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Isivivinyo Esilawulwa Ngokungahleliwe

Umtholampilo Wasemuva Olawulwa Ngokungahleliwe Ukuhlolwa Kwe-Chiropractic kanye Nethimba Lemithi Esebenzayo. Ucwaningo lapho ababambiqhaza bahlukaniswa ngenhlanhla ngamaqembu ahlukene aqhathanisa ukwelashwa okuhlukile noma okunye ukungenelela. Ukusebenzisa ithuba lokuhlukanisa abantu ngamaqembu kusho ukuthi amaqembu azofana nokuthi imiphumela yokwelashwa abayitholayo ingaqhathaniswa ngokufanele.

Ngesikhathi sokuhlolwa, akwaziwa ukuthi yikuphi ukwelashwa okungcono kakhulu. A Isivivinyo Esilawulwa Ngokungahleliwe noma (I-RCT) idizayini inika abahlanganyeli ngokungahleliwe eqenjini lokuhlola noma iqembu lokulawula. Njengoba ucwaningo lwenziwa, umehluko kuphela olindelekile kusukela kumaqembu okulawula kanye nokuhlola ocwaningweni olulawulwa ngokungahleliwe (I-RCT) ukuguquguquka komphumela okufundwayo.

Izinzuzo

  • Kulula ukungaboni/imaski kunezifundo zokubheka
  • Ukwenza okungahleliwe okuhle kususa noma yikuphi ukuchema kwabantu
  • Izibalo zabantu ababambe iqhaza zibonakala ngokucacile
  • Imiphumela ingahlaziywa ngamathuluzi ezibalo aziwayo

Okumbi

  • Ayivezi imbangela
  • Kuyabiza ngesikhathi nangemali
  • Ukulahleka kokulandelela okubangelwa ukwelashwa
  • Ukuchema kwamavolontiya: inani labantu elibamba iqhaza lingase lingameleli lonke

Ukuze uthole izimpendulo zanoma imiphi imibuzo ongase ube nayo sicela ushayele uDkt. Jimenez kokuthi 915-850-0900

Izinkombandlela Zezempilo Zokulimala Komsebenzi Zobuhlungu Obuphansi Emuva e-El Paso, TX

Izinkombandlela Zezempilo Zokulimala Komsebenzi Zobuhlungu Obuphansi Emuva e-El Paso, TX

by | Ukuhlungu obusemhlane, I-Chiropractic, Ubuhlungu obungapheliyo, Isivivinyo Esilawulwa Ngokungahleliwe

Ubuhlungu obuphansi emuva bumelela esinye sezikhalazo ezivame kakhulu ezilungiselelweni zokunakekelwa kwezempilo. Nakuba ukulimala okuhlukahlukene kanye nezimo ezihlobene nesistimu ye-musculoskeletal kanye nezinzwa kungabangela ubuhlungu obuphansi emuva, ochwepheshe abaningi bezempilo bakholelwa ukuthi ukulimala komsebenzi kungase kube nokuxhumana okuvame kakhulu ebuhlungu obuphansi emuva. Isibonelo, ukuma okungalungile nokunyakaza okuphindaphindiwe kungase kubangele ukulimala okuhlobene nomsebenzi. Kwezinye izimo, izingozi zemvelo emsebenzini zingadala ukulimala emsebenzini. Kunoma ikuphi, ukuxilonga umthombo wobuhlungu obuphansi beqolo besiguli ukuze kutholwe kahle ukuthi iyiphi indlela yokwelapha engcono kakhulu yokubuyisela impilo nempilo yasekuqaleni yomuntu ngokuvamile kuyinselele.

 

Okokuqala futhi okubaluleke kakhulu, ukuthola odokotela abalungile bomthombo wakho othize wezinhlungu eziphansi emuva kubalulekile ukuze uthole ukukhululeka ezimpawini zakho. Ochwepheshe abaningi bezempilo baqeqeshiwe futhi banolwazi ekwelapheni izinhlungu eziphansi ezihlobene nomsebenzi, okuhlanganisa nodokotela be-chiropractic noma i-chiropractors. Ngenxa yalokho, kuye kwasungulwa imihlahlandlela eminingi yokwelashwa kokulimala emsebenzini ukuze kuphathe ubuhlungu obuphansi emuva kuzilungiselelo zokunakekelwa kwezempilo. Ukunakekelwa kwe-Chiropractic kugxile ekuxilongeni, ekwelapheni, nasekuvimbeleni ukulimala nezimo ezihlukahlukene, njenge-LBP, ehambisana nesistimu ye-musculoskeletal ne-nervous. Ngokulungisa ngokucophelela ukungahambi kahle komgogodla, ukunakekelwa kwe-chiropractic kungasiza ekuthuthukiseni izimpawu zobuhlungu obuphansi emuva, phakathi kwezinye izimpawu. Inhloso yalesi sihloko esilandelayo ukuxoxa ngeziqondiso zezempilo emsebenzini zokuphatha ubuhlungu obuphansi emuva.

 

Imihlahlandlela Yezempilo Yasemsebenzini Yokuphathwa Kobuhlungu Beqolo: Ukuqhathaniswa Kwamazwe Ngamazwe

 

abstract

 

  • Ingemuva: Umthwalo omkhulu wenhlalakahle yezomnotho wobuhlungu obuphansi emuva ugcizelela isidingo sokuphatha le nkinga, ikakhulukazi esimweni somsebenzi ngempumelelo. Ukubhekana nalokhu, kuye kwakhishwa imihlahlandlela yokusebenza emazweni ahlukahlukene.
  • Izinhloso: Ukuqhathanisa imihlahlandlela yamazwe ngamazwe etholakalayo yokuphatha ubuhlungu obuphansi emuva esimweni sokunakekelwa kwezempilo emsebenzini.
  • Izindlela: Imihlahlandlela iqhathaniswe ngokuphathelene nenqubo yekhwalithi eyamukelwa ngokuvamile kusetshenziswa ithuluzi le-AGREE futhi yafingqwa mayelana nekomidi leziqondiso, isethulo, iqembu eliqondiwe, kanye nezincomo zokuhlola nokuphatha (okungukuthi, iseluleko, isu lokubuyela emsebenzini, nokwelashwa).
  • Imiphumela neziphetho: Imiphumela ibonisa ukuthi imihlahlandlela ihlangabezana ngokuhlukile nemibandela yekhwalithi. Amaphutha ajwayelekile aphathelene nokungabi bikho kokubuyekezwa okufanele kwangaphandle enqubweni yokuthuthukiswa, ukuntula ukunaka izithiyo zenhlangano kanye nemiphumela yezindleko, nokuntuleka kolwazi ngezinga abahleli nabathuthukisi ababezimele ngalo. Kwakukhona isivumelwano esijwayelekile ezindabeni eziningi eziyisisekelo ekuphathweni kwezempilo emsebenzini wobuhlungu be-back. Izincomo zokuhlola zazihlanganisa ukulinganisa kokuxilonga, ukuhlolelwa amafulegi abomvu nezinkinga zemizwa, nokuhlonza izithiyo ezingaba khona ezingokwengqondo nezokusetshenzelwa ukuze zilulame. Iziqondiso ziphinde zavumelana ngeseluleko sokuthi ubuhlungu obuphansi emuva buyisimo sokuzibekela umkhawulo nokuthi ukuhlala emsebenzini noma ukubuyela emsebenzini (kancane kancane) emsebenzini, uma kunesidingo ngemisebenzi eguquliwe, kufanele kukhuthazwe futhi kusekelwe.

 

Ukuqonda kukaDkt Alex Jimenez

Ubuhlungu obuphansi emuva bungenye yezinkinga zezempilo ezivame kakhulu eziphathwa emahhovisi e-chiropractic. Nakuba isihloko esilandelayo sichaza ubuhlungu obuphansi emuva njengesimo sokuzikhawulela, imbangela ye-LBP yomuntu ingase futhi ibangele ubuhlungu obucindezelayo nobuhlungu obukhulu kanye nokungahambi kahle kokushiya kungalashwa. Kubalulekile kumuntu onezimpawu zobuhlungu obuphansi emuva ukuze afune ukwelashwa okufanele nge-chiropractor ukuze axilonge kahle futhi aphathe izinkinga zabo zezempilo kanye nokubavimbela ukuthi babuye esikhathini esizayo. Iziguli ezithola ubuhlungu obuphansi emuva isikhathi esingaphezu kwezinyanga ze-3 zingaphansi kwamaphesenti angu-3 okungenzeka zibuyele emsebenzini. Ukunakekelwa kwe-Chiropractic kuyindlela yokwelashwa ehlukile ephephile futhi ephumelelayo engasiza ukubuyisela umsebenzi wokuqala womgogodla. Ngaphezu kwalokho, udokotela we-chiropractic, noma i-chiropractor, anganikeza ukuguqulwa kwendlela yokuphila, njengeseluleko sokudla okunempilo nokufaneleka, ukusheshisa inqubo yokululama yesiguli. Ukuphulukisa ngokunyakaza kubalulekile ekubuyiseleni kwe-LBP.

 

Ubuhlungu obuphansi emuva (LBP) bungenye yezinkinga zempilo ezivame kakhulu emazweni ezimboni. Naphezu kwemvelo yayo enhle kanye nenkambo ezwakalayo, i-LBP ivame ukuhlotshaniswa nokungakwazi ukusebenza, ukulahlekelwa umkhiqizo ngenxa yekhefu lokugula, kanye nezindleko eziphezulu zomphakathi.[1]

 

Ngenxa yalowo mthelela, kunesidingo esisobala samasu okuphatha aphumelelayo asekelwe ebufakazini besayensi obutholakala ocwaningweni lwekhwalithi ezwakalayo yendlela yokwenza. Ngokuvamile, lezi zilingo ezilawulwa ngokungahleliwe (ama-RCT) ekusebenzeni kokungenelela kokwelapha, izifundo zokuxilonga, noma izifundo zokubheka ezingenzeka ezicini eziyingozi noma imiphumela emibi. Ubufakazi besayensi, obufingqiwe ekubuyekezweni okuhlelekile nokuhlaziywa kwe-meta, bunikeza isisekelo esiqinile sezinkombandlela zokuphatha i-LBP. Ephepheni eledlule, u-Koes et al. kuqhathanise imihlahlandlela ehlukahlukene ekhona yokwelashwa yokuphatha i-LBP eqondiswe ochwepheshe bokunakekelwa kwezempilo okuyisisekelo, okubonisa ukufana okukhulu.[2]

 

Izinkinga ekunakekelweni kwezempilo emsebenzini zihlukene. Ukuphatha kugxile kakhulu ekwelulekeni isisebenzi nge-LBP kanye nokubhekana nezindaba zokubasiza ukuthi baqhubeke nokusebenza noma babuyele emsebenzini (RTW) ngemva kokufakwa ohlwini lwabagulayo. Kodwa-ke, i-LBP iphinde ibe yinkinga ebalulekile ekunakekelweni kwezempilo ngenxa yokungakwazi ukusebenza okuhlobene, ukulahlekelwa kokukhiqiza, kanye nekhefu lokugula. Iziqondiso ezimbalwa, noma izigaba zemihlahlandlela, manje sezishicilelwe ezidingida izindaba ezithile zokuphatha endaweni yokunakekelwa kwezempilo emsebenzini. Njengoba ubufakazi bungamazwe ngamazwe, kungalindeleka ukuthi izincomo zezinkombandlela ezahlukene zomsebenzi ze-LBP zizofana kakhulu noma zifane. Kodwa-ke, akucaci ukuthi imihlahlandlela iyahlangabezana nemibandela yekhwalithi eyamukelwe njengamanje.

 

Leli phepha lihlaziya ngokucophelela imihlahlandlela yokusebenza etholakalayo yokuphatha i-LBP futhi liqhathanise izincomo zabo zokuhlola nokuphatha.

 

Imilayezo Eyinhloko

 

  • Emazweni ahlukahlukene, imihlahlandlela yezempilo yomsebenzi ikhishwa ukuze kuthuthukiswe ukuphathwa kobuhlungu obuphansi emuva esimweni somsebenzi.
  • Amaphutha avamile ale mihlahlandlela aphathelene nokungabi bikho kokubuyekezwa okufanele kwangaphandle enqubweni yokuthuthukiswa, ukunganakwa kwezithiyo zenhlangano kanye nemiphumela yezindleko, kanye nokuntuleka kolwazi ngokuzimela kwabahleli nabathuthukisi.
  • Ngokuvamile, izincomo zokuhlola eziqondisweni zazihlanganisa ukulinganisa kokuxilonga, ukuhlola amafulegi abomvu nezinkinga zezinzwa, nokuhlonza izithiyo ezingaba khona ezingokwengqondo nezokusebenza ukuze zilulame.
  • Kukhona isivumelwano esijwayelekile mayelana nezeluleko zokuthi ubuhlungu obuphansi emuva buyisimo sokuzimela nokuthi ukuhlala emsebenzini noma ukubuyela emsebenzini (kancane kancane) emsebenzini, uma kunesidingo ngemisebenzi eguquliwe, kufanele kukhuthazwe futhi kusekelwe.

 

izindlela

 

Imihlahlandlela yokuphathwa kwempilo yomsebenzi ye-LBP itholwe kumafayela omuntu siqu ababhali. Ukubuyisa kuhlolwe usesho lwe-Medline kusetshenziswa amagama angukhiye ubuhlungu obuphansi emuva, imihlahlandlela, kanye nomsebenzi kuze kube ngu-Okthoba 2001, kanye nokuxhumana komuntu siqu nochwepheshe kulo mkhakha. Izinqubomgomo bekufanele zihlangabezane nemibandela elandelayo yokufakwa:

 

  • Izinkombandlela ezihloselwe ukuphatha abasebenzi nge-LBP (ezilungiselelweni zokunakekelwa kwezempilo emsebenzini noma ukubhekana nezinkinga zomsebenzi) noma izingxenye ezihlukene zezinqubomgomo ezikhuluma ngalezi zihloko.
  • Imihlahlandlela iyatholakala ngesiNgisi noma ngesiDashi (noma ihunyushelwe kulezi zilimi).

 

Imibandela yokukhishwa bekuyilokhu:

 

  • Izinkombandlela zokuvimbela okuyinhloko (okungukuthi, ukuvimbela ngaphambi kokuqala kwezimpawu) ze-LBP ehlobene nomsebenzi (isibonelo, ukuphakamisa imiyalelo yabasebenzi).
  • Imihlahlandlela yomtholampilo yokuphathwa kwe-LBP ekunakekelweni okuyinhloko.[2]

 

Ikhwalithi yezinkombandlela ezifakiwe yahlolwa kusetshenziswa ithuluzi le-AGREE, ithuluzi elijwayelekile elidizayinelwe ngokuyinhloko ukusiza abathuthukisi bemihlahlandlela nabasebenzisi ukuhlola ikhwalithi yendlela yokwenza yezinkombandlela zokuzijwayeza zomtholampilo.[3]

 

Ithuluzi le-AGREE linikeza uhlaka lokuhlola ikhwalithi ezintweni ezingu-24 (ithebula 1), ngayinye ilinganiselwe esikalini samaphuzu amane. Ukusebenza okugcwele kuyatholakala ku-www.agreecollaboration.org.

 

Ababuyekezi ababili (i-BS kanye no-HH) balinganisele ngokuzimela ikhwalithi yezinkombandlela base behlangana ukuze baxoxe ngokungaboni ngaso linye futhi bafinyelele ukuvumelana ngezilinganiso. Lapho bengavumelani, umbuyekezi wesithathu (i-MvT) wahlanganisa umehluko osele futhi wanquma ngezilinganiso. Ukuze kube lula ukuhlaziya kulokhu kubuyekezwa, izilinganiso zishintshiwe zaba okuguquguqukayo okungaqondakali kokuthi into ngayinye yekhwalithi ifinyelelwe yini noma ayizange ifinyelelwe.

 

Izincomo zokuhlola zafingqwa futhi zaqhathaniswa nezincomo ngezeluleko, ukwelashwa, nokubuyela kumasu omsebenzi. Imihlahlandlela ekhethiwe yaphinde yaphawulwa futhi yafinyelelwa mayelana nekomidi leziqondiso, ukwethulwa kwenqubo, iqembu okuhlosiwe, kanye nezinga izincomo ezisekelwe ngalo ebufakazini besayensi obukhona. Lonke lolu lwazi lukhishwe ngokuqondile kumhlahlandlela oshicilelwe.

 

Impumelelo Yenqubomgomo

 

  • Ukuphathwa kobuhlungu obuphansi emuva ekunakekelweni kwezempilo emsebenzini kufanele kulandele imihlahlandlela esekelwe ebufakazini.
  • Imihlahlandlela yesikhathi esizayo yomsebenzi yokuphatha ubuhlungu obuphansi emuva kanye nezibuyekezo zalezo ziqondiso kufanele zicabangele imibandela yokuthuthukiswa okufanele, ukuqaliswa, nokuhlolwa kwezindlela njengoba kuphakanyiswe ukusebenzisana kwe-AGREE.

