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Mayesero Olamulidwa Mwachisawawa

Back Clinic Randomized Controlled Trial Chiropractic ndi Functional Medicine Team. Kafukufuku yemwe otenga nawo mbali amagawidwa mwangozi m'magulu osiyana omwe amafananiza mankhwala osiyanasiyana kapena njira zina. Kugwiritsa ntchito mwayi wogawa anthu m'magulu kumatanthauza kuti maguluwo adzakhala ofanana komanso kuti zotsatira za mankhwala omwe amalandira zikhoza kufananizidwa bwino kwambiri.

Pa nthawi yoyesedwa, sizidziwika kuti ndi mankhwala ati omwe ali abwino kwambiri. A Mayesero Olamulidwa Mwachisawawa kapena (RCT) kupanga mwachisawawa amagawira ophunzira mu gulu loyesera kapena gulu lolamulira. Pamene phunzirolo likuchitidwa, kusiyana koyembekezeka kokha kuchokera kumagulu olamulira ndi oyesera mu mayesero oyendetsedwa mwachisawawa (RCT) ndiye kusintha kwa zotsatira zomwe zikuphunziridwa.

ubwino

  • Chosavuta kuchiwona/chigoba kusiyana ndi maphunziro owonera
  • Kusintha kwabwino kumachotsa kukondera kulikonse kwa anthu
  • Chiwerengero cha anthu omwe akutenga nawo mbali akudziwika bwino
  • Zotsatira zitha kufufuzidwa ndi zida zowerengera zodziwika bwino

kuipa

  • Siziwulula chifukwa
  • Zokwera mtengo mu nthawi ndi ndalama
  • Kutayika kotsatira komwe kumachitika chifukwa cha chithandizo
  • Zosankha zodzipereka: anthu omwe atenga nawo mbali sangakhale oyimira onse

Kuti mupeze mayankho a mafunso aliwonse omwe mungakhale nawo chonde imbani Dr. Jimenez pa 915-850-0900

Malangizo a Umoyo Wovulaza Ntchito pa Ululu Wochepa Kwambiri ku El Paso, TX

Malangizo a Umoyo Wovulaza Ntchito pa Ululu Wochepa Kwambiri ku El Paso, TX

by | Ululu Wabwerere, Chiropractic, aakulu Chisoni, Mayesero Olamulidwa Mwachisawawa

Kupweteka kwapang'onopang'ono kumayimira chimodzi mwamadandaulo omwe amapezeka kwambiri m'malo azachipatala. Ngakhale kuvulala kosiyanasiyana ndi mikhalidwe yokhudzana ndi minofu ndi mitsempha ya mitsempha ingayambitse kupweteka kwa msana, akatswiri ambiri azachipatala amakhulupirira kuti kuvulala kwa ntchito kungakhale ndi kugwirizana kwakukulu kwa kupweteka kwa msana. Mwachitsanzo, kaimidwe kosayenera ndi mayendedwe obwerezabwereza nthawi zambiri angayambitse kuvulala kokhudzana ndi ntchito. Nthawi zina, ngozi za chilengedwe kuntchito zingayambitse kuvulala kuntchito. Mulimonsemo, kudziwa komwe kumayambitsa kupweteka kwapang'onopang'ono kwa wodwala kuti adziwe bwino njira yomwe ingakhale njira yabwino yothandizira kubwezeretsa thanzi la munthu komanso thanzi lake nthawi zambiri zimakhala zovuta.

 

Choyamba, kupeza madokotala oyenerera kuti mukhale ndi gwero lenileni la ululu wochepa wammbuyo ndikofunikira kuti mupeze mpumulo ku zizindikiro zanu. Ambiri ogwira ntchito zachipatala ali oyenerera komanso odziwa bwino ntchito yochizira ululu wammbuyo wokhudzana ndi ntchito, kuphatikizapo madokotala a chiropractic kapena chiropractors. Chotsatira chake, ndondomeko zingapo zothandizira kuvulala kwa ntchito zakhazikitsidwa kuti zithetse ululu wochepa wammbuyo m'malo osamalira thanzi. Chisamaliro cha Chiropractic chimayang'ana pakuzindikira, kuchiza, ndi kupewa kuvulala ndi mikhalidwe yosiyanasiyana, monga LBP, yokhudzana ndi dongosolo la minofu ndi mafupa. Mwa kukonza mosamalitsa kusalongosoka kwa msana, chisamaliro cha chiropractic chingathandize kusintha zizindikiro za ululu wochepa wa msana, pakati pa zizindikiro zina. Cholinga cha nkhani yotsatirayi ndi kukambirana malangizo a zaumoyo ogwira ntchito pa kayendetsedwe ka ululu wochepa.

 

Malangizo a Occupational Health for Management of Low Back Pain: Kuyerekeza Kwapadziko Lonse

 

Kudalirika

 

  • Background: Kulemera kwakukulu kwa chikhalidwe cha anthu ndi kupweteka kwa msana kumatsindika kufunika kothana ndi vutoli, makamaka pankhani ya ntchito bwino. Pofuna kuthana ndi izi, malangizo a ntchito aperekedwa m'mayiko osiyanasiyana.
  • Zolinga: Kuyerekeza malangizo omwe alipo padziko lonse lapansi posamalira ululu wochepa wammbuyo m'malo osamalira thanzi lantchito.
  • Njira: Malangizowo anafaniziridwa ponena za makhalidwe omwe amavomerezedwa kawirikawiri pogwiritsa ntchito chida cha AGREE komanso mwachidule ponena za komiti yotsogolera, kufotokozera, gulu lachindunji, ndi malingaliro owunikira ndi oyang'anira (ndiko, uphungu, kubwerera kuntchito, ndi chithandizo).
  • Zotsatira ndi Zotsatira: Zotsatira zikuwonetsa kuti malangizowa adakwaniritsa mosiyanasiyana njira zabwino. Zolakwika zodziwika bwino zokhudzana ndi kusowa kwa kuwunika koyenera kwakunja munjira yachitukuko, kusowa chidwi kwa zopinga za bungwe ndi zovuta zamtengo wapatali, komanso kusowa kwa chidziwitso pazomwe akonzi ndi omanga anali odziyimira pawokha. Panali mgwirizano wamba pazinthu zambiri zofunika pakuwongolera thanzi lantchito za ululu wammbuyo. Malingaliro owunikirawo adaphatikizanso kuyesa kwa matenda, kuyang'ana mbendera zofiira ndi zovuta zaubongo, komanso kuzindikira zolepheretsa zama psychosocial ndi malo antchito kuti zitheke. Malangizowo adagwirizananso ndi uphungu wakuti kupweteka kwa msana kumakhala kudziletsa komanso kuti kukhalabe kuntchito kapena kubwerera mwamsanga (pang'onopang'ono) kuntchito, ngati kuli kofunikira ndi ntchito zosinthidwa, ziyenera kulimbikitsidwa ndi kuthandizidwa.

 

Kuzindikira kwa Dr. Alex Jimenez

Kupweteka kwam'mbuyo ndi chimodzi mwazinthu zomwe zafala kwambiri m'maofesi a chiropractic. Ngakhale kuti nkhani yotsatirayi ikufotokoza ululu wochepa wa msana monga kudziletsa kudziletsa, chifukwa cha LBP ya munthu ingayambitsenso kupweteka komanso kupweteka kwambiri komanso kusokonezeka kwa kumanzere. Ndikofunikira kwa munthu yemwe ali ndi zizindikiro za ululu wochepa wammbuyo kuti apeze chithandizo choyenera ndi chiropractor kuti adziwe bwino ndikuchiza matenda awo komanso kuwaletsa kuti asabwererenso mtsogolo. Odwala omwe amamva kupweteka kwa msana kwa miyezi yoposa 3 ndi osachepera 3 peresenti kuti abwerere kuntchito. Chisamaliro cha Chiropractic ndi njira yotetezeka komanso yothandiza yothandizira yomwe ingathandize kubwezeretsa ntchito yoyambirira ya msana. Kuphatikiza apo, dokotala wa chiropractic, kapena chiropractor, atha kupereka zosintha zamoyo, monga upangiri wazakudya komanso zolimbitsa thupi, kuti muchepetse kuchira kwa wodwalayo. Kuchiritsa kudzera mukuyenda ndikofunikira kuti LBP ibwezeretse.

 

Ululu wammbuyo (LBP) ndi amodzi mwamavuto azaumoyo omwe amafala kwambiri m'maiko ogulitsa. Ngakhale kuti ndi yabwino komanso yomveka bwino, LBP nthawi zambiri imagwirizanitsidwa ndi kulephera, kutayika kwa zokolola chifukwa cha tchuthi chodwala, komanso kukwera mtengo kwa chikhalidwe cha anthu.[1]

 

Chifukwa cha kukhudzidwa kumeneku, pakufunika kowonekeratu kuti pakhale njira zoyendetsera bwino zozikidwa pa umboni wa sayansi wochokera ku maphunziro a njira zomveka bwino. Kawirikawiri, awa ndi mayesero olamulidwa mwachisawawa (RCTs) pakuchita bwino kwa chithandizo chamankhwala, maphunziro a matenda, kapena maphunziro omwe akuyembekezeka kuyang'anitsitsa pazifukwa kapena zotsatira zake. Umboni wa sayansi, mwachidule mu ndemanga zowonongeka ndi kusanthula meta, umapereka maziko olimba a malangizo oyendetsera LBP. Mu pepala lapitalo, Koes et al. anayerekeza malangizo azachipatala osiyanasiyana omwe alipo poyang'anira LBP yolunjika kwa akatswiri azachipatala, kuwonetsa kufanana kwakukulu.[2]

 

Mavuto azaumoyo pantchito ndi osiyanasiyana. Utsogoleri umayang'ana makamaka pa uphungu wogwira ntchito ndi LBP ndi kuthana ndi nkhani zowathandiza kuti apitirize kugwira ntchito kapena kubwerera kuntchito (RTW) pambuyo pa mndandanda wa odwala. Komabe, LBP ndi nkhani yofunika kwambiri pazaumoyo wapantchito chifukwa cholephera kugwira ntchito, kutayika kwa zokolola, komanso tchuthi chodwala. Malangizo angapo, kapena zigawo za malangizo, zasindikizidwa tsopano zokhudzana ndi nkhani zenizeni za kasamalidwe kachipatala pa ntchito. Popeza kuti umboniwo ndi wapadziko lonse lapansi, zingayembekezere kuti malingaliro a maupangiri osiyanasiyana a ntchito ya LBP akhale ofanana kwambiri. Komabe, sizikudziwikiratu ngati malangizowo akukwaniritsa mfundo zovomerezeka pakali pano.

 

Pepalali likuwunikira mozama malangizo a ntchito omwe alipo poyang'anira LBP ndikufanizira zowunikira ndi zowongolera.

 

Mauthenga Aakulu

 

  • M'mayiko osiyanasiyana, malangizo a zaumoyo ogwira ntchito amaperekedwa kuti apititse patsogolo kasamalidwe ka ululu wochepa wa msana pa ntchito.
  • Zolakwika zodziwika bwino za malangizowa zimakhudza kusowa kwa kuwunika koyenera kwakunja munjira yachitukuko, kusowa chidwi ndi zopinga za bungwe ndi zovuta zamitengo, komanso kusowa kwa chidziwitso chodziyimira pawokha kwa okonza ndi opanga.
  • Nthawi zambiri, malingaliro owunikira omwe ali m'zitsogozo anali kuwunika kwa matenda, kuyang'ana mbendera zofiira ndi mavuto amisempha, komanso kuzindikira zolepheretsa m'maganizo ndi kuntchito kuti zitheke.
  • Pali mgwirizano wambiri pa uphungu wakuti kupweteka kwa msana kumakhala kudziletsa komanso kuti kukhalabe kuntchito kapena kubwerera mwamsanga (pang'onopang'ono) kuntchito, ngati kuli kofunikira ndi ntchito zosinthidwa, ziyenera kulimbikitsidwa ndi kuthandizidwa.

 

Njira

 

Malangizo pa kayendetsedwe ka umoyo wa ntchito ya LBP adatengedwa kuchokera ku mafayilo aumwini a olemba. Kubwezeretsanso kunayang'aniridwa ndi kufufuza kwa Medline pogwiritsa ntchito mawu ofunika kwambiri opweteka kumbuyo, malangizo, ndi ntchito mpaka October 2001, ndi kulankhulana payekha ndi akatswiri m'munda. Ndondomeko zimayenera kukwaniritsa izi:

 

  • Malangizo okhudza kuyang'anira ogwira ntchito omwe ali ndi LBP (m'malo osamalira thanzi la ogwira ntchito kapena kuthana ndi mavuto a ntchito) kapena magawo osiyana a ndondomeko zomwe zimakhudza mitu imeneyi.
  • Malangizo akupezeka mu Chingerezi kapena Chidatchi (kapena kumasuliridwa m'zilankhulo izi).

 

Njira zochotsera zinali:

 

  • Malangizo oletsa kupewa koyamba (ndiko kuti, kupewa zisanachitike zizindikiro) za LBP yokhudzana ndi ntchito (mwachitsanzo, kukweza malangizo kwa ogwira ntchito).
  • Malangizo azachipatala oyendetsera LBP mu chisamaliro choyambirira. [2]

 

Ubwino wa malangizo omwe adaphatikizidwawo adawunikidwa pogwiritsa ntchito chida cha AGREE, chida chodziwika bwino chomwe chidapangidwa makamaka kuti chithandizire otsogolera otsogola ndi ogwiritsa ntchito kuwunika njira zamachitidwe azachipatala. [3]

 

Chida cha AGREE chimapereka ndondomeko yowunikira khalidwe la zinthu za 24 (tebulo 1), iliyonse imayikidwa pamlingo wa mfundo zinayi. Kugwiritsa ntchito kwathunthu kukupezeka pa www.agreecollaboration.org.

 

Owunikira awiri (BS ndi HH) adavotera pawokha ubwino wa malangizowo ndipo adakumana kuti akambirane zosagwirizana komanso kuti agwirizane pazakudyazo. Pamene sanagwirizane, wowunika wachitatu (MvT) adayanjanitsa kusiyana komwe kunatsala ndikusankha zowerengera. Kuti tithandizire kusanthula mu ndemangayi, zowerengera zidasinthidwa kukhala zosinthika zamtundu uliwonse ngati chinthu chilichonse chaubwino chinali kapena sichinakwaniritsidwe.

 

Malingaliro owunika adafupikitsidwa ndikufanizidwa ndi malingaliro pa upangiri, chithandizo, ndi njira zobwerera kuntchito. Malangizo osankhidwawo adadziwikanso ndikufikira pa komiti yotsogolera, kufotokozera njirayo, gulu lomwe likukhudzidwa, komanso momwe malingalirowo adachokera paumboni wasayansi womwe ulipo. Chidziwitso chonsechi chinatengedwa mwachindunji kuchokera ku malangizo ofalitsidwa.

 

Zotsatira za Ndondomeko

 

  • Kasamalidwe ka ululu wochepa wammbuyo mu chisamaliro chaumoyo wa ntchito ayenera kutsatira malangizo ozikidwa pa umboni.
  • Malangizo amtsogolo a ntchito yosamalira ululu wochepa wammbuyo ndi zosintha za malangizowo ayenera kuganizira za njira zoyendetsera bwino, kukhazikitsa, ndi kuyesa njira monga momwe mgwirizano wa AGREE wanenera.

 

Results

 

Kusankha Maphunziro

 

Kufufuza kwathu kunapeza zitsogozo khumi, koma zinayi sizinaphatikizidwe chifukwa zinkagwira ntchito ndi kasamalidwe ka LBP mu chisamaliro chapadera, [15] cholinga chake chinali chitsogozo cha ogwira ntchito odwala omwe ali ndi odwala ambiri (osati makamaka LBP), [16] anapangidwira kupewa kwakukulu kwa LBP kuntchito, [17] kapena kunalibe mu Chingerezi kapena Chidatchi. [18] Chifukwa chake, kusankha komaliza kunali ndi malangizo asanu ndi limodzi otsatirawa, olembedwa ndi tsiku lotulutsidwa:

 

(1) Canada (Quebec). Njira yasayansi yowunika ndi kuyang'anira zovuta za msana zokhudzana ndi ntchito. A monograph kwa madokotala. Lipoti la Quebec Task Force pa Spinal Disorders. Quebec Canada (1987) [4]

 

(2) Australia (Victoria). Malangizo oyendetsera antchito omwe ali ndi ululu wochepa wammbuyo. Victorian WorkCover Authority, Australia (1996) [5] (Ili ndi ndondomeko yosinthidwa ya malangizo opangidwa ndi South Australian WorkCover Corporation mu October 1993.)

 

(3) USA. Malangizo Ogwiritsira Ntchito Mankhwala Ogwira Ntchito. American College of Occupational and Environmental Medicine. USA (1997) [6]

 

(4) New Zealand

 

(a) Wogwira ntchito komanso wogwira ntchito! Kusamalira ululu wopweteka kwambiri wa msana kuntchito. Accident Compensation Corporation ndi National Health Committee. New Zealand (2000) [7]

 

(b) Chitsogozo cha odwala kuti athetse ululu wopweteka kwambiri. Accident Compensation Corporation ndi National Health Committee. New Zealand (1998) [8]

 

(c) Unikani mbendera zachikaso pamalingaliro am'mutu wam'mbuyo. Accident Compensation Corporation ndi National Health Committee. New Zealand (1997) [9]

(5) Netherlands. Chitsogozo cha Dutch choyang'anira madokotala ogwira ntchito ogwira ntchito omwe ali ndi ululu wochepa wammbuyo. Dutch Association of Occupational Medicine (NVAB). Netherlands (1999) [10]

 

(6) UK

 

(a) Malangizo a zaumoyo pantchito yosamalira ululu wammbuyo pamalangizo akuluakulu a ntchito. Faculty of Occupational Medicine. UK (2000) [11]

 

(b) Malangizo a zaumoyo pantchito yosamalira ululu wochepa wammbuyo kuntchito kwa asing'anga. Faculty of Occupational Medicine. UK (2000) [12]

 

(c) Malangizo a zaumoyo pantchito yosamalira ululu wochepa wammbuyo pakuwunika kwaumboni wantchito. Faculty of Occupational Medicine. UK (2000) [13]

 

(d) Bukhu Lambuyo, Ofesi Yolemba. UK (1996) [14]

Malangizo awiri (4 ndi 6) sakanatha kuyesedwa paokha kuchokera ku zolemba zina zomwe amazitchula (4bc, 6bd), kotero kuti zolembazi zinaphatikizidwanso mu ndemanga.

 

Kuunika kwa Ubwino wa Maupangiri

 

Poyambirira, panali mgwirizano pakati pa owunikira awiriwo okhudzana ndi 106 (77%) mwazinthu za 138. Pambuyo pamisonkhano iwiri, chigwirizano chinafikiridwa pazinthu zonse kupatula zinayi, zomwe zimafuna chigamulo ndi wobwereza wachitatu. Gulu 1 likuwonetsa mavoti omaliza.

 

Malangizo onse ophatikizidwa adapereka njira zosiyanasiyana zoyendetsera LBP muumoyo wantchito. Mu ndondomeko zisanu mwa zisanu ndi chimodzizo, zolinga zonse za ndondomekoyi zinafotokozedwa momveka bwino, [46, 1014] ogwiritsira ntchito ndondomekoyi adafotokozedwa momveka bwino, [514] mfundo zazikulu zomwe zimadziwika mosavuta zinaphatikizidwa, [4, 614] kapena kuunikanso mozama. njira zinaperekedwa kuti ziwonetsedwe ndi kufufuza. [49, 1114]

 

Zotsatira za kafukufuku wa AGREE zinasonyeza kuti palibe ndondomeko yomwe inapereka chidwi chokwanira pa zopinga zomwe zingatheke m'bungwe ndi zovuta zamtengo wapatali pokwaniritsa ndondomekozo. Sizinadziwikenso pazitsogozo zonse zophatikizidwa ngati iwo anali odziyimira pawokha ku bungwe lopereka ndalama komanso ngati panali mikangano kapena ayi kwa mamembala a makomiti achitukuko. Komanso, sizinali zodziwika bwino pazitsogozo zonse ngati akatswiri adawunikiranso ndondomeko zakunja asanasindikizidwe. Chitsogozo cha UK chokhacho chinafotokozera momveka bwino njira yomwe imagwiritsidwa ntchito popanga malingaliro ndikupereka kukonzanso njirayo.[11]

 

Table 1 Mavoti a Occupational Health Guidelines

 

Kupanga Malangizo

 

Gulu 2 likuwonetsa mbiri yakale pazachitukuko za malangizowo.

 

Omwe adagwiritsa ntchito malangizowa anali madokotala ndi othandizira ena azaumoyo pantchito yazaumoyo. Ndondomeko zingapo zidalunjikitsidwanso pakudziwitsa olemba anzawo ntchito, ogwira ntchito [68, 11, 14], kapena mamembala a mabungwe omwe ali ndi chidwi ndi thanzi lantchito.[4] Malangizo achi Dutch adangolunjika kwa dokotala wa zantchito. [10]

 

Makomiti otsogola omwe anali ndi udindo wopanga malangizowa anali amitundu yosiyanasiyana, kuphatikiza maphunziro monga epidemiology, ergonomics, physiotherapy, general practice, occupational medicine, occupational therapy, orthopedics, ndi oimira mabungwe a olemba ntchito ndi mabungwe ogwira ntchito. Oimira Chiropractic ndi osteopathic anali mu komiti yotsogolera ya malangizo a New Zealand.[79] Gulu lantchito la Quebec (Canada) linaphatikizansopo oimira mankhwala ochiritsira, rheumatology, zachuma zaumoyo, malamulo, neurosurgery, biomechanical engineering, ndi library science. Mosiyana ndi zimenezi, komiti yotsogolera ya malangizo a Chidatchi inali ndi madokotala a ntchito okha.[10]

 

Malangizowa adaperekedwa ngati chikalata chosiyana, [4, 5, 10] monga mutu m'buku, [6] kapena zolemba zingapo zogwirizana.[79, 1114]

 

Maupangiri aku UK, [13] USA, [6] ndi Canada[4] malangizo adapereka chidziwitso panjira yofufuzira yomwe imagwiritsidwa ntchito pozindikiritsa zolemba zoyenera komanso kuyeza kwa umboni. Kumbali ina, malangizo achi Dutch[10] ndi aku Australia[5] adathandizira malingaliro awo ndi maumboni okha. Malangizo a New Zealand sanawonetse kulumikizana kwachindunji pakati pa malingaliro ndi nkhawa [79]. Wowerengayo adatumizidwa ku mabuku ena kuti adziwe zambiri.

 

Table 2 Mbiri Yachidziwitso cha Maupangiri

 

Table 3 Malangizo Otsogolera pa Ntchito

 

Table 4 Malangizo Otsogolera pa Ntchito

 

Odwala Population and Diagnostic Recommendations

 

Ngakhale kuti malangizo onse akugwiritsidwa ntchito kwa ogwira ntchito omwe ali ndi LBP, nthawi zambiri sizinkadziwika bwino ngati amachitira ndi LBP yovuta kapena yosatha kapena zonse ziwiri. LBP yovuta komanso yosatha nthawi zambiri sinafotokozedwe, ndipo mfundo zodulira zidaperekedwa (mwachitsanzo, <miyezi 3). Nthawi zambiri sizinkadziwika ngati izi zikutanthauza kuyambika kwa zizindikiro kapena kusagwira ntchito. Komabe, chitsogozo cha Canada chinayambitsa dongosolo lamagulu (achimake / subacute / aakulu) kutengera kugawidwa kwa zonena za matenda a msana ndi nthawi kuyambira pomwe sanagwire ntchito.[4]

 

Malangizo onse adasiyanitsa LBP yeniyeni komanso yosadziwika. Specific LBP ikukhudza zomwe zingakhale zoopsa kwambiri ngati mbendera yofiira ngati kuthyoka, zotupa, kapena matenda, ndipo malangizo a Dutch ndi UK amasiyanitsanso radicular syndrome kapena ululu wa minyewa.[1013] Njira zonse zinali zogwirizana ndi malingaliro awo kuti atenge mbiri yachipatala ndikuyesa thupi, kuphatikizapo kuwunika kwa mitsempha. Pazochitika za matenda omwe amaganiziridwa (mbendera zofiira), mayeso a x-ray adalimbikitsidwa ndi malangizo ambiri. Kuphatikiza apo, New Zealand ndi malangizo a US adalimbikitsanso kuyezetsa magazi kwa x-ray pamene zizindikiro sizikuyenda bwino pakadutsa milungu inayi. wodwala LBP (yosiyana ndi zizindikiro zilizonse zachipatala).[6]

 

Maupangiri ambiri amawona kuti zochitika zama psychosocial ngati mbendera zachikasu ngati zolepheretsa kuchira zomwe othandizira azaumoyo ayenera kuthana nazo. Malangizo a New Zealand[9] ndi UK [11, 12] adafotokoza momveka bwino zinthu ndikuwafunsa mafunso kuti azindikire mbendera zachikasu zamalingaliro.

 

Malangizo onse adafotokoza kufunikira kwa mbiri yachipatala yozindikiritsa zochitika zakuthupi ndi zamaganizidwe zomwe zimakhudzana ndi LBP, kuphatikiza zofuna zakuthupi (kugwira pamanja, kukweza, kupindika, kupindika, ndi kukhudzana ndi kugwedezeka kwa thupi lonse), ngozi kapena kuvulala, ndi zovuta zomwe zimaganiziridwa. pobwerera kuntchito kapena maubwenzi kuntchito. Maupangiri a Chidatchi ndi Canada anali ndi malingaliro oti achite kafukufuku wapantchito[10] kapena kuwunika luso lantchito pakafunika kutero.[4]

 

Chidule cha Malangizo pa Kuunika kwa LBP

 

  • Kuzindikira matenda (LBP yosadziwika, radicular syndrome, LBP yeniyeni).
  • Kupatula mbendera zofiira ndi kuyezetsa minyewa.
  • Zindikirani zomwe zimakupangitsani kuti mukhale ndi malingaliro komanso zolepheretsa kuti muchiritsidwe.
  • Dziwani zinthu zapantchito (zakuthupi ndi m'maganizo) zomwe zingagwirizane ndi vuto la LBP ndikubwerera kuntchito.
  • Mayeso a X-ray amangopezeka pa milandu yomwe akukayikira kuti ali ndi matenda enaake.

 

Malangizo Okhudza Chidziwitso ndi Upangiri, Chithandizo, ndi Njira Zobwerera Kuntchito

 

Maupangiri ambiri amalimbikitsa kutsimikizira wogwira ntchitoyo ndikupereka chidziwitso chokhudza kudziletsa kwa LBP komanso kuneneratu kwabwino. Chilimbikitso chobwerera ku zochitika wamba nthawi zambiri chimalangizidwa.

 

Mogwirizana ndi ndondomeko yobwerera kuntchito yokhazikika, malangizo onse adatsindikanso kufunika kobwerera kuntchito mofulumira, ngakhale patakhalabe LBP ndipo, ngati kuli kofunikira, kuyambira ndi ntchito zosinthidwa pazochitika zovuta kwambiri. Ntchito zitha kuonjezedwa pang'onopang'ono (maola ndi ntchito) mpaka kubwerera kwathunthu kuntchito kukwaniritsidwa. Malangizo aku US ndi Dutch adapereka ndandanda yatsatanetsatane yanthawi yobwerera kuntchito. Njira yachi Dutch inati abwerere ku ntchito mkati mwa milungu iwiri ndi kusintha ntchito ngati pakufunika kutero.[10] Dongosolo lachi Dutch linagogomezeranso kufunikira kwa kasamalidwe ka nthawi kochepa ponena za kubwerera kuntchito.[10] Chitsogozo cha US chinapereka kuyesera kulikonse kuti wodwalayo akhale ndi zochitika zambiri, kuphatikizapo ntchito; Zolinga zanthawi yayitali ya olumala pobwerera kuntchito zidaperekedwa ngati masiku 02 okhala ndi ntchito zosinthidwa ndi masiku 714 ngati ntchito zosinthidwa sizikugwiritsidwa ntchito / zilipo.[6] Mosiyana ndi enawo, malangizo aku Canada adalangiza kuti abwerere kuntchito pokhapokha zizindikiro ndi zoletsa zinasintha. [4]

 

Njira zochiritsira zomwe zimalangizidwa kawirikawiri m'zitsogozo zonse zomwe zinaphatikizidwazo zinali: mankhwala ochepetsera ululu, [5, 7, 8] mapulogalamu ochita masewera olimbitsa thupi pang'onopang'ono, [6, 10] ndi kukonzanso machitidwe osiyanasiyana.[1013] Malangizo a ku United States amalimbikitsa kuti anthu atumizidwe pakatha milungu iwiri ku pulogalamu yolimbitsa thupi yokhala ndi masewera olimbitsa thupi, masewera olimbitsa thupi a thunthu, komanso kuchuluka kwa masewera olimbitsa thupi.[6] Lamulo la Chidatchi linalimbikitsa kuti ngati palibe kupita patsogolo mkati mwa milungu iwiri yochoka kuntchito, ogwira ntchito ayenera kutumizidwa ku pulogalamu yochita masewera olimbitsa thupi (zowonjezera pang'onopang'ono zolimbitsa thupi) ndipo, ngati palibe kusintha pakadutsa milungu inayi, ku pulogalamu yokonzanso machitidwe osiyanasiyana.[10] ] Upangiri waku UK udalimbikitsa kuti ogwira ntchito omwe amavutika kuti abwerere kuntchito zawo pakatha milungu 412 atumizidwe ku pulogalamu yokonzanso. Pulogalamu yokonzansoyi iyenera kuphatikizapo maphunziro, chilimbikitso ndi uphungu, ndondomeko yowonjezereka yolimbitsa thupi ndi masewera olimbitsa thupi, komanso kuchepetsa ululu malinga ndi mfundo zamakhalidwe; ziyenera kuphatikizidwa muzochitika za ntchito ndikuwongolera mwamphamvu kubwerera kuntchito. [11-13] Mndandanda wochuluka wa njira zochiritsira zomwe zingatheke zinaperekedwa mu malangizo a Canada ndi Australia [4, 5], ngakhale kuti zambiri mwa izi sizinakhazikitsidwe. pa umboni wa sayansi.

 

Chidule cha Malangizo Okhudza Chidziwitso, Malangizo, Kubwerera ku Njira Zogwirira Ntchito, ndi Chithandizo cha Ogwira Ntchito ndi LBP

 

  • Mutsimikizireni wogwira ntchitoyo ndikupereka chidziwitso chokwanira chokhudza kudziletsa kwa LBP ndi momwe mungadziwire bwino.
  • Alangizeni wogwira ntchitoyo kuti apitirize ntchito wamba kapena kuti abwerere ku masewera olimbitsa thupi ndikugwira ntchito mwamsanga, ngakhale pangakhale ululu.
  • Ogwira ntchito ambiri omwe ali ndi LBP amabwerera kuntchito zambiri kapena zochepa kwambiri. Ganizirani zakusintha kwakanthawi kantchito (maola / ntchito) pokhapokha ngati kuli kofunikira.
  • Wogwira ntchito akalephera kubwerera kuntchito mkati mwa masabata a 212 (pali kusiyana kwakukulu kwa nthawi muzotsatira zosiyana), tumizani ku pulogalamu yolimbitsa thupi yomwe ikuwonjezeka pang'onopang'ono, kapena kukonzanso machitidwe osiyanasiyana (zolimbitsa thupi, maphunziro, chilimbikitso, ndi kusamalira ululu potsatira mfundo zamakhalidwe). ). Mapulogalamu okonzanso awa
    iyenera kukhazikitsidwa pamisonkhano yantchito.

 

Kukambirana

 

Ulamuliro wa LBP muzochitika za umoyo wapantchito uyenera kuthana ndi mgwirizano pakati pa madandaulo otsika kwambiri ndi ntchito ndikupanga njira zomwe zikufuna kubwereranso kuntchito. Ndemangayi ikuyerekeza malangizo azaumoyo omwe alipo ochokera kumayiko osiyanasiyana. Ndondomeko sizimalembedwa kawirikawiri ku Medline, kotero pofufuza malangizo, tinkayenera kudalira mafayilo athu komanso kulankhulana kwathu.

 

Makhalidwe Abwino ndi Njira Zachitukuko za Maupangiri

 

Kuwunika kochitidwa ndi chida cha AGREE[3] kunawonetsa kusiyana kwina kwa maupangiri omwe akuwunikiridwa, omwe mwina angawonetse kusiyana kwa masiku a chitukuko ndi kufalitsa malangizowo. Mwachitsanzo, malangizo aku Canada, adasindikizidwa mu 1987 ndi malangizo aku Australia mu 1996. [4, 5] Malangizo ena anali aposachedwa kwambiri ndipo adaphatikiza umboni wochulukirapo komanso njira zotsogola zaposachedwa.

 

Zolakwika zingapo zodziwika zokhudzana ndi chitukuko cha malangizowo zidawonetsedwa ndikuwunika ndi chida cha AGREE. Choyamba, ndikofunikira kufotokoza momveka bwino ngati chitsogozo chili chodziyimira pawokha kuchokera ku bungwe lopereka ndalama, komanso ngati pali mikangano yokhudzana ndi zofuna za mamembala a komiti yotsogolera. Palibe malangizo omwe adaphatikizidwa omwe adafotokoza momveka bwino nkhaniyi. Kupitilira apo, kuwunikiranso kwakunja kwachitsogozo ndi akatswiri azachipatala komanso njira yotsatsira asanasindikizidwe kunalibenso malangizo onse omwe akuphatikizidwa mu ndemangayi.

 

Malangizo angapo adapereka chidziwitso chokwanira cha momwe mabuku ofunikira adafufuzidwira ndikumasuliridwa kukhala malingaliro. [4, 6, 11, 13] Malangizo ena adathandizira malingaliro awo ndi maumboni, [5, 7, 9, 10] koma izi sizilola kuwunika kwa kulimba kwa malangizowo kapena malingaliro awo.

 

Malangizo amadalira umboni wa sayansi, umene umasintha pakapita nthawi, ndipo n'zochititsa chidwi kuti chitsogozo chimodzi chokha choperekedwa kuti chisinthidwe mtsogolo.[11, 12] Mwinamwake pali zosintha zomwe zakonzedweratu pazitsogozo zina koma sizinafotokozedwe momveka bwino (ndipo mosiyana kufotokoza pamenepo). kukhala zosintha zamtsogolo sizikutanthauza kuti zidzachitikadi). Kulephera kupereka malipotiku kungathenso kukhala zoona pazotsatira zina za AGREE zomwe tidazivotera molakwika. Kugwiritsiridwa ntchito kwa ndondomeko ya AGREE monga chitsogozo cha chitukuko ndi kupereka malipoti a ndondomeko ziyenera kuthandizira kuwongolera ndondomeko zamtsogolo.

 

Kuwunika ndi Kuwongolera kwa LBP

 

Njira zodziwira zomwe zimalangizidwa m'mabuku a zaumoyo za ntchito zinali zofanana kwambiri ndi malangizo a malangizo achipatala, [2] ndipo, momveka bwino, kusiyana kwakukulu kunali kutsindika pa kuthetsa nkhani za ntchito. Njira zomwe zafotokozedwera poyang'anira zochitika zapantchito pakuwunika kwa LBP kwa wogwira ntchito payekha zimakhudza kuzindikira ntchito zovuta, zoopsa, ndi zopinga zobwerera kuntchito ndi mbiri yantchito. Mwachiwonekere, zopinga zobwerera kuntchito izi sizimangokhudza kuchuluka kwa thupi, komanso mavuto okhudzana ndi m'maganizo okhudzana ndi maudindo, mgwirizano ndi ogwira nawo ntchito, komanso chikhalidwe cha anthu kuntchito.[10] Kuyang'anira mbendera zachikaso zokhudzana ndi ntchito kungathandize kuzindikira ogwira ntchito omwe ali pachiwopsezo chakumva zowawa zosatha komanso olumala.[1113]

 

Chinthu chofunika kwambiri pazitsogozo ndi chakuti iwo anali osasinthasintha ponena za malingaliro awo kuti atsimikizire wogwira ntchitoyo ndi LBP, ndi kulimbikitsa ndi kuthandizira kubwerera kuntchito ngakhale ali ndi zizindikiro zopitirirabe. Pali mgwirizano wamba kuti antchito ambiri sayenera kudikirira mpaka atasiya kumva kuwawa asanabwerere kuntchito. Mndandanda wa njira zothandizira chithandizo choperekedwa ndi malangizo a Canada ndi Australia angasonyeze kusowa kwa umboni panthawiyo, [4, 5] kusiya ogwiritsa ntchito malangizowo kuti asankhe okha. Komabe, n’zokayikitsa ngati mndandanda woterewu umathandiziradi kuti chisamaliro chikhale chotukuka, ndipo m’malingaliro athu malangizo a kalozera ayenera kuzikidwa pa umboni wotsimikizirika wa sayansi.

 

The US, Dutch, and UK occupational guidelines [6, 1013] amalimbikitsa kuti chithandizo chogwira ntchito chamagulu ambiri ndicho njira yodalirika yobwerera kuntchito, ndipo izi zimathandizidwa ndi umboni wamphamvu wochokera ku RCTs [19, 20] Komabe, kafukufuku wochuluka akadalipobe. zofunikira kuti zizindikire zomwe zili mulingo woyenera komanso kuchuluka kwa phukusi lamankhwala. [13, 21]

 

Ngakhale kuti pali umboni wina wothandizapo pazochitika zapantchito mu aetiology ya LBP, [22] njira zowonongeka za malo ogwira ntchito zikusowa, ndipo sizikuperekedwa monga malingaliro mu malangizowo. Mwina izi zikuyimira kusowa chidaliro muumboni pazochitika zonse za malo ogwira ntchito, zovuta zomasulira kukhala malangizo othandiza, kapena chifukwa chakuti nkhanizi zimasokonezedwa ndi malamulo a m'deralo (omwe adatchulidwa mu ndondomeko ya UK [11]). Zitha kukhala kuti kulowererapo kwa ergonomics, komwe kumafuna kukambirana ndi wogwira ntchito, owalemba ntchito, ndi katswiri wa ergonomist, kudzakhala kubwezera kothandiza pakulowererapo kwa ntchito. 23] inagogomezedwa mu malangizo a Dutch ndi UK, [24] koma kuwunikanso njira iyi ndi kukhazikitsidwa kwake kumafunika.

 

Kupanga Malangizo Amtsogolo mu Ntchito Zaumoyo Wantchito

 

Cholinga cha ndemangayi chinali kupereka zonse mwachidule komanso kuwunika mozama kwa malangizo a ntchito pa kayendetsedwe ka LBP. Kuwunikiridwa kofunikira kwa maupangiri ndikuthandizira kuwongolera chitukuko chamtsogolo komanso zosintha zomwe zakonzedwa. M'gawo lomwe likukulabe la njira zowongolera timawona zonse zomwe zidachitika kale ngati zoyamikirika; timazindikira kufunikira kwa chitsogozo chachipatala, ndipo timayamikira kuti otsogolera otsogolera sangadikire kafukufuku kuti apereke njira zonse ndi umboni wofunikira. Komabe, pali mwayi wowongolera komanso malangizo amtsogolo ndi zosintha ziyenera kuganizira zoyenera kuchita pakukula bwino, kukhazikitsidwa, ndi kuunika kwa malangizo omwe aperekedwa ndi mgwirizano wa AGREE.

 

Kukhazikitsidwa kwa malangizowa sikungakwaniritsidwe ndi kuwunikaku, koma zidadziwika kuti palibe zikalata zotsogola zomwe zidafotokoza za njira zogwirira ntchito, kotero sizikudziwika kuti magulu omwe akuyembekezeredwawo adafikira bwanji, ndi zotsatira zotani zomwe zingakhale nazo. . Ili likhoza kukhala gawo lopindulitsa pakufufuza kwina.

 

Kukhalapo kwa maupangiri aumoyo wapantchitowa kukuwonetsa kuti malangizo azachipatala omwe alipo a LBP2 amawonedwa ngati osayenera kapena osakwanira pantchito zachipatala. Pali malingaliro omveka padziko lonse lapansi kuti zosowa za wogwira ntchito amene akuvutika ndi ululu wammbuyo zimagwirizanitsidwa kwambiri ndi zochitika zosiyanasiyana za ntchito zomwe sizimakhudzidwa ndi chitsogozo choyambirira cha chisamaliro, motero, kuchita. Chomwe chikuwonekera ndi chakuti, ngakhale kuti pali zolakwika za njira, mgwirizano waukulu ukuwonekera pa njira zingapo zofunika zaumoyo za ntchito zothandizira wogwira ntchitoyo ndi ululu wammbuyo, zina zomwe zimakhala zatsopano komanso zovuta zomwe anthu ankawona kale. Pali mgwirizano pa uthenga wofunikira woti kutaya ntchito kwanthawi yayitali kumawononga, ndikuti kubwereranso koyambirira kuyenera kulimbikitsidwa ndi kuthandizidwa; palibe chifukwa chodikirira kuthetsa kwathunthu kwa zizindikiro. Ngakhale kuti njira zolangizidwa zimasiyana pang'ono, pali kuvomerezana kwakukulu pamtengo wotsimikizirika ndi uphungu wabwino, kupezeka kwa ntchito (yosakhalitsa) yosinthidwa, kuthana ndi zochitika zapantchito (kutengera osewera onse), ndi kukonzanso kwa ogwira ntchito omwe akuvutika kubwerera kuntchito.

 

Zothokoza

 

Kafukufukuyu adathandizidwa ndi Dutch Health Care Insurance Council (CVZ), thandizo la DPZ no. 169/0, Amstelveen, Netherlands. JB Staal panopa akugwira ntchito ku Dipatimenti ya Epidemiology, Maastricht University, PO Box 616 6200 MD Maastricht, Netherlands. W van Mechelen nayenso ndi gawo la Research Center on Physical Activity, Work and Health, Body@work TNO-VUmc.

 

Pomaliza, zizindikiro za ululu wammbuyo ndi chimodzi mwazinthu zomwe zimakhudzidwa kwambiri ndi kuvulala kwa ntchito. Chifukwa chake, malangizo angapo azaumoyo akhazikitsidwa kuti athetse ululu wammbuyo. Chisamaliro cha Chiropractic, pakati pa njira zina zothandizira, zingagwiritsidwe ntchito pofuna kuthandiza wodwalayo kupeza mpumulo ku LBP yawo. Komanso, nkhani yomwe ili pamwambayi inasonyeza chitetezo ndi mphamvu zamitundu yosiyanasiyana ya chikhalidwe komanso njira zina zothandizira pa matenda, chithandizo ndi kupewa matenda osiyanasiyana opweteka a msana. Komabe, maphunziro owonjezera ofufuza amafunikira kuti adziwe bwino momwe mungagwiritsire ntchito njira iliyonse yamankhwala. Zambiri zomwe zatchulidwa kuchokera ku National Center for Biotechnology Information (NCBI). Kuchuluka kwa chidziwitso chathu kumangokhala kwa chiropractic komanso kuvulala kwa msana ndi mikhalidwe. Kuti tikambirane nkhaniyi, chonde omasuka kufunsa Dr. Jimenez kapena tilankhule nafe pa 915-850-0900 .

 

Wosankhidwa ndi Dr. Alex Jimenez

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

Mitu Yowonjezera: Ululu Wobwerera

 

Malinga ndi ziwerengero, pafupifupi 80% ya anthu adzakhala ndi zizindikiro za ululu wammbuyo kamodzi pa moyo wawo wonse. Ululu wammbuyo ndi dandaulo lofala lomwe lingakhalepo chifukwa cha kuvulala kosiyanasiyana ndi/kapena mikhalidwe. Nthawi zambiri, kuwonongeka kwachilengedwe kwa msana ndi zaka kungayambitse ululu wammbuyo. Herniated discs zimachitika pamene chofewa, ngati gel pakati pa intervertebral disc ikukankhira kupyola mu misozi yozungulira, mphete yakunja ya cartilage, kuponderezana ndi kukwiyitsa mizu ya mitsempha. Ma disc herniations nthawi zambiri amapezeka m'munsi kumbuyo, kapena msana, koma amathanso kuchitika m'mphepete mwa khomo lachiberekero, kapena khosi. Kulowetsedwa kwa mitsempha yomwe imapezeka m'munsi kumbuyo chifukwa cha kuvulala ndi / kapena kuwonjezereka kwa chikhalidwe kungayambitse zizindikiro za sciatica.

 

 

chithunzi cha blog cha cartoon paperboy nkhani zazikulu

 

MUTU WOFUNIKA KWAMBIRI: Chithandizo cha Migraine Pain

 

 

ZINTHU ZINA: ZOWONJEZERA: El Paso, Tx | Othamanga

 

Palibe kanthu
Zothandizira
1. Van Tulder MW, Koes BW, Bouter LM. Kafukufuku wamtengo wapatali wa ululu wammbuyo ku Netherlands. Ululu 1995; 62:233-40.
2. Koes BW, van Tulder MW, Ostelo R, et al. Malangizo azachipatala osamalira ululu wochepa wammbuyo mu chisamaliro choyambirira: International
kuyerekeza. Msana 2001;26:2504�14.
3. GWIRIZANI Mgwirizano. Kuwunika kwa Maupangiri Kafukufuku &
Evaluation Instrument, www.agreecollaboration.org.
4. Spitzer WO, Leblanc FE, Dupuis M. Njira ya sayansi ku
kuunika ndi kasamalidwe ka matenda a msana okhudzana ndi ntchito. A monograph kwa madokotala. Lipoti la Quebec Task Force on Spinal Disorders. Msana 1987;12(zothandizira 7S):1�59.
5. Victorian WorkCover Authority. Malangizo oyendetsera antchito omwe ali ndi ululu wochepa wammbuyo. Melbourne: Victorian WorkCover Authority, 1996.
6. Harris JS. Malangizo ogwiritsira ntchito mankhwala. Beverly, MA: OEM Press, 1997.
7. Bungwe la Malipiro a Ngozi ndi National Health Committee. Yogwira ndi ntchito! Kusamalira ululu wopweteka kwambiri wa msana kuntchito. Wellington, New Zealand, 2000.
8. Bungwe la Malipiro a Ngozi ndi Komiti Yadziko Lonse ya Zaumoyo, Unduna wa Zaumoyo. Kalozera wa odwala kuti athetse ululu wopweteka kwambiri. Wellington, New Zealand, 1998.
9. Kendall, Linton SJ, Main CJ. Chitsogozo chowunika mbendera zachikaso zama psychosocial mu ululu wammbuyo wammbuyo. Ziwopsezo za kulemala kwanthawi yayitali komanso kutaya ntchito. Wellington, New Zealand, Accident Rehabilitation & Compensation Insurance Corporation ya New Zealand ndi National Health Committee, 1997.
10. Nederlandse Vereniging voor Arbeids- en Bedrijfsgeneeskunde (Dutch Association of Occupational Medicine, NVAB). Handelen van de bedrijfsarts bij werknemers met lage-rugklachten. Richtlijnen voor Bedrijfsartsen. [Malangizo achi Dutch otsogolera madokotala ogwira ntchito ogwira ntchito omwe ali ndi ululu wochepa wammbuyo]. Epulo 1999.
11. Carter JT, Birell LN. Malangizo aumoyo wapantchito pakuwongolera ululu wochepa wammbuyo pantchito" malingaliro akulu. London: Faculty of Occupational Medicine, 2000 (www.facoccmed.ac.uk).
12. Malangizo a zaumoyo pantchito yosamalira ululu wochepa wa msana kuntchito�kapepala kwa asing'anga. London: Faculty of Occupational Medicine, 2000 (www.facoccmed.ac.uk).
13. Waddell G, Burton AK. Malangizo azaumoyo pantchito yosamalira ululu wochepa wammbuyo pantchito" kuwunika kwaumboni. Ntchito Med 2001; 51:124-35.
14. Roland M, et al. Bukhu lakumbuyo. Norwich: The Stationery Office, 1996.
15. ICSI. Chitsogozo chaumoyo. Kupweteka kwapambuyo kwa wamkulu. Institute for Clinical Systems Integration, 1998 (www.icsi.org/guide/).
16. Kazimirski JC. Chidule cha mfundo za CMA: Udindo wa dokotala pothandiza odwala kubwerera kuntchito atadwala kapena kuvulala. CMAJ 1997;156:680A�680C.
17. Yamamoto S. Malangizo pa kupewa kwa malo ogwira ntchito kupweteka kwa msana. Chidziwitso cha Bureau of Labor Standards, No. 57. Industrial Health 1997;35:143�72.
18. INSERM. Les Lombalgies en milieu professionel: quel facteurs de risque et quelle prevention? [Kupweteka kwa msana kuntchito: zowopsa ndi kupewa]. Paris: les editions INSERM, Synthese bibliographique kuzindikira a la demande de la CANAM, 2000.
19. Lindstro?m I, Ohund C, Eek C, et al. Zotsatira za zochitika zolimbitsa thupi kwa odwala omwe ali ndi ululu wopweteka kwambiri wam'mbuyo: kufufuza kosasinthika kwachipatala ndi njira yogwiritsira ntchito-conditioning. Physical Therapy 1992; 72:279-93.
20. Karjalainen K, Malmivaara A, van Tulder M, et al. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain in achikulire azaka zogwira ntchito: kuwunika mwadongosolo mkati mwa dongosolo la Cochrane Collaboration Back Review Group. Msana 2001;26:262�9.
21. Staal JB, Hlobil H, van Tulder MW, et al. Njira zobwerera kuntchito chifukwa cha ululu wochepa wa msana: ndemanga yofotokozera zomwe zili mkati ndi malingaliro a njira zogwirira ntchito. Masewera Med 2002;32:251�67.
22. Hoogendoorn WE, van Poppel MN, Bongers PM, et al. Kulemera kwa thupi panthawi ya ntchito ndi nthawi yopuma monga zifukwa zowopsa za ululu wammbuyo. Scand J Work Environ Health 1999;25:387�403.
23. Loisel P, Gosselin L, Durand P, et al. Kuyesedwa kwachidziwitso kwa anthu, mwachisawawa pa kasamalidwe ka ululu wammbuyo. Msana 1997;22:2911-18.
24. Loisel P, Gosselin L, Durand P, et al. Kukhazikitsa pulogalamu ya ergonomics yogwira nawo ntchito pokonzanso ogwira ntchito omwe akuvutika ndi ululu wammbuyo wa subacute. Appl Ergon 2001; 32:53-60.
25. Frank J, Sinclair S, Hogg-Johnson S, et al. Kupewa kulemala chifukwa cha ululu wammbuyo wokhudzana ndi ntchito. Umboni watsopano umapereka chiyembekezo chatsopano �ngati titha kungotenga osewera onse kumbali. CMAJ 1998;158:1625�31.
Tsekani Accordion
Kusokoneza Msana vs. Kulimbikitsana kwa Cervicogenic Headache ku El Paso, TX

Kusokoneza Msana vs. Kulimbikitsana kwa Cervicogenic Headache ku El Paso, TX

by | Chiropractic, khosi Chisoni, Mayesero Olamulidwa Mwachisawawa

Mutu waukulu umadziwika ngati kupweteka kwa mutu chifukwa cha matenda a mutu wokha. Mitundu itatu ya matenda a mutu woyamba ndi, migraine, kupweteka kwamutu kwamtundu wamtundu komanso mutu wamagulu. Kupweteka kwamutu ndi chizindikiro chopweteka komanso chofooketsa chomwe chingathenso kuchitika chifukwa cha chifukwa china. Mutu wachiwiri umadziwika ngati kupweteka kwa mutu komwe kumachitika chifukwa cha kuvulala ndi / kapena chikhalidwe. Kusokonezeka kwa msana, kapena kugwedeza, pambali pa msana wa chiberekero, kapena khosi, nthawi zambiri kumagwirizanitsidwa ndi zizindikiro zosiyanasiyana za mutu.

 

Mutu wa Cervicogenic ndi mutu wachiwiri womwe umayambitsidwa ndi kuvulala ndi / kapena chikhalidwe chomwe chimakhudza zigawo zozungulira za msana wa khomo lachiberekero, kapena khosi. Akatswiri ambiri azachipatala amalangiza kugwiritsa ntchito mankhwala / mankhwala kuti athandizire kuwongolera mutu, komabe, njira zingapo zamankhwala zothandizira zitha kugwiritsidwa ntchito moyenera komanso moyenera pochiza mutu wachiwiri. Cholinga cha nkhani yotsatirayi ndikuwonetsa zotsatira za chiberekero cha chiberekero ndi chapamwamba cha thoracic polimbana ndi kulimbikitsana ndi kuchita masewera olimbitsa thupi kwa odwala omwe ali ndi mutu wa cervicogenic.

 

Upper Cervical and Upper Thoracic Manipulation Versus Mobilization and Exercise in Odwala omwe ali ndi Cervicogenic Headache: Multi-Center Randomized Clinical Trial

 

Kudalirika

 

  • Background: Ngakhale kuti njira zothandizira zomwe zimagwiritsidwa ntchito kawirikawiri, palibe maphunziro omwe amayerekezera mwachindunji mphamvu ya chiberekero ndi thoracic kuti alimbikitse ndi kuchita masewera olimbitsa thupi mwa anthu omwe ali ndi mutu wa cervicogenic (CH). Cholinga cha phunziroli chinali kufananitsa zotsatira za kugwiritsidwa ntchito kwa kulimbikitsa ndi kuchita masewera olimbitsa thupi mwa anthu omwe ali ndi CH.
  • Njira: Otsatira zana limodzi ndi khumi (n?=?110) omwe ali ndi CH adasinthidwa mwachisawawa kuti alandire chiberekero ndi thoracic manipulation (n?=?58) kapena kulimbikitsa ndi kuchita masewera olimbitsa thupi (n?=?52). Chotsatira chachikulu chinali kupweteka kwa mutu monga momwe anayesedwera ndi Numeric Pain Rating Scale (NPRS). Zotsatira zachiwiri zinaphatikizapo kumutu kwa mutu, nthawi ya mutu, kulemala monga momwe Neck Disability Index (NDI), kumwa mankhwala, ndi Global Rating of Change (GRC). Nthawi ya chithandizo inali masabata a 4 ndikuwunika kotsatira pa sabata la 1, masabata a 4, ndi miyezi ya 3 pambuyo pa gawo loyamba la chithandizo. Cholinga chachikulu chinayesedwa ndi kusanthula kwamitundu yosiyanasiyana ya 2 (ANOVA), ndi gulu lachipatala (kuwongolera motsutsana ndi kukakamiza ndi kuchita masewera olimbitsa thupi) monga pakati pa maphunziro ndi nthawi (zoyambira, sabata la 1, masabata a 4 ndi miyezi ya 3) monga nkhani zamkati zimasiyanasiyana.
  • Results: 2X4 ANOVA inasonyeza kuti anthu omwe ali ndi CH omwe adalandira chiberekero ndi chifuwa cha thoracic adachepetsa kwambiri kupweteka kwa mutu (p?
  • Zotsatira: Magawo asanu ndi limodzi mpaka asanu ndi atatu a kumtunda kwa chiberekero ndi kumtunda kwa thoracic kunasonyezedwa kuti ndi othandiza kwambiri kuposa kulimbikitsa ndi kuchita masewera olimbitsa thupi kwa odwala omwe ali ndi CH, ndipo zotsatira zake zinasungidwa pa miyezi ya 3.
  • Kulembetsa mayeso: NCT01580280 Epulo 16, 2012.
  • Keywords: Mutu wa Cervicogenic, Kuwongolera kwa Msana, Kulimbikitsa, Kuthamanga kwambiri, kuthamanga kwambiri kwa matalikidwe otsika.

