunyuka okuphawulekayo ekuthandeni nasekuqondweni njengonyango olongezelelekileyo. Iindidi zongenelelo lwengqondo eziqeshwe njengenxalenye yenkqubo yonyango yeentlungu ezininzi ziyahluka ngokokuziqhelanisa nonyango, i-etiology yeentlungu, kunye neempawu zesigulana. Ngokufanayo, uphando malunga nokusebenza kwamanyathelo angenelelo lwengqondo kwiintlungu ezingapheliyo kubonise ukuhluka, nangona kuthembisa, iziphumo kwiimpawu eziphambili ezifundwayo. Olu gqabantshintshi luza kuchaza ngokufutshane iindlela zonyango ezisetyenziselwa unyango olusebenzayo kunye nokusebenza kwazo ngokufanelekileyo kwiziphumo eziphambili.

Izindlela zengqondo zangoku eziphathekayo ekulawuleni iintlungu ezingapheliyo ziquka ukungenelela okujolise ekuphumezeni ukulawulwa kwezinto ezizimeleyo, ukuguquka kokuziphatha, kunye nokuguqulwa kwengqondo kunokuba kupheliswe ngokuthe ngqo indawo yeentlungu. Ngaloo ndlela, bajolise kwizinto eziphathekayo zokuziphatha, iimvakalelo kunye neengcamango zentlungu engapheliyo kunye nezinto ezibangela ukugcinwa kwayo. Ukwaziswa kwesi sikhokelo esinikwe nguHoffman et al [18] kunye no-Kerns et al, [19] oku kulandelwa rhoqo kwiindawo zonyango ezisekelwe kwengqondo zihlaziywa: ubuchule be-psychophysiological, iindlela zokuziphatha zonyango, unyango lwendlela yokuziphatha kunye nokungenelela okusekelwe.

Iingcaphephe zengqondo

Biofeedback

I-Biofeedback yindlela yokufunda apho izigulane zifunda ukutolika impendulo (ngohlobo lwengcaciso yomzimba) malunga nemisebenzi ethile yempilo. Ngokomzekelo, isigulane sinokusebenzisa izixhobo ze-biofeedback ukufunda ukuqaphela iziganeko zomthambo emzimbeni wazo kwaye emva koko zifunde ukukhulula ezo ndawo ukunciphisa uxinzelelo lwe-muscular. Impendulo inikezwa ngezixhobo ezahlukeneyo zokulinganisela ezinokunika ulwazi malunga nomsebenzi wombane wengqondo, uxinzelelo lwegazi, ukuhamba kwegazi, ithoni ye-muscle, umsebenzi we-electrodermal, izinga leentliziyo, kunye nokushisa kwesikhumba, phakathi kweminye imisebenzi yomzimba ngokukhawuleza. Injongo ye-biofeedback iyayifumana isigulane ukuba ifunde indlela yokuqalisa inkqubo yokuzilawula ngokwasemzimbeni ngokuphumeza ukulawula ngokuzithandela malunga nezimpendulo ezithile zomzimba ekugqibeleni ukwandisa ukuguquguquka komzimba ngokuqonda ngokubanzi nokuqeqeshwa okuthe ngqo. Ngako oko isigulane siza kusebenzisa izakhono ezizodwa zokulawula ukuzama ukunciphisa umcimbi ongathandekiyo (umz., Intlungu) okanye ukuphendulwa kwemizimba engathandekiyo (umzekelo, ukuphendula uxinzelelo). Iingcali ezininzi zeengqondo ziqeqeshwe kwiinkqubo ze-biofeedback kwaye zibonelela ngeenkonzo njengenxalenye yonyango. I-Biofeedback iye yonyulwa njengomsebenzi onobungqina beentlungu ezinxulumene nentloko kunye ne-temporomandibular disorders (TMD). [20] Ukuhlalutya kwe-meta-uphando lwe-55 kuveze ukuba ukungenelela kwe-biofeedback (kubandakanya iindlela ezahlukeneyo ze-biofeedback) kwanikezela ukuphucula okubalulekileyo malunga nokuvama kokuhlaselwa kwe-migraine kunye nemibono yokulawulwa kwentloko ukuzinyameka xa kuqhathaniswa nezimo zolawulo. [I-21] Izifundo zinike inkxaso yenkxaso ye-biofeedback ye-TMD, nangona uphuculo oluthe xaxa malunga nentlungu kunye nokukhubazeka okuchaphazelekayo sele kufunyenwe kwiiprotokholi ezidibanisa i-biofeedback kunye nengqiqo ukuqeqeshwa kwezakhono zokuziphatha, phantsi kwengcinga yokuba indlela yokusebenzisana yonyango ngokubanzi ichaza i-gamut yeengxaki ze-biopsychosocial ezingadibana nazo ngenxa ye-TMD. [22]

Indlela yokuziphatha

Uqeqesho lokuphumula

Ngokuqhelekileyo yamkelwa ukuba uxinzelelo luyinto ebalulekileyo ekubandakanyekeni kunye nokugcinwa kweentlungu ezingapheliyo. [16,23] Ukuxinwa kwengxaki kunokuba yinto engqongileyo, ngokomzimba, okanye ngokwengqondo nangokwemvakalelo, nangona kunjalo ezi ndlela zihambelana ngokugqithiseleyo. Ukugxilwa koqeqesho lokuphumula kukunciphisa amanqanaba omgudu (ngokomzimba nangokwengqondo) ngokusebenza kwenkqubo ye-nervympathetic ne-nervous system kunye nokufumana ukuqonda okubanzi malunga namaziko kunye nokusebenza kwengqondo, ngaleyo ndlela kufezekiswe ukunciphisa intlungu kunye nokwandisa ukulawula iintlungu. Izigulane ziyakwazi ukufundiswa iindlela ezininzi zokuziphucula kwaye zizenzele ngokwazo okanye ngokubambisana, kunye nezixhobo ezixhasayo kwezinye iindlela zokuziphatha zobuhlungu nokuziphatha. Ezi zilandelayo zichazwe ngokufutshane iinkqubo zokuphumula eziqhelekileyo ezifundiswa ngabafundi beengqondo.

Ukuphefumla. Ukuphefumula ngokufayo kuyindlela yobomi bokuphucula apho izigulane ziyalwa ukuba zisebenzise izihlunu zesithsaba sazo ngokuchasene nezihlunu zesifuba saso ukuze zibandakanye ukuziloba. Ukuphefumula ngokuqhawula isithintelo kuvumela imiphunga ukuba yande (egqitywe ukwandiswa kwesisu ngexesha lokutshatyalaliswa) kwaye ngoko kwandisa ukondla kwe-oksijini. [24]

Ukuphumla kwemisipha yokuqhubekayo (PMR). I-PMR ibonakaliswe ngokubandakanya ukudibanisa kwemisipha kunye nokuzilalisa kwemisipha ethile okanye amaqela emisipha kuwo wonke umzimba. [25] Isigulane siyalwa ngokuqhelekileyo ukuba sihlanganyele ekusebenziseni uxhaphalo / ukuphumula ngendlela elandelanayo kude kube zonke iindawo zomzimba ziye zaqwalaselwa.

Uqeqesho lwe-Autogenic (AT). I-AT yindlela yokuzihlaziya ngokuzilawulayo apho isigulane siphinda ibinzana ngokubambisana nokubonisa ukukhupha isimo sokuphumla. [26,27] Le ndlela idibanisa ukuxilongo, ukubonakala, kunye nobuchule bokuphefumla.

Ukubonakalisa / ukujonga umfanekiso. Le ndlela ikhuthaza izigulane ukuba zisebenzise zonke iingqondo zabo ekucingeni indawo ecacileyo, ephilileyo kunye nekhuselekileyo ukuphumeza indlela yokuphumla kunye nokuphazamiseka kwiintlungu kunye neengcamango ezinxulumene nentlungu kunye nokuvakalelwa. [27]

Ngokudibeneyo, iindlela zokuphumla zifunyenwe ziluncedo kulawulo lweentlobo ngeentlobo zeemeko zentlungu engapheliyo kunye nolawulo lweentlungu ezibalulekileyo (umzekelo, umgangatho wobomi onxulumene nempilo). [28-31 ] Iindlela zokuphumla zihlala zenziwa ngokudibene nezinye iindlela zolawulo lwentlungu, kwaye kukho ukugqagqana okubonakalayo kwiindlela zokucinga zokuphumla kunye ne-biofeedback, umzekelo.

Unyango loPhatha

Unyango lokuziphatha olusebenzayo lwentlungu engapheliyo lukhokelwa yimigaqo-nkqubo yoqobo esebenzayo ecetyiswe nguSkinner [32] kwaye icokisiwe yiFordyce [33] ukuze isebenze kulawulo lweentlungu. Iimpawu eziphambili zomzekelo wokusebenza kwemeko yokusebenza njengoko inxulumene nentlungu ebambekayo yokuba isimilo sentlungu ekugqibeleni sinokuthi siguquke kwaye sigcinwe njengezibonakalisayo iintlungu ezingapheliyo ngenxa yokuqiniswa okuqinisekileyo okanye okungalunganga kwendlela yokuziphatha enikiweyo kunye nesohlwayo sokuziqhelanisa ngakumbi. Ukuziphatha kabuhlungu. Ukuba ukomeleza kunye neziphumo ezilandelayo zenzeka rhoqo, zinokubangela imeko yokuziphatha, oko ke kwandise ukubakho kokuphindaphinda indlela yokuziphatha kwixa elizayo. Ke ngoko, isimilo esimiselweyo senzeka njengemveliso yokufunda yeziphumo (zokwenyani okanye ezilindelweyo) zokuzibandakanya kwindlela oziphethe ngayo. Umzekelo wokuziphatha okuqhubekekayo kukuqhubeka nokusetyenziswa kwamayeza behavior indlela yokuziphatha ebangelwa kukufunda ngemibutho ephindaphindwayo ethatha amayeza ilandelwa kukususwa kwemvakalelo yokuvava (iintlungu). Ngokufanayo, iimpawu zokuziphatha zentlungu (umz., Intetho yomlomo wentlungu, amanqanaba omsebenzi asezantsi) unokuba yimeko yokuziphatha enokuthi iqhubekekise iintlungu ezingapheliyo kunye nokulandelelana kwayo. Unyango olukhokelwa yimigaqo yokuziphatha esebenzayo lujolise ekucimeni isimilo esibuhlungu ngokuziphatha okufanayo ngemigaqo yokufunda enokuthi isekwe yiyo. Ngokubanzi, izinto zonyango zonyango olusebenzayo zibandakanya ukwenziwa okuhleliweyo, iishedyuli zamayeza ezinamaxesha, kunye nokusetyenziswa kwemigaqo yokuqinisa ukonyusa isimilo esihle kunye nokunciphisa indlela yokuziphatha ebuhlungu.

Ukusebenza ngokusetyenzisiweyo. Iingcali zengqondo zikwazi ukuphumeza iinkqubo zengqesho ezidityanisiweyo zezigulane ezingapheliyo eziye zanciphisa amanqanaba omsebenzi wazo (ukwandisa amathuba okwenyuka komzimba) kwaye emva koko zifumana amanqanaba aphakamileyo entlungu xa eqhuba umsebenzi. Izigulane ziyalelwe ukuba ziphule ngokukhuselekileyo umjikelezo wokungahambi kunye nokuhlaziywa ngokubandakanyeka kwintsebenzo ngendlela elawulwayo kunye nexesha elingapheliyo. Ngale ndlela, izigulane zinokunyusa ngokukhawuleza ubude bexesha kunye nobukhulu bomsebenzi ukuphucula ukusebenza. Iingcali zengqondo zijongene nenkqubela phambili kwaye zibonelela ngokufanelekileyo ukuthotyelwa, ukulungiswa kweengcamango okanye ukuchazwa kakuhle kweentlungu ezibangelwa ngumsebenzi, apho kufanelekile, kunye neengxaki zokusombulula izithintelo zokuthobela. Le ndlela ihlala ihlanganiswe kwiinkqubo zonyango zolawulo lwentlungu.

Iishedyuli zamachiza ezithatha ixesha. Ingcali yeengqondo ingaba ngumboneleli obalulekileyo wokunakekelwa kwezempilo ekujongeni ulawulo lweemithi zentlungu. Kwezinye iimeko, oogqirha beengqondo banethuba lokuqhagamshelana ngokuthe rhoqo kunye nezigulane kunezigulane kunabanogqirha kwaye ngoko banokubambisana njengabalingani abalulekileyo beendlela zokwenza unyango oludibeneyo. Iingcali zengqondo ziza kuseka iishedyuli zamachiza ezithatha ixesha lokunciphisa amathuba okuxhomekeka kwimizi yeentlungu zokufumana ulawulo olufanelekileyo kwiintlungu. Ukongezelela, izazi zeengqondo zixhotyiswe ukubandakanya izigulane kwiingxoxo ezibalulekileyo malunga nokubaluleka kokunamathela ngokufanelekileyo kumachiza kunye neengcebiso zonyango kunye nokuxazulula iingxaki ezinokuthintela ukulandelwa ngokukhuselekileyo.

Uloyiko lokuphepha. Umzekelo wokugwema ukwesaba okungapheliyo ukusetyenziswa kwentlungu yintlungu engapheliyo (i-LBP). [34] Lo mzekelo uthatha kakhulu kwimigaqo yokuziphatha esebenzayo ichazwe ngaphambili. Ngokwenene, imodeli yokugwema ukwesaba ithi xa ubuhlungu obukhulu buchazwa ngokuphindaphindiweyo njengengozi yengozi okanye iimpawu zokulimala kabuhlungu, izigulane zingasengozini yokuzibandakanya ekukhuseleni ukuziphatha okukhuselekayo kunye neengcamango ezomeleza ngakumbi inkolelo yokuba intlungu uphawu lweengozi kunye nokuqhubela phambili ukuhlaziywa komzimba. Njengoko umjikelezo uyaqhubeka, ukuphepha kungadala kwiintlobo zeentlobo zomsebenzi kwaye kubangele ukungathandabuzeki kwemvakalelo ebonakalayo ebonakaliswe ngokuchazwa ngokukrakra kweengqondo zomzimba. Uphando luye lwabonisa ukuba inqanaba eliphezulu leentlungu elixhatshazwayo lidibene nokugcinwa komjikelezo. [35] Unyango olujoliswe ekugqibeleni umjikelezo wokugwema ukwesaba uqeshe imisebenzi eyoyikisayo ekuqinisekiseni ukuba ukwesaba, okubangelwa yimingcipheko yokuthatha inxaxheba kwimisebenzi . Ukubhengezwa ngokubanzi kuqhutyelwa nge-psychoeducation malunga neentlungu kunye neengcamango zokuhlaziywa kwengqondo ezijolise kwiingcamango eziphathekayo kunye nokulindela ngemisebenzi kunye nentlungu. Iingcali zengqondo zisesimweni esihle kakhulu sokwenza ezi ntlobo zongenelelo ezilinganisa ngokugqithiseleyo unyango oluqhelekileyo elisetyenziselwa unyango lweengxaki ezithile zokuxhalabisa.

Nangona unyango olusondeleyo lwezonyango luye lwaboniswa ukuba luncedo ekwenzeni unyango lweengxaki zesifo seengingqi i-CR (i-CRPS-1) [i-36] kunye ne-LBP [37] kwimilo yecala elilodwa, isilingo esiphezulu esilinganiselwe ngokulandelanayo esilinganiselwe unyango lwamayeza kunye neenkqubo ezahlukeneyo zonyango lwenkqubo kunye neenkqubo ezahlukeneyo zonyango lwenkqubo yodwa kunye neqela lokulawula uluhlu lubone ukuba ezi zimbini zonyango zenzeke ekuphuculeni okubonakalayo kwimilinganiselo yempatho yentlungu, ukwesaba ukunyakaza / ukulimala, intlungu, Ukudakumba, kunye nomgangatho womsebenzi. [I-38] Iziphumo ezivela kulolu vavanyo zibonisa ukuba ukungenelela kokubambisana kwakunxulumene nokusebenza ngonyango olubalulekileyo kangangokuthi unyango olungabonakaliyo olubonakalayo aluzange lubonakale lubangele ukufumana unyango olongezelelweyo. [38] Inqaku elisixwayisayo ekuchazeni kwezi Iziphumo zigqamisa ukuba ilingo elilawulwa ngokungahleliwe (RCT) libandakanya iintlobo ezahlukeneyo zentlungu engapheliyo e ixutywe ngaphaya kwe-LBP kunye ne-CRPS-1 kwaye ayizange ibandakanye kuphela izigulane ezinamaqondo aphakamileyo enkwantya-ntlungu; ukungenelela kwaziswa kwakhona kwiifom zeqela kunokuba zifomathi zomntu ngamnye. Nangona unyango lwe-in-vivo lungcono kakhulu ekunciphiseni ubuhlungu obuyingozi kunye nemibono yokulimala kwemisebenzi, ukunyangwa kwezinto ezibonakalayo kubonakala ngathi kusebenza njengongenelelo lokusebenza okuphuculweyo ekuphuculeni ukukhubazeka okusebenzayo kunye nezikhalazo eziphambili. [39] Olunye uvavanyo lweklinikhi lufanisa ukuphumelela kwonyango- Ulwahlulo olusekelweyo (TBC) lonyango lonyango kuphela kwi-TBC longezwe ngemisebenzi eyenziwe ngokucwangcisiweyo okanye ukubonakaliswa ngokubaluleka kwezigulane ezine-LBP ezinobunzima kunye nobunzima. [Iziphumo ze-40] zibonise ukuba akukho ntohluko kwi-4-iveki kunye neziphumo zeenyanga ze-6 zokunciphisa ukukhubazeka , ubunzima beentlungu, ukukhathazeka kwentlungu, kunye nokuphazamiseka komzimba phakathi kwamacandelo enyango, nangona ukunyanzeliswa kwamagunya kunye ne-TBC kwenza ukuba kuncitshiswe kuninzi kwiinkonzo zokugwema ukwesaba ukwenziwa kwiinyanga ze-6. alukho kwiziphumo eziphuculweyo malunga namanyathelo afana nokuphuhliswa kwe-chr I-LBP ye-oni ngaphaya kophuculo olwenziwe ngeTBC yedwa. [40]

Iindlela zokuziphatha

Ungenelelo ngononophelo lweendlela zokuziphatha (i-CBT) zongenelelo lweentlungu ezingapheliyo zisebenzisa imigaqo-nkqubo yengqondo ukwenza utshintsho olusebenzayo kwizimo zezigulana, ukuqonda okanye kuvavanyo, kunye neemvakalelo. Olu ngenelelo luhlala luqulathe imfundo esisiseko yengqondo malunga nentlungu kunye nesigulo esithile seempawu zesigulana, izinto ezininzi zokuziphatha, uqeqesho lwezakhono, iindlela zokusombulula iingxaki, kunye necandelo lokuhlengahlengisa ukuqonda, nangona olona nyango lonyango luhluka ngokoklinikhi. Izinto zokuziphatha zinokubandakanya izakhono ezahlukeneyo zokuphumla (njengoko zijongwa kwicandelo lendlela yokuziphatha), imiyalelo yokuhamba ngenqanaba / ukwenziwa okuhleliweyo, iindlela zokuziphatha, kunye nokukhuthaza ukuqala kwakhona kwemisebenzi yomzimba ukuba kukho imbali ebalulekileyo yokuthintela umsebenzi kunye nokubekwa kwimeko yesiqhelo emva koko. Eyona njongo iphambili kuqeqesho lwezakhono kukuchonga izicwangciso zokuziphatha gwenxa (umz., Ukonakalisa, ukuthintela) isigulana esisebenzisana naso ekusebenziseni iindlela zokuguqula imeko (umzekelo, ukusetyenziswa kweengxelo ezizezakho, inkxaso yezentlalo). Njengenqaku lesilumkiso, inqanaba apho isicwangciso-buchule silungelelanisa okanye singalunganga kwaye ukusebenza okuqondakalayo kwezicwangciso ezithile zokulwa ziyahluka ukusuka komnye umntu ukuya komnye. [41] Ngalo lonke unyango, iindlela zokusombulula iingxaki ziyahlonitshwa ukunceda abaguli kwiinzame zabo zokunamathela kunye nokubanceda ukuba bandise ukusebenza kwabo. Uhlengahlengiso lwengqondo lubandakanya ukwamkelwa kokungalunganga okwenziwayo sisigulana, ukwenza umngeni kukuchongwa okungalunganga okuchongiweyo, kunye nohlengahlengiso lweengcinga ukuze zivelise ezinye. Ngokuziqhelanisa nohlengahlengiso lokuqonda, abaguli baya bekwazi ngakumbi ukuqonda indlela iimvakalelo zabo, ukuqonda, kunye nokutolika okuzilungisa ngayo iintlungu zabo kwicala elilungileyo nelingalunganga. Ngenxa yoko, kucingelwa ukuba abaguli baya kufumana umbono omkhulu wokulawula iintlungu zabo, babe nakho ukulawula indlela abaziphethe ngayo kunye neengcinga zabo njengoko zinxulumene nentlungu, kwaye babe nakho ukuvavanya ngokuchanekileyo intsingiselo abayinikezela kwintlungu yabo. . Izinto ezongezelelweyo ngamanye amaxesha zibandakanyiwe kungenelelo lwe-CBT lubandakanya uqeqesho lwezakhono zentlalo, uqeqesho kunxibelelwano, kunye neendlela ezibanzi kulawulo loxinzelelo. Ukuhamba ngongenelelo lwe-CBT ejolise kwintlungu, uninzi lwezigulana ziyaxhamla kuphuculo ngokubhekisele kwimpilo yabo yeemvakalelo kunye nokusebenza, kwaye ekugqibeleni umgangatho wabo wobomi onxulumene nempilo.

UDkt. Alex Jimenez usebenza ngokuzivocavoca umzimba kunye nokuzilolonga.

Ungenelelo lwe-CBT luhanjiswa ngaphakathi kwenkxaso kunye novelwano oluzama ukuqonda iintlungu zesigulana ngokwembono ye-biopsychosocial kwaye ngendlela edibeneyo. Oochwephesha babona indima yabo 'njengabafundisi-ntsapho' okanye 'abaqeqeshi'kwaye umyalezo odluliselwe kwizigulana kukufunda ukulawula ngcono iintlungu zabo nokuphucula ukusebenza kwabo kwemihla ngemihla kunye nomgangatho wobomi ngokuchasene nokujolisa okanye ukuphelisa iintlungu. Injongo ephambili kukunyusa ukuqonda kwezigulana ngeentlungu zabo kunye neenzame zabo zokulawula iintlungu kunye nokulandelelana kwazo ngendlela ekhuselekileyo neguqukayo; Ke ngoko, ukufundisa abaguli ukuba babeke esweni indlela abaziphethe ngayo, iingcinga zabo, kunye neemvakalelo yinto ebalulekileyo kunyango kunye nesicwangciso esiliqili sokwenza ukusebenza ngempumelelo. Ukongeza, i-Therapist izama ukukhuthaza indawo enethemba, enyanisekileyo nenokhuthazo apho isigulana sinokuba nobuchule ngakumbi ekuqondeni nasekufundeni kwimpumelelo yabo nasekufundeni nasekuphuculeni kwimizamo engaphumelelanga. Ngale ndlela, abanyangi kunye nezigulana basebenza kunye ekuchongeni impumelelo yesigulana, izithintelo ekubambeleleni kunyango, kunye nokuphuhlisa ulondolozo kunye nokubuyela kwisicwangciso sokuthintela kwimeko eyakhayo, yokusebenzisana kunye nokuthembeka. Inqaku elinomtsalane kwindlela yokuziphatha kwengqondo kukuxhasa isigulana njengomthathi-nxaxheba okhutheleyo ekuvuseleleni iintlungu okanye kwinkqubo yolawulo.

Uphando lufumene ukuba i-CBT ibe yonyango olusebenzayo lwentlungu engapheliyo kunye ne-sequelae yayo njengoko ibonakaliswe ngenguqu ebonakalayo kwimimandla eyahlukeneyo (oko kukuthi, amanyathelo okuvalelwa kwintlungu, ukukhathazeka / ukuchaphazeleka, ukuphathwa kwengqondo kunye nokuhlola, ukuziphatha kweentlungu kunye nenqanaba lomsebenzi kunye nomsebenzi wendima yentlalo ) xa kuthelekiswa neemeko zokulawula uluhlu lokulinda. [42] Xa kuthelekiswa namanye amachiza asebenzayo okanye izimo zokulawula, i-CBT ibangele ukuphucula okuphawulekayo, kunye nemiphumo encinci (ubungakanani bomzimba ~ 0.50), ngokubhekisele kumava obuhlungu, ukuxilongwa kwengqondo kunye nokuhlolwa , kunye nomsebenzi wendima yentlalontle. [42] Uhlalutyo olutshanje lwe-meta-uphando lweziphumo ze-52 eziqhathaniswa nophatho lwezonyango (BT) kunye ne-CBT malunga nokuphathwa njengemiqathango yokulawula yesiqhelo kunye neemeko zolawulo olusebenzayo kumaxesha athile ahlukeneyo. [43] Le meta-analysis bagqiba ukuba idatha yabo ayizange iboleke inkxaso ye-BT ngaphaya kokuphuculwa kwintlungu ngokukhawuleza emva kokonyango xa kuthelekiswa nonyango njengeemeko zolawulo eziqhelekileyo. [43] Ngokubhekiselele kwi-CB T, baqukumbele ukuba i-CBT inciphise imiphumo emihle yintlungu yokukhubazeka, kunye nomoya; Nangona kunjalo, akukho idatha ekhoyo ekhoyo ukuphanda impembelelo ethile yenkcazo yonyango kwiziphumo ezikhethiweyo. [43] Ngokubanzi, kubonakala ukuba ii-CBT kunye ne-BT zindlela zokwenza unyango olufanelekileyo ukuphucula imizwa; iziphumo ezihlala zizinzileyo kwiindawo zokulandelela iinkcukacha. Nangona kunjalo, njengoko kuboniswe ngophando oluthile kunye nokuhlaziywa kweemeta, into ebalulekileyo ekuqwalaseleni ukuphumelela kwe-CBT yokulawulwa kwentlungu engapheliyo ijoliswe kwimibandela yokubonelela ngokufanelekileyo, ukungabikho kwamacandelo okunyanga ofanayo, ukungafani kokunikezelwa kwamanyango kunye nokunyango abantu kunye nokuhlukahluka kwimiba yeziphumo zentshisekelo kuzo zonke izilingo zophando. [13] Ukugqithisa ngakumbi ukuchazwa kokufunyaniswa kwempumelelo yimimiselo yesigulane kunye neenguqu ezongezelelweyo ezingasichaphazela ngokuzimeleyo iziphumo zonyango.

Izindlela eziMkelweyo

Iindlela ezisekwe ekwamkelweni zihlala zichongwa njengonyango lwesithathu lwendlela yokuziphatha ngokuziphatha. Ukwamkelwa kunye nokuzibophelela kunyango (UMTHETHO) yeyona nto ixhaphakileyo kwizonyango zengqondo ezamkelweyo. UMTHETHO ugxininisa ukubaluleka kokuququzelela inkqubela yomthengi ekufikeleleni kubomi obuxabiseke ngakumbi nobonelisayo ngokwandisa ukuguquguquka kwengqondo kunokugxila ngokungqongqo kulwakhiwo ngokutsha lokuqonda. [44] Kwimeko yeentlungu ezingapheliyo, i-ACT ijolise kwiindlela zokulawula ezingasebenziyo kunye nokuthintelwa kwamava ngokukhuthaza ubuchule obumisela ukuguquguquka kwengqondo. Ezi nkqubo zintandathu zingumthetho zibandakanya: ukwamkelwa, ukuqonda okungalunganga, ukubakho, ubuqu bakho njengomxholo, amaxabiso kunye nokuzimisela. [45] Ngokufutshane, ukwamkelwa kukhuthaza izigulana ezinganyangekiyo ukuba zamkele iintlungu kunye nokulandelelana kwazo kunokuba zizame ukuyitshintsha, ngokwenza njalo ukukhuthaza isigulana ukuba siyeke umlo olilize ojolise ekuphelisweni kwentlungu yabo. Ukuchaphazeleka kwengqondo (deliteralization) yeendlela zokuqesha ziqeshelwe ukuguqula ukusebenza kweengcinga endaweni yokunciphisa ukuhamba kwabo okanye ukulungisa umxholo wabo. Ngale ndlela, ukuchasana kwengqondo kunokutshintsha nje intsingiselo engathandekiyo okanye ukusebenza kweengcinga ezingalunganga kwaye ngaloo ndlela kunciphise ukunamathela kunye nokuphendula okulandelayo kokuziphatha kunye nokuziphatha kwezi ngcinga. Inkqubo engundoqo yokubakho igxininisa ukusebenzisana okungagwebanga phakathi kweengcinga zakho kunye nezizimeleyo kunye neziganeko. Amaxabiso asetyenziswa njengezikhokelo zokukhetha isimilo kunye nokutolikwa okubonakaliswa ngala maxabiso umntu azabalazela ukuwenza kubomi bemihla ngemihla. Okokugqibela, ngokwenza isenzo sokuzibophelela, abaguli banokuqonda utshintsho kwindlela yokuziphatha elungelelaniswe nexabiso lomntu ngamnye. Ke, UMTHETHO usebenzisa imigaqo-siseko emithandathu ngokudibeneyo kunye nomnye ukuthatha indlela ebanzi yokwandisa ukuguquguquka kwengqondo kunye nokunciphisa ukubandezeleka. Izigulana ziyakhuthazwa ukuba zijonge iintlungu ngokungaphephekiyo kwaye zamkelwe ngendlela engagwetywanga ukuze ziqhubeke nokufumana intsingiselo ebomini ngaphandle kobukho beentlungu. Iinkqubo ezingundoqo ezinxulumeneyo zibonisa umzekelo wokuqonda nokwamkela iinkqubo nokuzinikela kunye neenkqubo zokutshintsha indlela yokuziphatha. [45]

Iziphumo zophando malunga nokusebenza kweendlela ezisekelwe kwi-ACT zokulawula ubuhlungu obungapheliyo zi thembisa, nangona kunjalo zifunwa ukuhlolwa okuqhubekayo. I-RCT ngokuthelekisa UMTHETHO nomqathango wokulawula uluhlu kubhengeze ukuphuculwa okukhulu kwiintlungu ezonakalisa ukukhubazeka, ukunyaniseka kweentlungu, ukwaneliseka komphefumlo, ukwesaba ukunyakaza, kunye noxinzelelo lwengqondo olugcinwe kwi-7 inyanga yokulandelelana. [46] Ilingo elikhulu lichazwe Ukuphucula intlungu, ukuxinezeleka, ukuxhalaba, ukukhubazeka, ukutyelela, unyango lwezempilo, isimo somsebenzi kunye nokusebenza ngokomzimba. [47] Ukuhlaziywa kwe-meta-uphendlo yakutshanje ekuphononongeni ukungenelela okusukeleyo (UMTHETHO nokunciphisa uxinzelelo lwengqondo) kwizigulane ezinentlungu engapheliyo yafumanisa ukuba, ngokuqhelekileyo, iindlela zokubamkela ezisekelweyo zikhokelela kwiziphumo ezilungileyo kwizigulane ezinentlungu engapheliyo. [48] Ngokukodwa, ukuhlalutya kweemeta kubonakalise ubuncinci kumgangatho ophakathi kwintlungu, ukuxinezeleka, ukuxhalaba, ukukhathazeka ngokwenyama kunye nomgangatho wobomi , kunye nemiphumo emincinci efunyenweyo xa ukuhlolwa kweeklinikhi ezilawulwayo kwakungabandakanywa kwaye i-RCT kuphela ifakiwe kwi-analysis. [48] Ezinye iindlela zokunikwa uphando lweengcamango zengqondo-yokuziphatha kunye nokunyangwa kwengqondo ngokusekelwe kwengqondo, nangona uphando lwezobugcisa ekusebenzeni kwezi zonyango zokulawulwa kweentlungu ezingapheliyo zisencinane.

Lindele

Into ebalulekileyo engahoywanga ngokubanzi exhaphakileyo kuzo zonke iindlela zonyango kukuqwalaselwa kokulindelwe sisigulana kwimpumelelo yonyango. Ngaphandle kwenkqubela phambili ekwakhiweni nasekuhanjisweni kwonyango olusebenzayo oluninzi lweentlungu ezingapheliyo, kugxininiswe kancinci ekubonakaliseni ukubaluleka kokulindelwa kwimpumelelo nasekugxileni kwimizamo yokuphucula okulindelwe zizigulana. Ukwamkelwa ukuba i-placebo yeentlungu ibonakaliswa ziipropathi ezisebenzayo ezikhokelela kuthembeko olunokuthenjwa, olubonakalayo, kunye nolunokulinganiswa kunye nemixhaso ye-neurobiological okwangoku okwangoku kuphando lwentlungu. Izifundo ezininzi ziye zaqinisekisa ukuba, xa inyanzeliswa ngendlela eyonyusa ulindelo (ngokusebenzisa ubuqili bolindelo olucacileyo kunye / okanye imeko), i-analgesic placebos inokubangela utshintsho olubonakalayo nolulinganisekayo kwimbono yeentlungu kwinqanaba lokuzixela kunye ne-neurological inqanaba lokulungisa iintlungu. [49,50] I-analgesic placebos ichazwe ngokubanzi njengonyango olulinganisiweyo okanye iinkqubo ezenzeka kwimeko yengqondo kunye nefuthe kumava omntu kunye / okanye kwi-physiology. [51] Ukuqondwa kwangoku kwe-placebo kugxininisa ukubaluleka kwemeko yengqondo kunye ne-placebos efakwe ngaphakathi. Isiseko semeko yengqondo kunye nesiko lonyango kulindelwe zizigulana. Ke ngoko, ayimangalisi into yokuba isiphumo se-placebo sibetheleleke phantse kulo lonke unyango; Kananjalo, oogqirha kunye nezigulana ngokufanayo ziya kuthi zixhamle ekuqapheleni ukuba kukho indawo eyongezelelweyo apho unyango lwangoku lusondela kwiintlungu ezinokuphuculwa.

Kucetyisiwe ukuba iziphumo ezilindelweyo zezona mpembelelo ziphambili zokuqhuba utshintsho olufunyenweyo ngeendlela ezahlukeneyo zoqeqesho lokuphumla, i-hypnosis, unyango lokuvezwa, kunye neendlela ezininzi zonyango ezijolise kukuqonda. Ngaloo ndlela, indlela efanelekileyo yokulawulwa kweentlungu ezingapheliyo zixhomekeke kumandla okulindela izigulane kwimpumelelo. Ngelishwa, amaxesha amaninzi, ababoneleli ngezempilo bayakhathala ukujongana ngqo nokugxininisa ukubaluleka kokulindelwa zizigulana njengezinto ezibandakanyekayo ezinegalelo kulawulo oluyimpumelelo lweentlungu ezingapheliyo. I-zeitgeist kuluntu lwethu kukuba ukunyanga ukunyanga kwezifo ezenza ukuba ulindelo ngokubanzi lokuba iintlungu (nokuba zintlungu ezingapheliyo) kufuneka zisuswe ngenkqubela phambili kwezonyango. Konke oku kulindelwe ngokuqhelekileyo kushiya abaguli abaninzi bedidekile ziziphumo zonyango ezikhoyo kwaye banegalelo kuphando olungapheliyo lwe- cure . Ukufumana i- cure ngaphandle kokulawula ngokubhekisele kwiimeko zeentlungu ezingapheliyo. Kwimeko-bume yethu yangoku, apho iintlungu ezinganyangekiyo zixhaphaza izigidi zabantu baseMelika minyaka le, inomdla wethu ukubethelela kwaye siqhubeke nokukhuthaza ukutshintsha kwengcinga endaweni yoko kugxile kulawulo olusebenzayo lweentlungu ezingapheliyo. Indlela esebenzayo nethembisayo yokufezekisa oku kukwenza uninzi lwezinto ezilindelwe zizigulana (ezizizo) kunye nokufundisa abaguli abaziintlungu kunye noluntu ngokubanzi (iipesenti ezingama-20 zabo baya kuthi babe zizigulana eziqaqanjelwa) kwixesha elizayo ngokubhekisele kulawulo lwentlungu. Mhlawumbi oku kunokwenzeka ekuqaleni ngoku, ngemfundo esekwe kubungqina ngokubhekisele kwi-placebo kunye neziphumo zonyango ezingacacanga ezinokuthi izigulana zikwazi ukulungisa iinkolelo ezingachazwanga ngaphambili. Emva koko oogqirha banokujolisa ekuphuculeni okulindelweyo kwizigulana ngaphakathi kwimeko zonyango (ngendlela eyiyo) kunye nokunciphisa ukulindela okungenathemba okuthintela impumelelo yonyango, ke ngoko, ukufunda ukuphucula unyango lwabo lwangoku ngeendlela ezininzi ezikhokelwa kukongamela ekuphuculeni indawo ye-placebo inokuvelisa, nkqu kunyango olusebenzayo . Iingcali zengqondo ziyakwazi ukujongana nale micimbi kunye nezigulana zabo kwaye zibancede babe ngabameli bempumelelo yabo yonyango.

Abaququzeleli Bemizwelo Yobunzima

Umba osoloko ulucelomngeni kulawulo lweentlungu ezingapheliyo kukuxhaphaka ngokungathandabuzekiyo koxinzelelo lweemvakalelo. Uphando lubonakalisile ukuba uxinzelelo kunye noxinzelelo lokuphazamiseka lonyuka laphindaphindeka kathathu phakathi kwezigulana ezinganyangekiyo kunabantu ngokubanzi. [52,53] Rhoqo, izigulana eziqaqanjelwa zizifo zengqondo zibizwa ngokuba "zizigulana ezinzima" ngababoneleli bezempilo, mhlawumbi kunciphisa ukhathalelo abalulufumanayo. Izigulana ezinedepression zineziphumo ezibi zokudakumba kunye nonyango lwentlungu, xa kuthelekiswa nezigulana ezinesifo esisodwa okanye uxinzelelo. [54,55] Iingcali zengqondo zikulungele ngokumangalisayo ukujongana uninzi lwezifo zengqondo ezidla ngokudibana nabantu abaziintlungu ezingapheliyo kwaye ke ngoko ziphucula iintlungu. Iziphumo zonyango kunye nokunciphisa ukubandezeleka ngokweemvakalelo kwezigulana. Iingcali zengqondo zinokujongana neempawu eziphambili (umzekelo, i-anhedonia, inkuthazo ephantsi, izithintelo ekusombululeni iingxaki) zoxinzelelo eziphazamisa ukuthatha inxaxheba kunyango kunye noxinzelelo lweemvakalelo. Ngapha koko, ngaphandle kokuphazamiseka kwengqondo, iingcali zengqondo zinokunceda izigulana ezinganyangekiyo ziqhubele phambili kwindima ebalulekileyo abanokuthi bayenze (umzekelo, ukuphulukana nomsebenzi, ukukhubazeka), ubunzima phakathi kwabantu abanokudibana nabo (umz., Umbono wokuzahlula oziswa yintlungu), kunye Ukubandezeleka ngokweemvakalelo (umzekelo, ixhala, umsindo, usizi, ukuphoxeka) kuyanyanzeleka kumava abo. Ke, iingcali zengqondo zinokuchaphazela ngokuqinisekileyo ikhosi yonyango ngokunciphisa ifuthe lokudibana neemvakalelo ekujongwa kuzo njengenxalenye yonyango.

isiphelo

Izinzuzo zokubandakanya unyango lweengqondo kwiindlela ezahlukeneyo zokulawula ubuhlungu obungapheliyo zininzi. Ezi zibandakanya, kodwa azikhawulelwanga, ukunyusa ukuphathwa kweentlungu, ukuphucula izixhobo ezinokubangela iintlungu, ukukhubazeka okunxulumene nentlungu, kunye nokunciphisa uxinzelelo lwengqondo olwenziwe ngeendlela ezahlukeneyo zokuzilawula, ukuziphatha, nokuqonda ubuchule. Ngokuphunyezwa kwezi nguqu, isazi sengqondo singakwazi ukunceda ngokuphumelelayo izigulane zivakale ngakumbi kumyalelo wokulawulwa kweentlungu kwaye zenze ukuba baphile ngokuqhelekileyo ubomi ngokusemandleni nangona kukho intlungu. Ngaphezu koko, izakhono ezifunyenwe ngongenelelo lwangokwengqondo nokuxhobisa izigulane ukuba zibe ngabathathi-nxaxheba ekulawuleni izifo zabo kwaye zibandakanye izakhono ezibalulekileyo izigulane ezingasebenzisa ubomi babo bonke. Iinkonzo ezongezelelweyo zeendlela ezidibeneyo kunye neendlela ezipheleleyo ekulawuleni ubuhlungu obungapheliyo zingabandakanya ukunyuka kwamazinga okubuyela emsebenzini, ukunciphisa iindleko zonyango lwempilo, kunye nokukhula komgangatho wokuphila kwezilwanyana kwizigulane kwihlabathi lonke.

Umfanekiso womqeqeshi unikezela ngcebiso isigulane kwisigulane.

Imihlathi

Ukwazisa: Akukho zintlukwano zomdla zavakaliswa ngokumalunga kweli phepha.

Ukuququmbela, ukungenelela kwengqondo kungasetyenziswa ngokufanelekileyo ekuncediseni iimpawu zentlungu engapheliyo kunye nokusetyenziswa kwamanyathelo enyango, njengokhathalelo lwe-chiropractic. Ukongezelela, uphando olusentla lubonise indlela iindlela ezithile zokungenelela kwengqondo ezinokuphucula iziphumo zempatho yokuphathwa kabuhlungu obungapheliyo. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kwakunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

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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.

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

ISIHLOKO ESIBALULEKILEYO: Ukulawula uxinzelelo lomsebenzi

IINGCUKACHA EZIBALULEKILEYO: UKUPHATHA KWE-EXTRA: I-Car Accident Injury Treatment El Paso, TX I-Chiropractor

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Vala i-Accordion

I-Migraine Pain kunye neLumbar Herniated Treatment Treatment e-El Paso, TX

by iicrosoft | Ucwaningo lwaBasebenzi, Disc Disc, Migraine, Uvavanyo oluLungeleleneyo oluLungisiweyo, Unyango lokuthotywa koMnqonqo, Unyango

Enye yezona zinto ezibangeleyo zentlungu ephantsi ye-back and sciatica inokubangelwa ukunyanzeliswa kweengcambu zeembilini kwi-back back kwi-disc ye-lumbar herniated, okanye i-dis ruptured in the lumbar spine. Iimpawu eziqhelekileyo zedisk herniated discs ziquka ubunzima obuhlukahlukeneyo beentlungu, ukuxhamla kwemisipha okanye ukunyanzelisa, ukunyanzeliswa kwamathambo kunye nokulahleka komlenze kunye nokulahlekelwa komsebenzi wemilenze efanele. Nangona ezi zinto zingabonakali zihambelana ngokusondelene, i-disc ye-herniated disc ingasichaphazela umgudu womlomo wesibeleko, ubonakalisa iimpawu ze-migraine kunye nentloko. Injongo yamanqaku alandelayo kukufundisa izigulane kwaye zibonise ubudlelwane phakathi kwentlungu ye-migraine kunye ne-lumbar disniated disc, ngokuqhubekayo kuxubusha unyango kwezi zimbini.