 

Imiphumela

 

Ukukhethwa Kwezifundo

 

Ukusesha kwethu kwathola iziqondiso eziyishumi, kodwa ezine zazingafakwa ngoba zibhekene nokuphathwa kwe-LBP ekunakekelweni okuyinhloko, [15] zazihloselwe isiqondiso sabasebenzi abasohlwini lokugula ngokujwayelekile (hhayi ikakhulukazi i-LBP), [16] yayihloselwe ukuvimbela okuyinhloko kwe-LBP emsebenzini, [17] noma bekungatholakali ngesiNgisi noma ngesiDashi.[18] Ngakho-ke, ukukhetha kokugcina bekuhlanganisa imihlahlandlela eyisithupha elandelayo, ebhalwe ngosuku lokukhishwa kwayo:

 

(1) ECanada (Quebec). Indlela yesayensi yokuhlola nokuphathwa kwezinkinga zomgogodla ezihlobene nomsebenzi. I-monograph yodokotela. Umbiko we-Quebec Task Force on Spinal Disorders. I-Quebec Canada (1987) [4]

 

(2) Australia (Victoria). Imihlahlandlela yokuphatha abasebenzi abanezinhlungu eziphansi ezikhokhelwayo. I-Victorian WorkCover Authority, e-Australia (1996).[5] (Lena inguqulo ebuyekeziwe yezinkombandlela ezakhiwe yi-South Australian WorkCover Corporation ngo-Okthoba 1993.)

 

(3) e-USA. Imihlahlandlela Yokuzilolonga Kwemithi Yasemsebenzini. I-American College of Occupational and Environmental Medicine. USA (1997) [6]

 

(4) ENew Zealand

 

(a) Iyasebenza futhi iyasebenza! Ukuphatha ubuhlungu obukhulu obuphansi emuva emsebenzini. I-Accident Compensation Corporation kanye neKomidi Lezempilo Likazwelonke. I-New Zealand (2000) [7]

 

(b) Umhlahlandlela wesiguli ekulawuleni ubuhlungu obuphansi emuva. I-Accident Compensation Corporation kanye neKomidi Lezempilo Likazwelonke. I-New Zealand (1998) [8]

 

(c) Hlola amafulegi aphuzi ngokwengqondo nesomphakathi kubuhlungu obukhulu obuphansi beqolo. I-Accident Compensation Corporation kanye neKomidi Lezempilo Likazwelonke. I-New Zealand (1997) [9]

(5) eNetherlands. Isiqondiso se-Dutch sokuphatha odokotela bomsebenzi wabasebenzi abanezinhlungu eziphansi emuva. I-Dutch Association of Occupational Medicine (NVAB). I-Netherlands (1999) [10]

 

(6) e-UK

 

(a) Imihlahlandlela yezempilo yomsebenzi yokuphatha ubuhlungu obuphansi emuva emsebenzini izincomo eziyinhloko. I-Faculty of Occupational Medicine. UK (2000) [11]

 

(b)Iziqondiso zezempilo emsebenzini zokulawula izinhlungu eziphansi emuva emsebenzini wamapheshana odokotela. I-Faculty of Occupational Medicine. UK (2000) [12]

 

(c) Imihlahlandlela yezempilo yomsebenzi yokuphatha ubuhlungu obuphansi emuva ekubuyekezweni kobufakazi bomsebenzi. I-Faculty of Occupational Medicine. UK (2000) [13]

 

(d)Incwadi Engemuva, Ihhovisi Lezokubhala. UK (1996) [14]

Imihlahlandlela emibili (4 kanye ne-6) ayikwazanga ukuhlolwa ngokuzimele kumadokhumenti engeziwe ababhekisela kuwo (4bc, 6bd), ngakho le mibhalo ifakiwe ekubuyekezweni.

 

Ukuhlolwa Kwekhwalithi Yemihlahlandlela

 

Ekuqaleni, kube nesivumelwano phakathi kwababuyekezi ababili mayelana ne-106 (77%) yezilinganiso zezinto eziyi-138. Ngemuva kwemihlangano emibili, kwafinyelelwa kusivumelwano kuzo zonke izinto ngaphandle kwezine, obekudingeka ukuba umbuyekezi wesithathu akhiphe isinqumo. Ithebula 1 lethula izilinganiso zokugcina.

 

Zonke iziqondiso ezifakiwe zethule izinketho ezahlukene zokuphatha i-LBP empilweni yomsebenzi. Kuzinqubomgomo ezinhlanu kweziyisithupha, izinhloso eziphelele zenqubo zachazwa ngokucacile, [46, 1014] abasebenzisi abahlosiwe bohlelo bachazwe ngokucacile, [514] izincomo eziyinhloko ezibonakala kalula zifakiwe, [4, 614] noma ukubuyekezwa okubucayi. imibandela yethulwe ngezinjongo zokuqapha nokucwaninga.[49, 1114]

 

Imiphumela yokuhlolwa kwe-AGREE ibonise ukuthi ayikho imihlahlandlela enake ngokwanele izithiyo zenhlangano ezingaba khona kanye nemiphumela yezindleko ekusebenziseni izincomo. Akukacaci kuzo zonke iziqondiso ezifakiwe ukuthi ngabe bezizimele noma cha ezihlokweni ezixhasa ngemali nokuthi ngabe kukhona yini ukungqubuzana kwezidingo kumalungu amakomiti okuthuthukisa imihlahlandlela. Ngaphezu kwalokho, bekungacaci kuyo yonke imihlahlandlela ukuthi ochwepheshe bebezibuyekeze yini izinqubomgomo ngaphandle ngaphambi kokushicilelwa. Yisiqondiso sase-UK kuphela esichaze ngokucacile indlela esetshenziselwa ukwenza izincomo futhi sihlinzekelwe ukubuyekeza indlela.[11]

 

Ithebula 1 Izilinganiso Zemihlahlandlela Yezempilo Yasemsebenzini

 

Ukuthuthukiswa Kwemihlahlandlela

 

Ithebula lesi-2 lethula ulwazi lwangemuva mayelana nenqubo yokuthuthukiswa kwemihlahlandlela.

 

Abasebenzisi ababehlosiwe bemihlahlandlela kwakungodokotela nabanye abahlinzeki bezempilo emkhakheni wokunakekelwa kwezempilo emsebenzini. Izinqubomgomo ezimbalwa nazo zaziqondiswe ekwaziseni abaqashi, abasebenzi [68, 11, 14], noma amalungu ezinhlangano ezinentshisekelo ngempilo yomsebenzi.[4] Umhlahlandlela wama-Dutch wawuqondiswe kudokotela wezempilo wasemsebenzini kuphela.[10]

 

Amakomidi eziqondiso ayenomthwalo wemfanelo wokwenza le mihlahlandlela ngokuvamile ayehlanganisa imikhakha eminingi, okuhlanganisa imikhakha efana ne-epidemiology, i-ergonomics, i-physiotherapy, umkhuba ovamile, imithi yomsebenzi, ukwelapha ngomsebenzi, i-orthopedics, kanye nabamele izinhlangano zabaqashi nezinyunyana. Abamele i-Chiropractic kanye ne-osteopathic basekomitini leziqondiso zemihlahlandlela yaseNew Zealand.[79] Ithimba laseQuebec (eCanada) liphinde lahlanganisa nabamele imithi yokuvuselela, i-rheumatology, ezomnotho zezempilo, umthetho, i-neurosurgery, ubunjiniyela be-biomechanical, kanye nesayensi yelabhulali. Ngokuphambene, ikomidi leziqondiso lesiqondiso samaDashi lalihlanganisa odokotela bomsebenzi kuphela.[10]

 

Imihlahlandlela ikhishwe njengedokhumenti ehlukile, [4, 5, 10] njengesahluko sencwadi yokufunda, [6] noma njengemibhalo eminingana ehlobene.[79, 1114]

 

I-UK, [13] i-USA, [6] kanye ne-Canadian[4] imihlahlandlela inikeze ulwazi ngesu lokusesha elisetshenziswa ekuhlonzweni kwezincwadi ezifanele kanye nokukalwa kobufakazi. Ngakolunye uhlangothi, imihlahlandlela yama-Dutch[10] kanye ne-Australian[5] isekela izincomo zabo kuphela ngezinkomba. Iziqondiso zaseNew Zealand azizange zibonise ukuxhumana okuqondile phakathi kweziphakamiso nokukhathazeka [79]. Umfundi udluliselwe kwezinye izincwadi ukuze athole ulwazi oluyisisekelo.

 

Ithebula 2 Ulwazi Lwesendlalelo Semihlahlandlela

 

Ithebula 3 Lezincomo Zemihlahlandlela Yomsebenzi

 

Ithebula 4 Lezincomo Zemihlahlandlela Yomsebenzi

 

Izincomo Zenani Labantu Besiguli Nezokuxilonga

 

Nakuba zonke iziqondiso zigxile kubasebenzi abane-LBP, ngokuvamile kwakungacaci ukuthi babhekana ne-LBP enzima noma engapheli noma kokubili. I-LBP ebukhali futhi engapheli ngokuvamile ayizange ichazwe, futhi amaphuzu anqunywe anikezwe (isibonelo, <izinyanga ezingu-3). Ngokuvamile bekungacaci ukuthi lokhu kubhekiselwa ekuqaleni kwezimpawu noma ukungabikho emsebenzini. Nokho, umhlahlandlela waseCanada wethula uhlelo lokuhlukanisa (acute/subacute/ chronic) ngokusekelwe ekusabalaliseni izimangalo zokuphazamiseka komgogodla ngesikhathi kusukela ukungabikho emsebenzini.[4]

 

Yonke imihlahlandlela ihlukanise i-LBP ethile nengaqondile. I-LBP ethile iphathelene nezimo ezingase zibe bucayi zefulegi elibomvu njengokuphuka, amathumba, noma izifo, kanye nemihlahlandlela ye-Dutch ne-UK futhi ihlukanisa i-radicular syndrome noma ubuhlungu bezimpande zenzwa.[1013] Zonke izinqubo zazihambisana nezincomo zabo zokuthatha umlando womtholampilo kanye nokwenza ukuhlolwa ngokomzimba, kuhlanganise nokuhlolwa kwezinzwa. Ezimeni ze-pathology esolwayo ethile (amafulege abomvu), ukuhlolwa kwe-x-ray kwatuswa yiziqondiso eziningi. Ngaphezu kwalokho, iNew Zealand kanye nesiqondiso sase-US baphinde batusa ukuhlolwa kwe-x-ray lapho izimpawu zingathuthuki ngemva kwamasonto amane.[6, 9] Isiqondiso sase-UK sathi ukuhlolwa kwe-x-ray akubonisiwe futhi akusizi ukuphathwa kwezempilo emsebenzini. isiguli esine-LBP (ehlukile kunoma yiziphi izinkomba zomtholampilo).[1113]

 

Imihlahlandlela eminingi ibheka izici ezingokwengqondo nezenhlalo njengamafulegi aphuzi njengezithiyo zokululama okufanele abahlinzeki bezempilo babhekane nazo. Imihlahlandlela ye-New Zealand[9] kanye ne-UK [11, 12] ibeke ngokusobala izici kanye nemibuzo ephakanyisiwe ukuhlonza lawo mafulegi aphuzi angokwengqondo nezenhlalo.

 

Yonke imihlahlandlela ibhekane nokubaluleka komlando womtholampilo ohlonza izici zendawo yokusebenza ngokomzimba nangokwengqondo ezihambisana ne-LBP, okuhlanganisa izidingo zomzimba zomsebenzi (ukuphatha mathupha, ukuphakamisa, ukugoba, ukusonteka, nokuchayeka ekudlidlizeni komzimba wonke), izingozi noma ukulimala, kanye nobunzima obubonakalayo. ekubuyeleni emsebenzini noma ebudlelwaneni emsebenzini. Iziqondiso zesiDashi nezaseCanada zaziqukethe izincomo zokwenza uphenyo lwasemsebenzini[10] noma ukuhlolwa kwamakhono omsebenzi uma kudingeka.[4]

 

Isifinyezo Sezincomo Zokuhlolwa Kwe-LBP

 

  • I-triage yokuxilonga (i-LBP engaqondile, i-radicular syndrome, i-LBP ethile).
  • Ungafaki amafulegi abomvu nokuhlolwa kwemizwa.
  • Thola izici ezingokwengqondo nezenhlalo kanye nezithiyo ezingaba khona zokululama.
  • Thola izici zendawo yokusebenza (ezomzimba kanye nezengqondo) ezingase zihlobane nenkinga ye-LBP futhi ubuyele emsebenzini.
  • Ukuhlolwa kwe-X-Ray kukhawulelwe ezimweni ezisolwayo ze-pathology ethile.

 

Izincomo Mayelana Nolwazi Nezeluleko, Ukwelashwa, kanye Namasu Okubuyela Emsebenzini

 

Imihlahlandlela eminingi itusa ukuqinisekisa isisebenzi kanye nokunikeza ulwazi mayelana nemvelo yokuzibekela imingcele ye-LBP kanye nokubikezela okuhle. Ukukhuthazwa kokubuyela emsebenzini ojwayelekile ngokujwayelekile ngangokunokwenzeka kwakwelulekwa njalo.

 

Ngokuvumelana nezincomo zokubuyela emsebenzini ojwayelekile, zonke iziqondiso ziphinde zagcizelela ukubaluleka kokubuyela emsebenzini ngokushesha ngangokunokwenzeka, ngisho noma kusekhona i-LBP ethile futhi, uma kunesidingo, kuqala ngemisebenzi eguquliwe ezimweni ezinzima kakhulu. Khona-ke imisebenzi yayingase yenyuswe kancane kancane (amahora nemisebenzi) kuze kufinyelelwe ekubuyiselweni okuphelele emsebenzini. Imihlahlandlela yase-US ne-Dutch inikeze amashejuli amaningi esikhathi sokubuyela emsebenzini. Indlela yamaDashi ihlongoze ukubuyela emsebenzini phakathi kwamasonto amabili nokushintshwa kwemisebenzi uma kunesidingo.[10] Uhlelo lwamaDashi luphinde lwagcizelela ukubaluleka kokuphatha isikhathi esincikene mayelana nokubuyela emsebenzini.[10] Isiqondiso sase-US saphakamisa yonke imizamo yokugcina isiguli sisezingeni eliphezulu lomsebenzi, kuhlanganise nemisebenzi yomsebenzi; okuhloswe isikhathi sokukhubazeka mayelana nokubuyela emsebenzini kwanikezwa njengezinsuku ezingu-02 ezinemisebenzi eshintshiwe kanye nezinsuku ezingu-714 uma imisebenzi eguquliwe ingasetshenziswa/itholakala.[6] Ngokungafani nezinye, isiqondiso saseCanada seluleka ukubuyela emsebenzini kuphela lapho izimpawu nemikhawulo yokusebenza sekuthuthukile.[4]

 

Izinketho zokwelapha ezinconyiwe kakhulu kuzo zonke iziqondiso ezifakiwe kwakuyizi: imithi yokunciphisa ubuhlungu, [5, 7, 8] izinhlelo zokuzivocavoca ezihamba kancane kancane, [6, 10] kanye nokuvuselelwa kwemikhakha eminingi.[1013] Umhlahlandlela wase-US watusa ukudluliselwa phakathi kwamasonto amabili ohlelweni lokuvivinya umzimba oluhlanganisa ukuvivinya umzimba kwe-aerobic, ukuvivinya umzimba kokuqina kwemisipha yomboko, kanye nenani lokuzivocavoca.[6] Umhlahlandlela wamaDashi watusa ukuthi uma ingekho inqubekela phambili phakathi namasonto amabili okungabikho emsebenzini, izisebenzi kufanele ziyiswe ohlelweni lwezinga lomsebenzi (ukuzivocavoca okwandayo kancane kancane) futhi, uma kungekho ntuthuko emasontweni amane, ohlelweni lokuvuselela imikhakha eminingi.[10] ] Umhlahlandlela wase-UK uncome ukuthi abasebenzi abanobunzima bokubuyela emisebenzini ejwayelekile emasontweni angama-412 kufanele badluliselwe ohlelweni olusebenzayo lokubuyisela. Lolu hlelo lokuvuselela kufanele luhlanganise imfundo, ukuqinisekiswa kanye nezeluleko, uhlelo oluqhubekayo lokuzivocavoca okunamandla nokuqina, nokuphathwa kobuhlungu ngokuvumelana nezimiso zokuziphatha; kufanele ishunyekwe esimweni somsebenzi futhi iqondiswe ngokuqinile ekubuyeleni emsebenzini.[11-13] Uhlu olubanzi lwezinketho zokwelashwa ezingenzeka zethulwe eziqondisweni zaseCanada nase-Australia [4, 5], nakuba iningi lalezi lalingasekelwe. ngobufakazi besayensi.