 

Dr Jimenez White Coat

Kuzindikira kwa Dr. Alex Jimenez

Poyerekeza ndi mutu woyamba, monga migraine, mutu wa masango ndi mutu wamtundu wovuta, mutu wachiwiri umadziwika ngati kupweteka kwa mutu chifukwa cha matenda ena kapena vuto linalake. Pankhani ya mutu wa cervicogenic, chifukwa cha kupweteka kwa mutu ndi chifukwa cha kuvulala ndi / kapena chikhalidwe cha msana wa khomo lachiberekero ndi mapangidwe ake ozungulira, kuphatikizapo vertebrae, intervertebral discs ndi zofewa. Kuphatikiza apo, akatswiri ambiri azachipatala amakhulupirira kuti mutu woyamba ukhoza kulumikizidwa ndi zovuta zaumoyo msana wa khomo lachiberekero, kapena khosi. Chithandizo cha mutu wa Cervicogenic chiyenera kulunjika komwe kumachokera zizindikirozo ndipo zimatha kusiyana malinga ndi wodwalayo. Chisamaliro cha Chiropractic chimagwiritsa ntchito kusintha kwa msana ndi kusintha kwapamanja kuti abwezeretse mosamala kapangidwe kake koyambirira ndi ntchito ya msana, kuthandiza kuchepetsa kupsinjika ndi kupanikizika kuti apititse patsogolo zizindikiro za mutu wa cervicogenic, pakati pa mitundu ina ya mutu. Chisamaliro cha Chiropractic chingagwiritsidwenso ntchito kuthandizira kuchiza mutu woyamba, monga mutu waching'alang'ala.

 

Background

 

The International Classification of Headache Disorders imatanthauzira mutu wa cervicogenic (CH) monga, �kupweteka kwa mutu chifukwa cha kusokonezeka kwa msana wa khomo lachiberekero ndi chigawo chake cha bony, disc, ndi / kapena zofewa za minofu, kawirikawiri koma osati nthawi zonse pamodzi ndi ululu wa khosi. ] (p.1) Kukula kwa CH kwadziwika kuti kuli pakati pa 760 ndi 0.4% ya mutu wa mutu [20, 2], ndipo mpaka 3% mwa odwala omwe ali ndi mutu pambuyo pa kuvulala kwa chikwapu [53]. Mbali zazikulu za CH nthawi zambiri zimaphatikizapo: kusagwirizana kwa kupweteka kwa mutu popanda kusuntha-mbali, kutulutsa ululu ndi kupanikizika kwa kunja kwa khosi lapamwamba la khosi, kuyenda kochepa kwa khomo lachiberekero, ndi kuyambitsa kuzunzidwa ndi mayendedwe osiyanasiyana ovuta kapena osasunthika [4, 4].

 

Anthu omwe ali ndi CH nthawi zambiri amathandizidwa ndi mankhwala opangira msana kuphatikizapo kulimbikitsana ndi kuwongolera [6]. Kulimbikitsa msana kumakhala ndi njira zochepetsera pang'onopang'ono, zomveka, zozungulira pomwe kuwongolera kumakhala ndi njira zothamangira kwambiri zotsika kwambiri. [7] Pofufuza mwadongosolo posachedwa, Bronfort ndi anzake adanena kuti chithandizo chamsana (zolimbikitsana ndi kugwiritsira ntchito) zinali zogwira mtima poyang'anira akuluakulu omwe ali ndi CH [8]. Komabe, iwo sananene ngati kusokoneza kunabweretsa zotsatira zabwino kwambiri poyerekeza ndi kulimbikitsa kayendetsedwe ka anthuwa.

 

Kafukufuku wambiri wafufuza zotsatira za kusintha kwa msana pakuwongolera CH [9�13]. Haas et al. [10] adafufuza momwe chiberekero chimagwirira ntchito pamitu yomwe ili ndi CH. Jull ndi al. [11] adawonetsa kuthandizira kwamankhwala pakuwongolera komanso / kapena kuchita masewera olimbitsa thupi pakuwongolera CH. Komabe gulu lachidziwitso lachidziwitso linaphatikizapo kusokoneza ndi kusonkhanitsa kotero silingadziwike ngati zotsatira zopindulitsa zinali chifukwa cha kusokoneza, kusonkhanitsa kapena kuphatikiza.

 

Kafukufuku wowerengeka adawunika phindu la kuwongolera motsutsana ndi kulimbikitsana pakuwongolera kupweteka kwapakhosi kapena popanda kuchita masewera olimbitsa thupi [14�16]. Komabe, palibe kafukufuku yemwe wayerekeza mwachindunji zotsatira za kusokoneza ndi kulimbikitsa komanso kuchita masewera olimbitsa thupi kwa odwala omwe ali ndi CH. Poganizira za kuopsa kwa kuwongolera [17], ndikofunikira kudziwa ngati kuwongolera kumabweretsa zotsatira zabwino poyerekeza ndi kulimbikitsa oyang'anira odwala omwe ali ndi CH. Choncho, cholinga cha mayesero achipatalawa mwachisawawa chinali kufanizitsa zotsatira za kusokoneza ndi kulimbikitsana ndi kuchita masewera olimbitsa thupi kwa odwala omwe ali ndi CH. Tinkaganiza kuti odwala omwe amalandira chithandizo pa nthawi ya chithandizo cha masabata a 4 amatha kuchepetsa kupweteka kwa mutu, kupweteka kwa mutu, kupweteka kwa mutu, kulemala, ndi kumwa mankhwala pakutsatira kwa mwezi wa 3 kusiyana ndi odwala omwe akulandira chiberekero ndi thoracic mobilization pamodzi ndi masewera olimbitsa thupi. .

 

Njira

 

ophunzira

 

M'mayesero achipatala opangidwa mwachisawawa, odwala otsatizana omwe ali ndi CH akupereka 1 pa 8 zipatala zochiritsira odwala kunja kwa madera osiyanasiyana (Arizona, Georgia, New York, Ohio, Pennsylvania, South Carolina) adalembedwa kwa miyezi 29. nthawi (kuyambira Epulo 2012 mpaka Ogasiti 2014). Kuti odwala akhale oyenerera, amayenera kusonyeza kuti ali ndi matenda a CH malinga ndi ndondomeko yowunikiranso [5] yopangidwa ndi Cervicogenic Headache International Study Group (CHISG) [5, 18, 19]. CH idasankhidwa molingana ndi �zofunikira zazikulu� (osaphatikiza umboni wotsimikizira ndi zotsekera zoziziritsa kukhosi) komanso "makhalidwe opweteka amutu" a CHISG. Choncho, kuti athe kuphatikizidwa mu phunziroli, odwala amayenera kusonyeza zotsatirazi: (1) kusagwirizana kwa mutu wa ululu wa mutu popanda sideshift, kuyambira kumtunda wapamwamba wa khosi kapena dera la occipital, potsirizira pake kufalikira kudera la oculofrontotemporal mbali yazizindikiro, (2) kupweteka komwe kumayambitsidwa ndi kusuntha kwa khosi komanso / kapena malo osasangalatsa, (3) kutsika kwapang'onopang'ono kwa msana wa khomo lachiberekero [20] (ie, kuchepera kapena kofanana ndi 32 � ya kumanja kapena kumanzere kumayenda mozungulira Kuyesa kwa Flexion-Rotation [21�23], (4) kupweteka komwe kumabwera chifukwa cha kupanikizika kwakunja pamtundu umodzi wapakhomo lachiberekero (C0-3), ndi (5) kupweteka kwapakati mpaka koopsa, kosapweteka komanso kosapweteka. Kuphatikiza apo, otenga nawo mbali amayenera kukhala ndi mutu pafupipafupi wa 1 pa sabata kwa miyezi ingapo ya 3, kuchuluka kwa kupweteka kwamutu kwa mfundo ziwiri (0�10 pamlingo wa NPRS), kuchuluka kwa kulumala kwa 20% kapena zazikulu (ie, mapointi 10 kapena kupitilira apo pa sikelo ya 0�50 NDI), ndikukhala pakati pa 18 ndi 65 eya rs zaka.

 

Odwala sanatengedwe ngati awonetsa mitu ina yayikulu (ie, migraine, TTH), akudwala mutu wa mayiko awiri, kapena kuwonetsa mbendera zofiira (mwachitsanzo, chotupa, kusweka, matenda a metabolic, nyamakazi, osteoporosis, kupuma kwa magazi kuposa 140/90 mmHg, mbiri yakale yogwiritsira ntchito steroid, ndi zina zotero), zoperekedwa ndi zizindikiro ziwiri kapena zingapo zabwino za neurologic zogwirizana ndi kupanikizika kwa mitsempha ya mitsempha (kufooka kwa minofu kumaphatikizapo gulu lalikulu la minofu ya kumtunda, kuchepa kwapamwamba kwambiri kwa tendon reflex, kapena kuchepa kapena kusakhalapo. kuti pinprick mumtundu uliwonse wam'mwamba wa dermatome), woperekedwa ndi matenda a khomo lachiberekero msana stenosis, kusonyeza zizindikiro za m'mphepete mwa m'mwamba, anali ndi umboni wa kukhudzidwa kwa dongosolo lapakati la mitsempha (hyperreflexia, kusokonezeka kwa malingaliro m'manja, kuwonongeka kwa minofu ya manja, kusakhazikika pakuyenda. nystagmus, kuwonongeka kwa maso, kusokonezeka kwa nkhope, kusintha kwa kukoma, kupezeka kwa ma pathological reflexes), anali ndi mbiri ya kuvulala kwa whiplash mkati mwa masabata a 6 apitawo, anali ndi opaleshoni isanayambe kumutu kapena khosi, adalandira chithandizo cha kupweteka kwa mutu kapena khosi kuchokera kwa dokotala aliyense m'mwezi wapitawo, adalandira chithandizo chamankhwala kapena chiropractic chifukwa cha kupweteka kwa mutu kapena khosi mkati. miyezi yapitayi ya 3, kapena anali ndi milandu yodikirira yokhudza mutu kapena kupweteka kwa khosi.

 

Zolemba zaposachedwa kwambiri zikuwonetsa kuti kuyezetsa kwa mtsempha wa khomo pachibelekeropo sikungathe kuzindikira anthu omwe ali pachiwopsezo cha zovuta zam'mitsempha chifukwa cha kusintha kwa khomo lachiberekero [24, 25], ndipo zizindikiro zilizonse zomwe zimapezeka pakuyezetsa kusanachitike zitha kukhala zosagwirizana ndi kusintha kwa magazi. mtsempha wamagazi [26, 27]. Chifukwa chake, kuyesa kwa mtsempha wa chiberekero kusanachitike sikunachitike mu phunziroli; komabe, mafunso owunikira matenda a mitsempha ya khomo lachiberekero amayenera kukhala opanda pake [24, 28, 29]. Kafukufukuyu adavomerezedwa ndi Institutional Review Board ku Long Island University, Brooklyn, NY. Kafukufukuyu adalembetsedwa pa www.clinicaltrials.gov yokhala ndi chizindikiritso cha mayeso NCT01580280. Odwala onse adadziwitsidwa kuti adzalandira kuponderezedwa kapena kulimbikitsana ndi kuchita masewera olimbitsa thupi ndiyeno amapereka chilolezo chodziwitsidwa asanalembetse phunziroli.

 

Kuchiza Ochiritsa

 

Othandizira thupi khumi ndi awiri (omwe ali ndi zaka 36.6, SD 5.62) adagwira nawo ntchito yopereka chithandizo kwa odwala mu phunziroli. Anali ndi zaka zambiri za 10.3 (SD 5.66, zaka 3�20) zaka zambiri zachipatala, ndipo onse anali atamaliza pulogalamu ya 60 h post-graduate certification yomwe imaphatikizapo maphunziro othandiza mu njira zamabuku kuphatikizapo kugwiritsa ntchito khomo lachiberekero ndi thoracic. Kuonetsetsa kuti mayesero onse, kuwunika kwa zotsatira, ndi njira zochiritsira zinali zovomerezeka, odwala onse ochita nawo masewera olimbitsa thupi amayenera kuphunzira buku la machitidwe oyendetsera ntchito ndikuchita nawo gawo la maphunziro a 4 h ndi wofufuza wamkulu.

 

Njira Zoyeserera

 

Odwala onse anapereka zidziwitso za chiwerengero cha anthu, anamaliza Mafunso a Neck Pain Medical Screening, ndipo anamaliza maulendo angapo odziwonetsera okha, otsatiridwa ndi mbiri yovomerezeka ndi kufufuza kwa thupi pa chiyambi. Miyezo yodziwonetsera yokha inaphatikizapo kupweteka kwa mutu monga momwe NPRS (0�10), NDI (0�50), mutu wafupipafupi (chiwerengero cha masiku omwe ali ndi mutu sabata yatha), nthawi ya mutu (maola okwana a mutu pamapeto omaliza. sabata), ndi kumwa mankhwala (kawirikawiri wodwala adamwa mankhwala osokoneza bongo kapena mankhwala opweteka kwambiri sabata yatha).

 

Kuyeza kovomerezeka kwa thupi sikunali kokha, koma kumaphatikizapo miyeso ya C1-2 (atlanto-axial joint) ROM yozungulira kumanja ndi kumanzere pogwiritsa ntchito Flexion-Rotation Test (FRT). Kudalirika kwapakati pa FRT kwapezeka kuti ndikwabwino kwambiri (ICC: 0.93; 95 % CI: 0.87, 0.96) [30].

 

Zotsatira zake

 

Chotsatira choyambirira chomwe chinagwiritsidwa ntchito mu phunziroli chinali kupweteka kwa mutu wa wodwalayo monga momwe NPRS imayesedwera. Odwala adafunsidwa kuti awonetse kuchuluka kwa kupweteka kwa mutu pa sabata yapitayi pogwiritsa ntchito mlingo wa 11 kuchokera ku 0 (�palibe ululu) mpaka 10 ("zowawa zowawa kwambiri") kumayambiriro, sabata la 1, mwezi wa 1, ndi miyezi ya 3 ikutsatira gawo loyamba la chithandizo [31]. NPRS ndi chida chodalirika komanso chovomerezeka chowunika kuchuluka kwa ululu [32�34]. Ngakhale kuti palibe deta yomwe ilipo kwa odwala omwe ali ndi CH, MCID ya NPRS yasonyezedwa kuti ndi 1.3 kwa odwala omwe ali ndi ululu wa khosi [32] ndi 1.74 kwa odwala omwe ali ndi matenda osiyanasiyana opweteka kwambiri [34]. Choncho, tinasankha kuphatikiza odwala omwe ali ndi chiwerengero cha NPRS cha mfundo za 2 (20%) kapena kuposa.

 

Zotsatira zachiwiri zinaphatikizapo NDI, Global Rating of Change (GRC), kupweteka kwa mutu, nthawi ya mutu, ndi kumwa mankhwala. NDI ndi chida chogwiritsidwa ntchito kwambiri poyesa kulemala kwa odwala omwe ali ndi ululu wa khosi [35�37]. NDI ndi mafunso odzipangira okha omwe ali ndi zinthu za 10 zomwe zimachokera ku 0 (palibe chilema) mpaka zisanu (chilema chonse) [38]. Mayankho a manambala a chinthu chilichonse amaphatikizidwa pa chiwongolero chonse kuyambira 0 mpaka 50; komabe, owunika ena asankha kuchulukitsa ziwerengero ziwiriziwiri, kenako ndikunena za NDI pamlingo wa 0�100% [36, 39]. Zotsatira zapamwamba zikuyimira kuchuluka kwa kulumala. NDI yapezeka kuti ili ndi kudalirika koyezetsa-kuyesanso, kudalirika komanga, kukhazikika kwamkati mkati komanso kuyankha bwino pakuwunika kulumala kwa odwala omwe ali ndi ululu wapakhosi [36], radiculopathy ya khomo lachiberekero [33, 40], matenda okhudzana ndi chikwapu [38, 41, 42], ndi kupweteka kwapakhosi kopanda tanthauzo [43, 44]. Ngakhale kuti palibe kafukufuku amene adafufuza za psychometric properties za NDI mwa odwala omwe ali ndi CH, tinasankha kungophatikizapo odwala omwe ali ndi NDI mfundo khumi (20 %) kapena kuposerapo, chifukwa chiwerengero chodulidwachi chimagwira MCID ya NDI, yomwe. zanenedwa kuti pafupifupi mfundo zinayi, zisanu ndi zitatu, ndi zisanu ndi zinayi (0�50) kwa odwala omwe ali ndi ululu wosakanizika wapakhosi [44], kupweteka kwa khosi [45], ndi chiberekero cha chiberekero [33], motero. Kupweteka kwamutu kumayesedwa ngati chiwerengero cha masiku omwe ali ndi mutu mu sabata yatha, kuyambira 0 mpaka 7 masiku. Kutalika kwa mutu kunayesedwa monga maola onse a mutu wa sabata yatha, ndi magawo asanu ndi limodzi otheka: (1) 0�5 h, (2) 6�10 h, (3) 11�15 h, (4) 16�20 h, (5) 21�25 h, kapena (6) maola 26 kapena kuposa. Kumwa mankhwala kunayesedwa monga kuchuluka kwa nthawi zomwe wodwalayo adatenga mankhwala kapena mankhwala oletsa kupweteka kapena oletsa kutupa m'sabata yapitayi chifukwa cha mutu wawo, ndi zosankha zisanu: (1) ayi, (2) kamodzi sabata, (3) kamodzi masiku angapo, (4) kamodzi kapena kawiri pa tsiku, kapena (5) katatu kapena kupitirira pa tsiku.

 

Odwala anabwerera kwa 1-sabata, 4-masabata, ndi 3-miyezi yotsatila kumene zotsatira zomwe tazitchulazi zinasonkhanitsidwanso. Kuonjezera apo, pa sabata la 1, masabata a 4 ndi miyezi ya 3, odwala anamaliza funso la 15-point GRC pogwiritsa ntchito sikelo yofotokozedwa ndi Jaeschke et al. [46] kuti ayese malingaliro awo a ntchito yabwino. Sikelo imachokera ku -7 (kuipitsitsa kwambiri) kufika ku ziro (pafupifupi mofanana) kufika ku +7 (kwabwinoko kwambiri). Mafotokozedwe apakatikati akuipiraipira kapena kuwongolera amapatsidwa mikhalidwe kuyambira -1 mpaka -6 ndi +1 mpaka +6, motsatana. MCID ya GRC sinafotokozedwe mwachindunji koma zambiri za +4 ndi +5 zakhala zikuwonetsa kusintha kwapang'onopang'ono kwa odwala [46]. Komabe, ziyenera kudziwidwa kuti posachedwa Schmitt ndi Abbott adanena kuti GRC silingagwirizane ndi kusintha kwa ntchito kwa anthu omwe ali ndi kuvulala kwa chiuno ndi m'chiuno [47]. Zotsatira zonse zidasonkhanitsidwa ndi wowunika wosawona kugawika kwamagulu.

 

Paulendo woyamba odwala anamaliza zotsatira zonse ndiye analandira gawo loyamba la chithandizo. Odwala anamaliza magawo a 6�8 a chithandizo cha kuwongolera kapena kulimbikitsa pamodzi ndi masewera olimbitsa thupi pa masabata a 4. Kuonjezera apo, maphunziro adafunsidwa ngati adakumana ndi "zovuta" zazikulu [48, 49] (stroke kapena kuperewera kwa ubongo kosatha) panthawi iliyonse yotsatila.

 

Randomization

 

Pambuyo pa kuwunika koyambira, odwala adapatsidwa mwayi woti alandire kuwongolera kapena kulimbikitsa komanso kuchita masewera olimbitsa thupi. Kugawidwa kobisika kunkachitidwa pogwiritsa ntchito tebulo la manambala opangidwa ndi makompyuta opangidwa ndi munthu wosakhudzidwa ndi olemba odwala asanayambe kuphunzira. Makhadi amtundu wamunthu payekha, owerengeka motsatizana ndi magawo omwe adapatsidwa mwachisawawa adakonzedwa pamasamba aliwonse a 8 osonkhanitsira deta. Makhadi olozerawo ankapindidwa ndi kuikidwa m’maenvulopu osaoneka bwino osindikizidwa. Akhungu pakuwunika koyambira, wochiritsayo adatsegula envelopuyo ndikupitiliza chithandizo molingana ndi gulu lomwe adapatsidwa. Odwala adalangizidwa kuti asakambirane njira yachipatala yomwe adalandira ndi katswiri wofufuza. Katswiri woyezetsa adakhalabe wakhungu ku gulu lachipatala la wodwalayo nthawi zonse; komabe, malingana ndi chikhalidwe cha machitidwewa sikunali kotheka kwa odwala khungu kapena kuchiza odwala.

 

Manipulation Group

 

Zosokoneza zomwe zimayang'ana kumanja ndi kumanzere kwa C1-2 zofotokozera komanso zofotokozera za T1-2 za mayiko awiriwa zinachitidwa osachepera limodzi mwa magawo a chithandizo cha 6�8 (Mkuyu 1 ndi ?ndi2) .2). Pazigawo zina zachipatala, othandizira amatha kubwereza C1-2 ndi / kapena T1-2 manipulations kapena kufotokozera zina za msana (ie, C0-1, C2-3, C3-7, T2-9, nthiti 1�9) pogwiritsa ntchito kusintha. . Kusankhidwa kwa zigawo za msana zomwe zimayang'anizana nazo zinasiyidwa kwa katswiri wochizira matenda ndipo zinachokera ku kuphatikiza kwa malipoti a odwala ndi kufufuza pamanja. Pazinthu zonse zapamwamba za khomo lachiberekero ndi cham'mwamba cha thoracic, ngati palibe phokoso la phokoso kapena phokoso lomwe linamveka poyesera koyamba, wothandizirayo adayikanso wodwalayo ndikuchitanso kachiwiri. Kuyesa kwakukulu kwa 2 kunachitika kwa wodwala aliyense mofanana ndi maphunziro ena [14, 50�53]. Madokotala adalangizidwa kuti zosinthikazo zitha kutsagana ndi mawu omveka angapo [54�58]. Odwala adalimbikitsidwa kuti azigwira ntchito mwachizolowezi mkati mwa malire a ululu; komabe, kulimbikitsa ndi kulembedwa kwa masewera olimbitsa thupi, kapena kugwiritsa ntchito njira zina, sizinaperekedwe kwa gululi.

 

Chithunzi cha 1 HVLA Kuwongolera Kuwongolera Kulunjika kumanja C1-2 Kufotokozera | El Paso, TX Chiropractor

 

Chithunzi 2 HVLA Thrust Manipulation Ikuwongoleredwa Bilaterally ku Upper Thoracic Spine | El Paso, TX Chiropractor

 

Kuwongolera komwe kumayang'ana C1-2 kunkachitika ndi wodwala ali pa supine. Panjira iyi, mbali yakumanzere yakumanzere kwa atlasi ya wodwalayo idalumikizidwa ndi chala chachiwiri chakumanzere kwa chala chachiwiri cha wodwalayo. Kuti adziwe mphamvu za kumanzere kwa C1-2 kufotokozera, wodwalayo adayikidwa pogwiritsa ntchito kuwonjezereka, kusintha kwapambuyo-pambuyo (PA), ipsilateral side-bend ndi contralateral side-shift. Pamene akukhalabe ndi malowa, wothandizirayo anachita kusinthasintha kwapamwamba kwambiri, kutsika kwa matalikidwe otsika kumanzere kwa atlanto-axial joint pogwiritsa ntchito kuzungulira kolondola mu arc kumunsi kwa diso ndikumasulira ku tebulo (mkuyu 1). Izi zinabwerezedwa pogwiritsa ntchito njira yomweyi koma yolunjika ku ndondomeko yoyenera ya C1-2.

 

Kuwongolera komwe kumayang'ana T1-2 kunachitika ndi wodwala ali pa supine. Kwa njirayi, wodwalayo adamugwira manja ake ndi manja ake pachifuwa ndi zigongono zikugwirizana kwambiri. Wothandizirayo adalumikizana ndi njira zodutsa m'munsi mwa vertebrae ya gawo loyenda lomwe lili ndi thenar eminence ndi phalanx yapakati yachiwerengero chachitatu. Chiwongolero chakumtunda chidayikidwa pamalo omwe chandamalidwayo powonjezera kuzungulira ndi kupindikira kumbali kwa wochiritsa pomwe dzanja lakumunsi limagwiritsa ntchito katchulidwe ndi kupatuka kwa radial kuti akwaniritse kuzungulira ndi kupindikira mbali, motsatana. Danga lotsika kwa njira ya xiphoid ndi malire a costochondral a wothandizira adagwiritsidwa ntchito ngati malo olumikizirana ndi zigono za wodwalayo kuti apereke kuwongolera kutsogolo kupita kumbuyo komwe kumayang'ana T1-2 kumbali zonse (mkuyu 2).

 

Gulu la Mobilization and Exercise Group

 

Kulimbikitsana komwe kumayang'ana kumanja ndi kumanzere kwa C1-2 ndi mafotokozedwe apakati a T1-2 kunachitika pa gawo limodzi la 6�8. Pazigawo zina zachipatala, othandizira amatha kubwereza C1-2 ndi / kapena T1-2 mobilizations kapena kufotokozera zina za msana (ie, C0-1, C2 / 3, C3-7, T2-9, nthiti 1�9) pogwiritsa ntchito kulimbikitsa. . Kusankhidwa kwa zigawo za msana zomwe zimayang'anizana nazo zinasiyidwa kwa katswiri wochizira matenda ndipo zinachokera ku kuphatikiza kwa malipoti a odwala ndi kufufuza pamanja. Komabe, pofuna kupewa �kukhudzana� kapena �chidwi� poyerekeza ndi gulu lowongolera, asing'anga adalangizidwa kuti asonkhanitse gawo limodzi la khomo lachiberekero (mwachitsanzo, kumanja ndi kumanzere) ndi gawo limodzi la thoracic kapena nthiti pagawo lililonse lamankhwala.

 

Kulimbikitsana kwa C1-2 kunkachitika kawirikawiri. Panjira imeneyi, wochiritsayo adalimbikitsa 30 s kumanzere kumanzere kumanzere kwa giredi IV PA gawo loyenda la C1-2 monga akufotokozera Maitland [7]. Njira yomweyi idabwerezedwa kwa mphindi 30 kupita kumalo olumikizirana atlanto-axial. Kuonjezera apo, komanso pa gawo limodzi, kulimbikitsana kumtunda wa thoracic (T1-2) msana ndi wodwala wodwala kunachitika. Panjira imeneyi, wochiritsayo adachita 30 s bout imodzi yapakati kalasi IV PA yolimbikitsa gawo la T1-2 monga afotokozera Maitland [7]. Choncho, tinagwiritsa ntchito 180 (ie, maulendo atatu a 30 pafupifupi pafupifupi 2 Hz) oscillations omaliza pamutu uliwonse pa chithandizo cholimbikitsa. Mwachidziwitso, palibe umboni wapamwamba kwambiri mpaka pano wosonyeza kuti nthawi yayitali yolimbikitsana imabweretsa kuchepetsa kupweteka kwambiri kusiyana ndi nthawi yayifupi kapena mlingo wa kulimbikitsa [59, 60].

 

Zochita zolimbitsa thupi za Cranio-cervical flexion [11, 61�63] zinkachitidwa ndi wodwala pa supine, ndi mawondo opindika ndi udindo wa mutu wokhazikika poyika mitsempha ya craniocervical ndi khomo lachiberekero pakati pa malo, kotero kuti mzere pakati pa mphumi ndi chibwano zinali zopingasa, ndipo mzere wopingasa kuchokera m'mbali mwa khutu unkadutsa khosi lake motalika. Mphamvu yodzaza ndi mpweya ya biofeedback unit (Chattanooga Group, Inc., Hixson, TN) idayikidwa kumbuyo kwa khosi la wodwalayo ndikulowetsedwa ku 20 mmHg [63]. Pazochita zolimbitsa thupi, odwala amayenera kuchita craniocervical flexion action (�kugwedeza mutu, mofanana ndi kusonyeza kuti inde) [63] ndikuyesera kuyang'ana kupanikizika kwa 22, 24, 26, 28, ndi 30 mmHg kuchokera. mpumulo woyambira wa 20 mmHg ndikusunga malo okhazikika kwa 10 s [61, 62]. Kugwedeza mutu kunkachitika modekha komanso pang'onopang'ono. Kupumula kwa 10 kunaloledwa pakati pa mayesero. Ngati kupanikizika kunasokonekera pansi pa kukakamizidwa kwa chandamale, kupanikizika sikunakhazikitsidwe mokhazikika, m'malo mwa ma flexors apamwamba (sternocleidomastoid kapena anterior scalene) kunachitika, kapena kuchotsedwa kwa khosi kunazindikirika kusanachitike 10 s isometric hold, kunkaonedwa ngati kulephera. [63]. Kukakamiza kotsiriza kopambana kunagwiritsidwa ntchito kuti adziwe mlingo wa masewera olimbitsa thupi a wodwala aliyense momwe ma seti a 3 a kubwereza kwa 10 ndi 10 s isometric kugwira anachitidwa. Kuphatikiza pa kukakamiza komanso kuchita masewera olimbitsa thupi a cranio-cervical flexion, odwala amayenera kuchita masewera olimbitsa thupi kwa mphindi 10 (mwachitsanzo, kugwiritsa ntchito ma Therabands) kapena zolemetsa zaulere) kuminofu ya lamba pamapewa pa gawo lililonse la chithandizo, mwa kulekerera kwawo, ndi makamaka kuyang'ana pa trapezius yapansi ndi serratus anterior [11].

 

Kukula Kwambiri

 

Zitsanzo za kukula kwake ndi kuwerengera mphamvu kunachitika pogwiritsa ntchito mapulogalamu a pa intaneti ochokera ku MGH Biostatistics Center (Boston, MA). Mawerengedwewa adachokera pakuwona kusiyana kwa 2-point (kapena 20%) mu NPRS (kupweteka kwa mutu) pakutsatira kwa miyezi ya 3, poganiza kuti pali kusiyana kwakukulu kwa mfundo zitatu, kuyesa kwa 2-tailed, ndi msinkhu wa alpha wofanana. ku 0.05. Izi zidapanga kukula kwachitsanzo cha odwala 49 pagulu lililonse. Polola kuti chiwerengero cha anthu osiya maphunziro chikhale chokhazikika cha 10%, tinakonza zolembera odwala osachepera 108 mu phunziroli. Kukula kwachitsanzochi kunapereka mphamvu zoposa 90% kuti zizindikire kusintha kwakukulu kwa chiwerengero cha NPRS.

 

Kusanthula Deta

 

Ziwerengero zofotokozera, kuphatikizapo mawerengedwe afupipafupi amitundu yosiyanasiyana ndi miyeso ya chizolowezi chapakati ndi kubalalitsidwa kwa zosinthika mosalekeza anawerengedwa kuti afotokoze mwachidule deta. Zotsatira za chithandizo pa kupweteka kwa mutu ndi kulemala zinayesedwa aliyense ndi 2-by-4 yosakanikirana-model-model analysis of variance (ANOVA), ndi gulu lachipatala (kusokoneza ndi kulimbikitsana ndi kuchita masewera olimbitsa thupi) monga pakati pa maphunziro ndi nthawi (zoyambira), 1 sabata, 4 masabata, ndi 3 miyezi kutsatira) monga mkati-nkhani zosiyanasiyana. Osiyana ANOVA anachitidwa ndi NPRS (kupweteka kwa mutu) ndi NDI (kulemala) monga kudalira kosinthika. Pa ANOVA iliyonse, lingaliro lachidwi linali kuyanjana kwa njira za 2 (gulu ndi nthawi).

 

Mayeso odziyimira pawokha adagwiritsidwa ntchito kuti adziwe kusiyana pakati pa magulu a kusintha kwa chiwerengero kuchokera pachiyambi kupita kukutsatira kwa mwezi wa 3 pamutu waukulu ndi kulemala. Mayesero osiyana a Mann�Whitney U anachitidwa ndi mutu wafupipafupi, GRC, nthawi ya mutu komanso kumwa mankhwala monga kudalira kosiyana. Tidachita mayeso a Little�s Missing Completely at Random (MCAR) [64] kuti tiwone ngati zomwe zidasoweka zokhudzana ndi kusiya maphunziro zidasowa mwachisawawa kapena kusowa pazifukwa zomveka. Kusanthula kwacholinga-kuchiritsa kudachitika pogwiritsa ntchito Expectation-Maximization pomwe data yosowa imawerengedwa pogwiritsa ntchito ma equation obwerera. Mafananidwe okonzekera awiriwa adachitidwa poyang'ana kusiyana pakati pa nthawi zoyambira ndi zotsatila pakati pamagulu pogwiritsa ntchito kukonza kwa Bonferroni pa mlingo wa alpha wa .05.

 

Tidasokoneza odwala monga oyankha pakutsatira kwa mwezi wa 3 pogwiritsa ntchito mapepala odulidwa a 2 mfundo zowonjezera chifukwa cha kupweteka kwa mutu monga momwe NPRS imayesedwera. Nambala zofunika kuchiza (NNT) ndi 95 % nthawi zodalirika (CI) zinawerengedwanso pa nthawi yotsatila ya miyezi ya 3 pogwiritsa ntchito matanthauzo onsewa kuti apindule. Kusanthula deta kunachitika pogwiritsa ntchito SPSS 21.0.

 

Results

 

Odwala mazana awiri ndi makumi asanu ndi limodzi omwe ali ndi vuto lalikulu la mutu wa mutu adayang'aniridwa kuti ayenerere kuyenerera. Zifukwa zosayenera zingapezeke mu Chithunzi 3, chithunzi choyendayenda cha kulembera odwala ndi kusunga. Mwa odwala 251 omwe adayesedwa, odwala 110, omwe ali ndi zaka 35.16 (SD 11.48) komanso nthawi yayitali ya zizindikiro za zaka 4.56 (SD 6.27), adakwaniritsa zoyenera, adavomera kutenga nawo mbali, ndipo adasinthidwa mwachisawawa (n ?=?58) ndi magulu olimbikitsa ndi kuchita masewera olimbitsa thupi (n?=?52). Zosintha zoyambira pagulu lililonse zitha kupezeka mu Gulu 1. Odwala khumi ndi awiri ochokera ku zipatala zachipatala za 8 zachipatala aliyense amachitira odwala 25, 23, 20, 14, 13, 7, 6 kapena 2, motsatana; Komanso, aliyense wa ochiritsa 12 anachitira pafupifupi gawo lofanana la odwala pagulu lililonse. Panalibe kusiyana kwakukulu (p?=?0.227) pakati pa chiwerengero chokwanira cha magawo omaliza a chithandizo cha gulu lowongolera (7.17, SD 0.96) ndi gulu lolimbikitsa ndi kuchita masewera olimbitsa thupi (6.90, SD 1.35). Kuonjezera apo, chiwerengero cha magawo ochiritsira omwe amawunikira C1-2 ndi 6.41 (SD 1.63) kwa gulu lowongolera ndi 6.52 (SD 2.01) kwa gulu lolimbikitsana ndi masewera olimbitsa thupi, ndipo izi sizinali zosiyana kwambiri (p =? 0.762. Odwala zana limodzi ndi asanu ndi awiri mwa odwala 110 adamaliza njira zonse zotuluka m'miyezi itatu (3% kutsatira). Mayeso a Little�s Kusowa Kwathunthu pa Mwachisawawa (MCAR) sanali ofunikira (p?=?97); Chifukwa chake, tidagwiritsa ntchito njira ya Expectation-Maximization imputation m'malo mwa zikhalidwe zomwe zikusowa ndi zonenedweratu pazotsatira za miyezi itatu.

 

Chithunzi cha 3 Chithunzi Choyenda cha Kulembera Odwala ndi Kusunga | El Paso, TX Chiropractor

 

Gulu 1 Zosintha Zoyambira, Chiwerengero cha Anthu ndi Miyezo Yotsatira | El Paso, TX Chiropractor

 

Gulu lonse ndi kuyanjana kwa nthawi kwa zotsatira zoyamba za kupweteka kwa mutu kunali kofunikira kwambiri kwa NPRS (F (3,106)?=?11.196; p?

 

Table 2 Kusintha kwa Mutu Kupweteka Kwambiri ndi Kulemala | El Paso, TX Chiropractor

 

Gulu 3 Peresenti ya Maphunziro Opeza 50, 75, ndi 100 Peresenti Kuchepetsa | El Paso, TX Chiropractor

 

Pazotsatira zachiwiri gulu lalikulu ndi kuyanjana kwa nthawi kunalipo kwa NDI (F(3,106)?=?8.57; p?

 

Mayeso a Mann�Whitney U adawonetsa kuti odwala omwe ali pamwamba pa khomo lachiberekero ndi chapamwamba cha thoracic manipulation gulu amamva kupweteka kwamutu pafupipafupi pa sabata la 1 (p?

 

Sitinasonkhanitse deta iliyonse pazochitika za �zing'onozing'ono' zowonongeka [48, 49] (zizindikiro za ubongo zosakhalitsa, kuuma kowonjezereka, kupweteka kowawa, kutopa kapena zina); komabe, palibe "zikuluzikulu" zovuta zoyipa [48, 49] (sitiroko kapena zofooka zokhazikika zaubongo) zidanenedwa kwa gulu lililonse.

 

Kukambirana

 

Statement of Principal Finds

 

Kudziwa kwathu, phunziroli ndiloyeso loyamba lachidziwitso lachidziwitso lachidziwitso kuti lifananize mwachindunji mphamvu ya chiberekero ndi thoracic kugwiritsira ntchito kulimbikitsa ndi kuchita masewera olimbitsa thupi kwa odwala omwe ali ndi CH. Zotsatira zikuwonetsa magawo a 6�8 owongolera pa masabata a 4, omwe amalunjika makamaka kumtunda wa khomo lachiberekero (C1-2) ndi upper thoracic (T1-2) spines, zomwe zidapangitsa kuti pakhale kusintha kwakukulu pakupweteka kwamutu, kulumala, kumutu kwamutu, nthawi yayitali ya mutu. , ndi kumwa mankhwala kuposa kulimbikitsa pamodzi ndi masewera olimbitsa thupi. Mfundoyi ikuyerekeza kusintha kwapakati pamagulu pakati pa kupweteka kwa mutu (2.1 mfundo) ndi kulemala (6.0 mfundo kapena 12.0 %) kuposa ma MCID omwe adanenedwa pamiyeso yonseyi. Ngakhale kuti MCID ya NDI mwa odwala omwe ali ndi CH sichinafufuzidwebe, komabe ziyenera kudziwika kuti chiwerengero chochepa cha 95 % CI cha olumala (mfundo 3.5) chinali pansi pang'ono (kapena pafupifupi milandu iwiri) MCID yomwe zapezeka kuti ndi 3.5 [65], 5 [66], ndi 7.5 [45] mfundo za odwala omwe ali ndi ululu wa khosi, 8.5 [33] mfundo za odwala omwe ali ndi chiberekero cha chiberekero, ndi 3.5 [44] mfundo kwa odwala osakanikirana, kupweteka kwapakhosi kosadziwika. Komabe, ziyenera kuzindikirika kuti magulu onsewa adapanga kusintha kwachipatala. Kuonjezera apo, NNT imasonyeza kwa odwala anayi aliwonse omwe amathandizidwa ndi kugwiritsira ntchito, m'malo molimbikitsana, wodwala wina wowonjezera amapeza kuchepetsa kupweteka kwachipatala pakutsatira miyezi ya 3.

 

Mphamvu ndi Zofooka za Phunziro

 

Kuphatikizika kwa 12 ochiza ochiritsa akuthupi ochokera ku zipatala 8 zapadera m'maiko 6 osiyanasiyana kumathandizira kuti zomwe tapeza zitheke. Ngakhale kuti kusiyana kwakukulu kunazindikirika mpaka miyezi ya 3, sizidziwika ngati zopindulitsazi zikanakhala zokhazikika kwa nthawi yaitali. Kuphatikiza apo, tidagwiritsa ntchito njira zowongolera zothamanga kwambiri, zotsika kwambiri zomwe zidagwiritsa ntchito njira zolumikizirana zozungulira ndikumasulira nthawi imodzi ndi njira zolimbikitsira ku Maitland grade IV PA; motero, sitingatsimikize kuti zotsatirazi ndizodziwika ku mitundu ina ya njira zothandizira zothandizira. Ena angatsutse kuti gulu loyerekeza lingakhale silinalandire kulowererapo kokwanira. Tinayesetsa kulinganiza zovomerezeka zamkati ndi zakunja kotero kuti chithandizo chokhazikika chamagulu onse awiri ndikupereka kufotokozera momveka bwino za njira zomwe zimagwiritsidwa ntchito zomwe zidzalolanso kubwerezabwereza. Kuphatikiza apo, sitinayese zochitika zazing'ono zoyipa ndipo tidangofunsa za zochitika ziwiri zazikulu zomwe zingachitike. Cholepheretsa china ndikuti taphatikiza zotsatira zachiwiri zingapo. Zokonda za akatswiri pankhani ya njira yomwe akuganiza kuti ingakhale yabwino kwambiri sizinasonkhanitsidwe ndipo zitha kukhudza zotsatira zake.

 

Mphamvu ndi Zofooka Zogwirizana ndi Maphunziro Ena: Kusiyana Kofunikira Pazotsatira

 

Jull ndi al. [11] adawonetsa chithandizo chamankhwala chamankhwala osokoneza bongo komanso masewera olimbitsa thupi pakuwongolera CH; komabe, phukusi lamankhwalali linaphatikizapo kulimbikitsana komanso kusokoneza. Kafukufuku wamakono angapereke umboni wosonyeza kuti kasamalidwe ka odwala omwe ali ndi CH ayenera kuphatikizapo njira ina yogwiritsira ntchito ngakhale kuti nthawi zambiri amanenedwa kuti kugwiritsira ntchito khomo lachiberekero kuyenera kupewedwa chifukwa cha chiopsezo cha zochitika zoopsa [67, 68]. Kuwonjezera apo, zasonyezedwa kuti anthu omwe akulandira kupweteka kwa msana chifukwa cha ululu wa khosi ndi mutu sakhala ndi vuto la vertebrobasilar kuposa ngati atalandira chithandizo ndi dokotala wawo [69]. Kuphatikiza apo, mutatha kuwunikanso malipoti amilandu a 134, Puentedura et al. anaganiza kuti ndi kusankha koyenera kwa odwala mwa kuyang'anitsitsa mbendera zofiira ndi zotsutsana, zochitika zambiri zoipa zomwe zimagwirizanitsidwa ndi kugwiritsira ntchito chiberekero zikanatha kupewedwa [70].

 

Tanthauzo la Phunziroli: Mafotokozedwe Otheka ndi Zomwe Zingachitike kwa Achipatala ndi Opanga Ndondomeko

 

Malingana ndi zotsatira za kafukufuku wamakono madokotala ayenera kuganizira zophatikizira kusintha kwa msana kwa anthu omwe ali ndi CH. Kuwunika kwakanthawi kwaposachedwa kwapeza kuti kulimbikitsa ndi kuwongolera kukhala kothandiza pakuwongolera odwala omwe ali ndi CH koma sanathe kudziwa kuti ndi njira iti yomwe inali yabwino kwambiri [8]. Kuonjezera apo, malangizo achipatala adanena kuti kugwiritsira ntchito, kulimbikitsana ndi kuchita masewera olimbitsa thupi kunali kothandiza kwa odwala omwe ali ndi CH; komabe, chitsogozocho sichinapereke malingaliro okhudza kupambana kwa njira iliyonse. [71] Zotsatira zamakono zingathandize olemba ndemanga zowonongeka zamtsogolo ndi malangizo achipatala popereka malingaliro omveka bwino okhudza kugwiritsidwa ntchito kwa msana kwa anthuwa.

 

Mafunso Osayankhidwa ndi Kafukufuku Wamtsogolo

 

Njira zomwe zikufotokozera chifukwa chake kuwongolera kungapangitse kuti pakhale kusintha kwakukulu siziyenera kufotokozedwa. Zanenedwa kuti kusuntha kwachangu kwa vertebrae ndi nthawi yocheperapo ya 200 ms kungasinthe kutulutsa kosiyana [72] mwa kulimbikitsa ma mechanoreceptors ndi proprioceptors, potero kusintha milingo ya alpha motorneuron excitability ndi ntchito ya minofu yotsatira [72�74]. Kuwongolera kungapangitsenso zolandilira m'mitsempha yakuya ya paraspinal, ndipo kulimbikitsana kumatha kuthandizira zolandilira mumitsempha yapamtunda [75]. Biomechanical [76, 77], msana kapena segmental [78, 79] ndi njira yapakati yotsika yoletsa kupweteka kwapakati [80�83] zitsanzo ndizofotokozera zomveka za zotsatira za hypoalgesic zomwe zimawonedwa potsatira kusintha. Posachedwapa, zotsatira za biomechanical zowonongeka zakhala zikufufuzidwa ndi sayansi [84], ndipo n'zosakayikitsa kuti zopindulitsa zachipatala zomwe zimapezeka mu phunziro lathu zimagwirizanitsidwa ndi kuyankha kwa neurophysiological komwe kumaphatikizapo kumveka kwa kanthawi kochepa pa nyanga ya dorsal ya msana [78]; komabe, chitsanzochi chikuthandizidwa pakali pano pa zomwe zapeza kuchokera ku zowawa zosakhalitsa, zoyesera zomwe zimachititsa kuti anthu azikhala ndi thanzi labwino [85, 86], osati odwala omwe ali ndi CH. Kafukufuku wamtsogolo akuyenera kuyang'ana njira zosiyanasiyana zamachiritso amanja okhala ndi milingo yosiyanasiyana ndikuphatikiza kutsata kwa chaka chimodzi. Kuphatikiza apo, maphunziro amtsogolo omwe amawunika zotsatira za neurophysiological pakuwongolera ndi kusonkhanitsa adzakhala ofunikira kuti adziwe chifukwa chake pangakhale kapena pasakhale kusiyana pazachipatala pakati pamankhwala awiriwa.

 

Kutsiliza

 

Zotsatira za kafukufuku wamakono zimasonyeza kuti odwala omwe ali ndi CH omwe adalandira chiberekero ndi chifuwa cha thoracic adachepetsa kwambiri kupweteka kwa mutu, kulemala, kupweteka kwa mutu, kupweteka kwa mutu, ndi kumwa mankhwala poyerekeza ndi gulu lomwe linalandira kulimbikitsana ndi kuchita masewera olimbitsa thupi; Kuonjezera apo, zotsatirazo zinasungidwa pakatsatira miyezi ya 3. Kafukufuku wamtsogolo akuyenera kuyang'ana momwe mitundu yosiyanasiyana imagwirira ntchito komanso milingo yakusintha ndikuphatikizanso kutsata kwanthawi yayitali.

 

Zothokoza

 

Palibe m'modzi mwa olemba omwe adalandira ndalama za kafukufukuyu. Olembawo akufuna kuthokoza onse omwe atenga nawo mbali pa kafukufukuyu.

 

Mawu a M'munsi

 

  • Zofuna zokakamiza: Dr. James Dunning ndi Purezidenti wa American Academy of Manipulative Therapy (AAMT). AAMT imapereka mapulogalamu ophunzirira maphunziro apamwamba pakuwongolera msana, kulimbikitsa msana, kusowa kowuma, kusokoneza malekezero, kupititsa patsogolo, kulimbikitsa minofu yofewa yothandizidwa ndi zida komanso kuchita masewera olimbitsa thupi kwa akatswiri ovomerezeka, osteopaths ndi madokotala azachipatala. Dr. James Dunning, Raymond Butts, Thomas Perreault, ndi Firas Mourad ndi aphunzitsi akuluakulu a AAMT. Olemba ena amalengeza kuti alibe zokonda zopikisana.
  • Zopereka kwa olemba: JRD adatenga nawo gawo pakupanga, kupanga, kupeza deta, kusanthula ziwerengero ndi kulemba zolemba pamanja. RB ndi IY adatenga nawo gawo pakupanga, kusonkhanitsa deta, kusanthula mawerengero ndi kukonzanso zolembazo. FM idatenga nawo gawo pakupanga, kusanthula ziwerengero, kutanthauzira kwa data ndikukonzanso zolembazo. MH adatenga nawo mbali pakupanga, kupanga ndi kukonzanso zolembazo. CF ndi JC adakhudzidwa ndi kusanthula kwa ziwerengero, kutanthauzira kwa deta, ndi kukonzanso mozama kwa zolembazo kuti zikhale zofunikira zaluntha. TS, JD, DB, ndi TH adagwira nawo ntchito yosonkhanitsa deta ndi kukonzanso zolembazo. Olemba onse adawerenga ndikuvomereza zolemba zomaliza.

 

Zowonjezera Zowonjezera

 

Ncbi.nlm.nih.gov/pmc/articles/PMC4744384/

 

Pomaliza,�Kupweteka kwamutu chifukwa cha mutu wachiwiri chifukwa cha matenda omwe ali pafupi ndi msana wa khomo lachiberekero, kapena khosi, kungayambitse zizindikiro zowawa komanso zofooketsa zomwe zingasokoneze moyo wa wodwalayo. Kuwongolera kwa msana ndi kulimbikitsa kutha kugwiritsidwa ntchito mosamala komanso moyenera kuti zithandizire kusintha zizindikiro za mutu wa cervicogenic. Zambiri zomwe zatchulidwa kuchokera ku National Center for Biotechnology Information (NCBI). Kuchuluka kwa chidziwitso chathu kumangokhala kwa chiropractic komanso kuvulala kwa msana ndi mikhalidwe. Kuti tikambirane nkhaniyi, chonde omasuka kufunsa Dr. Jimenez kapena tilankhule nafe pa 915-850-0900 .

 

Wosankhidwa ndi Dr. Alex Jimenez

 

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

Mitu Yowonjezera: Ululu Wobwerera

 

Malinga ndi ziwerengero, pafupifupi 80% ya anthu adzakhala ndi zizindikiro za ululu wammbuyo kamodzi pa moyo wawo wonse. Ululu wammbuyo ndi dandaulo lofala lomwe lingakhalepo chifukwa cha kuvulala kosiyanasiyana ndi/kapena mikhalidwe. Nthawi zambiri, kuwonongeka kwachilengedwe kwa msana ndi zaka kungayambitse ululu wammbuyo. Herniated discs zimachitika pamene chofewa, ngati gel pakati pa intervertebral disc ikukankhira kupyola mu misozi yozungulira, mphete yakunja ya cartilage, kuponderezana ndi kukwiyitsa mizu ya mitsempha. Ma disc herniations nthawi zambiri amapezeka m'munsi kumbuyo, kapena msana, koma amathanso kuchitika m'mphepete mwa khomo lachiberekero, kapena khosi. Kulowetsedwa kwa mitsempha yomwe imapezeka m'munsi kumbuyo chifukwa cha kuvulala ndi / kapena kuwonjezereka kwa chikhalidwe kungayambitse zizindikiro za sciatica.