Ukuhlaziywa Okubalulekileyo Kwonyango Lonyango Ukusetyenziswa Kweengxaki Zentloko: Ukukhawuleza, Iiprofayili, Iinjongo, uLonxibelelwano kunye nokuPhumela okuZibhaliweyo

Abstract

imvelaphi

Nangona ukwandiswa kwezonyango zonyango kwintsholongwane, abaninzi abanezifo eziqhelekileyo eziqhelekileyo zintsholongwane zifuna uncedo ngaphandle kwezicwangciso zonyango. Injongo yaleli phepha kukuvavanya uphando lwezophando malunga nokuxhaphaka kokusetyenziswa kwezigulane zonyango zokwenza unyango lweentloko kunye nezinto eziphambili ezihambelana nesi si gulane.

tindlela

Ukuhlaziywa okubalulekileyo kweencwadi eziphindiweyo zontanga ezichongiweyo zephepha ze-35 ezifunyenweyo zifunyenwe ngophando olutsha olusisigxina malunga nokuxhaphaka, iiprofayili, izizathu, ukunxibelelana kunye nokusebenza ngokuzenzekelayo kwindlela yokusetyenziswa kweyonyango phakathi kwabo baneengxaki zentloko.

iziphumo

Nangona iilwazi ezifumanekayo zazincitshiswa kwaye izifundo zazinemiqathango eninzi yeendlela, ukusetyenziswa kwonyango olusesikweni kubonakala lulona lugqirha lonyango olungasetyenziselwa ukulawula iintloko eziqhelekileyo eziqhelekileyo. Isizathu esiqhelekileyo sokukhetha olu hlobo lwonyango lwalufuna ukukhululeka kwentlungu. Nangona ipesenteji ephezulu zezi gulane mhlawumbi ziqhubeka nokunyamekelwa ngonyango ngokufanayo, malunga nesiqingatha kungenokuba ziveze ukusetyenziswa kolu unyango kumgqirha wazo.

izigqibo

Kukho isidingo sokuba uphando olongezelelekileyo lwempilo kunye neenkonzo zempilo zezempilo ukwenzela ukuvavanya indima, ukhuseleko, ukusetyenziswa kunye neendleko zemali ezinxulumene nophatho lwezonyango olusesikweni. Abanikezeli bokunakekelwa kwempilo yeprayimari kufuneka baqikelele ukusebenzisa le ndlela eyaziwayo kakhulu ekulawuleni ikhanda ukwenzela ukuncedisa ukulungiselela ukunakekelwa okukhuselekileyo, okufanelekileyo kunye nokulungelelaniswa.

Internet: Intloko, i-Migraine, Intloko yesifo, intloko yesifo sekhanda, Ulwaphulo lwe-Manual, unyango lwezilwanyana, i-Chiropractic, i-Osteopathy, i-Massage

imvelaphi

I-co-occurrence ye-tension headache kunye ne-migraine iphezulu kakhulu [1]. Ngokulandelelanayo, zizifo zesibini kunye nesithathu ezixhaphakileyo kwihlabathi jikelele kunye ne-migraine ranking njengeyona sizathu sesixhenxe esiphezulu sokukhubazeka kwihlabathi jikelele [2] kunye neshumi elinesithandathu kwiimeko eziqhelekileyo zokuxilonga e-US [3]. Ezi ziphazamiso ziqhelekileyo zentloko zibeka umthwalo omkhulu kwimpilo yomntu, imali kunye nemveliso yomsebenzi yabantu abanale ngxaki [3�5] kunye ne-migraine entsonkothileyo ngakumbi kukudityaniswa kwe-cardiovascular and psychiatric co-morbidities [6, 7].

Ukuthintela unyango lweziyobisi lwe-migraine lubandakanya i-analgesics, i-anticonvulsants, i-antidepressants kunye ne-beta-blockers. Unyango lwamachiza othintelo kwiintloko zohlobo lwengcinezelo lunokuquka iipilisi zokuthomalalisa iintlungu, ii-NSAID, iziphumlisi zemisipha kunye netyhefu ye-botulinum kunye namayeza okuthomalalisa kunye nee-antidepressants. Ngelixa unyango lwamachiza othintelo luyimpumelelo kwinani elikhulu labagulayo, ukuphazamiseka kwentloko kusachazwa njengokungafunyaniswanga kwaye kunyangwa ngaphantsi kwezicwangciso zonyango [8�16] kunye nezinye izifundo ezixela ukuba abaguli banokuyeka ukuqhubeka namayeza okuthintela intloko ixesha elide [9] 17, XNUMX].

Kukho inani leendlela ezingezizo iziyobisi ezisetyenziselwa ukuthintela intloko ebuhlungu. Ezi ziquka unyango lwezengqondo ezifana nonyango lokuziphatha kwengqondo, uqeqesho lokuphumla kunye ne-EMG (electromyography) biofeedback. Ukongezelela, kukho i-acupuncture, ukongezwa kwesondlo (kubandakanya i-magnesium, i-B12, i-B6, kunye ne-Coenzyme Q10) kunye nonyango lomzimba. Ukusetyenziswa konyango lomzimba lubalulekile, ngophando lwamva nje lwehlabathi oluxela unyango lomzimba njengolona lusetyenziswa rhoqo �olulolunye okanye unyango oluncedisayo’ kwiziphazamiso zentloko kumazwe amaninzi [18]. Olona ngenelelo luxhaphakileyo lonyango lonyango lolawulo lwentloko lunyango lwezandla (MT), [19�21] esiluchaza apha njengonyango olubandakanya �ukuxhaphazwa komqolo (njengoko kuqhele ukwenziwa ngabanyangi be-chiropractors, i-osteopaths, kunye nonyango lomzimba), ijoyinti kunye nomqolo. ukuhlanganisa, ukuphululwa konyango, kunye nolunye unyango olukhohlisayo kunye nolwesekwe emzimbeni [22].

Iziphumo ezintle ziye zaxelwa kwizilingo ezininzi zeklinikhi ezithelekisa iMT nolawulo [23�27], olunye unyango lwenyama [28�30] kunye nemiba yokhathalelo lwezonyango [31�34]. Uphando oluphezulu oluphezulu luyafuneka nangona kunjalo ukuvavanya ukusebenza kwe-MT njengonyango lweentloko eziqhelekileyo eziqhelekileyo. Uphononongo olutshanje olucwangcisiweyo lwezilingo zeklinikhi zeMT zokuthintela ingxelo ye-migraine inani leendlela ezimfutshane ezimfutshane kunye nesidingo sophando oluphezulu oluphezulu ngaphambi kokuba kwenziwe izigqibo eziqinileyo [35, 36]. Uphononongo lwakutsha nje lwezilingo ze-MT zohlobo loxinzelelo lwentloko kunye nentloko ye-cervicogenic zilumkile ekuxeleni iziphumo ezilungileyo kunye nesidingo esinamandla sophando olomeleleyo [37�41]. Nangona ubungqina bekliniki obunqamlekileyo bekungekho ukuhlaziywa okubalulekileyo kokusetyenziswa okubalulekileyo kwe-MT ngabantu beentloko.

tindlela

Injongo yale sifundo kukunika ingxelo evela kwincwadi yokuphononongwa ngontanga; 1) ukuxhaphaka kwe-MT ukusetshenziswa kwonyango lweenwele eziqhelekileyo eziqhelekileyo kunye ne-2) ezichaphazelekayo kunye nokusetyenziswa kwezihloko eziphambili. Uphononongo olongezelelweyo lubonisa indawo eziphambili ezifanelwe uphando oluthe gqolo ukuze kuphuculwe iinkqubo zeklinikhi, ootitshala kunye nomgaqo-nkqubo wezempilo kule ndawo.

uyilo

Uphando olubanzi lwamanqaku ahlaziywe ngoontanga apapashwe ngesiNgesi phakathi kwe-2000 kunye ne-2015 enika ingxelo entsha yophando olufunyenweyo kwiinkalo eziphambili zokusetyenziswa kwe-MT phakathi kwezigulane ezine-migraine kunye ne-non-migraine disorder disorders yenziwa. Iidatabase ezikhangelweyo zaziyi-MEDLINE, AMED, CINAHL, EMBASE kunye ne-EBSCO. Amagama angundoqo kunye namabinzana asetyenzisiweyo ngala: �intloko�, �migraine�, �intloko ebuhlungu�, �cephalgia�, �intloko engapheliyo� KUNYE � nonyango lwezandla�, �ukuxhaphazwa komqolo�, �i-manipulative, unyango �chiropractic�, �osteopathy�, �massage�, �unyango lomzimba� okanye �physiotherapy� KWAYE ke �ukuxhaphaka�, �ukusetyenziswa� okanye �iprofayile� yasetyenziswa kukhangelo olongezelelweyo ngokuchasene namagama angaphambili. Uphando lwedatha lukhatshwa kukusetshwa ngesandla kweejenali ezibalaseleyo eziphononongwe ngoontanga. Bonke ababhali bafikelele kuncwadi oluhlaziyiweyo (idatha) kwaye banikezela ngegalelo kuhlalutyo.

Ngenxa yokujoliswa kokuhlaziywa, uvavanyo lweencwadi zonxibelelwano ezingapheliyo kunye nokucwangciswa kophando olulinganayo lwezonyango aluzange lubekelwe ngaphandle njengamaphepha athatyathwa njengaleta, iibhalelwano, i-editorials, ingxelo zeengxelo kunye namazwana. Uphando olongezelelweyo lwenziwa kwiibriographies kwiincwadi ezichongiweyo. Zonke iicatshulwa ezikhethiweyo zihlolwe kwaye kuphela abo babika iziphumo ezintsha zokufumana iziphumo kwi-MT ukusetshenziswa kwintloko yesifo kubantu abadala baqukwa ekuhlaziyweni. Amanqaku atyunjiwe kwaye akhethiweyo ukuhlaziywa kwakuyi-manuscripts ikakhulu kwimigqaliselo ye-epidemiological kunye nezoqoqosho lwezoqoqosho. Ukuhlaziywa kubandakanya amaphepha okunika ingxelo yokusetyenziswa kwe-MT kunye nokusetyenziswa kwezinye iindlela zokwelapha, kodwa kuphela apho izigulane ze-MT ziquka inxalenye enkulu (njengoko kuchaziwe) yoluntu olubandakanyiweyo. Iziphumo zazingeniswa kwi-Endnote X7 kunye nezicatshulwa zisuswe.

Iziphumo zophando, Uhlalutyo kunye noVavanyo lweMgangatho

Umzobo 1 uchaza inkqubo yokukhangela uncwadi. Ukukhangela kokuqala kuchonge amanqaku e-3286, i-35 edibene nemilinganiselo yokubandakanywa. Ulwazi oluvela kwinqaku ngalinye luhlelwe kwitheyibhile yokuhlaziya (Itheyibhile 1) ukushwankathela iziphumo zamaphepha afakiweyo. Ulwazi luxelwa phantsi kwamaqela amabini akhethiweyo entloko kunye nakumsebenzi ngamnye weMT - chiropractic, physiotherapy, osteopathy kunye nonyango lwe-massage � apho iinkcukacha ezaneleyo zazifumaneka.

Umzobo we-1 Isatifiketi sokuhamba kweSifundo seSifundo

Umzobo 1: Isatifiketi sokuhamba koKhetho lokuFundisisa.

Itheyibhile ye-1 Uvavanyo olusekelwe kuPhando lweeNcwadi zoLwazi Ukusetyenziswa

Ithebula 1: Uphando olusekelwe kuphando olwenziwe ngonyango lwezonyango lweengxaki zentloko.

Uvavanyo lomgangatho wamanqaku achongiweyo ukuba ahlaziywe luqhutywe kusetyenziswa inkqubo yokulinganisa umgangatho (Itheyibhile 2) ephuhliswe ukuvavanya okubalulekileyo koncwadi lwezempilo olusetyenziselwa ukuxhaphaka kunye neziganeko zeengxaki zempilo [42] eguqulelwe kwizifundo ezifanayo [43�45] . Le nkqubo yokubeka amanqaku yayisebenza kuninzi lwezoyilo zophando ezibandakanya uphando kunye nodliwano-ndlebe olucwangcisiweyo olusekelwe kwisaveyi (29 yamaphepha e-35) kodwa yayingasetyenziswanga kwinani elincinci lezifundo ezibandakanyiweyo ezisekelwe kwiirekhodi zeklinikhi, uhlalutyo lwesibini okanye iimpawu zengcali.

Abalobi ababini abahlukeneyo (i-CM kunye ne-JA) bafuna uphando ngokuzimeleyo kwaye bafumana amanqaku. Iziphumo zamaphuzu zaqhathaniswa kwaye naluphi na ulwahlulo oluthe lwaxoxwa ngalo kwaye lucwangciswa ngabo bonke ababhali. Amanqaku omgangatho wecandelo ngalinye elifanelekileyo lichazwe kwiThebhile 3.

iziphumo

Iziphumo eziphambili zamanqaku e-35 zahlanganiswa kwaye zavavanywa kusetyenziswa indlela yokuphonononga ebalulekileyo eguqulelwe kuphando lwangaphambili [46, 47]. Ngokusekelwe kulwazi oluncinci olukhoyo kwezinye iintlobo zentloko, ukufunyaniswa kokuxhaphaka kuxelwe kwelinye lamacandelo amabini - mhlawumbi njenge-"migraine" yamaphepha engxelo yezifundo apho abantu babebaninzi okanye benziwe ngokupheleleyo kwizigulane ze-migraine okanye "njengentloko" kumaphepha apho inani labantu abaphononongayo lalinolunye uhlobo lwentloko (kubandakanywa yintloko ye-tension-type, i-cluster headaches, intloko ye-cervicogenic) kunye / okanye apho uhlobo lwentloko lwalungachazwanga ngokucacileyo. Amaphepha alishumi achaze iziphumo ezivavanya amazinga okuxhaphaka kwisigaba �migraine� yedwa, amaphepha e-18 achaze iziphumo zokuvavanya ukuxhaphaka kwecandelo le-"headache" yodwa kunye namaphepha e-3 abike iziphumo kuzo zombini iindidi. Ngokusekelwe kubume bolwazi olukhoyo, ukusetyenziswa okuxhaphakileyo kwahlulwa ngababoneleli bonyango lwezandla. Idatha ekhutshiweyo emva koko yahlalutywa kwaye yadityaniswa kwiindidi ezine ezinezihloko: ukuxhaphaka; iprofayili kunye nezizathu zokusetyenziswa kweMT; ukusetyenziswa kunye kunye nomyalelo wokusetyenziswa kwababoneleli beentloko; kunye novavanyo oluzibikayo lweziphumo zonyango lweMT.

Ukusetyenziswa kweMT

Amanqaku angamashumi amathathu ananye ahlaziywayo kunye nobukhulu obuncinci besampula (> 100) ingxelo efunyenweyo malunga nokuxhaphaka kokusetyenziswa kweMT. Ukuxhaphaka kokusetyenziswa kwe-chiropractic kulabo abane-migraine ukusuka kwi-1.0 ukuya kwi-36.2% (ithetha: i-14.4%) phakathi kwabantu bonke [19�21, 48�52] kwaye ukusuka kwi-8.9 ukuya kwi-27.1% (ithetha: 18.0%) ngaphakathi kwentloko-ikliniki abantu abagulayo [53, 54]. Ukuxhaphaka kokusetyenziswa kwe-chiropractic kulabo baxelwe njengentloko bevela kwi-4 ukuya kwi-28.0% (ithetha: i-12.9%) phakathi kwabantu bonke [20, 48, 51, 55�57]; ukusuka kwi-12.0 ukuya kwi-22.0% (ithetha: i-18.6%) ngaphakathi kwentloko / intlungu yekliniki yabantu abagulayo [58�60] kunye ne-1.9 ukuya kwi-45.5% (ithetha: i-9.8%) ngaphakathi kwezigulane ze-chiropractic [61�69].

Ukusetyenziswa kokuxhaphaka kwe-physiotherapy kulabo abane-migraine bavela kwi-9.0 ukuya ku-57.0% (ithetha: 24.7%) phakathi kwabantu bonke [19, 20, 48, 52] kunye ne-4.9 ukuya kwi-18.7% (ithetha: 11.8%) ngaphakathi kwintloko-kliniki abantu abanezigulane [54, 70]. Ukusetyenziswa kwe-physiotherapy kulabo bavakaliswe njengeentloko zivela kwi-12.2 ukuya kwi-52.0% (ithetha: 32.1%) phakathi koluntu jikelele [20, 48] kunye ne-27.8 ukuya kwi-35.0 %% (ithetha: 31.4%) ngaphakathi kwintloko / iintlungu zekliniki [60, 70].

Ukusetyenziswa kwe-massage yonyango kulabo abane-migraine ukusuka kwi-2.0 ukuya kwi-29.7% (ithetha: i-15.6%) phakathi kwabantu bonke [49, 50, 71] kunye ne-10.1 ukuya kwi-56.4% (ithetha: 33.9%) ngaphakathi kwentloko-ikliniki yabantu [53, 54, 72, 73]. Ukusetyenziswa kwe-massage / acupressure kulabo baxelwe njengentloko ngaphakathi kwentloko / intlungu yekliniki izigulane zabantu zivela kwi-12.0 ukuya kwi-54.0% (ithetha: 32.5%) [58�60, 70].

Ukusetyenziswa kwe-osteopathy kwalabo abane-migraine kuthiwa yi-1% phakathi kwabantu bonke [49]; njenge-2.7% ngaphakathi kwintsholongwane-i-klinikhi yesigulane isiguli [53] kunye ne-1.7% kwisigulane sesigulana se-osteopathy [74]. I-headache ubukhulu be-9% ngaphakathi kwintloko yesifo / intlungu yeklinikhi yoluntu [60] kwaye yahlukana ukusuka kwi-2.7 ukuya kwi-10.0% (ithetha: 6.4%) kwisifo sengqondo se-osteopathy [74, 75].

Ukulingana kwezinga lokusetyenziswa kwe-MT kuzo zonke i-MT professions kubabo abane-migraine bavela kwi-1.0 ukuya ku-57.0% (bathetha: 15.9%) phakathi kwabantu bonke; zivela kwi-2.7 ukuya kwi-56.4% (ithetha: 18.4%) ngaphakathi kwintloko yesigulane kunye nezigidi zabantu kwaye zichazwe njenge-1.7% kwisibalo esisodwa seM MT. Ukulingana kwesantya sokusetyenziswa kweMT kuzo zonke i-MT professions kulabo bachazwa njengeentloko zivela kwi-4.0 ukuya kwi-52.0% (ithetha: 17.7%) phakathi kwabantu bonke; ukusuka kwi-9.0 ukuya kwi-54.0% (ithetha: i-32.3%) ngaphakathi kwintloko-kliniki yezigulane zabantu kunye ne-1.9 ukuya kwi-45.5% (ithetha: 9.25%) ngaphakathi kwe-MT yeziguli.

Iphrofayili kunye nezikhuthazo zokusetyenziswa kweMT

Ngelixa iiprofayili zesigulana zentlalo yoluntu zingakhange zixelwe phakathi kwabantu bentloko ebebesebenzisa iMT kuphela, izifundo ezininzi zixela ezi ziphumo apho abasebenzisi beMT benze ipesenti enkulu yonyango olungelulo lwezonyango olusetyenziswa ngabantu bophononongo (uluhlu lwama-40% � 86% : kuthetha 63%). Ngelixa iziphumo zahlukeneyo kwinqanaba lengeniso [58, 70] kunye nenqanaba lemfundo, [70, 72, 73] eli qela lesigulane lalinokuthi libe lidala [70, 72], female [20], linomlinganiselo ophezulu we-comorbid. iimeko [58, 70, 76] kunye nezinga eliphezulu lokutyelela kwangaphambili kwezonyango [20, 58, 70] xa kuthelekiswa neqela elingelona lomsebenzisi. Ngokubanzi, eli qela laxelwa ukuba linezinga eliphezulu leentloko ezingapheliyo okanye ukukhubazeka kwentloko kunabasebenzisi abangasebenzisi [20, 54, 58, 70, 72, 77].

Izifundo ezininzi ngaphakathi kwentloko-ikliniki yabemi bachaza izigulane ezikhuthazayo zokusetyenziswa kwonyango oluhambelanayo kunye nolunye unyango lwentloko apho abasebenzisi beMT benza inxalenye ebalulekileyo yabemi bophononongo (uluhlu lwe-40% � 86%: kuthetha i-63%) [58, 70, 72, 78]. Ukususela kolu phando eyona mpembelelo ixhaphakileyo echazwe zizigulana zophononongo yayikukufuna isiqabu kwiintlungu zentloko ezibalelwa kwi-45.4% � 84.0% (ithetha: 60.5%) yeempendulo. Eyesibini eyona nto ixhaphakileyo yayiyinkxalabo yesigulane malunga �ukhuseleko okanye iziphumo ebezingalindelekanga � yonyango lwentloko yonyango, ibalwa kwi-27.2% � 53.0% (ithetha: 43.8%) yeempendulo [58, 70, 72]. �Ukungoneliseki ngokhathalelo lwezonyango� kubalelwe kwi-9.2% � 35.0% (ithetha: 26.1%) yeempendulo [58, 70, 72].

Inani elilinganiselweyo lamaphepha ahlaziywayo (onke avela eItali) ingxelo malunga nomthombo wokuthunyelwa okanye isincomo kwi-MT yonyango lwentloko [53, 58, 59]. Ukususela kwezi zifundo, ukuthunyelwa kwi-GP ukuya kwi-chiropractor ukusuka kwi-50.0 ukuya kwi-60.8% (ithetha: i-55.7%), ngelixa ukuthunyelwa kubahlobo / izalamane zivela kwi-33.0 ukuya kwi-43.8% (ithetha: 38.7%) kunye nokuzincoma ukusuka kwi-0 ukuya 16.7% (ithetha: 5.6%). Ukufumana unyango lwe-massage, ukuthunyelwa kwi-GP ukusuka kwi-23.2 ukuya kwi-50.0% (ithetha: i-36.6%), ngelixa ukuthunyelwa kubahlobo / izalamane zivela kwi-38.4 ukuya kwi-42.3% (ithetha: 40.4%) kunye nokuzincoma ukusuka kwi-7.7 ukuya kwi-38.4% ( kuthetha: 23.1%). Ukufumana i-acupressure, ukuthunyelwa kwi-GP ukusuka kwi-33.0 ukuya kwi-50.0% (ithetha: i-41.5%), ngelixa ukuthunyelwa kubahlobo / izalamane kwabikwa njenge-50% kunye nokuzincoma ukusuka kwi-0 ukuya kwi-16.6% (ithetha: 8.3%). Olunye uphando luchaze ukufunyaniswa kwe-osteopathy apho ukuthunyelwa kwii-GP kunye nabahlobo / izalamane kwaxelwa njenge-42.8% kwaye ukuzincoma kuye kwabikwa njenge-14.4%. Ngokubanzi, umlinganiselo ophezulu wokudluliselwa phakathi kwezi zifundo wawusuka kwi-GPs ukuya kwii-chiropractors zentloko engapheliyo ye-tension-type (56.2%), i-cluster headache (50%) kunye ne-migraine (60.8%).

Ukusetyenziswa ngokufanayo kunye neNkundla yokuSebenza kwabaNika iNtloko kunye noNxibelelwano oludibeneyo lwaBasebenzisi baseMT

Izifundo ezininzi zinika ingxelo malunga nokusetyenziswa kwangaxeshanye ukuphathwa kweentloko zonyango kunye nonyango olongezelelweyo kunye nolunye unyango. Kwezo zifundo apho ipesenti enkulu yezigulane zingabasebenzisi be-MT�s (uluhlu lwe-57.0% � 86.4%: luthetha i-62.8%), [58, 70, 78] ukusetyenziswa okufanayo kwonyango phakathi kwe-29.5% kunye ne-79.0% ( kuthetha: i-60.0%) yabantu abaneentloko zesigulane.

Ezi zifundo ziqhubeka zinika ingxelo malunga nenqanaba lesigulane esingachaziyo kubaboneleli bezonyango malunga nokusetyenziswa kweMT ngenxa yentloko. I-Non-disclocation iphakathi kwe-25.5 kunye ne-72.0% (ithetha: i-52.6%) yabantu besigulane, kunye nesizathu esiqhelekileyo sokungabonakali sichazwe njengogqirha �akazange abuze, ukusuka kwi-37.0 ukuya kwi-80.0% (ithetha: 58.5%). . Oku kwalandelwa yinkolelo yesigulana yokuba �ayibalulekanga into yokuba ugqirha azi � okanye �akukho nalinye ishishini likagqirha�, ukusuka kwi-10.0 ukuya kwi-49.8% (intsingiselo: 30.0%). Oku kwalandelwa yinkolelo yokuba "ugqirha akayi kuqonda" okanye "angadikibali" ezi zonyango, ukusuka kwi-10.0 ukuya kwi-13.0% (ithetha: 11.5%) [53, 77].

Omnye uphando olubanzi lwamazwe ngamazwe luchaze ukulungiswa komboneleli oqhelekileyo wokunyamekela intloko ngokuthelekisa iziphumo phakathi kwamazwe amaninzi kwizigulana ze-migraine [21]. Abanikezeli bokunakekelwa kweprayimari ezilandelwa ngamagqabantshintshi babecelwa njengababoneleli bokuqala nabesibini unyango lwe migraine phantse onke amazwe ahlolwe. Okukuphela kweAustralia, apho abo abanomdlavuza ongapheli bakhetha i-chiropractors njengababoneleli abaqhelekileyo kwixesha elilinganayo kuma-neurologists (i-14% bobabini) ngelixa i-episodic migraine ekhethiweyo i-chiropractors ephindaphindiweyo kwiiurologists (13% ngokubhekiselele kwi-5%). Ngokwahlukileyo, iingcali zonyango zikhethwe njengomniki-mboleko kulabo abane-migraine engapheliyo yi-10% e-USA naseKhanada, i-1% eJamani kunye ne-0% ye-UK neFransi. Iingcali zonyango zikhethwe njengomniki-mboleko kulabo abane-episodic migraine nge-7% e-USA, i-6% eJamani, i-4% eCanada kunye ne-1% e-UK naseFransi.

Ukusebenza ngokuzimeleyo kweziphumo zeziphumo zonyango

Izifundo ezininzi zentloko kunye neentlungu zeklinikhi zabemi zibonelela ngeziphumo zokuzichaza ngokusebenza konyango lwentloko yeMT. I-chiropractic, isigulane sokuzixela ngokufanelekileyo okanye ngokufanelekileyo ngokupheleleyo ukukhululeka kwentloko ukusuka kwi-27.0 ukuya kwi-82.0% (ithetha: 45.0%) [53, 58�60, 78]. Ngonyango lwe-massage, isigulane esizixelayo ngokukhululeka kwentloko ngokuyinxenye okanye esebenzayo ngokupheleleyo ukusuka kwi-33.0 ukuya kwi-64.5% (ithetha: 45.2%) [53, 58, 60, 73, 78], kwaye ngenxa ye-acupressure le isuka kwi-33.4 ukuya kwi-50.0%. (ithetha: 44.5%) [53, 58, 59]. Kwi-osteopathy kunye ne-physiotherapy, uphando oluthile luchaze ukusebenza njenge-17 kunye ne-36% ngokulandelanayo [60].

Xa iziphumo zidityanisiwe kuzo zonke iiprofessional zeMT ukunikezelwa kwengxelo yeMT ngokuyinxenye okanye ngokupheleleyo isusela kwi-17.0 ukuya kwi-82.0% (ithetha i-42.5%) [53, 58�60, 73, 78]. Ukongezelela, uphando oluthile lwabantu ngokubanzi lubonelela ngokufunyaniswayo ngokusebenza ngokuzixelayo kwi-chiropractic kunye ne-physiotherapy kwi-25.6 kunye ne-25.1% ngokulandelanayo kwabo banentloko engapheliyo kunye ne-38 kunye ne-38% ngokulandelanayo kwabo banentloko yesibini engapheliyo [79].

ingxoxo

Eli phepha linikeza ukuhlaziywa kokubaluleka kokuqala kokubaluleka kokubaluleka kunye nezinto eziphambili ezichaphazelekayo nokusetyenziswa kwe-MT unyango lweentloko ngaphakathi kwincwadi ehlaziywe ngontanga. Nangona ulwahlulo lweendlela zokufunda kunye nokungafumaneki kwedata kuthintela izigqibo eziqinileyo, ezi ziphumo ziphakamisa ulwazi malunga nemibandela ebaluleke kubaququzeleli-nkqubo, ootitshala, abanikiweyo bentloko kunye nophando olusasa.

Uphononongo lwethu lufumene ukuba ukusetyenziswa kwe-MT kwakuphezulu kakhulu ngaphakathi kwentloko yezonyango-ikliniki yabantu xa kuthelekiswa nabantu ngokubanzi. Nangona kunjalo, ukusetyenziswa kwababoneleli beMT ngamnye kuyahluka phakathi kwemimandla eyahlukeneyo kwaye oku kunokwenzeka ngenxa yezinto ezininzi ezibandakanya ukuhluka kokufikelela koluntu, inkxaso-mali yezempilo kunye nokufumaneka kwababoneleli beMT. Ngokomzekelo, ukusetyenziswa kwe-physiotherapy kwezinye iintlobo zentloko kunokuba phezulu kwiindawo zaseYurophu [20, 60] ngelixa ukusetyenziswa kwe-chiropractors kwezinye iintlobo zentloko kunokuba phezulu e-Australia nase-USA [19, 21]. Ngokubanzi, ukuxhaphaka kokusetyenziswa kwe-MT ngenxa yentloko kubonakala kuninzi kwaye kubonakala ukuba lolona hlobo luqhelekileyo lonyango lomzimba olusetyenziselwa intloko kumazwe amaninzi [19�21, 49]. Izifundo zomgangatho ophezulu we-epidemiological ziyafuneka ukulinganisa ukuxhaphaka kokusetyenziswa kwe-MT kwiintlobo ezahlukeneyo zeentloko kunye neentlobo ezincinci, zombini phakathi kwabantu ngokubanzi kunye nabemi bekliniki.

Ngaphandle kwexesha elibanzi, idatha ingaphelelanga malunga nokuba ngubani, njani kwaye kutheni izigulane zentloko zifuna uMT. Ukusuka kolwazi olukhoyo, nangona kunjalo, iimfuno zonyango lwe-MT izigulane zentloko zinokuba nzima kakhulu kwaye zininzi zoluleko ngokumalunga nalabo phantsi koononyango lwonyango kuphela. Iziphumo zentlalo-manani zibonisa ukuba abasebenzisi be-MT kunye nezinye iindlela zokuqulunqa kunye neendlela ezingaphezulu zinezinga eliphezulu lokukhubazeka kwentloko kunye nokungaxhatshali xa kuthelekiswa nabangewona abasebenzisi. Oku kufunyaniswayo kungahambelana nokuphakama okuphezulu kwabasebenzisi be-MT ngaphakathi kwintloko-klinikhi yabantu kunye nembali yezonyulo zonyango. Oku kunokuba nefuthe kwixesha elizayo lwe-MT ukuyila iindleko zombini ngokubhekiselele ekukhetheni izifundo zesilingo ezivela ngaphakathi ngaphakathi nangaphandle kwezicwangciso ze-MT kunye nesigqibo sokuvavanya ukungenelela kwe-MT kunye ne-MT ngokudibanisa namanye amanyathelo.

Ulwazi oluncinci lubonisa ukuba iindlela ezininzi malunga nokusetyenziswa kwezonyango kunye nononyango lwezonyango ezifana ne-MT ziqhelekileyo. Nangona iziphumo zibonisa ukuba i-MT ifunwa kaninzi ngenxa yezizathu zokufuna ukuphulwa kwentloko, ubungqina bokuxhasa ukuphumelela kwe-MT yokuncediswa kwentloko kuyaqhubeka. Ababoneleli beMT kufuneka bahlale bekhumbula umgangatho wobungqina obunikwe ingenelelo ngoncedo olunikwe intloko yesifo kunye nokwazisa izigulane apho kungenelela ngoncedo olululo okanye olukhuselekileyo kunyango. Uphando oluninzi lufunekayo ukuvavanya ezi zonyango ngokwahlukeneyo kunye neendlela ezininzi zokufunda kunye nezifundo ukuba zibandakanye ukulandelelwa kwexesha elide.

Ulwazi olungapheliyo e-Itali, lubonisa ukuhanjiswa kwe-GPs kwi-MT unyango lwentloko lunokuqhelekileyo kwezinye iindawo, ngelixa le nto ingenakwenzeka ukuba isasazeke ngokugqithiseleyo kwimeko yesigulana esingabonakali kwiingcali zoogqirha malunga nokusetyenziswa kolu unyango kwezinye izifundo. Ubunonophelo bempilo esemgangathweni obuninzi bufuna uxhulumano oluvulekileyo nolusisiseko phakathi kwezigulane kunye nababoneleli kunye naphakathi kwababoneleli ngokwabo. Ukungabonakali kungonakalisa kakubi ukulawulwa kwezonyango ukuba izigulane ezingaphenduliyo zifuna uphando olongezelelweyo lwe-diagnostic [80] okanye ukuphunyezwa kweendlela eziphambili zolawulo lweentloko [81] okanye ukuthintela ingxoxo kwiimeko apho i-MT ingatsholwa khona [82]. Abanikezeli beentloko zaseprayimari banokuzuza ngokunikela ingqwalasela ethile ingxaki yokungabonakali kwezonyango zonyango ezingenalo unyango. Ingxoxo evulekileyo phakathi kwababoneleli kunye nezigulane malunga nokusetyenziswa kwe-MT yentloko kunye neziphumo ezinxulumene nazo zinokuphucula ukunakekelwa kwegulane jikelele.

Uphando lwexesha elizayo

Nangona kunesidingo esinamandla sokwenza uphando olongezelelweyo oluphezulu ukuhlola ukuphumelela kwe-MT njengonyango lweentloko, ukusetyenziswa ngokubanzi kwe-MT kubeka ingqwalasela kwimfuno yoluntu lwempilo yoluntu kunye nophando lweenkonzo zezempilo kule ndawo yokuphathwa kwintloko. Isidingo salolu hlobo lophando sagqitywa kwingxelo yehlabathi yakutshanje malunga nokusetyenziswa kwezinto eziphathekayo zonyango [18]. Ukuqhubela phambili olu lwazi kunokukhokelela ekuphuculweni komgaqo-nkqubo wezempilo kunye nokunikezelwa kweenkonzo zonyango.

Ukusetyenziswa kakhulu kwezonyango ezifana ne-MT kuye kwaxelwa ngaphantsi kophando lwesizwe oluchaza ukusetyenziswa kwezempilo ezinxulumene nentloko [3, 5, 83�85]. Kungakhathaliseki ukuba, indima yonyango lomzimba ekulawuleni intloko yentloko iyaqhubeka nokuvavanywa, ngokuphindaphindiweyo ngaphakathi kweendlela eziqhelekileyo kunye nezicwangciso zokulawulwa kweentloko [86�89]. Ukuqhubela phambili olu phando lunokuqhubela phambili ukuqonda kwethu ukusebenza kunye neziphumo ezinxulumene neendlela ezininzi zokulawula intloko.

Ukuqhubela phambili kwesi sifundo sokwenza uphando olongezelelweyo ukuqonda indlela yokusetyenziswa kwezempilo ehambelana nezi gulane ezisebenzisa i-MT kwi-headache management. Incinci iyaziwa malunga nemvelaphi yoluntu, iintlobo zeentloko, inqanaba lokukhubazeka kwentloko kunye neentlobo eziqhelekileyo eziqhelekileyo kwesi si gulane. Ngaloo nto, ulwazi olunjalo lunokunika iinkcazelo ezingabalulekanga kumniki-kliniki nokwenza imfundo.

Imida

Uyilo kunye neziphumo zophononongo lwethu zinenani lemida. Uyilo lophononongo luthintelwe kukhangelo kwiijenali zolwimi lwesiNgesi kuphela. Ngenxa yoko, olunye uphando malunga nesi sihloko lunokuthi luphoswe. Nangona inkqubo yokulinganisa umgangatho eyamkelwe kolu hlaziyo ifuna ukuqinisekiswa okungakumbi, idatha esiyiqokelele yayikhawulelwe ngumgangatho ophantsi ukuya kumodareyithwa wamaphepha akhoyo aphakathi kwe-6.4 kumanqaku e-10 (Itheyibhile 3). Amanqaku asezantsi kakhulu ngenxa yemibandela ebalulekileyo yendlela yokusebenza kunye nobungakanani besampulu encinci ehambelana namaphepha amaninzi aqokelelweyo. Uninzi lwedatha malunga nesi sihloko yayingafani ngokwendalo (imfonomfono, uphando ngeposi kunye nodliwano-ndlebe lobuso ngobuso). Bekukho ukunqongophala kwemibuzo yogqirha kunye nezigulane eziqinisekisiweyo zokunika ingxelo ngeziphumo, njengemibuzo malunga nokuxhaphaka, apho amaxesha asetyenzisiweyo ahluka phakathi �ngoku�, �iinyanga ezili-12 ezidlulileyo & � ngonaphakade�.

Idata ngokubaluleka kokusetyenziswa kwe-MT yamakhanda entloko yayingancinci ngokukodwa kumntu ngamnye we-MT xa kuthelekiswa nedata efunyenwe ngaphakathi kubantu abanzi kunye nentloko ye-kliniki. Izifundo ezininzi zavavanya ukusetyenziswa kwe-MT yentloko ngaphandle kokuchonga iintlobo zeentloko. Uphando olulodwa ngaphakathi kwe-MT labantu luchaze ipesenteji yezigulane ezisekho ngenxa yezigulana zodwa (i-osteopathy). Ukuxhaphaka kwe-MT ukusetshenziswa kwintloko yaxelwa kakhulu kwiiprogram zezigulane zezigulane, kodwa nangona ulwazi lucacisiwe kwiintlobo zentloko. Asifumananga uphando olwenziwe malunga nokusabalalisa kwezigulane zentloko ngaphakathi kwe-physiotherapy okanye ukuxilisa izigulane zezigulane kwizigulane usebenzisa iziphumo zethu zokukhangela.

Ukungabikho kwedatha yezihloko ezithile kwakudinga ukubonelela ngeziphumo ezifunyenwe nabasebenzisi bezinye iinkonzo ezingabangezifo zonyango. Idata phakathi kweendawo ezininzi zendawo yayingqongqo kunye neyona nkcukacha eyingcipheko yayisisiseko sokudluliselwa kwi-MT abahlinzeki bamakhanda entloko (amaphepha amathathu ase-Italia kuphela). Le mingcele ixhasa umnxeba wophando olungakumbi ukuba lujoliswe kuphela kwizikhundla ze-MT kunye nemimandla eyahlukileyo kwimimandla ngaphambi kokuba izigqibo ezigqithisileyo zingathathwa.

isiphelo

Iimfuno zalabo abaneentloko ezibuhlungu zinokuba nzima kwaye zininzi zoluleko kwindalo. Ngaphandle kophando lwezonyango, umgangatho ophezulu wophando lwezempilo lukawonke-wonke kunye neenkonzo zempilo ziyafuneka ukulinganisa nokuphonononga inani lemiba ebalulekileyo ekuhanjisweni nasekusetyenzisweni kweMTs kulawulo lwentloko. Ngeemfuno ezingafezekiyo eziseleyo kwabaninzi abaphathwa yintloko ephindaphindiweyo, oogqirha kufuneka bahlale bekuqonda ukusetyenziswa kwe-MTs kwaye bahlale bevulekile ukuxoxa ngale ndlela yokulawula intloko ukuze kuqinisekiswe ukhuseleko olukhulu, ukusebenza kunye nokulungelelaniswa kokhathalelo lwentloko.

Imibulelo

Ayingeni.

Inkxaso

Olu phando alufumananga nkxaso-mali ithile evela kuyo nayiphi na i-arhente yenkxaso-mali kuluntu, kushishino okanye kumacandelo angenzi nzuzo ngelixa umbhali wokuqala kweli phepha efumana i-PhD yokufunda eyenziwe yafumaneka yi-Australian Chiropractors� Association.

Ukufumaneka kweDatha kunye neZiko

Akusebenzi (yonke idatha ichazwe kwinqaku).

Imirhumo yabalobi

I-CM, i-JA kunye ne-DS yenzele iphepha. I-CM yenza uphando lweencwadi, ukuqokelela idatha kunye nokukhethwa. I-CM kunye ne-DS banikeze uhlalutyo nokutolika. I-CM kunye ne-JA babhala iirejista. Bonke ababhali babenegalelo ekuhlaziyweni olubukhali kunye nomxholo wengqondo. Bonke abalobi bafunde kwaye bavumile umbhalo wesigqi wokugqibela.

Ukugqithisa inzala

Ababhali bavakalisa ukuba abanalo inxaxheba.

Imvume yokupapashwa

Ayingeni.

UkuVunywa kweMigaqo kunye neMvume yokuBamba iqhaza

Ayingeni.

Inqaku loMpapashi

Uhlobo lwe-Springer luhlala lungathathi hlangothi malunga namabango asemagqabini kwimpapasho epapashwe kunye namaziko eziko.

izifinyezo

MT Unyango lwemiqulu
EMG Electromyography

I ngcaciso

Ncbi.nlm.nih.gov/pmc/articles/PMC5364599/

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

I-15% yabantu abaxhamlileyo banesifo se-migraines, imeko ephosakeleyo ebangela ukuba umntu akwazi ukwenza imisebenzi yansuku zonke. Nangona ngokungaqondwa ngokubanzi ngophando namhlanje, ndiyakholelwa ukuba intlungu ye-migraine ingabonakalisa uphawu lwezempilo enkulu. Ii-discs ze-Lumbar ze-herniated, okanye i-disc ruptured kwi-lumbar spine, yinto eqhelekileyo yokubandezeleka kwe-back back and sciatica. Xa i-soft-gel-like-center ye-lumbar disniated disc igxininisa iingcambu zentliziyo ye-back back, ingabangela iimpawu zentlungu kunye nokuphazamiseka, ukuphazamiseka kunye nobuthathaka kwimida ephantsi. Ngaphezu koko, i-disc ye-lniar herniated ingakwazi ukungalingani isakhiwo kunye nomsebenzi walo lonke umgudu, ukukhuthaza iimpawu kunye nomlenze wesibeletho oza kudala ekugqibeleni i-migraines. Abantu abahlala bevalelwa intlungu ye-migraine kufuneka bahambe ngokunyanisekileyo malunga nosuku lwabo benethemba lokuphepha umbane wesinye isiqhelo esibuhlungu. Ngethamsanqa, ezininzi iintlungu ze-migraine kunye nezindlela zokunyuselwa kwiinkcukacha ze-disniate ze-discs zifumaneka ukuze zincede ukuphucula kunye nokulawula iimpawu. Ezinye iindlela zokonyango ziyakucingelwa kwakhona phambi kokungenelela kokugonywa.

I-Treatment against Versus Operative Treatment for Lumbar Disc Herniation: Iziphumo ezi-8 zeMigangatho yeziGulane zeziThamo Iziphumo zoPhando (SPORT)

Abstract

IsiCwangciso soFundo

Iimeko eziqhelekileyo eziza kulandelwa ngokulandelelana kunye nokuhlola okuqhelekileyo.

injongo

Ukuvavanya iziphumo ze-8 zeminyaka yokuhlinzwa kunye nokunakekelwa kwabangasebenzi.