 

Isifinyezo Sezincomo Ngokuphathelene Nolwazi, Iseluleko, Ukubuyela Ezinyathelweni Zomsebenzi, Nokwelashwa Kwabasebenzi abane-LBP

 

  • Qinisekisa isisebenzi futhi unikeze ulwazi olwanele mayelana nesimo sokuzibekela imingcele se-LBP kanye nokubikezela okuhle.
  • Yazisa isisebenzi ukuthi siqhubeke nemisebenzi evamile noma sibuyele ekuzilolongeni njalo futhi sisebenze ngokushesha, ngisho noma kusekhona izinhlungu.
  • Iningi labasebenzi abane-LBP babuyela emisebenzini evamile noma emincane ngokushesha. Cabangela ukulungiswa kwesikhashana kwemisebenzi yomsebenzi (amahora/imisebenzi) kuphela uma kunesidingo.
  • Uma isisebenzi sihluleka ukubuyela emsebenzini phakathi kwamasonto e-212 (kukhona ukuhluka okukhulu esikalini sesikhathi emikhombandlela ehlukene), sidlulisele ohlelweni lokuvivinya umzimba olukhula kancane kancane, noma ukuvuselelwa kwemikhakha eminingi (ukuzivocavoca, imfundo, ukuqinisekiswa, nokuphathwa kobuhlungu ngokulandela izimiso zokuziphatha. ). Lezi zinhlelo zokuhlunyeleliswa kwezimilo
    kufanele igxiliswe esimweni somsebenzi.

 

Ingxoxo

 

Ukuphathwa kwe-LBP esimweni sezempilo somsebenzi kufanele kubhekane nobudlelwano phakathi kwezikhalazo eziphansi kanye nomsebenzi futhi kuthuthukiswe amasu ahloselwe ukubuyela ngokuphephile emsebenzini. Lokhu kubuyekezwa kuqhathanise imihlahlandlela yezempilo yasemsebenzini evela emazweni ahlukahlukene. Izinqubomgomo azivamile ukukhonjwa ku-Medline, ngakho-ke lapho sifuna imihlahlandlela, kwakudingeka sithembele ikakhulukazi kumafayela omuntu siqu kanye nokuxhumana komuntu siqu.

 

Ikhwalithi Nezinqubo Zokuthuthukiswa Kwemihlahlandlela

 

Ukuhlolwa kwethuluzi le-AGREE[3] kubonise umehluko othile kwikhwalithi yezinkombandlela ezibuyekeziwe, ezingase zibonise ngokwengxenye ukuhluka kwezinsuku zokuthuthukiswa nokushicilelwa kwemihlahlandlela. Umhlahlandlela waseCanada, isibonelo, wanyatheliswa ngo-1987 kanye nesiqondiso sase-Australia ngo-1996. [4, 5] Eminye imihlahlandlela yayisanda kwenzeka futhi yahlanganisa isisekelo sobufakazi obuningi kanye nendlela yokuqondisa esesikhathini samanje.

 

Amaphutha amaningana avamile ahlobene nenqubo yokuthuthukisa imihlahlandlela aboniswe ukuhlolwa kwethuluzi le-AGREE. Okokuqala, kubalulekile ukucacisa ukuthi umhlahlandlela uzimele yini ngokohlelo kumgwamanda oxhasa ngezimali, nokuthi kukhona yini ukungqubuzana kwezintshisekelo kumalungu ekomidi lomhlahlandlela. Awukho umhlahlandlela ofakiwe obike ngokucacile lezi zinkinga. Ngaphezu kwalokho, ukubuyekezwa kwangaphandle okubikiwe komhlahlandlela ochwepheshe bezokwelapha kanye ne-methodological ngaphambi kokushicilelwa kwakungenayo yonke imihlahlandlela efakwe kulokhu kubuyekezwa.

 

Imihlahlandlela eminingana inikeze ulwazi olunzulu ngendlela izincwadi ezifanele ezaziseshwa ngayo futhi zahunyushelwa ezincomweni.[4, 6, 11, 13] Eminye imihlahlandlela isekela izincomo zabo ngezinkomba,[5, 7, 9, 10] kodwa lokhu akukuvumeli ukuhlolwa ukuqina kweziqondiso noma izincomo zazo.

 

Imihlahlandlela incike ebufakazini besayensi, obushintshayo ngokuhamba kwesikhathi, futhi kuyamangaza ukuthi umhlahlandlela owodwa kuphela onikeziwe ukuze kube nokubuyekezwa okuzayo.[11, 12] Kungenzeka kunezibuyekezo ezihlelelwe eminye imihlahlandlela kodwa azicaciswanga (futhi ngokuphambene zisho lapho. kuzoba isibuyekezo esizayo akusho ukuthi kuzokwenzeka ngempela). Lokhu kuntuleka kokubika kungase kubambezeleke kwezinye izimo ze-AGREE esizilinganisele kabi. Ukusetshenziswa kohlaka lwe-AGREE njengomhlahlandlela wakho kokubili ukuthuthukiswa kanye nokubikwa kwemihlahlandlela kufanele kusize ukuthuthukisa ikhwalithi yezinkombandlela zesikhathi esizayo.

 

Ukuhlolwa nokuphathwa kwe-LBP

 

Izinqubo zokuxilonga ezituswe eziqondisweni zezempilo zomsebenzi zazifana kakhulu nezincomo zemihlahlandlela yomtholampilo, [2] futhi, ngokunengqondo, umehluko omkhulu wawuwukugcizelelwa kokubhekana nezinkinga zomsebenzi. Izindlela ezibikiwe zokubhekana nezici zendawo yokusebenza ekuhlolweni kwe-LBP yesisebenzi ngasinye eziphathelene nokuhlonzwa kwemisebenzi enzima, izici eziyingozi, kanye nezithiyo zokubuyela emsebenzini ngemilando yomsebenzi. Ngokusobala, lezi zithiyo zokubuyela emsebenzini azikhathazi nje kuphela izici zomthwalo womzimba, kodwa futhi nezinkinga eziphathelene nomsebenzi ezingokwengqondo nezenhlalo mayelana nezibopho, ukubambisana nabasebenza nabo, kanye nesimo senhlalo emsebenzini.[10] Ukuhlolelwa amafulegi aphuzi ahlobene nomsebenzi ngokwengqondo kungasiza ekuboneni labo basebenzi abasengozini yobuhlungu obungapheli nokukhubazeka.[1113]

 

Isici esingaba esibalulekile sezinkombandlela ukuthi zazingaguquguquki mayelana nezincomo zabo zokuqinisekisa isisebenzi nge-LBP, nokukhuthaza nokweseka ukubuyela emsebenzini ngisho nezimpawu ezithile eziqhubekayo. Kunokuvumelana okuvamile ukuthi iningi labasebenzi akumele lilinde baze bakhululeke ngokuphelele ngaphambi kokuba babuyele emsebenzini. Uhlu lwezinketho zokwelapha ezinikezwa yiziqondiso zaseCanada nase-Australia zingase zibonise ukuntuleka kobufakazi ngaleso sikhathi, [4, 5] zishiya abasebenzisi beziqondiso ukuthi bazikhethele bona. Nokho, kuyangabazeka ukuthi izinhlu ezinjalo zinesandla ngempela ekunakekelweni okuthuthukisiwe, futhi ngokubona kwethu izincomo zesiqondiso kufanele zisekelwe ebufakazini obuphusile besayensi.

 

Iziqondiso zokusebenza zase-US, Dutch, kanye ne-UK [6, 1013] zincoma ukuthi ukwelashwa okusebenzayo kwemikhakha eminingi kuwukungenelela okuthembisayo kakhulu ukuze ubuyele emsebenzini, futhi lokhu kusekelwa ubufakazi obuqinile obuvela kuma-RCT. [19, 20] Nokho, ucwaningo olwengeziwe lusaqhubeka okudingekayo ukuhlonza okuqukethwe okuphelele kanye nokuqina kwalawo maphakheji okwelashwa.[13, 21]

 

Naphezu kobufakazi obuthile bomnikelo wezici zendawo yokusebenza ku-aetiology ye-LBP, [22] izindlela ezihlelekile zokuzivumelanisa nendawo yokusebenza azikho, futhi azinikezwa njengezincomo eziqondisweni. Mhlawumbe lokhu kumelela ukuntula ukuzethemba ebufakazini bomthelela wonkana wezici zendawo yokusebenza, ubunzima bokuhumushela ekuqondisweni okusebenzayo, noma ngenxa yokuthi lezi zindaba ziphambaniswa nomthetho wendawo (okwashiwo kuwo kumhlahlandlela wase-UK[11]). Kungase kube ukuthi ukungenelela kwe-ergonomics okubambe iqhaza, okuhlongoza ukubonisana nomsebenzi, umqashi, kanye ne-ergonomist, kuzovela kube ukubuyisela okuwusizo ekungeneni emsebenzini.[23, 24] Inani elingaba khona lokuthola bonke abadlali eceleni I-25] yagcizelelwa eziqondisweni ze-Dutch kanye ne-UK, [1113] kodwa ukuhlolwa okwengeziwe kwale ndlela kanye nokuqaliswa kwayo kuyadingeka.

 

Ukuthuthukiswa Kwemihlahlandlela Yekusasa Ekunakekelweni Kwezempilo Kwasemsebenzini

 

Inhloso yalokhu kubuyekezwa kwakuwukunikeza kokubili ukubuka konke kanye nokuhlolwa okubalulekile kwemihlahlandlela yokusebenza yokuphathwa kwe-LBP. Ukuhlolwa okubalulekile kwemihlahlandlela kwenzelwe ukusiza ukuqondisa intuthuko yesikhathi esizayo kanye nezibuyekezo ezihleliwe zemihlahlandlela. Emkhakheni osavelayo wendlela yokusebenza yomhlahlandlela sibheka zonke izinhlelo ezedlule njengezincomekayo; siyasibona isidingo sokuqondiswa komtholampilo, futhi sibonga ukuthi abathuthukisi beziqondiso abakwazi ukulinda ucwaningo ukuze lunikeze yonke indlela yokusebenza nobufakazi obudingekayo. Nokho, sikhona isikhala sokuthuthukisa futhi imihlahlandlela yesikhathi esizayo kanye nezibuyekezo kufanele zicabangele imibandela yokuthuthukiswa okufanele, ukuqaliswa, nokuhlolwa kwemihlahlandlela njengoba kuphakanyiswe ukusebenzisana kwe-AGREE.

 

Ukuqaliswa kokusetshenziswa kwemihlahlandlela kungaphezu kobubanzi balokhu kubuyekezwa, kodwa kwaphawulwa ukuthi akukho neyodwa imibhalo yeziqondiso echaze ngokuqondile amasu okuqalisa, ngakho akuqiniseki ukuthi ngabe amaqembu okuhlosiwe afinyelelwe kangakanani, nokuthi imiphi imiphumela okungenzeka ukuthi yaba nayo. . Lokhu kungase kube indawo enezithelo zocwaningo olwengeziwe.

 

Khona kanye ukuba khona kwale mihlahlandlela yezempilo yomsebenzi kubonisa ukuthi imihlahlandlela yomtholampilo yokunakekelwa okuyinhloko ekhona ye-LBP2 ibhekwa njengengafaneleki noma enganele ekunakekelweni kwezempilo yasemsebenzini. Kunombono ocacile emhlabeni wonke wokuthi izidingo zesisebenzi esibhekene nezinhlungu zokubuyela emuva zixhumene nezinhlobonhlobo zezinkinga zomsebenzi ezingahlanganiswa nesiqondiso esivamile sokunakekelwa okuyisisekelo futhi, ngenxa yalokho, ukuzijwayeza. Okuvelayo ukuthi, naphezu kwamaphutha e-methodological, ukuvumelana okukhulu kubonakala ezinhlobonhlobo zamasu ezempilo ayisisekelo okuphatha isisebenzi esinobuhlungu bomhlane, okunye okuyimibono emisha kanye nenselele eyayibanjwe ngaphambilini. Kunesivumelwano ngomlayezo oyisisekelo wokuthi ukulahlekelwa umsebenzi isikhathi eside kuyingozi, nokuthi ukubuya emsebenzini kusenesikhathi kufanele kukhuthazwe futhi kwenziwe lula; asikho isidingo sokulinda ukuqedwa okuphelele kwezimpawu. Nakuba amasu anconyiwe ehluka ngandlela thize, kukhona ukuvumelana okukhulu ngenani lokuqinisekiswa okuhle nezeluleko, ukubakhona komsebenzi oguquliwe (wesikhashana), ukubhekana nezici zasemsebenzini (ukwenza bonke abadlali babe seceleni), kanye nokuhlunyeleliswa kwezimilo kwabasebenzi abanobunzima bokubuyela emsebenzini.

 

Ukubonga

 

Lolu cwaningo lusekelwe yi-Dutch Health Care Insurance Council (CVZ), isibonelelo se-DPZ No. 169/0, Amstelveen, Netherlands. U-JB Staal njengamanje usebenza eMnyangweni Wezifo Eziwumshayabhuqe, eNyuvesi yaseMaastricht, PO Box 616 6200 MD Maastricht, Netherlands. U-W van Mechelen futhi uyingxenye Yesikhungo Sokucwaninga Ngomsebenzi Womzimba, Umsebenzi kanye Nezempilo, Umzimba@work TNO-VUmc.

 

Ekuphetheni, izimpawu zobuhlungu obuphansi emuva zingenye yezinkinga zezempilo ezivame kakhulu ezihlobene nokulimala emsebenzini. Ngenxa yalokho, kuye kwasungulwa imihlahlandlela eminingi yezempilo yomsebenzi ukuze kuphathwe ubuhlungu obuphansi emuva. Ukunakekelwa kwe-Chiropractic, phakathi kwezinye izindlela zokwelashwa, kungasetshenziswa ukuze kusizwe isiguli sithole ukukhululeka ku-LBP yabo. Ngaphezu kwalokho, lesi sihloko esingenhla sibonise ukuphepha nokusebenza kwezinhlobonhlobo zendabuko kanye nezinketho zokwelashwa ezihlukile ekuxilongweni, ekwelapheni nasekuvimbeleni izimo ezihlukahlukene zobuhlungu obuphansi emuva. Kodwa-ke, ucwaningo olwengeziwe luyadingeka ukuze kutholwe kahle ukusebenza kahle kwendlela ngayinye yokwelapha. Ulwazi olubalulwe ku-National Center for Biotechnology Information (NCBI). Ububanzi bolwazi lwethu bukhawulelwe ku-chiropractic kanye nokulimala komgogodla nezimo. Ukuze uxoxe ngesihloko, sicela ukhululeke ukubuza uDkt. Jimenez noma usithinte ku 915-850-0900 .

 

Ikhethwe nguDkt Alex Jimenez

 

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

 

Izihloko Ezengeziwe: Ubuhlungu Emuva

 

Ngokwezibalo, cishe i-80% yabantu izothola izimpawu zobuhlungu beqolo okungenani kanye kukho konke ukuphila kwabo. Ukuhlungu obusemhlane isikhalazo esivamile esingaba umphumela ngenxa yokulimala okuhlukahlukene kanye/noma izimo. Izikhathi eziningi, ukuwohloka kwemvelo komgogodla ngeminyaka kungabangela ubuhlungu emuva. Ama-discs we-Herniated kwenzeka lapho isikhungo esithambile, esifana nejeli se-intervertebral disc siphusha izinyembezi endaweni ezungezile, indandatho yangaphandle ye-cartilage, ukucindezela nokucasula izimpande zemizwa. Ama-Disc herniations avame ukwenzeka emhlane ophansi, noma i-lumbar spine, kodwa kungenzeka futhi eduze nomgogodla womlomo wesibeletho, noma intamo. Ukufakwa kwezinzwa ezitholakala emhlane ophansi ngenxa yokulimala kanye/noma isimo esishubile kungaholela ezimpawini ze-sciatica.