 

chithunzi cha blog cha cartoon paperboy nkhani zazikulu

 

MUTU WOFUNIKA KWAMBIRI: Chithandizo cha Migraine Pain

 

 

ZINTHU ZINA: ZOWONJEZERA: El Paso, Tx | Othamanga

 

Palibe kanthu
Zothandizira
1. The International Classifcation of Headache Disorders: 3rd Edition. Cephalalgia. 2013;33(9):629-808.[Adasankhidwa]
2. Anthony M. Cervicogenic mutu: kufalikira ndi kuyankha kwa mankhwala a steroid m'deralo.�Clin Exp Rheumatol.�2000;18(2 Mapad 19):S59�64.�[Adasankhidwa]
3. Nilsson N. Kuchuluka kwa mutu wa cervicogenic mu zitsanzo za anthu azaka za 20-59.Spine (Phila Pa 1976)�1995;20(17):1884�8. doi: 10.1097/00007632-199509000-00008.�[Adasankhidwa][Cross Ref]
4. Bogduk N, Govind J. Cervicogenic Mutu wa mutu: kuunika kwa umboni wokhudzana ndi matenda, kuyesa kosokoneza, ndi chithandizo.�Lancet Neurol.�2009;8(10):959�68. doi: 10.1016/S1474-4422(09)70209-1.[Adasankhidwa] [Cross Ref]
5. Sjaastad O, Fredriksen TA, Pfaffenrath V. Mutu wa Cervicogenic: njira zodziwira matenda. Gulu la Cervicogenic Headache International Study Group.�Kupweteka kwa mutu.�1998;38(6):442�5. doi: 10.1046/j.1526-4610.1998.3806442.x.�[Adasankhidwa] [Cross Ref]
6. Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Pareja JA. Kuchiza kwa msana pakuwongolera mutu wa cervicogenic.�Kupweteka kwa mutu.�2005;45(9):1260�3. doi: 10.1111/j.1526-4610.2005.00253_1.x.�[Adasankhidwa] [Cross Ref]
7. Maitland GD.�Kusintha kwa Vertebral.�5. Oxford: Butterworth-Heinemann; 1986.
8. Bronfort G, Haas M, Evans R, Leininger B, Triano J. Kuchita bwino kwa chithandizo chamankhwala: lipoti la umboni la UK.�Chiropr Osteopat.�2010;18:3. doi: 10.1186/1746-1340-18-3.�[Nkhani yaulere ya PMC] [Adasankhidwa][Cross Ref]
9. Haas M, Groupp E, Aickin M, Fairweather A, Ganger B, Attwood M, et al. Kuyankha kwa mlingo wa chisamaliro cha chiropractic cha mutu wanthawi zonse wa cervicogenic ndi ululu wokhudzana ndi khosi: kafukufuku woyendetsa mwachisawawa.J Manipulative Physiol Ther.�2004;27(9):547�53. doi: 10.1016/j.jmpt.2004.10.007.�[Adasankhidwa] [Cross Ref]
10. Haas M, Spegman A, Peterson D, Aickin M, Vavrek D. Kuyankha kwa Mlingo ndi mphamvu ya kusintha kwa msana kwa mutu wa mutu wa cervicogenic: mayesero oyendetsedwa mwachisawawa.Msana J.�2010;10(2):117�28. doi: 10.1016/j.spinee.2009.09.002.�[Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
11. Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, et al. Kuyesedwa kosasinthika kochita masewera olimbitsa thupi komanso kuchiza matenda a mutu wa cervicogenic.�Spine (Phila Pa 1976)�2002;27(17):1835�43. doi: 10.1097/00007632-200209010-00004.�[Adasankhidwa] [Cross Ref]
12. Nilsson N. Kuyesedwa kosasinthika kwa zotsatira za kusintha kwa msana pochiza mutu wa cervicogenic.J Manipulative Physiol Ther.�1995;18(7):435-40[Adasankhidwa]
13. Nilsson N, Christensen HW, Hartvigsen J. Zotsatira za kusintha kwa msana pochiza mutu wa cervicogenic.�J Manipulative Physiol Ther.�1997;20(5):326-30[Adasankhidwa]
14. Dunning JR, Cleland JA, Waldrop MA, Arnot CF, Young IA, Turner M, et al. Kuwongolera kwa khomo lachiberekero ndi chapamwamba cha thoracic motsutsana ndi kusakhazikika kwa odwala omwe ali ndi ululu wapakhosi: kuyesedwa kwachipatala kosawerengeka kosawerengeka.�J Orthop Sports Phys Ther.�2012;42(1):5�18. doi: 10.2519/jospt.2012.3894.�[Adasankhidwa] [Cross Ref]
15. Hurwitz EL, Morgenstern H, Harber P, Kominski GF, Yu F, Adams AH. Kuyesedwa kosasinthika kwa chiropractic manipulation ndi kulimbikitsa odwala omwe ali ndi ululu wa khosi: zotsatira zachipatala kuchokera ku phunziro la UCLA-pain-pain.Am J Public Health. �2002;92(10):1634�41. doi: 10.2105/AJPH.92.10.1634.[Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
16. Leaver AM, Maher CG, Herbert RD, Latimer J, McAuley JH, Jull G, et al. Kuyesedwa kosasinthika kuyerekeza kuwongolera ndi kukakamiza kwaposachedwa kupweteka kwapakhosi.�Arch Phys Med Rehabil2010;91(9):1313�8. doi: 10.1016/j.apmr.2010.06.006.�[Adasankhidwa] [Cross Ref]
17. Wand BM, Heine PJ, O'Connell NE. Kodi tiyenera kusiya kugwiritsira ntchito khomo lachiberekero chifukwa cha kupweteka kwa khosi? Inde.�BMJ.�2012;344ndi: 3679. doi: 10.1136/bmj.e3679.�[Adasankhidwa] [Cross Ref]
18. Sjaastad O, Fredriksen TA. Cervicogenic mutu: njira, magulu ndi epidemiology.�Clin Exp Rheumatol.�2000;18(2 Mapad 19):S3�6.�[Adasankhidwa]
19. Vincent MB, Luna RA. Mutu wa Cervicogenic: kuyerekeza ndi mutu waching'alang'ala komanso wovuta kumutu.�Cephalalgia. �1999;19(Ndemanga za 25): 11-6. doi: 10.1177/0333102499019S2503.�[Adasankhidwa][Cross Ref]
20. Zwart JA. Kusuntha kwa khosi muzovuta zosiyanasiyana zamutu.�Kupweteka kwa mutu.�1997;37(1):6�11. doi: 10.1046/j.1526-4610.1997.3701006.x.�[Adasankhidwa] [Cross Ref]
21. Hall T, Robinson K. The flexion-rotation test and active cervical move-kuyerekeza muyeso wa mutu wa cervicogenic.�Munthu Ther.�2004;9(4):197�202. doi: 10.1016/j.math.2004.04.004.[Adasankhidwa] [Cross Ref]
22. Hall TM, Briffa K, Hopper D, Robinson KW. Ubale pakati pa mutu wa cervicogenic ndi kuwonongeka komwe kumatsimikiziridwa ndi kuyesa kwa flexion-rotation.�J Manipulative Physiol Ther.�2010;33(9):666�71. doi: 10.1016/j.jmpt.2010.09.002.�[Adasankhidwa] [Cross Ref]
23. Ogince M, Hall T, Robinson K, Blackmore AM. Kuzindikira kutsimikizika kwa mayeso a chiberekero-kuzungulira-kuzungulira mu mutu wa C1/2 wokhudzana ndi cervicogenic.�Munthu Ther.�2007;12(3):256�62. doi: 10.1016/j.math.2006.06.016.�[Adasankhidwa] [Cross Ref]
24. Hutting N, Verhagen AP, Vijverman V, Keesenberg MD, Dixon G, Scholten-Peeters GG. Kuzindikira kulondola kwa mayeso a premanipulative vertebrobasilar insufficiency: kuwunika mwadongosolo.�Munthu Ther.�2013;18(3):177�82. doi: 10.1016/j.math.2012.09.009.�[Adasankhidwa] [Cross Ref]
25. Kerry R, ​​Taylor AJ, Mitchell J, McCarthy C. Cervical arterial dysfunction and manual therapy: a critical literature review to inform professional practice.�Munthu Ther.�2008;13(4):278�88. doi: 10.1016/j.math.2007.10.006.�[Adasankhidwa] [Cross Ref]
26. Thomas LC, Rivett DA, Bateman G, Stanwell P, Levi CR. Zotsatira za njira zosankhidwa zapamanja zothandizira kupweteka kwa khosi pamakina amtundu wa vertebral ndi mkati mwa carotid arterial blood flow and cerebral inflow.�Phys Pa.�2013;93(11):1563�74. doi: 10.2522/ptj.20120477.�[Adasankhidwa] [Cross Ref]
27. Quesnele JJ, Triano JJ, Noseworthy MD, Wells GD. Kusintha kwa magazi a vertebral mtsempha wamagazi potsatira malo osiyanasiyana amutu komanso kusintha kwa msana wa khomo lachiberekero.�J Manipulative Physiol Ther.�2014;37(1):22�31. doi: 10.1016/j.jmpt.2013.07.008.�[Adasankhidwa] [Cross Ref]
28. Taylor AJ, Kerry R. The 'vertebral artery test'.�Munthu Ther.�2005;10(4):297. doi: 10.1016/j.math.2005.02.005.�[Adasankhidwa] [Cross Ref]
29. Kerry R, ​​Taylor AJ, Mitchell J, McCarthy C, Brew J. Manual therapy and cervical arterial dysfunction, directions for future: a clinical perspective.�J Man Manip Ther.�2008;16(1):39�48. doi: 10.1179/106698108790818620.�[Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
30. Hall TM, Robinson KW, Fujinawa O, Akasaka K, Pyne EA. Kudalirika kwa Intertester ndi kutsimikizika kwa matenda a khomo lachiberekero flexion-rotation test.�J Manipulative Physiol Ther.�2008;31(4):293�300. doi: 10.1016/j.jmpt.2008.03.012.�[Adasankhidwa] [Cross Ref]
31. Jensen MP, Karoly P, Braver S. Kuyeza kupweteka kwachipatala: kuyerekezera njira zisanu ndi chimodzi.�Ululu. 1986;27(1):117�26. doi: 10.1016/0304-3959(86)90228-9.�[Adasankhidwa] [Cross Ref]
32. Cleland JA, Childs JD, Whitman JM. Psychometric katundu wa Neck Disability Index ndi chiwerengero cha ululu wa chiwerengero cha odwala omwe ali ndi ululu wa khosi.Arch Phys Med Rehabil2008;89(1):69�74. doi: 10.1016/j.apmr.2007.08.126.�[Adasankhidwa] [Cross Ref]
33. Young IA, Cleland JA, Michener LA, Brown C. Kudalirika, kumanga zovomerezeka, ndi kuyankha kwa Neck Disability Index, mlingo wodziwika bwino wa odwala, ndi chiwerengero cha chiwerengero cha ululu kwa odwala omwe ali ndi chiberekero cha chiberekero.�Am J Phys Med Rehabil.�2010;89(10):831�9. doi: 10.1097/PHM.0b013e3181ec98e6.�[Adasankhidwa] [Cross Ref]
34. Farrar JT, Young JP, Jr, LaMoreaux L, Werth JL, Poole RM. Kufunika kwachipatala kwa kusintha kwa ululu wopweteka kwambiri kumayesedwa pa chiwerengero cha 11-pointal pain rating scale.�Ululu. 2001;94(2):149�58. doi: 10.1016/S0304-3959(01)00349-9.�[Adasankhidwa] [Cross Ref]
35. Vernon H. The Neck Disability Index: state-of-the-art, 1991-2008.�J Manipulative Physiol Ther.�2008;31(7):491�502. doi: 10.1016/j.jmpt.2008.08.006.�[Adasankhidwa] [Cross Ref]
36. MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, et al. Kuyeza katundu wa Neck Disability Index: kuwunika mwadongosolo.�J Orthop Sports Phys Ther.�2009;39(5):400�17. doi: 10.2519/jospt.2009.2930.�[Adasankhidwa] [Cross Ref]
37. Pietrobon R, Coeytaux RR, Carey TS, Richardson WJ, DeVellis RF. Miyezo yokhazikika yoyezera zotsatira zogwira ntchito za ululu wa khomo lachiberekero kapena kusagwira bwino ntchito: kuwunika mwadongosolo.�Spine (Phila Pa 1976)�2002;27(5):515�22. doi: 10.1097/00007632-200203010-00012.�[Adasankhidwa] [Cross Ref]
38. Vernon H, Mior S. The Neck Disability Index: kafukufuku wodalirika komanso wovomerezeka.�J Manipulative Physiol Ther.�1991;14(7):409-15[Adasankhidwa]
39. Vernon H. The psychometric properties of the Neck Disability Index.�Arch Phys Med Rehabil2008;89(7):1414�5. doi: 10.1016/j.apmr.2008.05.003.�[Adasankhidwa] [Cross Ref]
40. Cleland JA, Fritz JM, Whitman JM, Palmer JA. Kudalirika ndi kupanga kutsimikizika kwa Neck Disability Index ndi kuchuluka kwa odwala omwe ali ndi khomo lachiberekero radiculopathy.Spine (Phila Pa 1976)�2006;31(5):598�602. doi: 10.1097/01.brs.0000201241.90914.22.�[Adasankhidwa] [Cross Ref]
41. Hoving JL, O'Leary EF, Niere KR, Green S, Buchbinder R. Kutsimikizika kwa index of neck disability index, Northwick Park neck pain questionnaire, ndi njira yopezera vuto poyezera kulemala komwe kumakhudzana ndi matenda okhudzana ndi chikwapu.Ululu. 2003;102(3):273�81. doi: 10.1016/S0304-3959(02)00406-2.�[Adasankhidwa] [Cross Ref]
42. Miettinen T, Leino E, Airaksinen O, Lindgren KA. Kuthekera kogwiritsa ntchito mafunso osavuta ovomerezeka kulosera zamavuto azaumoyo anthawi yayitali pambuyo pa kuvulala kwa whiplash. �Spine (Phila Pa 1976)�2004;29(3):E47�51. doi: 10.1097/01.BRS.0000106496.23202.60.�[Adasankhidwa] [Cross Ref]
43. McCarthy MJ, Grevitt MP, Silcocks P, Hobbs G. Kudalirika kwa Vernon and Mior neck disability index, komanso kutsimikizika kwake poyerekeza ndi mafunso achidule a kafukufuku wa zaumoyo a form-36.�Eur Spine J.�2007;16(12):2111�7. doi: 10.1007/s00586-007-0503-y.�[Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
44. Pool JJ, Ostelo RW, Hoving JL, Bouter LM, de Vet HC. Kusintha kocheperako kofunikira kwa Neck Disability Index ndi Numerical Rating Scale kwa odwala omwe ali ndi ululu wa khosi.Spine (Phila Pa 1976)�2007;32(26):3047�51. doi: 10.1097/BRS.0b013e31815cf75b.�[Adasankhidwa] [Cross Ref]
45. Young BA, Walker MJ, Strunce JB, Boyles RE, Whitman JM, Childs JD. Kuyankha kwa Neck Disability Index mwa odwala omwe ali ndi vuto la khosi la makina.�Msana J.�2009;9(10):802�8. doi: 10.1016/j.spinee.2009.06.002.�[Adasankhidwa] [Cross Ref]
46. Jaeschke R, Woyimba J, Guyatt GH. Kuyeza kwa thanzi. Kuzindikira kusiyana kocheperako kofunikira pachipatala.�Control Clin Trials.�1989;10(4):407�15. doi: 10.1016/0197-2456(89)90005-6.[Adasankhidwa] [Cross Ref]
47. Schmitt J, Abbott JH. Kusintha kwapadziko lonse lapansi sikuwonetsa kusintha kwa magwiridwe antchito pakapita nthawi muzochita zamankhwala.�J Orthop Sports Phys Ther.�2015;45(2):106�11. doi: 10.2519/jospt.2015.5247.�[Adasankhidwa][Cross Ref]
48. Carlesso L, Macdermid JC, Santaguida L. Standardization of adverse event terminology and reporting in orthopaedic therapy - applications to the cervical spine.�J Orthop Sports Phys Ther.�2010;40:455;63. doi: 10.2519/jospt.2010.3229.�[Adasankhidwa] [Cross Ref]
49. Carlesso LC, Gross AR, Santaguida PL, Burnie S, Voth S, Sadi J. Zochitika zoipa zogwirizana ndi kugwiritsidwa ntchito kwa chiberekero cha chiberekero ndi kulimbikitsa chithandizo cha kupweteka kwa khosi kwa akuluakulu: kubwereza mwadongosolo.�Munthu Ther.�2010;15(5):434�44. doi: 10.1016/j.math.2010.02.006.�[Adasankhidwa] [Cross Ref]
50. Cleland JA, Glynn P, Whitman JM, Eberhart SL, MacDonald C, Childs JD. Zotsatira zachidule zotsutsana ndi kukakamiza kosasunthika / kuwongolera komwe kumayendetsedwa pamsana wa thoracic kwa odwala omwe ali ndi ululu wa khosi: kuyesedwa kwachipatala kosasinthika.�Phys Pa.�2007;87(4):431�40. doi: 10.2522/ptj.20060217.�[Adasankhidwa][Cross Ref]
51. Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland JA, Alburquerque-Sendin F, Palomeque-del-Cerro L, Mendez-Sanchez R. Kuphatikizidwa kwa thoracic thrust manipulation mu electro-therapy/thermal program Kusamalira odwala omwe ali ndi ululu wopweteka kwambiri wa khosi: kuyesedwa kosasinthika kwachipatala.�Munthu Ther.�2009;14(3):306�13. doi: 10.1016/j.math.2008.04.006.�[Adasankhidwa] [Cross Ref]
52. Gonzalez-Iglesias J, Fernandez-de-las-Penas C, Cleland JA, Gutierrez-Vega MR. Kuwongolera kwa msana wa Thoracic kwa oyang'anira odwala omwe ali ndi ululu wa khosi: kuyesedwa kosasinthika kwachipatala.�J Orthop Sports Phys Ther.�2009;39(1):20�7. doi: 10.2519/jospt.2009.2914.�[Adasankhidwa] [Cross Ref]
53. Lau HM, Wing Chiu TT, Lam TH. Kuchita bwino kwa kugwiritsidwa ntchito kwa thoracic kwa odwala omwe ali ndi ululu wopweteka wapakhosi - kuyesedwa kosasinthika.Munthu Ther.�2011;16(2):141�7. doi: 10.1016/j.math.2010.08.003.�[Adasankhidwa] [Cross Ref]
54. Beffa R, Mathews R. Kodi kusinthaku kumapangitsa kuti pakhale mgwirizano? Kufufuza komwe kuli mawu a cavitation.�J Manipulative Physiol Ther.�2004;27(2): e2. doi: 10.1016/j.jmpt.2003.12.014.[Adasankhidwa] [Cross Ref]
55. Dunning J, Mourad F, Barbero M, Leoni D, Cescon C, Butts R. Bilateral and multiple cavitation sounds in upper cervical thrust manipulation.�BMC Musculoskelet Disord.�2013;14:24. doi: 10.1186/1471-2474-14-24.�[Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
56. Reggars JW. The manipulative crack. Kusanthula pafupipafupi.�Australas Chiropr Osteopathy. �1996;5(2):39-44[Nkhani yaulere ya PMC] [Adasankhidwa]
57. Ross JK, Bereznick DE, McGill SM. Kuzindikira malo a cavitation panthawi ya lumbar ndi thoracic spinal manipulation: kodi kusintha kwa msana ndikolondola komanso mwachindunji? �Spine (Phila Pa 1976)�2004;29(13):1452�7. doi: 10.1097/01.BRS.0000129024.95630.57.�[Adasankhidwa] [Cross Ref]
58. Evans DW, Lucas N. Kodi 'manipulation' ndi chiyani? Kubwerezanso.�Munthu Ther.�2010;15(3):286�91. doi: 10.1016/j.math.2009.12.009.�[Adasankhidwa] [Cross Ref]
59. Gross A, Miller J, D'Sylva J, Burnie SJ, Goldsmith CH, Graham N, et al. Kuwongolera kapena kulimbikitsa kupweteka kwa khosi: kuwunika kwa cochrane.�Munthu Ther.�2010;15(4):315�33. doi: 10.1016/j.math.2010.04.002.[Adasankhidwa] [Cross Ref]
60. Moss P, Sluka K, Wright A. Zotsatira zoyamba za kulimbikitsana kwa mawondo pa osteoarthritic hyperalgesia.�Munthu Ther.�2007;12(2):109�18. doi: 10.1016/j.math.2006.02.009.�[Adasankhidwa] [Cross Ref]
61. Falla D, Bilenkij G, Jull G. Odwala omwe ali ndi ululu wopweteka wa m'khosi amasonyeza kusintha kwa machitidwe a minofu panthawi yogwira ntchito yogwira ntchito yapamwamba.Spine (Phila Pa 1976)�2004;29(13):1436�40. doi: 10.1097/01.BRS.0000128759.02487.BF.�[Adasankhidwa] [Cross Ref]
62. Falla D, Jull G, Dall'Alba P, Rainoldi A, Merletti R. An electromyographic analysis of deep cervical flexor muscles in performance of craniocervical flexion.�Phys Pa.�2003;83(10):899-906[Adasankhidwa]
63. Jull G. Kukanika kwa minofu ya khomo lachiberekero mu whiplash.�Journal of Musculoskeletal Pain. �2000;8:143�54. doi: 10.1300/J094v08n01_12.�[Cross Ref]
64. Rubin LH, Witkiewitz K, Andre JS, Reilly S. Njira zothanirana ndi zomwe zikusowa muzasayansi yamakhalidwe: Osataya mwana Khoswe ndi madzi osamba.�J Undergrad Neurosci Educ.�2007;5(2):A71�7.�[Nkhani yaulere ya PMC] [Adasankhidwa]
65. Jorritsma W, Dijkstra PU, de Vries GE, Geertzen JH, Reneman MF. Kuzindikira kusintha koyenera komanso kuyankha kwa ululu wa khosi ndi sikelo yolemala ndi Neck Disability Index.�Eur Spine J.�2012;21(12):2550�7. doi: 10.1007/s00586-012-2407-8.�[Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
66. Stratford PW, Riddle DL, Binkley JM, Spadoni G, Westaway MD, Padfield B. Pogwiritsa ntchito Neck Disability Index popanga zisankho zokhudza wodwala aliyense payekha.Physiother Can.�1999;51:107;12.
67. Ernst E. Manipulation of the cervical spine: kuwunika mwadongosolo lamilandu ya zochitika zoyipa kwambiri, 1995-2001.�Med J Aust. �2002;176(8):376-80[Adasankhidwa]
68. Oppenheim JS, Spitzer DE, Segal DH. Zovuta za Nonvascular pambuyo pa kugwedezeka kwa msana.�Msana J.�2005;5(6):660�6. doi: 10.1016/j.spinee.2005.08.006.�[Adasankhidwa] [Cross Ref]
69. Cassidy JD, Boyle E, Cote P, He Y, Hogg-Johnson S, Silver FL, et al. Chiwopsezo cha vertebrobasilar stroke ndi chisamaliro cha chiropractic: zotsatira za kuwongolera milandu kwa anthu komanso maphunziro a crossover.Spine (Phila Pa 1976)�2008;33(4 Suppl):S176�83. doi: 10.1097/BRS.0b013e3181644600.�[Adasankhidwa] [Cross Ref]
70. Puentedura EJ, March J, Anders J, Perez A, Landers MR, Wallmann HW, et al. Chitetezo cha kusinthika kwa msana wa khomo lachiberekero: kodi zochitika zoyipa zimatha kupewedwa ndipo kodi kusinthaku kukuchitika moyenera? Ndemanga ya malipoti a milandu 134.�J Man Manip Ther.�2012;20(2):66�74. doi: 10.1179/2042618611Y.0000000022.[Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
71. Ana JD, Cleland JA, Elliott JM, Teyhen DS, Wainner RS, Whitman JM, et al. Ululu wa m'khosi: malangizo azachipatala okhudzana ndi gulu lapadziko lonse la ntchito, kulemala, ndi thanzi kuchokera ku gawo la mafupa la American Physical Therapy Association.J Orthop Sports Phys Ther.�2008;38(9):A1�A34. doi: 10.2519/jospt.2008.0303.�[Adasankhidwa] [Cross Ref]
72. Pickar JG, Kang YM. Kuyankha kwa minofu ya Paraspinal pa nthawi ya kugwedezeka kwa msana pansi pa ulamuliro wamphamvu.�J Manipulative Physiol Ther.�2006;29(1):22�31. doi: 10.1016/j.jmpt.2005.11.014.[Adasankhidwa] [Cross Ref]
73. Herzog W, Scheele D, Conway PJ. Mayankho a Electromyographic a minofu yakumbuyo ndi miyendo yolumikizidwa ndi chithandizo chamsana.�Spine (Phila Pa 1976)�1999;24(2):146�52. doi: 10.1097/00007632-199901150-00012.�[Adasankhidwa] [Cross Ref]
74. Indahl A, Kaigle AM, Reikeras O, Holm SH. Kulumikizana pakati pa porcine lumbar intervertebral disc, zygapophysial joints, ndi paraspinal muscles.Spine (Phila Pa 1976)�1997;22(24):2834�40. doi: 10.1097/00007632-199712150-00006.�[Adasankhidwa] [Cross Ref]
75. Bolton PS, Budgell BS. Kuwongolera kwa msana ndi kulimbikitsa msana kumakhudza mabedi osiyanasiyana a axial sensory.�Med Hypotheses.�2006;66(2):258�62. doi: 10.1016/j.mehy.2005.08.054.�[Adasankhidwa] [Cross Ref]
76. Cassidy JD, Lopes AA, Yong-Hing K. Zotsatira zaposachedwa za kuwongolera motsutsana ndi kulimbikitsa pa zowawa ndi kusuntha kwamtundu wa khomo lachiberekero: mayeso oyendetsedwa mwachisawawa.�J Manipulative Physiol Ther.�1992;15(9):570-5[Adasankhidwa]
77. Martinez-Segura R, Fernandez-de-las-Penas C, Ruiz-Saez M, Lopez-Jimenez C, Rodriguez-Blanco C. Zotsatira zaposachedwa pa ululu wa khosi ndi kayendetsedwe kake kake pambuyo pa chiberekero chimodzi cha chiberekero chapamwamba-liwiro lotsika-amplitude m'nkhani zomwe zikuwonetsa kupweteka kwa khosi: kuyesedwa kosasinthika.�J Manipulative Physiol Ther.�2006;29(7):511�7. doi: 10.1016/j.jmpt.2006.06.022.�[Adasankhidwa] [Cross Ref]
78. Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. Njira zothandizira pamanja pochiza ululu wa musculoskeletal: chitsanzo chokwanira.�Munthu Ther.�2009;14(5):531�8. doi: 10.1016/j.math.2008.09.001.�[Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
79. Dunning J, Rushton A. Zotsatira za khomo lachiberekero lothamanga kwambiri la low-amplitude thrust thrust pa resting electromyographic activity of biceps brachii muscle.�Munthu Ther.�2009;14(5):508�13. doi: 10.1016/j.math.2008.09.003.�[Adasankhidwa] [Cross Ref]
80. Haavik-Taylor H, Murphy B. Cervical spine manipulation alters sensorimotor integration: somatosensory evoked zotheka kuphunzira.�Clin Neurophysiol2007;118(2):391�402. doi: 10.1016/j.clinph.2006.09.014.�[Adasankhidwa] [Cross Ref]
81. Millan M. Kutsika kuwongolera zowawa.�Prog Neurobiology. �2002;66:355�74. doi: 10.1016/S0301-0082(02)00009-6.�[Adasankhidwa] [Cross Ref]
82. Skyba D, Radhakrishnan R, Rohlwing J, Wright A, Sluka K. Kusokoneza pamodzi kumachepetsa hyperalgesia poyambitsa monoamine receptors koma osati opioid kapena GABA receptors mu msana.Ululu. 2003;106:159�68. doi: 10.1016/S0304-3959(03)00320-8.�[Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
83. Zusman M. Forebrain-mediated sensitization of the central pain pathways: "non-enieni" ululu ndi chithunzi chatsopano cha mankhwala othandizira.�Munthu Ther.�2002;7:80;8. doi: 10.1054/math.2002.0442.�[Adasankhidwa] [Cross Ref]
84. Bialosky JE, George SZ, Bishop MD. Momwe chithandizo cha spinal manipulative therapy chimagwirira ntchito: bwanji mumafunsa chifukwa chiyani?�J Orthop Sports Phys Ther.�2008;38(6):293�5. doi: 10.2519/jospt.2008.0118.�[Adasankhidwa] [Cross Ref]
85. Bishop MD, Beneciuk JM, George SZ. Kuchepetsa kwanthawi yayitali kwa sensory kufupikitsa pambuyo pa kusintha kwa msana wa thoracic. �Msana J.�2011;11(5):440�6. doi: 10.1016/j.spinee.2011.03.001.[Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
86. George SZ, Bishop MD, Bialosky JE, Zeppieri G, Jr, Robinson ME. Zotsatira zaposachedwa za kusinthika kwa msana pakumva kupweteka kwamafuta: kafukufuku woyeserera.�BMC Musculoskelet Disord.�2006;7:68. doi: 10.1186/1471-2474-7-68.�[Nkhani yaulere ya PMC] [Adasankhidwa] [Cross Ref]
Tsekani Accordion
Malangizo Othandizira Kumutu kwa Chiropractic ku El Paso, TX

Malangizo Othandizira Kumutu kwa Chiropractic ku El Paso, TX

by | Chiropractic, Mayesero Olamulidwa Mwachisawawa

Kupweteka kwa mutu ndi chimodzi mwa zifukwa zofala kwambiri zoyendera ofesi ya dokotala. Anthu ambiri amakumana nawo nthawi ina m'moyo wawo ndipo amatha kukhudza aliyense, mosasamala kanthu za msinkhu, mtundu komanso jenda. Bungwe la International Headache Society, kapena IHS, limayika mutu ngati mutu waukulu, pamene sunayambe chifukwa cha kuvulala kwina ndi / kapena chikhalidwe, kapena chachiwiri, pamene pali chifukwa chachikulu kumbuyo kwawo. Kuchokera mutu waching'alang'ala kuphatikizika kwa mutu ndi kupwetekedwa kwa mutu, anthu omwe amavutika ndi mutu nthawi zonse amavutika kuti achite nawo ntchito zawo za tsiku ndi tsiku. Akatswiri ambiri azachipatala amathandizira kupweteka mutu, komabe chisamaliro cha chiropractic chakhala njira yodziwika bwino yochizira matenda osiyanasiyana. Cholinga cha nkhani yotsatirayi ndikuwonetsa malangizo ozikidwa pa umboni wa chithandizo cha chiropractic kwa akuluakulu omwe ali ndi mutu.

 

Maupangiri Ozikidwa pa Umboni wa Chiropractic Chithandizo cha Akuluakulu Omwe Ali ndi Mutu

 

Kudalirika

 

  • Cholinga: Cholinga cha bukhuli ndikupereka malangizo okhudzana ndi umboni pa chithandizo cha chiropractic cha mutu wa akuluakulu.
  • Njira: Kufufuza mwadongosolo m'mabuku a mayesero achipatala olamulidwa omwe adasindikizidwa kupyolera mu August 2009 yokhudzana ndi machitidwe a chiropractic anachitidwa pogwiritsa ntchito MEDLINE; EMBASE; Mankhwala Ogwirizana ndi Othandizira; Cumulative Index to Nursing and Allied Health Literature; Buku, Njira, ndi Natural Therapy Index System; Alt HealthWatch; Index to Chiropractic Literature; ndi Cochrane Library. Nambala, ubwino, ndi kusasinthasintha kwa zomwe zapezedwa zimaganiziridwa kuti zimapereka umboni wamphamvu (wamphamvu, wocheperapo, wochepa, kapena wotsutsana) ndikupanga malingaliro a machitidwe.
  • Results: Zolemba makumi awiri ndi chimodzi zidakwaniritsa zofunikira zophatikizidwa ndipo zidagwiritsidwa ntchito kupanga malingaliro. Umboni sunapitirire mlingo wapakatikati. Kwa mutu waching'alang'ala, kusintha kwa msana ndi njira zambiri zothandizira anthu osiyanasiyana kuphatikizapo kutikita minofu kumalimbikitsidwa kuti azisamalira odwala omwe ali ndi episodic kapena aakulu migraine. Pamutu wamtundu wamavuto, kuwongolera kwa msana sikungavomerezedwe pakuwongolera mutu wamtundu wa episodic. Malingaliro sangapangidwe kapena otsutsana ndi kugwiritsidwa ntchito kwa msana kwa odwala omwe ali ndi mutu wovuta kwambiri. Kulimbikitsa kwa craniocervical kwanthawi yayitali kungakhale kopindulitsa pakuwongolera kwanthawi yayitali kwa odwala omwe ali ndi mutu wanthawi yayitali kapena wovuta kwambiri. Kwa mutu wa cervicogenic, kusintha kwa msana kumalimbikitsidwa. Kulimbikitsana pamodzi kapena kuchita masewera olimbitsa thupi akuya kungapangitse zizindikiro. Palibe phindu lowonjezera lophatikizira kuphatikiza kulimbikitsana ndi zolimbitsa thupi zakuya kwa khosi kwa odwala omwe ali ndi mutu wa cervicogenic. Zochitika zoyipa sizinayankhidwe m'mayesero ambiri azachipatala; ndipo ngati iwo anali, palibe kapena iwo anali aang'ono.
  • Zotsatira: Umboni umasonyeza kuti chisamaliro cha chiropractic, kuphatikizapo kusintha kwa msana, kumathandizira migraine
    ndi mutu wa cervicogenic. Mtundu, mafupipafupi, mlingo, ndi nthawi ya chithandizo ziyenera kutengera malingaliro awo, zochitika zachipatala, ndi zomwe zapeza. Umboni wogwiritsira ntchito kugwiritsidwa ntchito kwa msana monga njira yodzipatula kwa odwala omwe ali ndi vuto la mutu wamtunduwu amakhalabe wofanana. (J Manipulative Physiol Ther 2011; 34:274-289)
  • Mawu Ofunikira Pakulozera: Kuwongolera kwa Msana; Migraine Matenda; Kupweteka kwamtundu wa Mutu; Mutu wa Post-traumatic; Malangizo Othandizira; Chiropractic

 

Dr Jimenez White Coat

Kuzindikira kwa Dr. Alex Jimenez

Kupweteka kwa mutu, kapena kupweteka kwa mutu, kuphatikizapo migraine ndi mitundu ina ya mutu, ndi imodzi mwa mitundu yambiri ya ululu yomwe imanenedwa pakati pa anthu ambiri. Izi zitha kuchitika pamutu umodzi kapena mbali zonse ziwiri za mutu, zitha kudzipatula pamalo enaake kapena zimawonekera pamutu pamutu umodzi. Ngakhale kuti zizindikiro za mutu zimatha kusiyana malinga ndi mtundu wa ululu wa mutu komanso chifukwa cha gwero la nkhani ya thanzi, kupweteka kwa mutu kumaonedwa kuti ndi kudandaula kwakukulu mosasamala kanthu za kuuma kwawo ndi mawonekedwe awo. Kupweteka kwa mutu, kapena kupweteka kwa mutu, kumatha kuchitika chifukwa cha kusokonezeka kwa msana, kapena kugwedezeka, pamtunda wa msana. Kupyolera mukugwiritsa ntchito kusintha kwa msana ndi kuwongolera pamanja, chisamaliro cha chiropractic chimatha kuwongolera bwino msana, kuchepetsa kupsinjika ndi kupanikizika pazigawo zozungulira za msana, kuti pamapeto pake zithandizire kusintha zizindikiro za ululu wa mutu wa migraine komanso thanzi labwino komanso thanzi.

 

Kupweteka kwamutu kumakhala kofala kwa akuluakulu. Kupweteka kwa mutu mobwerezabwereza kumasokoneza moyo wa banja, zochita za anthu, ndi mphamvu za ntchito [1,2] Padziko lonse lapansi, malinga ndi World Health Organization, mutu wa migraine wokha ndi 19th pakati pa zifukwa zonse za zaka zomwe zimakhala zolemala. Mutu ndi wachitatu pazifukwa zofunira chithandizo chamankhwala ku North America.[3]

 

Kuzindikira kolondola ndikofunikira pakuwongolera ndi chithandizo, ndipo mitundu yambiri yamutu yamutu imafotokozedwa mu International Classification of Headache Disorders 2 (International Headache Society [IHS]) [4]. Maguluwa amapangidwa kuti azigwiritsidwa ntchito pazachipatala komanso kafukufuku. Kupweteka kwamutu kofala kwambiri, kupsinjika kwamtundu ndi mutu waching'alang'ala, kumatengedwa kuti ndi mutu waukulu womwe ndi wa episodic kapena wosakhazikika. Episodic migraine kapena kupweteka kwamtundu wa mutu kumapezeka masiku osakwana 15 pamwezi, pomwe mutu umakhala wopitilira masiku 15 pamwezi kwa 3 (ching'alang'ala) kapena miyezi 6 (mutu wamtundu wamavuto).[4] Kupweteka kwachiwiri kwa mutu kumabwera chifukwa cha zovuta zachipatala pamutu kapena pakhosi zomwe zingakhalenso episodic kapena aakulu. Mutu wa Cervicogenic ndi mutu wachiwiri womwe umathandizidwa ndi chiropractors ndipo umaphatikizapo ululu womwe umatchulidwa kuchokera ku gwero la khosi ndipo umazindikiridwa mu 1 kapena zigawo zambiri za mutu. IHS imazindikira mutu wa cervicogenic ngati vuto lodziwika bwino, [4] ndi umboni wakuti mutu ukhoza kukhala chifukwa cha vuto la khosi kapena zilonda zochokera m'mbiri ndi zochitika zachipatala (mbiri ya kuvulala kwa khosi, kuwonjezereka kwa ululu, kuchepetsedwa kwa kayendetsedwe ka chiberekero, ndi kufatsa kwa khosi, kupatula ululu wa myofascial wokha) ndizofunikira pakuzindikira matenda koma sizikhala zotsutsana m'mabuku. [4,5] Pamene ululu wa myofascial wokha ndiwo umayambitsa, wodwalayo ayenera kuyang'aniridwa ngati ali ndi mutu wovuta. [4]

 

Njira zochiritsira zomwe zimagwiritsidwa ntchito ndi akatswiri a chiropractors posamalira odwala omwe ali ndi mutu amaphatikizapo kusintha kwa msana, kulimbikitsa, kugwiritsira ntchito msana, maphunziro okhudza kusintha kwa moyo, njira zochiritsira, kutentha / ayezi, kutikita minofu, chithandizo chapamwamba cha minofu yofewa monga trigger point therapy, ndi kulimbikitsa ndi kutambasula thupi. Pali chiyembekezo chokulirapo cha akatswiri azaumoyo, kuphatikiza chiropractic, kuti atenge ndikugwiritsa ntchito chidziwitso chofufuza, potengera kuchuluka kwaumboni wopezeka wofufuza kuti adziwitse zochitika zachipatala. Chotsatira chake, cholinga cha Canadian Chiropractic Association (CCA) ndi Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards (Federation) Clinical Practice Guidelines Project ndi kupanga malangizo ogwiritsira ntchito pogwiritsa ntchito umboni womwe ulipo. Cholinga cha bukhuli ndikupereka malangizo okhudzana ndi umboni pa chithandizo cha chiropractic cha mutu wa akuluakulu.

 

Njira

 

Komiti Yoyang'anira Malangizo (GDC) idakonza ndikusintha njira zotsatirira zolemba, kufufuza, kuwunika, kusanthula, ndi kumasulira. Njirazi zikugwirizana ndi mfundo zomwe zaperekedwa ndi �Kuwunika kwa Maupangiri Kafukufuku ndi Kuwunika� mgwirizano (www.agreecollaboration.org). Chitsogozo ichi ndi chida chothandizira kwa akatswiri. Sikuti ndi muyezo wa chisamaliro. Chitsogozocho chimagwirizanitsa umboni wofalitsidwa ku zochitika zachipatala ndipo ndi gawo limodzi la 1 la njira yodziwitsidwa ndi chithandizo cha odwala.

 

Magwero a Deta ndi Kusaka

 

Kufufuza mwadongosolo komanso kuwunika kwa mabuku ochizira kunachitika pogwiritsa ntchito njira zomwe Cochrane Collaboration Back Review Group [6] ndi Oxman ndi Guyatt [7] Njira yofufuzira inapangidwa mu MEDLINE pofufuza mawu a MeSH okhudzana ndi chiropractic ndi zochitika zinazake ndipo kenaka anasinthidwa kuzinthu zina. Njira yofufuzira mabuku inali yotakata mwadala. Kuchiza kwa chiropractic kumatanthauzidwa ngati kuphatikizapo mankhwala omwe amagwiritsidwa ntchito kwambiri ndi madokotala ndipo sanali olekezera ku njira zochiritsira zomwe zimaperekedwa kokha ndi chiropractors. Khoka lalikulu linaponyedwa kuti liphatikizepo mankhwala omwe angaperekedwe mu chisamaliro cha chiropractic komanso omwe angaperekedwenso pa nkhani ya chisamaliro ndi akatswiri ena azaumoyo mu kafukufuku wina wa kafukufuku (Zowonjezera A). Kuponderezedwa kwa msana kumatanthauzidwa ngati kuthamanga kwapamwamba kwapansi-amplitude yoperekedwa ku msana. Thandizo lomwe silinaphatikizidwe limaphatikizapo njira zochepetsera ululu kapena za neurostimulation, pharmacotherapy, jakisoni wa poizoni wa botulinum, chithandizo chamalingaliro kapena machitidwe, komanso kutema mphini.

 

Kusaka kwa mabuku kunamalizidwa kuyambira Epulo mpaka Meyi 2006, kusinthidwa mu 2007 (gawo 1), ndikusinthidwanso mu Ogasiti 2009 (gawo 2). Zosungirako zofufuzidwa zinaphatikizapo MEDLINE; EMBASE; Mankhwala Ogwirizana ndi Othandizira; Cumulative Index to Nursing and Allied Health Literature; Buku, Njira, ndi Natural Therapy Index System; Alt HealthWatch; Index to Chiropractic Literature; ndi Library ya Cochrane (Zowonjezera A). Zosaka zidali ndi zolemba zosindikizidwa mu Chingerezi kapena zolemba zachingerezi. Njira yofufuzira inali yokwanira kwa akuluakulu (? Zaka 18); ngakhale maphunziro ofufuza okhala ndi njira zophatikizira mitu yophatikizira zaka zambiri, monga akulu ndi achinyamata, adabwezedwa pogwiritsa ntchito njira yofufuzira. Mindandanda yazolozera zoperekedwa muzowunikira mwadongosolo (SRs) idawunikiridwanso ndi GDC kuti achepetse zolemba zoyenera kuti zisaphonye.

 

Zosankha Zosankhira Umboni

 

Zotsatira zofufuzira zidawonetsedwa pakompyuta, ndipo kuwunika kwamagawo angapo kunagwiritsidwa ntchito (Zowonjezera B): siteji 1A (mutu), 1B (abstract); siteji 2A (zolemba zonse), 2B (zolemba zonse-njira, kufunikira); ndi gawo 3 (zolemba zonse-zomaliza za GDC zowunika ngati akatswiri okhudzana ndi zamankhwala). Zobwerezabwereza zidachotsedwa, ndipo zolemba zoyenera zidatengedwa ngati zamagetsi ndi/kapena makope olimba kuti muwunike mwatsatanetsatane. Oyesa osiyanasiyana, pogwiritsa ntchito njira zomwezo, adamaliza zowonera mu 2007 ndi 2009 chifukwa cha nthawi yayitali pakati pakusaka.

 

Mayesero achipatala olamulidwa okha (CCTs); mayesero osasinthika, olamulidwa (RCTs); ndi ndondomeko zowunikira (SRs) zinasankhidwa ngati umboni wa chitsogozo ichi chogwirizana ndi ndondomeko zamakono zomasulira zomwe zapeza kuchipatala. GDC sinayese maphunziro owonetsetsa, mndandanda wamilandu, kapena malipoti amilandu chifukwa cha chikhalidwe chawo chosalamulirika komanso khalidwe lotsika la methodological vs CCTs. Njirayi ikugwirizana ndi njira zosinthidwa za SRs zofalitsidwa ndi Cochrane Back Review Group. [8] Ngati ma SR angapo adasindikizidwa ndi olemba omwewo pamutu womwe wapatsidwa, zofalitsa zaposachedwa zokha zidawerengedwa ndikugwiritsidwa ntchito popanga umboni. Ndemanga mwadongosolo ma SRs adachotsedwanso kuti apewe kuwerengera kawiri zotsatira za kafukufuku.

 

Kuwunika kwa Literature ndi Kutanthauzira

 

Makhalidwe abwino a CCTs kapena RCTs anaphatikizapo njira za 11 zoyankhidwa ndi �inde (chiwerengero 1)� kapena �ayi (chiwerengero 0)/sikudziwa (chiwerengero 0)� (Table 1). GDC inalemba zina zowonjezera za 2: (1) ofufuza akugwiritsa ntchito njira zowunikira za IHS pakulembetsa maphunziro ndi (2) kuwunika kwa zotsatirapo (Table 1, columns L ndi M). Kugwiritsa ntchito njira za IHS[4] zinali zogwirizana ndi ndondomeko ya Clinical Practice Guideline (CPG) kuti atsimikizire zachidziwitso cha matenda mkati ndi m'maphunziro onse a kafukufuku. Maphunziro sanaphatikizidwe ngati njira zowunikira za IHS sizinagwiritsidwe ntchito ndi ochita kafukufuku kuti alowe nawo mu phunziro (Zowonjezera C); ndipo ngati isanafike 2004, mutu wa cervicogenic usanaphatikizidwe mu gulu la IHS, njira zodziwira matenda a Cervicogenic Headache International Study Group [9] sizinagwiritsidwe ntchito. Zotsatira zoyipa zidawunikidwa ngati gwero lachiwopsezo chomwe chingakhalepo ndi chithandizo. Palibe zolemetsa (zolemera) zomwe zinagwiritsidwa ntchito pazikhalidwe za munthu aliyense, ndipo zotheka zowerengera zamtundu wa 0 mpaka 11. Onse akhungu a maphunziro ndi opereka chithandizo adawerengedwa m'nkhani zofufuza ndi GDC, popeza zinthuzi zalembedwa mu chida chowonetsera khalidwe. [6] Njira za GDC sizinasinthe kapena kusintha chida choyezera. Cholinga cha njirayi chinali chakuti njira zina zochizira (mwachitsanzo, kukondoweza kwa mitsempha ya transcutaneous [TENS], ultrasound) ndi mapangidwe a mayesero angapangitse khungu la odwala ndi/kapena ochiritsa.[10] GDC sinalepheretse kuwunika kwa zizindikiro za khalidweli ngati zilidi zanenedwa mu maphunziro a zachipatala pofuna kuchiza matenda a mutu. A GDC adawonanso ngati kunja kwa luso lawo kuti asinthe, popanda kutsimikizira, chida chomwe chimagwiritsidwa ntchito kwambiri powunika zolemba zamankhwala.[6] Zida zatsopano zofufuzira zowunikira ndi kuwerengera kwa mabuku opangira chithandizo chamanja, komabe, ndizofunikira kwambiri ndipo zimawonedwa ngati malo opangira kafukufuku wamtsogolo mu gawo lazokambirana pansipa.

 

Table 1 Miyezo Yoyenera ya Mayesero Olamuliridwa a Machiritso Athupi a Kuwongolera Matenda a Mutu

 

Owunika zolembalemba anali othandizira pulojekiti yosiyana ndi GDC ndipo analibe khungu pophunzira olemba, mabungwe, ndi magwero a magazini. Mamembala atatu a GDC (MD, RR, ndi LS) adatsimikizira njira zowonetsera khalidwe labwino pomaliza kufufuza kwapamwamba pamagulu ang'onoang'ono a 10. [11-20] Chigwirizano chapamwamba chinatsimikiziridwa pazitsulo zamtundu uliwonse. Mgwirizano wathunthu pa zinthu zonse unakwaniritsidwa pa maphunziro a 5: mu 10 pa zinthu 11 pa maphunziro 4 ndi 8 mwa zinthu 11 pa phunziro limodzi lotsala. Zosemphana zonse zinathetsedwa mosavuta pokambirana ndi �kumvana ndi GDC (Table 1). Chifukwa cha kusiyanasiyana kwa njira zofufuzira m'mayesero onse, palibe kusanthula meta kapena kuphatikiza zowerengera zomwe zidachitika. Mayesero omwe adapeza oposa theka la chiwerengero chonse chotheka (ie, ?1) amaonedwa kuti ndi apamwamba kwambiri. Mayesero omwe adapeza 6 mpaka 0 adawonedwa ngati otsika. Maphunziro okhala ndi zolakwika zazikulu zamakina kapena kufufuza njira zamankhwala zapadera sizinaphatikizidwe (mwachitsanzo, chithandizo chomwe sichinaganizidwe kuti ndi choyenera ndi GDC pa chisamaliro cha chiropractic cha odwala omwe ali ndi mutu; Zowonjezera Table 5).

 

Chiyerekezo chapamwamba cha ma SR chimaphatikizanso mfundo 9 zoyankhidwa ndi inde (chiwerengero 1) kapena ayi (chigoli 0)/sindikudziwa (chigoli 0) ndi kuyankha kwamtundu wa chinthu J �palibe zolakwika,� � zolakwika zazing'ono,� kapena �zolakwika zazikulu� (Gulu 2). Zomwe zingatheke zinayambira pa 0 mpaka 9. Kutsimikiza kwa khalidwe la sayansi la SRs ndi zolakwika zazikulu, zolakwika zazing'ono, kapena zolakwika, monga momwe zalembedwera mu gawo J (Table 2), zinachokera ku mayankho a olemba mabuku ku zinthu 9 zam'mbuyo. . Magawo otsatirawa adagwiritsidwa ntchito kuti apeze mtundu wonse wa sayansi wa SR: ngati yankho lopanda / sindikudziwa lidagwiritsidwa ntchito, SR ikhoza kukhala ndi zolakwika zazing'ono. Komabe, ngati �Ayi anagwiritsidwa ntchito pazinthu B, D, F, kapena H, kubwerezaku kukanakhala ndi zolakwika zazikulu.[21] Ndemanga zadongosolo zomwe zidapeza ndalama zopitilira theka lazomwe zingatheke (ie, ?5) popanda zolakwika kapena zolakwika zazing'ono zidavoteledwa ngati zapamwamba. Ndemanga zadongosolo zomwe zidapeza 4 kapena kuchepera ndi/kapena zophophonya zazikulu sizinaphatikizidwe.

 

Table 2 Mawerengedwe Oyenerera a Ndemanga Zadongosolo Zamankhwala Olimbitsa Thupi a Kasamalidwe ka Matenda a Mutu

 

Ndemanga zimatanthauzidwa kuti ndizokhazikika ngati zikuphatikiza njira yowonekera komanso yobwerezabwereza yofufuzira ndi kusanthula zolembazo komanso ngati njira zophatikizira ndi zopatula zamaphunziro zidafotokozedwa. Njira, ndondomeko zophatikizira, njira zowonetsera khalidwe la maphunziro, makhalidwe a maphunziro ophatikizidwa, njira zopangira deta, ndi zotsatira zinayesedwa. Ovotera adakwaniritsa mgwirizano wathunthu pazowerengera zonse za 7 SRs[22-28] ndi zinthu 7 za 9 za 2�zowonjezera za SRs. ).

 

Kupanga Malangizo Ogwiritsa Ntchito

 

GDC inatanthauzira umboni wokhudzana ndi chithandizo cha chiropractic cha odwala mutu. Chidule chatsatanetsatane chazolembazo chidzatumizidwa patsamba la Project CCA/Federation Clinical Practice Guidelines Project.

 

Mayesero osankhidwa mwachisawawa, olamulidwa ndi zomwe adapeza adayesedwa kuti adziwitse malingaliro a chithandizo. Kupereka umboni wamphamvu wonse (wamphamvu, wocheperako, wocheperako, wotsutsana, kapena wopanda umboni),[6] GDC idawona kuchuluka, mtundu, ndi kusasinthika kwa zotsatira za kafukufuku (Table 3). Umboni wamphamvu unkaganiziridwa pokhapokha pamene ma RCT ambiri apamwamba amatsimikizira zomwe ofufuza ena adapeza m'madera ena. Ma SR apamwamba okha ndi omwe adayesedwa pokhudzana ndi umboni wa umboni ndikudziwitsa malingaliro a chithandizo. GDC idawona kuti njira zochiritsira zimakhala ndi zopindulitsa zotsimikiziridwa zikathandizidwa ndi umboni wocheperako.

 

Table 3 Mphamvu ya Umboni

 

Malangizo ogwiritsira ntchito adapangidwa pamisonkhano yamagulu ogwira ntchito.

 

Results

 

Table 4 Literature Summary of !uality Ratings of the Umboni Wothandizira Pakati pa Mutu wa Migraine wokhala kapena wopanda Aura

 

Table 5 Chidule cha Zolemba ndi Makhalidwe Abwino a Umboni Wothandizira Kupweteka kwa Mutu Wamtundu

 

Table 6 Literature Summary and Quality Ratings of the Evidence for Interventions for Cervicogenic Headache

 

Table 7 Chidule cha Zolemba ndi Mawerengedwe Abwino a Ndemanga Zadongosolo Zamankhwala Olimbitsa Thupi a Kasamalidwe ka Matenda a Mutu

 

Mabuku

 

Kuchokera pakufufuza kwa mabuku, zolembedwa za 6206 zidadziwika. Nkhani makumi awiri ndi chimodzi zidakumana ndi zofunikira zomaliza zophatikizidwira ndipo zidaganiziridwa pakukulitsa malingaliro ochita (16 CCTs / RCTs [11-20,31-36] ndi 5 SRs [24-27,29]). Makhalidwe abwino a nkhani zomwe zikuphatikizidwa amaperekedwa mu Matebulo 1 ndi 2. Zowonjezera Table 3 imatchula zolemba zomwe sizikuphatikizidwa pakuwunika komaliza ndi GDC ndi chifukwa (zifukwa) zowachotsera. Kusakhalapo kwa phunziro ndi akatswiri akhungu ndi mafotokozedwe osakhutiritsa a kulowererapo ankadziwika kawirikawiri zolepheretsa njira za mayesero olamulidwa. Mitundu yamutu yomwe inayesedwa m'mayeserowa inaphatikizapo migraine (Table 4), kupweteka kwa mutu (Table 5), ndi mutu wa cervicogenic (Table 6). Chifukwa chake, mitundu iyi yamutu yokhayo imayimiridwa ndi umboni ndi zoyeserera mu CPG iyi. Maumboni achidule a ma SR aperekedwa mu Gulu 7.

 

Malangizo Othandizira: Chithandizo cha Migraine

 

  • Kuwongolera kwa msana kumalimbikitsidwa kuti azisamalira odwala omwe ali ndi episodic kapena aakulu migraine omwe ali ndi aura kapena opanda aura. Malingaliro awa amachokera ku maphunziro omwe amagwiritsa ntchito mankhwala pafupipafupi 1 mpaka 2 pa sabata kwa masabata a 8 (umboni waumboni, wochepetsetsa). RCT imodzi yapamwamba kwambiri, [20] 1 yotsika kwambiri ya RCT, [17] ndi 1 yapamwamba kwambiri ya SR [24] imathandizira kugwiritsidwa ntchito kwa msana kwa odwala omwe ali ndi episodic kapena aakulu migraine (Matebulo 4 ndi 7).
  • Thandizo lakutikita minofu mlungu ndi mlungu likulimbikitsidwa kuti muchepetse nthawi zambiri za mutu waching'alang'ala komanso kuti muchepetse zizindikiro zomwe zingagwirizane ndi kupweteka kwa mutu (mulingo waumboni, wapakati). RCT imodzi yapamwamba [16] imathandizira malingaliro awa (Table 4). Ofufuzawo adagwiritsa ntchito kutikita kwa mphindi 45 poyang'ana ma neuromuscular ndi trigger point of the back, phewa, khosi, ndi mutu.
  • Multimodal multidisciplinary care (masewera olimbitsa thupi, kupumula, kupsinjika maganizo ndi uphungu wopatsa thanzi, kupaka minofu) kumalimbikitsidwa kuti azisamalira odwala omwe ali ndi episodic kapena aakulu migraine. Onetsani ngati kuli koyenera (mulingo waumboni, wapakati). RCT imodzi yapamwamba [32] imathandizira kuti pakhale njira zambiri zothandizira migraine (Table 4). Kuchitapo kanthu kumayika patsogolo njira yoyendetsera bwino yomwe ili ndi masewera olimbitsa thupi, maphunziro, kusintha kwa moyo, komanso kudzilamulira.
  • Pali deta yosakwanira yachipatala yolangizira kapena yotsutsana ndi kugwiritsa ntchito masewera olimbitsa thupi okha kapena kuchita masewera olimbitsa thupi pamodzi ndi mankhwala ochiritsira amtundu wa multimodal kwa oyang'anira odwala omwe ali ndi episodic kapena aakulu migraine (zolimbitsa thupi aerobic, chiberekero cha chiberekero [cROM], kapena kutambasula thupi lonse). Ma CCT atatu otsika kwambiri [13,33,34] amathandizira kuti izi zitheke (Table 4).