Isishwankathelo seNkcazelo yedatha

Nangona izilingo ezingenamsebenzi zibonise ukungafani kwexesha elifutshane malunga nokuhlinzwa, iziphumo zexesha elide ukuthelekisa ukutyunjwa kwonyango olungasebenziyo kuyaqhubeka kungqubuzana.

tindlela

Abaviwa abagqityiweyo abanokucinga-baqinisekisile ukudibanisa i-disvertebral disniniation intlanganiso Intlanganiso yokufaneleka yokuphuhliswa kwe-SPORT ebhaliswe kubafundi abathathi-nxaxheba (abaxhamli be-501) kunye nabaqashi be-Observatory (i-743 participants) kwii-clinics ze-13 zemigudu kwi-11 US. Ukungenelela kwakuyi-discectomy evulekileyo ngokuqhelekileyo ngokubhekiselele ekunyamekelweni kokungekho kokusebenza. Amanyathelo omphumo oyintloko aguquka ukusuka kwisiseko kwi-SF-36 Bodily Pain (BP) kunye ne-Physical Function (PF) izikali kunye ne-Oswestry Disability Index (i-ODI-AAOS / i-modems version) ehlolwe kwii-6 iiveki, iinyanga ze-3 kunye ne-6, kwaye ngonyaka emva koko.

iziphumo

Izibonelelo zabonwa ngotyando kuhlalutyo lwenjongo-yokunyanga yeqela elingenamsebenzi kuzo zonke iziphumo zokuqala nezesekondari ngaphandle kwenqanaba lomsebenzi; Nangona kunjalo, ngokunganyamekeli kakhulu kunikezelo lonyango (i-49% yezigulana ezinikezelwe kunyango olungasebenziyo ezifumana utyando ngokuchasene ne-60% yezigulana ezabelwe utyando) ezi ziphumo ziye zabonwa zincinci kwaye zingabalulekanga ngokwezibalo kwiziphumo zokuqala (BP, PF, ODI ). Ngokubalulekileyo, uthelekiso lulonke lweziphumo eziziisekondari lwalukhulu kakhulu ngoqhaqho kuhlalutyo lokufuna ukunyanga (i-sciatica bothersomeness [p> 0.005], ukoneliseka ziimpawu [p> 0.013], kunye nokuziphucula ngokwakho [p> 0.013]) ekulandeleleni ixesha elide. Uhlalutyo olunyangiweyo lubonakalisa unyango olunempembelelo kunyango lweziphumo zesiphumo esiphambili (kuthetha utshintsho Uqhaqho ngokuchasene nokungasebenzi, isiphumo sonyango; 95% CI): BP (45.3 vs. 34.4; 10.9; 7.7 ukuya kwi-14); PF (42.2 vs. 31.5; 10.6; 7.7 ukuya ku-13.5) kunye ne-ODI (? 36.2 vs.? 24.8;? 11.2;? 13.6 ukuya ku-9.1).

isiphelo

Izigulane ezikhethwe ngokucophelela eziye zenziwa ukuhlinzwa kwi-disc ye-lumbar ziphucuke kakhulu kunezigulane ezingaphelelanga; kwakungekho ncinane ekungcoleni iziphumo kwiqela (ukusetyenziswa kunye nokungasebenzi) ukusuka kwi-4 ukuya kwi-8 iminyaka.

Internet: I-SPORT, i-disvertebral disniation, ukuhlinzwa, ukungabikho kokusebenza, iziphumo

intshayelelo

I-Lumbar discectomy yokunceda i-sciatica kwizigulane ezine-intervertebral disc herniation (IDH) luphawu oluphandwe kakuhle kunye noluqhelekileyo lotyando lomqolo, kodwa amaxabiso olu tyando abonisa ukuhluka okukhulu kwendawo. Izilingo ezininzi ezingahleliwe kunye namaqela amakhulu alindelekileyo ziye zabonisa ukuba utyando lubonelela ngokukhawuleza kwiintlungu kunye nokubuyiswa okubonakalayo kwizigulane ezine-disc ye-herniated.

Kwi-RCT ye-classic yokuvandlakanywa kokuhlinzwa ngokungahambisani nonyango lwe-IDH, i-Weber et al. ibonise ukuphucula okukhulu kwiqela lokuhlinzwa kwi-1 kunyaka obalaseleyo; Kwakukho uphuculo olongezelelekileyo lotyando lwe-4 iminyaka, nangona kungabonakali ngokubalulekayo, kodwa akukho mvelaphi ebonakalayo kwiziphumo kwiminyaka ye-10. [2] Nangona kunjalo, inani lezigulane kwiqela elingasebenziyo ekugqibeleni liye lahlinzwa ngaphaya kwelo xesha, luyinkimbinkimbi ukuchazwa kweziphumo zexesha elide. I-Maine Lumbar Spine Study, iqela elikhangelelanayo, lifumene uphuculo olungakumbi ngonyaka omnye kwiqela lokuhlinzwa elincinci ngaphezu kwexesha, kodwa lahlala likhulu kakhulu kwiqela eligqityiweyo le-sciatica eliphazamisayo, umsebenzi osebenzayo kunye nokwaneliseka, kodwa akukho nto eyahlukileyo kumsebenzi okanye iziphumo zokukhubazeka. [3] Eli phepha libika iziphumo zonyaka we-8 kwiziphumo zoPhando lweziPhumo zoPhando (SPORT) ngokusekelwe ekulandelelweni okuqhubekayo kweengxoxo ze-disni ze-randnized and randomized cohorts.

tindlela

IsiCwangciso soFundo

I-SPORT lulingo olungenamkhethe kunye neqela lokujonga ngokufanayo eliqhutywe kwii-11 zase-US kumaziko ezonyango ze-13 ezineendlela ezininzi ze-spine. Iikomiti zezifundo zabantu kwiziko ngalinye elithatha inxaxheba ziphumeze iprothokholi esemgangathweni yawo omabini amaqela oqwalaselo kunye namaqela angenamkhethe. Iikhrayitheriya zokubandakanywa kwezigulana kunye nokungabandakanywa, ungenelelo lokufunda, imilinganiselo yeziphumo, kunye neenkqubo zokulandelela eziye zaxelwa ngaphambili.[5�8]

Abemi abagulayo

Amadoda nabasetyhini bafanelekile ukuba baneempawu kunye neempawu eziqinisekisayo ze-radiculopathy ye-lumbar eqhubekayo ubuncinane kwiiveki ezintandathu, i-disc herniation kwinqanaba elihambelanayo kunye necala kwi-imaging, kwaye babebhekwa njengabaviwa bokuhlinzwa. Umxholo wokubhaliswa kwangaphambili kokhathalelo olungasebenzisiyo awuzange uchazwe ngaphambili kwiprothokholi.[5�7] Ukubhaliswa okuthe ngqo kunye neendlela zokukhutshwa zichazwe kwenye indawo.[6,7]

Umongikazi wophando kwiziko ngalinye labathathi-nxaxheba abachongiweyo, baqinisekiswe ukufaneleka kwaye basebenzise isinqumo sokwabelana ngokubambisana nge-uniformity of registration. Abathathi-nxaxheba banikezelwa ukubhaliswa kwilingo le-randomized or group observation. Ubhaliso lwaqala ngoMatshi we-2000 kwaye lwaphela ngoNovemba ka-2004.

Iingenelo zokuFunda

Utyando lwaluyi-discectomy evulekileyo eqhelekileyo kunye novavanyo lwengcambu yemithambo-luvo ebandakanyekayo. -i-steroidal anti-inflammatory drugs ukuba iyanyamezelwa. Unyango olungasebenzisiyo lwalulungiselelwe umntu ngamnye kwisigulana ngasinye kwaye lulandelelwa ngokufanelekileyo.[7,9�5]

Imilinganiselo yoFundo

Iiphelo zokugqibela zasePrayimari zaseBloly Pain (BP) kunye nePhysical Function (PF) izikali ze-SF-36 Health Survey [10] kunye ne-AAOS / Modems version ye-Oswestry Disability Index (ODI) [11] njengoko kulinganiswa kwiiveki ze-6, i-3 kunye neenyanga ze-6, kwaye ngonyaka emva koko. Ukuba utyando lwabambezeleka ngaphaya kweeveki ezintandathu, idatha eyongezelelweyo yokulandelelwa yafunyanwa iiveki ze-6 kunye neenyanga ze-3 emva kokusebenza. Iziphumo eziqhelekileyo zibandakanya ukuphuculwa kwengxelo ngokuzimela; isimo somsebenzi; ukwanelisa iimpawu zangoku kunye nokunyamekela; [12] kunye ne-sciatica yobunzima njengoko kulinganiswa yinkcazo ye-sciatica ephazamisayo. [13,14] Impembelelo yonyango yachazwa njengomdahluko kwiinguqu zentsingiselo ukusuka kwinqanaba lokuqala phakathi kwamaqela okugula kunye nabangasebenzi.

Ukuqwalaselwa kwezibalo

Uhlalutyo lokuqala uthelekiso lweendlela kunye nobungakanani beempawu zesigulana esisiseko phakathi kwamaqela angacwangciswanga kunye nokujonga naphakathi kweengalo zokuqala zonyango zomntu ngamnye kunye neqela elidibeneyo. Ubungakanani bedatha elahlekileyo kunye nepesenti yezigulana ezenziwa utyando zabalwa ngengalo yonyango kulandelelwano ngalunye olucwangcisiweyo. Ukuxelwa kwangaphambili kwesiseko sexesha kude kube kunyango lonyango (kubandakanya nonyango olwenziweyo) kuzo zombini ii-cohorts zichongiwe ngemodeli yengozi yokuhlengahlengiswa kwemodeli yokulinganisa kunye nenqobo yokufaka ye-p <0.1 yokungena kunye p> 0.05 ukuphuma. Abaxeli bokungabikho kotyelelo olulandelayo olwenzeka rhoqo kwisithuba seminyaka esi-8 babekwa bucala ngokwahlulahlulwahlulwa kwempahla. Iimpawu ezisisiseko ezichaze utyando okanye utyelelo oluphosakeleyo ngalo naliphi na ixesha-lamaxesha emva koko zangena kwiimodeli ezinde zeziphumo zokuqala. Ezo zihlala zibalulekile kwiimodeli ezide zesiphumo zibandakanyiwe njengokuhlengahlengisa ii-covariates kuzo zonke iimodeli zokuhlengahlengiswa kwexesha elide ukuze zilungelelanise ukuphazamiseka okunokubakho ngenxa yokhetho lokhetho kunyango kunye neepateni zedatha ezingekhoyo. [15] Ukongeza, iziphumo ezisisiseko, iziko, ubudala kunye nesini zibandakanyiwe kuzo zonke iimodeli zesiphumo sobude.

Uhlalutyo oluphambili luqhathaniswa nophatho olusakhulayo kunye nolusetyenziswayo olusebenzisa utshintsho ukusuka kwisiseko kumlandelelwano ngalunye, kunye nemiphumo edibeneyo yokuguqula imodeli kubandakanye nomphumo ngamnye wokungahambi ngokukhawuleza ukulungiselela ukulungelelaniswa phakathi kokulinganisa okuphindaphindiweyo phakathi kwabantu. Iqela elingazange lihlaziywe lihlaziywe ngokusesikweni kwisiseko sokunyanga. [6] Ngenxa yokuwela, ukuhlaziywa okongeziweyo kwenziwe ngokusekelwe kwonyango olwenziweyo. Kule zihlalutyo eziphathiswe ngokukhawuleza, isibonakaliso sonyango sisisigxina sexesha, sivumela ukuba ixesha lotyando litshintshile. Ixesha lokulandelela lilinganiselwe kubhaliso lweengcebiso zokufuna ukunyanga, ngelixa uhlalutyo oluphathwa ngolu hlobo lwamaxesha okulandelwa ayenziwa ukusuka ekuqaleni kokonyango (oko kukuthi ixesha lotyando lweqela elisebenzayo kunye nexesha ubhaliso lweqela elingasebenziyo), kunye nee-covariates ezisisiseko zahlaziywa ekulandeleni ngokukhawuleza kwandulela ixesha lotyando. Le nkqubo inempembelelo yokuquka zonke iinguqu ezivela kwisiseko phambi kotyando kwiingqikelelo zempembelelo yokungahambi kokusebenza kunye nazo zonke iinguqu emva kokuhlinzwa kwiingqikelelo zempatho. Iziphumo zesithandathu ze-sciatica kunye neziphumo zobunqunu zihlalutywe ngeendlela ezinomlinganiselo osusela kuma-equation equation equations [16] kunye nemisebenzi eqhelekileyo kunye ne-logit ngokulandelanayo, usebenzisa iinjongo ezifanayo zokuphatha kunye nokulungiswa kweenkcazo zokuhlaziywa njengendlela yeziphambili. Nganye yahlaziywa ukuze kuveliswe ukulinganiswa okuhlukileyo okuphathwa ngonyango. Ezi ziphumo ziqhathaniswa nokusebenzisa uvavanyo lwe-Wald kunye nokuvavanya onke amaxesha okutyelela okulandelelanayo kwimilinganiselo yeziphumo zonyango ezicatshangelwayo phakathi kwama-cohorts amabili. [15] Ukuhlalutya kokugqibela kudibanisa ama-cohorts.

Ukuphonononga iimbali zombini zonyango kuwo onke amaxesha, ixesha elilinganiselwayo leemiphumo (indawo engaphantsi kwekhalo) kwinqanaba ngalinye lonyango lalingeniswa ngokusebenzisa ukuqikelela kwixesha ngalinye kwixesha elide lokuguqula kunye nokuthelekisa ukusebenzisa i-Wald test [15]

U-Kaplan-Meier uqikelele ukuhlaziywa kwemilinganiselo kwiminyaka ye-8 ibingeniswe kwii-cohorts ezingaqhelekanga kunye nokuqhathaniswa nokuqhathaniswa nokuhlolwa kwe-log-rank. [17,18]

Iikhompyuter zenziwe kusetyenziswa iinkqubo ze-SAS PROC MIXED yedatha eqhubekayo kunye ne-PROC GENMOD kwiziphumo zesibini kunye nezingaqhelekanga (SAS version 9.1 Windows XP Pro, Cary, NC). Ukubaluleka kwesitatisti kuchazwe njenge-p <0.05 esekwe kuvavanyo lwamacala amabini obungenalo uhlengahlengiso olwenziwe kuthelekiso oluninzi. Idatha yolu hlalutyo yaqokelelwa ngoFebruwari 4, 2013.

iziphumo

Ngokubanzi, abathathi-nxaxheba be-1,244 SPORT kunye ne-lumbar disvertebral disniation babhalisiwe (i-501 kwiqela elincinciweyo, kunye ne-743 kwinqanaba elibukeleyo) (Umfanekiso 1). Kwinqanaba elincinane, i-245 yabelwa ukonyango kunye ne-256 kwonyango olungasebenzi. Kulabo bantu abangazange baqhutywe ngokuhlinzwa, i-57% yahlinzwa ngo-1 ngonyaka kunye ne-60% ngeminyaka eyi-8. Kwinqanaba elingenanto yokunyamekela, i-41% yezigulane zahlinzwa ngo-1 ngonyaka kunye ne-48% ngeminyaka eyi-8. Kwinqanaba lokuqwalasela, izigulane ze-521 zaqala ukukhetha ukuhlinzwa kwaye izigulane ze-222 zanyula ukhetha ukunakekelwa kwabangasebenzi. Kulabo baqala ukukhetha ukuhlinzwa, i-95% yafumana utyando nge-1 ngonyaka; Kwi-8 iminyaka i-12 ezongezelelweyo izigulane ziye zahlinzwa ngokusisiseko. Kulabo banyulwa unyango olungasebenziyo, i-20% yahlinzwa ngo-1 ngonyaka kunye ne-25% ngeminyaka eyi-8. Kwizibini zombini ezidibeneyo, izigulane ze-820 zanikwa utyando ngexesha elithile kwi-8 iminyaka yokuqala; I-424 (34%) yahlala ingasebenzi. Ngaphezulu kweminyaka eyi-8, i-1,192 (i-96%) yabhaliso lwangaphambili lwagqitywa ubuncinane ukutyelela kwe-1 kwaye zibandakanywe kuhlalutyo (iqela elihle: i-94% kunye neqela elikhangelelanayo 97%); I-63% yabhalisi bokuqala abanikezelwa ngeminyaka kwi-8 iminyaka kunye nokulahlekelwa ngenxa yokulahla, ukutyelelwa okungekho, okanye ukufa (Umfanekiso 1).

Umzobo-I-1-Ukungabhaliseki-UkuBhaliswa-UkuHlulwa kweNkcitho-nokuLandela

Umzobo 1: Ukukhutshwa, ukubhaliswa, ukulandelelaniswa nokulandelelwaniswa kwabathathi-nxaxheba.

Iimpawu zoMonde

Iimpawu ezisisiseko ziye zaxelwa ngaphambili kwaye zishwankathelwa kwiThebhile 1. [5,6,8] Amaqela adityanisiweyo ayenomlinganiselo weminyaka eyi-41.7 kunye namadoda angaphezulu kancinci kunabasetyhini. Ngokubanzi, amaqela angabonakaliyo kunye nokuqwalasela ayefana. Nangona kunjalo, izigulane ezikwiqela lokujonga zineziphene ezisisiseko (amanqaku aphezulu e-ODI), babenokuthanda utyando, badla ngokuyilinganisa ingxaki yabo njengento eyandayo, kwaye babenokuthi babe nentsilelo yeemvakalelo. Izifundo ezafumana utyando ngexesha lokufunda yayizi: zincinci; kuncinci ukusebenza; kunokwenzeka ukuba axele ukuba unembuyekezo yabasebenzi; wayenentlungu engaphezulu yesiseko kunye nokunciphisa ukusebenza; amanxeba ambalwa kunye nezinye izifo ezidibeneyo; ukunganeliseki okukhulu ngeempawu zabo; badla ngokuyilinganisa imeko yabo njengesiya isiba mandundu ekubhaliseni; kwaye bebethanda kakhulu utyando. Izifundo ezifumana utyando zikwalindeleke ngakumbi ukuba zibe novavanyo oluqinisekileyo lomlenze othe ngqo, kunye ne-neurologic, i-sensory, kunye nokusilela kwemoto rhoqo. Ngokwe-Radiographically, i-herniations yabo yayinokwenzeka ngakumbi ukuba ibe kumanqanaba e-L4�5 kunye ne-L5-S1 kwaye ibe yi-posterolateral kwindawo.

Itheyibhile ye-1 Izigulane zoLuntu lweeNkcukacha zoLuntu, iMirbidities kunye neMeko yeNqanaba leMpilo

Ithebula 1: Izigulana zokubala zabantu, izigulane kunye neendlela zempilo ngokwemigangatho yokufunda kunye nokwamkelwa kwonyango.

Ukunyangwa koPhando kunye neengxaki

Utyando olubanzi kunye noxinzelelo lwangokufanayo phakathi kweentlobo ezimbini (iThebhile 2). Ixesha lokupasa eliqhelekileyo lalingamaxesha ambalwa kwiqela elincinci (i-80.5 imizuzu engqinelanayo nemizuzu ye-74.9 yokuqwalasela, p = 0.049). Ilahleko lokulahleka kwegazi ngu-75.3cc kwinqanaba elingafaniyo ne-63.2cc ekuqwalaseleni, p = 0.13. Kuphela izigulane ze-6 zizonke ezifunekayo zokumpontshelwa kwe-intra-operative. Kwakungekho nto yokufa kwabantu. Inkxalabo eqhelekileyo yokuqhawula isalathiso sasemaphandleni (kunye ne-3% yamatyala). Ukusebenza kwakhona kwenzeka kwi-11% yamatyala ngama-5 iminyaka, i-12% ngama-6 iminyaka, i-14% ngeminyaka eyi-7, kunye ne-15% ngeminyaka eyi-8 emva kokuhlinzwa. Amanani okuphinda asebenze ayengafani nakakhulu phakathi kwama-cohort. Amashumi asibhozo anesibhozo kwi-119 imisebenzi kwakhona yaphawula uhlobo lokuphinda lusebenze; malunga ne-85% yalezi (74 / 87) zifakwe kwiimpawu eziphindaphindiweyo kwinqanaba elifanayo. Ukufa omnye kwenzeka phakathi kweentsuku ze-90 emva kokuhlinzwa ngokuphathelele ukuhlinzwa kwentliziyo kwenye iziko; ukufa kwagwetywa ukuba akuhambelani kwaye kwaxelwa kwiBhodi yokuHlola yeziNtu kunye neBhodi kunye neNgcaciso yoLondolozo loKhuseleko.

U mnqamlezo

Ukungabambelelwanga kwintsebenzo yesicatshulwa kuthintela zombini iingalo zonyango: izigulane zakhetha ukulibaziseka okanye ukuncipha ukuhlinzwa kwiingalo zokugqithisa kwaye zawela ekuqhutyweni kwindlela engasebenziyo. (Umzobo we-1) Ulwahlulo oluninzi lwezigulana eziwela ngaphaya kokunakekelwa kokungabikho kokusebenza phakathi kwe-8 iminyaka yobhaliso kukuba babekhulile, baneemali eziphezulu, abanelisekanga ngaphantsi kweempawu zabo, mhlawumbi babe ne-disniation kwizinga eliphezulu, kunokwenzeka ukuba ubonise ukhetho olusisiseko lokunyamekela okungekho emsebenzini, ubuncinci bokubona ukuba iimpawu zabo ziba zibi nakwinqanaba, kwaye zineentlungu ezingaphantsi kunye nokukhubazeka (Itheyibhile 3). Izigulana eziwela ngaphaya koovulindlela ngaphakathi kwe-8 iminyaka zazinganelisekanga ngeempawu zabo kwisiseko; bekunokwenzeka ukuba baqonda ukuba bebenzima nakakhulu kwisiseko; kunokwenzeka ukuba ubonise ukhetho olusisiseko lokuhlinzwa; kwaye wayenomsebenzi obaluleke kakhulu owenziwe ngomzimba kunye nokukhubazeka okungakumbi.

Itheyibhile 3 Isitatimende esibalulekileyo sokuQinisekisa kunyango

Ithebula 3: Iziganeko ezibalulekileyo zokubambelela unyango phakathi kwezigulane ze-RCT.

Impembelelo Eyona Ngundoqo Yonyango

Injongo yokuThatha uhlalutyo Uhlalutyo lwenjongo yokuphathwa kweqela elingahleliweyo, onke amanyathelo kwi-8 iminyaka yokuhlinzwa okhethwayo kodwa kwakungekho nemiphumo ebalulekileyo yonyango kwiziphumo eziphambili zempembelelo (Itheyibhile 4 kunye ne-2 Figure). Kwimilinganiselo eninzi yokuphatha iinjongo phakathi kwamaqela amabini okhathalelo ngexesha (indawo-phantsi kwekhava), iziphumo ezizimbini ziphezulu kakhulu kunye nokuhlinzwa ngokucwangcisa ukufuna ukuphathwa (i-sciatica ephazamisayo (p = 0.005), ukwaneliseka (p = 0.013), kunye nophuculo oluzimeleyo (p = 0.013)) (Umfanekiso we-3) Ukuphuculwa kwenkcazo ye-sciatica ephazamisayo ibonakaliswe ngokubalulekayo ekuncedeni ukuhlinzwa ngokuthelekiswa kwexesha elide (nangona kungabalulekanga kwiminyaka eyi-6 kunye 7) (Itheyibhile 4).

Umzobo-I-2-Iziphumo eziPrayimari-kwi-Randomized-and-Observational-Cohorts

Umzobo 2: Iziphumo eziphambili (iSF-36 Ubuhlungu Bodily kunye neMisebenzi yePhysical, kunye ne-Index ye-Disability Disability Index) kuma-cohorts angabonakaliyo kunye nokuqwalasela ngexesha le-8 yeminyaka yokulandelelana.

Umzobo-I-3-Iziphumo eziPhezulu-kwi-Rand-based-Observational-Cohorts.

Umzobo 3: Iziphumo ezisesekondari (iSciatica Bothersomeness, Ukwaneliseka ngeZimpawu, kunye nokuziPhucula iNkqubo yoPhuculo loPhuculo loMhlaba) kwii-cohorts ezingabonakaliyo kunye nokuqwalasela ngexesha le-8 yeminyaka yokulandelelana.

Itheyibhile ye-4 Iziphumo eziPhambili zokuHlola kwi-1 kwi-8

Ithebula 4: Uhlalutyo lweprayimari lubangela iminyaka 1 kwi-8. Injongo yokuphulukisa iqela elingalindelekanga kunye nokuhlaziywa * ngokuhlalutya ngokunyangwa kwonyango olwenziwe ngolu hlobo oluhlangeneyo.

Uhlalutyo olwenziweyo Iziphumo zokunyanga ezihlengahlengisiweyo ezibonwe kulungelelwaniso kunye nokujonga ziyafana. Ngokuhambelana, ii-cohorts zidityanisiwe kuhlalutyo lokugqibela. Iziphumo zonyango kwiziphumo eziphambili kuhlalutyo oluhlangeneyo lokuphathwa njengonyango lwalunentsingiselo kwaye lubalulekile ukuya kwiminyaka eyi-8: SF-36 BP 10.9 p <0.001 (95% CI 7.7 to 14); I-SF-36 PF 10.6 p <0.001 (95% CI 7.7 ukuya kwi-13.5); I-ODI? 11.3 p <0.001 (95% CI? 13.6 kuye ku-9.1) (Itheyibhile 4). Umbhalo osemazantsi weTheyibhile 4 uchaza uhlengahlengiso lwee-covariates ezikhethelwe imodeli yokugqibela.

Iziphumo ezivela kwiinjongo zokuphatha kunye nokuphathwa ngokucatshulwa kwala ma-cohorts zifaniswa kuMzekeliso 2. Kuhlalutyo oludibeneyo, imiphumo yonyango yayibonakaliswe ngokubalulekayo ekuthandweni kwazo zonke izicwangciso zephondo eziphambili kunye nesekondari (ngaphandle kwemeko yomsebenzi engazange ihluke phakathi kwamaqela enyango) ngexesha ngalinye (Itheyibhile 4 kunye ne-3).

Ukulahlekelwa-Ukulandelwa

Kwi-8-year-follow-up, i-63% yabhalisi bokuqala abanikezelwe ngedatha, ngokulahlekelwa ngenxa yokulahla, ukutyelelwa okungekho, okanye ukufa. Itheyibhile 5 isishwankathela impawu ezisisiseko zalabo abalahlekelwe ukulandelelana ngokumalunga nezo zigcinwe kwisifundo kwi-8-iminyaka. Abo bahlala kwisifundo kwi-8 iminyaka babesele badala; kunokwenzeka ukuba ngumfazi, umhlophe, ufundiswe kwiikholeji, kwaye usebenze kwisiseko; kuncinci ukukhubazeka, ukufumana umvuzo okanye ukutshaya; uphawu olungaphantsi kwesiseko kunye nosizi olungaphantsi komzimba, umsebenzi osebenza kakuhle, ukukhubazeka okuphantsi kwe-ODI, impilo engcono yengqondo, kunye ne-sciatica encinci. Ezi ntlukwano zincinci kodwa zibalulekileyo. Itheyibhile 6 isishwankathela iziphumo zexeshana ngexesha leminyaka yokuqala ye-2 kulabo bagcinwa kwisifundo kwi-8 iminyaka xa kuthelekiswa nezo zilahlekile ukulandelelana. Abo balahlekelwe ukulandelelana babe nemiphumo emibi ngokwemyinge; nangona kunjalo le nto yayiyinyaniso kumaqela atyunjiweyo kunye angabandakanyekanga kunye neengxaki ezingekho ngundoqo kwimiphumo yonyango. Iziphumo zexesha elide ngoko ke zinokwenzeka ukuba zithembeke ngokwemilinganiselo kumabini omabini, kodwa ukuthelekiswa phakathi kweziphumo zokugonywa kunye nokungabikho komsebenzi kubonakala kungenakucala ngaphandle kokulahleka kwexesha elide ukulandelwa.

Itheyibhile ye-5 Izigulane zoLuntu lweeNkcukacha zoLuntu, iMirbidities kunye neMeko yeNqanaba leMpilo

Ithebula 5: Iimpawu zokubala zabantu abathintekayo, izigulane, kunye nemilinganiselo yezinga lempilo ngokubhekiselele kwisimo sokulandelelana kwesigulane njenge-02 / 01 / 2013 xa idatha ye-IDH8yr ifakwe.

Itheyibhile ye6 Ixesha elixinekile Umyinge weempatho zonyango

Ithebula 6: I-average average average treatment of effects in the year 2 (AUC) kwii-cohorts eziphathekayo eziphathekayo ezinokulandelelana ezihlangeneyo zidibanise uhlalutyo lweziphumo eziphambili, ngokutsho kwonyango olwamkelweyo kunye nesimo sokulandelwa kwesigulane.

ingxoxo

Kwi zi gulane ezine disc disc Ukuqinisekiswa ngumbono kunye neempawu zomlenze eziqhubekayo ubuncinane ubuncinane kwiiveki ze-6, unyango lwaluphezulu kunonyango olungasebenziyo ekunciphiseni iimpawu kunye nokuphucula umsebenzi. Kuhlalutyo oluphathwa ngolu hlobo, unyango lwonyango lotyando lwabonwa nje ngeeveki ze-6, zabonakala zifikelele kwii-6 ngeenyanga kwaye zaqhubeka zingaphezu kwe-8 iminyaka; Kuphawuleka ukuba iqela elingasebenziyo liye laphucula kakhulu kwaye ukuphuculwa kwaqhubeka nokunciphisa ukuphulwa kwemiphumela kwiqela (ukusebenza kunye nokungasebenzi) phakathi kwe-4 kunye ne-8 iminyaka. Uhlalutyo lwengqondo olude lwexesha, zonke iziphumo zabonisa inzuzo encinci yokuhlinzwa, kodwa kuphela iziphumo zesibini ze-sciatica eziphazamisayo, ukwanelisa iimpawu kunye nokuphuculwa kwezinto ezizimeleyo zazibalo. Inzuzo encinane yokuqhubekayo kwiqela lotyando emva kwexesha liye lenza intlaniso-jikelele yokuphatha iinjongo zibaluleke kakhulu ngexesha elide nangona amanqanaba aphezulu okuwela. Imiphumo emikhulu ebonwe kuhlalutyo oluqhutywe ngolu hlobo emva kokuba utshintsho lweempawu zezigulane ze-crossover zibonisa ukuba uhlalutyo lokufuna ukunyanga luyakunciphisa umphumo wokwenyuka kokuhlinzwa ngenxa yokuba ukuxuba unyango ngenxa ye-crossover kulindeleke ukuba kuhlaziywe Ukungafihli ukulandelelaniswa phakathi kwezigulane ezona zibi nakwizinga elisezantsi kwaye iziphumo ezigqithisileyo zisesigxina mhlawumbi zikhokelela kwiziphumo ezide ziqikelelwa kwixesha elide ekugqibeleni kunye nokungabikho amaqela asebenzayo kodwa iingqikelela ezingenakulungelelaniswa kweziphumo zonyango.

Ukuthelekisa kwezinye iZifundo

Azikho ezinye izifundo zexesha elide ezingacwangciswanga ezibika imilinganiselo yeziphumo eziphambili njenge-SPORT. Iziphumo zeziphumo eziphambili ze-SPORT kwiminyaka eyi-2 zifana kakhulu nezo ze-Peul et al kodwa ukulandelela ixesha elide kwisifundo se-Peul kuyimfuneko yokuthelekisa ngakumbi. IMIDLALO phakathi kwamaqela onyango yahlala ingatshintshi phakathi kwe-4,20 kunye ne-1 iminyaka yokulandela. Enye yezinto ezikulo mahluko inokuba buvelwano lwemilinganiselo yesiphumo � umzekelo, i-sciatica bothersomeness, eyahluke kakhulu kwiminyaka eyi-8 ngenjongo yokunyanga, ingaba ngumqondiso obuthathaka ngakumbi wokuphumelela kwonyango kunokuba ngokubanzi. umlinganiselo wesiphumo osetyenziswa ngu Weber et al. [8]

Iziphumo zexesha elide ze-SPORT ziyafana neMaine Lumbar Spine Study (MLSS). [21] I-MLSS inike ingxelo yokuphuculwa kweenkcukacha-manani kakhulu kwiminyaka eli-10 kwi-sciatica ephazamisayo kwiqela lotyando (? 11.9) xa kuthelekiswa namaqela angenzelelo (? 5.8) enefuthe lonyango? 6.1 p = 0.004; kwi-SPORT ukuphuculwa kwe-sciatica ephazamisayo kwiqela lokuhlinzwa kwiminyaka eyi-8 yayifana nesiphumo seminyaka eli-10 kwi-MLSS (? 11) nangona iqela elingasebenziyo kwi-SPORT lenze ngcono kunabalingane babo be-MLSS (? 9.1) nangona kunjalo IMIDLALO, ngelixa incinci, ihlala ibalulekile ngokweenkcukacha manani (? 1.5; p <0.001) ngenxa yesayizi enkulu kakhulu yesampulu. Uphuculo olukhulu kwii-cohorts ezingasebenziyo phakathi kwe-SPORT kunye ne-MLSS zinokunxulumana nokwahluka kunyango olungasebenziyo ekuhambeni kwexesha, iyantlukwano phakathi kwamaqela amabini ukusukela kwi-MLSS kwaye ayifuni mfanekiso-ngqondweni we-IDH.

Ngaphezulu kweminyaka ye-8 kwakukho ubungqina obuncinane bokulimala ukusuka kwonyango. Ireyithi ye-8 yonyaka yokuvuselela kwakhona yayiyi-14.7%, ephantsi kwe-25% ebikwe yi-MLSS kwiminyaka ye-10. [22]

Imida

Nangona iziphumo zethu zilungelelaniswa kwiimpawu zokuwela phezu kwezigulane kunye nolawulo lwe-covariates ebalulekileyo yesiseko, uhlalutyo olubonakalisiweyo olubonakalisiweyo alubelani ngokhuseleko oluluqilima ekudidekeni olukhoyo kuhlalutyo lwenjongo yokunyanga.[4�6] Nangona kunjalo, Nangona kunjalo, uhlalutyo lweenjongo zokunyanga luyaziwa ngokuba lucalucalulo phambi kokungahambelani kwinqanaba elibonwe kwi-SPORT, kwaye uhlalutyo lwethu oluhlengahlengisiweyo njengoko luhlalutyelwe lubonakaliswe ukuvelisa iziphumo ezichanekileyo phantsi kweengcinga ezifanelekileyo malunga nokuxhomekeka kokuthotyelwa kweziphumo zexesha elide. .[23] Olunye uthintelo olunokubakho luyi-heterogeneity, yongenelelo lonyango olungasebenzisiyo, njengoko kuxoxwe ngalo kumaphepha ethu angaphambili. idatha kwiminyaka eyi-5,6,8 kunye nelahleko ngenxa yokuyeka, ukutyelelwa, okanye ukufa; ngokusekelwe kuhlalutyo olusisiseko kunye nolandelelwano lwexeshana elifutshane, oku kunokukhokelela kwiziphumo eziqikelelweyo zexesha elide eziqikelelweyo zexesha elide kuwo omabini amaqela onyango kodwa uqikelelo olungakhethi cala lonyango lotyando.

izigqibo

Ukuhlalutya kwenjongo yokwenza unyango, ezincinci, izibalo ezingabalulekanga zonyango zonyango ziye zabonwa kwiziphumo eziphambili kodwa iziphumo ezinokubaluleka kwe-sciatica eziphazamisayo, ukwanelisa iimpawu kunye nokuphuculwa kwezinto ezizimeleyo kuboniswe kwiminyaka eyi-8 nangona amazinga aphezulu enyango ukuwela. Uhlalutyo oluphathiswe ngolu hlobo oludibanisa i-cohorts engabonakaliyo kunye neyokuqwalasela, elawulwa ngokucophelela ukuze kuphazamise izinto ezisemgangathweni, ibonise ukuphucula okukhulu kwintlungu, umsebenzi, ukwaneliseka kunye nenkqubela yokuzimelela kwiminyaka ye-8 xa kuthelekiswa nezigulane eziphathwa ngokungasebenzi. Nangona kunjalo, iqela elingasebenziyo, nangona kunjalo, libonise uphuculo olungaphezulu kwexesha, kunye ne-54% yokunika ingxelo ngokwaneliso zabo kunye ne-73% yanelisekile ngonakekelo lwabo emva kweminyaka eyi-8.

Imibulelo

Iziko leSizwe leArthritis kunye neMusculoskeletal and Skin Diseases (U01-AR45444; P60-AR062799) kunye neOfisi yoPhando ngeMpilo yabaseTyhini, amaZiko eSizwe ezeMpilo, kunye neZiko leSizwe loKhuseleko lweMisebenzi kunye neMpilo, amaZiko eSifo. Iimali zegranti yoLawulo noThintelo zafunyanwa ukuxhasa lo msebenzi. Imisebenzi efanelekileyo yezemali ngaphandle komsebenzi ongenisiweyo: iingcebiso, izibonelelo, amasheya.

Olu pho nonongo luye lwaziswa kwiBrieanna Weinstein noHarry Herkowitz, iinkokheli ngamalungelo abo, ezenza umhlaba ube yindawo engcono.

Imihlathi

Ezinye izidakamizwa zibandakanya: i-stroke, isifo sikashukela, i-osteoporosis, umhlaza, i-fibromyalgia, i-CTS, i-PTSD, utywala, ukuxhomekeka kweziyobisi, intliziyo, imiphunga, isibindi, iinjongo, isitya segazi, isimiso se-nervous, i-blood pressure, i-migraine, ixhala, isisu, isisu

Ekugqibeleni, abantu abachaphazelekayo ngenxa yeentlungu zamagraine bafuna uhlobo olunyangekileyo lwenyango ukuze bancedise ukuphucula kunye nokulawula iimpawu zabo, ingakumbi ukuba i-migraines yabo ifunyenwe kwi-disc ye-lniar herniated disc. Injongo yamanqaku alandelayo kwakufuneka ukudibanisa le mibini miba kunye kunye nokubonisa iziphumo zophando apha ngasentla. Iinketho ezahlukeneyo zonyango zinokuqwalaselwa ngaphambi kokuba utyunjelwe intlungu ye-migraine kunye nokuphathwa kwe-disniated disc. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Intlungu Yentambo

Intlungu yesikhumba isishalazo esiqhelekileyo esinokubangelwa ngenxa yeemeko ezahlukeneyo kunye / okanye iimeko. Ngokwezibalo, ukulimala kwengozi yemoto kunye nokulimala kwe-whiplash zizinye zezona zinto zixhaphake iintlungu phakathi kwabantu bonke. Ngethuba lengozi yengozi, igalelo elizenzekelayo elivela kweso siganeko kunokubangela ukuba intloko nentamo iqhume ngokukhawuleza emva kwanoma iyiphi na indlela, eyonakalise izakhiwo eziyinkimbinkimbi ezungeze umgudu wesibeleko. Ixinzelelo kumathambo kunye nemigqa, kunye neyezinye izicubu entanyeni, kunokubangela iintlungu zentamo kunye nokubonakalisa imiqondiso emzimbeni womntu.

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

ISIHLOKO ESIBALULEKILEYO: I-EXTRA EXTRA: Ungcono!

EZINYE IINGCUKACHA EZIBALULEKILEYO: UKWENZISA: Ukulimala kwezemidlalo? | Vincent Garcia | Umonde | El Paso, TX I-Chiropractor

Ngenanto

Ucaphulo

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Vala i-Accordion

Imithi ye-Migraine kunye neCervic Herniation Treatment e-El Paso, TX

by iicrosoft | Disc Disc, Migraine, Ukubuyiswa komzimba, Uvavanyo oluLungeleleneyo oluLungisiweyo, Unyango

Migraine yimeko ebuthathakayo ebonakaliswe yintloko yeentlobo ezihlukeneyo, ezihlala zihamba kunye neentlanzi kunye nobuzwe bokukhanya kunye nesandi. Nangona abaphandi banamhlanje bengayiqondi isizathu esiyiyo esi siyizifo eziphambili zentloko, oogqirha abaninzi bezempilo bayakholelwa ukuba ukungahambi kakuhle komgudu wesibeleko kungakhokelela ekufuduleni. Nangona kunjalo, uphando olutsha olusisiseko-uphando luye lwafumanisa ukuba ukukhutshwa kwetranshini ye-cervical, umba wezempilo ochaphazelekayo kunye ne-disvertebral diss yesigxina esingaphezulu, kunokubangela intlungu yentloko. Injongo yale nqaku ilandelayo kukufundisa izigulane nokubanceda baqonde umthombo weempawu zabo kunye nokubonakalisa iintlobo ezininzi zonyango olusebenzayo kwi-migraine kunye ne-disc.

IiNyango zoLondolozo lweeNtsholongwane eziPhezulu eziSisigxina: UkuHlola okuSingqinisiso lweeLingo eziLawuliweyo ezingapheliyo

Abstract

Oku kulwazi lwethu uphononongo lokuqala olucwangcisiweyo malunga nokusebenza konyango lwe-manual izilingo zeklinikhi (RCT) kwiintloko ezingapheliyo. Uphando olubanzi lweencwadi zesiNgesi kwi-CINHAL, Cochrane, Medline, Ovid kunye nePubMed ezichongiweyo ze-6 RCTs zonke eziphanda intloko engapheliyo ye-tension-type (CTTH). Olunye uphononongo lusebenzise unyango lwe-massage kunye nezifundo ezihlanu zisebenzisa iphysiotherapy. Izifundo ezine zathathwa njengomgangatho olungileyo wemethodi kwisikali se-PEDro. Zonke izifundo zaziyi-pragmatic okanye zingasetyenziswanga unyango njengeqela lokulawula, kwaye izifundo ezimbini kuphela zigweme ukungenelela ngokubambisana, oku kunokukhokelela ekuthandeni okunokwenzeka kwaye kwenza ukuchazwa kweziphumo kube nzima ngakumbi. Ii-RCTs zibonisa ukuba i-massage kunye ne-physiotherapy zikhetho zonyango olusebenzayo kulawulo lwe-CTTH. Enye ye-RCTs ibonise ukuba i-physiotherapy iyanciphisa ukuphindaphinda kwentloko kunye nokuqina kwezibalo ezibaluleke ngakumbi kunokunyamekela okuqhelekileyo ngugqirha jikelele. Ukusebenza kwe-physiotherapy emva kokunyanga kunye nokulandelwa kweenyanga ze-6 kufana nokusebenza kwe-tricyclic antidepressants. Ubungakanani bempembelelo ye-physiotherapy yaya kuthi ga kwi-0.62. I-RCTs yonyango lwexesha elizayo iyacelwa ukuba ijongane nokusebenza kakuhle kwi-migraine engapheliyo kunye nangaphandle kokusetyenziswa kakubi kweyeza. Ii-RCT zexesha elizayo malunga nentloko kufuneka zihambelane nezikhokelo ze-International Headache Society's izilingo zeklinikhi, oko kukuthi i-frequency njenge-primary end-point, ngelixa ubude kunye nokuqina kufuneka kube yindawo yokugqibela, ukuphepha ukungenelela ngokubambisana, kubandakanya ubungakanani besampulu eyaneleyo kunye nokulandelwa. ixesha ubuncinane iinyanga ezi-6.