 

 

isithombe sebhulogi kakhathuni paperboy izindaba ezinkulu

 

ISIHLOKO ESIBALULEKILE ENGEZIWE: Ukwelashwa Kwezinhlungu Ze-Migraine

 

 

IZIHLOKO EZININGI: ENGEZIWE NGENXA: El Paso, Tx | Abasubathi

 

Akukho lutho
Okubhekwayo
1. Van Tulder MW, Koes BW, Bouter LM. Ucwaningo lwezindleko zokugula lwezinhlungu zasemuva eNetherlands. Ubuhlungu 1995;62:233�40.
2. Koes BW, van Tulder MW, Ostelo R, et al. Imihlahlandlela yomtholampilo yokuphathwa kobuhlungu obuphansi emuva ekunakekelweni okuyisisekelo: i-international
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Vala i-Accordion
Ukuguqulwa Komgogodla vs. Ukugqugquzela I-Cervicogenic Headache e-El Paso, TX

Ukuguqulwa Komgogodla vs. Ukugqugquzela I-Cervicogenic Headache e-El Paso, TX

by | I-Chiropractic, Neck Pain, Isivivinyo Esilawulwa Ngokungahleliwe

Ikhanda eliyinhloko libonakala njengobuhlungu bekhanda obubangelwa ukuphazamiseka kwekhanda ngokwalo. Izinhlobo ezintathu zezinkinga eziyinhloko zekhanda zihlanganisa, migraine, uhlobo lwekhanda elicindezelayo kanye nekhanda leqembu. Ubuhlungu bekhanda kuwuphawu olubuhlungu futhi oluthena amandla okungenzeka futhi ngenxa yesinye isizathu esiyinhloko. Ikhanda lesibili libonakala njengobuhlungu bekhanda okwenzeka ngenxa yokulimala kanye / noma isimo. Ukungahambi kahle komgogodla, noma i-subluxation, eduze komgogodla womlomo wesibeletho, noma intamo, ngokuvamile ihlotshaniswa nezimpawu ezihlukahlukene zekhanda.

 

Ikhanda le-Cervicogenic liyinhloko yesibili ebangelwa ukulimala kanye / noma isimo esithinta izakhiwo ezizungezile zomgogodla wesibeletho, noma intamo. Ochwepheshe abaningi bezokunakekelwa kwempilo bazoncoma ukusetshenziswa kwezidakamizwa/imithi ukusiza ukuthuthukisa ikhanda, noma kunjalo, izinketho eziningana zokwelapha ezihlukile zingasetshenziswa ngokuphepha nangempumelelo ukwelapha ikhanda lesibili. Inhloso yalesi sihloko esilandelayo ukukhombisa umthelela wokuxhaphazwa komlomo wesibeletho esiphezulu kanye ne-thoracic engaphezulu ngokuhambisana nokugqugquzela nokuzivocavoca ezigulini ezinekhanda le-cervicogenic.

 

Ukuphathwa Kwe-Cervical Ephezulu kanye Ne-Upper Thoracic Manipulation Versus Mobilization and Exercise in Patients with Cervicogenic Headache: I-Multi-Center Randomized Clinical Trial

 

abstract

 

  • Ingemuva: Nakuba ukungenelela okuvame ukusetshenziswa, azikho izifundo eziqhathanise ngokuqondile ukuphumelela kokukhwabanisa komlomo wesibeletho kanye ne-thoracic ekuhlanganiseni nasekuvivinyeni umzimba kubantu abanekhanda le-cervicogenic (CH). Inhloso yalolu cwaningo kwakuwukuqhathanisa imiphumela yokukhohlisa ekuhlanganiseni nasekuvivinyeni umzimba kubantu abane-CH.
  • Izindlela: Abahlanganyeli abayikhulu neshumi (n?=?110) abane-CH bahlelwe ngokungahleliwe ukuze bathole kokubili ukuxhaphazwa komlomo wesibeletho kanye ne-thoracic (n?=?58) noma ukuhlanganisa nokuzivocavoca (n?=?52). Umphumela oyinhloko kwakuwukuqina kwekhanda njengoba kulinganiswa i-Numeric Pain Rating Scale (NPRS). Imiphumela yesibili yayihlanganisa imvamisa yekhanda, ubude bekhanda, ukukhubazeka njengoba kulinganiswa ne-Neck Disability Index (NDI), ukuthathwa kwemithi, kanye ne-Global Rating of Change (GRC). Isikhathi sokwelashwa sasingamaviki angu-4 ngokuhlolwa kokulandelela ngeviki le-1, amaviki angu-4, nezinyanga ezingu-3 ngemva kweseshini yokuqala yokwelashwa. Inhloso eyinhloko yahlolwa ngokuhlaziywa kwe-2-way-model-model exubile yokuhluka (ANOVA), neqembu lokwelapha (ukukhwabanisa ngokumelene nokugqugquzela nokuzivocavoca) njengokuhluka phakathi kwezifundo kanye nesikhathi (isisekelo, isonto le-1, amaviki e-4 nezinyanga ze-3) njenge ukuhlukahluka kwezihloko.
  • Ezenye: I-2X4 ANOVA ibonise ukuthi abantu abane-CH abathole kokubili ukuxhaphazwa komlomo wesibeletho kanye ne-thoracic bathole ukuncipha okukhulu kakhulu kokuqina kwekhanda (p?
  • Iziphetho: Izikhathi eziyisithupha kuya kweziyisishiyagalombili zokukhwabanisa komlomo wesibeletho kanye nephezulu ye-thoracic ziboniswe ukuthi zisebenza kangcono kunokugqugquzela nokuzivocavoca ezigulini ezine-CH, futhi imiphumela yagcinwa ezinyangeni ze-3.
  • Ukubhaliswa kwesilingo: NCT01580280 Ephreli 16, 2012.
  • Amagama angukhiye: Ikhanda le-Cervicogenic, ukuxhaphazwa komgogodla, ukugqugquzela, isivinini esiphansi se-amplitude thrust

 

UDkt Jimenez White Coat

Ukuqonda kukaDkt Alex Jimenez

Uma kuqhathaniswa nekhanda eliyinhloko, njenge migraine, ikhanda lekhanda le-cluster kanye nohlobo lwekhanda lokucindezeleka, ikhanda lesibili libonakala njengobuhlungu bekhanda obubangelwa esinye isifo noma inkinga engokomzimba. Endabeni yekhanda le-cervicogenic, imbangela yobuhlungu bekhanda ngenxa yokulimala kanye / noma isimo eduze komgogodla womlomo wesibeletho kanye nezakhiwo ezizungezile, kuhlanganise nama-vertebrae, ama-intervertebral discs kanye nezicubu ezithambile. Ngaphezu kwalokho, ochwepheshe abaningi bezempilo bakholelwa ukuthi ikhanda eliyinhloko lingahlotshaniswa nezindaba zezempilo emgogodleni wesibeletho, noma intamo. Ukwelashwa kwekhanda le-Cervicogenic kufanele kuqondise umthombo wezimpawu futhi kungahluka kuye ngokuthi isiguli. Ukunakekelwa kwe-Chiropractic kusebenzisa ukulungiswa komgogodla kanye nokuphathwa ngesandla ukuze kubuyiselwe ngokucophelela isakhiwo sokuqala nokusebenza komgogodla, okusiza ukunciphisa ukucindezeleka nokucindezela ukuze kuthuthukiswe izimpawu zekhanda le-cervicogenic, phakathi kolunye uhlobo lwekhanda. Ukunakekelwa kwe-Chiropractic kungasetshenziswa futhi ukusiza ukwelapha ikhanda eliyinhloko, njenge-migraines.

 

Background

 

I-International Classification of Headache Disorders ichaza ikhanda le-cervicogenic (CH) njengokuthi, �ubuhlungu bekhanda obubangelwa ukuphazamiseka komgogodla womlomo wesibeletho kanye nengxenye yawo ye-bony, i-disc, kanye / noma izakhi zezicubu ezithambile, ngokuvamile kodwa hhayi njalo ezihambisana nobuhlungu bentamo.� [1 ] (p.760) Ukusabalala kwe-CH kuye kwabikwa ukuthi kuphakathi kwe-0.4 ne-20% yabantu abakhanda ikhanda [2, 3], futhi phezulu njenge-53% ezigulini ezinekhanda elibuhlungu ngemuva kokulimala kwe-whiplash [4]. Izici ezivelele ze-CH ngokuvamile zihlanganisa: unilaterality yobuhlungu bekhanda ngaphandle kwe-side-shift, ukukhishwa kobuhlungu ngokucindezelwa kwangaphandle phezu kwentamo engenhla ye-ipsilateral, ububanzi obulinganiselwe bokunyakaza komlomo wesibeletho, nokuqala kokuhlaselwa ukunyakaza okuhlukahlukene okungahambi kahle noma okuqhubekayo kwentamo [4, 5].

 

Abantu abane-CH bavame ukuphathwa ngokwelashwa okukhohlisayo komgogodla okuhlanganisa kokubili ukuhlanganisa kanye nokukhwabanisa [6]. Ukuhlanganisa umgogodla kuhlanganisa izindlela ezihamba kancane, ezinesigqi, ezinyakazayo kuyilapho ukukhohlisa kuhlanganisa amasu e-high-velocity low-amplitude low-amplitude. [7] Ekubuyekezweni okuhlelekile kwakamuva, i-Bronfort kanye nozakwabo babike ukuthi ukwelapha okuguquguqukayo komgogodla (kokubili ukuhlanganisa kanye nokukhwabanisa) kwakuphumelela ekulawuleni abantu abadala abane-CH [8]. Kodwa-ke, abazange babike uma ukukhwabanisa kubangele imiphumela ephakeme kakhulu uma kuqhathaniswa nokugqugquzela ukuphathwa kwalesi sibalo.

 

Ucwaningo oluningana luphenye umphumela wokuxhaphaza umgogodla ekuphathweni kwe-CH [9�13]. Haas et al. [10] uphenye ukuphumelela kokuxhaphazwa komlomo wesibeletho ezifundweni ezine-CH. Jull et al. [11] ubonise ukuphumelela kokwelashwa kokwelapha okukhohlisayo kanye/noma ukuvivinya umzimba ekuphathweni kwe-CH. Kodwa-ke iqembu lokwelapha okukhohlisayo lalihlanganisa ukukhohlisa nokuhlanganisa ngakho-ke alikwazi ukunqunywa ukuthi umphumela onenzuzo wawuwumphumela wokukhohlisa, ukuhlanganisa noma inhlanganisela.

 

Ucwaningo olumbalwa luye lwahlola izinzuzo zokuxhaphaza ngokumelene nokugqugquzela ukuphathwa kobuhlungu bentamo yemishini noma ngaphandle kokuzivocavoca [14�16]. Kodwa-ke, azikho izifundo eziqhathanise ngokuqondile imiphumela yokukhohlisa ngokumelene nokuhlanganisa nokuzivocavoca ezigulini ezine-CH. Uma kucatshangelwa izingozi ezihlosiwe zokukhohlisa [17], kubalulekile ukunquma ukuthi ingabe ukukhohlisa kuholela emiphumeleni ethuthukisiwe uma kuqhathaniswa nokugqugquzelwa kokuphathwa kweziguli ezine-CH. Ngakho-ke, inhloso yalolu cwaningo lomtholampilo olungahleliwe kwakuwukuqhathanisa imiphumela yokukhwabanisa ngokumelene nokuhlanganisa nokuzivocavoca ezigulini ezine-CH. Sacabanga ukuthi iziguli ezithola ukuxhashazwa esikhathini sokwelashwa kweviki le-4 zizothola ukunciphisa okukhulu ekuqineni kwekhanda, imvamisa yekhanda, ubude bekhanda, ukukhubazeka, kanye nokuthatha imithi ekulandeleni inyanga ye-3 kuneziguli ezithola ukugqugquzela umlomo wesibeletho kanye ne-thoracic kuhlangene nokuzivocavoca. .

 

izindlela

 

Abahlanganyeli

 

Kulolu cwaningo lomtholampilo olugxile ezindaweni eziningi, iziguli ezilandelanayo ezine-CH ezethula emitholampilo yeziguli zangaphandle eziyi-1 ezilashwa ngaphandle ezivela ezindaweni ezihlukahlukene (i-Arizona, Georgia, New York, Ohio, Pennsylvania, South Carolina) zaqashwa esikhathini esiyizinyanga ezingama-8. isikhathi (kusukela kuMbasa 29 kuya kuNcwaba 2012). Ukuze iziguli zifaneleke, kwakudingeka zibonise ukuxilongwa kwe-CH ngokuvumelana nenqubo yokuxilonga ebuyekeziwe [2014] eyakhiwe yi-Cervicogenic Headache International Study Group (CHISG) [5, 5, 18]. I-CH yahlukaniswa ngokuvumelana �imibandela emikhulu� (ngaphandle kobufakazi obuqinisekisayo ngokuvinjelwa kokuxilonga okubulala izinzwa) kanye � izici zobuhlungu bekhanda� be-CHISG. Ngakho-ke, ukuze kufakwe esifundweni, iziguli kwakudingeka zibonise zonke lezi zindlela ezilandelayo: (19) unilaterality yobuhlungu bekhanda ngaphandle kwe-sideshift, eqala endaweni engaphezulu yentamo noma esifundeni se-occipital, ekugcineni isakaze endaweni ye-oculofrontotemporal uhlangothi olunezimpawu, (1) ubuhlungu obubangelwa ukunyakaza kwentamo kanye / noma ukusimama okungahambi kahle, (2) uhla oluncishisiwe lokunyakaza kumgogodla womlomo wesibeletho [3] (okungukuthi, ngaphansi noma okulingana ne-20 � yokujikeleza kwesokudla noma kwesobunxele Ukuhlolwa kwe-Flexion-Rotation [32�21], (23) ubuhlungu obubangelwa ukucindezela kwangaphandle okungenani okukodwa kwamalunga aphezulu omlomo wesibeletho (C4-0), kanye (3) nobuhlungu obuphakathi kuya kobunzima, obungabhubhisi futhi obungabhubhisi. Ukwengeza, ababambiqhaza kwakudingeka babe nemvamisa yekhanda okungenani i-5 ngesonto okungenani izinyanga ze-1, isilinganiso esincane sobuhlungu bekhanda elibuhlungu amaphuzu amabili (3�0 esikalini se-NPRS), amaphuzu amancane okukhubazeka angama-10% noma okukhulu (okungukuthi, amaphuzu ayi-20 noma ngaphezulu esikalini esingu-10�0 NDI), futhi abe phakathi kuka-50 no-18 yebo rs ubudala.

 

Iziguli zazikhishwa uma zibonise ezinye izinhloko eziyinhloko (okungukuthi, i-migraine, i-TTH), ziphathwa yikhanda lezizwe ezimbili, noma zibonise noma yimaphi amafulegi abomvu (okungukuthi, isimila, ukuphuka, izifo ze-metabolic, i-rheumatoid arthritis, i-osteoporosis, ukuphumula kwegazi okukhulu kuno-140/90 mmHg, umlando omude wokusetshenziswa kwe-steroid, njll.), okwethulwa ngezimpawu ezimbili noma ngaphezulu ezinhle ze-neurologic ezihambisana nokucindezelwa kwezimpande zezinzwa (ubuthakathaka bemisipha obuhlanganisa iqembu elikhulu lomsipha ongaphezulu, ukuncipha kwe-tendon reflex ejulile yomkhawulo ongaphezulu, noma ukuzwa okunciphile noma ukungabikho. i-pinprick kunoma iyiphi i-dermatome yomkhawulo ongaphezulu), owethulwe ngokuxilonga i-stenosis yomgogodla womlomo wesibeletho, ubonise izimpawu ze-bilateral upper extremity, ube nobufakazi bokubandakanyeka kwesistimu yezinzwa ephakathi (hyperreflexia, ukuphazamiseka kwezinzwa esandleni, ukuwohloka kwemisipha yangaphakathi yezandla, ukungazinzi ngesikhathi sokuhamba. i-nystagmus, ukulahleka kokubona, ukuzwa kobuso, ukunambitheka okushintshile, ukuba khona kwe-pathological reflexes), wayenomlando wokulimala kwe-whiplash phakathi kwamasonto e-6 edlule, wayehlinzekwe ngaphambili ekhanda noma entanyeni, wayethole ukwelashwa kwekhanda noma ubuhlungu bentamo kunoma yimuphi udokotela phakathi nenyanga edlule, wayethole ukwelashwa ngokomzimba noma ukwelashwa kwe-chiropractic ubuhlungu bekhanda noma intamo ngaphakathi. izinyanga ze-3 zangaphambilini, noma babe nesinyathelo somthetho esilindile mayelana nobuhlungu bekhanda noma intamo yabo.

 

Izincwadi zakamuva zibonisa ukuthi ukuhlolwa komthambo womlomo wesibeletho wangaphambi kokukhohlisa akukwazi ukukhomba labo bantu abasengozini yezinkinga ze-vascular kusukela ekuxhashazweni komlomo wesibeletho [24, 25], futhi noma yiziphi izimpawu ezitholwe ngesikhathi sokuhlolwa kwangaphambilini kungase kungahambisani nezinguquko ekugelezeni kwegazi umthambo womgogodla [26, 27]. Ngakho-ke, ukuhlolwa kwe-artery yomlomo wesibeletho kwangaphambili akuzange kwenziwe kulolu cwaningo; kodwa-ke, imibuzo yokuhlola isifo se-artery yomlomo wesibeletho kwakudingeka ibe negative [24, 28, 29]. Lolu cwaningo lugunyazwe Ibhodi Lokubuyekeza Isikhungo e-Long Island University, eBrooklyn, NY. Ucwaningo lubhaliswe kokuthi www.clinicaltrials.gov ngesihlonzi sesilingo i-NCT01580280. Zonke iziguli zaziswe ukuthi zizothola ukuxhashazwa noma ukugqugquzelwa nokuzivocavoca bese zinikeza imvume enolwazi ngaphambi kokubhaliswa kwazo ocwaningweni.