 

Phunzirani Malangizo: Kupweteka kwamtundu wa Mutu

 

  • Kupititsa patsogolo kwa craniocervical mobilization (mwachitsanzo, Thera-Band, Resistive Exercise Systems; Hygenic Corporation, Akron, OH) kumalimbikitsidwa kwa nthawi yayitali (mwachitsanzo, miyezi 6) kwa odwala omwe ali ndi mutu wovuta kwambiri kapena wovuta kwambiri (umboni waumboni, zapakati). RCT imodzi yapamwamba [36] inasonyeza kuti kusonkhanitsa katundu wochepa kumachepetsa kwambiri zizindikiro za kupweteka kwa mutu kwa odwala panthawi yayitali (Table 5).
  • Kuwongolera kwa msana sikungavomerezedwe kwa oyang'anira odwala omwe ali ndi mutu wamtundu wa episodic tension (umboni waumboni, wapakati). Pali umboni wochepa wosonyeza kuti kusintha kwa msana pambuyo pa chithandizo chamankhwala chofewa choyambirira sichimapereka phindu lina kwa odwala omwe ali ndi mutu wovuta. RCT imodzi yapamwamba kwambiri [12] (Table 5) ndi zomwe zinalembedwa mu 4 SRs [24-27] (Table 7) zimasonyeza kuti palibe phindu la kugwiritsira ntchito msana kwa odwala omwe ali ndi mutu wamtundu wa episodic.
  • Malingaliro sangapangidwe kapena kutsutsana ndi kugwiritsidwa ntchito kwa msana (2 kawiri pa sabata kwa masabata a 6) kwa odwala omwe ali ndi mutu wovuta kwambiri. Olemba a 1 RCT[11] adavotera kuti ndi apamwamba kwambiri ndi chida chowunikira khalidwe [6] (Table 1), ndi chidule cha phunziroli mu 2 SRs [24,26] akusonyeza kuti kugwiritsira ntchito msana kungakhale kothandiza kwa mutu wovuta kwambiri. . Komabe, GDC imawona kuti RCT[11] ndi yovuta kutanthauzira komanso yosatsimikizika (Table 5). Chiyesocho sichimayendetsedwa moyenerera ndi kusalinganika kwa chiwerengero cha odwala omwe amakumana nawo pakati pa magulu ophunzirira (mwachitsanzo, maulendo a 12 kwa anthu omwe ali ndi mankhwala ofewa amtundu wofewa komanso gulu loyendetsa msana vs maulendo a 2 kwa anthu omwe ali mu gulu la amitriptyline). Palibe njira yodziwira ngati chidwi chofananira cha anthu omwe ali mu gulu la amitriptyline chingakhale chakhudza zotsatira za phunzirolo. Malingaliro awa ndi matanthauzidwe ochokera ku 2 ena SRs[25,27] amathandizira kuti izi zitheke (Table 7).
  • Palibe umboni wokwanira wotsimikizira kapena wotsutsana ndi kugwiritsa ntchito kugwedeza kwamanja, kugwiritsira ntchito minofu, kulimbikitsa kwa Cyriax, kapena masewera olimbitsa thupi / masewera olimbitsa thupi kwa odwala omwe ali ndi mutu wa episodic kapena wovuta kwambiri. Maphunziro atatu otsika kwambiri [19,31,35] (Table 5), 1 otsika kwambiri a RCT, [14] ndi 1 SR[25] amathandizira kuti izi zitheke (Table 7).

 

Yesani Malangizo: Cervicogenic Mutu wa Mutu

 

  • Kuwongolera kwa msana kumalimbikitsidwa kuti azisamalira odwala omwe ali ndi mutu wa cervicogenic. Malangizowa amachokera ku phunziro la 1 lomwe linagwiritsa ntchito pafupipafupi mankhwala a 2 pa sabata kwa masabata a 3 (umboni waumboni, wochepetsetsa). Mu RCT yapamwamba kwambiri, Nilsson et al [18] (Table 6) anasonyeza zotsatira zabwino kwambiri za kuthamanga kwapamwamba, kutsika kwa msana kwa odwala omwe ali ndi mutu wa cervicogenic. Kaphatikizidwe kaumboni kuchokera ku 2 SRs[24,29] (Table 7) imathandizira malingaliro awa.
  • Kulimbikitsana pamodzi kumalimbikitsidwa kuti azitsogolera odwala omwe ali ndi mutu wa cervicogenic (umboni waumboni, wochepetsetsa). Jull et al [15] adawunika zotsatira za kuphatikiza kwa Maitland 8 ku 12 mankhwala kwa masabata a 6 mu RCT yapamwamba (Table 6). Kulimbikitsa anthu kunkatsatira zochitika zachipatala, momwe kusankha njira zochepetsera komanso zothamanga kwambiri kunachokera pa kuwunika koyambirira ndi kopita patsogolo kwa kusagwira ntchito kwa khomo lachiberekero la odwala. Zotsatira zopindulitsa zinanenedwa pamutu wafupipafupi, mphamvu, komanso kupweteka kwa khosi ndi kulemala. Kaphatikizidwe kaumboni kuchokera ku 2 SRs[24,29] (Table 7) imathandizira malingaliro awa.
  • Zochita zolimbitsa thupi zozama zapakhosi zimalimbikitsidwa kuti aziwongolera odwala omwe ali ndi mutu wa cervicogenic (umboni waumboni, wokhazikika). Malingaliro awa amachokera ku kafukufuku wa 2 nthawi tsiku lililonse kwa masabata 6. Palibe phindu lowonjezera lophatikizira zolimbitsa thupi zakuya kwapakhosi komanso kulimbikitsana kwa mutu wa cervicogenic. RCT imodzi yapamwamba [15] (Table 6) ndi zowonera zomwe zaperekedwa mu 2 SRs [24,29] (Table 7) zimathandizira malingaliro awa.

 

Safety

 

Madokotala amasankha njira zochiritsira mogwirizana ndi zonse zomwe zilipo zachipatala kwa wodwala wopatsidwa. Pa ma 16 CCTs / RCTS [11-20,31-36] omwe akuphatikizidwa mu umboni wa CPG iyi, maphunziro a 6 okha [11,12,15,20,32,36] omwe amayesedwa mokwanira kapena kukambirana za zotsatira za odwala kapena chitetezo. magawo (Table 1, column M). Ponseponse, zoopsa zomwe zidanenedwa zinali zochepa. Mayesero atatu adanena za chitetezo cha kugwidwa kwa msana [11,12,20] Boline et al [11] adanena kuti 4.3% ya anthu adakumana ndi kuuma kwa khosi pambuyo pa kugwidwa kwa msana koyamba komwe kunatha pazochitika zonse pambuyo pa masabata oyambirira a 2 a chithandizo. Kupweteka kapena kuwonjezeka kwa mutu pambuyo pa kugwedezeka kwa msana (n = 2) zinali zifukwa zosiya chithandizo chotchulidwa ndi Tuchin et al. [20] Palibe zotsatirapo zomwe zinachitikira ndi nkhani zilizonse zomwe Bove et al [12] adaphunzira pogwiritsa ntchito kusintha kwa msana pofuna kuchiza mutu wamtundu wa episodic. Mayesero a chithandizo kuti awone zotsatira zogwira mtima sangalembetse chiwerengero chokwanira cha maphunziro kuti awone zochitika za zochitika zosadziwika bwino. Njira zina zofufuzira zimafunikira kuti �kukulitse kumvetsetsa bwino pakati pa zabwino ndi zoopsa.

 

Kukambirana

 

Kuwongolera kwa msana ndi njira zina zochiritsira zomwe zimagwiritsidwa ntchito mu chiropractic zaphunziridwa mu CCTs zingapo zomwe zimakhala zosiyana kwambiri ndi zolemba, mapangidwe, ndi khalidwe lonse. Mitundu ya odwala ndi amutu omwe amaimiridwa mwadongosolo mu umboni ndi migraine, kupweteka kwa mutu, ndi mutu wa cervicogenic. Zotsatira zoyambirira za thanzi zomwe zimanenedwa ndizofupikitsa mutu, mphamvu, nthawi, ndi khalidwe la moyo. Umboni si waukulu kuposa mlingo wapakatikati pa nthawi ino.

 

Umboni umatsimikizira kugwiritsidwa ntchito kwa msana kwa chiropractic kasamalidwe ka odwala omwe ali ndi mutu wa migraine kapena cervicogenic koma osati mutu wovuta. Kwa mutu waching'alang'ala, chisamaliro chamagulu ambiri pogwiritsa ntchito mlungu uliwonse 45-miniti kutikita minofu ndi chisamaliro cha multimodal (zolimbitsa thupi, kupumula, ndi kupsinjika maganizo ndi uphungu wopatsa thanzi) zingakhalenso zothandiza. Kapenanso, kulimbikitsana pamodzi kapena kuchita masewera olimbitsa thupi kwakuya kumalimbikitsidwa kuti mukhale ndi zizindikiro za mutu wa cervicogenic. Zikuwoneka kuti palibe phindu lowonjezera lophatikizana lolimbikitsana pamodzi ndi zolimbitsa thupi zakuya za khosi kwa odwala omwe ali ndi mutu wa cervicogenic. Umboni wocheperako umathandizira kugwiritsa ntchito kukweza kwa craniocervical kwanthawi yayitali pakuwongolera mutu kwanthawi yayitali.

 

sitingathe

 

Zoperewera za chitsogozochi zikuphatikizapo kuchuluka ndi ubwino wa umboni wothandizira womwe umapezeka panthawi yakusaka. Palibe kafukufuku waposachedwa wotsogola wapamwamba kwambiri yemwe ali ndi zotsatira zachipatala zomwe zatulutsidwa zomwe zasindikizidwa chifukwa cha chisamaliro cha chiropractic kwa odwala mutu. Maphunziro amafunikira kuti tipitilize kumvetsetsa kwathu kwamankhwala apadera odzipatula kapena osakanizidwa bwino kuti athe kuchiza migraine, kupweteka kwa mutu, mutu wa cervicogenic, kapena mitundu ina yamutu yomwe imaperekedwa kwa asing'anga (mwachitsanzo, masango, kupweteka mutu pambuyo pake) . Cholakwika china cha kaphatikizidwe ka mabukuwa ndikudalira maphunziro ofufuza omwe adasindikizidwa okhala ndi zitsanzo zazing'ono (Matebulo 4-6), ma paradigms am'nthawi yochepa, komanso nthawi zotsatiridwa. Mayesero achipatala opangidwa bwino omwe ali ndi chiwerengero chokwanira cha maphunziro, chithandizo cha nthawi yaitali, ndi nthawi zotsatila ziyenera kulipidwa kuti apititse patsogolo chisamaliro cha chiropractic, komanso kusokoneza msana makamaka, kuti athe kusamalira odwala omwe ali ndi mutu. Monga momwe zimakhalira ndi zowunikira zilizonse zamabuku ndi malangizo azachipatala, zidziwitso zoyambira ndi zolemba zosindikizidwa zikusintha. Maphunziro omwe mwina adadziwitsa ntchitoyi mwina adasindikizidwa pambuyo pomaliza kwa kafukufukuyu.[37-39]

 

Zoganizira za Future Research

 

Chigwirizano cha GDC ndikuti pakufunika maphunziro owonjezera a chiropractic ndi odwala omwe ali ndi vuto la mutu.

 

  • Kufufuza kwachipatala kwapamwamba kwambiri kumafunika. Kafukufuku wam'tsogolo amafunikira mapangidwe ophunzirira pogwiritsa ntchito ofananitsa mwachangu komanso osalandira chithandizo ndi/kapena magulu a placebo kuti apititse patsogolo umboni wa chisamaliro cha odwala. Kuchititsa khungu kwa odwala kuti azitha kuyang'anira zotsatira zayembekezero ndizofunikira ndipo zafufuzidwa ndi ochita kafukufuku mu chiropractic pazochitika zina zowawa. [10] Kuperewera kwa maphunziro omwe amafotokozedwa mwadongosolo kumapereka vuto lothandizira kupanga malingaliro ochiritsira ozikidwa pa umboni. Maphunziro onse amtsogolo akuyenera kukonzedwa pogwiritsa ntchito njira zovomerezeka (mwachitsanzo, Consolidated Standards of Reporting Trials [CONSORT] ndi Transparent Reporting of Evaluations with Non-randomized Designs [TREND]).
  • Kufotokozera mwadongosolo zachitetezo ndikofunikira pakufufuza kwa chiropractic. Mayesero onse azachipatala ayenera kusonkhanitsa ndikufotokozera za zotsatirapo zomwe zingakhalepo kapena zovulaza ngakhale palibe chomwe chikuwoneka.
  • Pangani zida zatsopano zowunikira kafukufuku wamankhwala amanja. Kuchititsa khungu kumathandizira kuyang'anira zomwe zikuyembekezeka komanso zotsatirapo zosagwirizana ndi opereka maphunziro m'magulu onse ophunzirira. Sizingatheke kuchititsa khungu anthu ndi opereka chithandizo m'maphunziro ogwira mtima a chithandizo chamanja. Ngakhale kuti panali zolepheretsa, kuchititsa khungu kwa maphunziro ndi opereka chithandizo adavotera m'nkhani zofufuza ndi GDC, popeza zinthuzi zikuphatikizidwa mu zida zapamwamba kwambiri.[6] Zida zofufuzira zapamwamba zowunikira ndikuwunikanso zolemba zamabuku azachipatala ndizofunikira mwachangu.
  • Kupititsa patsogolo kafukufuku pazotsatira zogwira ntchito mu chisamaliro cha chiropractic cha mutu. Chitsogozochi chinasonyeza kuti maphunziro a mutu amagwiritsira ntchito njira zosiyanasiyana poyesa zotsatira za mankhwala pa zotsatira za thanzi. Kuchuluka kwa mutu, mphamvu, ndi nthawi ndizo zotsatira zomwe zimagwiritsidwa ntchito nthawi zonse (Matebulo 4-6). Kuyesetsa kwakukulu kumafunika kuti muphatikizepo njira zovomerezeka za odwala mu kafukufuku wa chiropractic zomwe zimagwirizana ndi kusintha kwa moyo watsiku ndi tsiku ndi kuyambiranso machitidwe abwino.
  • Kuchita bwino kwa ndalama. Palibe maphunziro ofufuza omwe adapezedwa pamtengo wamtengo wapatali wa kugwidwa kwa msana pofuna kuchiza matenda a mutu. Mayesero azachipatala amtsogolo a kuwongolera kwa msana ayenera kuwunika momwe amathandizira.

 

Njira zina zofufuzira zimafunikira kuti mumvetsetse bwino kusiyana pakati pa phindu ndi zoopsa. CPG iyi sipereka ndemanga yamankhwala onse a chiropractic. Zosiyidwa zilizonse zikuwonetsa mipata m'mabuku azachipatala. Mtundu, mafupipafupi, mlingo, ndi nthawi ya chithandizo (s) ziyenera kutsatiridwa ndi malangizo otsogolera, zochitika zachipatala, ndi chidziwitso cha wodwalayo mpaka umboni wapamwamba ukupezeka.

 

Mawuwo

 

Pali umboni woyambira wothandizira chisamaliro cha chiropractic, kuphatikiza kuwongolera kwa msana, pakuwongolera mutu wa migraine ndi mutu wa cervicogenic. Mtundu, mafupipafupi, mlingo, ndi nthawi ya chithandizo ziyenera kutsatiridwa ndi malangizo otsogolera, zochitika zachipatala, ndi chidziwitso cha wodwalayo. Umboni wogwiritsira ntchito kugwiritsidwa ntchito kwa msana monga njira yodzipatula kwa odwala omwe ali ndi vuto la mutu wamtunduwu amakhalabe wofanana. Kafukufuku wochulukirapo akufunika.
Malangizo ogwiritsira ntchito amagwirizanitsa umboni wabwino kwambiri wopezeka ku zochitika zabwino zachipatala ndipo ndi gawo limodzi la 1 la njira yodziwitsidwa yopereka chithandizo chabwino. Lamuloli likufuna kuti likhale chithandizo choperekera chithandizo cha chiropractic kwa odwala omwe ali ndi mutu. Ndi �chikalata chamoyo� ndipo chikuyenera kuwunikiridwanso pakatuluka zatsopano. Kuphatikiza apo, sikulowa m'malo mwa chidziwitso chachipatala ndi ukatswiri wa sing'anga. Chikalatachi sichinapangidwe kuti chikhale ngati muyezo wa chisamaliro. M'malo mwake, chitsogozochi chikutsimikizira kudzipereka kwa ntchitoyo kuti ipititse patsogolo machitidwe ozikidwa pa umboni pogwiritsa ntchito kusinthana kwa chidziwitso ndi kusamutsa njira zothandizira kayendetsedwe ka chidziwitso cha kafukufuku.

 

Mapulogalamu Othandiza

 

  • Chitsogozo ichi ndi chithandizo choperekera chithandizo cha chiropractic kwa odwala omwe ali ndi mutu.
  • Kuwongolera kwa msana kumalimbikitsidwa kuti azisamalira odwala omwe ali ndi mutu wa migraine kapena mutu wa cervicogenic.
  • Multimodal multidisciplinary interventions kuphatikizapo kutikita minofu kungathandize odwala migraine.
  • Kulimbikitsana pamodzi kapena kuchita masewera olimbitsa thupi kwakuya kungapangitse zizindikiro za mutu wa cervicogenic.
  • Kulimbikitsana kwa craniocervical kwapang'onopang'ono kumatha kukulitsa mutu wovuta.

 

Zothokoza

 

Olembawo akuthokoza zotsatirazi chifukwa chothandizira ndondomekoyi: Ron Brady, DC; Grayden Bridge, DC; H James Duncan; Wanda Lee MacPhee, DC; Keith Thomson, DC, ND; Dean Wright, DC; ndi Peter Waite (Mamembala a Clinical Practice Guidelines Task Force). Olembawo akuthokoza zotsatirazi kuti athandizidwe ndi kufufuza kwa mabuku a Phase I: Simon Dagenais, DC, PhD; ndi Thor Eglinton, MSc, RN. Olembawo akuthokoza zotsatirazi kuti athandizidwe ndi Gawo lachiwiri lofufuzira mabuku owonjezera ndi chiwerengero cha umboni: Seema Bhatt, PhD; Mary-Doug Wright, MLS. Olembawo akuthokoza Karin Sorra, PhD kaamba ka thandizo lofufuza mabuku, kuchuluka kwa umboni, ndi thandizo la mkonzi.

 

Magwero a Ndalama ndi Kusemphana kwa Chidwi

 

Ndalamazo zinaperekedwa ndi CCA, Canadian Chiropractic Protective Association, ndi zopereka za chiropractic zachigawo kuchokera kumadera onse kupatula British Columbia. Ntchitoyi idathandizidwa ndi The CCA ndi Federation. Palibe mikangano ya chidwi yomwe idanenedwa pa kafukufukuyu.

 

Pomaliza, kupweteka kwa mutu ndi chimodzi mwa zifukwa zomwe anthu ambiri amafunira chithandizo chamankhwala. Ngakhale akatswiri ambiri azachipatala amatha kuchiza mutu, chisamaliro cha chiropractic ndi njira yodziwika bwino yothandizira yomwe imagwiritsidwa ntchito pochiza matenda osiyanasiyana, kuphatikiza mitundu ingapo ya mutu. Malinga ndi nkhani yomwe ili pamwambayi, umboni umasonyeza kuti chisamaliro cha chiropractic, kuphatikizapo kusintha kwa msana ndi kusintha kwa manja, kungathandize kuchepetsa mutu ndi migraine. Zambiri zomwe zatchulidwa kuchokera ku National Center for Biotechnology Information (NCBI). Kukula kwa chidziwitso chathu kumangokhala kwa chiropractic komanso kuvulala kwa msana ndi mikhalidwe. Kuti tikambirane nkhaniyi, chonde omasuka kufunsa Dr. Jimenez kapena tilankhule nafe pa 915-850-0900 .

 

Wosankhidwa ndi Dr. Alex Jimenez

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

Mitu Yowonjezera: Ululu Wobwerera

 

Malinga ndi ziwerengero, pafupifupi 80% ya anthu adzakhala ndi zizindikiro za ululu wammbuyo kamodzi pa moyo wawo wonse. Ululu wammbuyo ndi dandaulo lofala lomwe lingakhalepo chifukwa cha kuvulala kosiyanasiyana ndi/kapena mikhalidwe. Nthawi zambiri, kuwonongeka kwachilengedwe kwa msana ndi zaka kungayambitse ululu wammbuyo. Herniated discs zimachitika pamene chofewa, ngati gel pakati pa intervertebral disc ikukankhira kupyola mu misozi yozungulira, mphete yakunja ya cartilage, kuponderezana ndi kukwiyitsa mizu ya mitsempha. Ma disc herniations nthawi zambiri amapezeka m'munsi kumbuyo, kapena msana, koma amathanso kuchitika m'mphepete mwa khomo lachiberekero, kapena khosi. Kulowetsedwa kwa mitsempha yomwe imapezeka m'munsi kumbuyo chifukwa cha kuvulala ndi / kapena kuwonjezereka kwa chikhalidwe kungayambitse zizindikiro za sciatica.

 

chithunzi cha blog cha cartoon paperboy nkhani zazikulu

 

MUTU WOSANGALALA WOFUNIKA:�Kuchiza Ululu Wa Pakhosi El Paso, TX Chiropractor

 

 

ZINTHU ZINA: ZOWONJEZERA: El Paso, Tx | Othamanga

 

Palibe kanthu
Zothandizira

1. Robbins MS, Lipton RB. Epidemiology ya matenda oyamba amutu. Semin Neurol 2010; 30:107-19.
2. Stovner LJ, Andree C. Kukula kwa mutu ku Ulaya: ndemanga ya polojekiti ya Eurolight. J Kupweteka kwa Mutu Aug 2010; 11:289-99 .
3. Coulter ID, Hurwitz EL, Adams AH, Genovese BJ, Hays R, Shekelle PG. Odwala omwe amagwiritsa ntchito ma chiropractors ku North America: ndi ndani, ndipo chifukwa chiyani ali mu chisamaliro cha chiropractic? Msana (Phila Pa 1976) 2002;27(3):291-6 [nkhani 297-98].
4. International Headache Society. The International Classification of Headache Disorders, 2nd ed. Cephalalgia 2004; 24: 9-160 (Suppl 1).
5. Bogduk N, Govind J. Cervicogenic mutu wa mutu: kuunika kwa umboni pa matenda a matenda, mayesero owononga, ndi chithandizo. Lancet Neurol 2009; 8:959-68.
6. van Tulder M, Furlan A, Bombardier C, Bouter L. Njira zowongolera zowunikira mwadongosolo mu gulu la cochrane cochrane back review group. Msana (Phila Pa 1976) 2003; 28:1290-9 .
7. Oxman AD, Guyatt GH. Kutsimikizira kwa ndondomeko ya khalidwe lazolemba zowunikira. J Clin Epidemiol 1991; 44:1271-8.
8. Furlan AD, Pennick V, Bombardier C, van Tulder M. 2009 ndondomeko zosinthidwa za ndondomeko zowunikira mwadongosolo mu Gulu la Cochrane Back Review Group. Msana (Phila Pa 1976) 2009; 34:1929-41 .
9. Sjaastad O, Fredriksen TA, Pfaffenrath V. Mutu wa Cervicogenic: njira zodziwira matenda. Gulu la Cervicogenic Headache International Study Group. Mutu 1998;38:442-5.
10. Hawk C, Long CR, Reiter R, Davis CS, Cambron JA, Evans R. Nkhani pokonzekera mayesero oyendetsedwa ndi placebo a njira zamabuku: zotsatira za kafukufuku woyendetsa ndege. J Altern Wothandizira Med 2002; 8:21-32.
11. Boline PD, Kassak K, Bronfort G, Nelson C, Anderson AV. Kugwiritsidwa ntchito kwa msana vs. amitriptyline pofuna kuchiza mutu wa mutu wovuta kwambiri: kuyesedwa kwachipatala kosasintha. J Manipulative Physiol Ther 1995; 18: 148-54.
12. Bove G, Nilsson N. Kugwiritsidwa ntchito kwa msana pochiza mutu wa episodic-mtundu wa mutu: kuyesedwa kosasinthika. JAMA 1998;280:1576-9.
13. Dittrich SM, Gunther V, Franz G, Burtscher M, Holzner B, Kopp M. Kuchita masewera olimbitsa thupi ndi kupumula: kukhudza ululu ndi maganizo a amayi odwala migraine. Clin J Sport Med 2008; 18:363-5.
14. Donkin RD, Parkin-Smith GF, Gomes N. Zomwe zingatheke pogwiritsira ntchito chiropractic ndi kuphatikizika kwapamanja ndi kugwiritsira ntchito pamutu wamtundu wachisokonezo: phunziro loyendetsa ndege. J Neuromusculoskeletal Systen 2002; 10:89-97.
15. Jull G, Trott P, Potter H, et al. Kuyesedwa kosasinthika kochita masewera olimbitsa thupi komanso kuchiza matenda a mutu wa cervicogenic. Msana (Phila Pa 1976) 2002;27:1835-43 [zokambirana 1843].
16. Lawler SP, Cameron LD. Kuyesa kosasinthika, koyendetsedwa ndi misala ngati chithandizo cha migraine. Ann Behav Med 2006; 32:50-9.
17. Nelson CF, Bronfort G, Evans R, Boline P, Goldsmith C, Anderson AV. Kuchita bwino kwa kuwongolera kwa msana, amitriptyline komanso kuphatikiza kwamankhwala onse awiri a prophylaxis ya mutu wa migraine. J Manipulative Physiol Ther 1998; 21:511-9.
18. Nilsson N, Christensen HW, Hartvigsen J. Zotsatira za kusintha kwa msana pochiza mutu wa cervicogenic. J Manipulative Physiol Ther 1997; 20:326-30.
19. Soderberg E, Carlsson J, Stener-Victorin E. Chronic tension-mtundu wa mutu wothandizidwa ndi acupuncture, maphunziro a thupi ndi maphunziro opuma. Kusiyana kwamagulu. Cephalalgia 2006;26:1320-9.
20. Tuchin PJ, Pollard H, Bonello R. Kuyesedwa kosasinthika kwa chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther 2000;23:91-5.
21. Chou R, Huffman LH. Chithandizo cha Nonpharmacologic cha ululu wopweteka kwambiri komanso wopweteka kwambiri: kubwereza umboni wa American Pain Society / American College of Physicians clinic practice guideline. Ann Intern Med 2007; 147: 492-504.
22. Astin JA, Ernst E. Kuchita bwino kwa kusintha kwa msana pofuna kuchiza matenda a mutu: ndondomeko yowonongeka ya mayesero a zachipatala. Cephalalgia 2002;22:617-23.
23. Biondi DM. Thandizo lakuthupi la mutu: ndemanga yokonzedwa. Mutu 2005;45:738-46.
24. Bronfort G, Nilsson N, Haas M, et al. Thandizo la thupi losawonongeka kwa mutu wopweteka / wobwerezabwereza. Cochrane Database Syst Rev 2004: CD001878.
25. Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Miangolarra JC, Barriga FJ, Pareja JA. Kodi njira zothandizira pamanja zimathandizira kuchepetsa kupweteka kwa mutu wovuta?: kuwunika mwadongosolo. Clin J Pain 2006; 22:278-85.
26. Hurwitz EL, Aker PD, Adams AH, Meeker WC, Shekelle PG. Kuwongolera ndi kulimbikitsa msana wa khomo lachiberekero. Kuwunika mwadongosolo mabuku. Msana (Phila Pa 1976) 1996;21:1746-59.
27. Lenssinck ML, Damen L, Verhagen AP, Berger MY, Passchier J, Koes BW. Kuchita bwino kwa physiotherapy ndi kusintha kwa odwala omwe ali ndi mutu wovuta: kuwunika mwadongosolo. Ululu 2004;112:381-8.
28. Vernon H, McDermaid CS, Hagino C. Kuwunika mwachisawawa kwa mayesero a zachipatala owonjezera / njira zothandizira pochiza kupweteka kwa mutu ndi mutu wa cervicogenic. Wothandizira Ther Med 1999; 7:142-55.
29. Fernandez-de-Las-Penas C, Alonso-Blanco C, Cuadrado ML, Pareja JA. Thandizo la msana pakuwongolera mutu wa cervicogenic. Mutu 2005;45:1260-3.
30. Maltby JK, Harrison DD, Harrison D, Betz J, Ferrantelli JR, Clum GW. Nthawi zambiri komanso nthawi ya chisamaliro cha chiropractic pamutu, khosi ndi ululu wammbuyo. J Vertebr Subluxat Res 2008;2008:1-12.
31. Demirturk F, Akarcali I, Akbayrak T, Cita I, Inan L. Zotsatira za njira ziwiri zosiyana zothandizira pamanja pamutu wovuta kwambiri wa mutu. Pain Clin 2002; 14:121-8.
32. Lemstra M, Stewart B, Olszynski WP. Kuchita bwino kwa njira zambiri zothandizira anthu pochiza migraine: kuyesedwa kosasinthika kwachipatala. Mutu 2002;42:845-54.
33. Marcus DA, Scharff L, Mercer S, Turk DC. Nonpharmacological treatment for migraine: kuwonjezereka kwa chithandizo cha thupi ndi kupumula ndi kutentha kwa biofeedback. Cephalalgia 1998;18:266-72.
34. Narin SO, Pinar L, Erbas D, Ozturk V, Idiman F. Zotsatira za masewera olimbitsa thupi ndi kusintha kokhudzana ndi masewera olimbitsa thupi m'magazi a nitric oxide mlingo pa mutu wa migraine. Clin Rehabil 2003; 17:624-30.
35. Torelli P, Jensen R, Olesen J. Physiotherapy kwa mutu wamtundu wachisokonezo: phunziro loyendetsedwa. Cephalalgia 2004;24:29-36.
36. van Ettekoven H, Lucas C. Kuchita bwino kwa physiotherapy
kuphatikiza pulogalamu yophunzitsira ya craniocervical ya mutu wovuta; kuyesedwa kwachipatala kosasinthika. Cephalalgia 2006; 26:983-91 .
37. Vavrek D, Haas M, Peterson D. Kufufuza kwakuthupi ndi zotsatira zowawa zodziwonetsera nokha kuchokera ku mayesero osasinthika pamutu wa mutu wa cervicogenic. J Manipulative Physiol Ther 2010; 33:338-48.
38. Haas M, Aickin M, Vavrek D. Kufufuza koyambirira kwa chiyembekezero ndi opereka odwala omwe akukumana nawo muyeso lotseguka lachidziwitso losasinthika la kugwidwa kwa msana kwa mutu wa cervicogenic. J Manipulative Physiol Ther 2010; 33:5-13 .
39. Toro-Velasco C, Arroyo-Morales M, Ferna?ndez-de-Las- Pen?as C, Cleland JA, Barrero-Herna?ndez FJ. Zotsatira zachidule za chithandizo chamankhwala pa kusinthasintha kwa kugunda kwa mtima, chikhalidwe cha maganizo, ndi kupsinjika maganizo kwa odwala omwe ali ndi mutu wovuta kwambiri wa mutu: phunziro loyendetsa ndege. J Manipulative Physiol Ther 2009; 32:527-35.
40. Allais G, De Lorenzo C, Quirico PE, et al. Njira zosagwiritsa ntchito mankhwala zochizira mutu: transcutaneous magetsi mitsempha stimulation, lasertherapy ndi acupuncture mu kusintha migraine chithandizo. Neurol Sci 2003; 24 (Suppl 2): ​​S138-42.
41. Nilsson N. Kuyesedwa kosasinthika kwa zotsatira za kusintha kwa msana pochiza mutu wa cervicogenic. J Manipulative Physiol Ther 1995; 18:435-40.
42. Annal N, Soundappan SV, Palaniappan KMC, Chadrasekar S. Kuyamba kwa transcutaneous, low-voltage, non-pulsatile direct current (DC) mankhwala a migraine ndi mutu wanthawi zonse. Kuyerekeza ndi transcutaneous electrical nerve stimulation (TENS). Mutu Q 1992;3:434-7.
43. Nilsson N, Christensen HW, Hartvigsen J. Kusintha kosatha kwa kayendetsedwe ka kayendetsedwe kake kamene kamakhalapo pambuyo pa kugwidwa kwa msana: mayesero osasinthika, akhungu, olamulidwa. J Manipulative Physiol Ther 1996; 19: 165-8.
44. Anderson RE, Seniscal C. Kuyerekeza kwa osteopathic osankhidwa osankhidwa ndi kupumula kwa mutu-mtundu wa mavuto. Mutu 2006;46:1273-80.
45. Ouseley BR, Parkin-Smith GF. Zotsatira zomwe zingatheke za chiropractic spinal manipulation ndi kulimbikitsana pochiza mutu wa mutu wovuta kwambiri: phunziro loyendetsa ndege. Eur J Chiropr 2002;50:3-13.
46. ​​Fernandez-de-las-Penas C, Fernandez-Carnero J, Plaza Fernandez A, Lomas-Vega R, Miangolarra-Page JC. Dorsal manipulation mu whiplash kuvulala kwachikwapu: kuyesedwa kosasinthika. J Whiplash Related Disorders 2004; 3: 55-72.
47. Parker GB, Pryor DS, Tupling H. N'chifukwa chiyani migraine imayenda bwino panthawi yoyesedwa? Zotsatira zina kuchokera ku mayesero a chiberekero cha migraine. Aust NZJ Med 1980; 10:192-8 .
48. Parker GB, Tupling H, Pryor DS. Kuyesedwa kolamulidwa kwa chiberekero cha chiberekero cha migraine. Aust NZJ Med 1978; 8:589-93.
49. Foster KA, Liskin J, Cen S, et al. Njira ya Trager pochiza mutu wopweteka kwambiri: phunziro loyendetsa ndege. Altern Ther Health Med 2004; 10:40-6.
50. Haas M, Groupp E, Aickin M, et al. Kuyankha kwa mlingo wa chisamaliro cha chiropractic cha mutu wopweteka wa cervicogenic ndi kupweteka kwapakhosi: kafukufuku woyendetsa mwachisawawa. J Manipulative Physiol Ther 2004; 27:547-53.
51. Sjogren T, Nissinen KJ, Jarvenpaa SK, Ojanen MT, Vanharanta H, Malkia EA. Zotsatira za ntchito zolimbitsa thupi zolimbitsa thupi pakukula kwa mutu ndi zizindikiro za khosi ndi mapewa ndi mphamvu yapamwamba ya minofu ya ogwira ntchito muofesi: gulu losawerengeka loyendetsedwa modutsa mayesero. Ululu 2005;116:119-28.
52. Hanten WP, Olson SL, Hodson JL, Imler VL, Knab VM, Magee JL. Kuchita bwino kwa CV-4 ndi njira zopumira pamitu yomwe ili ndi mutu wovuta. J Manual Manipulative Ther 1999; 7:64-70.
53. Solomon S, Elkind A, Freitag F, Gallagher RM, Moore K, Swerdlow B, et al. Chitetezo ndi mphamvu ya cranial electrotherapy pochiza kupweteka kwa mutu. Mutu 1989; 29:445-50.
54. Hall T, Chan HT, Christensen L, Odenthal B, Wells C, Robinson K. Kuchita bwino kwa C1-C2 yodziyimira payokha apophyseal glide (SNAG) poyang'anira mutu wa cervicogenic. J Orthop Sports Phys Ther 2007;37:100-7.
55. Solomon S, Guglielmo KM. Chithandizo cha mutu ndi transcutaneous magetsi kukondoweza. Mutu 1985;25:12-5.
56. Hoyt WH, Shaffer F, Bard DA, Benesler ES, Blankenhorn GD, Gray JH, et al. Osteopathic manipulation pochiza kupweteka kwamutu kwa minofu. J Am Osteopath Assoc 1979; 78:322-5.
57. Vernon H, Jansz G, Goldsmith CH, McDermaid C. Kuyesedwa kwachipatala kosasinthika, komwe kumayendetsedwa ndi placebo kwa chiropractic ndi chithandizo chamankhwala chachipatala cha anthu akuluakulu omwe ali ndi mutu wovutitsa mutu: zotsatira za mayesero oimitsidwa. J Manipulative Physiol Ther 2009; 32:344-51.
58. Mongini F, Ciccone G, Rota E, Ferrero L, Ugolini A, Evangelista A, et al. Mphamvu ya ntchito yophunzitsa ndi thupi mu kuchepetsa kupweteka, khosi ndi ululu phewa: kuntchito ankalamulira mayesero. Cephalalgia 2008; 28: 541-52.
59. Fernandez-de-las-Penas C, Alonso-Blanco C, San-Roman J, Miangolarra-Page JC. Makhalidwe abwino a mayesero oyendetsedwa mwachisawawa a kugwidwa kwa msana ndi kulimbikitsana pamutu wa mutu, migraine, ndi mutu wa cervicogenic. J Orthop Sports Phys Ther 2006; 36:160-9.
60. Lew HL, Lin PH, Fuh JL, Wang SJ, Clark DJ, Walker WC. Makhalidwe ndi chithandizo cha mutu pambuyo pa kuvulala koopsa kwa ubongo: kuwunika koyang'ana. Am J Phys Med Rehabil 2006; 85:619-27 .

Tsekani Accordion
Migraine Headache Pain Chiropractic Therapy ku El Paso, TX

Migraine Headache Pain Chiropractic Therapy ku El Paso, TX

by | Chiropractic, Mayesero Olamulidwa Mwachisawawa

Mutu wa mutu wa Migraine wakhala ukuwoneka kuti ndi imodzi mwa matenda okhumudwitsa kwambiri poyerekeza ndi matenda ena omwe amadziwika bwino. Nthawi zambiri chifukwa cha kupsinjika maganizo, zizindikiro za mutu waching'alang'ala, kuphatikizapo kupweteka kwa mutu, kumva kuwala ndi phokoso komanso nseru, zimatha kukhudza kwambiri moyo wa munthu waching'alang'ala. Komabe, kafukufuku wofufuza apeza kuti chisamaliro cha chiropractic chingathandize kuchepetsa nthawi zambiri komanso kuuma kwa ululu wanu wa migraine. Akatswiri ambiri azachipatala awonetsa kuti kusayenda bwino kwa msana, kapena subluxation, kumatha kukhala komwe kumayambitsa kupweteka kwa mutu wa migraine. Cholinga cha nkhani yomwe ili pansipa ndikuwonetsa zotsatira za chiropractic spinal manipulative therapy for migraine.

 

Chiropractic Spinal Manipulative Therapy for Migraine: Atatu

 

Kudalirika

 

  • Mbiri ndi cholinga: Kufufuza momwe chiropractic spinal manipulative therapy (CSMT) imagwirira ntchito kwa odwala migraineurs.
  • Njira: Ichi chinali mayesero atatu omwe ali ndi zida, osakwatiwa, osakwatiwa, a placebo, osasinthika (RCT) a nthawi ya miyezi 17 kuphatikizapo 104 migraineurs omwe ali ndi vuto limodzi la migraine pamwezi. RCT idachitika ku Akershus University Hospital, Oslo, Norway. Thandizo logwira ntchito linali la CSMT, pamene placebo inali njira yowonongeka ya lateral m'mphepete mwa scapula ndi / kapena dera la gluteal. Gulu lolamulira linapitiliza kasamalidwe kawo kachitidwe ka mankhwala. RCT inali ndi 1?month run?in, 3 months intervention ndi zotsatira zotsatila pamapeto a kuthandizira komanso pa 3, 6 ndi 12 miyezi yotsatira. Mapeto oyambirira anali chiwerengero cha masiku a migraine pamwezi, pamene mapeto achiwiri anali nthawi ya migraine, mphamvu ya migraine ndi mutu wa mutu, ndi kumwa mankhwala.
  • Results: Masiku a Migraine adachepetsedwa kwambiri m'magulu onse atatu kuyambira pachiyambi kupita kuchipatala? (P <0.001). Zotsatira zinapitilira mu CSMT ndi gulu la placebo nthawi zonse zotsatila, pamene gulu lolamulira linabwerera ku chiyambi. Kuchepetsa masiku a migraine sikunali kosiyana kwambiri pakati pa magulu (P> 0.025 kuti agwirizane). Kutalika kwa Migraine ndi mutu wa mutu unachepetsedwa kwambiri mu CSMT kusiyana ndi gulu lolamulira kumapeto kwa kutsata (P = 0.02 ndi P = 0.04 kuti agwirizane, motsatira). Zoipa zinali zochepa, zofatsa komanso zosakhalitsa. Kuchititsa khungu kunalimbikitsidwa kwambiri mu RCT yonse.
  • Zotsatira: Ndizotheka kuchita chithandizo chamankhwala chapamanja cha RCT ndi placebo yobisika. Zotsatira za CSMT zomwe zimawonedwa mu phunziro lathu mwina chifukwa cha kuyankha kwa placebo.
  • Keywords: chiropractic, mutu, migraine, kuyesedwa kosasinthika, chithandizo chamsana

 

Dr-Jimenez_White-Coat_01.png

Kuzindikira kwa Dr. Alex Jimenez

Kupweteka kwa khosi ndi mutu ndi chifukwa chachitatu chomwe anthu amafunira chisamaliro cha chiropractic. Kafukufuku wambiri wasonyeza kuti chiropractic spinal manipulative therapy ndi njira yotetezeka komanso yothandiza yothandizira migraines. Chisamaliro cha Chiropractic chikhoza kukonza mosamalitsa kusokonezeka kulikonse kwa msana, kapena kusakanikirana, komwe kumapezeka pamtunda wa msana, zomwe zasonyezedwa kuti ndizo zimayambitsa mutu wa migraine. Kuonjezera apo, kusintha kwa msana ndi kugwiritsira ntchito pamanja kungathandize kuchepetsa kupsinjika maganizo ndi kupsinjika kwa minofu mwa kuchepetsa kuchuluka kwa kupanikizika komwe kumayikidwa pazitsulo zovuta za msana chifukwa cha kusokonezeka kwa msana, kapena subluxation. Mwa kuwongolera msana komanso kuchepetsa kupsinjika ndi kupsinjika kwa minofu, chisamaliro cha chiropractic chimatha kusintha zizindikiro za migraine ndikuchepetsa pafupipafupi.

 

Introduction

 

Mtengo wachuma wa mutu waching'alang'ala ndi wochuluka chifukwa cha kuchuluka kwake komanso kulemala panthawi yakuukira [1, 2, 3]. Chithandizo chodziwika bwino chamankhwala nthawi zambiri chimakhala njira yoyamba yothandizira migraine mwa akulu. Migraineurs omwe amawukiridwa pafupipafupi, osakwanira komanso/kapena otsutsana ndi mankhwala owopsa ndi omwe angakhale oyenera kulandira chithandizo cha prophylactic. Chithandizo cha Migraine prophylactic nthawi zambiri chimakhala chamankhwala, koma chithandizo chamankhwala sichachilendo, makamaka ngati chithandizo chamankhwala chikulephereka kapena ngati wodwala akufuna kupewa mankhwala [4]. Kafukufuku wasonyeza kuti mankhwala opatsirana a msana amatha kulimbikitsa machitidwe oletsa mitsempha pamagulu osiyanasiyana a msana chifukwa amatha kuyambitsa njira zosiyanasiyana zotsika pansi [5, 6, 7, 8, 9, 10].

 

Mayesero a Pharmacological randomized controlled trials (RCTs) nthawi zambiri amakhala akhungu? Pakalipano palibe kuvomerezana pa njira yachinyengo mu manual?therapy RCTs yomwe imatsanzira placebo mu mankhwala a RCTs [11]. Kupanda njira yoyenera ya sham ndiye cholepheretsa chachikulu m'mabuku onse am'mbuyomu? Therapy RCTs [12, 13]. Posachedwapa, tinapanga njira ya sham chiropractic spinal manipulative therapy (CSMT), kumene otenga nawo mbali omwe ali ndi migraine sanathe kusiyanitsa pakati pa CSMT yeniyeni ndi yabodza yomwe idawunikidwa pambuyo pa 12 iliyonse pa nthawi ya 3? [14].

 

Cholinga choyamba cha phunziroli chinali kupanga buku la mankhwala atatu? okhala ndi zida, osakwatiwa, osawona?, RCT ya placebo kwa odwala migraineurs omwe ali ndi njira yofanana ndi ya RCTs yamankhwala.

 

Cholinga chachiwiri chinali kuyesa mphamvu ya CSMT motsutsana ndi kugwiritsidwa ntchito kwa sham (placebo) ndi CSMT motsutsana ndi maulamuliro, mwachitsanzo, omwe adapitirizabe kasamalidwe kawo ka mankhwala.

 

Njira

 

Kupanga Phunziro

 

Kafukufukuyu anali atatu?okhala ndi zida, osakwatiwa?wakhungu, RCT ya placebo kwa miyezi 17. RCT inali ndi chiyambi cha mwezi wa 1, magawo a chithandizo cha 12 pa miyezi ya 3 ndi njira zotsatila kumapeto kwa kulowererapo, 3, 6 ndi 12 pambuyo pake.

 

Ophunzirawo anali, asanayambike, adasinthidwa mofanana m'magulu atatu: CSMT, placebo (kugwiritsa ntchito sham) ndi kulamulira (anapitirizabe kasamalidwe kawo ka mankhwala).

 

Mapangidwe a phunziroli akugwirizana ndi malingaliro a International Headache Society (IHS) ndi CONSORT (Zowonjezera S1) [1, 15, 16]. Komiti Yachigawo cha Norway ya Medical Research Ethics ndi Norwegian Social Science Data Services idavomereza ntchitoyi. RCT idalembetsedwa ku ClinicalTrials.gov (ID no: NCT01741714). Protocol yoyeserera yonse idasindikizidwa kale [17].

 

ophunzira

 

Ophunzira adalembedwa kuyambira Januware mpaka Seputembara 2013 makamaka kudzera mu dipatimenti ya Neurology, Chipatala cha Akershus University. Ena omwe adatenga nawo gawo adalembedwanso kudzera mwa General Practitioners ochokera ku Akershus ndi Oslo Counties kapena kutsatsa kwapa media. Onse omwe adatenga nawo mbali adalandira zambiri za polojekitiyi ndikutsatiridwa ndi kuyankhulana patelefoni.

 

Oyenerera omwe adatenga nawo gawo anali migraineurs a 18'70 zaka zakubadwa ndi kuukira kwa migraine kamodzi pamwezi ndipo amaloledwa kukhala ndi vuto lamtundu wamtundu wamtundu koma palibe mutu wina woyamba. Onse omwe adatenga nawo mbali adapezeka ndi chiropractor yemwe ali ndi chidziwitso cha matenda a mutu panthawi yofunsa mafunso komanso malinga ndi International Classification of Headache Disorders? II (ICHD? II) 2. Katswiri wa zamaganizo adapeza kuti onse omwe ali ndi migraineurs ochokera ku Akershus University Hospital.

 

Njira zodzipatula zinali zotsutsana ndi chithandizo chamsana, radiculopathy, mimba, kuvutika maganizo ndi CSMT mkati mwa miyezi yapitayi ya 12. Ophunzira omwe adalandira chithandizo chamankhwala [18], adasintha mankhwala awo a prophylactic migraine kapena kutenga pakati pa RCT adadziwitsidwa kuti adzachotsedwa pa phunziroli panthawiyo ndipo amaonedwa ngati osiya. Ophunzira adaloledwa kupitiriza ndikusintha mankhwala osokoneza bongo a migraine panthawi yonse yophunzira.

 

Ophunzira oyenerera anaitanidwa ku zokambirana ndi kuunika kwa thupi kuphatikizapo kufufuza mosamalitsa kwa msana ndi chiropractor (AC). Otenga nawo gawo ku CSMT kapena gulu la placebo anali ndi mayeso athunthu a msana.

 

Randomization ndi Masking

 

Pambuyo povomereza zolembedwa, otenga nawo mbali adasinthidwa mwanjira imodzi mwa zida zitatu zophunzirira pojambula gawo limodzi. Maere osindikizidwa osindikizidwa ndi zida zitatu zophunzirira aliyense adagawidwa m'magulu anayi malinga ndi zaka komanso jenda, mwachitsanzo, zaka 18�39 kapena 40�70, amuna kapena akazi.

 

Pambuyo pa gawo lililonse la chithandizo, otenga nawo gawo mu CSMT ndi gulu la placebo adamaliza kufunsa ngati amakhulupirira kuti chithandizo cha CSMT chinalandilidwa, komanso kuti anali otsimikiza bwanji kuti chithandizo chamankhwala chinalandiridwa pamlingo wa 0�10, pomwe 10 imayimira kutsimikizika kotheratu. [14].

 

Zonse ziwiri za block randomization ndi mafunso ochititsa khungu amayendetsedwa ndi gulu limodzi lakunja.

 

Zochita

 

Gulu la CSMT linalandira chithandizo chamsana pogwiritsa ntchito njira ya Gonstead, kukhudzana kwapadera, kuthamanga? mayesero a chiropractic pa gawo lililonse la chithandizo [19].

 

Gulu la placebo lidalandira chinyengo chabodza, kukhudzana kwakukulu kosagwirizana, kutsika?, kutsika? ]. Kulumikizana konse komwe sikunachiritsidwe kunachitika kunja kwa msana ndikulumikizana kokwanira komanso kopanda kupsinjika kwa minofu yofewa kotero kuti palibe ma cavitations olowa. Njira zogwiritsa ntchito mwachinyengo zidakhazikitsidwa kale ndipo zidasinthidwanso chimodzimodzi pakati pa omwe adatenga nawo gawo pa placebo molingana ndi ndondomeko ya nthawi ya chithandizo cha masabata a 14 kuti alimbikitse kutsimikizika kwa kafukufukuyu. Njira ya placebo ikufotokozedwa mwatsatanetsatane mu protocol yomwe ilipo [12].

 

Gawo lililonse lothandizira linatenga mphindi za 15 ndipo magulu onse awiriwa adayesedwa mofanana ndi kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe kake. Palibe kulowererapo kwina kapena upangiri wina womwe unaperekedwa kwa otenga nawo mbali panthawi yoyeserera. Magulu awiriwa adalandira chithandizo ku Akershus University Hospital ndi chiropractor mmodzi wodziwa bwino (AC).

 

Gulu lolamulira linapitirizabe kasamalidwe kawo ka mankhwala popanda kulandira chithandizo chamanja ndi wofufuza zachipatala.

 

Zotsatira

 

Ophunzirawo adadzaza diary yotsimikizika yamutu pamutu nthawi yonse yophunzirira ndikubweza pamwezi [20]. Pankhani ya ma diaries osabwezeredwa kapena kusowa kwa data, otenga nawo mbali adalumikizidwa ndi foni kuti atetezedwe.

 

Mapeto oyambirira? Mfundo yomalizira inali chiwerengero cha masiku a migraine pamwezi (masiku 30 / mwezi). Osachepera 25% kuchepetsa masiku a migraine kuyambira pachiyambi mpaka kumapeto kwa kulowererapo, ndi mlingo womwewo womwe unasungidwa pa 3, 6 ndi 12 miyezi yotsatira?

 

Mfundo zomaliza zachiwiri zinali nthawi ya migraine, migraine intensity ndi mutu wa mutu (HI), ndi kumwa mankhwala. Osachepera 25% kuchepetsa nthawi, mphamvu ndi HI, ndipo osachepera 50% kuchepetsa kumwa mankhwala kunayembekezeredwa kuyambira pachiyambi mpaka kumapeto kwa kulowererapo, ndi mlingo womwewo umakhalabe pa 3, 6 ndi 12 miyezi yotsatira mu gulu la CSMT.

 

Palibe kusintha komwe kumayembekezeredwa kwa pulayimale ndi sekondale?malo omaliza a placebo ndi gulu lowongolera.

 

Tsiku la migraine limatanthauzidwa ngati tsiku limene migraine ndi aura, migraine popanda aura kapena mwinamwake migraine inachitika. Kuukira kwa Migraine kwa > 24 h kunawerengedwa ngati kuukira kumodzi pokhapokha kupweteka? Ngati wodwala adagona panthawi ya migraine ndikudzuka popanda migraine, malinga ndi ICHD?III?, Kutalika kwa chiwonongekocho kunalembedwa kuti kukupitirizabe mpaka nthawi ya kudzutsidwa [48]. Nthawi yochepa ya migraine kuukira inali 21 h pokhapokha ngati triptan kapena mankhwala okhala ndi ergotamine anagwiritsidwa ntchito, momwemo sitinatchule nthawi yochepa. HI inawerengedwa ngati masiku a migraine mwezi uliwonse (masiku 22) � amatanthauza nthawi ya migraine (h / tsiku) � kutanthauza mphamvu (4�30 chiwerengero cha chiwerengero cha chiwerengero).

 

Mfundo zomaliza ndi zachiwiri zidasankhidwa kutengera Task Force ya IHS Clinical Trial Subcommittee's Clinical Trial Guidelines of Clinical Trials [1, 15]. Malingana ndi ndemanga zam'mbuyomu za migraine, kuchepetsedwa kwa 25% kunkaonedwa kuti ndiko kulingalira kokhazikika [12, 13].

 

Kusanthula kwa zotsatira kunawerengedwa m'masiku a 30 pambuyo pa gawo lomaliza lothandizira ndi masiku 30 pambuyo pa nthawi yotsatila, mwachitsanzo 3, 6 ndi 12 miyezi, motsatira.

 

Zochitika zonse zoipa (AEs) zinalembedwa pambuyo pochitapo kanthu mogwirizana ndi malangizo a CONSORT ndi IHS Task Force pa AEs mu mayesero a migraine [16, 23].

 

Chiwerengero cha Kusanthula

 

Tinatengera kuwerengera mphamvu pa kafukufuku waposachedwapa wa topiramate mu migraineurs [24]. Tinalingalira kusiyana kwapakati pa kuchepetsa chiwerengero cha masiku a mutu waching'alang'ala pamwezi pakati pa anthu ogwira ntchito ndi placebo, komanso pakati pa magulu ogwira ntchito ndi olamulira a masiku a 2.5, ndi SD ya 2.5 kuti achepetse gulu lililonse. Monga kusanthula koyambirira kumaphatikizapo kufananitsa kwamagulu awiri, mulingo wofunikira unayikidwa pa 0.025. Kwa mphamvu ya 80%, kukula kwa chitsanzo cha odwala 20 kunkafunika pagulu lililonse kuti azindikire kusiyana kwakukulu pakuchepetsa masiku a 2.5.

 

Makhalidwe a odwala poyambira adawonetsedwa ngati njira ndi SD kapena ma frequency ndi maperesenti pagulu lililonse ndikuyerekeza ndi zitsanzo zodziyimira pawokha t? test ndi ? 2 mayeso.