Internet: Izilingo zonyango ezingapheliyo, i-headache ephambili ye-Primary, i-Manual guitar, i-massage, i-Physiotherapy, i-Chiropractic

intshayelelo

Iintloko eziphambili ezingapheliyo, oko kukuthi okungapheliyo kwe-migraine (i-CM), iintloko ezingapheliyo zentloko (i-CTTH) kunye neentloko ezingapheliyo zentloko zineendleko ezibonakalayo kwezempilo, ezoqoqosho nezentlalo. Malunga ne-3% yabemi ngokubanzi banesifo esinganyangekiyo kwintloko yabasetyhini [1]. Ukwahlula-hlula kwaMazwe ngaMazwe kweengxaki zeNtloko ye-III? (ICDH-III?) Ichaza i-CM njenge-15 yeentsuku zentloko / inyanga ubuncinci iinyanga ze-3 ezineempawu ze-migraine kwi? Iintsuku ze-8 / inyanga, i-CTTH ichazwa ngokomndilili? Iintsuku ze-15 / inyanga ene-tension-type headache ubuncinci Iinyanga ezi-3, kunye nentloko engapheliyo yeentloko njengokuhlaselwa ubuncinci yonke imihla ngaphezulu konyaka omnye ngaphandle kokuxolelwa, okanye uxolelo oluhlala ixesha elide <inyanga enye [1].

Ngokumalunga ne-80% bathetha nodokotela wabo oyintloko kwi-headache engapheliyo ye-head [3], kwaye ulawulo lwe-pharmacological luqwalaselwa kuqala kumgca wonyango. Nangona kunjalo, umngcipheko kukuba kungabangela ukusetyenziswa ngokugqithiseleyo kwemithi yamakhanda entloko ngenxa yokuhlaselwa kwentloko. I-47% yalabo abanesifo esiyintloko esisifo esingapheliyo kwintsholongwane yabantu baseNorway basebenzise imithi yamakhanda entloko [1,4]. Ukuqwalasela ukusetyenziswa kakubi kweyeza ezinzima, zombini imithi yeprophylactic kunye nolawulo olungezo-pharmacological kufuneka ke lucatshangelwe kulawulo [5,6]. Iyeza zeprolactic zisetyenziswe kuphela yi-3% kubantu baseNorway ngokubanzi, ngelixa i-52% iye yazama u-physiotherapy kwaye i-28% iye yazama unyango lwe-chiropractic unyango olusisigxina [3]. Ulawulo olungekho phantsi kwe-pharmology luye lwaba luncedo lweziganeko ezimbalwa eziqhelekileyo eziqhelekileyo eziqhelekileyo eziqhelekileyo kwaye akukho mveliso yezolimo / i-7].

Ukuphononongwa okucwangcisiweyo kwangaphambili kugxile kwii-RCT ze-headache-type headache, i-migraine kunye / okanye i-headervogenic headache, kodwa kungekhona ekusebenzeni kakuhle kwintloko yesifo esiyintloko (5,6,8-11]. Ulwaphulo lwencwadi luyonyango olwenziwe ngamaziko e-physiotherapists, i-chiropractors, i-osteopath kunye nezinye iingcali zokunyanga iintlungu kunye nokukhubazeka, kwaye kubandakanya unyango lwe-massage, ukuhlanganiswa kunye kunye nokuphathwa [12].

Oku kulwazi lwethu lokuqala lokuhlaziywa olufanelekileyo lokuvavanya ukuphumelela kwezixhobo zonyango ezilawulwa ngandlela-thile (RCT) ze-headaches ezingapheliyo zintsholongwane usebenzisa ubuhlungu bentloko njengesiphelo sokugqibela kunye nobude bentloko kunye nobukhulu njengamaphuzu okugqibela.

Review

tindlela

Uphando loncwadi lwesiNgesi lwenziwa kwi-CINHAL, Cochrane, Medline, Ovid kunye nePubMed. Phendla amagama aye; i-migraine, i-migraine engapheliyo, i-headache-type-headache, intloko engapheliyo yohlobo lwe-tension, intloko ye-cluster, intloko ye-cluster engapheliyo kunye namagama; unyango lwe-massage, i-physiotherapy, i-spinal mobilization, unyango lwe-manipulative, unyango lwe-spinal manipulative, unyango lwe-osteopathic okanye i-chiropractic. Sichonge izifundo ngophando olubanzi lwekhompyuter. Uphononongo olufanelekileyo luhlolwe kwii-RCT ezongezelelweyo ezifanelekileyo. Ukukhethwa kwamanqaku kwenziwa ngababhali. Zonke ii-RCT ezibhalwe ngesiNgesi zisebenzisa nayiphi na i-manual therapy ye-CM, i-CTTH kunye / okanye i-headache ye-cluster engapheliyo ihlolwe. Izifundo ezibandakanya iintlobo zentloko edibeneyo ngaphandle kweziphumo ezithile ze-CM, i-CTTH kunye / okanye i-headache ye-cluster engapheliyo yayingabandakanywa. Uphononongo lubandakanya i-RCTs yonyango lwe-manual ebonisa ubuncinane enye yeeparamitha ezisebenzayo ezilandelayo; Ukuphindaphinda kwentloko, ubude bexesha kunye nokuqina kweentlungu ze-CM, CTTH kunye / okanye intloko engapheliyo yentloko njengoko kucetyiswa yi-International Headache Society's izikhokelo zolingo lwezonyango [13,14]. I-frequency ye-headache iyindawo ephambili yokuphela, ngelixa ubude kunye nobukhulu bentlungu ziindawo zokugqibela zesibini. Ukuxilongwa kwentloko kwahlelwa ngokukhethiweyo ngokwemiqathango ye-ICHD-III? okanye amahlelo angaphambili [2,15-17]. Umgangatho we-methodological we-RCTs ezibandakanyiweyo zavavanywa kusetyenziswa isikali se-PEDro, iThebhile 1[18]. I-RCT yayithathwa njengomgangatho ophezulu ukuba inqaku le-PEDro laliyi-?6 yamanqaku aphezulu e-10. Umgangatho we-methodological we-RCTs uhlolwe yi-AC. Uluhlu lokutshekisha lwe-PRISMA 2009 lwenziwe kolu hlaziyo lucwangcisiweyo. Ubungakanani besiphumo bubalwe xa kunokwenzeka. Ubungakanani bempembelelo ye-0.2 ithathwa njengento encinci, i-0.5 njengephakathi kunye ne-0.8 enkulu [19].

Ithebula 1: Amanqaku ePEDro ewe okanye hayi izinto.

Ukuhlaziywa okucwangcisiweyo kwenziwa ngokukodwa ngokusekelwe kwii-RCT ezifumanekayo kwaye azibhaliswanga njengeprotocol.

iziphumo

Uphando lweencwadi lubhengeze ii-RCT ezi-6 ezidibene neenkqubo zethu zokubandakanya. Olunye uphando olwenziwe lusetyenziselwa unyango lwe-massage (MT) kunye nezifundo ezintlanu ezisetyenziselwa i-physiotherapy (PT) [20-25]. Zonke iingcaphephe zihlolwe i-CTTH, ngelixa kungekho zifundo zivavanya i-CM okanye i-headset cluster headache.

Umgangatho wendlela Itheyibhile 2 ibonisa ukuba amanqaku e-PEDro yee-RCT afakwe kwi-1 ukuya kwi-8. Ii-RCT ezine zacatshangwa ngekhwalithi efanelekileyo yeendlela, ngelixa ii-RCT ezimbini zineziphumo eziphantsi.

Itheyibhile 2 I-PEDro Score ye-RCT efakwe

Ithebula 2: Amanqaku e-PEDro yeendlela zokwenziwa kwezilingo ezilawulwa ngandlela-thile (RCTs).

Izilingo ezilawulwa ngokungapheliyo (RCT) Itheyibhile 3 ibonisa uluntu lwabafundi, ukungenelela kunye nokusebenza kweeRCT ezintandathu.

Iziphumo ze-3 Iziphumo zonyango lwe-RCT ye-CTTH

Ithebula 3: Iziphumo zonyango olusesikweni olulinganiselwe (RCTs) lwe-headset-type headache (CTTH).

Ukunyanga kwamayeza Ugqirha we-physiotherapist waseSpain wenza i-2-exhobile i-crossover RCT ngokuthelekisa ngokuthe ngcembe kunye nemilinganiselo yeziphumo ezingaboniyo [20]. Uphononongo lubandakanya abathathi-nxaxheba abane-CTTH abafunyaniswe ngugqirha wemithambo-luvo. Iikhrayitheriya ze-ICHD-II ze-CTTH zatshintshiwe kancinane, okt ubunzima beentlungu buchazwe njenge-5 kwinqanaba le-0-10 yamanani okulinganisa iintlungu, kunye neempawu ezihamba kunye ne-photophobia, i-phonophobia okanye isicaphucaphu esingemninzi zazingavunyelwe [16]. Iindawo zokugqibela kunye nezesekondari azichazwanga. Iziphumo zibonisiwe kwiTheyibhile 3.

Physiotherapy I-RCT yaseMelika eyi-3 exhobileyo yayinemilinganiselo yesiphumo esingasimfamekiyo [21]. Iikhrayitheriya zokuxilonga zaziyi-25 iintsuku zentloko / inyanga> iinyanga ze-6 ngaphandle kweempawu ezinxulumene ne-nausea, ukuhlanza, i-photo- kunye ne-phonophobia, kodwa kunye nezihlunu zethenda, oko kukuthi i-CTTH ene-periranial tenderness. Abathathi-nxaxheba abaneentloko ze-cervicogenic okanye iziphumo ze-neurological zazingabandakanywa. Amanqaku okugqibela aphambili kunye nesekondari awazange achazwe kwangaphambili, kodwa isalathisi sentloko, esichazwe apha njengesiqhelo sentloko � ubukhali, yayiyi-end-point evandlakanyo.

Uphononongo lwaseTurkey luqhube i-RCT exhobileyo ye-2 kunye nemilinganiselo yeziphumo ezingabonakaliyo [22]. Abathathi-nxaxheba bafunyaniswa ukuba bane-CTTH ngokwe-ICHD-I [15]. Abathathi-nxaxheba abaneentloko ezixubileyo, i-neurological and systemic aliment, okanye abathathi-nxaxheba abaye bafumana i-physiotherapy kwiinyanga ze-6 ngaphambi kokuba isifundo sifakwe ngaphandle. Amanqaku okugqibela aphambili yayiyisalathisi sentloko esichazwa njengesiqhelo � ubungqongqo.

Isifundo saseDenmark siqhube i-2-exhobile i-RCT eneziphumo ezingaboniyo [23]. Abathathi-nxaxheba bafumanisa ukuba i-CTTH yi-neurologist ngokwemiqathango ye-ICHD-I [15]. Abathathi-nxaxheba ngezinye iintloko eziphambili, i-neuralgia, i-neurological, i-systemic okanye i-psychiatric ukuphazamiseka okanye ukusetyenziswa gwenxa kweyeza kuchazwe njenge> 100 iipilisi ze-analgesic okanye> iidosi ezi-2 zeetriptans kunye neergotamine ngenyanga azifakwanga. Indawo yokuphela ephambili yayihamba rhoqo entloko, kwaye amanqaku okuphela kwesibini yayilixesha lokuqaqanjelwa yintloko kunye namandla. Iziphumo eziboniswe kwiTheyibhile 3 azikhange ziphenjelelwe kukuthamba kwemisipha ye-pericranial.

Uphando lwe-Dutch lwenza i-2-enezixhobo ezixhobileyo, i-RCT eninzi kunye nemilinganiselo yempembelelo eyimpumputhe [24]. Abathathi-nxaxheba bafumene i-CTTH ngugqirha ngokwe-ICHD-I [15]. Abathathi-nxaxheba abaneentlobo ezininzi zeentloko okanye abo bafumene i-physiotherapy kwiinyanga ezidlulileyo ze-6 babengabandakanywa. Amaphuzu okuphela kweprayimari ayimvama yeentloko ngelixa ubude kunye nobukhulu bezinto eziphambili.

Ucwaningo lwe-2nd lwesiDatshi luqhube i-2-enezixhobo ezizixhobileyo ze-RCT, i-RCT eninzi kunye neendawo zokugqibela ezizimeleyo kunye nezesekondari, oko kukuthi i-headache frequency, ubude kunye nobukhulu [25]. Abathathi-nxaxheba bafumaniswe ngugqirha ngokwemiqathango ye-ICHD-II [16]. Abathathi-nxaxheba abane-arthritis ye-rheumatoid, isifo esicatshulwayo, ukukhulelwa, abangathethi isiDatshi, abo bafumene i-physiotherapy kwiinyanga ezidlulileyo ze-2, i-triptan, i-ergotamine okanye i-opiods abasebenzisi abangekho ngaphandle.

ingxoxo

Uhlolo lokuhlalutyo olukhoyo lwenkqubo oluhlola ukuphumelela kwonyango olusesikweni kwii-RCT zezintloko zintsholongwane ezingapheliyo zikhetha kuphela i-RCT ephathwa nge-CTTH. Ngaloo ndlela, ukuphumelela kweCM kunye nesifo sentloko esingaqhelekanga asiyi kuhlolwa kule ngxelo.

Iingqinisiso zendlela Umgangatho wendlela yezifundo ezivavanya unyango olusebenzayo lokuphazamiseka kwentloko zihlala zigxekwa ngokuba ziphantsi kakhulu. Ngamaxesha athile kufanelekile, kodwa uhlala esenza uyilo lwendlela kuthintela izifundo zonyango zonyango ukuba zingafikeleli kumgangatho wegolide kwii-RCTs zeekhemesti. Umzekelo, unyango lwe-placebo kunzima ukuseka ngelixa umphandi engenakumfanyekiswa ngongenelelo olwenziweyo. Amanqaku aphakathi kwezifundo ezibandakanyiweyo yayingama-5.8 (SD 2.6) amanqaku kunye nezifundo ezine ezazithathwa njengomgangatho olungileyo. Zonke ii-RCTs ziye zasilela ukubandakanya ubungakanani besampula? 50 kwiqela elincinci. Ubungakanani besampulu eyoneleyo ngokubalwa kwamandla ngaphambili kubalulekile ukuthintela iimpazamo zohlobo 2. Izifundo ezithathu azikhange zichaze indawo zokugqibela nezisekondari, eziphazamisa ukubala kobungakanani, kunye nomngcipheko wohlobo lwe-2 iimpazamo ezivela kumanyathelo amaninzi [20-22]. Ukuqhuba unyango lwe-RCT yesandla ixesha kunye neendleko ezichithayo, ngelixa ukumfamekisa kuhlala kunzima njengoko kungekho nyango lunye luqinisekisiweyo olunokusetyenziswa njengeqela lolawulo ukuza kuthi ga ngoku. Ke ngoko, zonke izifundo ezibandakanyiweyo zazingumqobo okanye zingasebenzisi nyango njengeqela lolawulo.

Ngaphandle kwabathathi-nxaxheba kwisifundo esiphenduleyo [21], bonke abathathi-nxaxheba bafunyaniswa ngugqirha okanye kwi-neurologist. Udliwano-ndlebe ngongxowankulu ngumgangatho wegolide, ngelixa uphando lwemibuzo kunye neendlebe zabavuni bezonxibelelwano zixhobo ezichanekileyo zokuxilonga malunga nokuphazamiseka kwengqondo [26].

Ulungelelwano lwentsebenziswano lwalugcinwe kuphela kwizifundo ezimbini [22,20]. Izifundo ezimbini zenze uhlalutyo lwenjongo yokunyanga okucetyiswayo ukukhusela kwimilinganiselo engapheliyo kunye nokugcina ukulinganiswa kokuqala (24,25,27].

iziphumo Ukuqhutyelwa kwe-massage yophando kwakubandakanye abathathi-nxaxheba be-11 kuphela, kodwa iqela le-massage liye linciphisa kakhulu ubuhlungu beentloko kuneqela elincinci le-ultrasound [20].

I-54%, i-82% kunye ne-85% yabathathi-nxaxheba kwii-RCT ezintathu ze-physiotherapy zine-50% yokunciphisa i-? -phezulu [23]. Oku kuthelekiswa ne-25-6% yabathathi-nxaxheba abaneempembelelo ezifanayo usebenzisa i-tricyclic antidepressants [24,25]. Isiphumo se-tricyclic sibonakala siphucula ngokuhamba kwexesha, okt emva kweenyanga ezingaphezu kwe-40 zonyango [70]. Nangona kunjalo, i-tricyclic antidepressants inoluhlu lweziphumo ebezingalindelekanga ngokuchasene nephysiotherapy, ngelixa unyango lwezandla lufuna ukubonisana ngakumbi. Izifundo ezibini zivavanye isalathisi sentloko esichazwa njengentloko ephindaphindiweyo � ukuqina [28,29]. Zomibini izifundo zibonise ukuphuculwa okukhulu emva kokunyanga kunye nenyanga ye-6 kunye neenyanga ze-29 ngokulandelanayo.

Iziphumo ezine ze-10.1 zithetha iminyaka elineentloko, ngaloo ndlela, isiphumo esicatshulwayo sinokubangelwa yimpembelelo yonyango kunokuba uphucule ngokukhawuleza okanye ukunyanzeliswa kwintetho [21-23,25].

Amachiza aphezulu entloko aqhelekileyo asetyenziswa kwiintsholongwane eziphambili, kwaye ukuba i-headache iphindwe kaninzi, kunomngcipheko okwandisiweyo weyeza unyango olubi kakhulu. Ukusetyenziswa ngokunyanga kwamayeza enkqubo yeprophylactic kuye kwacetyiswa ekulawuleni izikhwebu eziphambili ezingapheliyo [3]. Ekubeni imilathiso yonyango ibonakala ibe nenzuzo efana neempembelelo zamachiza e-prophylactic [28,29], ngaphandle kwemiphumo yecandelo lezonyango, imirhumo yonyango kufuneka iqwalaselwe kwinqanaba elilinganayo njengezicwangciso zolawulo lwe-pharmacy.

Ubungakanani besiphumo bunokubalwa kwii-RCT ezintathu kwezintandathu. Ubungakanani bempembelelo kwi-headache frequency ukuya kwi-0.62, ngelixa yayingaphantsi malunga nobude kunye nokuqina, ngelixa i-headache index (i-frequency � intensity) ifikelele kwi-0.37 (iThebhile 3). Ngaloo ndlela, ubungakanani obuncinci ukuya kobuphakathi bunokuthi bube bukhulu kumntu ngamnye, ngokukodwa ngokuqwalasela ukuba phantse yonke imihla intloko ithetha ukuba iintsuku ze-12 / 14 zincitshisiwe ukuba zithetha iintsuku ze-3 / 14 [25], ezilingana ne-75% yokunciphisa ukuphindaphinda kwentloko. Ngokuqhelekileyo ukunciphisa i-50% ngokuqhelekileyo kusetyenziswa kwiintlungu zentlungu, kodwa ngokuqwalasela ukuba i-CTTH inzima ukuyiphatha, abanye abaphandi basebenza nge-?30% yokuphucula i-primary efficacy parameter xa kuthelekiswa ne-placebo [30].

Imida Uphononongo lwangoku lunokuba luncedo. Omnye wabo ukhangelelwano lwentengiso njengoko abalobi abazange bazame ukufumanisa i-RCT engashicilelwa. Nangona senza uphando olunzulu, siyavuma ukuba kungenzeka ukuphosa enye i-RCT okanye embalwa, ngakumbi i-RCT engesiNgesi.

isiphelo

Ukunyangwa kwonyango kunendlela efanelekileyo ekulawuleni i-CTTH elingana namayeza eprophylactic ne-tricyclic anti-depressant. Okwangoku akukho zifundo zonyango olusesikweni isifo esingenasiphelo semigraine okanye isigxina esingasigxina. Iingcebiso zonyango zexesha elizayo I-RCT kwi-primary headache isifo esifanelekileyo kufuneka ihambisane nesinconywa soMbutho weNtloko weSizwe, oko kukuthi ekupheleni kokuphela kwintloko yesiseko kunye neendawo zokugqibela eziphambili zixesha kunye nobukhulu. Izifundo zonyango lwexesha elizayo kwi-CM kunye nangaphandle kokusetyenziswa kakubi kweyeza kunyanzeliswa, ekubeni iingcali ezinjalo azikho namhlanje.

Ukugqithisa inzala

Ababhali bavakalisa ukuba abanalo inxaxheba.

Igalelo lababhali

I-AC ilungiselele uxwebhu oluqulunqiweyo kwaye yenza uvavanyo lwendlela yokufunda. I-MBR inengcamango yokuqala yocwaningo, icebo loyilo lonke kwaye luhlaziyiweyo umbhalo wesandla. Bobabini abalobi baye bafunda baze bavunywa umbhalo wesigqi wokugqibela.

Ababhali� Ulwazi

U-Aleksander Chaibi yi-BPT, uMChiro, umfundi we-PhD kunye noMichael Bj'rn Russell ngunjingalwazi, MD, PhD, DrMedSci.

Imibulelo

Isibhedlele sase-Akershus University, eNorway, ngokuqinisekileyo sinikezela ngezixhobo zophando.

Inkxaso: Olu phofu lufumene inkxaso-mali evela ku-Extrastiftelsen, iNorway Chiropractic Association eNorway naseYunivesithi yase-Oslo.

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Ukukhulelwa kwetambo lomlomo wesibeleko kuyinto eqhelekileyo eyenzekayo xa i-disc intervertebral entanyeni, okanye umlenze wesibeleko, iphuka kunye ne-gel-like center iphuma emgodini womgudu, yongeza uxinzelelo kwiingcambu zomlenze. Iidiski ze-cervical herniated zingabangela iimpawu zentlungu, ukuxinwa kunye nobuthathaka entanyeni, emagxeni, esifubeni, kwizandla nangezandla kwakunye nokubonakalisa imiqondiso kwimida ephantsi. I-Migraine nayo ingabonakalisa iimpawu ezinxulumene nee-diski ze-herniated entanyeni. Njengoko sikhulile, i-intervertebral discs ngokwemvelo iqala ukuhlakala, ibenze ibe yingozi yokulimala okanye ukulimala. Izizathu eziqhelekileyo zokukhutshwa kwetayitila yomlomo ziquka ukunxiba kunye nokukhawuleza, ukunyakaza okuphindaphindiweyo, ukuphakanyiswa okungafanelekanga, ukulimala, ukukhuluphala kunye nemfuza.

Ukulandelelana kwexesha elide leNkcazo yeCervical Intervertebral Herniation kwizigulane ezithatyathwa kunye neMicrothelo eDityanisiweyo kunye neNyango.

Abstract

imvelaphi

I-Symptomatic disvertebral disniation (IDH) ebonisa intlungu yentamo ehambisana neentlungu zengalo yintlungu eqhubekayo yokukhula kwayo, kwaye isisizathu esiqhelekileyo sokunakekelwa kwezilwanyana ezingasetyenziswayo usebenzisa i-CAM) eKorea. Nangona kunjalo, uphando kwixesha elide luchukumiseka.

tindlela

Izigulane ze-165 ezipheleleyo ze-IDH zentsholongwane zivunyelwe phakathi kweJanuwari 2011 kunye noSeptemba 2014 kwisibhedlele esinika unyango oluqhelekileyo kunye nolwaseKorea olubandakanya unyango kunye neCAM njengoko imodareyitha esemgangathweni yaboniswa kwisifundo sokuqwalasela. Izigulane zenziwa unyango lwe-CAM olulawulwa ngabagqirha bamayeza aseKorea (i-KMDs) ngokuhambelana nomgaqo-nkqubo olungiselelwe ukuhlala ixesha lokuhlala esibhedlele, kunye nolunye unyango oluqhelekileyo ngabagqirha bezonyango (MDS) njengoko kubhekiswe yi-KMD. Iziphumo zexeshana ezifutshane zihlolwe ukukhutshwa kunye nokulandelwa kwexesha elide zenziwa ngudliwano-ntanethi emva kokukhutshwa. Isilinganiselo semilinganiselo yamanani (NRS) yentamo kunye nentlungu yeengalo, ukutshatyalaliswa kwentamo yokukhubazeka (NDI), i-5-point point-patient impact of change (PGIC), kwaye izinto ezichaphazela ixabiso elide elide lokuneliseka kwi-PGIC zihlolwe.

iziphumo

Kwizigulane ezili-165 ezifumene unyango lwezigulana ezilaliswayo kwiintsuku ezingama-20.8? Umahluko kwi-NRS phakathi kokungeniswa kunye nokukhutshwa kwixesha elide lokulandela iqela (n? =? 11.2) ngu-117 (625.36% CI, 196.7, 117) ngenxa yentlungu yentamo, i-2.71 (95% CI, 2.33, 3.09) ngenxa yeentlungu zengalo. , kunye ne-NDI 2.33 (95% CI, 1.9, 2.77), kunye namanqaku ahambelanayo kwiqela elingeyona ixesha elide lokulandelelana (n? =?14.6) yi-95 (11.89% CI, 17.32, 48) ngenxa yentlungu yentamo , 2.83 (95% CI, 2.22, 3.45) ngenxa yeentlungu zengalo, kwaye i-NDI yayingu-2.48 (95% CI, 1.84, 3.12). Ukwahluka kwixesha elide le-NRS yeentlungu zentamo kunye neentlungu zengalo ukusuka kwisiseko yi-14.86 (95% CI, 10.41, 19.3), kunye ne-3.15 (95% CI, 2.67, 3.64), ngokulandelanayo. I-PGIC ixelwe ukuba �yanelisayo� okanye ingaphezulu kwi-2.64% yezigulane kulandelelo lwexesha elide.

izigqibo

Nangona ukujonga okwenziwa kwesi sifundo kusenza sikwazi ukugqiba isigqibo esiphezulu, ezi ziphumo zibonisa ukuba unyango oludibeneyo olujoliswe kwi-CAM kwi-IDH yesifo sengqondo sesifo somlomo luyakwazi ukufumana iziphumo ezilungileyo kwiintlungu kunye nokuphucula ukusebenza.

UkuBhaliswa koTyala

I-ClinicalTrials.gov Isazisi: I-NCT02257723. Ngo-Oktobha 2, 2014.

Internet: Ikhefu le-intervertebral disnibral, iyeza elongezelelweyo kunye nelinye, unyango oluhlanganyelweyo, unyango olulwelwe unyango

imvelaphi

Intlungu yentamo yinto ehambelanayo eqhelekileyo apho ukuxhaphaka kwayo kuqikelelwa kwi-10'18%, kunye nokuxhaphaka kwexesha lokuphila kufikelela kwi-30'50%. Ukuxhaphaka kweentlungu zentamo kubantu abaneminyaka eyi-40 okanye ngaphezulu malunga ne-20% [1, 2]. Intlungu yentamo ihambelana nokunyanzeliswa kwentamo [3], kwaye ihlala ihamba kunye nentloko, isiyezi, ukukhubazeka okubonakalayo, i-tinnitus, kunye ne-autonomic nervous system dysfunction [4, 5]. Iimpawu ezihamba rhoqo ziquka intlungu ephezulu kunye nokuphazamiseka kwe-neurological [6], kunye neempawu zentlungu zentamo nazo ziqhubeka kwiimeko ezininzi ezikhokelela ekulahlekelweni komsebenzi ngenxa yokungahambi kakuhle [7]. Ukukhubazeka okunxulumene nentamo ngokuqhelekileyo kubi kakhulu kwizigulane ezineentlungu ezikhuphayo kuneentlungu ezinqamlekileyo kwindawo yentamo [8, 9], kwaye uphawu oluphambili lwe-cervical intervertebral disc herniation (IDH) yintlungu yengalo kwingingqi engabonakaliyo kwinqanaba le-disc ye-herniated. kunye / okanye ingcambu ye-nerve ecinezelweyo [10, 11].

Uluhlu lonyango olukhoyo lwe-IDH yomlomo wesibeleko lukhulu, luthatha unyango olugcinayo kwiindlela ezahlukeneyo zotyando. Unyango olulondolozayo lubandakanya ii-NSAID, ii-oral steroids, iinaliti ze-steroid, imfundo yesigulana, ukuphumla, iikhola zikaThomas, kunye nonyango lomzimba [12�14]. Unyango lotyando lunokuqwalaselwa xa unyango olulondolozayo lungaphumeleli. I-neuropathy evela kuxinzelelo lwentambo yomgogodla luphawu olupheleleyo lotyando. Ezinye izibonakaliso ziquka iimpawu zokunyanzeliswa kweengcambu ze-nerve kunye ne-motor ehambelanayo kunye nokulahleka kweemvakalelo. Izibonakaliso ezihambelanayo zingabandakanya ukuhla komgangatho wobomi ngenxa yeentlungu ezingapheliyo [15]. Ngelixa unyango lotyando lunokunceda ezinye izigulana ezineempawu ezinzima ze-neurological, uninzi lwezifundo ngeentlungu ze-neuropathic zomnqonqo zichaza ukuba iziphumo zexesha elide azibalulekanga [16�20]. Nangona uphando malunga nomphumo wonyango olulondolozayo kwizigulane ze-IDH zomlomo wesibeleko ziye zaxelwa ngamanye amaxesha, nokuba ngaba zisebenzayo kusekho ingxabano, kwaye kukho ukungabikho kwezifundo kwisiphumo sonyango olongezelelweyo kunye nolunye unyango (CAM).

Ngokuxhamla kwiNzuzo yeZifo zeSifo seNtsholongwane ye-2013 yaseKorea ye-21, izigulane ze-5585 zanikwa unyango lweentsholongwane zentsholongwane zentsholongwane kwiintsuku ze-99,582 ekunyamekelweni kwabangaphandle, apho iintsuku ze-100,205 zifunyenwe yiNtsholongwane yeNtsholongwane yezezeMpilo, kunye neyonyango. iindleko zonyango ezifanele ukubuyisela imali kwi-5,370,217 yase-Korean Won, kunye ne-4,004,731 yase-Korean Won ehlawulwa. Iingxaki ze-disversion yecervical yi-12th yezizathu eziqhelekileyo zokungeniswa kwizibhedlele zamachiza aseKorea, kubonisa ukuba akuqhelekanga ukunyamekela unyango lwe-IDH yomlomo wesibeleko.

Ezi zonyango ze-CAM njenge-acupuncture, i-pharmacopuncture, imithi yamachiza, kunye nokunyango olusesikweni kufunwa kakuhle eKorea ngenjongo yokufumanisa indlela engaphantsi yokuphazamiseka, engeyiyo yokuhlinzwa. Isibhedlele saseJaseng seMoriya yaseKorea, isibhedlela saseKorea esibhedlele esivunywe yiNgqobhoko yezeMpilo yeNtlalo kunye neNtlalontle ukuze ikhethe ngokusemandleni empeni, iyakhathalela izifo zengxangxube ye-900,000 yezigulana zonyaka. Esi si bhedlele silawula izigulane ezineenkqubo zokudibanisa zisebenzisa iyeza eziqhelekileyo kunye neKorea, apho oogqirha abaqhelekileyo kunye noogqirha bamayeza aseKorea (KMDs) basebenzisana neziphumo zonyango olufanelekileyo. Oogqirha abaqhelekileyo bathathe inxaxheba ekuxilongeni ngokusebenzisa ubugcisa bezinto zobugcisa ezifana ne-X-ray kunye nee-MRIs, kwaye kunyango ngokunyamekela ipesenti yezigulane ezinokudinga ukunakekelwa okukhulu. I-KMD ilawula kwaye ilawula unyango oluphambili lwazo zonke izigulane, kwaye sinqume ukuba isigulane sidinga ukuxilongwa okongezelelweyo kunye nonyango ukusuka kwidrama eqhelekileyo. Izigulane ze-IDH zesifo seentloko zentlungu intlungu okanye umonakalo ongenakunceda ukufumana unyango olungalawulekiyo ngoko ke kunikwa unyango olunganyangekiyo lokudibanisa ngexesha lo kwamkelwa.

Nangona kusetyenziswe ukusasazeka kwonyango lwe-IDH yomlomo wesibeleko kuquka iinkqubo ezininzi zokonyango, iziphumo zonyango lwazo kwizigulane ezivunyelwe kwi-IDH yomlomo wesibeleko. Indlela yokuxhatshazwa kwezilwanyana ezingagxininiswa ngokujoliswe kwiCAM ayinakufumaneka ngokubanzi kwizigulane, kunye nenjongo yale sifundo kukuzazisa kwaye kuhlolisise ubuchule nokusebenza kwexesha elide lo mzekelo wonyango wokudibanisa kwizigulane kunye ne-IDH yesibeleko usebenzisa isicwangciso sokufunda ngokucwangcisekileyo.

tindlela

IsiCwangciso soFundo

Olu pho nonongo luyilo lokufunda. Siye sabona izigulane ezinezikhalazo eziphambili zentlungu yomsindo okanye intlungu yesalathisi ebonwa njenge-IDH yesibeleko kwaye yavunyelwa ukususela ngoJanuwari 2011 ukuya kuSeptemba 2014 kwisibhedlele saseJaseng seCroatia e-Korea esinika iinkonzo ezinxibeleleneyo eziqhelekileyo kunye neKorea kunye neCAM njengendlela yokuziphatha. Ababhali baqhuba ukulandelelana kwexesha elide ngoonxibelelwano lwefoni ngexesha le-Matshi 2015. Iziphumo zeengxelo ze-5: i-scale scale rating (NRS), inkcazo yokukhubazeka kwentamo (i-UN), isigulane sokuguquka komhlaba (PGIC), ukuhlinzwa rhoqo emva kokukhutshwa, kunye nonyango lwangoku.

Olu pho nonongo luyingxelo malunga nenxalenye yokubhalisa i-registry data kwi-intanethi edibeneyo yezigulane ze-musculoskeletal disorder (i-ClinicalTrials.gov Isazisi: i-NCT02257723). Umgaqo-nkqubo wokufunda uvunyiwe yiBhodi yokuHlola yeziNtu zeSibhedlele saseJaseng yeyeza laseKorea. Bonke abathathi-nxaxheba banikezela imvume ebhaliweyo enolwazi phambi kokuthatha inxaxheba.

nxaxheba

Izigulane zidibana neendlela ezilandelayo zifakiwe.

Ukwamkelwa ekwenzeni unyango lwentamo okanye ukutyumla intlungu
I-IDH yesibeletho iqinisekisile kwi-MRI
Ukuxilongwa yi-KMD eyona nto ibangela isikhalazo esiphambili (intlungu yentamo okanye ukutyumza intlungu) yi-IDH yomlomo wesibeleko

Izigulane ezidibeneyo zilandelayo zichazwe ngaphandle.

Isikhalazo esingundoqo ngaphandle kweentlungu zentlungu okanye intlungu
Isikhalazo esihambelana ne-musculoskeletal (umz.
Iintlungu zentlungu engenakulinganiswa ne-IDH yomlomo wesibeleko (umzekelo, isisu somzimba, ukukhulelwa, isifo se-rheumatoid arthritis)
Ukwenqaba ukuthatha inxaxheba kwisifundo okanye ukungavunyelwanga ukuqokelela kunye nokudalulwa kolwazi lomntu siqu ngenjongo yokufunda

I-KMD ihlolisise imbangela yentlungu yesentsi okanye impawu zentlungu ngokubhekiselele kwimiphumo yokuvavanya ngegazi (ukulahlekelwa kwintliziyo, ubuthathaka bemoto, kunye ne-tendon reflex) kunye nokufundwa kwe-MRI ngabachwepheshe be-radiology. Izigulane ezidibene neendlela ezicetywayo zokubandakanywa ziye zahanjelwa kwi-ward yesigulana ngosuku lokuqala lokungeniswa kovavanyo nge-KMD, kwaye lulandelwa ngokusebenzisa intsebenziswano efanayo kunye nenkqubo yophando xa ikhutshwa. Ukuba isigulane samkelwa ngamaxesha amaninzi ngexesha lokufunda, kuphela irekhodi lokuqala lokungeniswa liye lafundwa kwaye lifakiwe.

Ngoncedo

Nangona unyango lweprotocol wawuqulethwe unyango oluninzi lwezigulane ze-IDH zesigqirha, naziphi na zonke iindlela zokonyango ezingabandakanywa kwiprojekti yonyango zavunyelwa kwaye ziyafumaneka kuwo onke amagqirha kunye nezigulane kunye nokusetyenziswa kwezi zonyango (uhlobo kunye nobunzima) kubhalwe kwikhompyutha iirekhodi ezinzulu. Unonyango oluqhelekileyo olunjengamayeza enhlungu kunye neengxube ze-epidural (usebenzisa i-anesthetics yendawo efana ne-lidocaine, i-steroids, kunye ne-adhesion adhesion adjuvants) yayilawulwa yi-specialist rehabilitation specialist ngokusebenzisa ukuhanjiswa kwe-KMD. Ukunyanga okungekho unyango kuphela kuvunyelwe ngexesha lokumkelwa.

Iprogram yoNyango yoPhilo lweMithi

Amayeza emfuyo athathwe ngamaxesha e-3 / ngosuku kwipilisi (2 g) kunye nefomction ye-decoction (i-120 ml) (i-Ostericum koreanum, i-Eucommia ulmoides, i-Acanthopanax sessiliflorus, i-Achyranthes bidentata, i-Psoralea corylifolia, iSaposhnikovia divaricata, i-Cibotium barometz, i-Lycium chinense, i-Boschniakia rossica, Cuscuta chinensis, Glycine max, kunye ne-Atractylodes japonica). Ezi zityalo zikhethwe ngokuchanekileyo kwimifuno echazwe rhoqo kwi-IDH yonyango kwiMveli yeMichiza yaseChina naseKorea yeMicrosoft [22] kwaye umyalelo wenziwa ngokuphuhliswa ngokusetyenziswa kwekliniki [23]. Izithako eziphambili zonyango lwezityalo ezisetyenziswe kulolu cwaningo (Acanthopanax sessiliflorus Seem, Achyranthes japonica Nakai, Saposhnikovia divaricata Schischk, i-Cibotium barometz J. Smith, uGlycine max Merrill kunye no-Eucommia ulmoides u-Oliver) baye bafundiswa kwi-vivo nakwi-vitro njengeGCSB- I-5 ye-anti-inflammatory [24], kunye neentsimbi [25] kunye neziphumo ezikhuselekileyo zokukhusela [26], kunye neekliniki ngenxa yokungabi phantsi kwezokhuseleko kunye nokuphumelela xa kuthelekiswa neCelecoxib kunyango lwe-osteoarthritis [27].

I-acupuncture iqhutywe iiseshini ze-1�2 / ngosuku kwiindawo zomlomo wesibeleko ze-Ah-shi kunye namanqaku e-acupuncture aphathelene neentlungu zentamo. I-Ah-shi point acupuncture ibhekisa kwinaliti ye-acupuncture yeendawo ezibuhlungu okanye ze-pathological. Amanqaku e-Ah-shi awahambelani ncam namanqaku ethenda okanye i-Buding, amanqaku e-Tianying, kodwa ngokubanzi ahambelana namanqaku abangela ukuphumla okanye intlungu phezu kwe-palpation [28].

Isisombululo se-pharmacopuncture sasilungiselelwa ngezithako ezinjengeemithi zonyango ezilawulwa ngomlomo (Ostericum koreanum, Eucommia ulmoides, Acanthopanax sessiliflorus, Achyranthes bidentata, Psoralea corylifolia, Saposhnikovia divaricata, Cibotium barometz, Lycium chinense, Boschniakia rossica, Cuscuta chinensis, Glycine max, kunye ne-Atractylodes i-japonica) ngokususa i-decocting kunye nokukhenkcela, ukudibanisa i-powder elungiselelwe kunye ne-saline evamile kunye nokulungelelanisa i-asidi kunye ne-pH. I-Pharmacopuncture ilawulwa i-1 iseshoni / imini kwi-Hyeopcheok yomlomo wesibeleko (i-Huatuo Jiaji, i-EX B2) kunye ne-Ah-shi ifikelela kwi-1 cc isebenzisa izilingo zokuxhatshazwa (CPL, 1 cc, 26G x 1.5, i-Shinchang co.

I-Bee-venom pharmacopuncture isetyenziswe ukuba uvavanyo lwe-skin reaction kwi-bee-venom lwalungalunganga. Isisombululo esixutyiweyo se-bee-venom (exutywe ne-saline eqhelekileyo kumlinganiselo we-1000:1) satofwa kwi-4�5 yomlomo wesibeleko iHyeopcheok (Huatuo Jiaji, EX B2) kunye namanqaku e-Ah-shi ngokokubona kukagqirha. Inqaku ngalinye latofwa malunga ne-0.2 cc ukuya kuthi ga kwi-0.5�1 cc iyonke kusetyenziswa iinaliti zenaliti ezilahlwayo (CPL, 1 cc, 26G x 1.5 isirinji, Shinchang medical co. Korea)

I-Chuna spinal manipulation [29, 30], eyindlela yokukhohlisa yaseKorea edibanisa ubuchule obuqhelekileyo bokukhohlisa kunye nesantya esiphezulu, i-amplitude ephantsi etyhala kumalungu kancinane ngaphaya koluhlu lwentshukumo, kunye namandla okwenziwa ngesandla ngaphakathi koluhlu lwe-passive, lwenziwa 3� Iiseshoni ezi-5 / ngeveki.

Izisiphumo

Zonke iziphumo zavavanywa yi-KMD ezafunyanwa phambi koqeqesho kunye nemfundo. Iimpawu zokuziphatha zabantu nezempilo (ubulili, ubudala, umsebenzi, ukutshaya, ukusetyenziswa kotywala, kunye nesifo esingaphantsi kwesifo) zaqokelelwa ngosuku lokuqala lokungeniswa ngokusebenzisa uphando olutshanje kwiimvavanyo zamanqanaba kunye nokuhlolwa kweengqondo. Ukulandelwa kwaqhutyelwa kwiiveki ze-2 emva kokungena okanye emva kokukhutshwa kwaye emva kokukhutshwa.

I-NRS [31] isebenzisa isikali se-11-point ukuvavanya iintlungu zangoku zentamo kunye neentlungu ezikhuphayo apho kungekho ntlungu ibonakaliswe ngu-�0�, kunye neyona ntlungu ibuhlungu inokucingelwa ngu-�10�. I-NRS yavavanywa ekumkelwe, ukukhutshwa, kunye nokulandelwa kwexesha elide. Ngenxa yokungabikho kweereferensi kumahluko obalulekileyo obalulekileyo ekliniki (MCID) yeentlungu zentamo okanye iintlungu ezikhuphayo ze-NRS, i-MCID ye-analogue scale scale (VAS) yasetyenziselwa ukuvavanya ngakumbi kwe-NRS.

I-[[32] yi-10-into yophando ehlola iqondo lokukhubazeka kwi-0 ukuya kwi-5 ekufezeni imisebenzi yansuku zonke. Ixabiso lihlulwe yi-50, kwaye liphindwa li-100. I-NA yahlolwa kwi-admission and discharge.

I-PGIC [i-33] isetyenzisiwe ukuvavanya umlinganiselo wokwaneliseka wezigulane kwimeko yangoku emva kokungeniswa. Ukwaneliseka kwalinganiswa nekhawu le-5-point from eyanelisayo, eyanelisayo, eyanelisayo, enganelisekanga, kwaye enganelisekiyo ekukhutsheni nasekulandeleni ixesha elide.