 

Ukwelapha Abelaphi

 

Abelaphi bomzimba abayishumi nambili (iminyaka yobudala eyi-36.6, SD 5.62) babambe iqhaza ekulethweni kokwelashwa kweziguli kulolu cwaningo. Babenesilinganiso seminyaka engu-10.3 (SD 5.66, ibanga leminyaka engu-3�20) yokuhlangenwe nakho komtholampilo, futhi bonke base beqede uhlelo lwesitifiketi samahora angu-60 oluhlanganisa ukuqeqeshwa okungokoqobo kumasu okwenziwa ngesandla okuhlanganisa nokusetshenziswa komlomo wesibeletho nesifuba somlomo. Ukuqinisekisa ukuthi zonke izivivinyo, ukuhlolwa kwemiphumela, kanye nezinqubo zokwelashwa zilinganiselwe, bonke abahlinzeki bomzimba ababambe iqhaza kwakudingeka bafunde incwadi yezinqubo ezijwayelekile zokusebenza futhi bahlanganyele esimisweni sokuqeqeshwa se-4 h nomseshi oyinhloko.

 

Izinqubo Zokuhlolwa

 

Zonke iziguli zinikeze ulwazi lwabantu, zagcwalisa i-Neck Pain Medical Screening Questionnaire, futhi zagcwalisa izinyathelo eziningi zokuzibika, ezilandelwa umlando ojwayelekile kanye nokuhlolwa ngokomzimba ekuqaleni. Izinyathelo zokuzibika zazihlanganisa ukushuba kwekhanda njengoba kukalwa yi-NPRS (0�10), i-NDI (0�50), imvamisa yekhanda elibuhlungu (inombolo yezinsuku ezinekhanda elibuhlungu ngesonto eledlule), ubude bekhanda lekhanda (inani lamahora okubuhlungu kwekhanda ekugcineni. ngesonto), kanye nokuthatha imithi (inani lezikhathi isiguli esasiphuze imithi yezinhlungu ezidakwayo noma ezitholakala ngaphandle kwe-counter ngesonto eledlule).

 

Ukuhlolwa okujwayelekile komzimba akuzange kukhawulelwe, kodwa kwakuhlanganisa izilinganiso ze-C1-2 (i-atlanto-axial joint) i-ROM yokuzungeza kwesokudla nesobunxele kusetshenziswa i-Flexion-Rotation Test (FRT). Ukuthembeka kwamanani aphakathi kwe-FRT kutholakale ukuthi kuhle kakhulu (ICC: 0.93; 95 % CI: 0.87, 0.96) [30].

 

Izinyathelo Zomphumela

 

Isilinganiso esiyinhloko somphumela esisetshenziswe kulolu cwaningo kwakuwukuqina kwekhanda lesiguli njengoba kulinganiswa yi-NPRS. Iziguli zabuzwa ukuthi zibonise ubukhulu obuphakathi kobuhlungu bekhanda phakathi nesonto eledlule zisebenzisa isikali se-11-point kusuka ku-0 (�no pain�) kuya ku-10 (�ubuhlungu obubi kakhulu obungacatshangwa�) ekuqaleni, i-1-isonto, inyanga ye-1, kanye nezinyanga ze-3 ezilandela iseshini yokuqala yokwelashwa [31]. I-NPRS iyithuluzi elithembekile nelivumelekile lokuhlola ukushuba kobuhlungu [32�34]. Nakuba kungekho datha ekhona ezigulini ezine-CH, i-MCID ye-NPRS iboniswe ukuthi i-1.3 ezigulini ezinezinhlungu zentamo yemishini [32] kanye ne-1.74 ezigulini ezinezimo ezihlukahlukene ezibuhlungu ezingapheli [34]. Ngakho-ke, sikhethe ukufaka kuphela iziguli ezinezibalo ze-NPRS zamaphuzu we-2 (20%) noma ngaphezulu.

 

Izinyathelo zemiphumela yesibili zazihlanganisa i-NDI, i-Global Rating of Change (GRC), imvamisa yekhanda elibuhlungu, ubude bekhanda elibuhlungu, kanye nokuthatha imithi. I-NDI iyithuluzi elisetshenziswa kakhulu ekuhloleni ukukhubazeka okuzilinganisa ezigulini ezinezinhlungu zentamo [35�37]. I-NDI iwuhlu lwemibuzo lokuzibika olunezinto ze-10 ezilinganiselwe kusuka ku-0 (akukho ukukhubazeka) kuya kwezinhlanu (ukukhubazeka okuphelele) [38]. Izimpendulo zezinombolo zento ngayinye zifingqwa ngenani lamaphuzu aphakathi kuka-0 no-50; Nokho, abanye abahloli bakhethe ukuphindaphinda amaphuzu aluhlaza ngamabili, bese bebika i-NDI esikalini esingu-0�100 % [36, 39]. Amaphuzu aphezulu amele amazinga akhuphukile okukhubazeka. I-NDI itholwe inokwethenjelwa okuhle kakhulu kokuhlolwa kokuhlolwa, ukuqina kokwakha okuqinile, ukungaguquguquki okuqinile kwangaphakathi kanye nokusabela okuhle ekuhloleni ukukhubazeka ezigulini ezinobuhlungu bentamo yemishini [36], i-radiculopathy yomlomo wesibeletho [33, 40], ukuphazamiseka okuhlobene ne-whiplash [38, 41, 42], kanye nobuhlungu bentamo obuxubile obungaqondile [43, 44]. Nakuba kungekho zifundo ezihlole izakhiwo ze-psychometric ze-NDI ezigulini ezine-CH, sikhethe ukufaka kuphela iziguli ezine-NDI amaphuzu amaphuzu ayishumi (20 %) noma ngaphezulu, ngoba lesi sici esinqunyiwe sithatha i-MCID ye-NDI, okuyinto Kuye kwabikwa ukuthi cishe amaphuzu amane, ayisishiyagalombili, nayisishiyagalolunye (0�50) ezigulini ezinobuhlungu obuhlangene obungaqondile bentamo [44], ubuhlungu bentamo yemishini [45], kanye ne-radiculopathy yomlomo wesibeletho [33], ngokulandelana. Ukuvama kwekhanda elibuhlungu kukalwe njengenani lezinsuku ezinekhanda elibuhlungu evikini eledlule, kusukela ku-0 kuya ezinsukwini ezingu-7. Ubude bekhanda elibuhlungu bulinganiswe njengengqikithi yamahora ekhanda elibuhlungu evikini eledlule, ngezigaba eziyisithupha ezingaba khona: (1) 0�5 h, (2) 6�10 h, (3) 11�15 h, (4) 16�20 h, (5) 21�25 h, noma (6) amahora angu-26 noma ngaphezulu. Ukuthathwa kwemithi kukalwa njengenani lezikhathi isiguli esithathe ngazo incwadi kadokotela noma i-over-the-counter ye-analgesic noma imithi elwa nokuvuvukala ngesonto eledlule ngenxa yekhanda labo, ngezinketho ezinhlanu: (1) neze, (2) kanye ngesonto, (3) kanye njalo ezinsukwini ezimbalwa, (4) kanye noma kabili ngosuku, noma (5) kathathu noma ngaphezulu ngosuku.

 

Iziguli zibuyele isonto le-1, amaviki angu-4, kanye nezinyanga ezingu-3 zokulandela lapho izinyathelo ezishiwo ngenhla ziphinde zaqoqwa. Ngaphezu kwalokho, ngeviki le-1, amaviki angu-4 kanye nezinyanga ze-3, iziguli zaqeda umbuzo we-GRC we-15-point ngokusekelwe esikalini esichazwe nguJaeschke et al. [46] ukukala umbono wabo womsebenzi othuthukisiwe. Isilinganiso sisukela ku -7 (okubi kakhulu) kuye kuziro (cishe okufanayo) kuye ku +7 (okungcono kakhulu). Izichazi zesikhashana zokuwohloka noma ukuthuthukiswa zinikezwa amanani ukusuka ku- -1 kuye ku -6 kanye no-+1 ukuya ku-+6, ngokulandelanayo. I-MCID ye-GRC ayizange ibikwe ngokuqondile kodwa amaphuzu we-+4 no-+5 ngokuvamile abe yinkomba yezinguquko ezilinganiselwe esimweni sesiguli [46]. Kodwa-ke, kufanele kuqashelwe ukuthi kamuva nje u-Schmitt no-Abbott babike ukuthi i-GRC ingase ingahlobani nezinguquko ekusebenzeni kwabantu abanokulimala kwe-hip ne-ankle [47]. Zonke izinyathelo zomphumela zaqoqwa umhloli ongaboni umsebenzi weqembu.

 

Ekuvakasheni kokuqala iziguli zaqeda zonke izinyathelo zomphumela zabe zithola iseshini yokuqala yokwelashwa. Iziguli ziqede izikhathi zokwelashwa ezingu-6�8 zokukhohlisa noma zokuhlanganisa kuhlanganiswe nokuzivocavoca emavikini angu-4. Ukwengeza, izihloko zabuzwa ukuthi ngabe ziye zabhekana yini nezenzakalo ezimbi kakhulu [48, 49] (ukushaywa unhlangothi noma ukulahlekelwa okuhlala njalo kwezinzwa) ngesikhathi ngasinye sokulandelela.

 

Randomization

 

Ngemva kokuhlolwa okuyisisekelo, iziguli zabelwa ngokungahleliwe ukuze zithole ukuxhashazwa noma ukuhlanganisa nokuzivocavoca. Ukwabiwa okufihliwe kwenziwa ngokusebenzisa ithebula lezinombolo zekhompiyutha ezingahleliwe ezidalwe ngumuntu ongahlangene nokuqasha iziguli ngaphambi kokuqala kocwaningo. Amakhadi enkomba angawodwana, anezinombolo ezilandelanayo anesabelo esingahleliwe alungiselelwa indawo ngayinye kweziyisi-8 zokuqoqwa kwedatha. Amakhadi ezinkomba ayegoqwa futhi afakwe ezimvilophini ezivaliwe ezivaliwe. Ephuphuthekiswe ekuhlolweni okuyisisekelo, umelaphayo wavula imvilophu futhi waqhubeka nokwelashwa ngokuvumelana nesabelo seqembu. Iziguli zayalwa ukuthi zingaxoxi ngenqubo ethile yokwelashwa etholwe nodokotela ohlolayo. Umelaphi ohlolayo uhlale engaboni isabelo seqembu lokwelapha lesiguli ngaso sonke isikhathi; noma kunjalo, ngokusekelwe esimweni sokungenelela kwakungenakwenzeka ukuphuphuthekisa iziguli noma ukwelapha abelaphi.

 

Iqembu Lokukhwabanisa

 

Ukukhohlisa okuqondise i-C1-2 yesokudla nesobunxele kanye nezinkulumo ze-T1-2 zamazwe amabili zenziwe okungenani izikhathi zokwelashwa eziyi-6�8 (Amakhiwane 1 kanye no-?kanye no-2).2). Kwezinye izikhathi zokwelashwa, abelaphi bangase baphinde ukukhohlisa kwe-C1-2 kanye/noma i-T1-2 noma baqondise okunye ukuchazwa komgogodla (okungukuthi, C0-1, C2-3, C3-7, T2-9, izimbambo 1�9) besebenzisa ukukhohlisa. . Ukukhethwa kwezigaba zomgogodla okuqondiswe kuzo kwashiywa ekuboneni komelaphi ophathayo futhi kwakusekelwe ekuhlanganiseni kwemibiko yesiguli kanye nokuhlolwa kwesandla. Kokubili ukuguqulwa komlomo wesibeletho nangaphezulu kwe-thoracic, uma kungekho msindo ophumayo noma oqhekezayo ozwakalayo emzamweni wokuqala, uchwepheshe wabeka kabusha isiguli futhi wenza ukukhwabanisa kwesibili. Imizamo eminingi ye-2 yenziwa esigulini ngasinye esifana nezinye izifundo [14, 50�53]. Odokotela bayalwe ukuthi ukukhwabanisa kungenzeka kuhambisane nemisindo eminingi ezwakalayo ezwakalayo [54�58]. Iziguli zakhuthazwa ukuba zigcine umsebenzi ovamile ngaphakathi kwemingcele yobuhlungu; nokho-ke, ukugqugquzelwa kanye nokunikezwa kwemithi yokuzivocavoca, nanoma yikuphi ukusetshenziswa kwezinye izindlela, akuzange kunikezwe leli qembu.

 

Umfanekiso 1 Ukukhohlisa Kwe-HVLA Kuqondiswe kwesokudla I-C1-2 Inkulumo | El Paso, TX Chiropractor

 

Umfanekiso 2 Ukukhohlisa Kwe-HVLA Okuqondiswe Ngaphakathi Ku-Upper Thoracic Spine | El Paso, TX Chiropractor

 

Ukukhohlisa okuqondiswe ku-C1-2 kwenziwa nesiguli sise-supine. Ngalesi senzo, ikhothamo elingemuva kwesobunxele lesiguli liye lathintwa isici esiseceleni se-proximal phalanx yomelaphi'umunwe wesibili wesokunxele kusetshenziswa �ukubamba imbeleko�. Ukuze wenze amabutho abekwe endaweni yesokunxele ye-C1-2, isiguli sasibekwe ngokusebenzisa isandiso, i-posterior-anterior (PA) shift, ipsilateral side-bend kanye ne-contralateral side-shift. Ngenkathi egcina lesi sikhundla, umelaphi wenza i-high-velocity eyodwa, i-low-amplitude thrust thrust ukuya engxenyeni yesokunxele ye-atlanto-axial esebenzisa ukujikeleza kwesokudla ku-arc ebheke esweni elingaphansi nokuhumusha kubheke etafuleni (Fig. 1). Lokhu kwaphindwa kusetshenziswa inqubo efanayo kodwa kuqondiswe ekukhulumeni okulungile kwe-C1-2.

 

Ukukhohlisa okuqondiswe ku-T1-2 kwenziwa nesiguli silele phezulu. Ngalolu hlelo lokusebenza, isiguli sasibambe izingalo zaso nezingalo zinqamule isifuba izindololwane ziqondaniswe ngendlela ephansi kakhulu. Umelaphi uthinte izinqubo eziguquguqukayo zomgogodla ophansi wengxenye yokunyakaza okuqondiwe ngokuphakama kwe-nar kanye ne-phalanx emaphakathi yedijithi yesithathu. Isigaxa esingaphezulu senziwe sasendaweni sesegimenti yokunyakaza okuqondiwe ngokungeza ukuzungezisa nokugoba eceleni kuya komelaphi kuyilapho isandla esingaphansi sisebenzisa ukubiza nokuchezuka kwe-radial ukuze kuzuzwe ukuzungezisa ukuya kanye nokugobela eceleni izikhathi, ngokulandelana. Isikhala esingaphansi kwenqubo ye-xiphoid kanye ne-costochondral margin yomelaphi sasetshenziswa njengendawo yokuthintana nezindololwane zesiguli ukuletha ukukhohlisa endaweni engaphambili kuya kwengemuva eqondiswe ku-T1-2 ngokubili (Fig. 2).

 

Ukugqugquzela kanye Neqembu Lokuzivocavoca

 

Ukugqugquzelwa okuqondiswe kwesokudla nakwesokunxele kwe-C1-2 nokuchazwa kwe-T1-2 yamazwe amabili kwenziwe okungenani kweseshini eyodwa yokwelapha engu-6�8. Kwezinye izikhathi zokwelashwa, abelaphi bangase baphinde ukuhlanganisa i-C1-2 kanye/noma i-T1-2 noma baqondise okunye ukukhuluma komgogodla (okungukuthi, C0-1, C2/3, C3-7, T2-9, izimbambo 1�9) besebenzisa ukuhlanganisa. . Ukukhethwa kwezingxenye zomgogodla okuqondiswe kuzo kwakushiywe ekuboneni komelaphi okwelapha futhi kwakusekelwe ekuhlanganiseni kwemibiko yesiguli kanye nokuhlolwa kwesandla. Kodwa-ke, ukuze kugwenywe �ukuthintwa� noma �umphumela wokunaka� uma kuqhathaniswa neqembu lokukhohlisa, abelaphi bayalwe ukuthi bahlanganise ingxenye eyodwa yomlomo wesibeletho (okungukuthi, kwesokudla nakwesokunxele) kanye nengxenye eyodwa yethoracic noma izimbambo ngesikhathi sokwelashwa ngasinye.