 

Mbiri ya nthawi ya mfundo zonse zomaliza inafanizidwa pakati pa magulu. Chifukwa cha kuyeza kobwerezabwereza kwa wodwala aliyense, mizere yosakanikirana yowerengera zamitundu yosiyanasiyana yamkati? Zotsatira zokhazikika za nthawi (yosakhala? linear), kugawa kwamagulu ndi kuyanjana pakati pa awiriwa kunaphatikizidwa. Zotsatira zosasinthika kwa odwala ndi otsetsereka adalowetsedwa mu chitsanzo. Pamene zotsalirazo zidasokonekera, malingaliro a bootstrap otengera zitsanzo zamagulu 1000 adagwiritsidwa ntchito. Kuyerekeza kwa awiriwiri kunachitika potengera kusiyanitsa kwa nthawi pakati pa gulu lililonse panthawi iliyonse ndi P?values ​​yofananira ndi 95% nthawi yodalirika. Kumwa mankhwala m'magulu kunanenedwa ndi Mlingo wamba wokhala ndi SD, ndipo magulu adafanizidwa ndi mayeso odziyimira pawokha apakati. Mlingo umatanthauzidwa ngati kayendetsedwe kamodzi ka triptan kapena ergotamine; paracetamol 1000 mg codeine; non?steroidal anti?inflammatory mankhwala (tolfenamic acid, 200 mg; diclofenac, 50 mg; aspirin, 1000 mg; ibuprofen, 600 mg; naproxen, 500 mg); ndi morphnomimetics (tramadol, 50 mg). Palibe odwala omwe adasintha mkono wophunzirira ndipo palibe omwe adasiya omwe adadzaza m'mabuku amutu atasiya kuphunzira. Chifukwa chake, kusanthula kwa protocol kokha kunali kofunikira.

 

Kuwunikaku kudachititsidwa khungu ku kugawika kwa chithandizo ndipo kunachitika mu SPSS v22 (IBM Corporation, Armonk, NY, USA) ndi STATA v14 (JSB) (StataCorp LP, College Station, TX, USA). Mulingo wofunikira wa 0.025 unagwiritsidwa ntchito pomaliza?

 

Ethics

 

Malangizo abwino azachipatala adatsatiridwa [25]. Zambiri zapakamwa ndi zolembedwa za polojekitiyi zidaperekedwa patsogolo pa kuphatikizidwa ndi kugawidwa kwamagulu. Chivomerezo cholembedwa chinapezedwa kwa onse otenga nawo mbali. Ogwira nawo ntchito mu gulu la placebo ndi gulu lolamulira adalonjezedwa chithandizo cha CSMT pambuyo pa RCT, ngati kuchitapo kanthu mwakhama kunapezeka kuti n'kothandiza. Inshuwaransi inaperekedwa kudzera mu Norwegian System of Compensation to Patients (Patient Injury Compensation), bungwe ladziko lodziimira lomwe limalipiritsa odwala ovulala ndi chithandizo choperekedwa ndi chithandizo chaumoyo ku Norway. Lamulo loyimitsa linatanthauzidwa pochotsa anthu mu kafukufukuyu molingana ndi malingaliro omwe ali mu kukulitsa kwa CONSORT kwa Lipoti Labwino la Zowopsa [26]. Ma AE onse adayang'aniridwa panthawiyi ndipo adachita zomwe zidachitika motsatira malingaliro a CONSORT ndi IHS Task Force pa AEs mu mayesero a migraine [16, 23]. Pakakhala AE yoopsa, wophunzirayo adzachotsedwa pa phunziroli ndikutumizidwa kwa General Practitioner kapena dipatimenti yodzidzimutsa kuchipatala malinga ndi zomwe zinachitika. Wofufuzayo (AC) anali kupezeka pa foni yam'manja nthawi iliyonse mu nthawi yonse ya maphunziro.

 

Results

 

Chithunzi ?1 chikuwonetsa tchati chotsatira cha 104 migraineurs chomwe chikuphatikizidwa mu phunziroli. Makhalidwe oyambira ndi kuchuluka kwa anthu anali ofanana m'magulu atatuwa (Table 1).

 

Chithunzi 1 Tchati cha Kuyenda kwa Phunziro

Chithunzi 1: Tchati chamayendedwe ophunzirira.

 

Table 1 Baseline Demographic and Clinical Characters

 

Zotsatira zake

 

Zotsatira pa mfundo zonse zomaliza zaperekedwa mumkuyu ?2ad ndi Tebulo 2, 3, 4.

 

Chithunzi 2

Chithunzi 2: (a) Masiku amutu; (b) nthawi ya mutu; (c) kupweteka kwa mutu; (d) mutu wa mutu. Mbiri ya nthawi muzomaliza ndi zachiwiri?mfundo, njira ndi zolakwika zimayimira 95% nthawi yodalirika. BL, maziko; gulu lolamulira (�); CSMT, chiropractic spinal manipulative therapy (?); placebo, kusintha kwa sham (?); PT, post?mankhwala; 3 m, 3?mwezi kutsatira; 6 m, 6?mwezi kutsatira; 12m, 12?mwezi kutsatira; VAS, mawonekedwe a analogue scale.

 

Table 2 Regression Coefficients ndi SE

 

Table 3 Njira ndi SD

 

Table 4 Amatanthauza Mlingo wa SD wa Mankhwala

 

Mfundo yomaliza? Masiku a Migraine adachepetsedwa kwambiri m'magulu onse kuyambira pachiyambi kupita kuchipatala? (P <0.001). Zotsatirazo zinapitirirabe mu CSMT ndi magulu a placebo pa 3, 6 ndi 12 miyezi yotsatira? Chitsanzo chosakanikirana chotsatira sichinasonyeze kusiyana kwakukulu kwa kusintha kwa masiku a migraine pakati pa CSMT ndi magulu a placebo (P = 2) kapena pakati pa CSMT ndi gulu lolamulira (P = 0.04; Table 0.06). Komabe, kufananitsa awiriwa pa nthawi imodzi kunawonetsa kusiyana kwakukulu pakati pa CSMT ndi gulu lolamulira nthawi zonse kuyambira pa post? treatment (Table 2).

 

Mapeto achiwiri?points. Panali kuchepa kwakukulu kuchokera pachiyambi kupita ku post? Chithandizo cha migraine nthawi, mphamvu ndi HI mu CSMT (P = 0.003, P = 0.002 ndi P <0.001, motsatira) ndi placebo (P <0.001, P = 0.001 ndi P <0.001 3, motsatana) magulu, ndipo zotsatira zake zidapitilira kutsata kwa miyezi 6, 12 ndi XNUMX.

 

Kusiyana kwakukulu pakati pa CSMT ndi magulu olamulira kunali kusintha kwa nthawi ya migraine (P = 0.02) ndi HI (P = 0.04; Table 2).

 

Pambuyo pa miyezi ya 12, kusintha kwa kumwa kwa paracetamol kunali kochepa kwambiri mu gulu la CSMT poyerekeza ndi placebo (P = 0.04) ndi magulu olamulira (P = 0.03) (Table 4).

 

Kuchititsa khungu. Pambuyo pa gawo lililonse la 12,> 80% ya ophunzirawo amakhulupirira kuti adalandira CSMT mosasamala kanthu za kugawidwa kwamagulu. Chiŵerengero chazovuta chokhulupirira kuti chithandizo cha CSMT chinalandiridwa chinali> 10 pamagulu onse a chithandizo m'magulu onse awiri (onse P <0.001).

 

Zotsatira zoyipa. Chiwerengero cha 703 cha magawo omwe angathe kuchitapo kanthu a 770 adayesedwa kwa AEs (355 mu gulu la CSMT ndi 348 mu gulu la placebo). Zifukwa zophonyera kuwunika kwa AE kunali kusiyiratu kapena kuphonya magawo olowererapo. Ma AE anali ochuluka kwambiri mu CSMT kusiyana ndi magawo a placebo (83 / 355 vs. 32 / 348; P <0.001). Kukoma mtima kwa m'deralo kunali AE yodziwika kwambiri yomwe inanenedwa ndi 11.3% (95% CI, 8.4�15.0) mu gulu la CSMT ndi 6.9% (95% CI, 4.7�10.1) mu gulu la placebo, pamene kutopa pa tsiku lothandizira ndi kupweteka kwa khosi. zidanenedwa ndi 8.5% ndi 2.0% (95% CI, 6.0�11.8 ndi 1.0�4.0), ndi 1.4% ndi 0.3% (95% CI, 0.6�3.3 ndi 0.1�1.9), motsatana. Ma AE ena onse (kupweteka kwa msana, dzanzi la nkhope, nseru, kukwiya kwa mutu waching'alang'ala komanso kutopa m'manja) zinali zosowa (<1%). Palibe ma AE ovuta kapena owopsa omwe adanenedwa.

 

Kukambirana

 

M'chidziwitso chathu, ili ndi buku loyamba? Chithandizo cha RCT chokhala ndi khungu lodziwika bwino. Athu atatu? okhala ndi zida, osakwatiwa, osakwatiwa, a placebo RCT adayesa mphamvu ya CSMT pochiza migraine ndi placebo (sham chiropractic) ndi kulamulira (kawirikawiri mankhwala opatsirana). Zotsatira zinasonyeza kuti masiku a migraine adachepetsedwa kwambiri m'magulu onse atatu kuyambira pachiyambi mpaka pambuyo? Zotsatira zinapitilira mu CSMT ndi magulu a placebo nthawi zonse zotsatila, pamene gulu lolamulira linabwerera ku chiyambi. Ma AE anali ofatsa komanso osakhalitsa, zomwe zimagwirizana ndi maphunziro am'mbuyomu.

 

Mapangidwe a kafukufukuyu adatsatira malingaliro a pharmacological RCTs monga amaperekedwa ndi IHS ndi CONSORT [1, 15, 16]. Manual?therapy RCTs ali ndi zopinga zazikulu zitatu poyerekeza ndi ma RCT a pharmacological. Choyamba, sikutheka kuchititsa khungu wofufuzayo pokhudzana ndi chithandizo chogwiritsidwa ntchito. Kachiwiri, kuvomerezana pa chithandizo cha inert placebo kulibe [11]. Chachitatu, zoyesayesa zam'mbuyomu zophatikizira gulu la placebo zasiya kutsimikizira khungu, motero, sizikudziwika ngati chithandizo chogwira ntchito ndi placebo chinabisidwa [27]. Chifukwa cha zovutazi tinaganiza zopanga RCT itatu?yokhala ndi zida, yosakwatiwa?, yomwe inaphatikizapo gulu lolamulira lomwe linapitirizabe chithandizo chamankhwala chokhazikika kuti tipeze chisonyezero cha kukula kwa kuyankha kwa placebo.

 

Zanenedwa kuti, mu pharmacological double?blind placebo RCTs, 50% okha ndi omwe angakhulupirire kuti amalandira chithandizo chachangu mu gulu lirilonse, ngati khungu liri langwiro. Komabe, izi sizingakhale zoona m'mabuku a RCTs, chifukwa mphamvu yogwira ntchito ndi placebo ikhoza kukhala yokhutiritsa kuposa piritsi [28]. Wofufuza m'modzi amachepetsa kusiyana kwa inter? investigator popereka chidziwitso chofanana kwa onse omwe atenga nawo mbali ndipo nthawi zambiri amalangizidwa kuti chithandizo cha placebo chiyenera kufanana ndi chithandizo chokhazikika malinga ndi ndondomeko, mafupipafupi a chithandizo ndi nthawi yomwe amathera ndi wofufuza kuti alole ziyembekezo zofanana m'magulu onse awiri. [28]. Kufunika kwa khungu lathu lopambana kumatsindikiridwa ndi mfundo yakuti ma RCTs onse am'mbuyo a mutu wa mutu alibe placebo. Chifukwa chake, timakhulupirira kuti zotsatira zathu zomwe tafotokozazi ndizovomerezeka pamlingo womwewo monga RCT yamankhwala [14].

 

Deta yomwe ikuyembekezeka ndi yodalirika kuposa deta yobwerera m'mbuyo potengera kukumbukira kukumbukira; komabe, kusamvera kungakhale kovuta, makamaka kumapeto kwa kafukufuku. Tikukhulupirira kuti kukhudzana pafupipafupi pakati pa otenga nawo mbali ndi wofufuzayo, kuphatikiza kulumikizana kwa mwezi ndi mwezi mu nthawi yotsatila, mwina kunapitilirabe kutsata kwathu muphunziro lathu lonse.

 

Ngakhale kuti chitsanzo chathu cha phunziro chinatha ndi anthu a 104 m'magulu atatuwa, kulingalira kwa kuwerengera mphamvu ndi chiwerengero chapamwamba chomaliza kumathandizira kuti deta yomwe yapezedwa ikhale yovomerezeka kwa anthu ofufuzidwa. Njira ya Gonstead imagwiritsidwa ntchito ndi 59% ya chiropractors [19] ndipo, motero, zotsatira zake zimakhala zodziwika bwino pa ntchitoyi. Kutsimikizika kwa matenda ndi imodzi mwamphamvu zathu zazikulu chifukwa pafupifupi onse omwe adatenga nawo gawo adapezeka ndi minyewa malinga ndi ICHD?II [2]. Mosiyana ndi ma RCTs am'mbuyomu a chiropractic migraine omwe adalemba anthu omwe adatenga nawo gawo kudzera muzofalitsa monga nyuzipepala ndi zotsatsa zawailesi [12], ambiri mwa omwe adatenga nawo gawo adatengedwa kuchokera ku dipatimenti ya Neurology, Chipatala cha Akershus University, zomwe zikuwonetsa kuti migraineurs amatha kuzunzidwa pafupipafupi / koopsa. omwe ndi ovuta kuchiza kusiyana ndi anthu wamba, monga adatumiziridwa ndi General Practitioner ndi / kapena nephrologist. Choncho, phunziro lathu likuyimira makamaka anthu a chipatala chapamwamba, ndipo zotsatira zake zikhoza kukhala zosiyana ngati otenga nawo mbali adatengedwa kuchokera kwa anthu ambiri. Kuchuluka kwa ululu wa khosi kwapezeka kuti ndikwambiri kwa odwala omwe ali ndi mutu wa migraine [29] ndipo, motero, kuchuluka kwa kupweteka kwa msana kosawerengeka mu phunziro lathu kungakhale kosokoneza komwe kunawoneka pa masiku a migraine.

 

Madokotala atatu a pragmatic chiropractic manual? Therapy RCTs pogwiritsa ntchito njira zosiyanasiyana zakhala zikugwiritsidwa ntchito kwa migraineurs [12, 30, 31, 32]. RCT ya ku Australia inasonyeza mkati mwa kuchepetsa kuchepa kwa migraine pafupipafupi, nthawi ndi mphamvu ya 40%, 43% ndi 36%, motero, pakutsatira miyezi ya 2 [30]. Kafukufuku wa ku America anapeza kuti migraine nthawi zambiri ndi mphamvu zochepetsera mkati mwa gulu ndi 33% ndi 42%, motero, pakutsatira mwezi wa 1 [31]. Kafukufuku wina wa ku Australia, yemwe anali RCT yokhayo yomwe ikuphatikizapo gulu lolamulira, mwachitsanzo, detuned ultrasound, anapeza mkati mwa gulu kuchepetsa pafupipafupi kwa migraine ndi nthawi ya 35% ndi 40%, motero, pakutsatira miyezi ya 2 mu gulu la CSMT, poyerekeza ndi kuchepetsa mkati mwa gulu la 17% ndi 20% mu gulu lolamulira, motero [32]. Kuchepetsa masiku a migraine kunali kofanana ndi kwathu (40%) mu gulu la CSMT kuyambira pachiyambi mpaka miyezi ya 3 kutsatira? Kufananitsa zotsatiridwa kwa nthawi yayitali ndizosatheka chifukwa maphunziro am'mbuyomu analibe nthawi yokwanira yotsatirira. Mapangidwe athu ophunzirira kuphatikiza kutsimikizika kolimba kwamkati kumatilola kutanthauzira zomwe zimawonedwa ngati kuyankha kwa placebo.

 

RCT yathu inali ndi ma AE ochepera poyerekeza ndi maphunziro achipatala am'mbuyomu? Komabe, sizinali ndi mphamvu zokwanira kuti zizindikire ma AE achilendo. Poyerekeza, AEs mu pharmacological migraine prophylactic placebo RCTs ndizofala kuphatikiza ma AE omwe si ofatsa komanso osakhalitsa [33, 34].

 

Kutsiliza

 

Kuchititsa khungu kunalimbikitsidwa kwambiri mu RCT yonse, AEs anali ochepa komanso ofatsa, ndipo zotsatira za CSMT ndi gulu la placebo mwina zinali yankho la placebo. Chifukwa chakuti anthu ena achizungu salola mankhwala chifukwa cha AEs kapena co?morbid disorders, CSMT ikhoza kuganiziridwa pamene njira zina zochiritsira sizikugwira ntchito kapena sizikuloledwa bwino.

 

Kuwulula Kusemphana kwa Chidwi

 

Olemba onse alemba fomu yowulula yunifolomu ya International Committee of Medical Journal Editors ndipo alengeza kuti palibe mikangano yazachuma kapena mikangano ina.

 

Kuthandiza Information

 

Ncbi.nlm.nih.gov/pmc/articles/PMC5214068/#ene13166-tbl-0001

 

Zothokoza

 

Olembawo akufuna kuthokoza moona mtima ku Akershus University Hospital, yomwe inapereka mokoma mtima malo opangira kafukufuku, ndi Chiropractor Clinic 1, Oslo, Norway, yomwe inachita mayesero onse a x?ray. Phunziroli linathandizidwa ndi ndalama zochokera ku Extrastiftelsen, Norwegian Chiropractic Association, Akershus University Hospital ndi University of Oslo ku Norway.

 

Pomaliza, zizindikiro zofooketsa za migraines, kuphatikizapo kupweteka kwa mutu kwambiri komanso kumva kuwala ndi phokoso komanso nseru, zingakhudze moyo wa munthu, mwamwayi, chisamaliro cha chiropractic chasonyezedwa kuti ndi njira yabwino komanso yothandiza yochizira mutu wa migraine. ululu. Komanso, nkhani yomwe ili pamwambayi imasonyeza kuti anthu omwe ali ndi mutu wa migraine anali ndi zizindikiro zochepa komanso masiku a migraine chifukwa cha chisamaliro cha chiropractic.�Zidziwitso zochokera ku National Center for Biotechnology Information (NCBI). Kukula kwa chidziwitso chathu kumangokhala kwa chiropractic komanso kuvulala kwa msana ndi mikhalidwe. Kuti tikambirane nkhaniyi, chonde omasuka kufunsa Dr. Jimenez kapena tilankhule nafe pa 915-850-0900 .

 

Wosankhidwa ndi Dr. Alex Jimenez

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

Mitu Yowonjezera: Ululu Wobwerera

 

Malinga ndi ziwerengero, pafupifupi 80% ya anthu adzakhala ndi zizindikiro za ululu wammbuyo kamodzi pa moyo wawo wonse. Ululu wammbuyo ndi dandaulo lofala lomwe lingakhalepo chifukwa cha kuvulala kosiyanasiyana ndi/kapena mikhalidwe. Nthawi zambiri, kuwonongeka kwachilengedwe kwa msana ndi zaka kungayambitse ululu wammbuyo. Herniated discs zimachitika pamene chofewa, ngati gel pakati pa intervertebral disc ikukankhira kupyola mu misozi yozungulira, mphete yakunja ya cartilage, kuponderezana ndi kukwiyitsa mizu ya mitsempha. Ma disc herniations nthawi zambiri amapezeka m'munsi kumbuyo, kapena msana, koma amathanso kuchitika m'mphepete mwa khomo lachiberekero, kapena khosi. Kulowetsedwa kwa mitsempha yomwe imapezeka m'munsi kumbuyo chifukwa cha kuvulala ndi / kapena kuwonjezereka kwa chikhalidwe kungayambitse zizindikiro za sciatica.

 

chithunzi cha blog cha cartoon paperboy nkhani zazikulu

 

MUTU WOSANGALALA WOFUNIKA:�Kuchiza Ululu Wa Pakhosi El Paso, TX Chiropractor

 

 

ZINTHU ZINA: ZOWONJEZERA: El Paso, Tx | Othamanga

 

Palibe kanthu
Zothandizira
1. Tfelt?Hansen P, Block G, Dahlof C,�Et al International Headache Society Clinical Trial Subcommittee. Malangizo a mayesero olamulidwa a mankhwala mu migraine: kope lachiwiri.�Cephalalgia�2000;20765; 786.[Adasankhidwa]
2. Komiti Yachigawo ya Mutu wa Mutu wa International Headache Society .�The International Classification of Headache Disorders: 2nd edition.�Cephalalgia�2004;24(Suppl. 19; 160[Adasankhidwa]
3. Vos T, Flaxman AD, Naghavi M,�Et al Zaka zakhala ndi olumala (YLDs) kwa 1160 sequelae ya matenda 289 ndi kuvulala 1990-2010: kusanthula mwadongosolo kwa Global Burden of Disease Study 2010.�Lancet�2012;380Zithunzi za 2163-2196[Adasankhidwa]
4. Diener HC, Charles A, Goadsby PJ, Holle D. �Njira zatsopano zothandizira kupewa ndi kuchiza migraine.�Lancet Neurol�2015;14Zithunzi za 1010-1022[Adasankhidwa]
5. McLain RF, Pickar JG.�Mapeto a Mechanoreceptor m'malumikizidwe amtundu wa thoracic ndi lumbar.�Mpaka (Phila Pa 1976)�1998;23Zithunzi za 168-173[Adasankhidwa]
6. Vernon H. �Kuwunika koyenera kwa kafukufuku wosokoneza?induced hypoalgesia.�J Wopanga Physiol Ther�2000;23Zithunzi za 134-138[Adasankhidwa]
7. Vicenzino B, Paungmali A, Buratowski S, Wright A. �Kuchiza kwachindunji kwa epicondylalgia osachiritsika kumatulutsa mawonekedwe apadera a hypoalgesia..�Munthu Ther�2001;6205; 212.[Adasankhidwa]
8. Boal RW, Gillette RG.�Central neuronal plasticity, ululu wochepa wammbuyo ndi chithandizo chamsana.�J Wopanga Physiol Ther�2004;27Zithunzi za 314-326[Adasankhidwa]
9. Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ.�Njira zothandizira mankhwala pochiza kupweteka kwa minofu ndi mafupa: chitsanzo chokwanira.�Munthu Ther�2009;14Zithunzi za 531-538[Adasankhidwa]
10. De Camargo VM, Alburquerque?Sendin F, Berzin F, Stefanelli VC, de Souza DP, Fernandez?de?las?Penas C.�Zotsatira zaposachedwa pa zochitika za electromyographic ndi zovuta zowawa pambuyo pa kugwidwa kwa chiberekero mu ululu wa khosi: kuyesedwa kosasinthika..�J Wopanga Physiol Ther�2011;34Zithunzi za 211-220[Adasankhidwa]
11. Hancock MJ, Maher CG, Latimer J, McAuley JH. �Kusankha placebo yoyenera yoyesera chithandizo chamsana.�Aust J Physiother�2006;52Zithunzi za 135-138[Adasankhidwa]
12. Chaibi A, Tuchin PJ, Russell MBThandizo pamanja la migraine: kuwunika mwadongosolo.�J Kupweteka kwa Mutu2011;�12Zithunzi za 127-133[Adasankhidwa]
13. Chaibi A, Russell MB. �Thandizo pamanja pamutu woyamba wa mutu: kuwunika mwadongosolo mayeso oyendetsedwa mwachisawawa.�J Kupweteka kwa Mutu�2014;15: 67 ndi[Adasankhidwa]
14. Chaibi A, Saltyte Benth J, Bjorn Russell M. �Kutsimikizika kwa placebo muzoyeserera zoyendetsedwa mwachisawawa.�Sci Rep�2015;5: 11774 ndi[Adasankhidwa]
15. Silberstein S, Tfelt?Hansen P, Dodick DW,�Et al Task Force ya International Headache Society Clinical Trial Subcommittee. Malangizo a mayesero olamulidwa a prophylactic chithandizo cha matenda a migraine akuluakulu.�Cephalalgia�2008;28Zithunzi za 484-495[Adasankhidwa]
16. Moher D, Hopewell S, Schulz KF,�Et al Kufotokozera ndi kutanthauzira kwa CONSORT 2010: malangizo osinthidwa ofotokozera mayesero otsatizana amagulu.�BMJ�2010;340c869 ndi[Adasankhidwa]
17. Chaibi A, Saltyte Benth J, Tuchin PJ, Russell MBChiropractic spinal manipulative therapy for migraine: ndondomeko yophunzira ya malo amodzi osawona?.�BMJ Open2015;�5e008095.�[Nkhani yaulere ya PMC] [Adasankhidwa]
18. French HP, Brennan A, White B, Cusack T.�Chithandizo chamanja cha osteoarthritis m'chiuno kapena bondo? kuwunika mwadongosolo.�Munthu Ther�2011;16Zithunzi za 109-117[Adasankhidwa]
19. Cooperstein R. �Njira ya Gonstead chiropractic (GCT).�J Chiropr Med�2003;2Zithunzi za 16-24[Adasankhidwa]
20. Russell MB, Rasmussen BK, Brennum J, Iversen HK, Jensen RA, Olesen J. �Kuwonetsera kwa chida chatsopano: diagnostic mutu diary.�Cephalalgia�1992;12Zithunzi za 369-374[Adasankhidwa]
21. Tfelt?Hansen P, Pascual J, Ramadan N,�Et al Malangizo a mayesero olamulidwa a mankhwala mu migraine: kope lachitatu. Kalozera kwa ofufuza.�Cephalalgia�2012;32Zithunzi za 6-38[Adasankhidwa]
22. Komiti Yachigawo ya Mutu wa Mutu wa International Headache Society .�The International Classification of Headache Disorders, kope lachitatu (beta version).�Cephalalgia�2013;33629; 808.[Adasankhidwa]
23. Tfelt?Hansen P, Bjarnason NH, Dahlof C, Derry S, Loder E, Massiou H.�Kuwunika ndi kulembetsa zochitika zovuta m'mayesero amankhwala achipatala mu migraine.�Cephalalgia�2008;28Zithunzi za 683-688[Adasankhidwa]
24. Silberstein SD, Neto W, Schmitt J, Jacobs D. �Topiramate mu kupewa migraine: zotsatira za mayesero akuluakulu olamulidwa.�Arch Neurol�2004;61Zithunzi za 490-495[Adasankhidwa]
25. Dixon JR. �The International Conference on Harmonization Good Clinical Practice malangizo.�Qual Assur�1998;6Zithunzi za 65-74[Adasankhidwa]
26. Ioannidis JP, Evans SJ, Gotzsche PC, �Et al Kufotokozera bwinoko zovulaza m'mayesero osasinthika: kukulitsa mawu a CONSORT.�Ann Intern Med�2004;141Zithunzi za 781-788[Adasankhidwa]
27. Scholten?Peeters GG, Thoomes E, Konings S,�Et al Kodi manipulative therapy ndi othandiza kwambiri kuposa kunyengerera anthu akuluakulu: kuwunika mwadongosolo komanso kusanthula meta?.�Chiropr Man Therap�2013;21: 34 ndi[Nkhani yaulere ya PMC] [Adasankhidwa]
28. Meissner K, Fassler M, Rucker G,�Et al Kusiyanasiyana kwamankhwala a placebo: kuwunika mwadongosolo kwa migraine prophylaxis.�JAMA Intern Med�2013;173: 10 ndi[Adasankhidwa]
29. Ashina S, Bendtsen L, Lyngberg AC, Lipton RB, Hajiyeva N, Jensen R.�Kuchuluka kwa ululu wa khosi mu migraine ndi kupsinjika? mtundu wa mutu: kafukufuku wa anthu.�Cephalalgia�2015;35Zithunzi za 211-219[Adasankhidwa]
30. Parker GB, Tupling H, Pryor DS.�Kuyesedwa kolamulidwa kwa chiberekero cha chiberekero cha migraine.�Aust NZ J Med�1978;8Zithunzi za 589-593[Adasankhidwa]
31. Nelson CF, Bronfort G, Evans R, Boline P, Goldsmith C, Anderson AV.Kuchita bwino kwa kuwongolera kwa msana, amitriptyline ndi kuphatikiza kwamankhwala onse awiri a prophylaxis ya mutu wa migraine..�J Wopanga Physiol Ther�1998;21Zithunzi za 511-519[Adasankhidwa]
32. Tuchin PJ, Pollard H, Bonello R.�Kuyesedwa kosasinthika kwa chiropractic spinal manipulative therapy kwa migraine.�J Wopanga Physiol Ther�2000;23Zithunzi za 91-95[Adasankhidwa]
33. Cagnie B, Vinck E, Beernaert A, Cambier D. �Kodi zotsatira za kugwedezeka kwa msana ndizofala bwanji ndipo kodi zotsatirazi zinganenedweratu? Munthu Ther�2004;9Zithunzi za 151-156[Adasankhidwa]
34. Hurwitz EL, Morgenstern H, Vassilaki M, Chiang LM.�Zotsatira zoyipa za chithandizo cha chiropractic ndi zotsatira zake pakukhutira ndi zotsatira zachipatala pakati pa odwala omwe adalembetsa nawo UCLA Neck Pain Study.�J Wopanga Physiol Ther�2004;27Zithunzi za 16-25[Adasankhidwa]
35. Thiel HW, Bolton JE, Docherty S, Portlock JC. �Chitetezo cha Chiropractic manipulation of the cervical spine: kafukufuku woyembekezeredwa wa dziko.�Mpaka (Phila Pa 1976)�2007;32Zithunzi za 2375-2378[Adasankhidwa]
36. Rubinstein SM, Leboeuf?Yde C, Knol DL, de Koekkoek TE, Pfeifle CE, van Tulder MW.�Zopindulitsa zimaposa kuopsa kwa odwala omwe akudwala chisamaliro cha chiropractic chifukwa cha ululu wa khosi: woyembekezera, wochuluka, wophunzirira gulu..�J Wopanga Physiol Ther�2007;30Zithunzi za 408-418[Adasankhidwa]
37. Eriksen K, Rochester RP, Hurwitz EL.�Zizindikiro, zotsatira zachipatala komanso kukhutitsidwa kwa odwala komwe kumakhudzana ndi chisamaliro chapamwamba cha chiberekero cha chiberekero: oyembekezera, ambiri, kafukufuku wamagulu..�BMC Musculoskelet Disord�2011;12: 219 ndi[Adasankhidwa]
38. Walker BF, Hebert JJ, Stomski NJ, �Et al Zotsatira za chiropractic wamba. Kuyesa kwachisawawa kwa OUCH kwa zochitika zoyipa.�Mphepete�2013;38Zithunzi za 1723-1729[Adasankhidwa]
39. Maiers M, Evans R, Hartvigsen J, Schulz C, Bronfort G.Zochitika zoyipa pakati pa okalamba omwe akulandira kugwedezeka kwa msana ndi kuchita masewera olimbitsa thupi m'mayesero achipatala mwachisawawa.�Munthu Ther�2015;20Zithunzi za 335-341[Adasankhidwa]
40. Jackson JL, Cogbill E, Santana?Davila R,�Et al Kuyerekeza mogwira mtima meta?kuwunika kwa mankhwala a prophylaxis wa mutu waching'alang'ala.�PLoS One�2015;10e0130733.�[Adasankhidwa]
41. Ferrari MD, Roon KI, Lipton RB, Goadsby PJ.�Oral triptans (serotonin 5?HT(1B/1D) agonists) mu chithandizo chachikulu cha migraine: meta?kuwunika kwa mayesero a 53..�Lancet�2001;358Zithunzi za 1668-1675[Adasankhidwa]
Tsekani Accordion
Psychology, Mutu, Kupweteka Kwambiri, Kupweteka Kwambiri ndi Chiropractic ku El Paso, TX

Psychology, Mutu, Kupweteka Kwambiri, Kupweteka Kwambiri ndi Chiropractic ku El Paso, TX

by | Ululu Wabwerere, Chiropractic, aakulu Chisoni, Migraine, Kukhazikitsanso Thupi, Mayesero Olamulidwa Mwachisawawa, kupanikizika, Kuchiza

Aliyense amamva ululu nthawi ndi nthawi. Ululu ndikumva kusapeza bwino komwe kumachitika chifukwa chovulala kapena matenda. Mukakoka minofu kapena kudula chala chanu, mwachitsanzo, chizindikiro chimatumizidwa kudzera mumitsempha kupita ku ubongo, kukuwonetsani kuti chinachake chalakwika m'thupi. Ululu ukhoza kukhala wosiyana kwa aliyense ndipo pali njira zingapo zomvera ndi kufotokozera ululu. Pambuyo pa kuvulala kapena matenda, ululu umatha, komabe, chimachitika ndi chiyani ngati ululu ukupitirira ngakhale mutachira?

 

Kupweteka kosautsa nthawi zambiri amatanthauzidwa ngati ululu uliwonse umene umatenga masabata oposa 12. Kupweteka kosalekeza kumatha kukhala kocheperako mpaka koopsa ndipo kumatha kukhala chifukwa cha kuvulala kapena opaleshoni yam'mbuyomu, migraine ndi mutu, nyamakazi, kuwonongeka kwa mitsempha, matenda ndi fibromyalgia. Kupweteka kosatha kumatha kusokoneza malingaliro ndi malingaliro a munthu, zomwe zimapangitsa kuti zikhale zovuta kuthetsa zizindikirozo. Kafukufuku wasonyeza kuti kuchitapo kanthu pamaganizo kungathandize kuchepetsa ululu wopweteka kwambiri. Akatswiri angapo azachipatala, monga dokotala wa chiropractic, amatha kupereka chisamaliro cha chiropractic pamodzi ndi njira zamaganizidwe kuti zithandizire kubwezeretsa thanzi ndi thanzi la odwala awo. Cholinga cha nkhani yotsatirayi ndikuwonetsa udindo wa kulowererapo kwa maganizo pa kayendetsedwe ka odwala omwe ali ndi ululu wosatha, kuphatikizapo kupweteka kwa mutu ndi kupweteka kwa msana.

 

 

Udindo wa Psychological Interventions mu Utsogoleri wa Odwala Omwe Ali ndi Ululu Wosatha

 

Kudalirika

 

Kupweteka kosautsa kumatha kumveka bwino kuchokera kumalingaliro a biopsychosocial omwe ululu umawonedwa ngati zovuta, zokumana nazo zambiri zomwe zimachokera ku kuyanjana kwamphamvu kwa thupi la wodwalayo, malingaliro, malingaliro, machitidwe, ndi chikhalidwe cha anthu. Lingaliro la biopsychosocial limayang'ana pakuwona kupweteka kosalekeza ngati matenda m'malo mwa matenda, pozindikira kuti ndizochitika zodziwikiratu komanso kuti njira zochiritsira zimayang'aniridwa ndi kasamalidwe, osati kuchiritsa, kupweteka kosalekeza. Njira zamakono zamaganizo zoyendetsera ululu wopweteka kwambiri zikuphatikizapo njira zothandizira zomwe zimafuna kukwaniritsa kudzilamulira, kusintha kwa khalidwe, ndi kusintha kwa chidziwitso m'malo mochotsa mwachindunji malo opweteka. Ubwino wophatikizirapo chithandizo chamankhwala m'njira zosiyanasiyana zothanirana ndi ululu wosaneneka umaphatikizapo, koma sikungowonjezera, kudziletsa kudziletsa, kuwongolera zowongolera zowawa, kuchepetsa kulemala kokhudzana ndi ululu, komanso kuchepetsa kupsinjika kwamalingaliro - kusintha komwe kumachitika. kudzera m'njira zosiyanasiyana zodziletsa, zamakhalidwe, komanso kuzindikira. Kupyolera mu kukhazikitsidwa kwa zosinthazi, akatswiri a zamaganizo angathandize odwala kuti azitha kulamulira ululu wawo ndikuwathandiza kukhala ndi moyo wabwino momwe angathere ngakhale akumva ululu. Komanso, luso lomwe amaphunzira kudzera m'malingaliro amaganizidwe limapatsa mphamvu ndikupangitsa odwala kukhala otenga nawo mbali pakuwongolera matenda awo ndikuphunzitsa maluso ofunikira omwe odwala angagwiritse ntchito pamoyo wawo wonse.

 

Keywords: Kusamalira ululu kosalekeza, psychology, chithandizo chamankhwala chamitundumitundu, chidziwitso chakhalidwe lachidziwitso cha ululu

 

Dr Jimenez White Coat

Kuzindikira kwa Dr. Alex Jimenez

Kupweteka kosautsa kwatsimikiziridwa kale kuti kukhudze thanzi lamaganizo la iwo omwe ali ndi zizindikiro zosalekeza, potsirizira pake amasintha malingaliro awo onse amalingaliro ndi maganizo. Kuphatikiza apo, odwala omwe ali ndi zovuta zambiri, kuphatikiza kupsinjika, nkhawa, ndi kupsinjika maganizo, angapangitse chithandizo kukhala chovuta. Udindo wa chisamaliro cha chiropractic ndi kubwezeretsa komanso kusunga ndi kukonza momwe msanawo umayendera pogwiritsira ntchito kusintha kwa msana ndi kuwongolera pamanja. Chisamaliro cha Chiropractic chimalola thupi kudzichiritsa mwachibadwa popanda kufunikira kwa mankhwala / mankhwala ndi njira zothandizira opaleshoni, ngakhale kuti izi zikhoza kutchulidwa ndi chiropractor ngati pakufunika. Komabe, chisamaliro cha chiropractic chimayang'ana pa thupi lonse, osati pa kuvulala kamodzi ndi / kapena chikhalidwe ndi zizindikiro zake. Kusintha kwa msana ndi kugwiritsira ntchito pamanja, pakati pa njira zina zothandizira ndi njira zomwe zimagwiritsidwa ntchito ndi chiropractor, zimafuna kuzindikira momwe wodwalayo alili m'maganizo ndi m'maganizo kuti athe kuwathandiza kukhala ndi thanzi labwino komanso thanzi. Odwala omwe amapita ku chipatala changa ali ndi nkhawa chifukwa cha ululu wawo wokhazikika nthawi zambiri amakhala ndi vuto la m'maganizo. Chifukwa chake, chisamaliro cha chiropractic chingakhale chofunikira kwambiri pakuwongolera kupweteka kosalekeza, pamodzi ndi zomwe zikuwonetsedwa pansipa.

 

Introduction

 

Ululu ndizochitika ponseponse zaumunthu. Akuti pafupifupi 20%�35% ya achikulire amamva kupweteka kosalekeza.[1,2] Bungwe la National Institute of Nursing Research linanena kuti ululu umakhudza anthu ambiri a ku America kuposa matenda a shuga, matenda a mtima, ndi khansa ataphatikizidwa.[3] Ululu watchulidwa chifukwa chachikulu chofunira chithandizo chamankhwala ku United States.[4] Kuphatikiza apo, mankhwala ochepetsa ululu ndi mankhwala achiwiri omwe amaperekedwa m'maofesi ndi zipinda zachipatala. [5] Kulimbitsanso kufunikira kwa kuunika kokwanira kwa ululu, bungwe la Joint Commission on the Accreditation of Healthcare Organizations linapereka lamulo lofuna kuti ululu uwonedwe ngati chizindikiro chachisanu chofunika kwambiri pa maulendo a zachipatala.[6]

 

Bungwe la International Association for the Study of Pain (IASP) limatanthawuza kupweteka ngati �chidziwitso chosasangalatsa chamalingaliro ndi malingaliro okhudzana ndi kuwonongeka kwenikweni kapena komwe kungachitike minofu, kapena kufotokozedwa motengera kuwonongeka koteroko. Tanthauzo la IASP likuwunikira chikhalidwe chambiri komanso chokhazikika cha ululu, zochitika zovuta zomwe zimakhala zosiyana ndi munthu aliyense. Kupweteka kosautsa nthawi zambiri kumasiyanitsidwa ndi ululu wopweteka kwambiri chifukwa cha kukhalitsa kwake kapena kulimbikira kwake, njira zake zosamalira thupi, ndi/kapena kuwononga kwake pa moyo wa munthu. Kawirikawiri, zimavomerezedwa kuti ululu umene umapitirira kupitirira nthawi yoyembekezeka ya machiritso a minofu pambuyo pa kuvulala kapena opaleshoni amaonedwa kuti ndi ululu wosatha. Komabe, nthawi yeniyeni yokhala ndi nthawi yoyembekezera machiritso imasinthasintha ndipo nthawi zambiri imakhala yovuta kudziwa. Kuti muchepetse kugawa, malangizo ena akuwonetsa kuti kupweteka kosalekeza kupitirira 7�3 miyezi nthawi zenera amaonedwa kuti ndi ululu wosatha.[6] Komabe, kugawa zowawa potengera kutalika kwa nthawi kumakhala kothandiza ndipo, nthawi zina, ndi njira yokhazikika. Nthawi zambiri, zinthu zina monga etiology, kuchuluka kwa ululu, ndi kukhudzidwa zimaganiziridwa pamodzi ndi nthawi yowerengera ululu wosaneneka. Njira ina yowonetsera kupweteka kosalekeza yakhazikitsidwa ndi njira yake yosamalira thupi; ndiko kuti, ululu umene umaganiziridwa kuti umatuluka chifukwa cha kukonzanso kwapakati ndi pakati. Nthawi zambiri ululu wosalekeza umaphatikizapo matenda a musculoskeletal, matenda a neuropathic, kupweteka kwa mutu, kupweteka kwa khansa, komanso kupweteka kwa visceral. Mowonjezereka, ululu ukhoza kukhala makamaka nociceptive (kutulutsa ululu wamakina kapena mankhwala), neuropathic (yomwe imabwera chifukwa cha kuwonongeka kwa mitsempha), kapena chapakati (chomwe chimachitika chifukwa cha kusagwira bwino ntchito kwa minyewa yapakati pa mitsempha yapakati).[7]

 

Tsoka ilo, zokumana nazo zowawa nthawi zambiri zimadziwika ndi kuvutika kosayenera kwakuthupi, m'malingaliro, chikhalidwe, ndi zachuma. Kupweteka kosalekeza kwadziwika kuti ndiko kumayambitsa kulumala kwanthawi yayitali pakati pa anthu aku America omwe akugwira ntchito.[9] Chifukwa kupweteka kosalekeza kumakhudza munthu m'madera angapo akukhalapo kwake kumakhalanso cholemetsa chachikulu chazachuma kudera lathu. Kuphatikizika kwachindunji ndi kosalunjika ndalama zowawa zakhala zikuyerekezedwa kuti zimachokera ku $ 125 biliyoni kufika ku $ 215 biliyoni, pachaka. [10,11] Zotsatira zofala za ululu wosatha zimaphatikizapo malipoti owonjezereka a kupsinjika maganizo (mwachitsanzo, kuvutika maganizo, nkhawa, ndi kukhumudwa), kuchuluka kwa ziwopsezo za kulemala kokhudzana ndi ululu, kusintha kokhudzana ndi ululu pakuzindikira, komanso kuchepa kwa moyo. Choncho, ululu wosatha ukhoza kumveka bwino kuchokera ku biopsychosocial kuona momwe ululu umawoneka ngati zovuta, zochitika zambiri zomwe zimachokera ku kuyanjana kwamphamvu kwa thupi la wodwalayo, malingaliro, maganizo, makhalidwe, ndi chikhalidwe cha anthu.

 

Uphungu Wopweteka

 

Chifukwa cha kufalikira kwa ululu ndi chikhalidwe chake chamitundumitundu, njira yabwino yothanirana ndi ululu idzakhala yokwanira, yophatikizana, komanso yosiyana. Njira zamakono zothandizira kupweteka kosalekeza zawonjezeka kwambiri kuposa kuchepetsa kuchepetsa komanso kuchitidwa opaleshoni, thupi, kapena mankhwala ochiritsira. Njira zamakono zimazindikira kufunika kwa chithandizo chamankhwala osiyanasiyana chomwe sichimangoyang'ana mbali za nociceptive za ululu komanso kuzindikira-kuwunika, komanso zolimbikitsa-zolimbikitsa pamodzi ndi zofanana zosasangalatsa komanso zotsatila. Kuwongolera kosiyanasiyana kwa ululu wosaneneka kumaphatikizapo chithandizo chamankhwala ambiri monga kuphatikiza ma analgesics, physiotherapy, therapy, komanso chithandizo chamaganizidwe. Njira ya multimodal mokwanira komanso momveka bwino imayang'anira kasamalidwe ka ululu pamagulu a maselo, machitidwe, kuzindikira, komanso magwiridwe antchito. Njirazi zasonyezedwa kuti zitsogolere ku zotsatira zapamwamba komanso zokhalitsa komanso zotsatilapo zomwe zikuphatikizapo malipoti opweteka, maganizo, kubwezeretsa ntchito za tsiku ndi tsiku, ntchito, ndi mankhwala kapena ntchito zothandizira zaumoyo; njira za multimodal zasonyezedwanso kuti zimakhala zotsika mtengo kusiyana ndi njira zosagwirizana. [12,13] Cholinga cha ndemangayi chidzakhala makamaka kufotokozera ubwino wa psychology pakusamalira ululu wosatha.

 

Dr. Jimenez akuchita chithandizo chamankhwala kwa wodwala.

 

Odwala amayamba kupita ku ofesi ya dokotala kufunafuna chithandizo kapena chithandizo cha matenda awo / kupweteka kwawo kwakukulu. Kwa odwala ambiri, malingana ndi etiology ndi matenda a ululu wawo pamodzi ndi zotsatira za biopsychosocial pa zowawa zowawa, ululu wopweteka udzathetsa ndikupita kwa nthawi, kapena kutsatira mankhwala omwe cholinga chake ndi kutsata zomwe zimaganiziridwa kuti zimapweteka kapena kupatsirana kwake. Komabe, odwala ena sangathe kuthetsa ululu wawo ngakhale kuti ali ndi chithandizo chochuluka chachipatala komanso chothandizira ndipo adzasintha kuchoka ku ululu wopweteka kwambiri kupita ku ululu wosatha, wosachiritsika. Mwachitsanzo, kafukufuku wasonyeza kuti pafupifupi 30% ya odwala omwe amapita kwa dokotala wawo wamkulu chifukwa cha madandaulo okhudzana ndi ululu wopweteka kwambiri adzapitirizabe kumva ululu ndipo, kwa ena ambiri, kuchepa kwa ntchito ndi kuvutika kwa miyezi 12 pambuyo pake. [14] Pamene ululu ndi zotsatira zake zikupitirira kukula ndi kuwonekera m'mbali zosiyanasiyana za moyo, ululu wosatha ukhoza kukhala vuto lalikulu la biopsychosocial, momwe mbali zambiri za biopsychosocial zimatha kupititsa patsogolo ndi kusunga ululu, motero kupitiriza kusokoneza moyo wa munthu wokhudzidwayo. Ndi panthawiyi kuti chithandizo choyambirira chamankhwala chikhoza kusiyanasiyana kuti chiphatikizepo zigawo zina zothandizira, kuphatikizapo njira zamaganizo zothandizira kupweteka.

 

Njira zamaganizidwe zothanirana ndi ululu wosaneneka zidayamba kutchuka chakumapeto kwa zaka za m'ma 1960 ndi kutuluka kwa Melzack ndi Wall's "gate-control theory of pain"[15] ndi "neuromatrix theory of pain"[16]. Mwachidule, ziphunzitsozi zimasonyeza kuti njira zamaganizo ndi zakuthupi zimagwirizanitsa kuti zikhudze kuzindikira, kupatsirana, ndi kuunika kwa ululu, ndikuzindikira kukhudzidwa kwa njirazi monga zinthu zosamalira zomwe zimakhudzidwa ndi zowawa zosatha kapena zautali. Mwakutero, ziphunzitsozi zidakhala ngati zida zoyambira zoyambitsa kusintha kwa njira yayikulu komanso yosasinthika yochizira ululu, yomwe imayang'aniridwa kwambiri ndi malingaliro achilengedwe. Madokotala ndi odwala omwe adapeza kuzindikira kowonjezereka ndikuyamikiridwa chifukwa cha zovuta za kukonzanso ndi kukonza zowawa; chifukwa chake, kuvomereza ndi zokonda za multidimensional conceptualizations za ululu zinakhazikitsidwa. Pakalipano, chitsanzo cha biopsychosocial cha ululu ndi, mwinamwake, njira yovomerezeka yovomerezeka yomvetsetsa ululu.[17] Lingaliro la biopsychosocial limayang'ana pakuwona kupweteka kosalekeza ngati matenda m'malo mwa matenda, pozindikira kuti ndizochitikira komanso kuti njira zochiritsira zimangoyang'anira kasamalidwe, osati kuchiza, kupweteka kosalekeza.[17] Pamene kugwiritsidwa ntchito kwa njira yowonjezereka komanso yowonjezereka yoyang'anira ululu wopweteka wawonekera, njira zothandizira maganizo zakhala zikuwonjezeka mochititsa chidwi ndi kuzindikiridwa ngati chithandizo chothandizira. Mitundu ya njira zothandizira m'maganizo zomwe zimagwiritsidwa ntchito monga gawo la ndondomeko ya mankhwala opweteka amitundu yosiyanasiyana zimasiyanasiyana malinga ndi momwe akatswiri amathandizira, etiology ya ululu, ndi makhalidwe a odwala. Momwemonso, kafukufuku wokhudzana ndi mphamvu zothandizira m'maganizo pa ululu wopweteka wasonyeza kusintha, ngakhale kulonjeza, zotsatira pazitsulo zazikulu zomwe zaphunziridwa. Chidulechi chidzafotokozera mwachidule njira zomwe zimagwiritsidwa ntchito kawirikawiri ndi malingaliro okhudzana ndi maganizo ndi momwe amachitira pa zotsatira zazikulu.

 

Njira zamakono zamaganizo zoyendetsera ululu wopweteka kwambiri zikuphatikizapo njira zothandizira zomwe zimafuna kukwaniritsa kudzilamulira, kusintha kwa khalidwe, ndi kusintha kwa chidziwitso m'malo mochotsa mwachindunji malo opweteka. Momwemonso, amayang'ana mbali zomwe nthawi zambiri zimanyalanyazidwa pamakhalidwe, malingaliro, ndi chidziwitso cha zowawa zosatha komanso zomwe zimapangitsa kuti zisamawonongeke. Kudziwitsidwa ndi ndondomeko yoperekedwa ndi Hoffman et al[18] ndi Kerns et al, [19] madera omwe amagwiritsidwa ntchito kawirikawiri amawunikiridwa: njira zamaganizo, machitidwe a chithandizo, chidziwitso cha khalidwe, ndi kuvomereza kovomerezeka.

 

Psychophysiological Techniques

 

Biofeedback

 

Biofeedback ndi njira yophunzirira yomwe odwala amaphunzira kutanthauzira mayankho (monga momwe thupi limagwirira ntchito) zokhudzana ndi ntchito zina za thupi. Mwachitsanzo, wodwala angagwiritse ntchito zida za biofeedback kuti aphunzire kuzindikira malo omwe ali ndi vuto m'thupi lawo ndipo kenako amaphunzira kupumula maderawo kuti achepetse kupsinjika kwa minofu. Ndemanga zimaperekedwa ndi zida zosiyanasiyana zoyezera zomwe zingapereke chidziwitso chokhudza ubongo wamagetsi, kuthamanga kwa magazi, kuthamanga kwa magazi, minofu ya minofu, electrodermal ntchito, kugunda kwa mtima, ndi kutentha kwa khungu, pakati pa ntchito zina za thupi mofulumira. Cholinga cha njira za biofeedback ndi chakuti wodwalayo aphunzire momwe angayambitsire njira zodzilamulira yekha mwa kukwaniritsa modzifunira pa mayankho ena a thupi kuti pamapeto pake awonjezere kusinthasintha kwa thupi kupyolera mu kuzindikira kwakukulu ndi maphunziro apadera. Motero wodwala adzagwiritsa ntchito luso lodzilamulira pofuna kuchepetsa chochitika chosafunikira (mwachitsanzo, kupweteka) kapena kusokonezeka kwa thupi pazochitika zosafunikira (mwachitsanzo, kuyankha kupsinjika maganizo). Akatswiri ambiri azamisala amaphunzitsidwa njira za biofeedback ndipo amapereka chithandizo ngati gawo la chithandizo. Biofeedback yasankhidwa ngati chithandizo chothandiza pa ululu wokhudzana ndi mutu ndi matenda a temporomandibular (TMD).[20] Kuwunika kwa meta kwa kafukufuku wa 55 kunavumbula kuti njira zothandizira biofeedback (kuphatikizapo njira zosiyanasiyana za biofeedback) zinabweretsa kusintha kwakukulu ponena za maulendo afupipafupi a mutu wa mutu waching'alang'ala komanso malingaliro a mutu wodzisamalira okha poyerekeza ndi mikhalidwe yolamulira. [21] Kafukufuku wapereka chithandizo champhamvu cha biofeedback kwa TMD, ngakhale kusintha kwakukulu kokhudzana ndi ululu ndi kulemala kokhudzana ndi ululu kwapezeka chifukwa cha ndondomeko zomwe zimagwirizanitsa biofeedback ndi maphunziro a chidziwitso cha khalidwe lachidziwitso, poganiza kuti njira yothandizira yophatikizana imagwirizana kwambiri ndi masewera a gamut. a biopsychosocial mavuto omwe angakumane nawo chifukwa cha TMD.[22]

 

Makhalidwe Abwino

 

Maphunziro Opumula

 

Nthawi zambiri amavomereza kuti kupsinjika maganizo ndi chinthu chofunika kwambiri chomwe chimakhudzidwa ndi kuwonjezereka ndi kusamalira ululu wosatha. Cholinga cha maphunziro opumula ndikuchepetsa kupsinjika (kwakuthupi ndi m'maganizo) kudzera mu kuyambitsa kwa dongosolo lamanjenje la parasympathetic ndikupeza chidziwitso chochuluka cha zochitika za thupi ndi zamaganizo, potero kukwaniritsa kuchepetsa ululu ndi kuonjezera kulamulira ululu. Odwala amatha kuphunzitsidwa njira zingapo zotsitsimula ndikuzichita payekha kapena mogwirizana ndi wina ndi mzake, komanso zigawo za adjuvant ku njira zina zothandizira kupweteka kwa khalidwe ndi chidziwitso. Zotsatirazi ndi mafotokozedwe achidule a njira zotsitsimula zomwe zimaphunzitsidwa ndi akatswiri a zamaganizo omwe amadziwika bwino posamalira ululu wosatha.

 

Kupuma kwa diaphragmatic. Kupuma kwa diaphragmatic ndi njira yoyambira yopumula pomwe odwala amalangizidwa kuti agwiritse ntchito minofu ya diaphragm kusiyana ndi minofu ya pachifuwa kuti achite masewera olimbitsa thupi. Kupuma pogwira diaphragm kumalola mapapu kukula pansi (odziwika ndi kutukuka kwa mimba pokoka mpweya) motero amawonjezera kutulutsa mpweya.[24]

 

Kupumula kwamphamvu kwa minofu (PMR). PMR imadziwika ndi kuphatikizika kwa kukakamira kwa minofu ndi kuchita masewera olimbitsa thupi omasuka a minofu kapena magulu aminyewa m'thupi lonse.[25] Wodwalayo amalangizidwa kuti azichita masewera olimbitsa thupi / kupumula motsatizana mpaka madera onse a thupi atayankhidwa.

 

Maphunziro a Autogenic (AT). AT ndi njira yodzilamulira yokhayokha yomwe wodwala amabwereza mawu pamodzi ndi kuwonetseratu kuti apangitse kukhala omasuka.