Abathathi-nxaxheba bafumana uviwo lomzimba kunye ne-neurological ekwamkelwe kunye nokukhutshwa kwinjongo yemoto kunye novavanyo loluvo lwengingqi yomlomo wesibeleko. Uluhlu lokunyakaza (i-ROM) yokuguqulwa kwentamo kunye nokwandiswa, ukuphazamiseka, ukunyanzeliswa, i-Valsalva, i-Spurling, i-Adson's, kunye neemvavanyo zokugwinya, kunye neemvavanyo eziphezulu zemoto kunye neemvavanyo zoluvo kunye neemvavanyo ezinzulu ze-tendon reflex zenziwa.

Uvavanyo lwezoKhuseleko

Zonke iziganeko ezinobungozi ezinokuthi zibhekiselele kunyango, ukusuka kwesikhumba kunye neempendulo zendawo ukuya kwiinkqubo zenkqubo, kunye nokubandakanya utshintsho okanye ukuxhatshazwa kwiipatheni zentlungu zijongwe ngokucophelela, zirekhodwe kwaye zichazwe ngexesha lokungeniswa. Iziganeko ezimbi ezinxulumene nonyango lwe-bee-venom ziyaziwa ukusuka kwiimpendulo zesikhumba ukuya kwiimpendulo ezinzima ze-immunological, kwaye ngoko ke ukusabela okungalunganga kuquka ukusabela kwe-systemic immunological kufuna unyango olongezelelweyo (umz. i-antihistamineic agents) zibekwe esweni ngokusondeleyo. . Ukubalwa kweeseli zegazi, iimvavanyo zesibindi kunye ne-renal, kunye nokuhlolwa komsebenzi wokuvuvukala kuqhutywe kuzo zonke izigulane ekungenisweni, kwaye ukuba kukho ukufunyaniswa okungaqhelekanga okudinga ukulandelwa njengoko kuhlolwe yi-KMD kunye noogqirha abaqhelekileyo, amakishi afanelekileyo aphinde ahlolwe. Izigulane ze-46 zizonke zagwetywa ukuba zifuna ukulandelwa ekungenisweni yi-KMD kunye noogqirha abaqhelekileyo kwaye balandelwa ngokufanelekileyo ngexesha lokuhlala esibhedlele, apho izigulane ze-9 zibonise iziphumo ezingaqhelekanga ekusebenzeni kwesibindi ekungenisweni. Umsebenzi wesibindi walandelwa kwezi zigulana zisithoba. Ubukho bokulimala kwesibindi bukwalinganiswe ukuba kuhlolwe ukuba kunokwenzeka ukwenzakala kwesibindi okubangelwa ngamachiza ukusuka kwi-herbal okanye amayeza aqhelekileyo athathwe ngokusebenzisa inkcazo (a) ye-ALT okanye i-DB yokwanda kwe-2� okanye ngaphezulu komda ophezulu wesiqhelo (ULN) okanye (b) kudityanisiwe ukunyuka kwe-AST, ALP, kunye ne-TB, ngaphandle kokuba enye yazo ingaphezulu kwe-2?�?ULN.

Izindlela zokuSitatisti

Lonke uhlalutyo lwenziwa kusetyenziswa ubalo lwephakheji ye-SAS version 9.3 (IZiko le-SAS, iCary, NC, USA), kunye p?

iziphumo

Ngexesha lokufunda izigulana ezingama-784 ezinengxaki yentamo zamkelwa, kwaye kwezi, izigulana ezingama-234 zafunyaniswa zine-IDH yomlomo wesibeleko ngaphandle kwezikhalazo eziphambili ze-musculoskeletal. Kwizigulana ezingama-234 zomlomo wesibeleko ze-IDH, izigulana ezili-175 zazingenalo ixabiso elilahlekileyo kwi-NRS kunye ne-NDI ekwamkelweni nakwiiveki ezi-2 emva kokwamkelwa okanye ukukhutshwa (ukulandelwa kwexesha elifutshane). Izigulana ezilishumi zaphinda zamkelwa kwakhona kwaye emva kokufakwa kwedatha yokwamkelwa yokuqala ukuba ulwamkelo lokuqala lwalulithuba lokufunda, kwasala izigulana ezili-165. Uvavanyo lokulandelwa kwexesha elide lwenziwa kwizigulana ze-117. Kwiqela elingelide elide elilandelelweyo (n? =? 48), izigulana ezingama-23 khange ziyiphendule ifowuni, i-10 yenqabile ukuthatha inxaxheba kulandelo lwexesha elide, kwaye i-15 sele itshintshile inani okanye iifowuni ezingenayo zithintelwe ( Umzobo 1). Iimpawu ezisisiseko liqela lokulandelwa kwexesha elide kunye neqela elingelolide ixesha elide zidweliswe kwiTheyibhile 1. Nangona bekungekho enye umahluko ophawulweyo phakathi kwamaqela e-2, abaguli abangama-29 kwiqela lokulandela ixesha elide bacetyisiwe ukuba benze utyando (24.8%), ngelixa sisigulana se-1 kuphela kwiqela elilandelwayo (0.02%) elacetyiswayo.

Umzobo 1: Umzobo weMfuyo yeSifundo

Itheyibhile ye1 Isiseko seenkcukacha zobuntu

Ithebula 1: Iimpawu zokubala zabantu.

Ubude bomndilili wokuhlala esibhedlele yayiyi-20.8?�?11.2 iintsuku. Uninzi lwabathathi-nxaxheba bafumana unyango lwe-inpatient lugxile kumayeza aseKorea kunye neCAM. Iyeza lezityalo lithathwe ngokuhambelana nenkqubo yonyango kwi-decoction form yi-81.8 % yezigulane kunye nefom yepilisi kwi-86.1 %, kwaye ezinye izigulane zamiselwa amanye amayeza esintu ngokokubona kwe-KMD. Ukusetyenziswa konyango oluqhelekileyo olungachazwanga kwi-protocol yonyango ye-CAM, izigulane ze-18.2% zathatha amayeza e-analgesic okanye i-injection ye-intramuscular avareji amaxesha angama-2.7? �? ). Asizange sisebenzise izithintelo kunyango lwe-pharmacological ngeenjongo zokufunda, kwaye sivumele oogqirha bezonyango eziqhelekileyo inkululeko epheleleyo yokuvavanya nokumisela amayeza aqhelekileyo njengoko ugqirha ebona kuyimfuneko kwisigulane. I-NSAID, i-antidepressants, kunye ne-relaxants ye-muscle yayiyeyona mayeza asetyenziswayo, kwaye i-opioids ilawulwa kwixesha elifutshane kwizigulane ze-2.3 kuphela.

Itheyibhile 2 Ubude beBhedlele Ukuhlala kunye neNongenelelo eLawulayo ngexesha lokuhlala

Ithebula 2: Ubude bexesha lokuhlala esibhedlele kunye nokungenelelo okulawulwa ngexesha lokuhlala.

I-NRS yeentlungu zentamo, i-NRS yokuqaqanjelwa yintlungu, kunye ne-NDI zonke ziye zancipha kakhulu ekukhutsheni nasekulandeleni ixesha elide xa kuthelekiswa nesiseko (ukwamkelwa) (3 Table). Indawo ephambili yeentlungu zentamo kunye nokuqaqanjelwa kwengalo yengalo kubonise ukwehla okukhulu kune-MCID (ukwehla kwe-NRS kwe-2.5 okanye okukhulu kwintlungu yentamo okanye kwintlungu eqaqambayo), kwaye amanqaku e-NDI aphuculwe ngaphezulu kwenqaku le-MCID le-7.5 [34, 35]. Umahluko kwi-NRS ekuphumeni kwiqela lokulandela ixesha elide (n? =? 117) yayingu-2.71 (95% CI, 2.33, 3.09) yentlungu yentamo, i-2.33 (95% CI, 1.9, 2.77) yeentlungu zengalo, kunye ye-NDI, 14.6 (95% CI, 11.89, 17.32). Umahluko kwi-NRS ekulandeleleni ixesha elide kwintlungu yentamo kunye nentlungu yengalo ukusuka kwisiseko yayiyi-3.15 (95% CI, 2.67, 3.64) kunye ne-2.64 (95% CI, 1.99, 3.29), ngokwahlukeneyo. Umahluko kwi-NRS ekukhutshweni kwiqela elilandelelanayo lokulandela ixesha elide (n? =? 48) yayingu-2.83 (95% CI, 2.22, 3.45) wentlungu yentamo, i-2.48 yeentlungu zengalo (95% CI, 1.84, 3.12) , kwaye ye-NDI yayiyi-14.86 (95% CI, 10.41, 19.3). Umahluko phakathi kweqela phakathi kokungeniswa kunye nokukhutshelwa kwezigulana ezilandelelanayo zexesha elide bekungabalulekanga (i-NRS yentlungu yentamo: ixabiso le-p? =? 0.741; I-NRS yokuqaqanjiswa kwengalo: p-ixabiso? =? 0.646; Isalathiso sokukhubazeka kweNeck: p-value? =? 0.775).

Itheyibhile 3 Ukuthelekiswa kweNqaku lokuBaliswa kweNombolo, ukuSaxisa ubuhlungu besikhumba kunye neNeck Disability Index Score

Ithebula 3: Ukuthelekiswa kwamanani okulinganisa amanani entanyeni kunye neentlungu zengalo kunye nentonga yokukhubazeka kwentamo kwiqela elilandelelanayo elide kunye neqela elilandelelanga elide lokulandela.

Umyinge wexesha elisuka ekwamkelweni ukuya kulandelelwano lwexesha elide laliyi-625.36?�?196.7 iintsuku. Zonke izigulane eziyi-165 zaphendula i-PGIC xa zikhutshwa, kwaye kwezi zigulane i-84.2 % yaphendula ukuba imeko yabo "yanelisayo" okanye ngaphezulu. Izigulana ezili-117 zizonke ziphendule kwi-PGIC kulandelelo lwexesha elide, kwaye i-79.5% ilinganisele imeko yabo yangoku 'njengeyanelisayo' okanye ngaphezulu. I-PGIC ixelwe ukuba iyanelisa kakhulu kwizigulane ze-48 (41.0%), eyanelisayo kwi-45 (38.5%), iyanelisa kancinci kwi-18 (15.4%), kwaye ayinelisekanga kwi-6 (5.1%). Izigulane ezisithoba ziye zenziwa utyando (7.6 %), ngelixa izigulane ezingama-21 zaphendula ukuba kungokunje zifumana unyango. Kwizigulane eziphantsi konyango ngoku, izigulane ze-10 (8.5%) zaqhubeka zifumana i-CAM, izigulane ze-12 (10.3%) zikhethe unyango oluqhelekileyo, kwaye isigulane se-1 sasifumana zombini (iThebhile 4).

Itheyibhile ye-4 Ikhefu ukususela kuMhla wokungeniswa ukuya kwixesha elide elilandelayo kunye noMonde wokuTshintsho kweTshintsho

Ithebula 4: Ixesha lokungena kumhla wokungena kwixesha elide lokulandelelana, kunye nesigulane somhlaba jikelele wesiguqu, utshintsho lwangaphambili kunye nonyango lwangoku kwiqela elilandela ixesha elide.

Ukwabelana ngesondo, ubudala, kunye neentlungu ezingathandekiyo zangasese ziyaneliseka p?

Uluhlu lwe-5 Uvavanyo lwezinto eziPhambili zokuQala

Ithebula 5: Uvavanyo lwezinto eziphambili zokuqala ezihambelana nomlinganiselo wokwaneliseka.

Umsebenzi wesibindi wawulinganiswa kuzo zonke izigulane ezamkelwayo, kwaye izigulane ezithoba zine-enzyme yesibindi ezingavumelekanga xa zamkelwa zifunyenwe ukuhlolwa kwegazi ngokulandelwa. Amanqanaba e-enzyme yesibindi abuyele kwiimeko eziqhelekileyo kwizigulane ze-6, xa i-2 igcina i-enzyme yesibindi, kwaye i-1 isigulane yayinobungozi besibindi kunye nokuhlolwa okuqhubekayo kwafumanisa ukuba i-hepatitis esebenzayo ibonisa i-Hbs antigen kwaye i-Hbs antibody negative. Kwakungabikho imeko ye-systemic immunological reaction kwi-bee pharmacopuncture ye-venom efuna unyango olongezelelweyo kwaye akukho ziganeko ezimbi ezichaziweyo.

ingxoxo

Ezi ziphumo zibonisa ukuba unyango lwe-inpatient ngokuyinhloko lugxininise kwi-CAM lugcina iziphumo zexesha elide lokunciphisa intlungu kunye nokuphuculwa komsebenzi kwizigulane ze-IDH zomlomo wesibeleko ezineentlungu zentamo okanye iintlungu zengalo ezikhuphayo. Amanqaku e-NRS kunye ne-NDI ekukhutshweni nasekulandeleni ixesha elide zonke zibonise ukwehla okukhulu. Kwakhona, njengoko ukubaluleka kwamanani kunye nokubaluleka kweklinikhi kunokwahluka, sihlolisise i-MCID kwaye saqinisekisa ukuba amanqaku e-NRS kunye ne-NDI aphuculwe ngaphezu kwe-MCID. I-MCID ixelwe kwi-2.5 kwi-VAS ngenxa yentlungu yentamo kunye nentlungu yengalo evuthayo, kunye ne-7.5 kumanqaku e-NDI [34, 35]. Umyinge wophuculo kwiintlungu kunye nezikali zokusebenza zonke zigqithise i-MCID, kwaye ezi ziphumo zinokuthi zibonakaliswe kwizinga lokwaneliseka kwesigulane. Kwizigulane ezili-165, izigulane eziyi-128 (84.2%) zithelekelele imeko yazo yangoku 'njengeyanelisayo' okanye ngaphezulu xa zikhutshwa. Ngexesha elide lokulandelelana, i-9 (7.6%) kwizigulane ze-117 zaqinisekiswa ukuba zifumene utyando lwentamo, kwaye izigulane ezininzi zibonise ukuncipha okuqhubekayo kwi-NRS kunye ne-NDI. Ukongezelela, izigulane ze-96 (82.1%) okwangoku azizange zifumane unyango lweempawu zentlungu yentamo, kwaye izigulane ze-93 (79.5%) ziphendule ukuba imeko yabo "yanelisayo" okanye ngaphezulu. Njengoko uthelekiso lwentlukwano phakathi kweqela kwixesha elide lokulandelelana kunye nezigulane ezingapheliyo azizange zenzelwe i-priori, le datha inokuthathwa njengohlalutyo lwedatha ye-post hoc. Umahluko phakathi kweqela phakathi kwempembelelo phakathi kokungeniswa kunye nokukhutshwa kwixesha elide lokulandelelana kunye nezigulane ezingapheliyo zazingabalulekanga, kwaye kwi-MCID, enokuthi ithathelwe ingqalelo njengomlinganiselo weklinikhi, amaqela e-2 avelisa iziphumo ezifanayo. .

Nangona zonke izigulane zifumana unyango olunzulu lwezonyango zaseKorea ngexesha lokuhlala esibhedlele, akukho ziganeko ezimbi ezinxulumene nophatho lwangonyango, ezibonisa ukhuseleko lweyeza lokudibanisa ngokugxila kwi-CAM. Ababhali bebenze baqhuba isifundo esiphezulu sokuvavanya ukhuseleko lwezonyango kunye nokutya okudibeneyo kunye neyeza zokutya kunye neziqhelekileyo kwiziphumo zokuhlolwa kwemisebenzi yesibindi se-6894 kwizibhedlele ezibhedlele kwizibhedlele zamachiza aseKorea, kunye neziphumo zokuvavanya ikhefu lomhlaza wesibeleko Izigulana ezibandakanyiweyo kwisifundo samanje zichazwe [36].

Amandla amakhulu olu pho nonongo kukuba lubonisa ukusebenza kweklinikhi kunye neziphumo zibonakalisa unyango njengoko ngokwenene lwenziwa eKorea kwimimiselo yonyango yokudibanisa amayeza aqhelekileyo kunye namaKorea agxile kwi-CAM. Unyango lweprotokholi lwalulungelelaniswa kwaye luqulethwe ngamangenelelo okusebenza kwawo kuye kwaqinisekiswa kwizifundo zolingo kwaye zisetyenziswa rhoqo kwimisebenzi yeklinikhi, kodwa iprotocol nayo yavumela ukulungelelaniswa komntu ngamnye ngokweempawu zesigulane kunye neempawu njengoko zibonwa ziyimfuneko yi-KMDs, kunye nepesenti kunye nokuphindaphinda kwezi. ukutenxa kwarekhodwa. Izinga lokwaneliseka elivavanyiweyo ekukhutshelweni alibonisi nje isimo sengqondo sesigulane malunga nesiphumo sonyango, kodwa kunye neendleko zonyango ezibandakanyiweyo ngokubandakanywa kwonyango olwahlukeneyo. Uthathela ingqalelo into yokuba abathathi-nxaxheba kolu phononongo yayingezozigulane eziye zagaywa ngeentengiso, kodwa izigulane ezityelela isibhedlele samayeza e-Korea ngokuzikhethela ukuba azifumani mbuyekezo yezoqoqosho ngokuthatha inxaxheba kuphononongo, into yokuba uninzi lwezigulana-izinga lokwaneliseka laliphezulu iphawuleka ngakumbi. Iziphumo zolu phononongo zinegalelo kwisiseko sobungqina bokusebenza okuphezulu konyango oludibeneyo kunyango lomntu ngamnye kwizigulane ezifunyanwe nge-IDH yomlomo wesibeleko, kunye nokuqinisekisa ukuba kunokwenzeka ukuphunyezwa kweklinikhi ngokuqwalaselwa kweendleko zonyango ezidibeneyo.

Owona mda mkhulu kwisifundo sethu ngowona mgangatho wendalo wesifundo ekujongwa kuso eswele ulawulo. Asikwazi ukufikelela kwizigqibo zokuba ngaba unyango oluhlanganisiweyo lweCAM lungaphezulu kolawulo olusebenzayo (umzekelo, utyando, ungenelelo oluqhelekileyo olunganyangiyo) okanye ikhondo lesifo. Omnye umda kukungafani kwamaqela ezigulana kunye nonyango. Abathathi-nxaxheba babezigulana ze-IDH yomlomo wesibeleko ezineempawu ezahlukileyo, ubukhali kunye nokungagungqi ekuthi inkqubela phambili yabo yaziwe ngokubanzi ukuba yahlukile, kunye nongenelelo lubandakanya unyango oluqhelekileyo olunje ngenaliti ye-epidural okanye amayeza entlungu kwezinye iimeko. Ke ngoko kuya kuchaneka ngakumbi ekuchazeni ukuba ezi ziphumo zibe ziziphumo zonyango oluqhelekileyo kunye nenkqubo yonyango yokudibanisa amayeza eKorea kunaleyo yonyango oluhlanganisiweyo lweCAM. Umgangatho wokuthotyelwa kwe-74% (n? =? 175) kwiiveki ezi-2 emva kokwamkelwa okanye ukukhutshwa kwezigulana ezingama-234 ezamkelweyo ziphantsi, ngakumbi xa kuthathwa ixesha elifutshane lokulandela. Oku kuthotyelwa okuphantsi kunokunxulumana nesimo sengqondo sesigulana ngokubhekisele ekuthatheni inxaxheba kuthatho-nxaxheba Njengokuba abathathi-nxaxheba bengakhange bafumane mbuyekezo ngokuthe ngqo yokuthatha inxaxheba kwetyala, kusenokwenzeka ukuba baswele inkuthazo yokuqhubeka nokuthatha inxaxheba, kwaye kungenzeka ukuba izigulana ezingalwamkelanga uvavanyo lokulandelela bezingonelisekanga ngonyango lokwamkelwa kufuneka ziqwalaselwe. Uvavanyo lwexesha elide lwenziwa ngodliwanondlebe ngefowuni kwizigulana ezili-117 (70%) kuma-165 abasisiseko abathathi-nxaxheba ngokuyinxenye ngenxa yokuphelelwa lixesha, elinciphisa inani kunye nomgangatho wolwazi lwexesha elide olunokuqokelelwa kwaye lukhokelele ekulahlekelweni sisigulana ekuphulukaneni qhagamshelana.

Enye imingcele kukuba asiphumelelanga ukuqhuba uvavanyo olunzulu lwezonyango. Ngokomzekelo, nangona abathathi-nxaxheba befumanisa ukuba i-disc ye-disniation ibe yintsholongwane ephambili esekelwe kwiimvavanyo ze-MRI kunye neempawu ze-neurological by KMDs, ulwazi olongezelelweyo lweengcamango ezifana ne-disc pathological level kunye nobunzima be-herniation abuqokelelwanga. Kwakhona, iinkcukacha malunga nokuphindaphinda kwakhona, ubude bazo zonke iziqendu kunye nokuba ngaba ezinye ziphiliswe ngokupheleleyo zingabandakanyi ukuvavanywa kwexesha elide, ukunciphisa ukuhlolwa kwamanani amaninzi. Ukongezelela, ngelixa izi zigulane ze-IDH zentsholongwane zifuna ukufakwa ngenxa yentlungu eninzi nentsimbi yesigxina nokukhubazeka okusebenzayo, okokuba oku kwaba kukuhlaselwa kokuqala kwentlungu yentamo kubaninzi bekubangelwa yiphumo elihle.

Nangona kunjalo, impembelelo yokuthobela ukulandelelana kwexesha elide akuvumelekanga ukuba ifikeleleke kodwa ingaba inxulumene nokusebenza konyango olude. Njengoko umehluko kwiimpawu zezigulane ezilandelelanayo ezilandelelwano olude kunye nexesha elide lingabonakaliswa kwiziphumo zexesha elifutshane ezihlolwe ukukhutshwa kunye neentlobo kunye nemali yonyango olongezelelweyo, into yokuba olu phofu aluzange lucinge ngale iziphumo ngokusebenzisa uhlalutyo olongezelelweyo ngumlinganiselo owongezelelweyo wale sifundo.

Impikiswano isajikeleza ukusebenza konyango lwe-IDH yomlomo wesibeleko. Ngelixa iinaliti ze-epidural steroid yeyona ndlela ixhaphakileyo yonyango lolondolozo olusetyenziswa eUnited States [37] uphononongo olucwangcisiweyo olwahlukeneyo lubonisa ukuba iziphumo ziguquguquka kakhulu kwaye azigqibeli [38�44]. Iindlela ezimbini zisetyenziswa ngokubanzi kwiinaliti ze-epidural: iindlela ze-interlaminar kunye ne-transforaminal. Indlela ye-transforaminal iye yagxekwa ngenxa yeengozi zokhuseleko [45�50], kwaye nangona ikhuselekile kunendlela ye-transforaminal, indlela ye-interlaminar iphinda ibambe ingozi enokubakho [51�56]. Iingxelo malunga nokusebenza kweyeza eliqhelekileyo leentlungu ze-neuropathic zibonisa iziphumo eziphikisanayo [57�61], kwaye iziphumo zokufunda kunyango lomzimba nazo azihambelani [62�64].

Gebremariam et al. [65] yavandlakanya usebenzo lwezohlukeneyo zonyango lwe-IDH kwintsholongwane yakutsha nje, kwaye igqiba ukuba nangona uphando olulandelayo olupapashwe ngokunyango olulondolozo kunye nokuhlinzwa lwabonisa ukuba utyando lwabangelwa kwimiphumo engcono kunonyango olulondolozayo, ufumane uhlalutyo lwangaphakathi, abukho ubungqina obuxhasa ukuba olunye unyango luphezulu. Nangona iinqununu zonyango lokuqala kunye nolawulo, ezinye izigulana zingakhetha ukwenziwa ngonyango kwi-IDH yesibeleko kwinjongo ephambili yokunciphisa ubuhlungu obubangelwa yi-neuropathy nokukhusela ukuqhubela phambili komonakalo we-neurological myelopathy [66]. Nangona ubungqina bobuninzi bezobugqirha kunye nolugqirha lwezobugqirha kwi-IDH yesibeleko bunzima ukufumana izibonelelo kunye nezibi ziyanelisekanga, ummandla uye wafundwa ngokubanzi, ngelixa kukho uhlahlo olucacileyo lwee-correlative izifundo kwi-CAM.

UManchikati et al. [67] ixelwe kuphononongo olulandelelweyo lwe-2 lweminyaka ethelekisa unyango lwenaliti ye-epidural kunye ne-lidocaine kunye nomxube we-lidocaine kunye ne-steroids ye-IDH yomlomo wesibeleko ukuba i-NRS kwiqela le-lidocaine yayingu-7.9?�?1.0 kwisiseko, kunye ne-3.8? Ukulandelwa kweminyaka emi-1.6, ngelixa i-NRS kwiqela le-lidocaine kunye ne-steroid yayingu-2?�?7.9 kwisiseko, kunye ne-0.9?�? I-NDI kwiqela le-lidocaine laliyi-3.8?�?1.7 kwisiseko, kunye ne-2?�? 29.6 kulandelelwano lweminyaka emi-5.3. Xa kuthelekiswa nesifundo sethu, nangona ukuphuculwa kwe-NRS kukhulu kancinci kuphononongo olwenziwe nguManchikanti et al., Le ye-NDI iyafana. Isiseko se-NRS sasiphezulu kwi-13.7 kule sifundo sangaphambili, kwaye abazange bahlule phakathi kweentlungu zentamo kunye neentlungu ezikhuphayo kuvavanyo lwe-NRS.

Iziphumo zokulandela unyaka ze-1 ngokuthelekisa unyango olulondolozayo kunye ne-plasma disc decompression (PDD) ye-IDH yomlomo wesibeleko ibonisa ukuba amanqaku e-VAS anciphise i-65.73, ngelixa i-NDI yehle nge-16.7 kwiqela le-PDD (n? =? 61), kwaye amanqaku e-VAS ancipha nge-36.45 , kunye ne-NDI yehle nge-12.40 kwiqela lonyango elilondolozayo (n? =? 57) [68]. Nangona kunjalo, isifundo esifundwayo sasilinganiselwe kwi-IDH yomlomo wesibeleko, umlinganiso wesiphumo seentlungu yayiku-VAS ukuthintela ukuthelekisa ngokuthe ngqo, kwaye ixesha lokulandela lalifutshane kunesifundo sethu.

Imodeli yonyango oludityanisiweyo olusetyenziswa kwisibhedlele samayeza saseKorea sinokuhluka kakhulu kwiimodeli zonyango zeCAM ezisetyenziswa kumazwe aseNtshona. Nangona unyango lwe-CAM lufumana ukuthandwa ngokubanzi eNtshona, i-CAM idla ngokukhawulelwa �yokuncedisana� kunokuba �amayeza ahlukile, kwaye ngokuqhelekileyo iqhutyelwa ngabasebenzi abaqhelekileyo njengendlela yokuncedisa unyango oluqhelekileyo emva kwemfundo kwi-acupuncture / naturopathy / njl. okanye ngokuthunyelwa kwiingcali zeCAM, apho abanye abanalo ilungelo lokuziqhelanisa nomntu ngamnye. Kwelinye icala, iKorea ithatha inkqubo yezonyango ezimbini apho ii-KMD zibamba amalungelo alinganayo nabasebenzi abaqhelekileyo, kwaye ayisebenzisi inkqubo yonyango esekwe kusapho, evumela abaguli inkululeko yokhetho olusisiseko lonyango oluqhelekileyo okanye unyango lwaseKorea. . Abathathi-nxaxheba bolu pho nonongo babeyizigulane ezivakatyelwe kwaye zangeniswa kwisibhedlele samayeza aseKorea ukuze unyango lweyeza laseKorea lwe-IDH yomlomo wesibeleko, kwaye imodeli yonyango edibeneyo ephunyezwe kwesi sibhedlele sonyango saseKorea ayisebenzisi i-CAM njengomlinganiselo owongezelelweyo. Ngoko ke, unyango oluqulethwe unyango lwe-CAM olufana ne-acupuncture, iyeza le-herbal, i-Chuna manipulation, kunye ne-bee-venom pharmacopuncture kwizigulane ezininzi, kwaye unyango oluqhelekileyo lwalulawulwa ngoogqirha abaqhelekileyo ngokuthunyelwa kwiindawo ezimbalwa ezikhethiweyo. Iyonke i-18.2 % yezigulane ifumene imiyalelo yamayeza e-analgesic amaxesha angama-2.7 ngaphezu kwexesha eliqhelekileyo lokungeniswa kweentsuku ezingama-20.8, elilingana ne-1'2 yeentsuku ze-prescription (ezibalwe njengamaxesha e-2 / ngosuku), kunye ne-epidural injections zanikezelwa kuphela kwi-4.8 kuphela. %, ephantsi xa kucingwa ukuba ezi zigulane bezifuna ukwamkelwa. Kunokucingelwa ukuba injongo ephambili yokwamkelwa kunyango olulondolozayo kwizigulane ezininzi ze-IDH zomlomo wesibeleko kukunciphisa intlungu. Inyani yokuba izigulane ezininzi zibonise intlungu ebalulekileyo kunye nokuchacha kokusebenza kolu phononongo lubambe ukufaneleka kwizigulana eziqwalasela ukukhetha isibhedlele samayeza saseKorea sonyango olulondolozayo phezu kotyando. Kwakhona, izigulane zaqinisekiswa ukuba zigcine imeko yazo ephuculweyo kwixesha elide lokulandelelana, kwaye i-9 kuphela yafumana utyando kwizigulane ze-117 ezihlolwe ixesha elide.

Izigulane zahlukana ngamaqela e-2 ngokwanqanaba olwanelisayo njengoko livavanywa ekulandelelweni kwexesha elide kunye ne-PGIC, kunye nokuhlaziywa kweengxaki zokuguqulwa kwezinto eziphathekayo kuqhutyelwe kwimimiselo engundoqo ukuze kuhlolwe izinto ezinobungqina bokuneliseka nokunganeliseki. Ubudala obudala buhlanganiswe nezinga eliphezulu lokwaneliseka, kwaye ubuhlungu obukrakra obungabonakaliyo buboniswa ukuba budibene nezinga eliphezulu lokwaneliseka kunokuba kungabikho ubuhlungu. Ukongezelela, izigulane ezithotyelwa unyango lwe-CAM zidibaniswe kunye namaxabiso anelisekile kakhulu xa kuthelekiswa nabangenayo unyango. Oku kunokuba kuchazwe ngenye into yokuba izigulane ezithe zikhulile zingaba namazinga aphezulu entlungu kwaye zibe zigaba eziphambili ze-degeneration, ezibangele iziphumo zonyango ezihle kwaye ziyanelisayo. Ngokufanayo, izigulane ezinobunzima obubuhlungu obungabonakaliyo bubuhlungu bunzima bunokuba bunzima kakhulu kunezinto ezingenayo intlungu. Ukongezelela, izigulane eziqhubekayo zokufumana unyango lwe-CAM zingaba zilungele phambili kwi-CAM, okubangele ukwaneliseka kwezinga eliphezulu.

Nangona iindibano ezininzi ezijoliswe kwixesha elide ziqhutywe ekwenzeni unyango okanye unyango, abo baphathwa unyango lweCAM kunye nonyango oluncinane. Iziphumo zolu pho nonongo zifaniswa neziphumo zexesha elide lokunyanga kweyeza. Izifundo ezimbalwa ziye zenziwa ekwenzeni unyango kwizigulana ezineenkxalabo eziphambili ze-IDH yomlomo wesibeleko, ezinokuthi zidibene nomehluko kwiinkqubo zezempilo jikelele.

izigqibo

Ukuqukumbela, nangona uhlobo lokuqwalaselwa kolu phononongo lusithintele ekwenzeni izigqibo eziqinisekileyo ezingenalo ulawulo, iiveki ze-3-ukunyangwa kwe-inpatient inpatient equlethwe yi-CAM esetyenziswe kwizicwangciso zeklinikhi zangempela zingabangela iziphumo ezanelisayo kunye nentlungu kunye nokuphuculwa komsebenzi ogcinwe ixesha elide. ixesha kwintlungu yentamo okanye izigulane ezibuhlungu zengalo ezifunyaniswa ne-IDH yomlomo wesibeleko.

Imibulelo

Lo msebenzi wawuxhaswa nguJaseng Medical Foundation.

izifinyezo

IDH I-discvertebral disc herniation
CAM Iyeza elongezelelweyo nelinye
KMD Ugqirha waseKorea
NRS Isilinganiselo sokubala
NA Inkcazo yokukhubazeka
PGIC Impembelelo yomhlaba jikelele yokuguquka
MCID Ukwahlula okubalulekileyo klinikhi
VAS Isalathiso sokufanisa
i-ROM Ukuhamba kwesindululo
ULN Umda ophezulu oqhelekileyo
CI Ixesha lokuzithemba
OR Uhlobo lwamazinga
PDD Ukunciphisa idilesi yePlasma

Imihlathi

Injongo yokunyanzela: Ababhali bavakalisa ukuba abanalo inxaxheba.

Igalelo lababhali: SHB, JWO, JSS, JHL kunye neHH bafumana umxholo wokufunda kwaye baqulunqa lo mbhalo, kunye ne-SHB, MRK kunye ne-IHH babhala umbhalo wesigqi wokugqibela. I-SHB, i-JWO, i-YJA kunye ne-ARC ithathe inxaxheba ekuthengeni idatha, kwaye i-KBP yenza uhlalutyo lwamanani. I-YJL, i-MRK, i-YJA kunye ne-IHH inegalelo ekuhlaleni nasekuchazeni idatha. SHB, JWO, JSS, JHL, YJL, MRK, YJA, ARC, KBP, BCS, MSL kunye ne-IHH banegalelo ekuqulunqweni kokufunda kwaye benza iinguqulelo ezibalulekileyo. Bonke abalobi baye bafunda kwaye bavumile isicatshulwa sokugqibela.

Ulwazi lomxhasi: Ncbi.nlm.nih.gov/pmc/articles/PMC4744400/

Ekugqibeleni, unyango lwe-migraine kunye neyeza zokunyuselwa kwentsholongwane njengengcebiso yonyango kwakunye neyeza elongezelelweyo kunye nelinye liza kusebenza ekuphuculeni nasekulawuleni iimpawu zabo. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Iziphumo zophando apha ngasentla zisebenzisa iindlela ezahlukeneyo zokugqiba iziphumo zokugqibela. Nangona iziphumo ziboniswe ukuba ziyimpumelelo ye-migraine kunye neyonyango yokukhulelwa kwe-disc, kuqhutywe uphononongo olongezelelweyo olufunekayo ukuchonga ukusebenza kwabo kwenene. Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Intlungu Yentambo

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

ISIHLOKO ESIBALULEKILEYO: I-EXTRA EXTRA: Ungcono!

EZINYE IINGCUKACHA EZIBALULEKILEYO: UKWENZISA: Ukulimala kwezemidlalo? | Vincent Garcia | Umonde | El Paso, TX I-Chiropractor

Ngenanto

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Vala i-Accordion

Ngenanto

Ucaphulo

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Vala i-Accordion

Unyango lwe-Manual for Treatment Migraine e-El Paso

by iicrosoft | Chiropractic, LweMpilo, Migraine, Ukubuyiswa komzimba

Indlela yokwelapha unyango olusisigxina, okanye unyango olunyango, luyindlela yokwelapha emzimbeni osebenzisa iindlela ezininzi zokuphatha ngezandla ukuphatha iintlobo ezahlukeneyo zokulimala kunye / okanye iimeko. Ulwaphulo lwemihlahlandlela luqhelekileyo lusetyenziswa ngabagqirha, abathinteli bezonyango kunye nabahlalutyi be-massage, phakathi kwabanye abaqeqeshiweyo kunye nabanobuchule bokunakekelwa kwempilo, ukuxilonga nokuphatha izicubu ezincinci kunye nentlungu. Uninzi lweengcali zonyango lucebisa unyango lwezonyango, okanye unyango olusetyenziswayo unyango lwe-migraine intloko yentlungu. Injongo yale nqaku ilandelayo kukufundisa izigulane kwiimpembelelo zonyango zokunyanga kwe-migraine.

IiNyango zoLondolozo lweMigraine: UkuHlola okuHlolo

Abstract

I-Migraine iyenzeka malunga ne-15% yabantu bonke. I-Migraine idla ngokulawulwa ngamachiza, kodwa ezinye izigulane azinyamezeli unyango lwe-migraine ngenxa yemiphumo emibi okanye ukhetha ukuphepha unyango kwezinye izizathu. Ulawulo olungekho phantsi kwee-pharmological yindlela yokwenza unyango oluthile. Sihlolisise ngokucwangcisiweyo izilingo ze-klinikhi (RCTs) ezinokwenziwa kwindlela yokwenza imilraine. I-RCTs ibonisa ukuba ukuxilisa unyango, i-physiotherapy, ukuphumula kunye ne-chiropractic ye-spinal manipulative therapy ingaba ngempumelelo ngokufanayo njengepropranolol kunye ne-topiramate ekulawuleni i-prophylactic ye-migraine. Nangona kunjalo, ii-RCT ezivandlakanyweyo zininzi zokungaphumeleli kweendlela. Ngoko ke, nayiphi isigqibo esiqinileyo siya kufuna i-RCT kwixesha elizayo, eliqhutywe kakuhle kwiinkqubo zonyango zokuthatha imitha.

Internet: Ukunyangwa kweencwadi, Ukuzihlaziya, i-Physiotherapy, i-Chiropractic, i-Migraine, unyango

intshayelelo

I-Migraine idla ngokulawulwa ngamachiza, kodwa ezinye izigulane azixhomekekanga kwiyeza kunye ne-prophylactic yezilwanyana ngenxa yemiphumo emibi, okanye ukuchasene ngenxa yokuxhatshazwa kweengxaki ze-myocardial okanye i-asthma phakathi kwabanye. Ezinye izigulane zinqwenela ukuphepha unyango kwezinye izizathu. Ngaloo ndlela, ulawulo olungekho kolawulo lwezonyango ezifana nokusilalisa umzimba, i-physiotherapy kunye ne-chiropractic inokusetyenziswa kwindlela yokwenza unyango. Ulwaphulo lwe-massage kumaziko aseNtshona asebenzisa i-massage ye-classic, amaphuzu okubangela, ukukhutshwa kwe-myofascial kunye nezinye izidumbu ezinqabileyo phakathi kwezinye iindlela zokwelapha ezisetyenziselwa izicubu ezingaqhelekanga. I-physiotherapy yanamhlanje igxininise ekuvuseleleni nasekusebenziseni umzimba, ngelixa unyango olusesikweni lugxininisa ukulungiswa kweposi, umsebenzi ococekileyo womzimba, ukunweba, ukusebenzisana nokusebenza kunye nokusetyenziswa kwamanyathelo. Ukuxhaswa ngokuqhelekileyo kuchazwa ngokuthi ukuhamba kwamalungu kumgangatho wesimo sokuhamba [1]. Izindlela ezibini eziqhelekileyo ze-chiropractic zizohlukeneyo kunye neGonstead, ezisetyenziswe ngu-91 kunye ne-59% ye-chiropractors [2]. Ukukhwabanisa kwe-Chiropractic (sp) yindlela elawulwa ngokungahambisani nokusebenzisa i-high-speed direction, i-low-amplitude incritude ejoliswe kwixesha elidlulileyo elidityanisiweyo lokuhamba kwenyama, ngaphandle kokudlula umlinganiselo we-anatomical [1]. Isicelo kunye nobude bezonyango ezahlukeneyo zonyango ziyahluka phakathi kwabo bawenzayo. Ngaloo ndlela, unyango olusesikweni aluyinto efanayo njengoko, ngokomzekelo, unyango oluthile kunye neziyobisi kumthamo othile.

Eli phepha liphonononga ngokutsha izilingo ezilawulwa ngononophelo (RCTs) ukuvavanya ukuphumelela kweendlela zokwenza umthambo kwi-migraine, oko kukuthi, ukuhlalisa umzimba, umzimba kunye ne-chiropractic.

indlela yokwenza

Uphando loncwadi lwenziwa kwi-CINAHL, Cochrane, Medline, Ovid kunye nePubMed. Amagama okukhangela ayeyi-migraine kunye ne-chiropractic, unyango olukhohlisayo, unyango lwe-massage, unyango lwe-osteopathic, i-physiotherapy okanye i-spinal mobilization. Zonke ii-RCT ezibhalwe ngesiNgesi zisebenzisa i-manual therapy kwi-migraine zihlolwe. I-Migraine yayihlelwe ngokukhethiweyo ngokwemiqathango ye-International Headache Societies ukusuka kwi-1988 okanye ukuhlaziywa kwayo kwi-2004, nangona kwakungeyona imfuneko epheleleyo [3, 4]. Izifundo kwafuneka zivavanye ubuncinci besiphumo se-migraine esifana nokuqina kweentlungu, ukuphindaphinda, okanye ubude bexesha. Umgangatho we-methodological wezifundo ze-RCT ezibandakanyiweyo zavavanywa ngokuzimeleyo ngababhali. Uvavanyo lubandakanya inani labantu bophando, ungenelelo, umlinganiselo wesiphumo, ukunikezelwa kwedatha kunye nohlalutyo (Itheyibhile 1). Awona manqaku aphezulu ngamanqaku ali-100 kunye namanqaku angama-50 athathwa njengendlela yokusebenza esemgangathweni [5�7].

iziphumo

Uphando loncwadi luchonge i-RCT ezisixhenxe kwi-migraine edibene neendlela zethu zokubandakanywa, oko kukuthi, izifundo ezimbini zokuxilisa i-massage [8, 9], isifundo esisodwa se-physiotherapy [10] kunye nezifundo ezine ze-chiropractic spinal manipulative therapy (CSMT) [11�14], ngelixa thina akafumananga zifundo ze-RCTs kwi-spinal mobilization okanye i-osteopathic njengongenelelo lwe-migraine.

I-Quality Code ye-RCT

Itheyibhile 2 ibonisa ababhali abaphakathi kwinqanaba le-methodological izifundo ezibandakanyiweyo ze-RCT [8�14]. Amanqaku aphakathi ahluka ukusuka kwi-39 ukuya kwi-59 amanqaku. Ii-RCT ezine zicatshangelwa ukuba zinomgangatho omhle we-methodology score (?50), kunye nee-RCT ezintathu zinezinga eliphantsi.

Izilingo eziLawulayo

Itheyibhile ye-3 ibonisa iinkcukacha kunye neziphumo eziphambili zezifundo ezahlukeneyo ze-RCT [8�14].

Ukunyanga kwamayeza

Uphando lwaseMerika lubandakanya abathathi-nxaxheba be-26 abane-chronic migraine abaxilongwa ngumbuzo wemibuzo [8]. Ukuguqulwa kwamathambo kunemiphumo ebalulekileyo kwiintlungu ezinzima xa kuthelekiswa nokulawula. Ubunzima bobuhlungu buncitshiswe i-71% kwiqela lokuxuba kwaye alitshintshi kwiqela lolawulo. Ukuchazwa kwedatha kunzima nakwezinye iziphumo kunye nokuhamba kwexesha kunye nokungaphelelwa kwexesha.