 

Ukuhlanganisa okuqondiswe ekukhulumeni kwe-C1-2 kwenziwa ngendlela evamile. Ngale ndlela, umelaphi wenze i-bout eyodwa ye-30 ye-unilateral grade IV PA ukuhlanganisa ingxenye ye-C1-2 njengoba kuchazwe yi-Maitland [7]. Le nqubo efanayo iphindiwe nge-bout eyodwa ye-30s ukuya ekuhlanganyeleni kwe-atlanto-axial kwesokudla. Ukwengeza, futhi okungenani iseshini eyodwa, ukugqugquzela okuqondiswe kumgogodla ophezulu we-thoracic (T1-2) nesiguli esinesiguli kwenziwa. Ngale ndlela, umelaphi wenze i-bout eyodwa ye-30 ye-central grade IV PA ukuhlanganisa ingxenye enyakazayo ye-T1-2 njengoba kuchazwe yi-Maitland [7]. Ngakho-ke, sisebenzise ama-oscillations angu-180 (okungukuthi, ama-30 s amathathu cishe ku-2 Hz) ama-oscillations ebanga lokugcina esewonke esihlokweni ngasinye sokwelashwa kokuhlanganisa. Ngokuphawulekayo, abukho ubufakazi bekhwalithi ephezulu kuze kube manje bokuphakamisa ukuthi ubude besikhathi sokuhlanganisa buholela ekunciphiseni okukhulu kobuhlungu kunesikhathi esifushane noma imithamo yokuhlanganisa [59, 60].

 

Ukuzivocavoca kwe-Cranio-cervical flexion [11, 61�63] kwenziwa nesiguli sihlezi phezulu, amadolo agobile futhi isikhundla sekhanda silinganiswe ngokubeka i-craniocervical kanye nomgogodla wesibeletho endaweni ephakathi, ukuze kube nomugqa phakathi Isiphongo kanye nesilevu sasivundlile, futhi umugqa ovundlile osuka ku-tragus wendlebe wawunqamula intamo ngobude. Iyunithi ye-biofeedback yokucindezela egcwele umoya (i-Chattanooga Group, Inc., Hixson, TN) yafakwa ngemuva kwentamo yesiguli futhi yafakwa kusisekelo esingu-20 mmHg [63]. Ngokuzivocavoca okuhleliwe, iziguli kwakudingeka zenze isenzo se-craniocervical flexion (�ukunqekuzisa ikhanda, okufana nokubonisa yebo) [63] futhi sizame ukukhomba ngokubonakalayo ukucindezela kwe-22, 24, 26, 28, kanye ne-30 mmHg kusuka. isisekelo sokuphumula se-20 mmHg nokubamba isikhundla siqinile ku-10 s [61, 62]. Isenzo sokuvuma ngekhanda senziwa ngendlela emnene nenensayo. Ukuphumula kwe-10 kuvunyelwe phakathi kwezilingo. Uma ukucindezela kuphambukile ngaphansi kokucindezela okuhlosiwe, ukucindezela akuzange kubanjwe ngokuqinile, ukufaka esikhundleni se-flexible engaphezulu (i-sternocleidomastoid noma i-anterior scalene) kwenzeka, noma ukuhoxiswa kwentamo kwaqashelwa ngaphambi kokuqedwa kokubamba kwe-isometric ye-10, kubhekwa njengokuhluleka. [63]. Ukucindezela kokugcina okuhlosiwe okuyimpumelelo kwasetshenziswa ukunquma izinga lokuzivocavoca lesiguli ngasinye lapho amasethi angu-3 ezimpinda eziyi-10 ngokubamba kwe-isometric eyi-10 enziwe. Ngaphezu kokuhlanganisa nokuzivocavoca kwe-cranio-cervical flexion, iziguli kwakudingeka zenze imizuzu eyi-10 yokuzivocavoca okuqhubekayo kokumelana (okungukuthi, ukusebenzisa ama-Therabands) noma izisindo zamahhala) emisipha yebhande lehlombe phakathi neseshini ngayinye yokwelashwa, ngaphakathi kokubekezelela kwazo, futhi ikakhulukazi egxile ku-trapezius ephansi kanye ne-serratus anterior [11].

 

Usayizi wesampula

 

Usayizi wesampula nokubalwa kwamandla kwenziwa kusetshenziswa isofthiwe eku-inthanethi evela ku-MGH Biostatistics Center (Boston, MA). Izibalo zazisekelwe ekutholeni umehluko we-2-point (noma i-20%) ku-NPRS (ukuqina kwekhanda elibuhlungu) ekulandeleni kwezinyanga ze-3, kucatshangwa ukuthi ukuphambuka okujwayelekile kwamaphuzu amathathu, ukuhlolwa komsila we-2, kanye nezinga le-alpha elilinganayo. ibe 0.05. Lokhu kukhiqize usayizi wesampula weziguli ezingama-49 iqembu ngalinye. Ukuvumela izinga lokuyeka ukufunda elilandelanayo elingu-10 %, sihlele ukuqasha okungenani iziguli eziyi-108 ocwaningweni. Lo sayizi wesampula unikeze amandla angaphezu kwangu-90 % okuthola ushintsho olubalulekile ngokwezibalo kuzikolo ze-NPRS.

 

Ukuhlaziya Data

 

Izibalo ezichazayo, okuhlanganisa ukubalwa kwemvamisa kokuguquguquka kwezigaba kanye nezilinganiso zokuthambekela okumaphakathi nokuhlakazeka kokuguquguqukayo okuqhubekayo kubalwe ukuze kufinyezwe idatha. Imiphumela yokwelashwa ekuqineni kwekhanda nokukhubazeka ngamunye wahlolwa ngokuhlaziywa kwe-2-by-4 yemodeli exubile yokuhluka (ANOVA), neqembu lokwelapha (ukukhwabanisa ngokumelene nokugqugquzela nokuzivocavoca) njengokuhlukahluka phakathi kwezihloko kanye nesikhathi (isisekelo, Iviki elingu-1, amaviki angu-4, nokulandelela izinyanga ezi-3) njengokuhlukahluka kwezifundo. Ama-ANOVA ahlukene ayenziwe nge-NPRS (ukuqina kwekhanda) kanye ne-NDI (ukukhubazeka) njengokuhlukahluka okuncike. Ku-ANOVA ngayinye, i-hypothesis yentshisekelo ibiwukusebenzelana kwezindlela ezi-2 (iqembu ngesikhathi).

 

Ukuhlolwa kwe-t okuzimele kwasetshenziselwa ukunquma umehluko phakathi kweqembu lokushintsha kwephesenti kusukela kwesisekelo kuya ekulandeleni kwezinyanga ezingu-3 kukho kokubili ukuqina kwekhanda nokukhubazeka. Ukuhlolwa okuhlukile kukaMann�Whitney U kwenziwa ngokuvama kwekhanda elibuhlungu, i-GRC, ubude bekhanda elibuhlungu kanye nokuthatha imithi njengokuhluka okuncikile. Senze Uhlolo Oluncane Olulahlekile Ngokungahleliwe (MCAR) [64] ukuze sinqume ukuthi ingabe amaphuzu edatha alahlekile ahlotshaniswa nokuyeka esikoleni abeshoda ngokungahleliwe noma alahlekile ngenxa yezizathu ezihlelekile. Ukuhlaziywa kwenhloso yokwelapha kwenziwe kusetshenziswa Ukulindela-Ukukhulisa lapho idatha engekho ihlanganiswa kusetshenziswa izibalo zokuhlehla. Ukuqhathanisa okuhleliwe kokubili kwenziwa kuhlolwa umehluko phakathi kwenkathi yokuqala neyokulandelela phakathi kwamaqembu kusetshenziswa ukulungiswa kwe-Bonferroni ezingeni le-alpha elithi .05.

 

Iziguli ze-dichotomized njengabaphenduli ekulandeleni kwezinyanga ze-3 zisebenzisa amaphuzu anqunywe we-2 amaphuzu wokuthuthukiswa kokuqina kwekhanda njengoba kulinganiswa yi-NPRS. Izinombolo ezidingekayo ukwelapha (NNT) kanye nezikhawu zokuzethemba ezingu-95 % (CI) nazo zibalwe esikhathini sokulandelela izinyanga ezingu-3 kusetshenziswa ngayinye yalezi zincazelo ukuze kube nomphumela oyimpumelelo. Ukuhlaziywa kwedatha kwenziwa kusetshenziswa i-SPSS 21.0.

 

Imiphumela

 

Iziguli ezingamakhulu amabili namashumi amahlanu nanye ezinesikhalazo esiyinhloko sobuhlungu bekhanda zahlolwa ukuze zikwazi ukufaneleka. Izizathu zokungafaneleki zingatholakala ku-Fig. 3, umdwebo wokugeleza wokuqashwa kwesiguli nokugcinwa. Ezigulini ezingama-251 ezihloliwe, iziguli eziyi-110, ezineminyaka yobudala engama-35.16 (SD 11.48) kanye nesikhathi esimaphakathi sezimpawu zeminyaka engu-4.56 (SD 6.27), zanelisa imibandela yokufaneleka, zavuma ukubamba iqhaza, futhi zenziwa ngokungahleliwe zibe ukukhohlisa (n ?=?58) kanye nokugqugquzela nokuzivocavoca (n?=?52) amaqembu. Okuguquguqukayo okuyisisekelo kweqembu ngalinye kungatholakala kuThebula 1. Abelaphi abayishumi nambili abavela emitholampilo ye-8 outpatient therapy ngokomzimba ngamunye welapha iziguli ezingama-25, 23, 20, 14, 13, 7, 6 noma 2, ngokulandelana; ngaphezu kwalokho, abelaphi abangu-12 ngamunye belaphe cishe ingxenye elinganayo yeziguli eqenjini ngalinye. Kwakungekho umehluko ophawulekayo (p?=?0.227) phakathi kwenani elilinganiselwe lezikhathi zokwelapha eziqediwe zeqembu lokukhohlisa (7.17, SD 0.96) kanye neqembu lokuhlanganisa nokuzivocavoca (6.90, SD 1.35). Ukwengeza, inani elilinganiselwe lezikhathi zokwelapha eziqondiswe ekukhulumeni kwe-C1-2 kwakuyi-6.41 (SD 1.63) yeqembu lokukhohlisa kanye ne-6.52 (SD 2.01) yeqembu lokuhlanganisa nokuzivocavoca, futhi lokhu kwakungefani kakhulu (p =? 0.762). Iziguli eziyikhulu nesikhombisa kweziyi-110 ziqede zonke izinyathelo zomphumela ngezinyanga ezi-3 (ukulandelela okungamaphesenti angama-97). Okuncane Okulahlekile Ngokuphelele Ekuhlolweni Okungahleliwe (MCAR) bekungabalulekile ngokwezibalo (p?=?0.281); ngakho-ke, sisebenzise indlela yokufaka i-Expectation-Maximization ukuze simiselele amanani angekho ngamavelu abikezelwe wemiphumela engekho yezinyanga ezi-3.

 

Umfanekiso wesi-3 Umdwebo Wokugeleza Wokuqashwa Nokugcinwa Kwesiguli | El Paso, TX Chiropractor

 

Ithebula 1 Okuguquguqukayo Okuyisisekelo, Izibalo zabantu kanye nezilinganiso zemiphumela | El Paso, TX Chiropractor

 

Iqembu eliphelele ngokusebenzisana kwesikhathi somphumela oyinhloko wokuqina kwekhanda lalibalulekile ngokwezibalo ku-NPRS (F (3,106)?=?11.196; p?

 

Ithebula 2 Izinguquko Ezibuhlungu Bekhanda Nokukhubazeka | El Paso, TX Chiropractor

 

Ithebula 3 Amaphesenti Ezifundo Ezizuza 50, 75, kanye Nokwehliswa Kwamaphesenti angu-100 | El Paso, TX Chiropractor

 

Ngemiphumela yesibili iqembu elibalulekile ngokusebenzisana kwesikhathi lalikhona ku-NDI (F(3,106)?=?8.57; p?

 

Ukuhlolwa kuka-Mann�Whitney U kwembula ukuthi iziguli eziseqenjini eliphezulu lomlomo wesibeletho kanye neqembu elingenhla lokuxhaphaza ithoracic zaba nekhanda elibuhlungu elingavamile evikini elingu-1 (p?

 

Asizange siqoqe noma iyiphi idatha mayelana nokuvela kwezenzakalo ezimbi ezimbi [48, 49] (izimpawu ze-neurological zesikhashana, ukwanda kokuqina, ubuhlungu obukhiphayo, ukukhathala noma okunye); kodwa-ke, azikho izenzakalo ezimbi ezimbi [48, 49] (ukushaywa unhlangothi noma ukulahlekelwa okungapheli kwezinzwa) ezibikwe kunoma yiliphi iqembu.

 

Ingxoxo

 

Isitatimende Semiphumela Eyinhloko

 

Ngolwazi lwethu, lolu cwaningo luyisivivinyo sokuqala somtholampilo esingahleliwe ukuze siqhathanise ngokuqondile ukuphumelela kokubili komlomo wesibeletho kanye ne-thoracic manipulation ekuhlanganiseni nasekuzivivinyeni ezigulini ezine-CH. Imiphumela iphakamisa izikhathi ze-6�8 zokuxhaphaza phezu kwamaviki e-4, eziqondiswe ikakhulukazi kokubili komlomo wesibeletho ongenhla (C1-2) kanye ne-upper thoracic (T1-2) spines, okubangele ukuthuthuka okukhulu ekuqineni kwekhanda, ukukhubazeka, imvamisa yekhanda, ubude bekhanda. , kanye nokudla kwemithi kunokugqugquzela kuhlanganiswe nokuzivocavoca. Iphuzu lilinganisela phakathi kweqembu izinguquko ekuqineni kwekhanda (amaphuzu angu-2.1) nokukhubazeka (amaphuzu angu-6.0 noma i-12.0 %) kudlule ama-MCID abikiwe kuzo zombili izinyathelo. Nakuba i-MCID ye-NDI ezigulini ezine-CH ingakaphenywa, kodwa kufanele kuqashelwe ukuthi isilinganiso esiphansi sesibopho se-95 % CI sokukhubazeka (amaphuzu angu-3.5) sasingaphansi kancane (noma silinganiswe ezimweni ezimbili) i-MCID ukuthi kutholakale ukuthi yi-3.5 [65], i-5 [66], kanye ne-7.5 [45] amaphuzu ezigulini ezinezinhlungu zentamo, i-8.5 [33] amaphuzu ezigulini ezine-radiculopathy yomlomo wesibeletho, kanye ne-3.5 [44] amaphuzu ezigulini ezixubile, ubuhlungu bentamo obungaqondile. Nokho, kufanele kuqashelwe ukuthi womabili amaqembu enze ngcono emtholampilo. Ukwengeza, i-NNT iphakamisa kuzo zonke iziguli ezine eziphathwe ngokuxhaphazwa, esikhundleni sokugqugquzela, isiguli esisodwa esengeziwe sifinyelela ukunciphisa ubuhlungu obubalulekile emtholampilo ekulandeleni kwezinyanga ze-3.

 

Amandla Nobuthakathaka Besifundo

 

Ukufakwa kwabelaphi bomzimba abangu-12 abavela emitholampilo yangasese engu-8 ezifundeni zezindawo ezihlukene ezingu-6 kuthuthukisa ukugcwaliseka kukonke kokutholakele kwethu. Nakuba umehluko omkhulu ubonwe kufika ezinyangeni ezi-3, akwaziwa ukuthi lezi zinzuzo beziyogcinwa isikhathi eside yini. Ukwengeza, sasebenzisa amasu okukhohlisa anesivinini esiphezulu, ama-low-amplitude asebenzisa ukusunduza okuphindwe kabili ekujikelezeni nasekuhumusheni kanyekanye kanye namasu okuhlanganisa e-Maitland esekelwe ebangeni le-IV PA; ngakho-ke, asinakuqiniseka ukuthi le miphumela ingenzeka kwezinye izinhlobo zamasu okwelapha okwenziwa ngesandla. Abanye bangase baphikise ngokuthi iqembu lokuqhathanisa kungenzeka alikutholanga ukungenelela okwanele. Sifune ukulinganisa ukufaneleka kwangaphakathi nangaphandle ngakho ukwelashwa okujwayelekile kwawo womabili amaqembu futhi sanikeza incazelo ecacile yamasu asetshenzisiwe azovumela ukuphindaphinda. Ngaphezu kwalokho, asizange silinganise izehlakalo ezimbi futhi sibuze kuphela izehlakalo ezimbili ezingaba ezinkulu ezimbi. Omunye umkhawulo ukuthi sifake imiphumela yesibili eminingi. Izinketho zobelaphi zokuthi iyiphi inqubo abacabanga ukuthi izoba ngcono ayizange iqoqwe futhi okungenzeka ibe nomthelela emiphumeleni.