 

Mawonekedwe / zithunzi zowongolera. Njira imeneyi imalimbikitsa odwala kugwiritsa ntchito mphamvu zawo zonse polingalira malo omveka bwino, odekha, ndi otetezeka kuti apeze chisangalalo ndi kusokoneza maganizo awo okhudzana ndi ululu ndi zowawa. [27]

 

Pamodzi, njira zotsitsimula zapezeka kuti zimakhala zopindulitsa pa kayendetsedwe ka mitundu yosiyanasiyana ya ululu wopweteka kwambiri komanso wopweteka kwambiri komanso kuyang'anira zowawa zofunika kwambiri (mwachitsanzo, moyo wokhudzana ndi thanzi).[28�31 ] Njira zotsitsimula nthawi zambiri zimagwiritsidwa ntchito limodzi ndi njira zina zothandizira ululu, ndipo pali kuphatikizika kwakukulu mu njira zomwe zimaganiziridwa kuti zisangalatse ndi biofeedback, mwachitsanzo.

 

Operant Behavior Therapy

 

Thandizo la machitidwe opangira ululu wosatha limatsogozedwa ndi mfundo zoyambirira zogwiritsira ntchito zomwe Skinner [32] amayengedwa ndi Fordyce[33] kuti azigwiritsidwa ntchito posamalira ululu. Mfundo zazikuluzikulu za mawonekedwe opangira opaleshoni monga momwe zimakhalira ndi ululu zimatsimikizira kuti khalidwe lopweteka limatha kusintha ndikukhalabe ngati mawonetseredwe opweteka kwambiri chifukwa cha kulimbitsa bwino kapena koipa kwa khalidwe lopweteka lomwe linaperekedwa komanso chilango cha kusinthasintha, osasintha. - khalidwe la ululu. Ngati kulimbikitsana ndi zotsatira zake zimachitika pafupipafupi mokwanira, zimatha kuwongolera khalidwelo, motero kuonjezera mwayi wobwereza khalidweli m'tsogolomu. Chifukwa chake, machitidwe okhazikika amachitika chifukwa chophunzira za zotsatira (zenizeni kapena zoyembekezeredwa) zakuchita zomwe mwapatsidwa. Chitsanzo cha khalidwe lokhazikika ndi kupitiriza kugwiritsa ntchito mankhwala � khalidwe lomwe limabwera chifukwa chophunzira kupyolera mu mayanjano mobwerezabwereza kuti kumwa mankhwala kumatsatiridwa ndi kuchotsedwa kwa kukhumudwa (ululu). Momwemonso, machitidwe opweteka (mwachitsanzo, mawu opweteka, kuchepa kwa zochitika) akhoza kukhala machitidwe omwe amachititsa kuti ululu wosatha upitirire ndi zotsatira zake. Zochizira zomwe zimatsogozedwa ndi mfundo zamakhalidwe ogwirira ntchito zimafuna kuzimitsa machitidwe opweteka a maladaptive kudzera mu mfundo zomwezo zomwe zitha kukhazikitsidwa nazo. Kawirikawiri, zigawo za chithandizo chamankhwala opangira opaleshoni zimaphatikizapo kutsegulira, ndondomeko ya mankhwala osagwiritsidwa ntchito nthawi, ndi kugwiritsa ntchito mfundo zowonjezera kuti muwonjezere makhalidwe abwino ndi kuchepetsa makhalidwe opweteka a maladaptive.

 

Kutsegula kwamagulu. Akatswiri a zamaganizo amatha kugwiritsa ntchito mapulogalamu apadera a odwala omwe amamva kupweteka kosalekeza omwe amachepetsa kwambiri ntchito zawo (kuwonjezeka kwa mwayi wochepetsera thupi) ndipo pambuyo pake amamva ululu wochuluka pochita nawo ntchito. Odwala amalangizidwa kuti athetse kusagwira ntchito ndi kuchotseratu zinthu mwakuchita zinthu molamulidwa komanso mopanda nthawi. Mwanjira iyi, odwala amatha kuonjezera nthawi ndi mphamvu ya ntchito kuti agwire bwino ntchito. Akatswiri a zamaganizo amatha kuyang'anira kupita patsogolo ndi kupereka chilimbikitso choyenera kuti atsatire, kuwongolera maganizo olakwika kapena kutanthauzira molakwika kwa ululu chifukwa cha ntchito, ngati kuli koyenera, ndi kuthetsa mavuto olepheretsa kutsatira. Njirayi nthawi zambiri imayikidwa mkati mwachidziwitso-khalidwe lothandizira kupweteka kwapamtima.

 

Madongosolo amankhwala osatengera nthawi. Katswiri wa zamaganizo akhoza kukhala wothandizira wothandizira zaumoyo poyang'anira kasamalidwe ka mankhwala opweteka. Nthawi zina, akatswiri a zamaganizo amakhala ndi mwayi wolumikizana pafupipafupi komanso mozama ndi odwala kuposa madokotala ndipo motero amatha kukhala othandizana nawo panjira yophatikizira yothandizira anthu ambiri. Akatswiri a zamaganizo angakhazikitse ndondomeko ya mankhwala osakhalitsa kuti achepetse mwayi wodalira mankhwala opweteka kuti athe kulamulira bwino ululu. Kuphatikiza apo, akatswiri azamisala ali ndi zida zokwanira kuti azitha kukambirana ndi odwala pakufunika koyenera kutsata mankhwala ndi malangizo azachipatala ndikuthana ndi zovuta zomwe zimawoneka kuti zimalepheretsa kutsata bwino.

 

Kupewa-mantha. Chitsanzo chopewa mantha cha ululu wosatha ndi heuristic yomwe imagwiritsidwa ntchito mobwerezabwereza pamutu wa ululu wopweteka kwambiri (LBP).[34] Chitsanzochi chimachokera ku mfundo zomwe zafotokozedwa kale. Kwenikweni, chitsanzo chopeŵa mantha chimasonyeza kuti pamene maiko opweteka kwambiri amatanthauziridwa molakwika ngati zizindikiro zoopsa kapena zizindikiro za kuvulala koopsa, odwala akhoza kukhala pachiopsezo chochita makhalidwe oopa kupeŵa ndi kuzindikira zomwe zimalimbitsa chikhulupiriro chakuti ululu ndi woopsa. chizindikiro choopsa ndi kupitiriza deconditioning thupi. Pamene kuzunguliraku kukupitilira, kupeŵa kungayambitse mitundu yambiri ya zochitika ndipo kumapangitsa kuti munthu asamangokhalira tcheru pazochitika zakuthupi zodziwika ndi kutanthauzira molakwika koopsa kwa zochitika za thupi. Kafukufuku wasonyeza kuti mlingo waukulu wa zowawa zowononga zimagwirizana ndi kukonza mkombero.[35] Thandizo lofuna kuthetsa vuto lopewa mantha limagwiritsa ntchito kuwonekera mwadongosolo kuzinthu zomwe anthu amawopa kuti atsimikizire zotsatira zowopsa, zomwe nthawi zambiri zimakhala zowopsa chifukwa chochita nawo zinthu. Kuwonetsedwa kwamagulu nthawi zambiri kumaphatikizidwa ndi psychoeducation yokhudzana ndi zowawa komanso kukonzanso kwachidziwitso komwe kumatsata kuzindikira koyipa komanso ziyembekezo za zochitika ndi zowawa. Akatswiri a zamaganizo ali m'malo abwino kwambiri ochitapo njira zochitira izi zomwe zimatsanzira kwambiri chithandizo chamankhwala chomwe chimagwiritsidwa ntchito pochiza matenda ena.

 

Ngakhale kuti chithandizo chamankhwala chodziwika bwino chasonyezedwa kuti n'chothandiza pochiza matenda opweteka amtundu wamtundu I (CRPS-1) [36] ndi LBP [37] muzojambula zamtundu umodzi, mayesero akuluakulu osadziwika bwino omwe amafananizidwa mwadongosolo. chithandizo chodziwikiratu pamodzi ndi chithandizo chamankhwala opweteka amitundu yambiri ndi chithandizo chamankhwala opweteka osiyanasiyana okha komanso ndi gulu loyang'anira mndandanda wodikirira anapeza kuti mankhwala awiriwa adathandiza kuti pakhale kusintha kwakukulu pa zotsatira za kupweteka kwakukulu, kuopa kuyenda / kuvulala, kudzipweteka nokha, kukhumudwa, ndi kuchuluka kwa zochita. [38] Zotsatira za mayeserowa zikusonyeza kuti njira zonse ziwirizi zinagwirizanitsidwa ndi chithandizo chachikulu chamankhwala kotero kuti chithandizo chodziwika bwino sichinawonekere kuti chikhale ndi phindu lowonjezera la chithandizo. [38] Chenjezo pakutanthauzira kwa zotsatirazi zikuwonetsa kuti mayesero olamulidwa mwachisawawa (RCT) adaphatikizapo mitundu yosiyanasiyana ya ululu wopweteka kwambiri womwe unapitirira kuposa LBP ndi CRPS-1 ndipo sanaphatikizepo odwala omwe ali ndi mantha aakulu okhudzana ndi ululu; njira zothandizira zidaperekedwanso m'magulu amagulu osati m'mawonekedwe amodzi. Ngakhale kuti mu-vivo mankhwala okhudzidwa ndi opambana pochepetsa kuwononga zowawa komanso malingaliro owopsa a ntchito, chithandizo chowonekera chikuwoneka ngati chothandiza ngati njira zochitirapo kanthu popititsa patsogolo kulemala ndi madandaulo akuluakulu.[39] Chiyeso china chachipatala chinafanizira mphamvu ya chithandizo chamankhwala (TBC) chithandizo chamankhwala chokha ku TBC chowonjezereka ndi zochitika zapamwamba kapena kuwonetseredwa kwapadera kwa odwala omwe ali ndi LBP yowawa kwambiri komanso yocheperako. [40] Zotsatira zinavumbula kuti panalibe kusiyana kwa zotsatira za masabata a 4 ndi mwezi wa 6 pofuna kuchepetsa kulemala, kupweteka kwambiri, kupwetekedwa mtima, kupweteka, ndi kuwonongeka kwa thupi pakati pa magulu a chithandizo, ngakhale kuti kuwonetseredwa kwapadera ndi TBC kunachepetsa kuchepetsa zikhulupiliro zopewa mantha pa miyezi 6. [40] Zomwe anapeza kuchokera ku mayesero a zachipatalawa zikusonyeza kuti kupititsa patsogolo TBC ndi zochitika zapamwamba kapena kuwonetseredwa bwino sikubweretsa zotsatira zabwino zokhudzana ndi chitukuko cha LBP chosatha kupitirira kusintha komwe kumachitika ndi TBC yokha.[40]

 

Njira Zachidziwitso-Makhalidwe

 

Njira zothandizira kuzindikira-khalidwe (CBT) za ululu wosatha zimagwiritsa ntchito mfundo zamaganizo kuti zisinthe kusintha kwa makhalidwe, kuzindikira kapena kuwunika, ndi momwe wodwalayo akumvera. Izi nthawi zambiri zimakhala ndi maphunziro a psychoeducation okhudza ululu ndi matenda opweteka a wodwala, zigawo zingapo zamakhalidwe, maphunziro a luso lothana ndi mavuto, njira zothetsera mavuto, komanso kukonzanso chidziwitso, ngakhale zigawo zenizeni za chithandizo zimasiyana malinga ndi dokotala. Zigawo zamakhalidwe zingaphatikizepo maluso osiyanasiyana opumula (monga momwe tawonetsera mu gawo la njira zamakhalidwe), malangizo oyendetsera ntchito / kutsegulira kwamagulu, njira zowonetsera khalidwe, ndikulimbikitsanso kuyambiranso kuchita masewera olimbitsa thupi ngati pali mbiri yofunikira ya kupeŵa ntchito ndi kuchotsedwa pambuyo pake. Cholinga chachikulu cha maphunziro a luso lothana ndi vutoli ndikuzindikira njira zamakono zogwiritsira ntchito maladaptive (mwachitsanzo, kuwononga, kupewa) zomwe wodwalayo akugwira nawo limodzi ndi kugwiritsa ntchito njira zodzitetezera (mwachitsanzo, kugwiritsa ntchito mawu abwino, chithandizo cha anthu). Monga chenjezo, kuchuluka kwa momwe njira imasinthira kapena kusakhazikika bwino komanso momwe njira zina zothanirana ndithandizira zimasiyanasiyana malinga ndi munthu aliyense.[41] Pa nthawi yonse ya chithandizo, njira zothetsera mavuto zimalemekezedwa kuti zithandize odwala pakuyesetsa kwawo kumamatira komanso kuwathandiza kuti azidzidalira okha. Kukonzanso kwachidziwitso kumaphatikizapo kuzindikira zomwe wodwala akudziwa zomwe zikuchitika, kutsutsa malingaliro olakwika omwe azindikiridwa, ndi kukonzanso malingaliro kuti apange malingaliro oyenerera, osinthika. Kupyolera mu machitidwe okonzanso chidziwitso, odwala amazindikira kwambiri momwe malingaliro awo, kuzindikira kwawo, ndi kutanthauzira kwawo kumasinthira ululu wawo m'njira zabwino ndi zoipa. Chotsatira chake, zikuganiziridwa kuti odwala adzapeza malingaliro ochuluka a kuwongolera ululu wawo, amatha kuyendetsa bwino khalidwe lawo ndi malingaliro awo pamene akukhudzana ndi zowawa, ndikutha kuwunika bwino tanthauzo lomwe amafotokozera ululu wawo. . Zina zowonjezera nthawi zina zimaphatikizidwa mu kulowererapo kwa CBT zimaphatikizapo maphunziro a luso la anthu, maphunziro a kulankhulana, ndi njira zambiri zoyendetsera nkhawa. Pogwiritsa ntchito njira zowawa za CBT, odwala ambiri amapindula ndi kusintha kokhudzana ndi umoyo wawo wamaganizo ndi ntchito, ndipo pamapeto pake umoyo wawo wapadziko lonse lapansi umakhudza thanzi lawo.

 

Dr. Alex Jimenez akuchita masewera olimbitsa thupi komanso kuchita masewera olimbitsa thupi.

 

Zothandizira za CBT zimaperekedwa m'malo othandizira komanso achifundo omwe amayesetsa kumvetsetsa ululu wa wodwalayo kuchokera kumalingaliro a biopsychosocial komanso mwanjira yophatikizika. Ochiritsa amawona udindo wawo monga �aphunzitsi�kapena ��makochi� ndipo uthenga womwe umaperekedwa kwa odwala ndi woti aphunzire kuthana ndi ululu wawo ndikuwongolera magwiridwe antchito awo atsiku ndi tsiku ndi moyo wabwino kusiyana ndi cholinga chochiza kapena kuthetsa ululu. Cholinga chachikulu ndikukulitsa kumvetsetsa kwa odwala ndi zowawa zawo ndi zoyesayesa zawo kuti athe kuthana ndi ululu ndi zotsatira zake motetezeka komanso mosinthika; Choncho, kuphunzitsa odwala kudziyang'anira okha khalidwe lawo, maganizo awo, ndi momwe akumvera ndi mbali yofunika kwambiri ya chithandizo ndi njira yothandiza kuti azitha kuchita bwino. Kuphatikiza apo, wochiritsayo amayesetsa kulimbikitsa malo okhala ndi chiyembekezo, owona, ndi olimbikitsa momwe wodwalayo atha kukhala ndi luso lozindikira ndi kuphunzira kuchokera pazopambana zawo ndikuphunzirapo ndikuwongolera atalephera kuchita bwino. Mwanjira imeneyi, ochiritsa ndi odwala amagwirira ntchito limodzi kuti azindikire kupambana kwa odwala, zolepheretsa kutsatira, komanso kupanga mapulani okonzekera komanso kupewa kuyambiranso m'malo olimbikitsa, ogwirizana, komanso odalirika. Chinthu chochititsa chidwi cha chidziwitso cha khalidwe lachidziwitso ndicho kuvomereza kwake kwa wodwalayo monga wogwira nawo ntchito mwakhama pa kukonzanso ululu wake kapena pulogalamu yoyendetsera.

 

Kafukufuku wapeza kuti CBT ndi chithandizo chamankhwala chothandizira kupweteka kosalekeza ndi zotsatira zake zomwe zimadziwika ndi kusintha kwakukulu m'madera osiyanasiyana (mwachitsanzo, miyeso ya zowawa, malingaliro / kukhudzidwa, kupirira kwachidziwitso ndi kuyesedwa, khalidwe la ululu ndi mlingo wa zochitika, ndi chikhalidwe cha anthu. ) poyerekezera ndi mikhalidwe yodikirira yodikirira. [42] Poyerekeza ndi mankhwala ena ogwira ntchito kapena machitidwe olamulira, CBT yachititsa kuti pakhale kusintha kwakukulu, ngakhale zotsatira zazing'ono (kukula kwa ~ 0.50), ponena za zowawa zowawa, kupirira kwachidziwitso ndi kuyesedwa, ndi ntchito ya chikhalidwe cha anthu. [42] Kuwunika kwaposachedwa kwambiri kwa kafukufuku wofalitsidwa 52 kuyerekeza ndi chithandizo chamankhwala (BT) ndi CBT motsutsana ndi chithandizo monga momwe zimakhalira nthawi zonse komanso momwe zimakhalira nthawi zonse. [43] Kuwunika kwa meta kumeneku kunatsimikizira kuti deta yawo sinapereke chithandizo kwa BT kupitirira kusintha kwa ululu mwamsanga pambuyo pa chithandizo poyerekeza ndi chithandizo monga momwe zimakhalira nthawi zonse. [43] Ponena za CBT, adatsimikiza kuti CBT ili ndi zotsatira zabwino zochepa za kulemala kwa ululu, ndi maganizo; komabe, palibe deta yokwanira kuti ifufuze mphamvu yeniyeni ya chithandizo chamankhwala pazotsatira zosankhidwa.[43] Ponseponse, zikuwoneka kuti CBT ndi BT ndi njira zochiritsira zothandiza kuwongolera malingaliro; zotsatira zomwe zimakhalabe zolimba pazotsatira za data. Komabe, monga momwe zasonyezedwera ndi ndemanga zingapo ndi kuwunika kwa meta, chinthu chofunika kwambiri chomwe chiyenera kuganiziridwa pofufuza momwe CBT ikuyendera pa kayendetsedwe ka ululu wopweteka kwambiri imayang'ana pa nkhani za kubereka bwino, kusowa kwa zigawo zofanana za chithandizo, kusiyana pakati pa kubereka kwa madokotala ndi chithandizo. kuchuluka kwa anthu, ndi kusiyanasiyana kwa zotsatira zosinthika zomwe zimakhudzidwa ndi kafukufuku wofufuza.[13] Kuonjezeranso kusokoneza kutanthauzira kwa zotsatira zogwira mtima ndi makhalidwe a odwala ndi zina zowonjezera zomwe zingakhudze zotsatira za mankhwala.

 

Njira Zovomerezeka Zovomerezeka

 

Njira zovomerezeka zovomerezeka nthawi zambiri zimadziwika kuti ndi njira yachitatu yochiritsira chidziwitso-khalidwe. Thandizo lovomerezeka ndi kudzipereka (ACT) ndilofala kwambiri pamankhwala ovomerezeka ovomerezeka. ACT imagogomezera kufunikira kothandizira kupita patsogolo kwa kasitomala kuti akhale ndi moyo wofunika komanso wokhutiritsa powonjezera kusinthasintha kwamalingaliro m'malo mongoyang'ana kwambiri pakukonzanso zidziwitso.[44] Pankhani ya ululu wosaneneka, ACT imayang'ana njira zowongolera zosagwira ntchito komanso kupewa zokumana nazo polimbikitsa njira zomwe zimakhazikitsa kusinthasintha kwamalingaliro. Njira zisanu ndi imodzi zazikulu za ACT ndi izi: kuvomereza, kusokonezeka kwa chidziwitso, kukhalapo, kudzikonda monga momwe zilili, zikhalidwe, ndi kuchitapo kanthu modzipereka.[45] Mwachidule, kuvomereza kumalimbikitsa odwala opweteka kwambiri kuti agwirizane ndi ululu ndi zotsatira zake m'malo moyesera kusintha, potero amalimbikitsa wodwalayo kuti asiye kumenyana kopanda pake komwe kumakhudza kuthetsa ululu wawo. Njira zakuzindikira (kuchotsa) zimagwiritsidwa ntchito kuti zisinthe momwe malingaliro amagwirira ntchito m'malo mochepetsa kuchuluka kwawo kapena kukonzanso zomwe zili. Mwanjira iyi, kusokonezeka kwachidziwitso kumatha kungosintha tanthauzo losayenera kapena kugwira ntchito kwa malingaliro oyipa ndipo motero kumachepetsa kukhudzidwa ndi kuyankha kwamalingaliro ndi khalidwe kumalingaliro otere. Cholinga chachikulu cha kukhalapo chikugogomezera kusagwirizana kopanda chiweruzo pakati pa malingaliro ndi zochitika zaumwini ndi zapadera. Makhalidwe amagwiritsidwa ntchito ngati chitsogozo posankha machitidwe ndi matanthauzidwe omwe amadziwika ndi mfundo zomwe munthu amayesetsa kuzitsatira pamoyo watsiku ndi tsiku. Pomaliza, pochita zinthu modzipereka, odwala amatha kuzindikira kusintha kwamakhalidwe mogwirizana ndi zomwe munthu amafunikira. Chifukwa chake, ACT imagwiritsa ntchito mfundo zazikuluzikulu zisanu ndi chimodzi molumikizana wina ndi mnzake kutenga njira yokhazikika pakukulitsa kusinthasintha kwamalingaliro ndikuchepetsa kuvutika. Odwala akulimbikitsidwa kuona ululu kukhala wosapeŵeka ndipo amavomereza mopanda chiweruzo kuti athe kupitiriza kupeza tanthauzo la moyo ngakhale kuti pali ululu. Njira zazikuluzikulu zogwirizanirana zimapereka chitsanzo cha kulingalira ndi kuvomereza ndi kudzipereka ndi kusintha kwa makhalidwe.[45]

 

Zotsatira za kafukufuku wokhudzana ndi mphamvu za ACT-based approach for kasamalidwe ka ululu wosaneneka akulonjeza, ngakhale kuti akuyenera kuyesedwa kwina. RCT yoyerekeza ACT ndi mkhalidwe wowongolera mndandanda wa anthu odikira inanena kusintha kwakukulu kwa kupweteka kwapweteka, kulemala kokhudzana ndi ululu, kukhutitsidwa ndi moyo, kuopa kusuntha, ndi kuvutika maganizo komwe kunasungidwa pakutsatira kwa mwezi wa 7. [46] Chiyeso chachikulu chinawonetsa kusintha kwakukulu kwa ululu, kuvutika maganizo, nkhawa zokhudzana ndi ululu, kulumala, maulendo achipatala, momwe ntchito, ndi machitidwe a thupi.[47] Kusanthula kwaposachedwa kwa meta kuyesa njira zovomerezeka zovomerezeka (ACT ndi kuchepetsa kupsinjika maganizo) kwa odwala omwe ali ndi ululu wosaneneka anapeza kuti, kawirikawiri, mankhwala ovomerezeka ovomerezeka amachititsa zotsatira zabwino kwa odwala omwe ali ndi ululu wosatha.[48] Mwachindunji, kusanthula kwa meta kunavumbulutsa kukula kwapang'onopang'ono kwapang'onopang'ono kwa kupweteka kwambiri, kukhumudwa, nkhawa, kukhala ndi thanzi labwino, komanso moyo wabwino, zokhala ndi zotulukapo zing'onozing'ono zomwe zidapezeka pamene mayesero azachipatala olamulidwa adachotsedwa ndipo ma RCT okha adaphatikizidwa pakuwunikaku.[48] Njira zina zovomerezeka zovomerezeka zimaphatikizirapo chithandizo chamaganizo-khalidwe labwino komanso malingaliro okhudzana ndi chidziwitso, ngakhale kufufuza kozama pakuchita bwino kwa mankhwalawa kwa kasamalidwe ka ululu wosatha akadali akhanda.

 

Zoyembekeza

 

Chinthu chofunikira komanso chosaiwalika chomwe chimapezeka munjira zonse za chithandizo ndikuganizira zomwe wodwalayo akuyembekezera kuti chithandizo chipambane. Ngakhale kuchulukirachulukira pakukonza ndi kupereka chithandizo chamankhwala chamagulu osiyanasiyana ochizira kupweteka kosalekeza, kugogomezera pang'ono kwayikidwa pakuzindikira kufunikira kwa ziyembekezo kuti apambane ndikuyang'ana zoyeserera pakupititsa patsogolo ziyembekezo za odwala. Kuzindikira kuti placebo ya ululu imadziwika ndi zinthu zogwira ntchito zomwe zimatsogolera ku zodalirika, zowoneka, komanso zosinthika zosinthika ndi neurobiological underpinnings pakali pano ndi patsogolo pa kafukufuku wowawa. Kafukufuku wochuluka watsimikizira kuti, pamene akulimbikitsidwa m'njira yomwe imakwaniritsa zoyembekeza (kudzera mwa kusokoneza zoyembekeza zomveka ndi / kapena kukhazikika), ma placebos a analgesic amatha kuchititsa kusintha kowoneka ndi kupimika kwakumva ululu pamlingo wodziwonetsera nokha komanso ubongo. mulingo wochepetsera ululu. [49,50] Mankhwala oletsa ululu amatanthauzidwa momveka bwino ngati njira zochiritsira zongoyerekeza kapena njira zomwe zimachitika m'maganizo ndikukhala ndi zotsatira pa zomwe munthu wina wakumana nazo komanso / kapena thupi lake.[51] Lingaliro lapano la placebo likugogomezera kufunikira kwa chikhalidwe chamaganizo momwe ma placebo amaphatikizidwa. Pansi pa psychosocial ndi mwambo wa chithandizo ndi zomwe odwala amayembekeza. Choncho, n'zosadabwitsa kuti zotsatira za placebo zimakhala zovuta kwambiri pamankhwala aliwonse; motero, madokotala ndi odwala mofanana angapindule pozindikira kuti m'menemo muli njira yowonjezera yomwe chithandizo chamakono cha ululu chingapitirire.

 

Aganiziridwa kuti ziyembekezo zakutsogolo ndizo zisonkhezero zazikulu zomwe zimayendetsa kusintha kwabwino komwe kumachitika kudzera munjira zosiyanasiyana zophunzitsira kupumula, hypnosis, chithandizo chamankhwala, komanso njira zambiri zochiritsira zomwe zimatsata malingaliro. Chifukwa chake, njira yabwino yothanirana ndi zowawa zosatha zimadalira mphamvu za odwala - ziyembekezo zakupambana. N'zomvetsa chisoni kuti nthawi zambiri, opereka chithandizo chamankhwala amanyalanyaza kulongosola mwachindunji ndikugogomezera kufunika kwa zomwe odwala amayembekeza monga zinthu zofunika kwambiri zomwe zimathandizira kuthetsa ululu wosatha. The zeitgeist m'dera lathu ndi yowonjezereka yachipatala cha matenda omwe amachititsa kuti anthu aziyembekeza kuti ululu (ngakhale ululu wosatha) uyenera kuthetsedwa mwa kupita patsogolo kwachipatala. Zoyembekeza zomwe anthu ambiri amayembekezerazi zimachititsa odwala ambiri kukhumudwa ndi zotsatira za chithandizo chamakono ndipo zimapangitsa kuti azifufuza mosalekeza "machiritso". Kupeza �mankhwala� ndikosiyana ndi lamulo lokhudzana ndi zowawa zosatha. M'nyengo yathu yamakono, kumene kupweteka kosalekeza kumavutitsa mamiliyoni ambiri a ku America pachaka, ndizofunika kwambiri kuti tilimbikitse ndikupitirizabe kulimbikitsa kusintha kwa malingaliro omwe m'malo mwake amayang'ana pa kayendetsedwe kabwino ka ululu wosaneneka. Njira yabwino komanso yodalirika yochitira izi ndikupindula kwambiri ndi odwala � ziyembekezo zabwino (zowona) ndikuphunzitsa odwala opweteka komanso anthu wamba (20% ya omwe m'tsogolomu adzakhala odwala opweteka) pazomwe zimapanga ziyembekezo zenizeni. za kasamalidwe ka ululu. Mwina, izi zitha kuchitika poyambilira kudzera mu maphunziro aposachedwa, ozikidwa pa umboni okhudzana ndi placebo ndi zotsatira zosadziwika bwino za chithandizo kotero kuti odwala athe kukonza zikhulupiriro zabodza zomwe angakhale nazo kale. Pambuyo pake, madokotala atha kukhala ndi cholinga chokulitsa ziyembekezo za odwala mkati mwazachipatala (moyenera) ndikuchepetsa ziyembekezo zokayikitsa zomwe zimalepheretsa kuchiza bwino, motero, kuphunzira kupititsa patsogolo chithandizo chawo chamitundumitundu poyesa kupititsa patsogolo kusintha kwa placebo kumatha kubweretsa, ngakhale. mkati �mankhwala ogwira ntchito�. Akatswiri a zamaganizo amatha kuthana ndi vutoli mosavuta ndi odwala awo ndikuwathandiza kukhala ochirikiza chithandizo chawo.

 

Zomwe Zimagwirizana ndi Ululu

 

Mbali yomwe nthawi zambiri imakhala yovuta pakusamalira ululu wosatha ndi kufalikira kwakukulu kwa kupsinjika maganizo kwa comorbid. Kafukufuku wasonyeza kuti kuvutika maganizo ndi matenda ovutika maganizo ndi ochuluka kuwirikiza katatu pakati pa odwala opweteka kwambiri kusiyana ndi anthu ambiri. chisamaliro chomwe adzalandira. Odwala omwe ali ndi vuto la kuvutika maganizo amakhala ndi zotsatira zoipa za kuvutika maganizo ndi mankhwala opweteka, poyerekeza ndi odwala omwe ali ndi vuto limodzi lopweteka kapena kuvutika maganizo. zotsatira za chithandizo ndi kuchepetsa kuvutika maganizo kwa odwala. Akatswiri a zamaganizo amatha kuthana ndi zizindikiro zazikulu (mwachitsanzo, anhedonia, zolimbikitsa zochepa, zolepheretsa kuthetsa mavuto) za kuvutika maganizo zomwe zimasokoneza mosavuta kutenga nawo mbali pa chithandizo ndi kupsinjika maganizo. Komanso, mosasamala kanthu za comorbidity yokhudzana ndi matenda amisala, akatswiri a zamaganizo angathandize odwala omwe ali ndi ululu wosatha kusintha ntchito zofunika zomwe angakumane nazo (mwachitsanzo, kutaya ntchito, kulumala), mavuto omwe angakhale nawo (mwachitsanzo, kudzipatula komwe kumabwera chifukwa cha ululu), ndi kuvutika maganizo (monga nkhawa, mkwiyo, chisoni, kukhumudwa) zomwe zimakhudzidwa ndi zomwe adakumana nazo. Chifukwa chake, akatswiri azamisala atha kukhudza njira yamankhwala pochepetsa kukopa kwamalingaliro omwe amanenedwa ngati gawo la chithandizo.

 

Kutsiliza

 

Ubwino wophatikizapo chithandizo chamaganizo m'njira zosiyanasiyana zoyendetsera ululu wopweteka kwambiri ndi wochuluka. Izi zikuphatikiza, koma sizongowonjezera, kuchulukitsitsa kudziwongolera zowawa, kuwongolera zida zothana ndi zowawa, kulemala kokhudzana ndi zowawa, komanso kuchepetsa kupsinjika kwamalingaliro komwe kumachitika kudzera m'njira zosiyanasiyana zodziletsa, zamakhalidwe, komanso kuzindikira. njira. Kupyolera mu kukhazikitsidwa kwa zosinthazi, katswiri wa zamaganizo angathandize odwala kuti azimva kuti akuwongolera ululu wawo ndikuwathandiza kukhala ndi moyo wabwino momwe angathere ngakhale akumva ululu. Komanso, luso lomwe amaphunzira kudzera m'malingaliro amaganizidwe limapatsa mphamvu ndikupangitsa odwala kukhala okhudzidwa ndi kasamalidwe ka matenda awo ndikuphunzitsa maluso ofunikira omwe odwala angagwiritse ntchito pamoyo wawo wonse. Zopindulitsa zowonjezera za njira yophatikizira komanso yowonjezereka yosamalira ululu wosatha ingaphatikizepo kuwonjezeka kwa chiwerengero cha kubwerera kuntchito, kuchepetsa ndalama zothandizira zaumoyo, komanso kuwonjezeka kwa moyo wokhudzana ndi thanzi la odwala mamiliyoni ambiri padziko lonse lapansi.

 

Chithunzi cha mphunzitsi akupereka malangizo ophunzitsira kwa wodwala.

 

Mawu a M'munsi

 

Kuwulura: Palibe mikangano ya chidwi yomwe idalengezedwa pokhudzana ndi pepalali.

 

Pomaliza, kulowerera m'maganizo kungagwiritsidwe ntchito bwino pothandizira kuthetsa zizindikiro za ululu wosatha pamodzi ndi kugwiritsa ntchito njira zina zothandizira, monga chisamaliro cha chiropractic. Komanso, kafukufuku wafukufuku pamwambawa adawonetsa momwe njira zothandizira maganizo zingathetsere zotsatira za chithandizo cha ululu wosatha. Zambiri zomwe zatchulidwa kuchokera ku National Center for Biotechnology Information (NCBI). Kukula kwa chidziwitso chathu kumangokhala kwa chiropractic komanso kuvulala kwa msana ndi mikhalidwe. Kuti tikambirane nkhaniyi, chonde omasuka kufunsa Dr. Jimenez kapena tilankhule nafe pa 915-850-0900 .

 

Wosankhidwa ndi Dr. Alex Jimenez

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

Mitu Yowonjezera: Ululu Wobwerera

 

Malinga ndi ziwerengero, pafupifupi 80% ya anthu adzakhala ndi zizindikiro za ululu wammbuyo kamodzi pa moyo wawo wonse. Ululu wammbuyo ndi dandaulo lofala lomwe lingakhalepo chifukwa cha kuvulala kosiyanasiyana ndi/kapena mikhalidwe. Nthawi zambiri, kuwonongeka kwachilengedwe kwa msana ndi zaka kungayambitse ululu wammbuyo. Herniated discs zimachitika pamene chofewa, ngati gel pakati pa intervertebral disc ikukankhira kupyola mu misozi yozungulira, mphete yakunja ya cartilage, kuponderezana ndi kukwiyitsa mizu ya mitsempha. Ma disc herniations nthawi zambiri amapezeka m'munsi kumbuyo, kapena msana, koma amathanso kuchitika m'mphepete mwa khomo lachiberekero, kapena khosi. Kulowetsedwa kwa mitsempha yomwe imapezeka m'munsi kumbuyo chifukwa cha kuvulala ndi / kapena kuwonjezereka kwa chikhalidwe kungayambitse zizindikiro za sciatica.

 

chithunzi cha blog cha cartoon paperboy nkhani zazikulu

 

MUTU WOFUNIKA KWAMBIRI: Kuwongolera Kupanikizika Kwapantchito

 

 

NKHANI ZOFUNIKA KWAMBIRI: ZOWONJEZERA ZOWONJEZERA: Chithandizo cha Ngozi ya Galimoto El Paso, TX Chiropractor

 

Palibe kanthu
Zothandizira
1. Boris-Karpel S. Policy ndi zovuta zoyeserera pakuwongolera ululu. Mu: Ebert MH, Kerns RD, akonzi.�Kasamalidwe ka ululu wamakhalidwe ndi psychopharmacologic.�New York: Cambridge University Press; 2010 masamba 407�433.
2. Harstall C, Ospina M. Kodi kupweteka kosalekeza kwachuluka bwanji?�Ululu: Zosintha Zachipatala.�2003;11(2):1-4.
3. National Institutes of Health.�Pepala lodziwikiratu: kuchepetsa ululu.�2007. [Idapezeka pa Marichi 30, 2011]. Ikupezeka ku:�www.ninr.nih.gov/NR/rdonlyres/DC0351A6-7029-4FE0-BEEA-7EFC3D1B23AE/0/Pain.pdf.
4. Abbot FV, Fraser MI. Kugwiritsa ntchito mankhwala osokoneza bongo komanso kugwiritsa ntchito mankhwala osokoneza bongo.�J Psychiatry Neurosci.�1998;23(1):13-34[Nkhani yaulere ya PMC] [Adasankhidwa]
5. Schappert SM, Burt CW. Kuyendera ma ambulatory kumaofesi a madokotala, m'madipatimenti azipatala, ndi madipatimenti owopsa: United States, 2001�02.�Vital Health Stat.�2006;13(159):1-66[Adasankhidwa]
6. Joint Commission of Accreditation of Healthcare Organizations.�Kuwunika ndi kuwongolera ululu: njira ya bungwe.�Oakbrook, IL: 2000.
7. Merkey H, Bogduk N, akonzi.�Gulu la ululu wosatha.� Kusindikiza kwachiwiri. Seattle, WA: IASP Press; 2. Task Force on Taxonomy of the IASP Part III: Mawu opweteka, mndandanda wamakono ndi matanthauzo ndi zolemba pakugwiritsa ntchito; Tsamba la 1994�209.
8. Woessner J. Chitsanzo chamaganizo cha ululu: njira zothandizira.�Pract Pain Manag.�2003;3(1):26-36.
9. Loeser JD. Zotsatira zachuma pakuwongolera zowawa.�Acta Anaesthesiol Scand. 1999;43(9):957-959.[Adasankhidwa]
10. National Research Council. �Matenda a musculoskeletal ndi malo ogwira ntchito: otsika kumbuyo ndi kumtunda.�Washington, DC: National Academy Press; 2001.�[Adasankhidwa]
11. Bungwe la US Census.�Zowerengera za United States: 1996.Chithunzi cha 116th. Washington, DC:
12. Flor H, Fydrich T, Turk DC. Kuchita bwino kwa malo opangira ululu wosiyanasiyana: kuwunika kwa meta-analytic.�Ululu. 1992;49(2):221-230[Adasankhidwa]
13. McCracken LM, Turk DC. Makhalidwe ndi chidziwitso-khalidwe chithandizo cha ululu wosatha: zotsatira, zolosera za zotsatira, ndi njira ya chithandizo.Msana. 2002;27(22):2564-2573[Adasankhidwa]
14. Von Korff M, Saunders K. Njira ya ululu wammbuyo mu chisamaliro chapadera.�Msana. 1996;21(24):2833-2837.[Adasankhidwa]
15. Melzack R, Wall PD. Njira zowawa: chiphunzitso chatsopano.�Sayansi.�1965;150(699):971-979[Adasankhidwa]
16. Melzack R. Ululu ndi kupsinjika maganizo: malingaliro atsopano. Mu: Gatchel RJ, Turk DC, akonzi.�Psychosocial factor mu ululu: malingaliro ovuta.�New York: Guilford Press; 1999 masamba 89�106.
17. Gatchel RJ. Maziko amalingaliro a kasamalidwe ka ululu: mbiri yakale. Mu: Gatchel RJ, mkonzi.�Zofunikira zachipatala pakuwongolera ululu.�Washington, DC: American Psychological Association; 2005 masamba 3-16.
18. Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back ululu.�Health Psychol.�2007;26(1):1-9[Adasankhidwa]
19. Kerns RD, Sellinger J, Goodin BR. Psychological treatment of chronic pain.�Annu Rev Clin Psychol2010 Sep 27;�[Epub patsogolo pa kusindikiza]
20. Yucha C, Montgomery D. �Zochita zozikidwa paumboni mu biofeedback ndi neurofeedback.�Wheat Ridge, CO: AAPB; 2008.
21. Nestoriuc Y, Martin A. Mphamvu ya biofeedback ya migraine: meta-analysis.�Ululu. 2007;128(1; 2): 111-127[Adasankhidwa]
22. Gardea MA, Gatchel RJ, Mishra KD. Kugwiritsa ntchito nthawi yayitali kwa biobehavioral chithandizo cha matenda a temporomandibular.J Behav Med. �2001;24(4):341-359[Adasankhidwa]
23. Turk DC, Monarch ES. Malingaliro a biopsychosocial pa ululu wopweteka. Mu: Turk DC, Gatchel RJ, akonzi.�Njira zama Psychosocial pakuwongolera ululu: bukhu la akatswiri.� Kusindikiza kwachiwiri. New York: Guilford Press; 2 masamba 2002-3.
24. Philips HC.Kasamalidwe ka maganizo a ululu wosatha: buku lothandizira.�New York: Springer Publishing; 1988. Kuwongolera: kupweteka kosalekeza ndi njira yodzilamulira; masamba 45-60.
25. Bernstein DA, Borkovek TD.�Progressive muscle relaxation Training: Buku lothandizira akatswiri.Champaign, IL: Research Press; 1973.
26. Linden WMaphunziro a Autogenic: kalozera wazachipatala.�New York: Guilford; 1990.
27. Jimmy RN.�Kudziwa kupweteka kosalekeza: kalozera wa akatswiri pankhani zamakhalidwe.�Sarasota, FL: Professional Resource Press; 1996.
28. Baird CL, Sands L. Zotsatira za zithunzi zotsogozedwa ndi kupumula pa umoyo wokhudzana ndi thanzi la amayi okalamba omwe ali ndi nyamakazi ya osteoarthritis.�Res Nurs Health.�2006;29(5):442-451[Adasankhidwa]
29. Carroll D, Seers K. Kupumula kwa mpumulo wa ululu wosatha: kubwereza mwadongosolo.�J Adv Nurs.�1998;27(3):476-487[Adasankhidwa]
30. Morone NE, Greco CM. Kuthandizira m'thupi kwa ululu wosaneneka kwa akulu akulu: kuwunikira kokhazikika.�Pain Med. �2007;8(4):359-375[Adasankhidwa]
31. Mannix LK, Chandurkar RS, Rybicki LA, Tusek DL, Solomon GD. Zotsatira za zithunzi zotsogozedwa paubwino wa moyo kwa odwala omwe ali ndi mutu wovuta kwambiri.�Kupweteka kwa mutu.�1999;39(5):326-334[Adasankhidwa]
32. Skinner BF.�Sayansi ndi khalidwe laumunthu.�New York: Free Press; 1953.
33. Fordyce WE.�Njira zamakhalidwe zowawa kwanthawi yayitali komanso matenda.�London, UK: Kampani ya CV Mosby; 1976.
34. Vlayen JW, Linton SJ. Kupewa-mantha ndi zotsatira zake mu ululu wosatha wa musculoskeletal: mkhalidwe waluso.�Ululu. 2000;85(3):317-332[Adasankhidwa]
35. Vlayen JW, de Jong J, Sieben J, Crombez G.mu vivo�chifukwa cha mantha obwera chifukwa cha ululu. Mu: Turk DC, Gatchel RJ, akonzi.�Njira zama Psychosocial pakuwongolera ululu: bukhu la akatswiri.� Kusindikiza kwachiwiri. New York: Guilford Press; 2 masamba 2002-210.
36. De Jong JR, Vlaeyen JW, Onghena P, Cuypers C, den Hollander M, Ruijgrok J. Kuchepetsa mantha okhudzana ndi ululu mu zovuta zamtundu wa matenda amtundu wa I: kugwiritsa ntchito kuwonetseredwa kwapamwamba mu vivo.�Ululu. 2005;116(3):264-275[Adasankhidwa]
37. Boersma K, Linton S, Overmeer T, Jansson M, Vlaeyen J, de Jong J. Kuchepetsa kupeŵa mantha ndi kupititsa patsogolo ntchito kupyolera mu vivo: kafukufuku wambiri woyambira pa odwala asanu ndi limodzi omwe ali ndi ululu wammbuyo.�Ululu. 2004;108(1; 2): 8-16[Adasankhidwa]
38. Bliokas VV, Cartmill TK, Nagy BJ. Kodi kuwonetseredwa mwadongosolo mu vivo kumakulitsa zotulukapo m'magulu osamalira ululu osatha?Clin J Pain. �2007;23(4):361-374[Adasankhidwa]
39. Leeuw M, Goossens ME, van Breukelen GJ, et al. Kuwonetsa mu vivo motsutsana ndi ntchito zogwirira ntchito mwa odwala omwe ali ndi ululu wopweteka kwambiri: zotsatira za mayesero olamulidwa mwachisawawa.Ululu. 2008;138(1):192-207.[Adasankhidwa]
40. George SZ, Zeppieri G, Cere AL, et al. Kuyesedwa kosasinthika kwa machitidwe opangira chithandizo chamankhwala opweteka kwambiri komanso opweteka kwambiri (NCT00373867)Ululu. 2008;140(1):145-157[Nkhani yaulere ya PMC][Adasankhidwa]
41. Roditi D, Waxenberg LB, Robinson ME. Kuchulukana kowoneka bwino kwa kupirira kumatanthawuza magulu ang'onoang'ono a odwala omwe ali ndi ululu wosaneneka.�Clin J Pain. �2010;26(8):677-682[Adasankhidwa]
42. Morley S, Eccleston C, Williams A. Kuwunika mwadongosolo komanso kusanthula meta-kuwunika koyang'aniridwa mosasinthika kwa cognitive Behavior therapy ndi Behaviotherapy kwa Kupweteka Kwambiri kwa Akuluakulu, Kusaphatikiza Kumutu.Ululu. 1999;80(1; 2): 1-13[Adasankhidwa]
43. Eccleston C, Williams AC, Morley S. Psychological Therapies for the management of chronic pain (kupatulapo mutu) mwa akuluakulu.�Cochrane Database Syst Rev.�2009;(2):CD007407.�[Adasankhidwa]
44. Blackledge JT, Hayes SC. Kuwongolera kwamalingaliro pakuvomera komanso kudzipereka.�J Clin Psychol2001;57(2):243-255[Adasankhidwa]
45. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Kuvomereza ndi kudzipereka chithandizo: chitsanzo, ndondomeko, ndi zotsatira.�Behav Res Ther.�2006;44(1):1-25[Adasankhidwa]
46. Wicksell RK, Ahlqvist J, Bring A, Melin L, Olsson GL. Kodi njira zowonetsera zingathe kupititsa patsogolo ntchito ndi kukhutira kwa moyo mwa anthu omwe ali ndi ululu wosatha komanso matenda okhudzana ndi chikwapu (WAD)? Kuyesa kosasinthika.�Cogn Behav Ther.�2008;37(3):169-182[Adasankhidwa]
47. Vowles KE, McCracken LM. Kuvomereza ndi Zochita Zogwirizana ndi Zowawa Zosatha: Kuphunzira Zakuthandiza Kwamankhwala Ndi Njira.�J Consult Clinl Psychol.�2008;76(3):397-407[Adasankhidwa]
48. Veehof MM, Oskam MJ, Schreurs KMG, Bohlmeijer ET. Njira zovomerezeka zochizira kupweteka kosalekeza: kuwunika mwadongosolo komanso kusanthula meta.�Ululu. 2011;152(3):533-542[Adasankhidwa]
49. Wager TD, Rilling JK, Smith EE, et al. Kusintha kopangidwa ndi placebo mu�f�MRI poyembekezera komanso kumva zowawa.�Sayansi.�2004;303(5661):1162-1167[Adasankhidwa]
50. Price DD, Craggs J, Verne GN, Perlstein WM, Robinson ME. Placebo analgesia imatsagana ndi kuchepa kwakukulu kwa zochitika za ubongo zokhudzana ndi ululu mwa odwala omwe ali ndi vuto la matumbo.Ululu. 2007;127(1; 2): 63-72[Adasankhidwa]
51. Price D, Finnis D, Benedetti F. Ndemanga yathunthu ya zotsatira za placebo: kupita patsogolo kwaposachedwa ndi malingaliro apano.�Annu Rev Psychol.�2008;59: 565-590[Adasankhidwa]
52. Holroyd KA. Kupweteka kwamutu kobwerezabwereza. Mu: Dworkin RH, Breitbart WS, akonzi.�Makhalidwe a maganizo a ululu: bukhu la opereka chithandizo chamankhwala.�Seattle, WA: IASP Press; 2004 masamba 370�403.
53. Fishbain DA. Njira zopangira zisankho zamankhwala a psychiatric comorbity pakuwongolera odwala omwe ali ndi ululu wosachiritsika.�Med Clin North Am.�1999;83(3):737-760[Adasankhidwa]
54. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity � ndemanga ya mabuku.�Arch Intern Med.�2003;163(20):2433-2445[Adasankhidwa]
55. Poleshuck EL, Talbot NL, Su H, et al. Ululu ngati wolosera za zotsatira za chithandizo cha kupsinjika maganizo mwa amayi omwe ali ndi nkhanza zogonana paubwana.�Compr Psychiatry.�2009;50(3):215-220[Nkhani yaulere ya PMC] [Adasankhidwa]
Tsekani Accordion
Kuchitapo kanthu kwa Mindfulness for Chronic Headache ku El Paso, TX

Kuchitapo kanthu kwa Mindfulness for Chronic Headache ku El Paso, TX

by | Chiropractic, Zinthu Zinachitiridwa, Kukhazikitsanso Thupi, Mayesero Olamulidwa Mwachisawawa, kupanikizika, Kuchiza

Ngati munadwalapo mutu, simuli nokha. Pafupifupi anthu 9 mwa 10 aliwonse ku United States amadwala mutu. Ngakhale kuti zina zimakhala zapakatikati, zina kawirikawiri, zina zimakhala zosasunthika komanso zopweteka, ndipo zina zimayambitsa ululu wofooketsa ndi nseru, kuchotsa ululu wa mutu ndiko kuyankha mwamsanga kwa ambiri. Koma, mungatani kuti muchepetse kupweteka kwa mutu?

 

Kafukufuku wasonyeza kuti chisamaliro cha chiropractic ndi njira ina yothandizira mitundu yambiri yamutu. Lipoti la 2014 mu Journal of Manipulative and Physiological Therapeutics (JMPT) linapeza kuti kusintha kwa msana ndi kusintha kwamanja komwe kumagwiritsidwa ntchito pa chisamaliro cha chiropractic kumapangitsa kuti pakhale zotsatira zochizira kupweteka kwapakhosi komanso kupweteka kwapakhosi komanso kupititsa patsogolo ubwino wa njira zosiyanasiyana zochiritsira. kupweteka kwa khosi. Kuphatikiza apo, kafukufuku wa 2011 JMPT adapeza kuti chisamaliro cha chiropractic chikhoza kusintha ndikuchepetsa pafupipafupi migraine ndi mutu wa cervicogenic.

 

Kodi Chiropractic Care Imathandiza Bwanji Mitu?

 

Chisamaliro cha Chiropractic chimayang'ana pa chithandizo cha kuvulala kosiyanasiyana ndi / kapena mikhalidwe ya minofu ndi mitsempha yamanjenje, kuphatikizapo mutu. Katswiri wa chiropractor amagwiritsa ntchito kusintha kwa msana ndi kuwongolera pamanja kuti akonze bwino momwe msanawo umayendera. A subluxation, kapena kusokonezeka kwa msana, kwasonyezedwa kuti kumayambitsa zizindikiro, monga khosi ndi khosi. ululu wammbuyo, ndi mutu ndi migraine. Msana wokhazikika ukhoza kupititsa patsogolo ntchito ya msana komanso kuchepetsa kupanikizika kwapangidwe. Kuonjezera apo, dokotala wa chiropractic angathandize kuchiza kupweteka kwa mutu ndi zizindikiro zina zowawa popereka uphungu wa zakudya, kupereka uphungu wa kaimidwe ndi ergonomics ndi kulimbikitsa kuwongolera kupsinjika ndi uphungu wolimbitsa thupi. Chisamaliro cha Chiropractic pamapeto pake chimachepetsa kupsinjika kwa minofu mozungulira msana, ndikubwezeretsa ntchito yoyambirira ya msana.

 

Dr. Alex Jimenez amachita kusintha kwa chiropractic kwa wodwala.

 

Dr. Alex Jimenez amapereka uphungu wolimbitsa thupi kwa wodwala.

 

Kuphatikiza apo, chisamaliro cha chiropractic chimatha kuchiza bwino komanso moyenera matenda ena a msana, kuphatikiza zizindikiro za khosi ndi ululu wammbuyo chifukwa cha khomo lachiberekero ndi lumbar herniated discs, pakati pa kuvulala kwina ndi / kapena mikhalidwe. Katswiri wa zachipatala amamvetsetsa momwe kusokonezeka kwa msana, kapena kusakanikirana, kungakhudzire madera osiyanasiyana a thupi ndipo amachitira thupi lonse m'malo mongoganizira za chizindikiro chokha. Chithandizo cha chiropractic chingathandize thupi la munthu mwachibadwa kubwezeretsa thanzi lake loyambirira ndi thanzi.

 

Kuyanjana kwa Mphunzitsi ndi odwala pa rehabilitation center.

 

Zimadziwika bwino kuti chisamaliro cha chiropractic chimakhala chothandiza kuvulala kosiyanasiyana komanso / kapena mikhalidwe, komabe, pazaka zingapo zapitazi, kafukufuku wofufuza apeza kuti chiropractic imatha kupititsa patsogolo moyo wathu mwa kuwongolera kupsinjika kwathu. Kafukufuku wambiri waposachedwapa wasonyeza kuti chisamaliro cha chiropractic chingasinthe chitetezo cha mthupi, kukhudza kugunda kwa mtima, komanso kuchepetsa kuthamanga kwa magazi. Kafukufuku wa 2011 wochokera ku Japan anasonyeza kuti chiropractic ikhoza kukhala ndi chikoka chachikulu pa thupi lanu kuposa momwe mumakhulupirira.

 

Kupsinjika maganizo ndi chizindikiro chofunikira cha thanzi, ndipo zizindikiro za ululu wosatha zimatha kukhudza kwambiri thanzi. Ofufuza ku Japan ankafuna kufufuza ngati chiropractic ingasinthe milingo ya kupsinjika kwa amuna ndi akazi a 12 omwe ali ndi ululu wa khosi ndi mutu. Koma asayansi ku Japan ankafuna kupeza chithunzithunzi chodziwika bwino cha momwe kusintha kwa msana wa chiropractic ndi kusintha kwapamanja kumakhudzira dongosolo la mitsempha, choncho amagwiritsa ntchito PET scans kuti ayang'ane ntchito za ubongo ndi mayesero a salvia kuti ayang'ane kusintha kwa mahomoni.