Isifundo saseNew Zealand sibandakanya i-48 migraineurs efunyaniswe ngemibuzo [9]. Ixesha elichaziweyo lokuhlaselwa kwe-migraine yayiyi-47 h, kwaye i-51% yabathathi-nxaxheba yayinokuhlaselwa okungaphezulu kwesinye ngenyanga. Uphononongo lubandakanya ixesha lokulandelela iiveki ezi-3. Imvamisa ye-migraine yancitshiswa kakhulu kwiqela lokuthambisa xa kuthelekiswa neqela lolawulo, ngelixa amandla ohlaselo engatshintshanga. Iziphumo kwixesha le-migraine alikho. Ukusetyenziswa kwamayeza kwakungatshintshi, ngelixa umgangatho wokulala wawuphuculwe kakhulu kwiqela lokuthambisa (p <0.01), kodwa hayi kwiqela lolawulo.

Umfanekiso wendoda endala efumana unyango lokusilalisa ukuphucula imithi yazo El Paso, TX I-Chiropractor

Ulungiso lwenyama

Isifundo sonyango saseMelika sonyango sasibandakanya i-migraineurs yabasetyhini kunye nohlaselo oluqhelekileyo oluchongwa yi-neurologist ngokwemigaqo yoMbutho weHlabathi weNtloko [3, 10]. Iziphumo zonyango ziye zachazwa njenge> 50% yokuphuculwa kobukrakra bentloko. Iziphumo zonyango ziye zajongwa kwi-13% yeqela lonyango kunye ne-51% yeqela lokuphumla (p <0.001). Ukunciphisa ukunciphisa ubunzima beentloko kwakuyi-16 kunye ne-41% ukusuka kwisiseko ukuya kunyango lwangemva kwonyango lomzimba kunye namaqela okuphumla. Iziphumo zagcinwa kunyaka wokulandelwa kwe-1 kuwo omabini amaqela. Inxalenye yesibini yophononongo inikezela abantu ngaphandle kwempembelelo yeklinikhi kwinxalenye yokuqala yesifundo, olunye ukhetho lonyango. Into enomdla kukuba, iziphumo zeklinikhi ziye zajongwa kwiipesenti ezingama-55 zabo bafumene unyango lomzimba kumjikelo wesibini ababengenaziphumo zekliniki ekuphumleni, ngelixa iipesenti ezingama-47 zazineziphumo zeklinikhi ekuphumleni kumjikelo wesibini. Ukunciphisa ukunciphisa ubunzima beentloko kwakuyi-30 kunye ne-38% kwonyango lomzimba kunye namaqela okuphumla. Ngelishwa, isifundo asibandakanyi iqela lolawulo.

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Unyango lwe-Chiropractic Spinal Manipulative Treatment

Uphando lwase-Australia lwaluquka i-migraineurs kunye nokuhlaselwa rhoqo kweso sifo se-neurologist [11]. Abathathi-nxaxheba bahlulwe ngamacandelo amathathu okufunda; ukunyanzeliswa komlomo ngonyango, unyango lwentliziyo ngomzimba we-physiotherapist okanye ugqirha, kunye nokunyanzeliswa kwentloko ka-physiotherapist okanye ugqirha. Ixesha lokuhlaselwa kwe-migraine lithatyathwa ngamaqela amathathu, njengoko bekude ixesha elide ekusebenzisweni komlomo ngonyango (30.5 h) kuneendlela zokwenziwa komlomo nge-physiotherapist okanye ugqirha (i-12.2 h) kunye namaqela okubambisana nesibindi (14.9 h). Uphando lwabaphandi abaninzi kwaye unyango phakathi kweqela ngalinye lucaleni kweemfuno ezigunyazisiweyo zamahhala. Akukho ziintlukwano ezibalulekayo ezifunyenweyo phakathi kwamaqela amathathu. Ukuphuculwa kwaphawulwa kuwo onke amaqela amathathu emva kokunyanga (Itheyibhile 3). Ngaphambi kokuvavanywa, abaculi bezonyango babenethemba kwaye banomdla malunga nokusebenza komsebenzi wesibeleko, ngelixa i-physiotherapists kunye noogqirha babengaqiniseki ngokubaluleka. Uphononongo aluzange lubandakanye iqela lolawulo nangona ukukhuliswa komlomo kuthethwa njengeqela lolawulo kwiphepha. Iinyanga ezilandelelweyo ze-20 emva kokuba ityala libonise uphuculo olongezelelweyo kuwo onke amaqela amathathu (Itheyibhile 3) [12].

UDkt Jimenez usebenza kwi-neckrest_preview ye-wrestler

Uphando lwaseMerika lubandakanya i-218 migraineurs efunyaniswa ngokubhekiselele kwiinkqubo ze-International Headache Society ngabagqirha [13]. Uphando lwaluphethe amaqela amathathu enyango, kodwa akukho liqela lolawulo. Ubunzima beentloko kwiintsuku ezineentloko zazingatshintshi kuwo onke amaqela amathathu. Ixesha eliqhelekileyo lancitshiswa ngokulinganayo kumaqela amathathu (Itheyibhile 3). I-medication counter (i-OTC) yancitshiswa ukusuka kwinqanaba lokuqala ukuya kwii-4 iiveki emva kwonyango kunye ne-55% kwiqela le-CSMT, i-28% kwiqela le-amitriptyline kunye ne-15% kwi-CSMT kunye ne-amitriptyline iqela.

Uphando lwesibini lwase-Australia lwalusekelwe kwimibuzo yoluhlu lwe-migraine [14]. Abathathi-nxaxheba babe ne-migraine kwiminyaka eyi-18.1. Impembelelo ye-CSMT yayibaluleke ngakumbi kuneqela lelawulo (Itheyibhile 3). Ukuncitshiswa kwe migraine kwamaza, ubunzulu kunye nexesha ukusuka lokwandlalela ukulandela-up baba 42, 13, kunye 36% kwiqela CSMT, kunye 17, 5, kunye 21% kwiqela kolawulo (data ebalwe yi kubahleli ngokususela kumanani ukusuka iphepha).

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Ukuqwalasela ngeendlela

Ukuxhaphaka kwe-migraine kwakunjalo ngokusekelwe kwimibuzo yeebuzo kunye nodokotela othe ngqo wenziwa udliwano-ndlebe, kodwa ngenxa yokuchaneka okulungileyo kunye nokungalunganga kwimibuzo lemibuzo [15]. Uvavanyo oluchanekileyo lwentloko lufuna udliwano-ndlebe ngabagqirha okanye abanye abaqeqeshi bezempilo abanokuvavanya kwiintsholongwane. Iingqungquthela zee-RCT ezisixhenxe zifumene abathathi-nxaxheba ngolubuzo lwemibuzo, kunye nokungaqiniseki kokungaqinisekiyo okulethwe yilo (Itheyibhile 3).

Uphononongo lwesibini lwaseMelika lubandakanya abathathi-nxaxheba ubuncinane abaneentsuku zentloko ngeenyanga [13]. Ubunzima bentloko ebuhlungu ngeentsuku ezinentloko ebuhlungu kwinqanaba lokuqala lahluka ukusuka kwi-4.4 ukuya kwi-5.0 kwisikali sebhokisi esingu-0�10 kumaqela amathathu onyango. Oku kuthetha ukuba abathathi-nxaxheba babene-co-occurrence ye-tension-type-headache, ekubeni i-headache ye-tension-type intensity ivame ukuhluka phakathi kwe-1 kunye ne-6 (i-mild or moderate), ngelixa ubunzima be-migraine bunokwahluka phakathi kwe-4 kunye ne-9 (ephakathi okanye enzima), kodwa ngokuqhelekileyo. yintlungu ebuhlungu phakathi kwe-7 kunye ne-9 [16, 17]. Ubunzima bentloko ngeentsuku ezineentloko azizange zitshintshwe phakathi kwesiseko kunye nokulandelelana, okubonisa ukuba umphumo obonwe wawungekho kuphela ngenxa yempembelelo kwi-migraine, kodwa kunye nefuthe kwi-headache ye-tension.

Ii-RCT eziquka iqela lolawulo zixhamla kwii-RCT eziqhathanisa unyango ombini, kuba umphumo kwiqela le-placebo lincinci kwaye lisoloko lihluka. Umzekelo RCTs kunyango nokoyika migraine ngokuthelekisa ukusebenza sumatriptan ongama kunye placebo wabonisa neempendulo placebo phakathi 10 ne 37%, ngelixa iziphumo enyangayo, oko kukuthi, ukusebenza sumatriptan thabatha ukusebenza placebo elifana [18, 19]. Omnye umzekelo yi-RCT ekwenzeni unyango lwe-migraine, ukuthelekisa i-topiramate kunye ne-placebo [20]. Ukunciphisa ukuhlaselwa kwandiswe kunye nomlinganiselo owandayo we-topramam 50, i-100 kunye ne-200 mg / ngosuku. Ukuthi ukuhlaselwa kwe-migraine intshukumo yancitshiswa ukusuka kwi-1.4 ukuya kwi-2.5 ukuhlaselwa ngenyanga ngenyanga kumaqela aphezulu kunye nohlaselo lwe-1.1 ngenyanga ngenyanga yeqela le-placebo ukusuka kwii-frequencies zokuhlaselwa ezivela kwi-5.1 ukuya kwi-5.8 ukuhlaselwa kwenyanga kumaqela amane.

Ngaloo ndlela, ukuchazwa kokusebenza kakuhle kwii-RCT ezine ngaphandle kweqela lokulawula akukho ngqo phambili [9�12]. Umgangatho we-methodological yazo zonke ii-RCT ezisixhenxe zinendawo yokuphucula njengoko amanqaku aphezulu e-100 ayekude nokulindela, ngokukodwa ukuxilongwa kwe-migraine ngokuchanekileyo kubalulekile.

Uninzi lwezifundo zibandakanya abambalwa abathathi-nxaxheba, okubangela ukuba iziphene ze-2 zenzeke. Ngaloo ndlela, ukubala kwamandla ngaphambi kokufunda kubalulekile kwizifundo ezizayo. Ukongezelela, izikhokelo zekliniki ezivela kuMbutho weZizwe oBaNtloko kufuneka zilandelwe, oko kukuthi, imvama yiphelo lesiphelo sokuqala, ngelixa ubude kunye nobukhulu bunokuba yimpompo yokugqibela (21, 22].

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

Ukunyangwa kwamathambo, njengonyango lokuxilonga, unyango lwezonyango kunye nokunyanga kwamayeza okugulisa amagulane uninzi lweendlela zokwelapha ze-migraine ezicetyiswa ngabaqeqeshi bezempilo ukuze bancede ukuphucula kunye nokulawula iimpawu ezibuhlungu ezinxulumene nale meko. Izigulane ezingakwazi ukusebenzisa iziyobisi kunye / okanye amayeza, kuquka abo banokukhetha ukuphepha ukuzisebenzisa, banokuzuza kwiindlela zokunyanga zonyango zonyango lwe-migraine, ngokwale nqaku elandelayo. Uphando olusisiseko-uphando olusisiseko luye lwafumanisa ukuba unyango lwezonyango lunokuthi lube luncedo ngonyango lwe-migraine njengeziyobisi kunye / okanye amayeza. Nangona kunjalo, uhlolo oluchanekileyo luzimisele ukuba iimeko ezizayo zonyango eziqhutywe ngokufanelekileyo ngokusetyenziswa kweendlela zokwenza imfesane yentloko ye-migraine zifuna ukugqitywa kweziphumo.

iziphumo

Ii-RCT ezimbini kwi-massage therapy zibandakanya abathathi-nxaxheba abambalwa, kunye neentsilelo ezikhankanywe kwiThebhile 3 [8, 9]. Zombini izifundo zibonise ukuba unyango lwe-massage lwalungcono kakhulu kuneqela lokulawula, ngokunciphisa ubukhulu be-migraine kunye nokuphindaphinda, ngokulandelanayo. I-27�28% (34�7% kunye ne-30�2%) inzuzo yonyango ekunciphiseni i-migraine frequency ngonyango lwe-massage ifaniswa ne-6, i-16 kunye ne-29% inzuzo yonyango ekunciphiseni i-migraine frequency ngonyango lwe-prophylactic kunye ne-topiramate 50, i-100 kunye 200 mg / ngosuku [20].

Isifundo esisodwa kwi-physiotherapy sikhulu, kodwa asibandakanyi iqela lolawulo [10]. Uphononongo lwachaza abaphenduli ukuba babe ne-50% okanye ngaphezulu ukunciphisa amandla emigraine. Inqanaba lomphendulayo kwipilisi yonyango kuphela yi-13% kwinxalenye yokuqala yocwaningo, ngelixa i-55% kwiqela elingazange lizuze ekuphumuleni, ngelixa i-responder rate yokuphumla yayingu-51% kwinxalenye yokuqala yocwaningo kwaye I-47% kwiqela elingazange lizuze kunyango lomzimba. Ukunciphisa ukuqina kwe-migraine kuvame ukuhambelana nokunciphisa imvama ye-migraine. Ukuthelekisa, umlinganiselo wabaphendulayo ngu-39, 49, 47 kunye ne-23% phakathi kwabo bafumana i-50, 100 kunye ne-200 mg / ngosuku kunye ne-placebo njengoko kuchazwe ngu-50% okanye ngaphezulu ukunciphisa imvamisa ye-migraine [20]. Uhlalutyo lwe-meta lwee-53 zophando malunga neprophylactic unyango kunye nepropranolol lubonise intsingiselo ye-44% kwimisebenzi ye-migraine [23]. Ngaloo ndlela, kubonakala ukuba unyango lomzimba kunye nokuphumula kunemiphumo emihle ngokulinganayo njenge-topiramate kunye nepropranolol.

Inye kuphela kwii-RCT ezine kwi-chiropractic spinal manipulative therapy (CSMT) yayiquka iqela lokulawula, ngelixa ezinye izifundo zithelekiswa nolunye unyango olusebenzayo [11�14]. Uphononongo lokuqala lwase-Australia lubonise ukuba i-migraine frequency yancitshiswa kuwo onke amaqela amathathu xa isiseko sithelekiswa neenyanga ze-20 emva komzila [11, 12]. I-chiropractors yayikhuthazwa kakhulu kunyango lwe-CSMT, ngelixa oogqirha kunye ne-physiotherapist babenokungabaza ngakumbi, okunokuthi kube nefuthe kwisiphumo. Uphononongo lwaseMelika lubonise ukuba i-CSMT, i-amitriptyline kunye ne-CSMT + i-amitriptyline yanciphisa i-migraine frequency 33, 22 kunye ne-22% ukusuka kwisiseko ukuya kwi-post-post-treatment (Itheyibhile 3). Uphononongo lwesibini lwase-Australia lufumene ukuba i-migraine frequency yanciphisa i-35% kwiqela le-CSMT, ngelixa liyancipha i-17% kwiqela lolawulo. Ngaloo ndlela, inzuzo yonyango ilingana ne-topiramate ye-100 mg / ngosuku kwaye i-effective ilingana ne-propranolol [20, 23].

Iingxelo ezintathu zeemeko ziphakamisa inkxalabo malunga ne-chiropractic yomlomo wesibeleko i-SMT, kodwa ukuphononongwa okucwangcisiweyo okutsha nje akufumananga datha eqinileyo malunga nesiganeko okanye ukuxhaphaka kweempembelelo ezimbi ezilandela i-chiropractic cervical SMT [24�27]. Nini ukubhekisa izigulane ze-migraine kunyango lwezandla? Izigulane ezingaphenduliyo okanye zinganyamezeli amayeza eprophylactic okanye abanqwenela ukuphepha amayeza ngenxa yezinye izizathu, banokuthunyelwa kunyango lwe-massage, unyango lomzimba okanye unyango lwe-chiropractic spinal manipulative, njengoko olu nyango lukhuselekile kunye neempendulo ezimbalwa ezimbi [27�29].

isiphelo

I-RCT ezikhoyo zibonisa ukuba ukuxilisa unyango, uphethiloli, ukuphumula kunye ne-chiropractic ye-spinal manipulative therapy ingaba yinkqubela efana nepropranolol kunye ne-topiramate ekulawuleni i-prophylactic ye-migraine. Nangona kunjalo, isigqibo esiqinileyo sifuna, kwixesha elizayo, i-RCT eqhutywe kakuhle ngaphandle kweendlela ezininzi zokungaphumeleli kwee-RCT ezivandlakanywe kwimiqathango yonyango. Ezi zifundo zimele zilandele izikhokelo zesilingo zonyango kwi-International Headache Society [21, 22].

Ukugqubana kwemidla

Akukho nto ipapashwe.

UkuFikelela: Eli nqaku lisasazwa phantsi kwemiqathango yeCredit Commons Attribution License evumela ukuba nayiphi na isetyenziswe, ukuhanjiswa kunye nokuveliswa kwanoma yimuphi umthombo, ukuba unikwe umlobi (original) kunye nomthombo oyimvelaphi.

Ukuqukumbela, ii-chiropractors, ii-physical therapists kunye nee-massage therapists, phakathi kwabanye abaqeqeshi bezempilo abaqeqeshiweyo nabanamava, bacebisa unyango lwezandla njengonyango lweentlungu zentloko ye-migraine. Injongo yale nqaku yayikukufundisa izigulane ngeziphumo zonyango lwe-manual unyango lwe-migraine. Ngaphaya koko, uphononongo olucwangcisiweyo lufumanise ukuba ikamva, ulingo lweklinikhi oluqhutywa kakuhle luyafuneka ukuze kuqukunjelwe iziphumo. Ulwazi olubhekiselele kwiZiko leSizwe loLwazi lweBiotechnology (NCBI). Ububanzi bolwazi lwethu bukhawulelwe kwi-chiropractic kunye nokulimala komgogodla kunye neemeko. Ukuxoxa ngombandela, nceda uzive ukhululekile ukubuza uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Intlungu Yentambo

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

ISIHLOKO ESIBALULEKILEYO: I-EXTRA EXTRA: Ungcono!

EZINYE IINGCUKACHA EZIBALULEKILEYO: UKWENZISA: Ukulimala kwezemidlalo? | Vincent Garcia | Umonde | El Paso, TX I-Chiropractor

Ngenanto

Ucaphulo

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Vala i-Accordion

Ukwelashwa kwe-Chiropratic Migraine Pain neMedication | El Paso, TX

by iicrosoft | Chiropractic, LweMpilo, Migraine

Iintlungu ze-Migraine ziphakathi kwezona zimeko eziqhelekileyo nezidityanisiweyo zoluntu. Ngenxa yoko, amaninzi amatyala e-migraine ahlale engafumani kakuhle, ekhokelela ekunyanga kwabo. Nangona unyango olufanelekileyo, nangona kunjalo, impilo yesigulane kunye nokuphila kakuhle kunye nomgangatho wobomi kunokuphucula kakhulu. Ukongezelela, imfundo yesigulane ibalulekile ekuncedeni izigulane zithathe amanyathelo okuzinyamekela kwaye zifunde ukuba zinokuhlangabezana njani nesimo esingapheliyo semeko yabo. Ulwaphulo lwe-Chiropractic unyango olusisigxina kunye nokusetyenziswa kwamachiza kuye kwaqhathaniswa nokuqhathaniswa nokusebenza komntu ngamnye ngenxa yentlungu ye-migraine. Injongo yale nqaku ilandelayo kukubonisa ukuphumelela kolunye unyango lwentlungu ye-migraine.

Uluhlu lweziganeko zeMigraine Changes Emva kovavanyo lweCandelo loPhando oluLawulayo

Abstract

Injongo: Ukubonisa iimpawu ezine ze-migraine, ababandakanyeka njengabathathi-nxaxheba kwi-trial trial kwi-chiropractic unyango olusisigxina lwe-spraine.
Indlela: Abathathi-nxaxheba kwinkqubo yokuphanda i-migraine, baphinde bahlaziywa iimpawu okanye iimpawu zekliniki kunye nokuphendula kwabo kwinyanga yokwenza unyango.
iziphumo: Iziganeko ezine ezikhethiweyo ze-migraine zasabela ngokuphawulekayo kwi-SMT, kwaye iimpawu ezininzi ezichaziweyo zichithwa okanye zincitshiswa kakhulu. Umlinganiselo wesantya seengqungquthela zancinciwe ngokwemitha yi-90%, ubude beqendu ngalinye ngu-38%, kwaye ukusetyenziswa kwamachiza kuncitshiswe ngu-94%. Ukongezelela, iimpawu ezininzi ezinxulumene nazo zancitshiswa kakhulu, kubandakanywa isicathulo, ukuhlanza, i-photophobia kunye ne-phonophobia.
Ingxoxo: Amatyala ahlukeneyo anikezelwa ukuncedisa oogqirha abenza ulwazi olungakumbi.
Imigqaliselo ebalulekileyo ye-Index (MeSH): I-Migraine, ukuxilongwa, unyango olusesikweni.

intshayelelo

I-Migraine, kwiifom zayo ezahlukeneyo, ichaphazela malunga ne-12 kwi-15% yabantu kwihlabathi lonke, kunye neziganeko eziqikelelweyo kwi-USA ye-6% yabesilisa kunye ne-18% yabesifazane (i-1). Ngokuxhomekeke kubuqili bokuhlaselwa okukhuselekileyo kubonakala ukuba ininzi, ukuba ayinjalo yonke, iimeko zemizimba zingathinteka (2). Ngenxa yoko i-migraine ibangela ingozi enkulu kubahlali abahlala rhoqo, ebenza ukuba bahluke kwiiyure ukusuka kumancinci ukuya kwi-3.

Enye inkcazo yokuqala ye-migraine igxininisa ubunzima obunokubakho kuphando lokuvavanya unyango lwe-migraine. �Ingxaki yentsapho ebonakaliswa kuhlaselo oluphindaphindiweyo lwentloko eguquguqukayo ngokubanzi, ukuphindaphinda kunye nobude. Uhlaselo luqhelekile kwaye ludla ngokunxulunyaniswa ne-anorexia, isicaphucaphu kunye nokugabha. Kwezinye iimeko zilandelwa, okanye zidibene nokuphazamiseka kwe-neurological and mood. Zonke ezi mpawu zingasentla azikho kuhlaselo ngalunye okanye kwisigulane ngasinye� (4). (I-Migraine kunye nentloko ye-World Federation of Neurology kwi-1969).

Ezinye zeempawu eziqhelekileyo ze-migraine ziquka intloko, i-aura, i-scotoma, i-photophobia, i-phonophobia, i-scintillations, i-nausea kunye / okanye ukuhlanza (5).

Umthombo weentlungu kwi-migraines ufumaneka kwiimitha zegazi ze-intra-extracranial (6). Iindonga zeempahla zegazi zintlungu evelele kwi-distension, traction okanye ukufuduka. Ukuxilongwa kwe-idiopathic yemithambo yegazi, kunye kunye nokwanda kwintlungu yokunciphisa intlungu, kubangelwa intloko ye-head headache (7).

I-Migraine iboniswe ukuba iyancitshiswe emva kweyonyango yokuguqula umlenze (8-18). Ukongezelela, olunye uphando lubonisa indima enokuthi iimeko ze-musculoskeal kwi-aetiology ye-migraine (19-22). Ukugqithiswa kakubi kwe-migraine okanye intloko yesifo sekhanda kungenza umphumo ophuculisayo wokuphucula (23). Ngoko ke, ukuxilongwa ngokuchanekileyo kufuneka kwenziwe, ngokusekelwe kwi-taxonomy evunyelweyo.

Inkqubo entsha yokwahlula ikhanda yenziwe yiKomidi yokuHlalwa kweNtloko yoMbutho weZizwe eziPhambili zeNtloko (i-IHS), equlethe uluhlu oluphambili olubandakanya i-migraine (i-24). Nangona kunjalo, le nkqubo ye-taxonomy isenokuba neendawo ezininzi ezinokubakho okanye ukuphikisana malunga nokuxilongwa kwentloko (23).

Eli phepha libonisa iziganeko ezintathu ze-migraine nge-aura (MA) kunye nenye ye-migraine ngaphandle kwe-aura (MW), icacisa iimpawu zabo, iimpawu zekliniki kunye nokuphendula kwi-chiropractic Treatment Manalative Treatment (SMT). Ababhali banethemba lokuphucula ulwazi lweengcali ze-migraine ezingaphendula kakuhle nge-SMT.

Iimpawu zeMigraine

I-IHS ichaza i-migraines njengobuncinane ubuncinci bezi zinto zilandelayo: indawo engafaniyo, umgangatho wokutsala, ukumodareyitha okanye ukuqina okukhulu, okunyanzeliswa ngumsebenzi oqhelekileyo womzimba. Ngexesha lentloko umntu kufuneka abe ne-nausea kunye / okanye ukugabha, kunye ne-photophobia kunye / okanye i-phonophobia (24). Ukongeza, akukho ngcebiso nokuba yeyembali, uvavanyo lomzimba okanye lwe-neurological ukuba umntu unentloko ebhalwe kumaqela 5-11 yenkqubo yokwahlulahlula (23-25).

Uphononongo lwangaphambili lombhali luneenkcukacha ezicacileyo zeentlobo ezahlukeneyo ze-migraine (8). I-aura yinto ephawulekayo phakathi kwezigaba zakudala eziqhelekileyo (MW) kunye ne-classic migraine (MA) (24). Ichazwe ngabagulayo be-migraine njengento e-opaque, okanye umgca we-zigzag ojikeleze ilifu, kunye namatyala e-hallucinations e-tactile abhalwe (6,7). Eyona auras ixhaphakileyo ibandakanya ukuphazamiseka kokubonwa kwe-homonymous, i-unilateral parathesias &/okanye ukuba ndindisholo, ubuthathaka obusecaleni, i-aphasia okanye ubunzima bokuthetha obungachazwanga.

Iindlela ezinokusetyenziswa zeentlobo ezahlukeneyo ze-migraine aziqondi kakuhle. Kukho inani leempawu ezicetywayo kwincwadi, kodwa akukho bani ubonakala ekwazi ukuchaza zonke iimpawu ezinokubangelwa ngabagulayo be-migraine (i-26). I-IHS ichaza utshintsho ekubunjweni kwegazi kunye nomsebenzi weplatelet njengendima ebangela. Iinkqubo ezenzeka kwindawo yengqondo zisebenza nge-trigemino-vascular system kunye ne-intra kunye ne-extracranial vasculature kunye nezikhala ze-perivascular (24).

Indlela

Ngokusekelwe kwiphando elidlulileyo lenkcazo (9) ebandakanya izifundo ze-32 ezifumana i-SMT ye-chiropractic ye-MA, amatyala amathathu aphakanyisiwe akhethwe ngenxa yeenguqu ezibalulekileyo isigulane esinokuhlangabezana nazo.

Abantu abane-migraines babhengezwa ukuba bathathe inxaxheba kwisifundo, nge-rediyo kunye namaphephandaba kwimimandla yaseSydney. Bonke abafake izicelo bazalise i-questionnaire, bavela kwiVernon (27) kwaye baxelelwe kwiphando langaphambili (9).

Abathathi-nxaxheba ukuba bathathe inxaxheba kwilingo banyulwe ngokulandela iimpendulo kwimibuzo yeempawu ezithile. Inkqubo yokuxilongwa kwe-MA yayikuthobela ubuncinane i-5 kulezi zibonakaliso ezilandelayo: ukuphendula kwintlungu efuna ukupheliswa kwemisebenzi okanye isidingo sokufuna indawo emnyama; intlungu ephakathi kweetempile; intlungu echazwe njenge-throbbing; iimpawu ezinxulumene neentlanzi, ukuhlanza, i-aura, i-photophobia okanye i-phonophobia; i-migraine yancinyiweyo yenguqu yemozulu; i-migraine iqhutywe yintloko okanye intshukumo yentamo; ukuxilongwa kwangaphambili kwe-migraine ngophando; kunye nembali yentsapho ye-migraine.

Abathathi-nxaxheba bekuye kwafuneka bafumane ukufudumala okungenani kanye ngenyanga, kodwa kungekhona imihla ngemihla kwaye i-migraines ayingenakuqaliswa ngengozi. Abathathi-nxaxheba bebangekho ngaphandle kweso sifundo ukuba kukho izichaso ezichaseneyo kwi-SMT, njenge-meningitis okanye i-aneurysm ye-cerebral. Ukongezelela, abathathi-nxaxheba be-arteritis yesikhashana, i-hypertenal intracranial hypertenal okanye izilonda ezihlala kuzo, nazo zingabandakanywa ngenxa yemicimbi yokhuseleko.

Ulingo lwenziwa kwiinyanga ezintandathu, kwaye luqulethwe ngamanqanaba e-3: iinyanga ezimbini zonyango lwangaphambili, unyango lweenyanga ezimbini, kunye neenyanga ezimbini emva kokunyanga. Abathathi-nxaxheba bagqibe iidayari ngexesha lovavanyo lonke beqaphela i-frequency, intensity, ubude, ukukhubazeka, iimpawu ezinxulumene nokusetyenziswa kweyeza kwisiqendu ngasinye se-migraine. Ukongezelela, iirekhodi zeklinikhi zifaniswa nokungena kwabo kwidayari ye-migraine episodes. Ngokufanayo, izifundo zidibene nomnxeba ngumlobi rhoqo emva kweeveki ezimbini kwaye zacela ukuba zichaze iziganeko ze-migraine ngokuthelekisa kwiidayari zabo.

Imbali eneenkcukacha yezigulane-iimpawu zentlungu ezizimeleyo zathathwa ngexesha lokubonisana kokuqala. Oku kubandakanya uhlobo lweentlungu, ubude bexesha, ukuqala, ubunzima, i-radiation, i-aggravating and reliving factors. Imbali yayiquka iimpawu zonyango, ukuphononongwa kweenkqubo ze-pathologies ezinokubakho, unyango lwangaphambili kunye nemiphumo yalo. Uvavanyo lwe-subluxation lubandakanya: uvavanyo lwe-orthopedic kunye ne-neurological, i-springing segmental, amanyathelo okuhamba okufana nokuqikelelwa okubonakalayo koluhlu lwentshukumo, ukuhlolwa kweeradiographs zangaphambili, iinkqubo ezithile zokuvavanya i-vertebral ye-chiropractic, kunye nokuphendula kwesigulane kwi-SMT.

Ukongezelela, uphando oluninzi lwama-vascular lwenziwa apho luboniswe khona, olubandakanya: uvavanyo lweerterbral test, ukuhlolwa kokunyanzelisa, ukuhlolwa kwengcinezelo yegazi, kunye nokuhlolwa kwesondo kwi-aortic eneurysm.

Ngethuba lexesha lokunyanga, izifundo zaqhubeka zirekhoda iigrafraine episodes kwidayari yabo, kwaye zifumana iifowuni zeefowuni ezivela kubalobi. Unyango lwaluquka ubukhulu obuncinane, ukunyuka kwamaqondo okuphambana okuphambene nomhlaba, okanye iinkalo zokulungiswa ezichongiweyo ukuhlolwa kweemviwo. Ukuthelekiswa kwenziwe ngeengqungquthela zokuqala zesigrafa ngaphambi kokuqala kokufunda kunye neenyanga ezintandathu emva kokuphela kwayo.

Icandelo 1

Umntwana oneminyaka engama-25 ubudala, i-65kg yaseCaucasian eyindoda enentlungu yentamo eyaqala ebuntwaneni, ukuba wayevakalelwa kukuba inxulumene nokuzalwa kwakhe ixesha elide. Ngethuba lembali isigulane sachaza ukuba wayenentloko ye-migraine rhoqo (i-3-4 ngeveki) eyayicinga ukuba inxulumene nengozi yemoto, iminyaka emibini ngaphambi kokubonisa kwakhe. Wachaza ukuba iimpawu zakhe ze-migraine yayiyintloko ebuhlungu, i-aura, isicaphucaphu, ukuhlanza, i-vertigo, kunye ne-photophobia. Ubuthongo buthanda ukuphelisa iimpawu kwaye wayefuna amayeza e-Allegren (25mg) yonke imihla.

Ukususela kwiidayari isigulane sasifuneka ukuba sigqibe kwisifundo, i-migraine yayiza kwenzeka ngamaxesha e-14 ngenyanga, igqibe umyinge weeyure ze-12.5 kwaye yayinokwenza imisebenzi emva kweeyure ze-8. Ukongeza i-analogue scale score (VAS) ye-avareji yesiqephu yayiyi-8.5 ngaphandle kwamanqaku aphezulu anokubakho alishumi, ahambelana nenkcazo yentlungu "eyoyikekayo".

Ekuhloliseni, wafunyanwa ene-suboccipital ne-upper musculature yomlomo wesibeleko, kunye nokunciphisa uluhlu lwesincinci phakathi kwe-occiput kunye ne-vertebra yokuqala yomlomo wesibeleko, i-atlanto-occipital facet joint (i-Occ-C1), kunye neentlungu zokuhamba kunye nokwandiswa yomlomo wesibeletho. Kwakhona waba nokunciphisa okunzulu kwi-thoracic spine motion kunye nokwanda kwe-kracphosis thoracic.

impatho

Isigulane safumana ukulungiswa kwe-chiropractic (kuchazwe ngasentla) kwisihlanganiso sakhe se-Occ-C1, umthamo ophezulu we-thoracic kunye ne-hypertonic musculature. Inkqubo yokuqala ye-16 eyahlukeneyo yonyango lwe-chiropractic yenziwa njengenxalenye yenkqubo yophando eyenziwa isigulane. Iprogram yayibandakanya ukurekhoda iimpawu eziliqela kuzo zonke iziganeko ze-migraine, kubandakanywa amanqaku anjengokubonakalayo, ubude, amayeza kunye nexesha ngaphambi kokuba babuyele kwisiqhelo imisebenzi. Ukongezelela, waboniswa ezinye iintambo kunye nezinye izivilo zentamo yakhe entanyeni kwaye wanyanzelisa.

Isiphumo

Isigulana sichaze ukuphuculwa okumangalisayo emva kwekhosi yonyango kwaye kuye kwanciphisa ngokuphawulekayo ukuphindaphinda kunye nokuqina kwemigraines. Oku kuye kwaqhubeka xa isigulane sidityaniswa kwixesha leenyanga ze-6 emva kokuba isifundo siphelile (Umfanekiso 1). Ngelo xesha isigulane sabika ukuba ne-2 migraines ngenyanga, kunye nenqaku le-VAS le-5 kwishumi, kwaye ixesha eliqhelekileyo liye lawela kwiiyure ze-7 (Imifanekiso 1-3). Ukongezelela, ngoku akazange asebenzise iyeza kwaye waphawula ukuba akasenaso isicaphucaphu, ukuhlanza, i-photophobia okanye i-phonophobia (Itheyibhile 1).

Uluhlu lwe-1 Ukuhlaziywa kweeNqaku ezikhethiweyo Ukunikezela nge-Migraine

Icandelo 2

Umabhalana oneminyaka engama-43 ubudala waseyunivesithi ekhalaza ngentloko engapheliyo ehlala ihleli kangangeentsuku ezintlanu, ingxaki ye-sinus ngenxa yokwaliwa, kunye nokuphazamiseka kokubona. Isigulane sathi safumana "migraines" eyenzeka ukususela kwiminyaka eyisibhozo. Ngexesha le-migraines wafumana isicaphucaphu, ukuphazamiseka okubonakalayo, i-photophobia, i-phonophobia kunye ne-scotoma. Iintlungu zazidla ngokuqala kufutshane neliso lakhe lasekunene kodwa zazihlala zitshintshela kwitempile yasekhohlo. Akazange achaze intlungu njengokubethelwa kwaye intlungu yayiyeka kuphela imisebenzi ngamaxesha ambalwa ngonyaka.

Isigulane sathi safumana i-migraines kanye ngenyanga, ngaphandle kwentsholongwane, xa i-migraines yayiza kwenzeka ubuncinane kanye ngeveki. Wayemiselwe i-hormone yonyango yokuguqula (HRT) kwiinyanga ezililishumi elinesibini emva kokumisa umva, okwakungatshintshanga imigraines. Wabuye wabika inani le-VAS lesibhozo kwisiqhelo sesiganeko kwaye isiqhelo sesiganeko siphelile phakathi kweeyure ezintandathu ukuya kweyisibhozo.

Kwimbali yakhe uye wanikela ingxelo yokuba uye wafumana ukuwa okuninzi ngelixa ekhwele ihashe phakathi kweminyaka esibhozo ukuya kwelishumi. Nangona kunjalo, wayekholelwa ukuba akukho mathambo aphukileyo ngexesha lokuwa, nangona oku akuzange kuqinisekiswe yi-radiographs ngexesha lokulimala. Wayenabantwana ababini kwaye ekhuthele, ngoku edlala intenetya, ehamba kwaye wayengumgadi okhutheleyo. Unyango lwakhe lwangaphambili lubandakanya amayeza angabhalwanga kwiingxaki zakhe ze-sinus (Teldane), nangona oku kungabonakali kuyikhulula i-migraine. Isigulana sathi ngaphambili wayenayo i-pethadine injections ngenxa yobunzima be-migraines.

Ekuhloliseni wayenokwanda oluthile lwe-thoracic kyphosis, ehambisana neTrapezius hypertonicity kunye namaphuzu okuqala. Wabonisa i-scoliosis encane (engekho kwi-Adams ukuvavanya) kwimimandla ye-lumbar ne-thoracic. Isigulana sinomlinganiselo wokulinganisela ekuhambeni kwemisipha yomlomo, ngokubhekiselele kumgca wesandla okhohlo kunye nokujikeleza okulungileyo.

impatho

Unyango lwalubandakanya uhlengahlengiso oluhlukeneyo lwe-chiropractic spinal, ngokukodwa kwi-C1-2, T5-6, i-L4-5 yamalungu ukulungisa umda wokuhamba. I-Vibrator massage, kunye nonyango lwe-infra-red lwalusetyenziselwa ukuncedisa unyango, ukukhulula i-spasm yemisipha yommandla ngaphambi kokuba uhlengahlengiso luhanjiswe. Isigulane sanikwa unyango lwe-14 kwiinyanga ezimbini zolingo lophando. Ukulandela unyango lokuqala wafumana intlungu yentamo ephakathi eyasombulula emva kweseshoni elandelayo.

Umzobo 1 utshintsho kwixesha eliqhelekileyo leMigraine Episodes yeeNkundla ezine

Umzobo 2 Utshintsho kwi-VAS izikolo ze-Migraines zeeNkundla ezine

Umzobo 3 utshintsho kwixesha leMigraines yeeNkundla ezine

Umzobo 4 utshintsho kwiMithi ye-Migraines yeeNkundla ezine

Isiphumo

Xa udityaniswa neenyanga ezintandathu emva kokufunda, isigulane sathi i-migraines ayizange ibe ne-migraine kwiinyanga ezine zokugqibela. Isiqendu sokugqibela uye waqaphela amanqaku e-VAS ancitshiswe ukuya kwisine, umyinge wexesha liye lancitshiswa laya kwiintsuku ezintathu kwaye ngoku wayewanciphise amayeza akhe ukuba angabikho (Fig 1-4). Ukongeza, ngoku wayene-nausea encinci, akukho photophobia okanye phonophobia, kwaye wayekuphucule kakhulu ukuhamba kwentamo. Wayeqhubekile efumana unyango lwe-chiropractic rhoqo ngenyanga, emva kokuphela kovavanyo lophando.

Icandelo 3

I-21 yinkwenkwekazi ubudala, i-171cm ende kakhulu iCaucasus iboniswe isikhalazo esiphambili se-migraines ezinzima. Isiqendu ngasinye sasihlala kwiiyure ezimbini ukuya kwezine, ngokuphindaphindiweyo kwee-episodes ezintathu ngeveki, kwaye zenzeke iminyaka emihlanu. Isigulane saxela ukuba i-neck post and shoulder shoulder, ehambelana nemigraines. Kwakhona ukholelwa ukuba i-migraine yokuqala yokunyanzelisa uxinzelelo kunye neziganeko ezilandelelanayo zaye zahlutha ngenxa yokuxinzezeleka kwengqondo. Isigulane asizange sichaze ezinye iingxaki zezempilo ngaphandle koxinzelelo olunzulu, apho engazange athathe amayeza.

I-migraines yesigulana yayibekwe kwindawo yangaphambili, yesikhashana kunye ne-occipital ngokudibeneyo. Akukho zimpawu zenzeke kwangaphambili ekuqaleni kwemigraines yakhe, kwaye akazange abe nokuphazamiseka okubonakalayo ngaphambi okanye ngexesha lee-migraine episodes. Uyichaze le ntlungu njengentlungu engayekiyo, ehlala kwindawo kwaye akazange akhalaze nakuphi na ukugula.

Ekuhambeni kokuqala, wahlawula i-migraine nganye phakathi kwe-4 kunye ne-5 kwi-VAS ye-1-10. Kwakhona waqaphela ukuba wayenomsoco, ukuhlanza, utywala, i-photophobia kunye ne-phonophobia.

Amanqanaba omlomo wesivalo ayewuncitshisiwe, ngokukodwa ngokujikeleza okufanelekileyo. Ukufunyaniswa kwenkalo kwabonakala kwi-trapezius, i-suboccipital kunye ne-supra scapulae izihlunu ngenxa yethoni ephakamileyo, umbala kunye nobushushu. Ukunyakaza kwesibonakaliso kubonise ukunyanzeliswa komda we-C1-2 kwi-facet ehlangene ngakwesokudla. Ukugqithisa okuphezulu kwe-supra scapular kunye ne-suboccipital ibonise iisisu ze-myofibrotic. Uvavanyo lwe-neurological ezifana neRhombergs, kunye novavanyo lwe-vertebrobasilar (Maines), lwalubi.

impatho

Unyango lokuqala yayikukucoca izihlunu kuncedwa ngumatshini wokuthambisa ngomatshini kwimithambo yemisipha ye-trapezius, suprascapularis kunye nemimandla yexeshana. Isigulana sinohlengahlengiso lomlomo wesibeleko se-C1- 2, kunye nohlengahlengiso kumacandelo e-T3-4 & T4-5.

Isigulane sabonwa emva kweentsuku ezintathu, apho wachaza ukuba intamo yakhe yayibuhlungu kakhulu. Nangona kunjalo, wayekhalaza ngeentlungu zentamo yasekunene kunye nesiyezi. Uvavanyo lubonakalise uthintelo lwesindululo sokwenziwa kwi-C1-2 segment yentshukumo. Umqolo wakhe we-thoracic wafunyanwa uthintelwe kwicandelo le-T5-6. Ukongeza, wayenomoya omncinci ukuya kwimodareyitha ye-hypertonicity kwi-suboccipital kunye nemisipha ye-paraspinal yomlomo wesibeleko kunye ne-supra scapular area. Waphinda wanyangwa �ngohlengahlengiso kunye nobuchule beethishu ezithambileyo. Isithintelo se-C1-2 ngasekunene salungiswa ngohlengahlengiso lomlomo wesibeleko. Isithintelo se-T5-6 siphinde salungiswa kwaye izicubu ze-myofibrotic zaphathwa nge-masseter.

Isigulana sabuya emva kweentsuku ezine. Wachaza ukuba ukufudumala kwakhe kuphuculwe. Wayengasenayo impawu ye-non-classical migraine. Nangona kunjalo, uvakalelo lwengcinezelo lwalube lukhona entloko, kodwa ngaphantsi kokuqala kokuqala unyango. Akukho intlungu yentamo. Uvavanyo lubonise umqobo wokunciphisa ukunyuswa kweC1-2 inxalenye yesiphakamiso. Kwakukho i-hypertonicity kwi-suboccipital ne-supra scapular muscle. Isigulane siphathwe ngokulungiswa komlomo kwiC1-2 nomsebenzi we-muscle kumaqela angama-muscle angentla. Ukuqeqeshwa kwamathambo kwacetyiswa kwakhona.