 

Amandla Nobuthakathaka Ngokuphathelene Nezinye Izifundo: Umehluko Obalulekile Emiphumeleni

 

Jull et al. [11] ubonise ukuphumelela kokwelashwa kokwelashwa okukhohlisayo nokuzivocavoca ekuphathweni kwe-CH; kodwa-ke, le phakheji yokwelashwa yayihlanganisa kokubili ukuhlanganisa kanye nokukhwabanisa. Ucwaningo lwamanje lungase lunikeze ubufakazi bokuthi ukuphathwa kweziguli ezine-CH kufanele kufake uhlobo oluthile lokukhwabanisa naphezu kweqiniso lokuthi kuvame ukuphakanyiswa ukuthi ukuxhaphazwa komlomo wesibeletho kufanele kugwenywe ngenxa yengozi yezenzakalo ezimbi kakhulu [67, 68]. Ngaphezu kwalokho, kuye kwaboniswa ukuthi abantu abathola ukuxhaphazwa komgogodla ngenxa yobuhlungu bentamo kanye nekhanda elibuhlungu abanamathuba amaningi okuba ne-vertebrobasilar stroke kunokuba bathole ukwelashwa ngudokotela wabo wezokwelapha [69]. Ukwengeza, ngemva kokubuyekeza imibiko yamacala ayi-134, uPuentedura et al. waphetha ngokuthi ngokukhethwa okufanele kweziguli ngokuhlolwa ngokucophelela kwamafulege abomvu kanye nokuphikisana, iningi lezehlakalo ezimbi ezihambisana nokuxhaphazwa komlomo wesibeletho zingavinjelwa [70].

 

Incazelo Yocwaningo: Izincazelo Ezingenzeka kanye Nemiphumela Kodokotela Nabenzi Bezinqubomgomo

 

Ngokusekelwe emiphumeleni yabahlengikazi bocwaningo lwamanje kufanele bacabangele ukuhlanganisa ukuguqulwa komgogodla kubantu abane-CH. Ukubuyekezwa okuhlelekile kwakamuva kuthole kokubili ukuhlanganisa kanye nokukhohlisa ukuthi kuphumelele ekuphatheni iziguli ezine-CH kodwa akukwazanga ukunquma ukuthi iyiphi indlela engcono kakhulu [8]. Ukwengeza, iziqondiso zomtholampilo zibike ukuthi ukuxhaphazwa, ukugqugquzela kanye nokuzivocavoca konke kwaphumelela ekulawuleni iziguli ezine-CH; kodwa-ke, umhlahlandlela awuzange wenze iziphakamiso mayelana nokuphakama kwanoma iyiphi indlela. [71] Imiphumela yamanje ingase isize ababhali bezibuyekezo ezihlelekile zesikhathi esizayo kanye neziqondiso zomtholampilo ekunikezeni izincomo eziqondile mayelana nokusetshenziswa kokuxhaphaza umgogodla kulesi sibalo.

 

Imibuzo Engaphenduleki kanye Nocwaningo Lwesikhathi esizayo

 

Izindlela eziyisisekelo zokuthi kungani ukukhohlisa kungase kubangele ukuthuthukiswa okukhulu kusazocaciswa. Kuye kwaphakanyiswa ukuthi ukuhamba kwe-high-velocity kwe-vertebrae enezikhathi ezicindezelayo ezingaphansi kwe-200 ms kungase kuguqule amazinga okukhipha afferent [72] ngokuvuselela ama-mechanoreceptors kanye nama-proprioceptors, ngaleyo ndlela kushintshe amazinga e-alpha motorneuron excitability kanye nomsebenzi we-muscle olandelayo [72�74]. Ukukhohlisa kungase futhi kushukumise ama-receptors emisipha ejulile ye-paraspinal, futhi ukuhlanganisa kungase kube mathubeni okusiza ama-receptors emisipha engaphezulu [75]. I-Biomechanical [76, 77], umgogodla noma i-segmental [78, 79] kanye nendlela yobuhlungu obungavimbeliyo eyehlayo emaphakathi [80�83] onobuhle yizincazelo ezizwakalayo zemiphumela ye-hypoalgesic ebonwe ngemva kokukhwabanisa. Muva nje, imiphumela ye-biomechanical yokukhwabanisa ibilokhu ingaphansi kokuhlolwa kwesayensi [84], futhi kubonakala sengathi izinzuzo zomtholampilo ezitholakala esifundweni sethu zihlotshaniswa nempendulo ye-neurophysiological ehilela ukujula kwezinzwa zesikhashana ophondweni lwe-dorsal yomgogodla [78]; kodwa-ke, lo modeli ohlongozwayo okwamanje usekelwa kuphela ekutholweni okuvela ebuhlungu besikhashana, okwenziwa ukuhlolwa ezifundweni ezinempilo [85, 86], hhayi iziguli ezine-CH. Izifundo zesikhathi esizayo kufanele zihlole izindlela zokwelapha ezihlukile ezinemithamo eyahlukene futhi zifake ukulandelelwa konyaka ongu-1. Ngaphezu kwalokho, izifundo zesikhathi esizayo ezihlola imiphumela ye-neurophysiological yakho kokubili ukukhohlisa nokuhlanganisa zizobaluleka ekunqumeni ukuthi kungani kungase kube khona noma ungabi khona umehluko emiphumeleni yomtholampilo phakathi kwalokhu kwelashwa okubili.

 

Isiphetho

 

Imiphumela yocwaningo lwamanje ibonise ukuthi iziguli ezine-CH ezathola ukuxhaphazwa komlomo wesibeletho kanye ne-thoracic zabhekana nokunciphisa okukhulu kakhulu ekuqineni kwekhanda, ukukhubazeka, imvamisa yekhanda, ubude bekhanda, kanye nokuthatha imithi uma kuqhathaniswa neqembu elithola ukugqugquzela nokuzivocavoca; ngaphezu kwalokho, imiphumela yagcinwa ekulandeleni kwezinyanga ezi-3. Ucwaningo lwesikhathi esizayo kufanele luhlole ukusebenza kahle kwezinhlobo ezahlukene nemithamo yokukhohlisa futhi lubandakanye ukulandelelwa kwesikhathi eside.

 

Ukubonga

 

Abekho kubabhali abathole uxhaso lwalolu cwaningo. Ababhali bafisa ukubonga bonke ababambe iqhaza ocwaningweni.

 

Imibhalo yaphansi

 

  • Izithakazelo zokuncintisana: UDkt. James Dunning unguMongameli we-American Academy of Manipulative Therapy (AAMT). I-AAMT ihlinzeka ngezinhlelo zokuqeqesha emva kokuthweswa iziqu ekuxhashazweni komgogodla, ukuhlanganisa umgogodla, ukudinga okomile, ukuxhaphaza umkhawulo, ukuhlanganisa umkhawulo, ukuhlanganisa izicubu ezithambile ezisizwa yizinsimbi kanye nokuzivocavoca kokwelapha kubelaphi bomzimba abanelayisensi, i-osteopaths kanye nodokotela bezokwelapha. UDkt. UJames Dunning, uRaymond Butts, uThomas Perreault, noFiras Mourad bangabaqeqeshi abaphezulu be-AAMT. Abanye ababhali bamemezela ukuthi abanazo izintshisekelo eziqhudelanayo.
  • Iminikelo yababhali: I-JRD ibambe iqhaza ekukhulelweni, ekuklameni, ekutholweni kwedatha, ekuhlaziyweni kwezibalo nasekubhalweni kombhalo wesandla. I-RB kanye ne-IY babambe iqhaza ekwakhiweni, ekuqoqweni kwedatha, ekuhlaziyweni kwezibalo nasekubuyekezeni umbhalo wesandla. I-FM ibambe iqhaza ekwakhiweni, ekuhlaziyweni kwezibalo, ekuchazeni idatha nasekubuyekezeni umbhalo wesandla. I-MH ibambe iqhaza ekuqanjweni, ekuklanyweni nasekubuyekezeni umbhalo wesandla. I-CF kanye ne-JC bahileleke ekuhlaziyweni kwezibalo, ukuchazwa kwedatha, nokubuyekezwa okubucayi kombhalo wesandla wokuqukethwe okuhlakaniphile okubalulekile. I-TS, JD, DB, kanye ne-TH bezibandakanye ekuqoqweni kwedatha nasekubuyekezeni umbhalo wesandla. Bonke ababhali bafunde futhi bagunyaza umbhalo wesandla wokugcina.

 

Ulwazi Lomnikeli

 

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

 

Ekuphetheni,�ubuhlungu bekhanda obubangelwa yikhanda lesibili ngenxa yenkinga yezempilo eduze kwezakhiwo ezizungezile zomgogodla wesibeletho, noma intamo, kungabangela izimpawu ezibuhlungu neziqeda amandla ezingase zithinte izinga lempilo yesiguli. Ukuxhashazwa komgogodla kanye nokuhlanganisa kungasetshenziswa ngokuphepha nangempumelelo ukusiza ukuthuthukisa izimpawu zekhanda le-cervicogenic. Ulwazi olubalulwe ku-National Center for Biotechnology Information (NCBI). Ububanzi bolwazi lwethu bukhawulelwe ku-chiropractic kanye nokulimala komgogodla nezimo. Ukuze uxoxe ngesihloko, sicela ukhululeke ukubuza uDkt. Jimenez noma usithinte ku 915-850-0900 .

 

Ikhethwe nguDkt Alex Jimenez

 

 

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

 

Izihloko Ezengeziwe: Ubuhlungu Emuva

 

Ngokwezibalo, cishe i-80% yabantu izothola izimpawu zobuhlungu beqolo okungenani kanye kukho konke ukuphila kwabo. Ukuhlungu obusemhlane isikhalazo esivamile esingaba umphumela ngenxa yokulimala okuhlukahlukene kanye/noma izimo. Izikhathi eziningi, ukuwohloka kwemvelo komgogodla ngeminyaka kungabangela ubuhlungu emuva. Ama-discs we-Herniated kwenzeka lapho isikhungo esithambile, esifana nejeli se-intervertebral disc siphusha izinyembezi endaweni ezungezile, indandatho yangaphandle ye-cartilage, ukucindezela nokucasula izimpande zemizwa. Ama-Disc herniations avame ukwenzeka emhlane ophansi, noma i-lumbar spine, kodwa kungenzeka futhi eduze nomgogodla womlomo wesibeletho, noma intamo. Ukufakwa kwezinzwa ezitholakala emhlane ophansi ngenxa yokulimala kanye/noma isimo esishubile kungaholela ezimpawini ze-sciatica.

 

isithombe sebhulogi kakhathuni paperboy izindaba ezinkulu

 

ISIHLOKO ESIBALULEKILE ENGEZIWE: Ukwelashwa Kwezinhlungu Ze-Migraine

 

 

IZIHLOKO EZININGI: ENGEZIWE NGENXA: El Paso, Tx | Abasubathi

 

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78.�Bialosky JE, Bishop MD, Price DD, Robinson ME, George SZ. Izindlela zokwelapha ngesandla ekwelapheni ubuhlungu be-musculoskeletal: imodeli ephelele.�Umuntu Ther.�I-2009;14(5):531�8. doi: 10.1016/j.math.2008.09.001.�[Isihloko samahhala se-PMC]�[I-PubMed]�[Isiphambano Ref]
79.�Dunning J, Rushton A. Imithelela yokuguqulwa kwesibeletho sesivinini esiphansi se-amplitude yomlomo wesibeletho ekuphumuleni komsebenzi we-electromyographic we-biceps brachii muscle.�Umuntu Ther.�I-2009;14(5):508�13. doi: 10.1016/j.math.2008.09.003.�[I-PubMed]�[Isiphambano Ref]
80.�U-Haavik-Taylor H, uMurphy B. Ukuguqulwa komgogodla wesibeletho kushintsha ukuhlanganiswa kwe-sensorimotor: isifundo esinamandla esivusa i-somatosensory.�I-Clin Neurophysiol.�I-2007;118(2):391�402. doi: 10.1016/j.clinph.2006.09.014.�[I-PubMed]�[Isiphambano Ref]
81.�Millan M. Ukwehla kokulawula ubuhlungu.�I-Prog Neurobiology.�I-2002;66:355�74. doi: 10.1016/S0301-0082(02)00009-6.�[I-PubMed]�[Isiphambano Ref]
82.�I-Skyba D, i-Radhakrishnan R, i-Rohlwing J, i-Wright A, i-Sluka K. Ukuxhaphaza ngokuhlanganyela kunciphisa i-hyperalgesia ngokwenza kusebenze ama-monoamine receptors kodwa hhayi i-opioid noma i-GABA receptors emgogodleni.Ubuhlungu.�I-2003;106:159�68. doi: 10.1016/S0304-3959(03)00320-8.�[Isihloko samahhala se-PMC]�[I-PubMed]�[Isiphambano Ref]
83.�Zusman M. Forebrain-mediated sensitization of central pain pathways: ubuhlungu “okungaqondile” kanye nesithombe esisha sokwelashwa okwenziwa ngesandla.�Umuntu Ther.�I-2002;7:80;8. doi: 10.1054/math.2002.0442.�[I-PubMed]�[Isiphambano Ref]
84.�Bialosky JE, George SZ, Bishop MD. Isebenza kanjani i-spinal manipulative therapy: kungani ubuza ukuthi kungani?�J Orthop Sports Phys Ther.�I-2008;38(6):293�5. doi: 10.2519/jospt.2008.0118.�[I-PubMed]�[Isiphambano Ref]
85.�Bishop MD, Beneciuk JM, George SZ. Ukuncishiswa ngokushesha kwe-temporary sensory summation ngemuva kokuxhaphaza umgogodla we-thoracic.�Umgogodla J.�I-2011;11(5):440�6. doi: 10.1016/j.spinee.2011.03.001.[Isihloko samahhala se-PMC]�[I-PubMed]�[Isiphambano Ref]
86.�George SZ, Bishop MD, Bialosky JE, Zeppieri G, Jr, Robinson ME. Imiphumela esheshayo yokuguqulwa komgogodla ekuzweleni kobuhlungu obushisayo: isifundo sokuhlola.�I-BMC Musculoskelet Disord.�I-2006;7:68. doi: 10.1186/1471-2474-7-68.�[Isihloko samahhala se-PMC]�[I-PubMed]�[Isiphambano Ref]
Vala i-Accordion
I-Chiropractic Headache Treatment Guidelines e-El Paso, TX

I-Chiropractic Headache Treatment Guidelines e-El Paso, TX

by | I-Chiropractic, Isivivinyo Esilawulwa Ngokungahleliwe

Ubuhlungu bekhanda bungenye yezizathu ezivame kakhulu zokuvakashelwa kwehhovisi likadokotela. Iningi labantu liyawathola esikhathini esithile empilweni yawo futhi angathinta noma ubani, kungakhathaliseki ubudala, uhlanga nobulili. I-International Headache Society, noma i-IHS, ihlukanisa ubuhlungu bekhanda njengento eyinhloko, uma ingabangelwa okunye ukulimala kanye / noma isimo, noma okwesibili, uma kunembangela eyinhloko ngemuva kwabo. Kusuka migraines ukuhlanganisa ikhanda elibuhlungu kanye nokucindezeleka kwekhanda, abantu abahlukunyezwa njalo bangase bakuthole kunzima ukuhlanganyela emisebenzini yabo yansuku zonke. Ochwepheshe abaningi bezempilo baphatha ubuhlungu bekhanda, noma kunjalo, ukunakekelwa kwe-chiropractic kuye kwaba yindlela yokwelapha ehlukile ethandwayo ezindabeni zezempilo ezihlukahlukene. Inhloso yalesi sihloko esilandelayo ukukhombisa iziqondiso ezisekelwe ebufakazini zokwelashwa kwe-chiropractic yabantu abadala abanekhanda elibuhlungu.