 

Pambuyo pa chisamaliro cha chiropractic, odwala adasintha ntchito zaubongo m'malo aubongo omwe amayambitsa kupweteka komanso kupsinjika. Iwo adachepetsanso kwambiri ma cortisol, zomwe zikuwonetsa kuchepa kwa nkhawa. Ophunzirawo adanenanso za ululu wochepa komanso moyo wabwino kwambiri pambuyo pa chithandizo. Kuchitapo kanthu mwanzeru, monga chisamaliro cha chiropractic, ndi njira ndi njira zoyendetsera kupsinjika. Kupanikizika kosalekeza kungayambitse matenda osiyanasiyana, kuphatikizapo kupweteka kwa khosi ndi msana komanso mutu ndi migraine. Njira zina zochitira zinthu mwanzeru zingathandizenso bwino komanso moyenera kusintha zizindikiro. Cholinga cha nkhani yotsatirayi ndi kusonyeza mphamvu ya kulowerera kwina kwa kulingalira, komwe kumadziwika kuti kuchepetsa kupsinjika maganizo, pakumva kupweteka kwakukulu komanso moyo wabwino kwa odwala omwe adapezeka kale ndi mutu wopweteka.

 

Kuchita Bwino kwa Kuchepetsa Kupsinjika Maganizo Motengera Kupsinjika Pakukulira Kwa Ululu Womwe Ukuwoneka ndi Ubwino Wamoyo Kwa Odwala Omwe Ali ndi Mutu Wosatha.

 

Kudalirika

 

Cholinga cha phunziroli chinali kudziwa mphamvu ya Mindfulness-Based Stress Reduction (MBSR) pakumva kupweteka kwamphamvu komanso moyo wabwino kwa odwala omwe ali ndi mutu wopweteka. Choncho, odwala makumi anayi okhudzana ndi matenda a matenda a ubongo ndi njira zodziwira matenda a International Headache Society (IHS) chifukwa cha mutu wa mutu wa migraine ndi mutu wamtundu wamtundu wovuta kwambiri anasankhidwa ndikupatsidwa mwachisawawa ku gulu lothandizira ndi gulu lolamulira, motero. Ophunzirawo adamaliza mafunso a Pain and Quality of Life (SF-36). Gulu lothandizira linalembetsa pulogalamu ya masabata asanu ndi atatu ya MBSR yomwe inaphatikizapo kusinkhasinkha ndi zochitika zapakhomo za tsiku ndi tsiku, pa sabata, gawo la 90-minutes. Zotsatira za kusanthula kwa covariance ndi kuthetsa kuyesedwa koyambirira kunasonyeza kusintha kwakukulu kwa ululu ndi umoyo wa moyo mu gulu lothandizira poyerekeza ndi gulu lolamulira. Zotsatira za phunziroli zasonyeza kuti MBSR ingagwiritsidwe ntchito popanga mankhwala osagwiritsa ntchito mankhwala kuti apititse patsogolo umoyo wa moyo ndi chitukuko cha njira zothetsera ululu kwa odwala omwe ali ndi mutu wopweteka. Ndipo angagwiritsidwe ntchito limodzi ndi mankhwala ena monga pharmacotherapy.

 

Keywords: kupweteka kosalekeza, mutu waching'alang'ala, kulingalira, khalidwe la moyo, kupweteka kwa mutu

 

Dr Jimenez White Coat

Kuzindikira kwa Dr. Alex Jimenez

Kupweteka kwa mutu ndi chizindikiro chofooketsa chomwe chimakhudza anthu ambiri. Pali mitundu yambiri yamutu wamutu, komabe, ambiri mwa iwo nthawi zambiri amagawana zomwe zimayambitsa. Kupsinjika kwanthawi yayitali kungayambitse matenda osiyanasiyana osayendetsedwa bwino, kuphatikiza kupsinjika kwa minofu, komwe kungayambitse kusayenda bwino kwa msana, kapena kutsika, komanso zizindikiro zina, monga kupweteka kwa khosi ndi msana, kupweteka kwa mutu ndi migraines. Njira zowongolera kupsinjika ndi njira zimatha kuthandizira kukonza ndikuwongolera zovuta zomwe zimagwirizana ndi kupsinjika. Kuchitapo kanthu mwanzeru monga chisamaliro cha chiropractic ndi kuchepetsa kupsinjika maganizo kwatsimikiziridwa kuti kumathandiza kuchepetsa kupsinjika maganizo ndi kuchepetsa zizindikiro za mutu wa mutu.

 

Introduction

 

Kupweteka kwa mutu ndi chimodzi mwazodandaula zomwe zimafufuzidwa m'machipatala akuluakulu ndi a ana. Ambiri mwa mitu iyi ndi mutu waching'alang'ala komanso mutu wovuta (Kurt & Kaplan, 2008). Mutu umagawidwa m'magulu awiri a mutu waukulu kapena wapachiyambi ndi wachiwiri. Makumi asanu ndi anayi pa zana aliwonse a mutu wa mutu ndi mutu waukulu, womwe pakati pa mutu wa migraine ndi kupwetekedwa kwa mutu ndi mitundu yofala kwambiri (International Headache Society [IHS], 2013). Malinga ndi tanthauzo lake, mutu waching'alang'ala nthawi zambiri umakhala wokhawokha komanso umagunda mwachilengedwe ndipo umatenga maola 4 mpaka 72. Zizindikiro zomwe zimagwirizanitsidwa nazo ndi monga nseru, kusanza, kukhudzika kwa kuwala, phokoso ndi ululu, ndipo nthawi zambiri zimawonjezeka ndi kuchita masewera olimbitsa thupi. Komanso, kupweteka kwa mutu kumadziwika ndi kupweteka kwapakati, kosasunthika, kupanikizika kapena kutsekeka, kupweteka kwapang'onopang'ono, monga bandeji kapena chipewa, komanso kupweteka pang'ono mpaka pang'ono, kulepheretsa zochitika za tsiku ndi tsiku (IHS, 2013).

 

Stovner et al. (2007) pogwiritsa ntchito njira zodziwira matenda a IHS, akuyerekeza kuchuluka kwa anthu akuluakulu omwe ali ndi vuto lopweteka lamutu pafupifupi 46% chifukwa cha mutu wamba, 42% chifukwa cha kupweteka kwa mutu. Izi zikusonyeza kuti zochitika ndi kufalikira kwa mutu wamtundu wa kupsinjika maganizo ndizokwera kwambiri kuposa momwe zinanenedweratu. Akuti pafupifupi 12 mpaka 18 peresenti ya anthu ali ndi migraines (Stovner & Andree, 2010). Azimayi amatha kukhala ndi migraines poyerekeza ndi amuna, kuchuluka kwa migraine kumakhala pafupifupi 6% kwa amuna ndi 18% kwa amayi (Tozer et al., 2006).

 

Mutu wa mutu wa Migraine ndi kupsinjika maganizo ndizodziwika bwino komanso zolembedwa bwino pazovuta zamaganizo ndi zathupi (Menken, Munsat, & Toole, 2000). Migraine ndi ululu wopweteka nthawi ndi nthawi komanso wofooketsa ndipo umakhudza kwambiri moyo, maubwenzi ndi zokolola. Bungwe la World Health Organization (WHO) lalengeza kuti migraine yoopsa kwambiri ndi imodzi mwa matenda ofooketsa kwambiri omwe ali ndi chiwerengero cha khumi ndi zisanu ndi zinayi (IHS, 2013; Menken et al., 2000).

 

Ngakhale kupangidwa kwa mankhwala ambiri ochizira komanso kupewa matenda a mutu waching'alang'ala, odwala angapo amawapeza kukhala osagwira ntchito ndipo ena amawaona kuti ndi osayenera chifukwa cha zotsatira zake zoyipa komanso zotsatirapo zake nthawi zambiri zimayambitsa kusiya chithandizo msanga. Chotsatira chake, chidwi chachikulu pa chitukuko cha mankhwala osakhala a pharmacologic chikhoza kuwonedwa (Mulleners, Haan, Dekker, & Ferrari, 2010).

 

Zinthu zamoyo zokha sizingafotokoze chiopsezo cha kupwetekedwa kwa mutu, kuyambika kwa kuukira ndi njira yake, kuwonjezereka kwa mutu, kulemala kwa mutu komanso umoyo wa moyo kwa odwala omwe ali ndi mutu wopweteka. Zochitika zoyipa pamoyo ndi (monga psychosocial factor) zomwe nthawi zambiri zimadziwika kuti ndizofunikira kwambiri pakukulitsa komanso kukulitsa mutu (Nash & Thebarge, 2006).

 

Pulogalamu ya Mindfulness-Based Stress Reduction (MBSR) ndi imodzi mwa mankhwala omwe aphunziridwa m'zaka makumi awiri zapitazi pa zowawa zosiyanasiyana. MBSR yopangidwa ndi Kabat-Zinn ndipo imagwiritsidwa ntchito m'magulu ambiri omwe ali ndi mavuto okhudzana ndi kupsinjika maganizo komanso kupweteka kosalekeza (Kabat-Zinn, 1990). Makamaka m'zaka zaposachedwa, maphunziro ambiri apangidwa kuti awone zotsatira za chithandizo cha MBSR. Kafukufuku wambiri wasonyeza zotsatira zazikulu za MBSR pazochitika zosiyanasiyana zamaganizo kuphatikizapo kuchepetsa zizindikiro zamaganizo za kupsinjika maganizo, nkhawa, kudandaula, nkhawa ndi kuvutika maganizo (Bohlmeijer, Prenger, Taal, & Cuijpers, 2010; Carlson, Speca, Patel, & Goodey, 2003; Grossman, Niemann, Schmidt, & Walach, 2004; Jain et al., 2007; Kabat-Zinn, 1982; Kabat-Zinn, Lipworth, & Burney, 1985; Kabat-Zinn et al., 1992; Teas et al. , 2002), ululu (Flugel et al., 2010; Kabat-Zinn, 1982; Kabat-Zinn et al., 1985; La Cour & Petersen, 2015; Rosenzweig et al., 2010; Zeidan, Gordon, Merchant, & Goolkasian , 2010) ndi moyo wabwino (Brown & Ryan, 2003; Carlson et al., 2003; Flugel et al., 2010; Kabat-Zinn, 1982; La Cour & Petersen, 2015; Morgan, Ransford, Morgan, Driban, & Wang, 2013; Rosenzweig et al., 2010).

 

Bohlmeijer et al. (2010) adafufuza meta-analysis ya maphunziro asanu ndi atatu omwe amayendetsedwa mwachisawawa pa zotsatira za pulogalamu ya MBSR, adatsimikiza kuti MBSR ili ndi zotsatira zochepa pa kuvutika maganizo, nkhawa ndi maganizo a anthu omwe ali ndi matenda aakulu azachipatala. Komanso Grossman et al. (2004) mu meta-analysis of 20 yoyendetsedwa ndi maphunziro osalamulirika pa zotsatira za pulogalamu ya MBSR pa thanzi lakuthupi ndi lamaganizo la zitsanzo zachipatala ndi zosagwirizana ndi zamankhwala, anapeza kukula kwakukulu kwa maphunziro oyendetsedwa bwino pa umoyo wamaganizo. Palibe kukula kwake kwa zizindikiro zenizeni monga kukhumudwa ndi nkhawa zomwe zidanenedwa. Ndemanga yaposachedwa kwambiri imaphatikizapo maphunziro a 16 olamulidwa ndi osalamuliridwa, Ndemangayi inanena kuti kulowerera kwa MBSR kumachepetsa kupweteka kwambiri, ndipo maphunziro oyesedwa kwambiri (6 a 8) amasonyeza kuchepetsa kwambiri kupweteka kwamphamvu kwa gulu lothandizira poyerekeza ndi gulu lolamulira (Reiner, Tibi, & Lipsitz, 2013).

 

Mu kafukufuku wina, ofufuza adapeza kukula kwakukulu kwa magawo ena a moyo mwachitsanzo kukula kwa mphamvu ndi kupweteka kwa thupi, kukula kosafunikira kwa ululu ndi zotsatira zazikulu zapakati mpaka zazikulu zochepetsera nkhawa ndi kuvutika maganizo (La Cour & Petersen, 2015) . Komanso mu kafukufuku wa Rosenzweig et al. (2010) kwa odwala omwe ali ndi ululu wopweteka kwambiri kuphatikizapo omwe akudwala migraine, panali kusiyana kwakukulu kwa kupweteka kwakukulu, zolepheretsa ntchito zowawa pakati pa odwala. Komabe, omwe akudwala mutu waching'alang'ala adawona kusintha kocheperako kwa ululu ndi mbali zosiyanasiyana za moyo. Kawirikawiri, magulu osiyanasiyana a ululu wosatha amasonyeza kusintha kwakukulu kwa kupweteka kwapweteka komanso zolepheretsa zogwira ntchito zokhudzana ndi ululu mu phunziroli. Maphunziro ena awiri adachitidwa ndi Kabat-Zinn ndikugwiritsa ntchito njira za MBSR zochizira odwala omwe ali ndi ululu wopweteka kwambiri, kuphatikizapo odwala ambiri omwe ali ndi mutu wopweteka. Kusanthula kwachiwerengero kunasonyeza kuchepa kwakukulu kwa ululu, kusokoneza kupweteka kwa ntchito za tsiku ndi tsiku, zizindikiro zachipatala ndi zamaganizo, nkhawa ndi kupsinjika maganizo, maonekedwe oipa a thupi, kusokoneza zowawa za tsiku ndi tsiku, kugwiritsa ntchito mankhwala osokoneza bongo komanso kuwonjezeka kwa chidaliro (Kabat-Zinn, 1982; Kabat-Zinn et al., 1985).

 

Chifukwa cha ululu ndi kutayika kwa ntchito komanso kuchepa kwa zokolola za ntchito komanso kugwiritsa ntchito kwambiri chithandizo chamankhwala, kupweteka mutu kumabweretsa ndalama kwa munthu payekha komanso anthu, zikuwoneka kuti mutu wopweteka kwambiri ndi vuto lalikulu la thanzi ndipo kupeza njira zothetsera vutoli kungakhale kufunika kwakukulu. Cholinga chachikulu cha phunziroli chinali kuyesa mphamvu ya MBSR kuwonjezera pa mankhwala ochiritsira ochiritsira m'chitsanzo cha odwala omwe ali ndi mutu wopweteka kwambiri kuti asonyeze mphamvu ya njirayi monga njira yothetsera ululu ndi kupititsa patsogolo umoyo wa odwala. ndi mutu wanthawi zonse.

 

Njira

 

Ophunzira ndi Ndondomeko

 

Uwu ndi mtundu wa kafukufuku wopangidwa mwachisawawa wamagulu awiri �pretest-posttest�. Komanso chivomerezo chinapezedwa kuchokera ku Komiti ya Ethics ya Zahedan University of Medical Sciences. Ophunzirawo adasankha kudzera mwa njira zosavuta zochitira sampuli kuchokera kwa odwala omwe ali ndi mutu wa mutu wa migraine ndi kupweteka kwa mutu, omwe amapezeka ndi katswiri wa zamaganizo ndi katswiri wa zamaganizo pogwiritsa ntchito njira zodziwira matenda a IHS-otchulidwa ku zipatala za yunivesite ya Zahedan University of Medical Sciences, Zahedan-Iran.

 

Pambuyo poyesa wodwala aliyense kuti akwaniritse njira zophatikizira ndi kuchotsedwa ndi kutenga kuyankhulana koyambirira, 40 mwa odwala makumi asanu ndi atatu mphambu asanu ndi awiri omwe ali ndi mutu wopweteka kwambiri adasankhidwa ndipo mwachisawawa adagawidwa m'magulu awiri ofanana a kulowerera ndi kulamulira. Magulu onse olamulira ndi othandizira adalandira chithandizo chamankhwala chodziwika bwino moyang'aniridwa ndi katswiri wazamisala. Pa nthawi ya chithandizo maphunziro atatu, chifukwa cha kusowa kwa nthawi zonse kapena njira zochotseramo, adatuluka kapena sanalowe mu phunziroli.

 

Mfundo Zowonjezera

 

  • (1) Chilolezo chodziwitsidwa kuti achite nawo magawo.
  • (2) Zaka zosachepera 18.
  • (3) Chiyeneretso chochepa cha maphunziro a digiri ya sekondale.
  • (4) Kuzindikiridwa kwa mutu wopweteka (ching'ono chachikulu cha migraine ndi mutu wamtundu wovuta) ndi katswiri wa zamaganizo komanso molingana ndi njira zodziwira matenda a IHS.
  • (5) 15 kapena masiku ochulukirapo pamwezi kwa miyezi yoposa 3 ndi miyezi isanu ndi umodzi ya mbiri ya migraines ndi kupweteka kwa mutu

 

Zosowa Zotsalira

 

  • (1) Anthu omwe sanafune kupitiriza kutenga nawo mbali mu kafukufukuyu kapena kusiya phunziroli pazifukwa zilizonse.
  • (2) Mavuto ena opweteka kwambiri.
  • (3) Psychosis, delirium ndi vuto lachidziwitso.
  • (4) Milandu yamavuto omwe amasokoneza mgwirizano.
  • (5) Kugwiritsa ntchito mankhwala osokoneza bongo.
  • (6) Kusokonezeka maganizo

 

Magulu Olowa

 

Magawo ochiritsira (MBSR) anachitikira kwa 1.5 kwa maola 2 pa sabata kwa mamembala a gulu lothandizira (mankhwala kuphatikizapo MBSR); Ngakhale kuti palibe MBSR yomwe inachitikira gulu lolamulira (mankhwala omwe amagwiritsidwa ntchito kawirikawiri) mpaka kumapeto kwa kafukufuku. MBSR idachitika kwa masabata a 8. Mu phunziro ili, pulogalamu ya 8-session MBSR (Chaskalon, 2011) yagwiritsidwa ntchito. Kuchita homuweki yosinkhasinkha pophunzitsa ophunzira m'magawo, njira zoyenera zaperekedwa mu CD ndi kabuku. Ngati wina wa maphunziro sanachite nawo gawo kapena magawo, kumayambiriro kwa gawo lotsatira wothandizirayo adzapereka zolemba zolembedwa za magawowo ku maphunzirowo, kuphatikizapo kubwereza chidule cha gawo lapitalo. Pulogalamu ya MBSR ndi zokambirana zinaperekedwa kwa odwala m'magawo asanu ndi atatu kuphatikizapo: kumvetsetsa ululu ndi etiology yake, kukambirana za kupsyinjika kwa ubale, mkwiyo ndi kukhudzidwa ndi ululu, Kumvetsetsa maganizo oipa odziwikiratu, kuzindikira malingaliro ndi malingaliro, kuyambitsa lingaliro la Kuvomereza, malo opuma. , malo opumira a mphindi zitatu, kuchita masewera olimbitsa thupi, zochitika zosangalatsa ndi zosasangalatsa tsiku ndi tsiku, kuyambitsa khalidwe, kukumbukira zochitika zachizoloŵezi, kuchita masewera olimbitsa thupi, Kuwona ndi kumva kuchita masewera olimbitsa thupi, kukhala pansi kusinkhasinkha, kuyenda moganizira, kuwerenga ndakatulo zokhudzana ndi kulingalira komanso kukambirana momwe mungachitire. sungani zomwe zapangidwa pamaphunziro onse, kambiranani mapulani ndi zifukwa zabwino zopitirizira mchitidwewu. Odwala adalandiranso chidziwitso chokhudza momwe angadziwire kuyambiranso kwamtsogolo komanso njira ndi mapulani omwe angayambitsire kuzindikira koyambirira kwa zizindikiro zowawa komanso kudziwongolera pazochitika zatsopano.

 

Gulu Lolamulira

 

Odwala omwe anali osankhidwa mwachisawawa mu gulu lolamulira anali kupitirizabe mankhwala ochiritsira (kuphatikizapo mankhwala enieni komanso osadziwika) ndi katswiri wawo wa mitsempha mpaka kumapeto kwa kafukufuku.

 

Zida

 

Zida ziwiri zazikuluzikulu zinagwiritsidwa ntchito poyesa kuyesedwa koyambirira ndi kuyesedwa pambuyo posonkhanitsa deta, kuphatikizapo mawonekedwe a chiwerengero cha anthu. Chipika chamutu chinagwiritsidwa ntchito kuti azindikire kukula kwa ululu pogwiritsa ntchito magawo atatu: (1) 10-point likert-scale ratings, (2) chiwerengero cha maola opweteka pa tsiku ndi (3) kupweteka kwapakati pamwezi. Gawo lirilonse limachokera ku 0 mpaka 100, mlingo wapamwamba kwambiri ndi 100. Popeza kuti wodwala aliyense amawerengera kuti amawamva kupweteka kwambiri mufunso, zovomerezeka ndi zodalirika siziganiziridwa. Ndipo ina inali mafunso afupiafupi a 36 (SF-36). Mafunsowa amagwiritsidwa ntchito m'magulu azaka zosiyanasiyana komanso matenda osiyanasiyana. Kudalirika ndi kutsimikizika kwa mafunsowa kudavomerezedwa ndi Ware et al (Ware, Osinski, Dewey, & Gandek, 2000). SF-36 imawunika momwe moyo ulili m'magulu a 8 monga: kugwira ntchito kwa thupi (PF), malire chifukwa cha thanzi la thupi (RP), kupweteka kwa thupi (PB), thanzi lonse (GH), mphamvu ndi nyonga (VT). ), chikhalidwe cha anthu (SF), malire a udindo chifukwa cha mavuto a maganizo (RE) komanso zimakhudza thanzi (AH). Chidachi chilinso ndi masikelo awiri achidule a Physical Component Summary (PCS) ndi Mental Component Summary (MCS). Mulingo uliwonse umachokera ku 0 mpaka 100, mlingo wapamwamba kwambiri wogwira ntchito ndi 100. Kutsimikizika ndi kudalirika kwa SF-36 kunayesedwa mu chiwerengero cha Iran. Ma coefficients ogwirizana amkati anali pakati pa 0.70 ndi 0.85 kwa 8 subscales ndi test-rest coefficients anali pakati pa 0.49 ndi 0.79 ndi nthawi ya sabata imodzi (Montazeri, Goshtasebi, Vahdaninia, & Gandek, 2005).

 

Kusanthula Deta

 

Pofufuza deta, kuphatikizapo kugwiritsa ntchito zizindikiro zofotokozera, kuyerekezera zotsatira za magulu othandizira ndi olamulira, kufufuza kwa covariance kunagwiritsidwa ntchito kuti adziwe momwe angagwiritsire ntchito komanso kuchotsedwa kwa zotsatira zoyesedwa kale pa 95% mlingo wodalirika.

 

Siyani

 

Pa nthawi ya chithandizo maphunziro atatu, chifukwa cha kusowa kwa nthawi zonse kapena njira zochotseramo, adatuluka kapena sanalowe mu phunziroli. Odwala makumi atatu ndi asanu ndi awiri mwa 40 adamaliza maphunziro aposachedwa ndipo zomwe zidasonkhanitsidwa zidasinthidwa.

 

Results

 

Kusanthula kuyerekeza kugawidwa kwa anthu pakati pa magulu awiriwa kunachitidwa pogwiritsa ntchito chi-square ndi t-test yodziimira. Deta ya chiwerengero cha magulu onsewa ikuwonetsedwa mu Table 1. Kugawidwa kwa zaka, zaka za maphunziro, jenda ndi chikhalidwe chaukwati zinali zofanana mu gulu lirilonse.

 

Gulu 1 Makhalidwe Aanthu Otenga Mbali

Gulu 1: Makhalidwe a anthu omwe akutenga nawo mbali.

 

Gulu 2 likuwonetsa zotsatira za kusanthula kwa covariance (ANCOVA). Mayeso a Levene anali osafunikira, F (1, 35) = 2.78, P = 0.105, zomwe zikuwonetsa kuti lingaliro la kusiyanasiyana kwa kusiyana kwavomerezedwa. Izi zikusonyeza kuti kusiyana pakati pa magulu ndi ofanana ndipo palibe kusiyana pakati pa magulu awiri.

 

Table 2 Zotsatira za Covarice Analysis

Gulu 2: Zotsatira za kusanthula kwa covariance kwa mphamvu ya MBSR pa ululu waukulu.

 

Chotsatira chachikulu cha kulowererapo kwa MBSR chinali chofunikira, F (1, 34) = 30.68, P = 0.001, pang'ono?2 = 0.47, kusonyeza kuti kupweteka kwapweteka kunali kochepa pambuyo pa kulowerera kwa MBSR (Mean = 53.89, SD.E = 2.40) kuposa gulu lolamulira (Kutanthauza = 71.94, SD.E = 2.20). Covariate (kuyesedwa koyambirira kwa ululu) kunalinso kofunika, F (1, 34) = 73.41, P = 0.001, pang'ono?2 = 0.68, kusonyeza kuti msinkhu wa ululu waukulu pamaso pa MBSR kulowererapo kunali ndi zotsatira zazikulu pa mlingo wa ululu waukulu. . Mwa kuyankhula kwina, panali mgwirizano wabwino pamagulu opweteka pakati pa kuyesedwa koyambirira ndi kuyesedwa. Choncho, kafukufuku woyamba wafukufuku amatsimikiziridwa ndipo chithandizo cha MBSR pa mphamvu yodziwika bwino chinali chothandiza kwa odwala omwe ali ndi mutu wopweteka kwambiri ndipo amatha kuchepetsa kukula kwa ululu wopweteka kwa odwalawa. Zofunikira zonse zimanenedwa pa p <0.05.

 

Lingaliro lachiwiri la phunziroli ndilopambana kwa njira ya MBSR pa umoyo wa moyo kwa odwala omwe ali ndi mutu wopweteka. Kufufuza momwe njira ya MBSR imathandizira pa umoyo wa odwala omwe ali ndi mutu wopweteka kwambiri komanso kuchotsa zosokoneza komanso zotsatira za kuyesa koyambirira, pofuna kufufuza deta, multivariate covariance analysis (MANCOVA) ya miyeso ya moyo wabwino imagwiritsidwa ntchito. kuti Table 3 ikuwonetsa zotsatira za kusanthula mu gulu lothandizira.

 

Table 3 Zotsatira za Covariance Analysis

Gulu 3: Zotsatira za kusanthula kwa covariance kwa mphamvu ya MBSR pa umoyo wa moyo.

 

Table 3 ikuwonetsa zotsatira za kusanthula kwa covariance (MANCOVA). Mfundo zotsatirazi ndizofunikira kuti mumvetse zotsatira zomwe zaperekedwa mu Gulu 3.

 

Mayeso a bokosilo anali osafunikira, F = 1.08, P = 0.320, kusonyeza kuti kusiyana � matrices a covariance ndi ofanana m'magulu awiri kotero kuti kulingalira kwa homogeneity kumakwaniritsidwa. Komanso F (10, 16) = 3.153, P = 0.020, Wilks� Lambda = 0.33, partial ?2 = 0.66, kusonyeza kuti kunali kusiyana kwakukulu pakati pa kuyesa kusanachitike kwa magulu muzosiyana zodalira.

 

Mayeso a Levene anali osafunikira pazinthu zina zodalira kuphatikiza [PF: F (1, 35) = 3.19, P = 0.083; RF: F (1, 35) = 1.92, P = 0.174; BP: F (1, 35) = 0.784, P = 0.382; GH: F (1, 35) = 0.659, P = 0.422; PCS: F (1, 35) = 2.371, P = 0.133; VT: F (1, 35) = 4.52, P = 0.141; AH: F (1, 35) = 1.03, P = 0.318], kusonyeza kuti kulingalira kwa kusiyanasiyana kwa kusiyana kunali kovomerezeka m'magulu a moyo wabwino komanso kuyesa kwa Levene kunali kofunikira pamitundu ina yodalira kuphatikizapo [RE: F (1, 35) = 4.27, P = 0.046; SF: F (1, 35) = 4.82, P = 0.035; MCS: F (1, 35) = 11.69, P = 0.002], kusonyeza kuti kulingalira kwa homogeneity kusiyana kunali kosweka mumagulu a moyo wabwino.

 

Chotsatira chachikulu cha kulowererapo kwa MBSR chinali chofunikira pazigawo zina zodalira kuphatikizapo [RP: F (1, 25) = 5.67, P = 0.025, partial ?2 = 0.18; BP: F (1, 25) = 12.62, P = 0.002, pang'ono ?2 = 0.34; GH: F (1, 25) = 9.44, P = 0.005, pang'ono ?2 = 0.28; PCS: F (1, 25) = 9.80, P = 0.004, pang'ono ?2 = 0.28; VT: F (1, 25) = 12.60, P = 0.002, pang'ono ?2 = 0.34; AH: F (1, 25) = 39.85, P = 0.001, pang'ono ?2 = 0.61; MCS: F (1, 25) = 12.49, P = 0.002, pang'ono ?2 = 0.33], zotsatirazi zikusonyeza kuti zigawo za RP, BP, GH, PCS, VT, AH, ndi MCS zinali zapamwamba pambuyo pa kulowerera kwa MBSR [RP: Kutanthauza = 61.62, SD.E = 6.18; BP: Kutanthauza = 48.97, SD.E = 2.98; GH: Kutanthauza = 48.77, SD.E = 2.85; PCS: Zikutanthauza = 58.52, SD.E = 2.72; VT: Kutanthauza = 44.99, SD.E = 2.81; AH: Kutanthauza = 52.60, SD.E = 1.97; MCS: Zikutanthauza = 44.82, SD.E = 2.43] kuposa gulu lolamulira [RP: Mean = 40.24, SD.E = 5.62; BP: Kutanthauza = 33.58, SD.E = 2.71; GH: Kutanthauza = 36.05, SD.E = 2.59; PCS: Zikutanthauza = 46.13, SD.E = 2.48; VT: Kutanthauza = 30.50, SD.E = 2.56; AH: Kutanthauza = 34.49, SD.E = 1.80; MCS: Kutanthauza = 32.32, SD.E = 2.21].

 

Ngakhale zili choncho, zotsatira zazikulu za kulowererapo kwa MBSR sizinali zofunikira pazinthu zina zodalira kuphatikizapo [PF: F (1, 25) = 1.05, P = 0.314, partial ?2 = 0.04; RE: F (1, 25) = 1.74, P = 0.199, pang'ono ?2 = 0.06; SF: F (1, 25) = 2.35, P = 0.138, pang'ono ?2 = 0.09]. Zotsatirazi zikuwonetsa, ngakhale njira zomwe zili m'magulu awa a moyo wabwino zinali zapamwamba [PF: Mean = 75.43, SD.E = 1.54; RE: Kutanthauza = 29.65, SD.E = 6.02; SF: Zikutanthauza = 51.96, SD.E = 2.63] kuposa gulu lolamulira [PF: Mean = 73.43, SD.E = 1.40; RE: Kutanthauza = 18.08, SD.E = 5.48; SF: Tanthauzo = 46.09, SD.E = 2.40], Koma kusiyana kwa Mean kunali kopanda tanthauzo.

 

Mwachidule, zotsatira za Covariance analysis (MANCOVA) mu Table 3 zimasonyeza kusiyana kwakukulu kwa chiwerengero cha magawo ochepa omwe amalepheretsa udindo chifukwa cha thanzi (RP), kupweteka kwa thupi (BP), thanzi lonse (GH), mphamvu ndi nyonga (VT). ), Kukhudza thanzi (AH) ndi kuchuluka kwa thanzi la thupi (PCS) ndi thanzi la maganizo (MCS). Ndipo zimasonyezanso kuti panalibe kusiyana kwakukulu kwa chiwerengero cha ntchito zakuthupi (PF), malire a maudindo chifukwa cha mavuto a maganizo (RE) ndi chikhalidwe cha anthu (SF) mu gulu lothandizira. Zofunikira zonse zimanenedwa pa p <0.05.

 

Kukambirana

 

Kafukufukuyu ankafuna kufufuza momwe MBSR imathandizira pakumva kupweteka kwambiri komanso moyo wabwino kwa odwala omwe ali ndi mutu wopweteka. Zotsatira zinasonyeza kuti chithandizo cha MBSR chinali chothandiza kwambiri pa kuchepetsa malingaliro opweteka kwambiri. Zotsatira za kafukufuku wamakono zimagwirizana ndi zotsatira za ofufuza ena omwe adagwiritsa ntchito njira yofanana ya ululu wosatha (mwachitsanzo Flugel et al., 2010; Kabat-Zinn, 1982; Kabat-Zinn et al., 1985; La Cour & Petersen , 2015; Reibel, Greeson, Brainard, & Rosenzweig, 2001; Reiner et al., 2013; Rosenzweig et al., 2010; zeidan et al., 2010). Mwachitsanzo, mu maphunziro awiri omwe anachitidwa ndi Kabat-Zinn, pomwe pulogalamu ya MBSR idagwiritsidwa ntchito pochiza odwala omwe ali ndi ululu wopweteka kwambiri ndi madokotala, odwala ambiri omwe ali ndi mutu wopweteka kwambiri anaphatikizidwanso. Phunziro loyamba la maphunziro awiriwa, linasonyeza kuchepa kwakukulu kwa ululu, kusokonezeka kwa ululu ndi ntchito za tsiku ndi tsiku, zizindikiro zachipatala ndi matenda a maganizo, kuphatikizapo nkhawa ndi kuvutika maganizo (Kabat-Zinn, 1982). Zotsatira za phunziro lachiwiri zinasonyeza kuchepa kwakukulu kwa ululu, maonekedwe oipa a thupi, nkhawa, kuvutika maganizo, kusokoneza zowawa za tsiku ndi tsiku, zizindikiro zachipatala, kugwiritsa ntchito mankhwala, komanso kusonyeza kuwonjezeka kwa kudzidalira (Kabat-Zinn et al., 1985) .

 

Komanso, zomwe zapezedwa pakali pano zikugwirizana ndi zotsatira za Rosenzweig et al. (2010), zotsatira zawo zimasonyeza kuti pulogalamu ya MBSR ndi yothandiza kuchepetsa, kupweteka kwa thupi, umoyo wa moyo ndi thanzi labwino la odwala omwe ali ndi zowawa zosiyanasiyana zowawa komanso kulingalira zimakhala zogwira mtima pazigawo zamaganizo ndi zomveka zakumva ululu mwa kudziletsa kudziletsa. kudzera muzochita zosinkhasinkha. Ngakhale zotsatira za Rosenzweig et al. (2010) inasonyeza kuti pakati pa odwala omwe ali ndi ululu wosatha kuchepetsa kuchepa kwa ululu wa thupi ndi kusintha kwa moyo wabwino kunali kogwirizana ndi odwala omwe ali ndi fibromyalgia, mutu wopweteka kwambiri. Mu kafukufuku wina wopangidwa ndi Flugel et al. (2010), ngakhale kuti kusintha kwabwino kunkawoneka pafupipafupi komanso kukula kwa ululu, kuchepetsa kupweteka sikunali kofunika kwambiri.

 

Mu phunziro lina, kupweteka kwapweteka kunachepetsedwa kwambiri pambuyo pochitapo kanthu kwa odwala omwe ali ndi mutu wovuta. Kuphatikiza apo, gulu la MBSR lidawonetsa ziwerengero zapamwamba pakuzindikira mozindikira poyerekeza ndi gulu lolamulira (Omidi & Zargar, 2014). Mu kafukufuku woyendetsa ndege wa Wells et al. (2014), zotsatira zawo zinasonyeza kuti MBSR yokhala ndi chithandizo chamankhwala chinali chotheka kwa odwala omwe ali ndi migraines. Ngakhale kuti kukula kwachitsanzo chaching'ono cha kafukufuku woyendetsa ndegewu sikunapereke mphamvu kuti azindikire kusiyana kwakukulu pakati pa kupweteka kwapweteka ndi mafupipafupi a migraine, zotsatira zinasonyeza kuti kulowereraku kunali ndi phindu pa nthawi ya mutu, kulemala, kudzidalira.

 

Pofotokoza zotsatira za mphamvu zogwiritsira ntchito malingaliro ochiritsira zowawa zinganenedwe, zitsanzo zamaganizo za ululu wosatha monga chitsanzo cha kupeŵa mantha zimasonyeza kuti njira zomwe anthu amatanthauzira zowawa zawo ndikuziyankha ndizofunikira kwambiri mu zowawa (Schutze, Rees, Preece, & Schutze, 2010). Kupweteka kwapang'onopang'ono kumagwirizanitsidwa kwambiri ndi mantha ndi nkhawa zomwe zimadza chifukwa cha ululu, njira zamaganizo zomwe mantha a ululu angayambitsire komanso kulemala kokhudzana ndi ululu kumagwirizanitsa komanso chifukwa chakuti kuwunika kolakwika kwa chidziwitso cha ululu kumalongosola 7 mpaka 31% ya kusiyana kwa mphamvu ya ululu. Choncho, njira iliyonse yomwe ingachepetse kuwonongeka kwa ululu kapena kusintha kusintha kwake kungathe kuchepetsa malingaliro a ululu waukulu ndi kulemala komwe kumayambitsa. Schutz ndi al. (2010) amatsutsa kuti kusamala pang'ono ndiye chiyambi cha zowawa zowawa. M'malo mwake, zikuwoneka kuti chizoloŵezi cha munthu kuchita nawo zinthu zodzipangira okha m'malo motengera chidziwitso ndi chidwi cha kusinthasintha kosakwanira, komanso kusazindikira zomwe zikuchitika pano (Kabat-Zinn, 1990), zipangitsa anthu Ganizirani zambiri za ululuwo ndipo mochulukirachulukira kuopsa kwake. Chifukwa chake, kusamala pang'ono kumapangitsa kuti pakhale kuwunika koyipa kwa ululu (Kabat-Zinn, 1990).

 

Chifukwa china chotheka chingakhale chakuti kuvomereza ululu ndi kukonzekera kusintha kumawonjezera malingaliro abwino, zomwe zimapangitsa kuchepetsa kupweteka kwambiri chifukwa cha zotsatira za dongosolo la endocrine ndi kupanga opioid amkati ndi kuchepetsa kulemala kokhudzana ndi ululu kapena kukonzekera anthu kuti agwiritse ntchito. njira zothandiza kuthana ndi ululu (Kratz, Davis, & Zautra, 2007). Chifukwa china chotheka kufotokozera zotsatira za kafukufuku wamakono pakuthandizira kuchepetsa ululu kungakhale chifukwa chakuti kupweteka kosalekeza kumapangidwa chifukwa cha kupsinjika maganizo kwambiri (Chrousos & Gold, 1992). Zotsatira zake ndi kusokonezeka kwa machitidwe a thupi ndi maganizo. Kulingalira kumatha kulola mwayi wofikira kutsogolo kwa cortex ndikuwongolera, madera aubongo omwe amaphatikiza ntchito zakuthupi ndi zamaganizidwe (Shapiro et al., 1995). Chotsatira chake ndi kulengedwa kwa kukopa pang'ono komwe kumachepetsa mphamvu ndi chidziwitso cha kupweteka kwa thupi ndi maganizo. Choncho, zikhumbo zowawa zimakhala ngati kumva ululu weniweni osati kuzindikira koipa. Zotsatira zake ndikutseka kwa njira zowawa zomwe zimatha kuchepetsa ululu (Astin, 2004).

 

Kusinkhasinkha Mwanzeru Kumachepetsa Ululu Kupyolera mu Njira zingapo za Ubongo ndi njira zosiyanasiyana monga kusintha chidwi muzochita zosinkhasinkha zimatha kusangalatsa mbali zonse zokhudzidwa komanso zokhudzidwa zakumva kupweteka. Kumbali ina, kulingalira kumachepetsa reactivity ku maganizo okhumudwitsa ndi malingaliro omwe amatsagana ndi kuzindikira kowawa ndikulimbitsa ululu. Komanso, kulingalira kumachepetsa zizindikiro zamaganizo monga comorbid nkhawa ndi kuvutika maganizo komanso kumawonjezera ntchito za parasympathetic, zomwe zingathandize kulimbikitsa kupumula kwakuya kwa minofu yomwe ingachepetse ululu. Pomaliza, kulingalira kumatha kuchepetsa kupsinjika ndi kusokonezeka kwamalingaliro kokhudzana ndi psychophysiologic activation mwa kulimbikitsa kukonzanso zinthu zolakwika ndi luso lodzilamulira. Kulingalira kwakukulu kunaneneratu kuchepa kwa nkhawa, kupsinjika maganizo, kulingalira koopsa ndi kulumala. Kafukufuku wina wasonyeza kuti kulingalira kuli ndi gawo lofunikira pakuwongolera malingaliro ndi malingaliro, ndipo kungakhale kothandiza pakukonzanso zinthu zoipa (Zeidan et al., 2011; Zeidan, Grant, Brown, McHaffie, & Coghill, 2012).

 

Cholinga chachiwiri cha phunziroli chinali kudziwa momwe pulogalamu ya MBSR imathandizira pa umoyo wa odwala omwe ali ndi mutu wopweteka. Kafukufukuyu adawonetsa kuti mankhwalawa anali othandiza kwambiri pamiyeso ya moyo, kuphatikizapo malire a udindo chifukwa cha thanzi, kupweteka kwa thupi, thanzi labwino, mphamvu ndi nyonga, thanzi la maganizo ndi miyeso yonse ya thupi ndi maganizo. Komabe, pulogalamu ya MBSR sinathe kuonjezera kwambiri umoyo wa moyo pakugwira ntchito kwa thupi, zoperewera chifukwa cha mavuto a maganizo ndi chikhalidwe cha anthu. Zikuwoneka zoonekeratu kuchokera ku maphunziro apitalo ndi amakono komanso kuchokera ku kafukufuku wamakono kuti MBSR ilibe mphamvu pa ntchito zakuthupi ndi zamagulu. Izi ndichifukwa choti zotsatira za ululu wa odwala omwe ali ndi mutu ndizochepa, ndipo kusinthako kumachedwa. Kumbali ina, odwala omwe ali ndi ululu wopweteka nthawi zambiri amaphunzira kunyalanyaza ululu kuti agwire bwino ntchito (La Cour & Petersen, 2015). Ngakhale, zosinthazo zakhala zikufunidwa ndikuwonjezera kuchuluka kwa gulu lothandizira poyerekeza ndi gulu lolamulira. Zotsatirazi zikugwirizana ndi zomwe zapezedwa m'mbuyomu (Brown & Ryan, 2003; Carlson et al., 2003; Flugel et al., 2010; Kabat-Zinn, 1982; La Cour & Petersen, 2015; Morgan et al., 2013; Reibel et al., 2001; al., 2010; Rosenzweig et al., XNUMX).

 

Ponena za zomwe zili m'magawo a MBSR, pulogalamuyi ikugogomezera kugwiritsa ntchito njira zochepetsera kupsinjika maganizo, kuthana ndi zowawa komanso kuzindikira za vutoli. Kusiya kumenyana ndi kuvomereza zomwe zilipo, popanda chiweruzo, ndilo lingaliro lalikulu la pulogalamuyi (Flugel et al., 2010). M'malo mwake, kusintha kwa kuvomereza popanda kuweruza kumalumikizidwa ndi kusintha kwa moyo (Rosenzweig et al., 2010). MBSR ikufuna kuwonjezera chidziwitso cha nthawi yomwe ilipo. Ndondomeko ya chithandizo ndi njira yatsopano komanso yaumwini yothetsera kupsinjika maganizo kwa munthuyo. Zovuta zakunja ndi gawo la moyo ndipo sizingasinthidwe, koma luso lothana ndi vutoli komanso momwe mungayankhire kupsinjika kungasinthidwe (Flugel et al., 2010). McCracken ndi velleman (2010) adawonetsa kuti kusinthasintha kwachidziwitso ndi kulingalira kwapamwamba kumagwirizanitsidwa ndi kuvutika kochepa ndi kulemala kwa odwala. Odwala omwe ali ndi ululu wosaneneka wokhala ndi malingaliro apamwamba adanenanso kuti kukhumudwa pang'ono, kupsinjika maganizo, nkhawa ndi ululu komanso kusintha kwa moyo wodzidalira komanso umoyo wabwino. Morgan et al. (2013) pophunzira odwala nyamakazi adapeza zotsatira zofanana, kotero kuti odwala omwe ali ndi malingaliro apamwamba amafotokoza kupsinjika kochepa, kuvutika maganizo komanso kudzidalira kwambiri komanso moyo wabwino. Monga tafotokozera pamwambapa, zikuyembekezeka kuti kuchepetsa kupweteka kwa odwala kumabweretsa kuchepa kwa mantha ndi nkhawa zomwe zimagwirizanitsidwa ndi ululu ndipo potero zimachepetsa zomwe zimalepheretsa kugwira ntchito. Komanso, zotsatira za maphunziro angapo (Cho, Heiby, McCracken, Lee, & Moon, 2010; McCracken, Gauntlett-Gilbert, & Vowles, 2007; Rosenzweig et al., 2010; Schutz et al., 2010) amatsimikizira izi. .

 

Maphunziro angapo apangidwa kuti awonetse mphamvu za mitundu yosiyanasiyana ya mankhwala okhudzana ndi malingaliro pa ululu wosatha, kuphatikizapo odwala mutu. Mosiyana ndi kafukufuku wina amene anafufuza magulu osiyanasiyana a odwala omwe ali ndi ululu wosaneneka, ubwino wa phunziroli ndi wakuti, wakhala akuchitidwa kwa odwala omwe ali ndi mutu wopweteka kwambiri.

 

Pamapeto pake, tiyenera kuvomereza kuti pali zolepheretsa mu kafukufukuyu monga kukula kwachitsanzo chaching'ono, kusowa kwa ndondomeko yotsatila kwa nthawi yayitali, otenga nawo mbali - kugwiritsa ntchito mankhwala ndi chithandizo chamankhwala mwachisawawa; ndipo ngakhale kuyesetsa kwa ochita kafukufuku, kusowa kwa mankhwala ofanana mokwanira kwa onse omwe atenga nawo mbali kumatha kusokoneza zotsatira za mayeso ndikupangitsa kuti zikhale zovuta kubwereza zotsatira. Popeza kuti phunziroli ndilo loyamba la mtundu wake kwa odwala omwe ali ndi mutu wopweteka kwambiri ku Iran, akulangizidwa kuti maphunziro ofanana ayenera kuchitidwa m'munda uno, ndi kukula kwake kwakukulu momwe zingathere. Ndipo maphunziro owonjezera amafufuza kukhazikika kwa chithandizo kumabweretsa nthawi yotsatiridwa kwa nthawi yayitali.

 

Kutsiliza

 

Malinga ndi zomwe zapezedwa mu phunziroli zikhoza kuganiziridwa kuti njira za MBSR nthawi zambiri zimakhala zogwira mtima pakumva kupweteka kwambiri komanso umoyo wa odwala omwe ali ndi mutu wopweteka. Ngakhale kuti panalibe kusiyana kwakukulu kowerengera m'mbali zina za moyo wabwino, monga momwe thupi limagwirira ntchito, zoperewera chifukwa cha mavuto a maganizo ndi chikhalidwe cha anthu, koma kusintha kwakukulu kwachinthu kunali kofunidwa ku phunzirolo. Choncho kuphatikiza mankhwala a MBSR ndi mankhwala ochiritsira ochiritsira mu ndondomeko ya chithandizo kwa odwala omwe ali ndi mutu wopweteka kwambiri akhoza kulangizidwa. Wofufuzayo amakhulupiriranso kuti ngakhale kuti pali zofooka ndi zofooka za kafukufuku wamakono, phunziroli likhoza kukhala njira yatsopano yochizira mutu wopweteka kwambiri ndipo ingapereke chidziwitso chatsopano pa chithandizo ichi.

 

Zothokoza

 

Kafukufukuyu adathandizidwa (monga lingaliro) mwa gawo la Zahedan University of Medical Science. Tikufuna kuthokoza onse omwe adatenga nawo gawo mu kafukufukuyu, asing'anga am'deralo, ogwira ntchito m'zipatala- Ali -ebn-abitaleb, Khatam-al-anbia ndi Ali asghar- chifukwa cha thandizo ndi thandizo lawo.

 

Pomaliza,�Chisamaliro cha chiropractic ndi njira yotetezeka komanso yothandiza yochizira yomwe imagwiritsidwa ntchito pothandizira kuwongolera komanso kuthana ndi zizindikiro za mutu wosakhazikika powongolera msana mosamala komanso mofatsa komanso kupereka njira zowongolera kupsinjika. Chifukwa chakuti kupsinjika maganizo kumagwirizanitsidwa ndi nkhani zosiyanasiyana za thanzi, kuphatikizapo kugwedezeka, kapena kusalongosoka kwa msana, ndi kupweteka kwa mutu kosalekeza, kuchitapo kanthu moganizira monga chisamaliro cha chiropractic ndi kuchepetsa kupsinjika maganizo (MBSR) ndizofunikira kwambiri pamutu wopweteka kwambiri. Potsirizira pake, nkhani yomwe ili pamwambayi inasonyeza kuti MBSR ikhoza kugwiritsidwa ntchito moyenera ngati njira yothetsera mutu wa mutu wanthawi zonse komanso kukhala ndi thanzi labwino komanso thanzi. Zambiri zomwe zatchulidwa kuchokera ku National Center for Biotechnology Information (NCBI). Kukula kwa chidziwitso chathu kumangokhala kwa chiropractic komanso kuvulala kwa msana ndi mikhalidwe. Kuti tikambirane nkhaniyi, chonde omasuka kufunsa Dr. Jimenez kapena tilankhule nafe pa 915-850-0900 .

 

Wosankhidwa ndi Dr. Alex Jimenez

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

Mitu Yowonjezera: Ululu Wobwerera

 

Malinga ndi ziwerengero, pafupifupi 80% ya anthu adzakhala ndi zizindikiro za ululu wammbuyo kamodzi pa moyo wawo wonse. Ululu wammbuyo ndi dandaulo lofala lomwe lingakhalepo chifukwa cha kuvulala kosiyanasiyana ndi/kapena mikhalidwe. Nthawi zambiri, kuwonongeka kwachilengedwe kwa msana ndi zaka kungayambitse ululu wammbuyo. Herniated discs zimachitika pamene chofewa, ngati gel pakati pa intervertebral disc ikukankhira kupyola mu misozi yozungulira, mphete yakunja ya cartilage, kuponderezana ndi kukwiyitsa mizu ya mitsempha. Ma disc herniations nthawi zambiri amapezeka m'munsi kumbuyo, kapena msana, koma amathanso kuchitika m'mphepete mwa khomo lachiberekero, kapena khosi. Kulowetsedwa kwa mitsempha yomwe imapezeka m'munsi kumbuyo chifukwa cha kuvulala ndi / kapena kuwonjezereka kwa chikhalidwe kungayambitse zizindikiro za sciatica.