Itheyibhile 2 Utshintsho kwiZiphumo zeZiphumo zeMigraine Iziqendu zokuThetha kweeNkundla ezine

Isigulane sabonakala sisonke sezihlandlo ezilishumi elinesithathu kwisithuba seenyanga ezimbini, kwaye satsho ukuba i-migraine episodes yanciphise kakhulu kunyango lokugqibela. Ukongezelela, wayengenasova intlungu yentamo. Uvavanyo luveze ukukhawulelwa kwendlela yokunyuswa kwemiqathango kwiC1-2 inxalenye yesiphakamiso, eyancitshiswa ngokulungiswa.

Isiphumo

Isigulana saqhagamshelana neenyanga ezintandathu emva kovavanyo lokulandelelana, apho wachaza ukuba ufumene ukunciphisa i-migraine episodes ukuya kanye kwiinyanga ezimbini. Nangona kunjalo, amanqaku akhe e-VAS kwisiqephu esiphakathi ngoku sasiyi-5.5, kodwa ubude bexesha eliqhelekileyo lancitshiswa nge-50%. Ukongezelela, uye waphawula ukunciphisa i-photophobia kunye ne-phonophobia, kodwa wayenesiyezi. Isigulane siphinde saqaphela ukunciphisa ukusetyenziswa kweyeza kwi-Nurofen ezintathu ngeveki (i-12 ngenyanga) ukuya kweyesithathu ngenyanga, emele ukunciphisa i-75% (umzobo 1-4).

Icandelo 4

Umntu oneminyaka engama-34 ubudala, i-75kg yaseCaucasian eyindoda eneentlungu zentamo kunye nemigraines eyaqala emva kokuba ebethe intloko yakhe ngelixa wayehamba elwandle. Esi siganeko senzeke xa isigulane sineminyaka eyi-19 ubudala kodwa isigulane sathi i-migraines ifikelele kwi-25 yeminyaka ubudala. Isigulana sathi kwiminyaka eyi-25 ubudala wayenentloko ye-migraine (izihlandlo ezithathu ukuya kwezine ngeveki) kodwa ngoku kunyaka odlulileyo ngaphambi kwentetho yakhe wafumana kabini ngeveki. Wachaza ukuba i-migraines yakhe yaqala kwingingqi ye-suboccipital, kwaye yasasaza iliso lakhe lasekunene. Uye waxela ukuba yintloko ebuhlungu ebuhlungu, i-aura, isicaphucaphu, ukuhlanza, i-vertigo, kunye ne-photophobia. Isigulana sithe sithatha i-aspirin kunye neyeza le-mersyndol malunga namaxesha amane ukuya kwamahlanu ngeveki.

Isigulana sichaze ukuba isiqendu esiphakathi sithathe iiyure ezilishumi elinesibini ukuya kwezilishumi elinesibhozo kwaye wayenokwenza imisebenzi emva kweeyure ezisibhozo ukuya kwezilishumi. Ukongeza i-analogue scale score (VAS) ye-avareji yesiqephu yayiyi-7.0 ngaphandle kwamanqaku aphezulu anokubakho alishumi, ahambelana nenkcazo yentlungu ephakathi. Uye waxela ukuba wayenonyango lwe-osteopathic malunga neminyaka emithathu ngaphambili, olwalunike isiqabu sexeshana elifutshane, nangona kunjalo, unyango lwe-physiotherapy lubonakalise ukuba alusebenzi.

Ekuhloliseni, wafumanisa ukuba kuncitshiswe kakhulu kwi-thoracic motion motion and increase in kyphosis thoracic, kunye nokunciphisa uluhlu lwesincinci phakathi kwe-vertebra yokuqala kunye yesibini yomlomo wesibeleko (C1- 2), i-atlanto-occipital facet joint (Occ -C1), kunye neentlungu zokuhamba kunye nokwandisa umlenze wesibeletho. Kwakhona waba ne-suboccipital ne-upper musculature yomlomo wesibeleko, ngokukodwa i-trapezius muscle.

impatho

Isigulane safumana ukulungiswa kwendawo ye-chiropractic kwi-joint C1-2, umthamo ophezulu we-thoracic kunye ne-hypertonic musculature. Emva kwekhosi ye-14 yonyango (eqhutywe njengenxalenye yenkqubo yophando) isigulane samfumana ukuba wayejongene nomntu ogqirhayo emva kweentsuku ezimbini. Isigulane saxela ukuba isicupunu sasinciphile kwaye i-aura yayingabalulekanga.

Isigulane sichaze ukuphuculwa emva kokuba unyango lokuqala luqhubekile xa isigulane sidibene neenyanga ze-6 emva kokuba isifundo siphelile. Ngelo xesha isigulane sabika ukuba sine-migraine enye ngenyanga, kwaye inqaku le-VAS liye lawela kwi-6 kwabalishumi. Nangona kunjalo, ubude bexesha eliphakathi kunye nokubuyela kwimisebenzi yesiqhelo ixesha lahlala lifana nangaphambi kokuba unyango luqale. Isigulana saxela ukuba ngoku sisebenzisa iyeza elinye kuphela ngenyanga kwaye akasenaso isicaphucaphu, ukugabha, kunye ne-aura (Fig 1-4).

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

"Ukunyamekela kokunyamekela kwe-chiropractic kunye nokusetyenziswa kwamachiza kuyahluka njani xa kuvela intlungu ye-migraine?"Unyango lwe-Chiropractic migraine, olufana nonyango lwe-chiropractic spinal manipulative or spinal manipulation, lusetyenziswa ngokuqhelekileyo ukunceda ukuphucula kunye nokulawula iimpawu ze-migraine. Uninzi lweengcali zezempilo zikwasebenzisa amayeza rhoqo, anje nge-amitriptyline, ukunceda ukuthomalalisa iimpawu ze-migraine nangona olu khetho lonyango lunokuthi luthobe okwethutyana iimpawu kunokuba lunyange imeko evela kumthombo. Ukunyamekela kwe-Chiropractic kunye nokusetyenziswa kweyeza kunokusetyenziswa kunye ukunceda ukwandisa ukukhululeka kwonyango, njengoko kucetyiswa ngumsebenzi wezempilo. Izifundo ezininzi ezisekelwe kubungqina, njengalezo ezikulo nqaku, zibonise ukusebenza kwe-chiropractic unyango lwentlungu ye-migraine, nangona kunjalo, uphando olongezelelweyo lophando lufunekayo ukuze kuqinisekiswe umphumo wabo othile ekulawuleni ubuhlungu be-migraine. Ngapha koko, ezinye izifundo zophando zibonise ukuba amayeza anokusebenza njengonyango lwe-chiropractic spinal manipulative kodwa adityaniswa neziphumo ebezingalindelekanga ezininzi. Iziphumo ebezingalindelekanga eziqhelekileyo zamayeza afana ne-amitriptyline zibandakanya: ukozela, isiyezi, umlomo owomileyo, ukubona luzizi, ukuqunjelwa, ingxaki yokuchama okanye ukufumana ubunzima. Uvavanyo olongezelelweyo malunga nokusebenza kokuguqulwa komgogodla kunye ne-amitriptyline iyadingeka.

isiphelo

Ezi zifundo ezine zibonisa ukunciphisa okubonakalayo ukukhubazeka okuhambelana nemigraines (Itheyibhile 1). Izigqibo zilinganiselwe noko, kuba isifundo asiqukethe iqela lokulawula ukuthelekisa ukusebenza kwe-placebo. Ngako oko i-SMT ye-chiropractic ibonakala iyanciphise kakhulu ukukhubazeka kwemigraine kula bantu.

Abasebenzi kufuneka baqonde ngokucacileyo imigaqo yokuxilonga xa bethula izifundo okanye izifundo zecala ekusebenzeni kwonyango (8). Oku kubaluleke ngakumbi ekubonisweni kwe-migraine kunye nophando olwenziwe ngonyango (12, 23).

Utshintsho kwimilinganiselo yempembelelo ye-migraine iziganeko zentsingiselo yeziganeko ezine zibonise ezinye iziphumo ezithandekayo (Itheyibhile 2). Njengoko kunokubonwa etafileni, ubude beepisodes kunye nokusetyenziswa kwamachiza kuncitshiswa kakhulu kwiimeko ezine. Nangona kunjalo, umntu akanako ukugqiba ukuba le nto ingaba yimeko yabanye abagulayo ngenxa yeqela elincinci lamatyala anikezelweyo.

Ukwamkela

Umlobi uyabuxabisa kakhulu umnikelo weDkt Dave Mealing ekulungiseleleni iphepha.

Uvavanyo oluLungeleleneyo oluLawulayo lwe-Chiropractic Spinal Treatment Therapy kwi-Migraine.

Abstract

Injongo: Ukuvavanya ukuphumelela kwe-chiropractic ye-spinal manipulative therapy (SMT) kunyango lwe-migraine.
Design: Iilingo elilawulwa ngokungalindelekanga lwexesha leenyanga ze-6. Icandelo lalingamacandelo e-3: Iinyanga ze-2 zokuqokelela idatha (phambi kokonyango), iinyanga ze-2 zonyango, kunye nezinye iinyanga ze-2 zokuqokelela idatha (emva kokonyango). Ukuthelekiswa kweziphumo kwizinto zokuqala ezisezantsi zenziwa kwiphepha leenyanga ze-6 zombini kwiqela le-SMT kunye neqela lolawulo.
Ukubeka: Isiko loPhando lweChiropractic saseYunivesithi yaseMacquarie.
Aba nxaxheba: Amavolontiya angamakhulu amabini anamabini anesixhenxe phakathi kwexesha le-10 kunye ne-70 iminyaka babesetyenziselwa ukuthengiswa kweendaba. Ukuxilongwa kwe-migraine kwenziwe ngesiseko somgangatho we-International Headache Society, ubuncinane ubuncinane bodwa kwimigraine ngenyanga.
Amanyathelo: Iinyanga ezimbini ze-SMT (iindlela ezihlukahlukeneyo) zokulungiswa kwe-vertebral ezimiselwe ngunyango (ubuninzi bezonyango ze-16).
Izisiphumo eziphambili zeziphumo: Abathathi-nxaxheba bagqiba i-diaries ephezulu yamaphepha entloko ngexesha lonke uvavanyo luchaza ukuphindaphindiweyo, ubunzima (amanqaku afanayo anjengokufaniswa), ixesha, ukukhubazeka, iimpawu ezihambelanayo kunye nokusetyenziswa kwamachiza nganye kwisiqhelo.
iziphumo: Impendulo yomndilili yeqela lonyango (n = 83) ibonakalise ukuphuculwa kweenkcukacha manani kwimigraine (P <.005), ubude bexesha (P <.01), ukukhubazeka (P <.05), kunye nokusetyenziswa kwamayeza (P <.001 xa kuthelekiswa neqela lolawulo (n = 40). Abantu abane basilele ukugqibezela ukulingwa ngenxa yezizathu ezahlukeneyo, kubandakanya notshintsho kwindawo yokuhlala, ingozi yemoto, kunye nokunyuka rhoqo kwemigraine. Icacisiwe ngamanye amagama, i-22% yabathathi-nxaxheba baxele ngaphezulu kwe-90% yokuncipha kwemigraines njengesiphumo seenyanga ezi-2 ze-SMT. Phantse iipesenti ezingama-50 zabathathi-nxaxheba baxele ukuphucuka okubonakalayo ekuziphatheni kwesiqendu ngasinye.
Isiphelo: Iziphumo zolu phando zixhasa iziphumo zangaphambili zibonisa ukuba abanye abantu baxela ukuphucuka okubonakalayo kwimigraines emva kwe-chiropractic SMT. Ipesenti ephezulu (> 80%) yabathathi-nxaxheba baxele uxinzelelo njengeyona nto iphambili kwimigraines yabo. Kubonakala kunokwenzeka ukuba ukhathalelo lwe-chiropractic lunefuthe kwimeko yomzimba enxulumene noxinzelelo kwaye kwaba bantu iziphumo ze-migraine ziyancitshiswa.

Ukunyanyiswa kwe-Spinal vs. Amitriptyline yoNyango lweNtshukumo yokuHlaba-Uhlobo lweeNtloko: Uvavanyo lweNzululwazi olungalindelekanga.

Abstract

Injongo: Ukuthelekisa ukuphumelela kokusetyenziswa kwamagulane kunye nokunyanga amayeza (amitriptyline) kwintloko yesifo esiyingozi.
Design: Ulingo olulawulwa ngokungaqhelekanga usebenzisa amaqela amabini afanayo. Uphononongo lwaluqulethe ixesha lokusikela kwe-2-wk, ixesha leyonyango le-6-wk kunye ne-4-wk yokuhamba emva kokuhamba, ixesha lokulandelela.
Ukubeka: Iikliniki yokugulisa kwiiklinikhi.
Izigulane: Izigulane ezilikhulu elinamanci mahlanu phakathi kwexesha le-18 kunye ne-70 kunye nokuxilongwa kweentlobo zentlungu ezinokubangela ubuncinane ubuncinane bexesha leenyanga ze-3 ngexesha lokuhamba ubuncinane kanye ngonyaka.
Amanyathelo: I-6 wk yonyango olusisigxina lomhlaza olunikezwa ngamagqirha okanye i-6 wk yonyango ye-amitriptyline ephethwe ngunyango.
Izisiphumo eziphambili zeziphumo: Utshintsho kwintlungu yesifo sengqondo imihla ngemihla, ubukhulu bentloko yesonto, ukusetyenziswa kwamachiza kunye nokuziphatha kwezempilo (SF-36).
iziphumo: Inani le-448 abantu baphendule kwizikhangiso zokuqesha; I-298 ayibandakanyiweyo ngexesha lokujonga. Kwizigulane ze-150 ezibhaliswe kwisifundo, i-24 (16%) yaphuma: 5 (6.6%) ukusuka kwipilisi yokuxhaphaza emlanjeni kunye ne-19 (27.1%) kwiqela le-amitriptyline. Ngethuba lonyango, amaqela amabini aphuculwe ngamazinga afanayo kakhulu kuzo zonke iziphumo eziphambili. Ngokumalunga nemilinganiselo esezantsi kwi-4 wk emva kokupheliswa kwonyango, iqela lokuxhaphaza umgudu libonisa ukunciphisa i-32% kwintlungu yesifo, i-42% kwintloko yesisindo, i-30% kwindlela yokusetyenziswa kwamachiza ngaphezulu kunye nokuphuculwa kwe-16% imeko yezempilo. Ngokuthelekisa, iqela le-amitriptyline lonyango alibonanga ukuphuculwa okanye ukugqithisa okuncinane ukusuka kwiimilinganiselo ezisezantsi. Ukulawula ukungafani kokuqala, yonke ingxaki yeqela kwi-4 wk emva kokupheliswa kweyeza kuthathwa njengento ebaluleke kakhulu ekliniki kwaye yayibaluleke kakhulu. Kwizigulane ezigqibile ukufundisisa, i-46 (82.1%) kwiqela le-amitriptyline lonyango libike iziphumo ezibandakanya ukulala, umlomo owomileyo kunye nokufumana ubunzima. Izigulane ezintathu (i-4.3%) kwiqela lokuxhaphaza umgudu libizela intliziyo embi kunye nokuqina.
Izigqibo: Iziphumo zolu pho nonongo lubonisa ukuba unyango olusisigxina lomlwanyana luyonyango olufanelekileyo lweentloko zentsholongwane. Ulwaphulo lwe-Amitriptyline lwalusebenza kancinci ngakumbi ekunciphiseni ubuhlungu ekupheleni kwexesha lokunyanga kodwa lwahlanganiswa nemiphumo engaphezulu. Kodwa emva kweeveki ezine emva kokupheliswa konyango, izigulane ezithe zafumana unyango olusisigxina emlanjeni lwafumana inzuzo yokwelapha kuzo zonke iziphumo eziphambene nezigulane ezithe zafumana unyango lwe-amitriptyline, obuye wabuyela kwiimpawu zokuqala. Inzuzo yokwelapha eqhubekayo ehambelana nokuphathwa kwemigudu ibonakala ibangela ukuba kunciphise imfuno yeyeza-counter-counter. Kukho imfuneko yokuvavanya ukuphumelela kwonyango lokugulisa amagulane ngaphezu kweeveki ezine kwaye uqhathanise unyango olusisigxina lomzimba kwindawo efanelekileyo ye-placebo efana nokuphathwa kwe-sham in trials.

Ukuququmbela,Ezi zifundo zophando zilandelayo zibonise ukusebenza kwe-chiropractic yonyango lwe-spinal manipulative ngelixa uphando oluthile luthelekisa nokusetyenziswa kwe-amitriptyline ye-migraine. Eli nqaku liqukumbela ukuba zombini unyango lwe-chiropractic migraine unyango kunye namayeza asebenze kakhulu ekuphuculeni intloko ye-migraine, nangona kunjalo, i-amitriptyline ibikwa ukuba ibonise iziphumo ezahlukeneyo zecala. Ekugqibeleni, izigulane zinokukhetha unyango olungcono kakhulu kwiintlungu zabo ze-migraine, njengoko kucetyiswa ngumsebenzi wezempilo. Ulwazi olubhekiselele kwiZiko leSizwe loLwazi lweBiotechnology (NCBI). Ububanzi bolwazi lwethu bukhawulelwe kwi-chiropractic kunye nokulimala komgogodla kunye neemeko. Ukuxoxa ngombandela, nceda uzive ukhululekile ukubuza uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Intlungu Yentambo

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

ISIHLOKO ESIBALULEKILEYO: I-EXTRA EXTRA: Ungcono!

EZINYE IINGCUKACHA EZIBALULEKILEYO: UKWENZISA: Ukulimala kwezemidlalo? | Vincent Garcia | Umonde | El Paso, TX I-Chiropractor

Ngenanto

Ucaphulo

1. I-Lipton RB, uStewart WF. I-Migraine e-United States: ukuhlaziywa kwe-epidemiology kunye nokusetyenziswa kwezempilo. Neurology 1993; 43 (I-Suppl 3): S6-10.
2. Stewart WF, Lipton RB, Celentous DD, et al. Ubuninzi bentloko ye-migraine e-United States. JAMA 1992; 267: 64-9.
3. UKumkani J. Migraine kwindawo yoMsebenzi. Brainwaves. I-Australian Brain Foundation 1995. I-Hawthorn, iVictoria.
4. Intloko kaWolf kunye nezinye iintlungu zentloko. Ihlaziywe nguDalessio DJ. 3rd Ed 1972 Oxford University Press, New York.
5. Linet OS, Stewart WF, Celentous DD, et al. Uvavanyo lwesifo seentloko phakathi kwentsha kunye nabantu abadala. JAMA 1989; 261: 221-6.
6. U-Anthony M. Migraine kunye noLawulo lwayo, i-Australian Family Physician 1986; 15 (5): 643-9.
7. Sjasstad O, Fredricksen TA, Sand T. Ukuhlaselwa kwentlungu yokuqala yokuhlaselwa: ukuthelekiswa phakathi kwe-classic migraine kunye neentloko zentloko. I-Neurology esebenzayo ye1989; 4: 73-8
8. Tuchin PJ, Bonello R. Classic migraine okanye hayi classic migraine, lowo ngumbuzo. U-Aust Chiro kunye no-Osteo 1996; 5: 66-74.
9. Tuchin PJ. Ukusebenza kwe-Chiropractic Spinal Manipulative Therapy (SMT) kunyango lwe-Migraine-Isifundo soPhando. U-Aust Chiro kunye no-Osteo 1997; 6: 41-7.
10. I-Parker GB, iTupling H, iPryor DS. Uvavanyo olulawulwayo lweMiqathango yokuSebenza koMlomo ku-Migraine, Aust NZ J Med 1978; 8: 585-93.
11. IHasselburg PD. IKhomishini yoPhando kwiChiropractic. I-Chiropractic eNew Zealand. I-1979 yokuprinta iHhovisi leNew Zealand.
12. I-Parker GB, iTupling H, iPryor DS. Kutheni Kutheni Ukunyuka Kwemigudu Kuphuculwe Ngethuba leNtsholongwane? Iziphumo ezongezelelweyo kwi-Trial of Manipulation of Migraine. U-Aust NZ J Med 1980; 10: 192-8.
13. UVernon H, uDhami MSI. I-Vertebrogenic Migraine, J Canadian Chiropractic Assoc 1985; 29 (1): 20-4.
14. Wight JS. I-Migraine: Uhlalutyo lweSatisatis of Chiropractic Treatment. J Am Chiro Assoc 1978; 12: 363-7.
15. UVernon H, uSteiman I, Hagino C. I-Cervicogenic Dysfunction kwi-muscle contraction headache kunye ne-migraine: isifundo esichazayo. J Uluhlu lwePhysiol Ther 1992; 15: 418-29.
16. U-Whittingham W, u-Ellis WS, iMolyneux TP. Impembelelo yokuphathwa (ukuguqula ubuchule bokubuyisela) kwiintloko zomzimba kunye ne-upper joint side of the colervical disadvantage: ityala lokufunda. J Uluhlu lwePhysiol Ther. 1994; 17 (6): 369-75.
17. Lenhart LJ. Ulawulo lweChiropractic lwe-Migraine ngaphandle kwe-Aura: Ucwaningo lwetyala. JNMS 1995; 3: 20-6.
18. I-Tuchin PJ, i-Scwafer T, i-Brookes M. Isifundo se-Head of Headaches. Aust Chiro Osteo 1996; 5: 47- 53.
19. UNelson CF. Intloko yexinzelelo, i-migraine iyaqhubeka: I-hypothesis. J Uluhlu lwePhysiol Ther 1994; 17 (3): 157-67.
20. I-Kidd R, uNelson C. Musculoskeletal ukungasebenzi komsi kwimigraine kunye nokukhathazeka kwentloko. Intloko ye1993; 33: 566-9.
21. UMilne E. Umatshini kunye nokunyanga kwe-migraine kunye nezinye iziphazamiso zentsholongwane yesibeleko kunye nesemva kwesithuba. Cephalgia 1989; 9 (I-Suppl 10): 381-2.
22. Intsha K, uDharmi M. I-Efficacy yoxhaphazo lwentsholongwane ngokuchasene nemithi yokwelapha kwiprogram yegrafraine. Ukuthengiselana kwe-Consortium ye-Chiropractic Research. 1987.
23. UMarcus DA. I-Migraine kunye nohlobo lweentloko zesifo: ukuqinisekiswa okungaqinisekiyo kweenkqubo zangoku zokuhlaziya. Ubuhlungu 1992; 8: 28-36.
24. IKomidi yokuHlalwa kweNtloko yeNtloko yeSizwe, uMbutho. Inkqubo yokuhlenga kunye nokuxilongwa kweengxaki zentloko, i-neuralgias kunye neentlungu zomzimba. Cephalgia 1988; 9 (I-Suppl 7): 1-93.
25. URasmussen BK, uJensen R, Schroll M, u-Olsen J. Ukuxubana phakathi kwe-migraine kunye nohlobo lweentloko zentlungu kubantu bonke. IArch Neurol 1992; 49: 914-8.
26. I-Vernon H. Ephezulu I-Cervical Syndrome: I-Diagnosis and Treatment. KuVernon H. (Ed): Ukuchongwa okungafaniyo kweentloko. 1988 Baltimore, Williams kunye noWilkins.
27. Vernon HT. Ukuguqulwa kwamagqabi kunye nentloko yentloko yomlomo wesibeleko. J Uluhlu lwePhysiol Ther 1989; 12: 455-68.

Vala i-Accordion

Ukuphathwa kwentloko ye-Chiropractic Treatment | El Paso, TX I-Chiropractor

by iicrosoft | Chiropractic, LweMpilo, Migraine

I-migraine ichongwa ngokuqhelekileyo ngeentlungu ezinzima okanye ukuxhalaba, ngokuqhelekileyo kwelinye icala lentloko, ngokuqhelekileyo lihamba kunye nesicathulo, ukuhlanza nokuvelela okukhulu ukukhanya nokuvakala. Inhlungu yentloko ye-Migraine inokuhlala ixesha elide ukuya kwiintsuku kwaye iimpawu zingaphaya kakhulu ziyakwazi ukukhubaza. Oogqirha abaninzi banokuphatha ukuhluka kweentlungu zentlungu, nangona kunjalo, ukusetyenziswa kweziyobisi kunye / okanye imishishini kunokukhawuleza ukuphucula iimpawu ezibuhlungu. Uphando olusiseko-uphando olusiseko olufana nolwachazwe ngezantsi, luye lwafumanisa ukuba unyango lwe-chiropractic lwe-spinal manipulation lungaphumelela ekuphuculeni i-migraine intloko. Injongo yale nqaku kukufundisa izigulane zentsholongwane ye-headaches ye-chiropractic unyango.

Iinyanga ezili-12 zeNtsholongwane yeCliniki ye-Chiropractic Spinal Treatment Treatment ye-Migraine

Abstract

Injongo: Ukuvavanya ukuphumelela kwe-Chiropractic yonyango yolondolozo lwentlobo (SMT) kunyango lwe-migraine.
Design: Uvavanyo lwekliniki olulindelekileyo lweenyanga ezililishumi elinambini. Icandelo lalingamacandelo e-3: inyanga ezimbini zonyango, unyango lweenyanga ezimbini, kunye neenyanga zenyanga zonyango. Ukuthelekiswa kweziphumo kwizinto zokuqala zokuqala zenziwe kunye neenyanga ze-6 emva kokupheliswa kokufunda.
Ukubeka: Isiko loPhando lweChiropractic saseYunivesithi yaseMacquarie
Aba nxaxheba: Amavolontiya angamashumi amathathu amabini, phakathi kweminyaka eyi-20 ukuya kwi-65 babesetyenziselwa ukuthengiswa kweendaba. Ukuxilongwa kwe-migraine kwakusekelwe kwiphepha lemibuzo echongiweyo, kunye ne-migraine encinci ngenyanga.
Amanyathelo: Iinyanga ezimbini ze-SMT ye-chiropractic kwiindawo zokulungisa izilwanyana ezinqunywe ngu-practitioner, ngokusebenzisa i-orthopedic and chiropractic testing.
Izisiphumo eziphambili zeziphumo: Abathathi-nxaxheba bazalise ii-diari ngexesha lovavanyo lonke ekuboneni ukuphindaphinda, ubunzima (amanqaku afanayo anjengomfanekiso), ubude, ukukhubazeka, iimpawu ezihambelanayo kunye nokusetyenziswa kwamachiza nganye kwisiganeko se-migraine.
iziphumo: Abathathi-nxaxheba bokuqala abangama-32 babonisa ukubalwa okuphawulekayo (p <0.05) ukuphucula imvama ye-migraine, i-VAS, ukukhubazeka, kunye nokusetyenziswa kwamayeza, xa kuthelekiswa namanqanaba okuqala okuqala. Olunye uvavanyo lweziphumo emva kokulandela inyanga ezintandathu (ngokusekwe kubathathi-nxaxheba abangama-24), kuqhubekile nokubonisa ukuphuculwa kwezibalo kwimigraine (p <0.005), VAS (p <0.01), ukukhubazeka (p <0.05), kunye nokusetyenziswa kwamayeza (p <0.01), xa kuthelekiswa namanqanaba okuqala asisiseko. Ukongeza, ulwazi lwaqokelelwa ngokubhekisele kulo naluphi na utshintsho kwintlungu yentamo elandela i-SMT ye-chiropractic. Iziphumo zibonise ukuba abathathi-nxaxheba abayi-14 (58%) baxela ukuba akukho kunyuka kwentlungu yentamo ngenxa yeenyanga ezimbini ze-SMT. Abathathi-nxaxheba abahlanu (21%) babike ukonyuka okuncinci, abathathi-nxaxheba abathathu (13%) baxela iintlungu ezincinci, kwaye abathathi-nxaxheba ababini (8%) baxela iintlungu ezilinganayo.
Isiphelo: Iziphumo zolu pho nonongo zixhasa inkxaso-mpilo yokuba i-Chiropractic SMT yonyango olufanelekileyo lwe-migraine, kwabanye abantu. Nangona kunjalo, ukufundwa okuphambili okulawulwayo kuyadingeka.
Imigqaliselo ebalulekileyo ye-Index (MeSH): Migraine; chiropractic; ukuguqulwa kwamagxa; eliza kuhlola; entanyeni.

intshayelelo

Umgudu wesibeleko njengesibangelwa intloko sele ichazwe kakuhle kwiincwadi (1,2). IKomidi yokuHlalwa kweNtloko yoMbutho weZizwe eziKwazisa iintloko, ichaze intloko yesifo sekhanda, ngaphezu kwezinye iintlobo zeentloko, kubandakanywa i-migraine kunye nohlobo lwentloko yesifo (3).

Nangona kunjalo, indima yeemeko zomgudu (ingakumbi umlenze wesibeleko) kunye nokunyanga kwabo kunye nokunyanga kwabo kwimigraine ayinalo ubudlelwane obuhle obuqinileyo okanye umzila ocacileyo (4-7). Ukongeza, i-migraine isoloko ine-criteria ye-diagnostic engaqinisekiyo okanye engagqithisiyo ngoko ukwenza indima yomlomo wesibeletho njengento engabonakaliyo (8,9).

Ukuphathwa kwentloko ye-Chiropractic Treatment | El Paso, TX I-Chiropractor

Iimigraines ziimeko eziqhelekileyo nezixhatshazayo kodwa ngenxa yolu hlobo olungaqinisekiyo lwe-etiology, unyango olude olude kakhulu aluzange lusekwe (9,10). Iimodeli ezininzi ezinxulumene neengxaki ezinxulumene nezimbande ze-migraine, apho iipasipoti zibonakala ziqaliswa ukuhamba kwegazi ku-cerebrum elandelwa ngu-extracranial vasodilatation ngexesha lesigaba sekhanda (11,12). Nangona kunjalo, ezinye iimodeli ezibonakalayo zibonakala zixhomekeke kwiinguqu ze-vascular ezihambelana nezizathu ze-neurolotiki kunye nokuphazamiseka kwe-serotonergic (10). Ngoko ke, unyango lwangaphambili lujolise ekuguquleni kwe-pharmacological ukuhamba kwegazi okanye i-serotonin block block (11).

Eli phepha liza kuphonononga ukuphumelela kwonyango lokuguqulwa kwamanzi emgulwini ngexesha lovavanyo lwekliniki lweenyanga ezililishumi elinambini.

Unyango lweChiropractic

I-SMT ye-Chiropractic ichazwa njengendlela yokuhamba ngokubambisana kweso sihlandlo esinezinto ezihlangeneyo ziqhutywe ngaphaya kweendlela eziqhelekileyo zokuhamba ngaphandle kokudlula imida ye-intanethi ye-anatomical (4). I-SMT idinga amandla ashukumisayo kwicala elithile, ngokuqhelekileyo nge-amplitude emfutshane ukulungisa ingxaki yokunciphisa i-vertebral motion okanye inkcazo yendawo. Uphulo luvame ukuqukwa kwamaplitude amancinci, ukukhawuleza okuphambene nokunyanzeliswa kwezinto eziphambeneyo (iindlela ezihlukahlukeneyo), kwimimandla yokulungiswa kwezilwanyana ezinqunywe ngumlando weklinikhi kunye neemviwo zomzimba.

UDkt. Jimenez usebenza kwi-wrestler's neck_preview | El Paso, TX I-Chiropractor

The most commonly used factors to locate vertebral fixation (denoted vertebral subluxation complex by�chiropractors) are a clinical history relating to mechanical pain patterns and medical details to excluded possible non- mechanical causes (4). These findings would then be confirmed by a thorough physical examination, by assessing which tests/signs (orthopaedic and chiropractic) were able to reproduce the presenting symptom (7).

Izifundo ekusebenzeni kunye neendleko-mpu melelo zonyango emva kweentlungu ziye zathola inzuzo enkulu kwi-chiropractic ye-spinal manipulative therapy (SMT). Ezi zifundo zichazwe kwiphepha elidlulileyo ngumbhali we-chiropractic kwinkqubo yokuhlawula abasebenzi (i-13). Ukongezelela, uphando oluninzi luye lwafumanisa ukuphucula intlungu yentloko kunye nentloko emva kwesifo se-SMT (4,7,14-17).

Eli phepha liza kuhlola iingcamango zokuba izimo zomgumbe zibonakala zifaka isandla kwi-aetiology kunye nokuxhatshazwa kwe-migraine.

Indlela

Isifundo sasineenyanga ezilishumi elinesibini esilindele ukuvavanywa kweekliniki ezibandakanya izifundo ze-32 ezifumana iikhosi ezimbini ze-SMT kwikota. Unyango lwaluquka ubukhulu obuncinane, ukunyuka kwempembelelo ephezulu yokuphamba kwamanzi (ukuchithwa kwe-chiropractic technique), kwimimandla ye-vertebral subluxation enqunywe uvavanyo loqobo.

Abathathi-nxaxheba baqeshwa ngonomathotholo kunye namaphephandaba kwingingqi yaseSydney. Abafakizicelo bagcwalise iphepha lemibuzo ebelixeliwe ngaphambili, kwaye bakhethwa ngokweempendulo kwezi mpawu zilandelayo. Abathathi-nxaxheba badinga ubuncinci be-5 kwezi zikhombisi ze-IHS zilandelayo: ukuphendula kwintlungu efuna ukupheliswa kwemisebenzi, isidingo sokufuna indawo emnyama ethuleyo, iintlungu ezingafaniyo ezibekwe kwindawo yokwexeshana, iintlungu ezichazwe njengokutshiza / ukubetha, iimpawu ezinxulumene nesicaphucaphu & / okanye ukugabha, i-photophobia kunye / okanye i-phonophobia, i-migraine eyonyuswe yintshukumo yentloko okanye yentamo, kunye nembali yosapho ye-migraine (3).

Ukufakwa kwaye kwaxhomekeka kubathathi-nxaxheba abafumana ubuncinane i-migraine ngenyanga. Ukugxothwa kwakusekelwe kwizibonakaliso ezingekho kwemigraine ye-migraine yemihla ngemihla okanye ukuqala kokubandezeleka. Abathathi-nxaxheba babandakanywa ngaphandle kweso sifundo ukuba kukho izichaso ezichaseneyo kwi-SMT, njenge-meningitis okanye i-aneurysm ye-cerebral. Ukongezelela, abathathi-nxaxheba nge-arteritis yesikhashana, ukuxinzeleleka kwengozi ye-hypertension okanye izilonda ezihlala phantsi nazo zazingabandakanywa ngenxa yemicimbi yokhuseleko.

Participants completed diaries during the initial six month trial noting the frequency, VAS, duration, disability, associated symptoms and use of medication for each migraine episode. Participants were instructed how to complete the diary which contained a table and an�instruction sheet. Participants had to note the date of the migraine, an intensity score based on a visual analogue scale, the hours the migraine lasted and the time before they could return to normal activities. In addition, participants noted associated symptoms using a letter abbreviation and they noted the type and strength of medication for each migraine episode.

Ukuphazamiseka komonde kwafezekiswa ngabathathi-nxaxheba bekwaziswa ukuba banokuthi banikezwe ngokukhawuleza iqela lokulawula eliza kufumana unyango lwe-placebo (ongasebenzi) unyango. Ngokukhawuleza, oogqirha "baphuphutheke" kwimiphumo yonyango yangaphambili, isabelo solawulo lwenkqubo kunye nezinye iziphumo.

Umba wokuqala wolu vavanyo wenziwa ngaphaya kweenyanga ezintandathu, kwaye iqukethe izigaba ze-3: iinyanga ezimbini zonyango lokuqala, unyango lweenyanga ezimbini, kunye neenyanga zenyanga zonyango. Abathathi-nxaxheba baqhagamshelana nombhali emva kweenyanga ezintandathu emva kokuvavanywa kokuqala kwaye bacela ukuba bazalise enye i-questionnaire malunga nemigqaliselo ye-migraine yangoku ngokuthelekiswa nolwazi olusiseko. I-questionnaire elandelelanayo yafunwa ulwazi malunga nemilinganiselo yempembelelo efanayo, njengoko kucacisiwe kwiidayari ezichazwe ngasentla.

Ukuthelekiswa kwenzelwe ukulinganiswa kokuqala kwesiphumo sokuqala kwemigraine ngaphambi kokuqalisa kwe-SMT, idatha ekupheleni kweenyanga ezimbini emva kwe-SMT, kwaye kwinyanga yesithandathu ilandele idatha. Uhlalutyo lwesitatisti lubandakanyeka ukuthelekisa utshintsho lweziphumo ezahlukeneyo zesiphumo, i-VAS, ubude, ukukhubazeka, kunye nokusetyenziswa kwamachiza kulo lonke uvavanyo. Uvavanyo lweetatisti oluqeshwe luyivavanyo lokubambisana kunye nokuvavanya ukuhlukana okukhulu phakathi kweqela ngalinye kunye nohlalutyo olulodwa lokuhlukana (ANOVA) ukuvavanya utshintsho kuwo onke amaqela.

UDkt Jimenez White Coat

Insight of Dr. Alex Jimenez

"Ngaba unyango lwe-chiropractic unyango olusisigxina lunceda njani ukulawula intlungu yam intloko ye-migraine?"�Although researchers today don’t know the definitive cause behind these complex headaches, many healthcare professionals believe migraines are often the result of an underlying issue along the cervical spine, or neck. If you suffer from migraine headache pain, chiropractic treatment can help correct spinal misalignments, or subluxations, in the cervical spine to improve the severity of the headache and decrease their frequency. It’s not necessary to rely on drugs and/or medications to relieve the painful symptoms, however, these may be used if properly directed by a healthcare professional. Rather than focusing on the head pain alone, a doctor of chiropractic will target the source of the issue and help improve your overall health and wellness.

iziphumo

Abathathi-ntathu ababini abathathi-nxaxheba, phakathi kwexesha le-23 ukuya kwi-60, bajoyine isifundo kunye nabafana be-14 kunye ne-18kazi. Itheyibhile 1 inikeza inani leenkcukacha ezichazayo kwiqela. Ubungakanani bexesha umntu ayenemigraines ephakathi kwe-5 ukuya kwi-36 iminyaka yeqela, kunye neminyaka eyi-18.1. Ubungakanani benkqutyana ye-migraine ephakathi kwe-0.75 ukuya kwii-108 iiyure zeqela, kunye neyure ephakathi kweeyure ze-23.3. Ukukhubazeka (ubude bexesha ngaphambi kokuba umntu abuyele kwimisebenzi eqhelekileyo) ye-migraine eqhelekileyo phakathi kwe-0 ukuya kwi-108 iiyure zeqela, kunye neyure ephakathi kweeyure ze-25.0.

Itheyibhile 1 Izibalo eziqhathanisiweyo neQela ngaphambi kokuqalisa isifundo | UDkt Alex Jimenez | El Paso, TX I-Chiropractor

Impendulo yeempesenti nganye kwinkqubo yokuxilonga ye-IHS izikhokelo zichazwe kwitafile 2 (Itheyibhile 2). Izimpendulo ezona ziphezulu ze-photophobia (i-91%), isicupunu (88%), ukusabela kwiintlungu ezifuna umntu ukuba afune indawo emnyama (84%), i-phonophobia (72%), uphawu lweentlungu (69%), iparieto- indawo yeentlungu (69%), ukungakwazi ukuqhubeka nemisebenzi eqhelekileyo (66%), kunye nembali yentsapho (63%).

Ithebula 2 I-IHS Imigaqo-mibuzo Iimpendulo zeqela ngaphambi kokuba kuqalwe iSifundo ... UDkt Alex Jimenez | El Paso, TX I-Chiropractor

I-criteria ye-IHS yokuxilonga ngeempendulo eziphantsi kunazo zonke ziyi-aura (31%), i-migraines iqhutywe yintloko okanye intshukumo yokunyakaza (53%), nokuhlanza (56%). Inani elilinganayo (44%) labantu abazange babonise i-aura njengento, nangona kunjalo, bachaza ukuba iinguqu ezibonakalayo ezibonakalayo okanye i-parasthesias. Ngoko ke, inani labantu abafumana i-migraine ne-aura (MA) kweli qela liyi-twenty-four (75%) yeqela elipheleleyo lamashumi amathathu anamibini.

Iqela libonise ukuphuculwa kweenkcukacha manani (p <0.05) kwimigraine frequency, VAS, ubude kunye nokukhubazeka, xa kuthelekiswa namanqanaba okuqala okusisiseko. Amanqanaba amarhoqo ancitshiswe ngama-46% kwiqela, ubukhali bancitshiswe nge-12%, ixesha elincitshiswe ngama-20%, ukukhubazeka kuncitshiswe yi-14% kuphela umntu othathe inxaxheba (3.1%) uxele ukuba iziqendu zabo ze-migraine zazimbi kakhulu emva kweenyanga ezimbini ze-SMT, kodwa oku akuzange kuxhaswe kwiinyanga ezimbini zokulandelwa konyango. Itheyibhile 3 ibonisa amanqaku ahlukileyo kudidi ngalunye lwamathandathu edayari kwizigaba ezithathu zetyala.

Ithebula 3 Iziphumo zokuqhathanisa zeQela ngaphambi kokuqalisa isifundo | UDkt Alex Jimenez | El Paso, TX I-Chiropractor

From the initial thirty two participants who entered the study, four participants failed to complete the entire trial, one due to alteration in work situation, one due to a fractured ankle, one due to soreness after SMT, and one ACO�following a perceived worsening of their migraine due to chiropractic SMT. In addition, four people failed to return their six month follow up data, and were excluded from the assessment. Therefore the assessment of changes in migraine at the twelve month period was based on 24 participants. Table 4 gives the comparative statistics for this group at the end of the 12 month period.

Itheyibhile 4 utshintsho kwiZiphumo zeZiphumo zeeNqanaba zokuQala eziQelayo Ukuthelekiswa neenyanga ze-12 Ukulandela | UDkt Alex Jimenez | El Paso, TX I-Chiropractor

Impendulo yomndilili kwiinyanga ezilishumi elinambini (n = 24) ibonakalise ukuphuculwa kwezibalo kwimigraine (p <0.005), VAS (p <0.01), ubude bexesha (p <0.05), kunye nokusetyenziswa kwamayeza (p <0.01), xa kuthelekiswa amanqanaba okwandlalela okusisiseko (Umzobo ????). Indawo enkulu yokuphucula yayihamba rhoqo iziqendu (i-60% yokuncitshiswa), kunye nobunzima obudibeneyo be-migraine nganye (ukunciphisa kwe-14%). Ukongeza, ubude be-migraine (i-20% yokunciphisa) kunye nokusetyenziswa kwamayeza, kuncitshiswe kakhulu kulandela ukungenelela kwe-SMT (ukuncitshiswa kwe-36%). Itheyibhile 3 ibonisa ukuba amanqaku ahlukeneyo kwizigaba ezithathu zetyala kunye nokubaluleka kweenkcukacha manani ngohlalutyo lokwahluka (ANOVA).