 

chithunzi cha blog cha cartoon paperboy nkhani zazikulu

 

MUTU WOFUNIKA KWAMBIRI: Kuwongolera Kupanikizika Kwapantchito

 

 

NKHANI ZOFUNIKA KWAMBIRI: ZOWONJEZERA ZOWONJEZERA: Chithandizo cha Ngozi ya Galimoto El Paso, TX Chiropractor

 

Palibe kanthu
Zothandizira

1. Astin J A. Health psychology therapies for the management of pain. Clinical Journal of Pain. 2004; 20:27-32. dx.doi.org/10.1097/00002508-200401000-00006 . [PubMed]
2. Bohlmeijer E, Prenger R, Taal E, Cuijpers P. Zotsatira za kuchepetsa kupsinjika maganizo pogwiritsa ntchito maganizo a anthu akuluakulu omwe ali ndi matenda aakulu: meta-analysis. J Psychosom Res. 2010; 68(6):539-544. dx.doi.org/10.1016/j.jpsychores.2009.10.005 . [PubMed]
3. Brown K. W, Ryan RM Ubwino wokhalapo: kulingalira ndi udindo wake pamaganizo abwino. J Pers Soc Psychol. 2003;84(4):822*848. dx.doi.org/10.1037/0022-3514.84.4.822 . [PubMed]
4. Carlson L. E, Speca M, Patel K. D, Goodey E. Mindfulness-based kuchepetsa kupsinjika maganizo pokhudzana ndi moyo wabwino, maganizo, zizindikiro za kupsinjika maganizo, ndi zizindikiro za chitetezo cha m'mawere ndi khansa ya prostate. Psychosom Med. 2003;65(4):571*581. [PubMed]
5. Chaskalson M. Malo ogwirira ntchito oganiza bwino: kukhazikitsa anthu okhazikika komanso mabungwe omwe ali ndi MBSR. John Wiley & Ana; 2011.
6. Cho S, Heiby E. M, McCracken L. M, Lee S. M, Mwezi DE Nkhawa zokhudzana ndi ululu monga mkhalapakati wa zotsatira za kulingalira pakugwira ntchito kwa thupi ndi maganizo kwa odwala opweteka kwambiri ku Korea. J Uwawa. 2010; 11(8):789-797. dx.doi.org/10.1016/j.jpain.2009.12.006 . [PubMed]
7. Chrousos G. P, Gold PW Malingaliro a kupsinjika maganizo ndi kusokonezeka kwa dongosolo lachisokonezo. Kufotokozera mwachidule za homeostasis yakuthupi ndi yamakhalidwe. JAMA. 1992;267(9):1244*1252. dx.doi.org/10.1001/jama.1992.03480090092034 . [PubMed]
8. Flugel Colle K. F, Vincent A, Cha S. S, Loehrer L. L, Bauer B. A, Wahner-Roedler DL Kuyeza kwa moyo wabwino komanso chidziwitso cha otenga nawo mbali ndi ndondomeko yochepetsera kupsinjika maganizo. Wothandizira Ther Clin Pract. 2010;16(1):36-40. dx.doi.org/10.1016/j.ctcp.2009.06.008 . [PubMed]
9. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based based kuchepetsa nkhawa ndi thanzi labwino. Meta-analysis. J Psychosom Res. 2004;57(1):35-43. dx.doi.org/10.1016/S0022-3999(03)00573-7 . [PubMed]
10. Komiti Yoyang'anira Mutu wa Mutu wa International Headache, Society. The International Classification of Headache Disorders, 3rd edition (beta version) Cephalalgia. 2013;33(9):629*808. dx.doi.org/10.1177/0333102413485658 . [PubMed]
11. Jain S, Shapiro S. L, Swanick S, Roesch S. C, Mills P. J, Bell I, Schwartz GE Mayesero osadziwika bwino a kusinkhasinkha kwamaganizo ndi maphunziro omasuka: zotsatira pa kupsinjika maganizo, malingaliro abwino, kuthamanga, ndi kusokoneza. Ann Behav Med. 2007;33(1):11-21. dx.doi.org/10.1207/s15324796abm3301_2 . [PubMed]
12. Kabat-Zinn J. Pulogalamu ya odwala kunja kwa mankhwala a khalidwe kwa odwala omwe amamva kupweteka kosalekeza pogwiritsa ntchito kusinkhasinkha kwamaganizo: malingaliro amalingaliro ndi zotsatira zoyambirira. Gen Hosp Psychiatry. 1982;4(1):33-47. [PubMed]
13. Kabat-Zinn Jon, University of Massachusetts Medical Center/Worcester . Kliniki Yochepetsera Kupsinjika. Kukhala ndi moyo watsoka: kugwiritsa ntchito nzeru za thupi ndi malingaliro anu kuthana ndi nkhawa, zowawa, ndi matenda. New York, NY: Delacorte Press; 1990.
14. Kabat-Zinn J, Lipworth L, Burney R. Kugwiritsa ntchito chipatala kusinkhasinkha kwamaganizo pofuna kudziletsa kudziletsa kwa ululu wopweteka. J Behav Med. 1985;8(2):163-190. dx.doi.org/10.1007/BF00845519 . [PubMed]
15. Kabat-Zinn J, Massion A. O, Kristeller J, Peterson L. G, Fletcher K. E, Pbert L, Santorelli SF Kuchita bwino kwa pulogalamu yochepetsera kupsinjika maganizo pochiza matenda ovutika maganizo. Ndine J Psychiatry. 1992; 149(7):936-943. dx.doi.org/10.1176/ajp.149.7.936 . [PubMed]
16. Kratz A. L, Davis M. C, Zautra AJ Kuvomereza kupweteka kumachepetsa kugwirizana pakati pa ululu ndi zotsatira zoipa za osteoarthritis ya akazi ndi odwala fibromyalgia. Ann Behav Med. 2007;33(3):291*301. dx.doi.org/10.1080/08836610701359860 . [Nkhani yaulere ya PMC] [PubMed]
17. Kurt S, Kaplan Y. Matenda a Epidemiological ndi matenda a mutu wa mutu kwa ophunzira a yunivesite. Clin Neurol Neurosurg. 2008;110(1):46-50. dx.doi.org/10.1016/j.clineuro.2007.09.001 . [PubMed]
18. La Cour P, Petersen M. Zotsatira za kusinkhasinkha mwachidwi pa ululu wosatha: kuyesedwa kosasinthika. Pain Med. 2015; 16 (4): 641-652. dx.doi.org/10.1111/pme.12605 . [PubMed]
19. McCracken L. M, Gauntlett-Gilbert J, Vowles KE Udindo wa kulingalira pamaganizo a chidziwitso-khalidwe lachidziwitso cha kuvutika kosalekeza kokhudzana ndi ululu ndi kulemala. Ululu. 2007;131(1-2):63-69. dx.doi.org/10.1016/j.pain.2006.12.013 . [PubMed]
20. McCracken L. M, Velleman SC Kusinthasintha kwa maganizo kwa akuluakulu omwe ali ndi ululu wopweteka kwambiri: phunziro la kuvomereza, kulingalira, ndi zochita zozikidwa pazikhalidwe pa chisamaliro choyambirira. Ululu. 2010; 148(1):141-147. dx.doi.org/10.1016/j.pain.2009.10.034 . [PubMed]
21. Menken M, Munsat T. L, Toole JF Mtolo wapadziko lonse wa kafukufuku wa matenda: zotsatira za ubongo wa ubongo. Arch Neurol. 2000; 57(3):418-420. dx.doi.org/10.1001/archneur.57.3.418 . [PubMed]
22. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): kumasulira ndi kutsimikizira maphunziro a Iranian version. Qual Life Res. 2005;14(3):875*882. dx.doi.org/10.1007/s11136-004-1014-5 . [PubMed]
23. Morgan N. L, Ransford G. L, Morgan L. P, Driban J. B, Wang C. Mindfulness imagwirizanitsidwa ndi zizindikiro zamaganizo, kudzidalira, komanso moyo wabwino pakati pa odwala omwe ali ndi zizindikiro za mawondo osteoarthritis. Osteoarthritis ndi Cartilage. 2013;21(Zowonjezera):S257�S258. dx.doi.org/10.1016/j.joca.2013.02.535 .
24. Mulleners W. M, Haan J, Dekker F, Ferrari MD Kupewa chithandizo cha migraine. Ned Tijdschr Geneeskd. 2010;154:A1512. [PubMed]
25. Nash J. M, Thebarge RW Kumvetsetsa kupsyinjika kwamaganizo, njira zake zamoyo, ndi zotsatira za mutu wa mutu woyamba. Mutu. 2006; 46 (9): 1377-1386. dx.doi.org/10.1111/j.1526-4610.2006.00580.x . [PubMed]
26. Omidi A, Zargar F. Zotsatira za kuchepetsa kupsinjika maganizo chifukwa cha kupsinjika maganizo pa ululu wowawa komanso kuzindikira mwachidwi kwa odwala omwe ali ndi mutu wovuta: kuyesedwa kwachipatala kosasinthika. Nurs Midwifery Stud. 2014;3(3):e21136. [Nkhani yaulere ya PMC] [PubMed]
27. Reibel D. K, Greeson J. M, Brainard G. C, Rosenzweig S. Mindfulness-based kuchepetsa kupsinjika maganizo ndi umoyo wokhudzana ndi thanzi la anthu odwala matenda osiyanasiyana. Gen Hosp Psychiatry. 2001;23(4):183-192. dx.doi.org/10.1016/S0163-8343(01)00149-9 . [PubMed]
28. Reiner K, Tibi L, Lipsitz JD Kodi kuchitapo kanthu moganizira mozama kumachepetsa kupweteka kwambiri? Ndemanga yovuta ya mabuku. Pain Med. 2013; 14(2):230-242. dx.doi.org/10.1111/pme.12006 . [PubMed]
29. Rosenzweig S, Greeson J. M, Reibel D. K, Green J. S, Jasser S. A, Beasley D. Mindfulness-based stress rececemia yopweteka kwambiri: kusiyana kwa zotsatira za mankhwala ndi ntchito ya kusinkhasinkha kunyumba. J Psychosom Res. 2010; 68(1):29-36. dx.doi.org/10.1016/j.jpsychores.2009.03.010 . [PubMed]
30. Schutze R, Rees C, Preece M, Schutze M. Kulingalira pang'ono kumaneneratu zowawa zowonongeka mu chitsanzo chopeŵa mantha cha ululu wosatha. Ululu. 2010;148(1):120*127. dx.doi.org/10.1016/j.pain.2009.10.030 . [PubMed]
31. Shapiro D. H, Wu J, Hong C, Buchsbaum M. S, Gottschalk L, Thompson V. E, Hillyard D, Hetu M, Friedman G. Kufufuza mgwirizano pakati pa kukhala ndi ulamuliro ndi kutaya mphamvu ku neuroanatomy yogwira ntchito mkati mwa kugona boma. Psychology. 1995; 38:133-145.
32. Stovner L, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, Zwart JA Mtolo wapadziko lonse wa mutu: zolemba za kufalikira kwa mutu ndi kulemala padziko lonse lapansi. Cephalalgia. 2007; 27(3): 193-210. dx.doi.org/10.1111/j.1468-2982.2007.01288.x . [PubMed]
33. Stovner L. J, Andree C. Kukula kwa mutu ku Ulaya: ndemanga ya polojekiti ya Eurolight. J Kupweteka kwa Mutu. 2010; 11(4):289-299. dx.doi.org/10.1007/s10194-010-0217-0 . [Nkhani yaulere ya PMC] [PubMed]
34. Teasdale J. D, Moore R. G, Hayhurst H, Papa M, Williams S, Segal ZV Metacognitive kuzindikira ndi kupewa kuyambiranso kuvutika maganizo: umboni wamphamvu. J Funsani Clin Psychol. 2002; 70(2):275-287. dx.doi.org/10.1037/0022-006X.70.2.275 . [PubMed]
35. Tozer B. S, Boatwright E. A, David P. S, Verma D. P, Blair J. E, Mayer A. P, Files JA Kupewa migraine kwa amayi nthawi yonse ya moyo. Mayo Clin Proc. 2006; 81(8):1086-1091. Chithunzi cha 1092. dx.doi.org/10.4065/81.8.1086 . [PubMed]
36. Ware J. E, Kosinski M, Dewey J. E, Gandek B. SF-36 kafukufuku waumoyo: Buku lothandizira ndi kutanthauzira. Malingaliro a kampani Quality Metric Inc; 2000.
37. Wells R. E, Burch R, Paulsen R. H, Wayne P. M, Houle T. T, Loder E. Kusinkhasinkha kwa migraines: woyendetsa ndege woyendetsa mwachisawawa. Mutu. 2014; 54 (9): 1484-1495. dx.doi.org/10.1111/head.12420 . [PubMed]
38. Zeidan F, Gordon N. S, Merchant J, Goolkasian P. Zotsatira za maphunziro a kusinkhasinkha mwachidule pa ululu woyesera. J Uwawa. 2010; 11(3): 199-209. dx.doi.org/10.1016/j.jpain.2009.07.015 . [PubMed]
39. Zeidan F, Grant JA, Brown C. A, McHaffie J. G, Cogill RC Mindfulness kuchepetsa ululu wokhudzana ndi kusinkhasinkha: umboni wa njira zapadera zaubongo pakuwongolera ululu. Neurosci Lett. 2012; 520 (2): 165-173. dx.doi.org/10.1016/j.neulet.2012.03.082 . [Nkhani yaulere ya PMC] [PubMed]
40. Zeidan F, Martucci K. T, Kraft R. A, Gordon N. S, McHaffie J. G, Coghill RC Njira za ubongo zothandizira kusinthasintha kwa ululu mwa kusinkhasinkha mwachidwi. Journal of Neuroscience. 2011;31(14):5540*5548. dx.doi.org/10.1523/JNEUROSCI.5791-10.2011 . [Nkhani yaulere ya PMC] [PubMed]

Tsekani Accordion
Kusamala kwa Mutu ndi Cervical Disc Herniation ku El Paso, TX

Kusamala kwa Mutu ndi Cervical Disc Herniation ku El Paso, TX

by | Zinthu Zinachitiridwa, Herniated Disc, Mayesero Olamulidwa Mwachisawawa, kupanikizika, Kuchiza

kupanikizika ndi zotsatira za kuyankha kwa thupi la munthu "kumenyana kapena kuthawa," njira yodzitetezera isanayambe kuyambika chifukwa cha chifundo cha mitsempha (SNS). Kupanikizika ndi gawo lofunika kwambiri pa moyo. Pamene kupsinjika maganizo kumayambitsa ndewu kapena kuyankha kwa ndege, kusakaniza kwa mankhwala ndi mahomoni amatulutsidwa m'magazi, omwe amakonzekeretsa thupi kuti liziwoneka ngati zoopsa. Ngakhale kupsinjika kwakanthawi kochepa kumakhala kothandiza, komabe, kupsinjika kwa nthawi yayitali kungayambitse matenda osiyanasiyana. Kuphatikiza apo, zovuta zamasiku ano zasintha ndipo zakhala zovuta kuti anthu athe kuthana ndi nkhawa zawo ndikukhalabe oganiza bwino.

 

Kodi Kupanikizika Kumakhudza Bwanji Thupi?

 

Kupsinjika maganizo kumatha kuchitika kudzera munjira zitatu zosiyanasiyana: kutengeka; thupi ndi chilengedwe. Kupsinjika maganizo kumakhudza zinthu zina zomwe zimakhudza malingaliro athu ndi kupanga zosankha. Kupsinjika kwakuthupi kumaphatikizapo kudya mosayenera ndi kusagona. Ndipo potsiriza, kupsinjika kwa chilengedwe kumachitika potengera zochitika zakunja. Mukakumana ndi mitundu ina yazovuta izi, dongosolo lamanjenje lachifundo limayambitsa kuyankha kwa "nkhondo kapena kuthawa", kutulutsa adrenaline ndi cortisol kuti tiwonjezere kugunda kwa mtima ndikukulitsa mphamvu zathu kutipangitsa kukhala tcheru kuti tithane ndi zomwe zili patsogolo pathu. .

 

Komabe, ngati kupsinjika komwe kumawoneka kuti kulipo nthawi zonse, ndewu ya SNS kapena kuyankha kwa ndege kumatha kukhalabe yogwira. Kupsinjika kwakanthawi kumatha kuyambitsa zovuta zosiyanasiyana zaumoyo, monga nkhawa, kukhumudwa, kupsinjika kwa minofu, kupweteka kwa khosi ndi msana, mavuto am'mimba, kunenepa kwambiri komanso kugona komanso kulephera kukumbukira komanso kukhazikika. Kuonjezera apo, kuthamanga kwa minofu pamphepete mwa msana chifukwa cha kupsinjika maganizo kungayambitse kusokonezeka kwa msana, kapena kusakanikirana, komwe kungayambitsenso disc herniation.

 

Mutu ndi Chimbale Herniation Kuchokera Kupsinjika Maganizo

 

Dongosolo la herniated limapezeka pamene malo ofewa, ngati gel a intervertebral disc amakankhira kupyolera mu misozi ya kunja kwake, mphete ya cartilage, kukwiyitsa ndi kukakamiza msana ndi / kapena mizu ya mitsempha. Disc herniation nthawi zambiri imapezeka mu khosi la msana, kapena khosi, ndi msana, kapena kumbuyo. Zizindikiro za herniated zimbale zimadalira malo psinjika pamodzi msana. Kupweteka kwa khosi ndi kupweteka kwa msana pamodzi ndi dzanzi, kumva kugwedeza ndi kufooka pamodzi ndi kumtunda ndi m'munsi ndi zina mwa zizindikiro zomwe zimagwirizanitsidwa ndi disc herniation. Kupweteka kwa mutu ndi migraine ndi zizindikiro zodziwika bwino zomwe zimagwirizanitsidwa ndi kupsinjika maganizo ndi ma discs a herniated pamodzi ndi msana wa khomo lachiberekero, chifukwa cha kusokonezeka kwa minofu ndi kusokonezeka kwa msana.

 

Mindfulness Interventions for Stress Management

 

Kuwongolera kupsinjika ndikofunikira pakuwongolera komanso kukhala ndi thanzi labwino komanso thanzi. Malinga ndi kafukufuku wofufuza, njira zothandizira kulingalira, monga chisamaliro cha chiropractic ndi kuchepetsa kupsinjika maganizo (MBSR), pakati pa ena, kungathandize mosamala komanso moyenera kuchepetsa nkhawa. Chisamaliro cha Chiropractic chimagwiritsa ntchito kusintha kwa msana ndi kusintha kwapamanja kuti abwezeretse mosamala momwe msanawo unayambira, kuchepetsa ululu ndi kusapeza bwino komanso kuchepetsa kupsinjika kwa minofu. Kuonjezera apo, chiropractor angaphatikizepo kusintha kwa moyo kuti athandize kupititsa patsogolo zizindikiro za kupsinjika maganizo. MBSR ingathandizenso kuchepetsa nkhawa, nkhawa komanso kukhumudwa.

 

Lumikizanani Masiku Ano

 

Ngati mukukumana ndi zizindikiro za nkhawa ndi mutu kapena migraine komanso kupweteka kwa khosi ndi kumbuyo komwe kumagwirizanitsidwa ndi disc herniation, njira zoganizira monga chisamaliro cha chiropractic zingakhale chithandizo chotetezeka komanso chothandiza pazovuta zanu. Dr. Alex Jimenez ntchito zothandizira kupsinjika maganizo zingakuthandizeni kuti mukhale ndi thanzi labwino komanso thanzi. Kufunafuna chithandizo choyenera kungakupatseni mpumulo womwe mukuyenera. Cholinga cha nkhani yotsatirayi ndikuwonetsa zotsatira za kuchepetsa kupsinjika maganizo kwa odwala omwe ali ndi mutu wovuta. Osamangochiza zizindikirozo, pitani komwe kumayambitsa vuto.

 

Zotsatira za Kuchepetsa Kupsinjika Maganizo Motengera Kupsinjika Pakupsinjika Maganizo Ndi Thanzi Lamaganizidwe mwa Odwala Omwe Ali ndi Kupweteka kwa Mutu

 

Kudalirika

 

Background: Mapulogalamu opititsa patsogolo thanzi la odwala omwe ali ndi matenda opweteka, monga mutu, nthawi zambiri amakhala akadali akhanda. Mindfulness-based stress reduction (MBSR) ndi psychotherapy yatsopano yomwe imawoneka yothandiza pochiza ululu wosatha ndi kupsinjika maganizo. Kafukufukuyu adayesa mphamvu ya MBSR pochiza kupsinjika komwe kumawoneka komanso thanzi lamakasitomala omwe ali ndi mutu wovuta.

 

Zida ndi njira: Kafukufukuyu ndi woyeserera mwachisawawa. Odwala makumi asanu ndi limodzi omwe ali ndi vuto la kupweteka kwa mutu malinga ndi International Headache Classification Subcommittee anapatsidwa mwachisawawa ku gulu la Treatment As Usual (TAU) kapena gulu loyesera (MBSR). Gulu la MBSR linalandira ophunzira asanu ndi atatu a mlungu ndi mlungu ndi magawo a 12-min. Misonkhanoyi idakhazikitsidwa pa protocol ya MBSR. The Brief Symptom Inventory (BSI) ndi Perceived Stress Scale (PSS) zinaperekedwa mu nthawi isanakwane ndi pambuyo pochiza komanso pakutsatira kwa miyezi ya 3 kwa magulu onse awiri.

 

Results: Tanthauzo la chiwerengero chonse cha BSI (global severity index; GSI) mu gulu la MBSR linali 1.63 � 0.56 isanayambe kulowererapo yomwe idachepetsedwa kwambiri ku 0.73 � 0.46 ndi 0.93 � 0.34 pambuyo pa kulowererapo komanso pazotsatira zotsatila, motero ( P <0.001). Kuonjezera apo, gulu la MBSR linawonetsa zochepetsetsa zochepetsera kupsinjika maganizo poyerekeza ndi gulu lolamulira pakuwunika kwa posttest. Tanthauzo la kupsyinjika komwe kumaganiziridwa asanalowepo kunali 16.96 � 2.53 ndipo adasinthidwa kukhala 12.7 � 2.69 ndi 13.5 � 2.33 pambuyo pa kulowererapo komanso pazigawo zotsatila, motsatira (P <0.001). Kumbali inayi, tanthauzo la GSI mu gulu la TAU linali 1.77 � 0.50 poyesedwa kuti linachepetsedwa kwambiri ku 1.59 � 0.52 ndi 1.78 � 0.47 pa posttest ndi kutsatira, motsatira (P <0.001). Komanso, tanthauzo la kupsinjika kwa gulu la TAU pakuyesedwa koyambirira linali 15.9 � 2.86 ndipo izi zidasinthidwa kukhala 16.13 � 2.44 ndi 15.76 � 2.22 poyesedwa ndi kutsatira, motsatana (P <0.001).

 

Kutsiliza: MBSR ikhoza kuchepetsa kupsinjika maganizo ndikuwongolera thanzi labwino kwa odwala omwe ali ndi mutu wovuta.

 

Keywords: Thanzi lamaganizidwe, kupweteka mutu, kuchepetsa kupsinjika maganizo (MBSR), kupsinjika maganizo, chithandizo monga mwachizolowezi (TAU)

 

Dr Jimenez White Coat

Kuzindikira kwa Dr. Alex Jimenez

Chisamaliro cha Chiropractic ndi njira yabwino yothetsera kupsinjika maganizo chifukwa imayang'ana pa msana, womwe ndi maziko a dongosolo lamanjenje. Chiropractic imagwiritsa ntchito kusintha kwa msana ndi kuwongolera pamanja kuti abwezeretse mosamalitsa kulumikizana kwa msana kuti alole kuti thupi lidzichiritsa lokha. Kusokonezeka kwa msana, kapena kusokonezeka, kungayambitse kusokonezeka kwa minofu pamphepete mwa msana ndipo kumayambitsa matenda osiyanasiyana, kuphatikizapo mutu ndi migraine, komanso disc herniation ndi sciatica. Chisamaliro cha Chiropractic chitha kuphatikizanso kusintha kwa moyo, monga upangiri wazakudya komanso malingaliro ochita masewera olimbitsa thupi, kuti apititse patsogolo zotsatira zake. Kuchepetsa kupsinjika motengera malingaliro kungathandizenso bwino kuthana ndi kupsinjika ndi zizindikiro.

 

Introduction

 

Kupweteka kwamutu kumapanga 90% ya mutu wonse. Pafupifupi 3% ya anthu akudwala mutu wovuta kwambiri [1]. Kupweteka kwa mutu nthawi zambiri kumayendera limodzi ndi kutsika kwa moyo komanso kusokonezeka kwamalingaliro. [2] M'zaka zaposachedwa, kafukufuku wambiri wofufuza mankhwala opweteka omwe amagwiritsidwa ntchito masiku ano asonyeza kuti chithandizo chamankhwala, chomwe chingakhale chothandiza pa ululu wopweteka kwambiri, sichigwira ntchito ndi ululu wopweteka kwambiri ndipo, makamaka, chimayambitsa mavuto ena. Mankhwala ambiri opweteka amapangidwa kuti azitha kupweteka kwambiri koma akagwiritsidwa ntchito pakapita nthawi amatha kuyambitsa mavuto ambiri monga kugwiritsa ntchito mankhwala osokoneza bongo komanso kupewa zinthu zofunika kwambiri.[3] Chinthu chodziwika bwino pamankhwala ambiri opweteka ndikuti amatsindika za kupewa kupweteka kapena kulimbana kuti muchepetse ululu. Kupweteka kwa mutu wopweteka kungakhale kosapiririka. Ma painkillers ndi njira zothandizira kupweteka zimatha kuwonjezera kusalolera komanso kumva ululu. Choncho, mankhwala omwe amawonjezera kuvomereza ndi kulolerana ndi ululu, makamaka kupweteka kosalekeza, ndi othandiza. Mindfulness-based stress reduction (MBSR) ndi mankhwala atsopano okhudza maganizo omwe amawoneka kuti ndi othandiza popititsa patsogolo ntchito za thupi komanso maganizo kwa odwala omwe ali ndi ululu wosatha. [4,5,6,7,8] M'zaka makumi awiri zapitazi, Kabat -Zinn et al. ku US adagwiritsa ntchito bwino kulingalira kwa mpumulo wa ululu ndi matenda okhudzana ndi ululu.[9] Kafukufuku waposachedwapa pa njira zovomerezeka zovomerezeka, monga kulingalira, amasonyeza bwino ntchito kwa odwala omwe ali ndi ululu wosatha. Kuganiza bwino kumachepetsa ululu pogwiritsa ntchito kuzindikira kwapang'onopang'ono kwa malingaliro, malingaliro ndi zomverera, komanso ubale wotalikirana ndi zochitika zamkati ndi zakunja.[10] Kafukufuku anapeza kuti pulogalamu ya MBSR ikhoza kuchepetsa kwambiri matenda okhudzana ndi ululu wopweteka kwambiri monga fibromyalgia, nyamakazi ya nyamakazi, kupweteka kwapakhosi, kupweteka kwa msana, ndi multiple sclerosis. , nkhawa, kuvutika maganizo, madandaulo a somatic, ubwino, kusintha, khalidwe la kugona, kutopa, ndi kugwira ntchito kwa thupi. monga kupweteka kwa mutu, nthawi zambiri akadali akhanda. Choncho, phunziroli linachitidwa kuti awone zotsatira za MBSR pa kupsinjika maganizo ndi thanzi labwino kwa odwala omwe ali ndi mutu wovuta.

 

Zida ndi njira

 

Kuyesa kosasinthika kumeneku kudachitika mu 2012 ku chipatala cha Shahid Beheshti ku Kashan City. Research Ethics Committee ya Kashan University of Medical Sciences idavomereza kafukufukuyu (IRCT No: 2014061618106N1). Ophunzirawo adaphatikizapo akuluakulu omwe ali ndi vuto lamutu lomwe linatumizidwa ndi akatswiri a maganizo ndi akatswiri a ubongo ku Kashan. Njira zophatikizirapo zinali motere: Kukhala ndi mutu wovuta molingana ndi International Headache Classification Subcommittee, wokonzeka kutenga nawo mbali mu phunziroli, osakhala ndi chidziwitso chachipatala cha organic brain disorder kapena psychotic disorder, komanso osakhala ndi mbiri ya chithandizo chamaganizo m'zaka zapitazi za 6. miyezi. Odwala omwe sanamalize kulowererapo ndipo anaphonya magawo oposa awiri adachotsedwa pa phunzirolo. Otenga nawo mbali, omwe adasaina fomu yovomerezeka yodziwitsidwa, adamaliza miyeso ngati kuyeserera. Pakuyerekeza kukula kwachitsanzo, tidatchulapo kafukufuku wina pomwe kusintha kwa kutopa kochuluka kunali 62 � 9.5 panthawi yopangira chithandizo ndi 54.5 � 11.5 munthawi yolandira chithandizo.[18] Kenako, pogwiritsa ntchito chiwerengero cha kukula kwachitsanzo, otenga nawo mbali 33 (okhala ndi chiopsezo chocheperako) pagulu lililonse ali ndi ? = 0.95 ndi 1 = 0.9 adapatulidwa. Pambuyo pa kuwerengera kukula kwachitsanzo, odwala 66 omwe ali ndi mutu wopweteka adasankhidwa pogwiritsa ntchito zitsanzo zabwino malinga ndi zomwe zikuphatikizidwa. Kenako, odwalawo anaitanidwa ndi kuitanidwa kuti achite nawo phunzirolo. Ngati wodwala avomereza kutenga nawo mbali, ndiye kuti adaitanidwa kuti apite nawo ku gawo lachidule la phunzirolo ndipo ngati si wodwala wina yemwe adasankhidwa chimodzimodzi. Kenaka pogwiritsa ntchito tebulo lachisawawa, adatumizidwa ku gulu loyesera (MBSR) kapena gulu lolamulira lomwe linkachitira mwachizolowezi. Potsirizira pake, odwala 3 adachotsedwa ku gulu lirilonse ndipo odwala 60 anaphatikizidwa (odwala 30 mu gulu lirilonse). Gulu la TAU linkathandizidwa kokha ndi mankhwala osokoneza bongo komanso kasamalidwe kachipatala. Gulu la MBSR linalandira maphunziro a MBSR kuwonjezera pa TAU. Odwala omwe ali mu gulu la MBSR adaphunzitsidwa kwa masabata a 8 ndi katswiri wa zamaganizo wachipatala ndi digiri ya PhD. The Brief Symptom Inventory (BSI) ndi Perceived Stress Scale (PSS) inaperekedwa musanayambe gawo loyamba la chithandizo mu gulu la MBSR, pambuyo pa gawo lachisanu ndi chitatu (posttest), ndi miyezi ya 3 pambuyo poyesedwa (kutsatira) m'magulu onse awiri. Gulu la TAU linaitanidwa ku Chipatala cha Shahid Beheshti kuti adzalembe mafunsowo. Chithunzi 1 chikuwonetsa chithunzithunzi cha Consolidated Standards of Reporting Trials (CONSORT) chosonyeza mayendedwe a otenga nawo mbali mu kafukufukuyu.

 

Chithunzi 1 Chithunzi cha CONSORT Chosonyeza Mayendedwe a Omwe Atenga nawo Phunziro

Chithunzi 1: Chithunzi cha CONSORT chosonyeza kuyenda kwa omwe atenga nawo mbali mu phunziroli.

 

Kupewera

 

Gulu lothandizira (MBSR) linaphunzitsidwa ku chipatala cha Shahid Beheshti. Misonkhano isanu ndi itatu ya mlungu uliwonse (120 min) inkachitika motsatira ndondomeko ya MBSR yomwe inapangidwa ndi Kabat-Zinn.[11] Maphunziro owonjezera adachitika kwa omwe adaphonya gawo limodzi kapena awiri. Kumapeto kwa maphunziro ndi miyezi ya 3 pambuyo pake (kutsata), magulu onse a MBSR ndi TAU adaitanidwa ku chipatala cha Shahid Beheshti (malo a mayesero a MBSR) ndipo adalangizidwa kuti amalize mafunso. Pamagawo a MBSR, ophunzirawo adaphunzitsidwa kuti azindikire malingaliro awo, malingaliro awo, ndi zomverera zakuthupi mopanda chiweruzo. Zochita zolimbitsa thupi zimaphunzitsidwa ngati mitundu iwiri ya machitidwe osinkhasinkha � mwamwambo komanso osakhazikika. Zochita zolimbitsa thupi zokhazikika zimaphatikizapo kusinkhasinkha kophunzitsidwa bwino, kusanthula thupi, ndi yoga yolingalira. Mu kusinkhasinkha mwachisawawa, chidwi ndi kuzindikira sizimangoyang'ana pazochitika za tsiku ndi tsiku, komanso pamalingaliro, malingaliro, ndi kukhudzika kwathupi ngakhale zimakhala zovuta komanso zowawa. Zonse zomwe zili m'magawowo zidatchulidwa mu Gulu 1.

 

Table 1 Agendas for Sessions of MBSR

Gulu 1: Agenda za magawo ochepetsa kupsinjika maganizo.

 

Zida Zoyeza

 

International Headache Classification Subcommittee Diary Scale for Headaches

 

Kupweteka kwa mutu kunayesedwa ndi sikelo ya diary ya mutu. [19] Odwalawo adafunsidwa kuti alembe diary yowawa kwambiri pamlingo wa 0-10. Kusakhalapo kwa ululu komanso mutu wolemala kwambiri umadziwika ndi 0 ndi 10, motsatana. Tanthauzo la kupweteka kwa mutu mu sabata linawerengedwa pogawaniza chiwerengero cha zovuta kwambiri ndi 7. Komanso, tanthauzo la kupweteka kwa mutu kwa mwezi umodzi linawerengedwa mwa kugawa chiwerengero cha chiwerengero cha zovuta ndi 30. Zochepa komanso zowerengeka za kupweteka kwa mutu kunali 0 ndi 10, motero. Diary yamutu inaperekedwa kwa odwala asanu ndipo katswiri wa zamaganizo ndi katswiri wa zamaganizo anatsimikizira zomwe zili mu chidacho. [20] Kudalirika kwa mtundu wa Perisiya wa sikeloyi kudawerengedwa ngati 0.88.[20]

 

Chidule cha Zizindikiro Zachidule (BSI)

 

Zizindikiro zamaganizidwe zidayesedwa ndi BSI. [21] Zolembazo zimakhala ndi zinthu 53 ndi ma subscales 9 omwe amawunika zizindikiro zamaganizidwe. Chinthu chilichonse chimakhala pakati pa 0 ndi 4 (mwachitsanzo: Ndili ndi nseru kapena kukhumudwa m'mimba mwanga). BSI ili ndi index yoopsa yapadziko lonse (GSI) idapeza zinthu zonse 53. Kudalirika kwa mayesowo kunanena kuti pali 0.89. [22] Mu phunziro lathu, GSI test-retest estimate inali .90 yochokera pa chitsanzo cha odwala 60 omwe ali ndi mutu wovuta kwambiri omwe anamaliza BSI.

 

Perceived Stress Scale (PSS)

 

Kupsyinjika komwe kumaganiziridwa kunayesedwa pogwiritsa ntchito PSS, [21,23] mlingo wa 10-chinthu chomwe chimayesa kuchuluka kwa zinthu zosalamulirika komanso zosayembekezereka za moyo m'mwezi watha (mwachitsanzo: Kumva kuti simungathe kulamulira zinthu zofunika pamoyo wanu. ?). Ofunsidwa amafotokoza za kuchuluka kwa chinthu mkati mwa mwezi watha pa sikelo ya 5-point, kuyambira 0 (siyina) mpaka 4 (nthawi zambiri). Kugoletsa kumatsirizidwa ndi kubwezeredwa kumbuyo kwa zinthu zinayi zolembedwa bwino [4,5,7,8] ndi kufotokoza mwachidule ziwerengero zonse. Ziwerengero zimachokera ku 0-40. Zotsatira zapamwamba zimasonyeza kupsinjika kwakukulu. Amaganiza kuti anthu kutengera zomwe akukumana nazo amawunika kuchuluka kwa zowopseza kapena zovuta. Kupambana kwakukulu kumawonetsa kupsinjika kwakukulu komwe kumaganiziridwa. Kutsimikizika kokwanira ndi kudalirika kotsimikizika ndi kusinthika komanso kusalana kwanenedwanso.[19] Mu kafukufuku wathu, ma alpha coefficients a Cronbach oyesa kusasinthasintha kwamkati kwa sikeloyi adawerengedwa kukhala 0.88.

 

Kusanthula kobwerezabwereza kwa kusiyana kunkachitidwa kuti afanizire magulu a MBSR ndi TAU pa miyeso ya kupsinjika maganizo ndi GSI pa pretreatment, posttreatment, ndi 3-mwezi wotsatira. Komanso, kuyesa kwa Chi-square kunagwiritsidwa ntchito kuyerekeza kuchuluka kwa anthu m'magulu awiriwa. P mtengo wochepera 0.05 unkawoneka ngati wofunikira pamayeso onse.

 

Results

 

Pakati pa maphunziro a 66, anthu a 2 ochokera ku gulu la MBSR adachotsedwa chifukwa chosowa magawo oposa 2. Komanso, atatu omwe adatenga nawo mbali adachotsedwa chifukwa sanamalize mafunso pambuyo poyesa kapena kutsata omwe m'modzi mwa iwo anali ochokera ku gulu la MBSR ndi atatu ochokera ku gulu la TAU. Table 2 inasonyeza makhalidwe a anthu a maphunziro ndi zotsatira za cheke cha randomisation. Zotsatira za t-mayesero a kusiyana pakati pa magulu a MBSR ndi TAU mu zaka zosinthika ndi Chi-square test muzosiyana zinasonyeza kuti panalibe kusiyana kwakukulu pakati pa kusiyana kwa chiwerengero cha anthu m'magulu awiri ndipo maphunzirowa anaperekedwa mwachisawawa m'magulu awiri.

 

Table 2 Maonekedwe a Chiwerengero cha Anthu Omwe Akuphunzira

Gulu 2: Mawonekedwe a kuchuluka kwa anthu amitu a,b.

 

Gulu la 3 limapereka ziwerengero zapakati ndi zopatuka zomwe zimadalira (zomwe zimaganiziridwa kupsinjika ndi GSI) ndi kuyerekezera zotsatira za zotsatira pa nthawi yokonzekera, nthawi ya chithandizo, ndi kutsata kwa mwezi wa 3.

 

Table 3 Njira, Mipatuko Yokhazikika ndi Kufanizira Zotsatira

Gulu 3: Njira, zopotoka zokhazikika, ndi kuyerekezera zotsatira za zotsatira pa chithandizo, pambuyo pake, ndi magawo otsatila mumagulu a MBSR ndi TAU a, b.

 

Table 3 imasonyeza kuchepetsa kupsinjika komwe kunalandira ndi GSI mu gulu lothandizira (MBSR) poyerekeza ndi gulu la TAU, pamene kuchepetsa kupsinjika komwe kunalandira ndi GSI sikunawonedwe mu gulu la TAU. Zotsatira zinawonetsa zotsatira zazikulu za nthawi ndi kuyanjana pakati pa nthawi ndi mtundu wa chithandizo pakusintha kwa mavoti (P ​​<0.001).

 

Zithunzi?

 

Chithunzi 2 Chithunzi cha CONSORT Chosonyeza Mayendedwe a Omwe Atenga nawo Phunziro

Chithunzi 2: Chithunzi cha CONSORT chosonyeza kuyenda kwa omwe atenga nawo mbali mu phunziroli.

 

Chithunzi cha 3 Tanthauzo la Kupsinjika Maganizo mu MBSR ndi Magulu Olamulira

Chithunzi 3: Tanthauzo la kupsinjika maganizo mu MBSR ndi magulu olamulira mu pretest, posttest, ndi kutsatira.

 

Kukambirana

 

Kafukufukuyu anayerekezera mphamvu ya MBSR ndi Chithandizo Monga Nthawi Zonse (TAU) mumaganizo omwe amadziwika ndi thanzi la odwala omwe ali ndi mutu wopweteka. Ngakhale kuti MBSR imadziwika kuti ndi chithandizo chamankhwala chothandizira zizindikiro za kupsinjika maganizo ndi ululu, pakufunika kufufuza momwe zimagwirira ntchito pochiza matenda a maganizo kwa odwala omwe ali ndi mutu wovuta, womwe ndi umodzi mwa madandaulo omwe anthu ambiri amadandaula nawo.

 

Zomwe tapeza pa kafukufuku wathu zikuwonetsa thanzi labwino lamalingaliro mu GSI index ya BSI. Mu kafukufuku wina, kusintha kwakukulu kwa kulowererapo kwa MBSR kunafotokozedwa pa zolemba zonse za 36-chinthu cha Short Form Health Survey (SF-36) [20,24] Kafukufuku wasonyeza kuchepa kwakukulu kwa mavuto a maganizo mu Chizindikiro cha Zizindikiro-90-Revised (90) SCL-1-R) subscale monga nkhawa ndi kupsinjika maganizo ndi MBSR pambuyo pochitapo kanthu ndikutsatira kwa chaka cha 5. [5] Reibel et al. adawonetsa MBSR kwa odwala omwe ali ndi ululu wopweteka kwambiri adanena kuchepa kwa zizindikiro zachipatala monga nkhawa, kuvutika maganizo, ndi ululu. [25] Zasonyezedwa kuti kupweteka kwa mutu ndi nkhawa zimatsagana ndi zoperewera pakuwongolera kwachidziwitso monga chidwi chokhazikika ndi kukumbukira ntchito. [XNUMX] Kutengeka maganizo kungawonjezere kuzunzika komwe kumakhudzana ndi kumva ululu.

 

MBSR imagwiritsa ntchito njira zotsatirazi kuti athe kusintha maganizo a wodwalayo: Choyamba, kulingalira kumabweretsa chidziwitso chowonjezereka cha zomwe zikuchitika mphindi iliyonse, ndi malingaliro ovomereza, osagwidwa ndi malingaliro achizolowezi, malingaliro, ndi machitidwe. Kuzindikira kowonjezereka kumadzetsa njira zatsopano zoyankhira ndi kupirira pokhudzana ndi wekha komanso dziko lapansi.[3] Kulingalira kumakhazikitsa kudzimva komwe kuli kokulirapo kuposa malingaliro, malingaliro, ndi kukhudzidwa kwathupi monga kupweteka. Zochita zolimbitsa thupi, makasitomala ophunzirira amakulitsa "wodziwonera". Ndi luso limeneli, amatha kuona maganizo awo ndi mmene akumvera popanda kuchitapo kanthu ndiponso mopanda kuwaweruza, zomwe poyamba ankazipewa, ndipo maganizo amene poyamba ankapewa amaonedwa mopanda kuchitapo kanthu komanso mopanda kuweruza. Makasitomalawo amaphunzira kuzindikira malingaliro popanda kuchitapo kanthu, kulamulidwa nawo, kapena kuwakhulupirira.[3]

 

Chachiwiri, kusamala kumathandiza wofuna chithandizo kukhala wolimbikira pochita zinthu zofunika zomwe zili zofunika kwa iwo. Odwala ambiri omwe ali ndi ululu wosatha amafuna kuti asakhale ndi ululu m'malo mokhala moyo wofunikira womwe wasankha. Koma pulogalamu ya MBSR inawaphunzitsa kuti azichita zinthu zofunika ngakhale kuti anali ndi ululu. Kafukufuku wasonyeza chidwi ndi mmene maganizo zowawa ali ndi mbali yofunika kupitiriza ululu [26]. Zigawo zamaganizo ndi zachidziwitso zimatha kuchepetsa chidwi cha ululu ndikudandaula nazo zomwe zingapangitse ululu ndikusokoneza ntchito za odwala. [27,28]

 

Chachitatu, zomwe zapeza kuchokera ku maphunziro ena zimasonyeza kuti MBSR ikhoza kusintha ntchito ya ubongo yomwe imayambitsa kukhudzidwa ndi kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka kayendetsedwe ka machitidwe ka machitidwebu ka machitidwebubukhu | chitetezo cha m'thupi [29,30] Kuchita mwanzeru kumachepetsa kuyambiranso kumalingaliro ovutitsa ndi malingaliro omwe amaphatikizana ndikulimbitsa kuzindikira kowawa.[31] Komanso kuchita zinthu mwanzeru kungachepetse kuyambika kwa psychophysiological kukhudzana ndi kupsinjika ndi kusokonezeka kwamalingaliro mwa kulimbikitsa luso lowunikiranso komanso kuwongolera malingaliro.[32]

 

Mphamvu ya phunziroli ndikugwiritsa ntchito njira yatsopano yogwiritsira ntchito psychotherapy pochepetsa kupsinjika pa madandaulo omwe sanaphunzirepo, koma ndivuto lachipatala. Zotsatira za phunziro lathu zikugwiritsa ntchito psychotherapy yosavuta yomwe siipanga chidziwitso chochuluka ndipo imagwiritsidwa ntchito mosavuta ngati luso lolimbana ndi wodwala yemwe ali ndi mutu wovuta. Choncho, akatswiri azachipatala okhudzana ndi dandaulo ili ndi wodwalayo azitha kugwiritsa ntchito mankhwalawa. Komanso, MBSR idzasintha moyo wa wodwalayo yemwe angakulitsidwe ndi vuto lake. Cholepheretsa chachikulu cha phunziroli chinali kusowa kwa kufananitsa pakati pa MBSR ndi ma psychotherapies agolide monga cognitive behaviour therapy (CBT). Akuti maphunziro amtsogolo akuyenera kufananiza mphamvu ya MBSR ndi njira zina zachikhalidwe komanso zatsopano zamakhalidwe abwino kwa odwala omwe ali ndi vuto lamutu.

 

Kutsiliza

 

Kafukufuku wathu amathandizira lingaliro lakuti odwala omwe akuvutika ndi mutu amatha kupititsa patsogolo thanzi lawo lamaganizo mwa kutenga nawo mbali mu pulogalamu ya MBSR. Mwachidule, zotsatira za kafukufukuyu zikusonyeza kuti MBSR ikhoza kuchepetsa nkhawa zokhudzana ndi ululu komanso kusokoneza ntchito za tsiku ndi tsiku panthawi yochepa. Mawonekedwe apadera a masewera olimbitsa thupi amaphunzitsidwa mosavuta ndipo palibe chifukwa chovutira luso lazidziwitso.

 

Thandizo lazachuma ndi chithandizo: Nil.

 

Kusemphana kwachidwi: Palibe mikangano ya chidwi.

 

Zopereka za Wolemba

 

AO adathandizira pakupanga ntchito, kuchititsa phunzirolo, ndikuvomereza mbali zonse za ntchitoyo. FZ inathandizira pakukonzekera ntchitoyi, kukonzanso ndondomekoyi, kuvomereza ndondomeko yomaliza ya zolembazo ndikuvomereza mbali zonse za ntchitoyo.

 

Kuvomereza

 

Olemba akuthokoza ogwira ntchito pachipatala cha Shahid Beheshti komanso omwe atenga nawo mbali. Olemba akuwonetsanso kuyamikira kwawo kwa Kabat-Zinn wochokera ku Center for Mindfulness (CFM) ku yunivesite ya Massachusetts amene mwachifundo anapereka makope apakompyuta a malangizo a MBSR.

 

Pomaliza,�Ngakhale kupsinjika kwakanthawi kochepa kumakhala kothandiza, kupsinjika kwanthawi yayitali kumatha kuyambitsa zovuta zosiyanasiyana zaumoyo, kuphatikiza nkhawa ndi kupsinjika maganizo komanso kupweteka kwa khosi ndi msana, mutu ndi disc herniation. Mwamwayi, kuchitapo kanthu mwachidwi, monga chisamaliro cha chiropractic ndi kuchepetsa kupsinjika maganizo (MBSR) ndizotetezeka komanso zogwira mtima zosamalira njira zina zothandizira. Potsirizira pake, nkhani yomwe ili pamwambayi inasonyeza zotsatira zochokera ku umboni wakuti MBSR ikhoza kuchepetsa kupsinjika maganizo ndi kupititsa patsogolo thanzi labwino la maganizo kwa odwala omwe ali ndi mutu wovuta. Zambiri zomwe zatchulidwa kuchokera ku National Center for Biotechnology Information (NCBI). Kuchuluka kwa chidziwitso chathu kumangokhala kwa chiropractic komanso kuvulala kwa msana ndi mikhalidwe. Kuti tikambirane nkhaniyi, chonde omasuka kufunsa Dr. Jimenez kapena tilankhule nafe pa 915-850-0900 .

 

Wosankhidwa ndi Dr. Alex Jimenez

 

Green-Call-Now-Button-24H-150x150-2-3.png

 

Mitu Yowonjezera: Ululu Wobwerera

 

Malinga ndi ziwerengero, pafupifupi 80% ya anthu adzakhala ndi zizindikiro za ululu wammbuyo kamodzi pa moyo wawo wonse. Ululu wammbuyo ndi dandaulo lofala lomwe lingakhalepo chifukwa cha kuvulala kosiyanasiyana ndi/kapena mikhalidwe. Nthawi zambiri, kuwonongeka kwachilengedwe kwa msana ndi zaka kungayambitse ululu wammbuyo. Herniated discs zimachitika pamene chofewa, ngati gel pakati pa intervertebral disc ikukankhira kupyola mu misozi yozungulira, mphete yakunja ya cartilage, kuponderezana ndi kukwiyitsa mizu ya mitsempha. Ma disc herniations nthawi zambiri amapezeka m'munsi kumbuyo, kapena msana, koma amathanso kuchitika m'mphepete mwa khomo lachiberekero, kapena khosi. Kulowetsedwa kwa mitsempha yomwe imapezeka m'munsi kumbuyo chifukwa cha kuvulala ndi / kapena kuwonjezereka kwa chikhalidwe kungayambitse zizindikiro za sciatica.

 

chithunzi cha blog cha cartoon paperboy nkhani zazikulu

 

MUTU WOFUNIKA KWAMBIRI: Kuwongolera Kupanikizika Kwapantchito

 

 

NKHANI ZOFUNIKA KWAMBIRI: ZOWONJEZERA ZOWONJEZERA: Chithandizo cha Ngozi ya Galimoto El Paso, TX Chiropractor

 

Palibe kanthu
Zothandizira
1. Trkanjec Z, Aleksic-Shihabi A. Kupweteka kwamutu kwamtundu wa Tension.�Acta Med Croatica.�2008;62:205;10.[Adasankhidwa]
2. Zirke N, Seydel C, Szczepek AJ, Olze H, Haupt H, Mazurek B. Psychological comorbidity kwa odwala omwe ali ndi tinnitus aakulu: Kusanthula ndi kuyerekezera ndi ululu wosatha, mphumu kapena atopic dermatitis odwala.Qual Life Res.�2013;22: 263-72[Adasankhidwa]
3. Dionne F, Blais MC, Monestes JL. Chithandizo chovomerezeka komanso chodzipereka pochiza zowawa zosatha.�Sante Ment Que.�2013;38: 131-52[Adasankhidwa]
4. Cathcart S, Galatis N, Immink M, Proeve M, Petkov J. Mwachidule, Thandizo lokhazikika pamutu wa mutu wovuta kwambiri: Kafukufuku woyendetsedwa mwachisawawa.�Behav Cogn Psychother.�2013;42:1;15.[Adasankhidwa]
5. Reibel DK, Greeson JM, Brainard GC, Rosenzweig S. Mindfulness-based stress reduction and health-related quality of life in the heterogeneous patient population.�Gen Hosp Psychiatry.�2001;23:183;92.[Adasankhidwa]
6. Grossman P, Niemann L, Schmidt S, Walach H. Kuchepetsa kupsinjika maganizo ndi ubwino wathanzi. Meta-analysis.�J Psychosom Res.�2004;57: 35-43[Adasankhidwa]
7. Rosenzweig S, Greeson JM, Reibel DK, Green JS, Jasser SA, Beasley D. Mindfulness-based stress reduction for chronic pain stress: Kusiyana kwa zotsatira za mankhwala ndi ntchito ya kusinkhasinkha kunyumba.J Psychosom Res.�2010;68: 29-36[Adasankhidwa]
8. Kerrigan D, Johnson K, Stewart M, Magyari T, Hutton N, Ellen JM, et al. Malingaliro, zokumana nazo, ndi masinthidwe omwe akuchitika pakati pa achinyamata akutawuni omwe akutenga nawo gawo pamalingaliro ochepetsa kupsinjika maganizo.�Kuthandizira Ther Clin Pract.�2011;17: 96-101[Adasankhidwa]
9. Kabat-Zinn J. New York: Dell Publishing; 1990. Kukhala ndi Moyo Watsoka Kwambiri; p. 185.
10. Hayes AM, Feldman G. Kufotokozera za kamangidwe ka malingaliro pankhani ya kuwongolera malingaliro ndi njira yosinthira chithandizo.�Clin Psychol-Sci Pr.2004:255-62.
11. Schmidt S, Grossman P, Schwarzer B, Jena S, Naumann J, Walach H. Kuchiza fibromyalgia ndi kuchepetsa kupsinjika maganizo: Zotsatira za mayesero oyendetsedwa ndi zida za 3.Ululu. 2011;152: 361-9[Adasankhidwa]
12. Pradhan EK, Baumgarten M, Langenberg P, Handwerger B, Gilpin AK, Magyari T, et al. Zotsatira za Mindfulness-Based Stress Reduction in the Rheumatoid Arthritis Odwala.�Matenda a Arthritis Rheum2007;57:1134;42.[Adasankhidwa]
13. Cramer H, Haller H, Lauche R, Dobos G. Mindfulness-based stress kuchepetsa kupweteka kwa msana. Ndemanga mwadongosolo.�BMC Imathandizira Altern Med.�2012;12:162. �[Nkhani yaulere ya PMC] [Adasankhidwa]
14. Bazarko D, Cate RA, Azocar F, Kreitzer MJ. Zotsatira za pulogalamu yochepetsera kupsinjika maganizo paumoyo ndi thanzi la anamwino omwe amalembedwa ntchito m'makampani.�J Health Workplace Behav Health.�2013;28: 107-33[Nkhani yaulere ya PMC] [Adasankhidwa]
15. Carlson LE, Garland SN. Zotsatira za mindfulness-based stress reduction (MBSR) pakugona, kukhumudwa, kupsinjika ndi kutopa kwa odwala omwe ali ndi khansa.Int J Behav Med2005;12: 278-85[Adasankhidwa]
16. Lengacher CA, Kip KE, Barta M, Post-White J, Jacobsen PB, Groer M, et al. Kafukufuku woyendetsa ndege wowunika momwe kuchepetsera kupsinjika kwamalingaliro motengera malingaliro, mawonekedwe athupi, salivary cortisol, ndi interleukin-6 pakati pa odwala omwe ali ndi khansa yapamwamba komanso owasamalira.J Holist Nurs.�2012;30: 170-85[Adasankhidwa]
17. Simpson J, Mapel T. Kafukufuku wokhudza ubwino wa thanzi la mindfulness-based stress reduction (MBSR) kwa anthu omwe ali ndi matenda osiyanasiyana a thupi ku New Zealand.�NZ Med J.�2011;124: 68-75[Adasankhidwa]
18. Omidi A, Mohammadi A, Zargar F, Akbari H. Mphamvu ya kuchepetsa kupsinjika maganizo mozikidwa pa maganizo States of veterans with post-traumatic stress disorder.�Arch Trauma Res.�2013;1: 151-4[Nkhani yaulere ya PMC][Adasankhidwa]
19. Cohen S, Kamarck T, Mermelstein R. Mulingo wapadziko lonse wa kupsinjika maganizo.�J Health Soc Behav.�1983;24: 385-96[Adasankhidwa]
20. Roth B, Robbins D. Kuchepetsa kupsinjika kozikidwa pamalingaliro komanso moyo wokhudzana ndi thanzi: Zomwe zapeza kuchokera ku zilankhulo ziwiri za odwala omwe ali mkati mwa mzinda.�Psychosom Med2004;66: 113-23[Adasankhidwa]
21. Brown KW, Ryan RM. Ubwino wopezekapo: Kusamala ndi gawo lake pakuchita bwino m'maganizo.�J Pers Soc Psychol. �2003;84: 822-48[Adasankhidwa]
22. Astin JA, Shapiro SL, Lee RA, Shapiro DH., Jr Kupanga kwaulamuliro mumankhwala amthupi lamalingaliro: Zokhudza chisamaliro chaumoyo.�Altern Ther Health Med.�1999;5: 42-7[Adasankhidwa]
23. Cohen S, Williamson G. Anazindikira kupsinjika mu chitsanzo chotheka cha United States. Mu: Spacapan S, Oskamp S, akonzi.�The Social Psychology of Health.�Newbury Park, CA: Sage; 1988 p. 185.
24. Geary C, Rosenthal SL. Mphamvu zokhazikika za MBSR pa kupsinjika maganizo, thanzi labwino, ndi zochitika zauzimu za tsiku ndi tsiku kwa chaka chimodzi mwa ogwira ntchito zachipatala. �J Altern Wothandizira Med.�2011;17:939;44.[Adasankhidwa]
25. Dick BD, Rashiq S, Verrier MJ, Ohinmaa A, Zhang J. Chizindikiro cholemetsa, kuwononga mankhwala, ndi kuthandizira kugwiritsa ntchito chida chamoyo chokhudzana ndi thanzi la 15D pachipatala chopweteka kwambiri.�Pain Res Treat 2011.�2011:809071.�[Nkhani yaulere ya PMC] [Adasankhidwa]
26. McCabe C, Lewis J, Shenker N, Hall J, Cohen H, Blake D. Osayang'ana tsopano! Ululu ndi chidwi.�Clin Med2005;5: 482-6[Nkhani yaulere ya PMC] [Adasankhidwa]
27. Bener A, Verjee M, Dafeeah EE, Falah O, Al-Juhaishi T, Schlogl J, et al. Psychological factor: Nkhawa, kupsinjika maganizo, ndi zizindikiro za somatization mwa odwala opweteka kwambiri.�J Pain Res.�2013;6:95;101.[Nkhani yaulere ya PMC] [Adasankhidwa]
28. Lee JE, Watson D, Frey-Law LA. Zinthu zamaganizo zimaneneratu kupweteka kwa minofu komweko ndi komwe kumatchulidwa: Kusanthula masango mwa akuluakulu athanzi.�Eur J Pain.�2013;17: 903-15[Nkhani yaulere ya PMC] [Adasankhidwa]
29. Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF, et al. Kusintha kwa ubongo ndi magwiridwe antchito a chitetezo chamthupi kumapangidwa ndi kusinkhasinkha mwanzeru. �Psychosom Med2003;65:564;70.[Adasankhidwa]
30. Lazar SW, Kerr CE, Wasserman RH, Gray JR, Greve DN, Treadway MT, et al. Kusinkhasinkha kumayenderana ndi kuchuluka kwa cortical makulidwe.�Neuroreport.�2005;16: 1893-7[Nkhani yaulere ya PMC] [Adasankhidwa]
31. McCracken LM, Jones R. Chithandizo cha ululu wosatha kwa akuluakulu m'zaka zachisanu ndi chiwiri ndi zisanu ndi zitatu za moyo: Kuphunzira koyambirira kwa Acceptance and Commitment Therapy (ACT) �Pain Med. �2012;13:860;7.[Adasankhidwa]
32. McCracken LM, Guti�rrez-Mart�nez O. Njira zosinthira kusinthasintha kwamaganizidwe m'magulu amagulu osiyanasiyana okhudzana ndi kupweteka kosatha kutengera Acceptance and Commitment Therapy.�Behav Res Ther.�2011;49: 267-74[Adasankhidwa]
Tsekani Accordion