Esinye isiphumo esongezelelweyo esimalunga nentlungu yentsimbi. Abathathi-nxaxheba abalishumi elinesine (58%) babike ukuba akukho kunyuka kwentlungu yentamo ngenxa yeenyanga ezimbini ze-SMT. Abathathi-nxaxheba abahlanu (i-21%) babike intlungu encinci, abathathi-nxaxheba abathathu (13%) babalisa intlungu ebunzima, kwaye abathathi-nxaxheba ababini (8%) babika intlungu ephakathi.

ingxoxo

Uninzi lwabathathi-nxaxheba bebengabantu abanesifo esingapheliyo se-migraine, ngokomyinge abanamava emigraines kwiminyaka eyi-18.1. Nangona kunjalo, iziphumo zibonise ukunciphisa okuphawulekayo (p <0.005) kwiimpawu zabo ze-migraine kunye nokukhubazeka kwabo. Inani elichazayo lemigraines ngenyanga lincitshisiwe ukusuka kwi-7.6 ukuya kwi-episodes ze-2.6.

Ukufundwa kweenyanga ezilishumi elinambini kwenza iziphumo zibaluleke kakhulu kuba ukugxekwa kwezifundo zakuqala kwakude ukuba ubude boluvavanyo bebufutshane kakhulu ukuba bungavumeli ukuba i-migraines (18) yendalo. Nangona kunjalo, isifundo sasinganiselwe kwisayizi yeesampuli kunye nelokuba ityala liyi-pragmatic study eyayingacingi ukuba yiyiphi imicimbi ye-chiropractic i-SNIT eyenegalelo ekuphuculeni kwimigraines.

In addition, the study was limited due to the lack of a control group. However, it could be argued that participants acted as their own form of control, due to the�baseline two months data collection, especially given the fact that this group were chronic migraine sufferers.

Olunye umda weli sifundo, njengakanye nezinye izifundo ze-migraine okanye iintloko zalapho kukho ukuxhaphaka okukhulu ekuxilongweni nasekuhlaleni i-migraines. Iphetshana elisetyenziswe kulolu cwaningo luthi luthembeke kakuhle, nangona kunjalo, kukho isiphakamiso esinamandla sokuba abaninzi abanezifo zentloko banokuba nohlobo olulodwa lweentloko (6-9). Inzuzo kunye noyilo lwale sifundo kukuba kungakhathaliseki ukuba "ukuxilongwa" ngokuthe ngqo kwe-migraine, ukuphuculwa kwengxelo echazwe ngokwayo kukuvumela ukuhlolwa kobungqina bonyango olubhekiselele kumbuzo (4).

Olu pho nonongo luyabonakala ukuqinisekisa ukuba kukho inani lezinto ezinqamlezayo okanye ezihlaziyekayo ezibandakanyekayo kwimigqabha ye-migraine kwaye ngoko-ke irhafu yonyango ingabonakaliyo kwixesha elide (4,5,9,15).

Iingcali kufuneka ziqaphele izicwangciso ezahlukeneyo zonyango kunye neenzuzo ezinxulumene nazo okanye ukulinganiselwa.

Kubaluleke kakhulu, ezininzi iimpawu ezichaphazelekayo ezichaphazelekayo ngabathathi-nxaxheba kwilingo zabikwa ukuba zinciphile emva kwe-SMT. Iimpawu ezihambelanayo eziye zancipha emva kwolu vavanyo zibandakanya i-nudea (i-41% yabathathi-nxaxheba baziva bencitshiswa), i-photophobia (i-31% ibonwa ukunciphisa), ukuhlanza (i-25% ibonwa ukunciphisa), kunye ne-phonophobia (i-25% iyancitshiswa). Iziphumo eziqhelekileyo ezichazwe ngokuqhelekileyo ezivame ukunyuka emva kwezilingo zamachiza ziquka i-nausea, ukuhlanza, ukukhathala, intlungu yesifuba, i-paraesthesia, i-somnolence, i-syncope, i-vertigo kunye ne-fibrillation engaphantsi kwesifo. Ukongezelela, ubungqina bwakutshanje buye buchaza i-sumatriptan ukuba yinto ebangela ukuba iiphene zizalwe kunye ne-myocardial infarction (19,20).

UDkt Jimenez usebenza kwimpilo yangemva kwintsebenzo ye-Push crossfit | El Paso, TX I-Chiropractor

Nangona kungekho nto ephawulwe yi-IHS, ukuxinezeleka njengokuba kukugqithisileyo okanye ukuphazamiseka kwento ekhankanywe yi-73% yabathathi-nxaxheba. Ukongeza, i-66% yabantu babalisa ubuhlungu bentamo ngexesha le-migraine, kunye ne-31% ngaphezulu yabantu ababizela intlungu ye-back back (abanye abantu bababini bebonke bodwa).

Kuyathakazelisa ukuba abantu abahlanu ekupheleni kweenyanga ze-12 babengenalo migraines kwaye beye banciphisa imfuno yonyango yi-100% elandela i-SMT ye-chiropractic. Akukho zigulane zivakalise ukuba i-migraines yabo yandile ngenxa yesilingo se-SMT.

isiphelo

Iziphumo zolu pho nonongo zixhasa inkxaso-mpilo yokuba i-Chiropractic SMT yonyango olufanelekileyo lwe-migraine, kwabanye abantu. Nangona kunjalo, ngenxa yobuninzi be-migraine, kunye nokufumanisa ukuba iipasodes zivame ukunciphisa emva kokungenelela, kuqhutyelwa uphando olubanzi olulawulwayo.

Icandelo elilawulwa ngandlela-thile elinokulawulwa ngandlela-thile ngokusebenzisa i-EPT ephawulwe (ukungathinteki), iqela lokuphathwa kakubi kunye neqela le-SMT lisondela kwisiphetho. Kukulindeleke ukuba olu vavanyo luya kunika ulwazi olubanzi malunga nokuphumelela kwe-SMT ye-Chiropractic kunyango lwe-migraine ne-aura.

Ukuququmbela,�because migraine headache pain can be significantly debilitating, it’s essential for patients who suffer from this complex type of head pain to understand the effectiveness of chiropractic spinal manipulative therapy. According to the results of the research study above, migraine headache chiropractic treatment can be effectively used to as migraine treatment. Regardless of the results of the twelve month clinical trial, further research studies are still required. Information referenced from the National Center for Biotechnology Information (NCBI). The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Intlungu Yentambo

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

ISIHLOKO ESIBALULEKILEYO: I-EXTRA EXTRA: Ungcono!

EZINYE IINGCUKACHA EZIBALULEKILEYO: UKWENZISA: Ukulimala kwezemidlalo? | Vincent Garcia | Umonde | El Paso, TX I-Chiropractor

Ngenanto

Ucaphulo

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2. Jull GA. Intloko yesibeleko: ukuhlaziywa. Ku: U-Greive GP (ed) unyango lwekhompyutheni yomnxeba wekholam ye-vertebral. 2nd ed 1994. Churchill Livingstone, e-Edinburgh. 333-34,6
3. IKomidi yokuHlalwa kweNtloko yeNtloko yeSizwe, uMbutho. Inkqubo yokuhlenga kunye nokuxilongwa kweengxaki zentloko, i-neuralgias kunye neentlungu zomzimba. Cephalgia 1988, 9. Suppl. 7: 1-93.
4. Tuchin PJ. Ukusebenza kwonyango lwe-chiropractic ye-spinal manipulative therapy (SMT) kunyango lwe-migraine-isifundo somqhubi. U-Aust Chiro kunye no-Osteo 1997; 6: 41-7.
5. UMilne E. Indlela kunye nokunyanga kwe-migraine kunye nezinye iziphazamiso zentsholongwane yesibeleko kunye nesemva kwesithuba. Cephaigia 1989; 9, Cinga 10: 381-2.
6. I-Kidd R, uNelson C. Musculoskeletal ukungasebenzi komsi kwimigraine kunye nokukhathazeka kwentloko. Intloko ye1993; 33: 566-9.
7. Tuchin PJ, Bonello R. Classic migraine okanye hayi classic migraine, lowo ngumbuzo. U-Aust Chiro kunye no-Osteo 1996; 5: 66-74.
8. UMarcus DA. I-Migraine kunye nohlobo lweentloko zesifo: ukuqinisekiswa okungaqinisekiyo kweenkqubo zangoku zokuhlaziya. 1992; Ubuhlungu 8: 28-36.
9. URasmussen BK, uJensen R, Schroll M, u-Olsen J. Ukuxubana phakathi kwe-migraine kunye nohlobo lweentloko zentlungu kubantu bonke. IArch Neurol 1992; 49: 914-8.
10. Lance JW. Ingcamango ye-migraine kunye nokukhangela i-headache drug head. Intloko ye1990; 1: 17-23.
11. UDalassio D. Ukukhubazeka kwe-migraine. Iiklinikhi J Pain 1990 6: 235-9.
12. Moskowitz MA. Iindlela ezisisiseko kwiintsholongwane zentloko. I-Neurol Clinic 1990; 16: 157-68
13. I-Tuchin PJ, uBonello R. Iziphumo zokuHlololwa koTywala kunye neNdleko kwiNkqubo yokuXhobisa abasebenzi baseNew South Wales. J Uluhlu lwePhysiol Ther 1995; lg: 503-11.
14. I-Tuchin PJ, i-Scwafer T, i-Brookes M. Isifundo esibuhlungu seentloko ezingapheliyo. U-Aust Chiro kunye no-Osteo 1996; 5: 47-53.
15. I-Parker GB, iTupling H, iPryor DS. Uvavanyo olulawulwayo lweMigudu yeMigraine. U-Aust NZ J Med 1978; 8: 585-93.
16. U-Young K, uDharmi M. Ukuphumelela kokunyanzeliswa komlomo ngokuchasene nemithi yokwelapha kwiprogram yegrafraine. Ukuthengiselana kwe-Consortium ye-Chiropractic Research. 1987.
17. UVernon H, uSteiman I, Hagino C. Ukungasebenzi kwe-Cervicogenic kwi-muscle contraction headache kunye ne-migraine: isifundo esichazayo. J Uluhlu lwePhysiol Ther 1992; 15: 418-29
18. I-Parker GB, iTupling H, iPryor DS. Kutheni i-migraine iphucula ngexesha lovavanyo lweklinikhi? Iziphumo ezongezelelweyo ukusuka kwisilingo sokunyanzeliswa komlomo kwesigulane. U-Aust NZ J Med 1980; 10: 192-8.
19. Ottervanger JP, Stricker BH. Ukuphendula kakubi kwe-Cardiovascular to sumatriptan: kubangelwa ukukhathazeka? CNS Izidakamizwa 1995; 3: 90-8.
20. Simmons VE, Blakeborough P. Ipropati yokhuseleko ye-sumatriptan. I-Rev Contemp I-1994; 5: 319-28.

Vala i-Accordion

Ukwelashwa kweMigraine Pain | UDkt Alex Jimenez

by iicrosoft | Chiropractic, LweMpilo, Migraine

I-migraine ibonakaliswe njenge-moderation kwi-headache, eninzi ihamba kunye neentlanzi kunye nobuzwe bokukhanya kunye nesandi. Phantse i-1 kwizindlu ze-United States zase-4 ziquka umntu ohluphekayo. Njengoko kunjalo, i-migraine ithathwa njengeyona 3rd imeko exhaphake kakhulu kwihlabathi. Abaphandi abazange baqaphele isizathu esicacileyo sokuba imigraines, nangona kunjalo, kukho izinto ezininzi zikholelwa ukuba zenze intlungu yintlungu enzima, kuquka ukuchithwa kakubi emgodini wesibeleko. Ukunyamekelwa kwe-Chiropractic yindlela ekhethwa yonyango eyaziwayo yokusetyenziswa ekuncedeni unyango lwe-migraine kunye nokuphucula iimpawu. Injongo yolu cwaningo lulandelayo lukubonisa imiphumo yokunyamekela kwe-chiropractic ekulawuleni ubuhlungu be-migraine.

I-Case of Chronic Migraine Remission emva kokunyamekela kweCrospractic Care

Abstract

Injongo: Ukubonisa isifundo se-patient of migraine esinefuthe elimangalisayo emva kokunyanga kwe-chiropractic yonyango (CSMT).
Clinical features: The case presented is a 72-year�old woman with a 60-year history of migraine headaches, which included nausea, vomiting, photophobia, and phonophobia.
Ukungenelela kunye nesiphumo: I-frequency ye-migraine episodes ngaphambi kokuba unyango lube yi-1 kwi-2 ngeveki, kubandakanywa isicathulo, ukuhlanza, isithombe-phobia kunye ne-phonophobia; kwaye ubude bemizuzu yesiqhelo ngasinye yi-1 kwiintsuku ze-3. Isigulane saphathwa nge-CSMT. Wachaza zonke iipasiti ezigqitywa emva kwe-CSMT. Isigulane sasinokuqinisekileyo ukuba kwakungekho nenye iinguqulelo zokuphila eza kuba negalelo ekuphuculeni kwakhe. Kwakhona waphawula ukuba ukusebenzisa imithi yakhe kwancitshiswa ngu-100%. Ulandelelwano lwe-7-nyaka luye lwabonisa ukuba umntu wayengakabikho nenye i-migraine isiqendu kweli xesha.
Isiphelo: Eli cala libalaselisa ukuba iigqeba lezigulane ze-migraine ziyakwazi ukuphendula kakuhle kwi-CSMT. Nangona uphando lwamaxwebhu alubonakali ubungqina obunzulu besayensi, kwimeko kunye nezinye izifundo eziqhutywayo, olu pho nonongo lubonisa ukuba uvavanyo lwe-CSMT lufanele lucatshungulwe ngenxa yesifo esingenasiphelo, esingasiphenduliyo se-headaches migraine, ingakumbi ukuba izigulane ze-migraine aziphendulanga kumachiza okanye zikhetha ukusebenzisa olunye unyango iindlela.
Iingqinisiso zokubhaliweyo: I-Migraine, i-Chiropractic, unyango olusisigxina

intshayelelo

I-Migraine ihlala yinto eqhelekileyo neyingozi. [1, 2] Inesiganeko esilinganiselwayo se-6% kwindoda kunye ne-18% kubafazi. [2] Uphando lwase-Australia lufumene indleko kwishishini ukuba liqikelelwe i-750 yezigidi. I-3] I-Lipton et al ifumene ukuba i-migraine enye yezona zizathu eziqhelekileyo zokubonisana nabasebenzi abaqhelekileyo, abachaphazelayo phakathi kwe-12 yezigidi kunye nabantu abayi-18 yezigidi ngonyaka ngamnye e-United States. [4] Iindleko eziqikelelweyo e-United States yi $ 25 billion kwimveliso elahlekileyo ngenxa ye-156 yeentsuku zexesha elipheleleyo lexesha elipheleleyo elahlekelwa lilonke ngonyaka. [5] Ulwazi lwakutsha luye lwaphakamisa ukuba la manani angaphezulu asele ayenayo, kodwa kwakhona angaphantsi, ngenxa yokuba abaninzi abagulayo abanakuchaza ingxaki yabo ngenxa yokuba bahluphekile I-stigma yentlalo. [6]

I-Brain Foundation e-Australia ithi i-23% yemindeni iqulethe ubuncinane omnye umntu ogulayo. Phantse bonke abagulayo be-migraine kunye ne-60% yalabo abaneentlobo zesifo sengqondo ezincitsheni zentsebenzo ekunciphiseni kwimisebenzi yentlalo kunye namandla okusebenza. Iindleko ezichanekileyo nezingangqaliyo ze-migraine zodwa ziza kuba malunga ne-1 billion ngonyaka. [3]

IKomidi yokuHlalwa kweNtloko yoMbutho weZizwe eziBaNtloko (IHS) ichaza i-migraines njengento elandelayo: indawo engabandakanyiyo, umgangatho wokupasa, ukulinganisela okanye ukunyaniseka okukhulu, kunye nokwenziwa komsebenzi oqhelekileyo. Ngethuba lobunzima beentloko, umntu kufuneka abe nesicathulo sengqondo kunye / okanye ukuhlanza, photophobia, kunye / okanye i-phonophobia. [7] Ukongezelela, akukho cetyiswa ngembali okanye ngovavanyo lomzimba okanye lwe-neurologic ukuba umntu unentloko yesandla ehlulwe kumaqela I-5 kwi-11 kwinkqubo yabo yokuhlenga. [7] Amaqela e-5 kwi-11 kwinkqubo yokuhlukanisa iquka intloko ehambelana nentlungu, intlupheko yesifo, ingxaki engeyiyo ingxubevange, izinto okanye ukuhoxiswa kwabo, ukusuleleka koxinzelelo, okanye ukuphazamiseka kwe-crane , intamo, amehlo, impumlo, isono, amazinyo, umlomo, okanye ezinye izakhiwo zobuso.

Okunye ukudideka kuhambelana nesici se-�aura� esahlula i-migraine nge-aura (MA) kunye ne-migraine ngaphandle kwe-aura (MW). I-aura idla ngokuba nokuphazamiseka kokubonwa kwehomonym, i-paresthesias kunye/okanye ukuba ndindisholo, ubuthathaka obunye, i-aphasia, okanye ubunzima bokuthetha obungachazwanga.[7] Ezinye ii-migraineurs zichaza i-aura njengento e-opaque, okanye umgca we-zigzag ojikeleze ifu; kwanamatyala okubona izinto ezingekhoyo kuye kwabhalwa. [8] Amagama amatsha e-MA kunye ne-MW athatha indawo yamagama amadala e-classic migraine kunye ne-migraine eqhelekileyo, ngokulandelanayo.

I-criteria ye-IHS yokuxilonga ye-MA (i-1.2) i-3 yile ilandelayo:

Enye okanye ngaphezulu kweempawu ze-aura ezibonakalisiweyo ezibonisa i-cortex eyigxininisa kunye / okanye ingxaki yokuchophaza kwengqondo.
Ubuncinane uphawu lwe-1 aura lukhula kancane ngaphezu kweminye imizuzu ye-4 okanye i-2 okanye iimpawu ezininzi ezilandelelanayo.
Akukho uphawu lwe-aura luhlala ngaphezu kwemizuzu ye-60.
Intloko ilandela i-aura ngekhefu lamahhala elingaphantsi kwemizuzu ye-60.

I-Migraine isoloko ingaphenduli unyango. [9] Nangona kunjalo, uphando oluninzi luye lwabonisa ukunciphisa amanqanaba emigraines emva kokunyanga kwe-chiropractic ye-spinal manipulative therapy (CSMT). [10-15]

Eli nqaku liza kuxubusha isigulane esinikeza uM MW kunye nempendulo yakhe emva kwe-CSMT. Ingxubusho iya kubonisa kwakhona imigaqo ethile yokuxilonga i-migraine kunye nezinye iintloko ezichaphazelekayo kwiingcali zonyango, i-osteopaths, okanye ezinye zezempilo.

Ingxelo yeNgxelo

Umfazi omhlophe we-72 oneminyaka engama-61-kg unikwe intloko ye-migraine eyaqala ebuntwaneni (malunga ne-12 yeminyaka ubudala). Isigulane asikwazanga ukuhambelana nantoni na ekuqaleni kwemigraines yakhe, nangona wayekholelwa ukuba kukho imbali yentsapho (uyise) kwimeko. Ngexesha lembali, isigulana sathi sinentloko ye-migraine rhoqo (i-1-2 ngeveki) apho naye wafumana isicaphucaphu, ukuhlanza, i-vertigo, kunye ne-photophobia. Kwakufuneka ayeke imisebenzi yokunciphisa iimpawu, kwaye wayesoloko efuna i-acetaminophen kunye neyeza le-codeine (25 mg) okanye i-sumatriptan succinate yokuthomalalisa iintlungu. Isigulane sasiphinda sithathe i-verapamil (i-calcium ion antagonist, ngenxa ye-hypertension ebalulekileyo), i-calcitriol (i-calcium uptake, i-osteoporosis), i-pnuemenium imihla ngemihla, kunye ne-carbamazipine (i-antiepileptic, i-neurotropic imithi) kabini imihla ngemihla.

Isigulane sichaze ukuba isiqephu esiphakathi sithatha i-1 ukuya kwiintsuku ze-3 kwaye akakwazi ukwenza imisebenzi yokuphila kwansuku zonke ubuncinane beeyure ze-12. Ukongezelela, i-analogue scale scale ebonakalayo ye-episode ye-avareji yayiyi-8.5 ngaphandle kwamanqaku aphezulu anokubakho kwi-10, ehambelana nenkcazo yentlungu "eyoyikekayo". Isigulana siqaphele ukuba uxinzelelo okanye uxinzelelo luya kubangela i-migraine kwaye ukukhanya kunye nengxolo kwandisa imeko yakhe. Wachaza i-migraine njengentlungu ebuhlungu yentloko ehlala kwindawo ye-parietotemporal kwaye yayihlala ishiywe ngasekhohlo.

Isigulane sasinomlando wangaphambili we-pulmonary embolism (iminyaka eyi-2 ngaphambi kokuba unyango) kwaye ube ne-hysterectomy eyingxenye ye-4 iminyaka ngaphambi kokuba unyango. Uye wachaza ukuba une-hypertension elawulwayo. Wayengumhlolokazi onabantwana aba-2, kwaye wayengazange atshaye. Umguli uzame iacupuncture, physiotherapy, unyango lwamazinyo kakhulu, kunye namanye amayeza amaninzi; kodwa akukho nto yayitshintshile iphethini yakhe ye-migraine. Watsho ukuba akazange abe nonyango lwangaphambili lwe-chiropractic. Isigulana saphinda satsho ukuba uye waphathwa yi-neurologist ye-"migraines" kwiminyaka emininzi.

Ekuhloliseni, wafunyanwa ene-senbo-sensitive ne-upper musculature yomlomo kunye nokunciphisa uluhlu lwesincinci phakathi kwe-occiput kunye ne-vertebra yokuqala yomlomo wesibeleko (Occ-C1), kunye neentlungu zokuhamba kunye nokwandisa umlenze wesibeletho. Kwakhona wayencitshiseko enkulu ekuhambeni kwemisipha kunye nokunyuka okuphawulekayo kwi-kyphosis yakhe.

Ukuhlolwa kwengcinezelo yegazi kuye kwabonisa ukuba wayexinzelelekile (178 / 94), apho isigulane sichaza sisiphumo esiqhelekileyo (isigaba se-2 ingozi yokusebenzisa ingozi usebenzisa iKomiti yeSizwe yoLungiso, ukuThengwa, ukuVavanywa kunye noPhando lwe-High Blood Pressure 7).

Ngokusekelwe kwi-IHS Headache Classification Committee kunye neendlela zokuxilonga, isigulane sasinodidi lwe-MW 1.1, olwalubizwa ngokuba yi-common migraine (Itheyibhile 1). Oku kubonakale okwesibini ukuya kwimodareyitha yokungasebenzi kakuhle kwecandelo lomlomo wesibeleko kunye ne-suboccipital ethambileyo kunye ne-paraspinal myofibrosis yomlomo wesibeleko.

Ithebula 1: Ukwahlulelwa kweentloko (iKomiti yokuHlalwa kweNtloko yeHS)

Isigulana sifumene i-CSMT (i-chiropractic �adjustments�) edibeneyo ye-Occ-C1, i-thoracic spine ephezulu (i-T2 nge-T7), kunye ne-hypertonic musculature echaphazelekayo. Izihlunu ze-Hypertonic zakhululwa nge-massage ethambileyo kunye nokwelula. Ikhosi yokuqala yonyango lwe-8 lwenziwa ngokuphindaphindiweyo kabini ngeveki kwiiveki ze-4. Inkqubo yonyango yayiquka ukurekhoda amanqaku amaninzi kwisiqendu ngasinye se-migraine. Oku kubandakanya ukuphindaphindwa, amanqaku abonwayo e-analogue, ubude besiqendu, amayeza, kunye nexesha phambi kokuba babuyele kwimisebenzi yesiqhelo.

Isigulane sichaze ukuphucuka okuphawulekayo emva kokunyanga kwakhe kuqala kwaye saqaphela ukunciphisa ubunzima beentloko nentlungu yentlungu. Oku kwaqhubeka nokunika ingxelo ngesigulane kungekho migraines kwikhosi yokuqala yonyango. Unyango olongezelelweyo lucetyiswa ukuba lwandise uluhlu lwayo lwenkqubela, lwandise ithoni ye-muscle, kwaye lunciphise ukuxhatshazwa kwemisipha ye-suboccipital. Ukongezelela, ukubeka esweni impawu zakhe ze-migraine zaqhubeka. Inkqubo yokonyango kwimizuzu yeeveki ze-8 iqhutywe. Emva kwesigaba esilandelayo sonyango, isigulane sasiqaphele ukunyuka kwentamo, intshukumo engcono, kwaye akukho migraine. Ukongezelela, wayengasetyenzisanga izilumko (i-acetaminophen, i-codeine, kunye ne-sumatriptan succinate) kwaye yaqaphela ukuba akazange ahlasele isisu, ukuhlanza, ifotophobia, okanye i-phonophobia (Ithebula 2). Isigulane saqhubeka sonyango kwii-2 ngeveki kwaye sachaza ukuba, emva kweenyanga ze-6, i-migraine episodes yayilahlekile ngokupheleleyo. Ukongezelela, wayengenasova intlungu yentamo. Uvavanyo alubonakali ntlungu eqhubekayo yokunyakaza kwentamo; nangona kunjalo, ukukhawulelwa kokunyanzeliswa kokunyusa kwiC1-2 inxalenye yesiphakamiso yayisekhona.

Ithebula 2: I-1: i-migraine (iKomidi yeCandelo lokuHlola iNhloko ye-IHS)

Isigulane okwangoku sonyango zonke iiveki ze-4, kwaye akayibizi kwakhona ukubuya kwakhe kwemigudu okanye intlungu yentamo. Isigulane asizange sibone nayiphi na i-migraines ixesha elingaphezulu kwe-7 iminyaka ukususela kwisiqephu sakhe sokugcina, esasisandul 'ukukhawuleza ngaphambi kokufumana unyango lwakhe lokuqala lwe-chiropractic.

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Intlungu ye-Migraine isifo esibangeleyo esinokulawulwa ngempumelelo ngokunyamekela kwe-chiropractic. Ukwelashwa kwe-Chiropractic inikezela ukhetho oluninzi lweenkonzo ezinokunceda izigulane ezinobungozi ezahlukeneyo kunye / okanye iimeko, kuquka iimpawu zentlungu engapheliyo, inqanaba lokuhamba kunye neminye imiba yempilo. Ukunyamekela kwe-Chiropractic kunokukunceda nokulawula uxinzelelo oluchaphazelekayo kunye ne-migraine. Abasebenzi bethu bazimisele ukunyanga izigulane ngokugxininisa kwimvelaphi yembambano kunokuba kunciphise okwesikhashana iimpawu ngokusebenzisa iziyobisi kunye / okanye imithi. Injongo yale nqaku kukubonisa iziphumo ezisekelwe kubungqina malunga nokuphuculwa kwe-migraine kusetyenziswa ukunakekelwa kwe-chiropractic nokufundisa izigulane ngendlela efanelekileyo yonyango kwimicimbi ethile yempilo. Utyando lwe-chiropractic lunikeza uncedo ekubuhlungu kwe-migraine kunye nempilo yonke kunye nokuphila kakuhle.

ingxoxo

Uphando lwezifundo alufaki amanqanaba aphezulu eenkcukacha zesayensi. Nangona kunjalo, ezinye iimeko zibonisa iziphumo ezibalulekileyo. Ngokomzekelo, amaxesha anomdla (omdala) kunye / okanye izibonakaliso ezinamandla anokugqamisa ukhetho oluthile lwenyango. Nangona uphando lweziganeko ezinjengale, kubakho njalo ukuba iziganeko zixazululwe ngokukhawuleza, kungekho ndlela ephumelelayo kunyango. Icala liboniswe ngokugqithiseleyo inketho yokwenza unyango. Ulandelelwano lwe-7-nyaka luye lwabonisa ukuba umntu wayengakabikho nenye i-migraine isiqendu kweli xesha. Isigulane sasinokuqiniseka ukuba kwakungekho enye iinguqulelo zokuphila eza kuba negalelo ekuphuculeni kwakhe. Kwakhona waphawula ukuba i-migraines yayimile emva kokuqala unyango.

Umlinganiselo oqhelekileyo wemigraines yakhe ngaphambi kokuba unyango luyi 1 ku-2 ngeveki, kunye neepisodes ezazihlala zibandakanya izibilini, ukuhlanza, i-photophobia kunye ne-phonophobia. Ukongezelela, ubude bemizuzu yesiqhelo ngasinye yi-1 kwiintsuku ze-3 ngaphambi kokufumana i-CSMT. Lo mntu uphinde waqaphela ukuba ukusetyenziswa kwamachiza akhe okunciphisa intlungu kwancitshiswa ngu-100% (Itheyibhile 3).

Itheyibhile 3 Isishwankathelo seenguqu eziphambili kule Nkundla

Itheyibhile 3: Isishwankathelo seenguqu eziphambili kule meko

I-Migraines yimeko eqhelekileyo kunye neleyo; kodwa ngenxa yokuba bane-etiology engaqinisekanga, ulawulo olufanelekileyo kakhulu lonyango luyinto engacacile. [16] Imodeli ye-etiological yangaphambili echaze izizathu zesisulu ze-migraine, apho iziqendu zibonakala ziqaliswa ukuhla kwegazi ku-cerebrum elandelwa ngu-extracranial vasodilation ngexesha leentloko I-8] Nangona kunjalo, ezinye iimodeli ze-etiological zibonakala zinxulumene nezinguqu zethambo ezinxulumene nezinguqu ze-neurologic kunye nokuphazamiseka kwe-serotonergic. [9] Ngenxa yoko, unyango lwangaphambili lujolise ekuguquleni kwegazi kwi-block ye-blood or serotonin block block. [17]

Studies examining the role of the cervical spine to headache (ie, �cervicogenic headache�) have been well described in the literature.[18-30] However, the relation of the cervical spine to migraine is less well documented.[10-15] Previous studies by this author have demonstrated an apparent reduction in migraines after CSMT.[10, 11] In addition, other studies have suggested that CSMT may be an effective intervention for migraine.[14, 15] Although, previous studies have some limitations (inaccurate diagnosis, overlapping symptoms, inadequate control groups), the level of evidence gives support for CSMT in migraine treatment.[11] However, practitioners need to be critically aware of potential overlap of diagnoses when reviewing migraine research or case studies on effectiveness of their treatment.[18-22] This is especially important in comparison of migraine patients who may be suitable for chiropractic manipulative therapy.[23-28]

Phakathi kwe-40% kunye ne-66% yezigulane ezine-migraine, ingakumbi abo banokuhlaselwa ngokugqithisileyo okanye ngokuphindaphindiweyo, abafuni uncedo kumgqirha. [29] Phakathi kwabo benzayo, abaninzi abaqhubeki ukutyelela ugqirha. ngenxa yokungahambi kweengqondo ezivela kubagulana kunye nenkolelo yokuba oogqirha abanako ukuphatha kakuhle imithi. Kuphononongo lwe-30 yaseBrithani, i-1999% ye-17 migraineurs ayengazange ayibonane nodokotela ngenxa yokuba bakholelwa ukuba imeko yabo ayiyi kuthathwa ngokungathí sina; kwaye i-9770% ayibonanga ugqirha ngenxa yokuba babekholelwa ukuba imishanguzo ye-migraine yayingasebenzi. [8] Isizathu esingaqhelekanga sokungafuneki ngcebiso yonyango (ekhankanywe yi-30% yezigulane) yayikholwa yizilwanyana ukuba ayifuni ugqirha uluvo lokuba baphathe ukuhlaselwa kwabo.

Icala linikezelwe ukuncedisa oogqirha benza isigqibo esinolwazi kunyango olukhethiweyo lwemigraines. Isiphumo sale meko siyabaluleka ngokumalunga nolunye uphando olugqiba ukuba i-CSMT yonyango olusebenzayo kubantu abathile. Iingcali zingaqwalasela i-CSMT ye-migraine ngokusekelwe kwezi zinto zilandelayo:

Ukunciphisa ukunyakaza kwentamo.
Utshintsho kwintambo yomsi weentamo, ukuthungwa, okanye ukuphendula kwisalathiso esisebenzayo kunye nesicatshulwa.
Ubumnandi obungavumelekanga bendawo ye-suboccipital.
Intlungu yentlungu ngaphambi okanye ekuqaleni kwe-migraine.
Ukuphendula kwangaphambili kwi-CSMT.

Njengazo zonke iingxelo zeemeko, iziphumo zikhawulelwe kwisicelo kubantu abaninzi. Ukwenza isigqibo sokwenza iikliniki kufuneka uqwalaselwe xa usebenzisa ezi ziphumo kwezinye izigulane kunye neemeko zeklinikhi.

isiphelo

Le meko ibonisa ukuba abanye abagulayo abanomdla bangaphendula kakuhle ngeendlela zokunyanga, eziquka i-CSMT. Ngenxa yoko, izigulane ze-migraine ezingayifumana ilingo le-CSMT kufuneka zikhuthazwe ukuba ziqwalaselwe ngale nyango kwaye zihlole nayiphi na impendulo. Xa kungekho ziphikisana ne-CSMT, isilingo sokuqala sonyango singagunyaziswa. Ukulandela izikhokelo zonyango olusisiseko-sobugcisa, oogqirha kufuneka baxoxe nge-CSMT kunye nezigulane ze-migraine njengendlela yokunyango. [31, 32] Iingxelo ezilandelayo kufuneka zijongene nale ngxaki kunye nenxaxheba i-CSMT inayo ekulawuleni i-migraine management.

Ukuququmbela, Intlungu ye-migraine yinto eqhelekileyo echaphazela inani elikhulu labantu. Nangona imbangela ye-migraines ayiqondi kakuhle, unyango lweentlungu ezinzima zentloko lunokukunceda ukulawula iimpawu. Ukwelashwa kwe-Chiropractic unyango olusisigxina, okanye i-CSMT, lunokuphucula umthambo kwiigulane kwaye lunokuba luncedo lokonyango olufanelekileyo. Nangona kunjalo, uphando olongezelelweyo zophando lufuneka ukuba lubonise iziphumo ezingaphezulu. Ulwazi oluchazwe kwiziko leSizwe loLwazi lweBiotechnology (NCBI). Ubungakanani beenkcukacha zethu zikhawulelwe kwi-chiropractic kunye nokulimala kwemigudu kunye nemeko. Ukuxoxa ngesihloko, nceda ukhululeke ukucela uDkt Jimenez okanye uqhagamshelane nathi 915-850-0900 .

Ikhutshwe nguDkt. Alex Jimenez

Imixholo eyongezelelweyo: Intlungu Yentambo

umfanekiso webhlogi weendaba eziphambili zephepha lephepha

ISIHLOKO ESIBALULEKILEYO: I-EXTRA EXTRA: Ungcono!

EZINYE IINGCUKACHA EZIBALULEKILEYO: UKWENZISA: Ukulimala kwezemidlalo? | Vincent Garcia | Umonde | El Paso, TX I-Chiropractor

Ngenanto

Ucaphulo

1. Bigal M.E., Lipton R.B., Stewart W.F. The epidemiology and impact of migraine. Curr Neurol Neurosci Rep. 2004;4(2): 98-104. [PubMed]

2. Lipton R.B., Stewart W.F., Diamond M.L., Diamond S., Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study 11. Intloko. 2001;41: 646--657. [PubMed]

3. UAlexander L. Migraine emsebenzini. Amaza engqondo. Australian Brain Foundation; Hawthorn, Victoria: 2003. pp. 1�4.

4. Lipton R.B., Bigal M.E. The epidemiology of migraine. Am J Med. 2005;118(Inkxaso 1):3S�10S. [PubMed]

5. Lipton R.B., Bigal M.E. Migraine: epidemiology, impact, and risk factors for progression. Intloko. 2005;45(Inkxaso yesi-1):S3�S13. [PubMed]

6. Stewart W.F., Lipton R.B. Migraine headache: epidemiology and health care utilization. I-Cephalalgia. 1993;13(suppl 12):41�46. [PubMed]

7. Headache Classification Committee of the International Headache, Society Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalgia. 2004;24(Supp. 1):1�151. [PubMed]

8. Goadsby P.J., Lipton R.B., Ferrari M.D. Migraine�current understanding and treatment. N Engl J Med. 2002;346:257�263. [PMID 11807151] [PubMed]

9. Goadsby P.J. The scientific basis of medication choice in symptomatic migraine treatment. Ngaba uJ Neurol Sci. 1999;26(suppl 3):S20�S26. [PubMed]

10. Tuchin P.J., Pollard H., Bonello R. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Uluhlu lwePhysiol Ther. 2000;23: 91--95. [PubMed]

11. Tuchin P.J. The efficacy of chiropractic spinal manipulative therapy (SMT) in the treatment of migraine�a pilot study. Aust Chiropr Osteopath. 1997;6: 41--47. [Inkcazelo yamahhala ye-PMC] [PubMed]

12. Tuchin P.J., Bonello R. Classic migraine or not classic migraine, that is the question. Aust Chiropr Osteopath. 1996;5: 66--74. [Inkcazelo yamahhala ye-PMC] [PubMed]

13. Tuchin P.J., Scwafer T., Brookes M. A case study of chronic headaches. Aust Chiropr Osteopath. 1996;5: 47--53. [Inkcazelo yamahhala ye-PMC] [PubMed]

14. Nelson C.F., Bronfort G., Evans R., Boline P., Goldsmith C., Anderson A.V. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Uluhlu lwePhysiol Ther. 1998;21: 511--519. [PubMed]

15. Parker G.B., Tupling H., Pryor D.S. A controlled trial of cervical manipulation for migraine. Aust NZ J Med. 1978;8: 585--593. [PubMed]

16. Dowson A.J., Lipscome S., Sender J. New guidelines for the management of migraine in primary care. Curr Med Res Opin. 2002;18: 414--439. [PubMed]

17. Ferrari M.D., Roon K.I., Lipton R.B. Oral triptans (serotonin 5-HT1B/1D agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet. 2001;358: 1668--1675. [PubMed]

18. Sjasstad O., Saunte C., Hovdahl H., Breivek H., Gronback E. Cervical headache: an hypothesis. Cephalgia. 1983;3: 249--256.

19. Vernon H.T. Spinal manipulation and headache of cervical origin. J Uluhlu lwePhysiol Ther. 1989;12: 455--468. [PubMed]

20. Sjasstad O., Fredricksen T.A., Stolt-Nielsen A. Cervicogenic headache, C2 rhizopathy, and occipital neuralgia: a connection. Cephalgia. 1986;6: 189--195. [PubMed]

21. Bogduk N. Cervical causes of headache and dizziness. In: Greive G.P., editor. Unyango lwangoku lonyango lwekholamu ye-vertebral. 2nd ed. Edinburgh; Churchill Livingstone: 1994. pp. 317�331.

22. Jull G.A. Cervical headache: a review. In: Greive GP, editor. Unyango lwangoku lonyango lwekholamu ye-vertebral. 2nd ed. Edinburgh; Churchill Livingstone: 1994. pp. 333�346.

23. Boline P.D., Kassak K., Bronfort G. Spinal manipulations vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Uluhlu lwePhysiol Ther. 1995;18: 148--154. [PubMed]

24. Vernon H., Steiman I., Hagino C. Cervicogenic dysfunction in muscle contraction headache and migraine: a descriptive study. J Uluhlu lwePhysiol Ther. 1992;15: 418--429. [PubMed]

25. Kidd R., Nelson C. Musculoskeletal dysfunction of the neck in migraine and tension headache. Intloko. 1993;33: 566--569. [PubMed]

26. Whittingham W., Ellis W.S., Molyneux T.P. The effect of manipulation (Toggle recoil technique) for headaches with upper cervical joint dysfunction: a case study. J Uluhlu lwePhysiol Ther. 1994;17: 369--375. [PubMed]

27. Jull G., Trott P., Potter H., Zito G., Shirley D., Richardson C. A randomized controlled trial of exercise and spinal manipulation for cervicogenic headache. Isihlwele. 2002;27: 1835--1843. [PubMed]

28. Bronfort G, Nilsson N, Assendelft WJJ, Bouter L, Goldsmith C, Evans R, et al. Unyango olungathinteliyo lwezonyango lwentloko engapheliyo (uphononongo lweCochrane). Ku: I-Cochrane Library Issue 2 2003. Oxford: Hlaziya iSoftware.

29. Dowson A., Jagger S. The UK migraine patient survey: quality of life and treatment. Curr Med Res Opin. 1999;15: 241--253. [PubMed]

30. Solomon G.D., Price K.L. Burden of migraine: a review of its socioeconomic impact. Pharmacoeconomics. 1997;11(Suppl 1):1�10. [PubMed]

31. Bronfort G., Assendelft W.J.J., Evans R., Haas M., Bouter L. Efficacy of spinal manipulation for chronic headache: a systematic review. J Uluhlu lwePhysiol Ther. 2001;24: 457--466. [PubMed]

32. Vernon H.T. Spinal manipulation in the management of tension-type migraine and cervicogenic headaches: the state of the evidence. Top Clin Chiropr. 2002;9: 14--21.

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Abstract

Insight of Dr. Alex Jimenez

intshayelelo

Ulawulo lwezinhlungu

Iingcaphephe zengqondo

Biofeedback

Indlela yokuziphatha

Uqeqesho lokuphumula

Unyango loPhatha

Iindlela zokuziphatha

Izindlela eziMkelweyo

Lindele

Abaququzeleli Bemizwelo Yobunzima

isiphelo

Imihlathi

Imixholo eyongezelelweyo: Ubunzima bokubuyisela

Ngenanto

Ucaphulo

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Ukuhlaziywa Okubalulekileyo Kwonyango Lonyango Ukusetyenziswa Kweengxaki Zentloko: Ukukhawuleza, Iiprofayili, Iinjongo, uLonxibelelwano kunye nokuPhumela okuZibhaliweyo

Abstract

imvelaphi

tindlela

iziphumo

izigqibo

imvelaphi

tindlela

uyilo

Iziphumo zophando, Uhlalutyo kunye noVavanyo lweMgangatho

iziphumo

Ukusetyenziswa kweMT

Iphrofayili kunye nezikhuthazo zokusetyenziswa kweMT

Ukusetyenziswa ngokufanayo kunye neNkundla yokuSebenza kwabaNika iNtloko kunye noNxibelelwano oludibeneyo lwaBasebenzisi baseMT

Ukusebenza ngokuzimeleyo kweziphumo zeziphumo zonyango

ingxoxo

Uphando lwexesha elizayo

Imida

isiphelo

Imibulelo

Inkxaso

Ukufumaneka kweDatha kunye neZiko

Imirhumo yabalobi

Ukugqithisa inzala

Imvume yokupapashwa

UkuVunywa kweMigaqo kunye neMvume yokuBamba iqhaza

Inqaku loMpapashi

izifinyezo

I ngcaciso

Insight of Dr. Alex Jimenez

I-Treatment against Versus Operative Treatment for Lumbar Disc Herniation: Iziphumo ezi-8 zeMigangatho yeziGulane zeziThamo Iziphumo zoPhando (SPORT)

Abstract

IsiCwangciso soFundo

injongo

Isishwankathelo seNkcazelo yedatha

tindlela

iziphumo

isiphelo

intshayelelo

tindlela

IsiCwangciso soFundo

Abemi abagulayo

Iingenelo zokuFunda

Imilinganiselo yoFundo

Ukuqwalaselwa kwezibalo

iziphumo

Iimpawu zoMonde

Ukunyangwa koPhando kunye neengxaki

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