 

Imihlahlandlela Esekelwe Ebufakazini Yokwelashwa Kwe-Chiropractic Yabantu Abadala Abanekhanda Lekhanda

 

abstract

 

  • Injongo: Inhloso yalo mbhalo wesandla ukuhlinzeka ngezincomo zokuzijwayeza ezinobufakazi zokwelashwa kwe-chiropractic yekhanda elibuhlungu kubantu abadala.
  • Izindlela: Ukusesha kwezincwadi ezihlelekile zokuhlolwa komtholampilo okulawulwayo okushicilelwe ngo-Agasti 2009 okuhambisana nomkhuba we-chiropractic kwenziwa kusetshenziswa imininingwane ye-MEDLINE; EMBASE; Imithi Ehlangene Neyokulekelela; i-Cumulative Index to Nursing and Allied Health Literature; I-Manuwali, Alternative, kanye ne-Natural Therapy Index System; I-Alt HealthWatch; Inkomba ku-Chiropractic Literature; kanye ne-Cochrane Library. Inombolo, ikhwalithi, nokungaguquguquki kokutholiwe kucatshangelwe njengokunikeza amandla ewonke obufakazi (okuqinile, okumaphakathi, okulinganiselwe, noma okushayisanayo) kanye nokwenza izincomo zokuzijwayeza.
  • Ezenye: Ama-athikili angamashumi amabili nanye ahlangabezane nemibandela yokufakwa futhi asetshenziselwa ukuthuthukisa izincomo. Ubufakazi abudlulanga izinga elimaphakathi. Nge-migraine, ukuguqulwa komgogodla kanye nokungenelela kwe-multidisciplinary multidisciplinary kuhlanganise ne-massage kunconywa ukuphatha iziguli ezine-episodic noma i-migraine engapheli. Ngekhanda lohlobo lokucindezeleka, ukuxhaphaza umgogodla akukwazi ukunconywa ekuphathweni kwekhanda lohlobo lwe-episodic tension-type. Isincomo asikwazi ukwenziwa noma ngokumelene nokusetshenziswa komgogodla ezigulini ezinekhanda elibuhlungu elingapheli. Ukuhlanganisa i-craniocervical yomthwalo ophansi kungase kube usizo ekulawuleni isikhathi eside kweziguli ezinezinhlungu zekhanda le-episodic noma ezingapheli. Ngekhanda le-cervicogenic, ukuguqulwa komgogodla kunconywa. Ukuhlanganisa ngokuhlanganyela noma ukuzivocavoca kwe-deep neck flexor kungase kuthuthukise izimpawu. Ayikho inzuzo eyengeziwe eqhubekayo yokuhlanganisa ukuhlanganisa okuhlangene kanye nokuzivocavoca kwentamo ejulile ye-flexor yeziguli ezinekhanda le-cervicogenic. Izenzakalo ezimbi azizange zibhekiswe ezivivinyweni eziningi zomtholampilo; futhi uma zazikhona, zazingekho noma zazincane.
  • Iziphetho: Ubufakazi bubonisa ukuthi ukunakekelwa kwe-chiropractic, kuhlanganise nokuguqulwa komgogodla, kuthuthukisa i-migraine
    kanye nekhanda le-cervicogenic. Uhlobo, imvamisa, umthamo, nobude besikhathi sokwelashwa kufanele kusekelwe ezincomweni zomhlahlandlela, ulwazi lomtholampilo, kanye nokutholakele. Ubufakazi bokusetshenziswa kokuguqulwa komgogodla njengendlela yokungenelela eyedwa ezigulini ezinekhanda lohlobo lwe-tension zihlala zilingana. (J Manipulative Physiol Ther 2011; 34:274-289)
  • Imigomo Yokukhomba Ebalulekile: Ukuxhaphaza Umgogodla; I-Migraine Disorders; I-Tension-Type Headache; Ikhanda elibuhlungu ngemuva kokuhlukumezeka; Isiqondiso Sokuzilolonga; I-Chiropractic

 

UDkt Jimenez White Coat

Ukuqonda kukaDkt Alex Jimenez

Ubuhlungu bekhanda, noma ubuhlungu bekhanda, okuhlanganisa i-migraine nezinye izinhlobo zekhanda, ingenye yezinhlobo ezivame kakhulu zobuhlungu ezibikwe phakathi kwabantu abaningi. Lezi zingase zenzeke ohlangothini olulodwa noma zombili zekhanda, zingahlukaniswa endaweni ethile noma zingase ziphume ekhanda zisuka endaweni eyodwa. Nakuba izimpawu zekhanda zingahluka kuye ngokuthi uhlobo lobuhlungu bekhanda kanye nangenxa yomthombo wenkinga yezempilo, ubuhlungu bekhanda bubhekwa njengesikhalazo esivamile kungakhathaliseki ubukhulu babo kanye nesimo sabo. Ubuhlungu bekhanda, noma ubuhlungu bekhanda, bungase buvele ngenxa yokungahambi kahle komgogodla, noma i-subluxation, ngobude bomgogodla. Ngokusetshenziswa kokulungiswa komgogodla kanye nokuphathwa ngesandla, ukunakekelwa kwe-chiropractic kungakwazi ukubuyisela ngokuphepha nangempumelelo umgogodla, ukunciphisa ukucindezeleka nokucindezela ezakhiweni ezizungezile zomgogodla, ukuze ekugcineni kusize ukuthuthukisa izimpawu zobuhlungu bekhanda le-migraine kanye nempilo yonke kanye nokuphila kahle.

 

Ubuhlungu bekhanda yinto evamile kubantu abadala. Ubuhlungu bekhanda obuphindaphindiwe bunomthelela omubi empilweni yomndeni, umsebenzi wezenhlalakahle, namandla okusebenza.[1,2] Emhlabeni wonke, ngokusho kwe-World Health Organization, i-migraine yodwa i-19th phakathi kwazo zonke izimbangela zeminyaka ehlala nokukhubazeka. Ubuhlungu bekhanda bungokwesithathu phakathi kwezizathu zokufuna ukunakekelwa kwe-chiropractic eNyakatho Melika.[3]

 

Ukuxilongwa okunembile kuyisihluthulelo sokuphatha nokwelashwa, futhi izinhlobo eziningi zezinhlobo zekhanda zichazwe ku-International Classification of Headache Disorders 2 (International Headache Society [IHS]).[4] Izigaba zenzelwe ukusetshenziswa komtholampilo kanye nocwaningo. Izinhlungu zekhanda ezivame kakhulu, uhlobo lwe-tension kanye ne-migraine, kubhekwa njengekhanda eliyinhloko eliyi-episodic noma elingapheli ngokwemvelo. I-Episodic migraine noma uhlobo lwekhanda lokucindezeleka lwenzeka ngaphansi kwezinsuku eziyi-15 ngenyanga, kuyilapho ubuhlungu bekhanda obungapheli buba khona ngaphezu kwezinsuku eziyi-15 ngenyanga okungenani izikhathi ezi-3 (i-migraine) noma izinyanga ezingu-6 (uhlobo lwekhanda lokucindezeleka).[4] Ubuhlungu bekhanda besibili kuthiwa bubangelwa izinkinga zomtholampilo ezisekhanda noma entanyeni ezingase zibe yi-episodic noma ezingapheli. Ikhanda le-Cervicogenic likhanda lesibili elivame ukuphathwa ngabahlengikazi futhi libandakanya ubuhlungu obubhekiswe emthonjeni entanyeni futhi bubonwa ku-1 noma izifunda eziningi zekhanda. I-IHS ibona ikhanda elibuhlungu le-cervicogenic njengesifo esihlukile, [4] kanye nobufakazi bokuthi ikhanda elibuhlungu lingabangelwa ukuphazamiseka kwentamo noma isilonda esisekelwe emlandweni nezici zomtholampilo (umlando wokuhlukumezeka kwentamo, ukukhushulwa kobuhlungu, ukunciphisa ububanzi bokunyakaza komlomo wesibeletho, kanye ukuthambekela kwentamo egxile, ngaphandle kobuhlungu be-myofascial kuphela) bubalulekile ekuxilongweni kodwa akukhona ukuphikisana ezincwadini.[4,5] Uma ubuhlungu be-myofascial bubodwa buyimbangela, isiguli kufanele silawulwe njengekhanda lohlobo lokucindezeleka.[4]

 

Izindlela zokwelapha ezivame ukusetshenziswa odokotela bezinhlungu ukuze banakekele iziguli ezinekhanda elibuhlungu zihlanganisa ukuxhashazwa komgogodla, ukuhlanganisa, ukuxhashazwa komgogodla okusizwa ngedivayisi, imfundo emayelana nezici eziguquguqukayo zokuphila, izindlela zokwelapha ngokomzimba, ukushisa/iqhwa, ukubhucungwa, ukwelapha okuthuthukisiwe kwezicubu ezithambile ezifana ne-trigger point therapy, nokuqinisa nokwelula umzimba. Kukhona ukulindela okukhulayo kochwepheshe bezempilo, kuhlanganise ne-chiropractic, ukwamukela nokusebenzisa ulwazi olusekelwe ocwaningweni, ukuthatha i-akhawunti eyanele ngekhwalithi yobufakazi obutholakalayo bokucwaninga ukuze bazise umkhuba womtholampilo. Ngenxa yalokho, inhloso ye-Canadian Chiropractic Association (CCA) kanye ne-Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards (Federation) I-Clinical Practice Guidelines Project Project ukuthuthukisa imihlahlandlela yokusebenza ngokusekelwe ebufakazini obutholakalayo. Inhloso yalo mbhalo wesandla ukuhlinzeka ngezincomo zokuzijwayeza ezinobufakazi zokwelashwa kwe-chiropractic yekhanda elibuhlungu kubantu abadala.

 

izindlela

 

IKomidi Lokuthuthukiswa Kwemihlahlandlela (GDC) lihlelele futhi lalungisa izinqubo ezihlelekile zokusesha izincwadi, ukuhlola, ukubuyekezwa, ukuhlaziya, nokutolika. Izindlela zihambisana nemibandela ehlongozwe �Ukucutshungulwa Kwemihlahlandlela Yokucwaninga Nokuhlola� ukusebenzisana (www.agreecollaboration.org). Lo mhlahlandlela uyithuluzi elisekela odokotela. Akuhlosiwe njengezinga lokunakekelwa. Umhlahlandlela uxhumanisa ubufakazi obutholakalayo obushicilelwe ekusebenzeni komtholampilo futhi ingxenye ye-1 kuphela yendlela enolwazi olunolwazi lokunakekelwa kwesiguli.

 

Imithombo Yedatha Nosesho

 

Ukusesha okuhlelekile nokuhlolwa kwezincwadi zokwelashwa kwenziwa kusetshenziswa izindlela ezinconywe i-Cochrane Collaboration Back Review Group[6] kanye no-Oxman no-Guyatt.[7] Isu lokusesha lakhiwe ku-MEDLINE ngokuhlola imigomo ye-MeSH ehlobene ne-chiropractic kanye nokungenelela okuqondile futhi kamuva kwaguqulwa kwezinye izingosi zolwazi. Isu lokusesha izincwadi lalibanzi ngamabomu. Ukwelashwa kwe-Chiropractic kwachazwa njengokuhlanganisa izindlela zokwelapha ezivame kakhulu ezisetshenziswa odokotela futhi akuzange kuvinjelwe ezindleleni zokwelashwa ezilethwa kuphela ama-chiropractors. Kwaphonswa inetha elibanzi ukuze lifake ukwelapha okungase kunikezwe ekunakekelweni kwe-chiropractic kanye nalezo ezingahle zilethwe kumongo wokunakekelwa ngabanye ochwepheshe bezempilo ocwaningweni oluthile locwaningo (Isithasiselo A). Ukuxhashazwa komgogodla kwachazwa njengokuphonswa kwe-high-velocity low-amplitude okulethwa emgogodleni. Imithi yokwelapha engabaliwe yayihlanganisa izinqubo ezihlaselayo zokudambisa ubuhlungu noma i-neurostimulation, i-pharmacotherapy, imijovo yobuthi be-botulinum, izindlela zokwelapha zengqondo noma zokuziphatha, kanye ne-acupuncture.

 

Ukusesha kwezincwadi kwaqedwa kusukela ngo-Ephreli kuya kuMeyi 2006, kwabuyekezwa ngo-2007 (isigaba 1), futhi kwabuyekezwa futhi ngo-Agasti 2009 (isigaba 2). Imininingo egciniwe eseshwayo ifaka phakathi i-MEDLINE; EMBASE; Imithi Ehlangene Neyokulekelela; i-Cumulative Index to Nursing and Allied Health Literature; I-Manuwali, Alternative, kanye ne-Natural Therapy Index System; I-Alt HealthWatch; Inkomba ye-Chiropractic Literature; kanye ne-Cochrane Library (Isithasiselo A). Ukusesha kwakuhlanganisa izindatshana ezishicilelwe ngesiNgisi noma ngezifinyezo zesiNgisi. Isu lokusesha lalilinganiselwe kubantu abadala (?iminyaka eyi-18); nakuba izifundo zocwaningo ezinemibandela yokufakwa kwezihloko ezihlanganisa ububanzi obubanzi beminyaka, njengabantu abadala kanye nentsha, zatholwa kusetshenziswa isu lokusesha. Uhlu lwezithenjwa oluhlinzekwe kuzibuyekezo ezihlelekile (ama-SRs) luphinde lwabuyekezwa yi-GDC ukuze kuncishiswe ama-athikili afanelekile ukuthi angaphuthelwa.

 

Imibandela Yokukhetha Ubufakazi

 

Imiphumela yosesho yahlolwa nge-elekthronikhi, futhi kwasetshenziswa ukuhlolwa kwezigaba eziningi (Isithasiselo B): isigaba 1A (isihloko), 1B (okungabonakali); isigaba 2A (umbhalo ogcwele), 2B (indlela yombhalo ogcwele, ukuhambisana); kanye nesiteji sesi-3 (ukuhlolwa kombhalo ogcwele kokugcina kwe-GDC njengochwepheshe bokuqukethwe bomtholampilo). Izingcaphuno eziyimpinda zisusiwe, futhi ama-athikili ahlobene alandwa njengamakhophi e-elekthronikhi kanye/noma aqinile ukuze ahlaziywe kabanzi. Abahloli abahlukene, besebenzisa indlela efanayo, baqedele izikrini zemibhalo ngo-2007 nango-2009 ngenxa yesikhathi esiphakathi kokusesha.

 

Izivivinyo zomtholampilo ezilawulwa kuphela (CCTs); ukuhlolwa okungahleliwe, okulawulwayo (RCTs); kanye nokubuyekezwa okuhlelekile (ama-SRs) kukhethwe njengesisekelo sobufakazi balesi siqondiso esihambisana nezindinganiso zamanje zokuhumusha okutholwe emitholampilo. I-GDC ayizange ilinganisele izifundo zokuqaphela, uchungechunge lwamacala, noma imibiko yezindaba ngenxa yesimo sayo esingalawuleki kanye nekhwalithi ephansi yendlela yokusebenza okungenzeka iphansi uma iqhathaniswa nama-CCT. Le ndlela ihambisana nezindlela ezibuyekeziwe zama-SRs ezishicilelwe yi-Cochrane Back Review Group.[8] Uma ama-SR amaningi ashicilelwe ababhali abafanayo esihlokweni esinikeziwe, okushicilelwe kwakamuva kuphela okubaliwe futhi kwasetshenziselwa ukuhlanganiswa kobufakazi. Ukubuyekezwa okuhlelekile kwama-SRs nakho akuzange kufakwe ukugwema ukubalwa kabili kwemiphumela yocwaningo.

 

Ukuhlola Nokuhunyushwa Kwemibhalo

 

Izilinganiso zekhwalithi zama-CCT noma ama-RCT afaka imibandela engu-11 ephendulwa ngokuthi �yebo (amaphuzu 1)� noma �cha (amaphuzu 0)/angazi (amaphuzu 0)� (Ithebula 1). I-GDC ibhale ezinye izindlela ezi-2 zokuthakaselayo: (1) ukusebenzisa kwabacwaningi indlela yokuxilonga ye-IHS ekubhaliseni isifundo kanye (2) nokuhlolwa kwemiphumela engemihle (Ithebula 1, amakholomu L kanye no-M). Ukusetshenziswa kwemibandela ye-IHS[4] bekufanelekile kule nqubo ye-Clinical Practice Guideline (CPG) ukuze kuqinisekiswe ukucaciswa kokuxilonga ngaphakathi nakuzo zonke izifundo zocwaningo. Izifundo azizange zifakwe uma i-IHS i-diagnostic criteria ingasetshenziswanga ngabacwaningi ukuze kufakwe isihloko esifundweni (Isithasiselo C); futhi uma ngaphambi kwe-2004, ngaphambi kokuba ikhanda le-cervicogenic lifakwe esigabeni se-IHS, indlela yokuxilonga ye-Cervicogenic Headache International Study Group [9] ayizange isetshenziswe. Imiphumela emibi iye yabuyekezwa njengommeleli wezingozi ezingaba khona ngokwelashwa. Azikho izici zokulinganisa ezisetshenziswe kumibandela yomuntu ngamunye, futhi izilinganiso zekhwalithi ezingenzeka zisukela ku-0 kuya ku-11. Kokubili ukuphuphuthekiswa kwezifundo nabahlinzeki bokunakekelwa kukalwe ezihlokweni zocwaningo yi-GDC, njengoba lezi zinto zifakwe kuhlu lwethuluzi lokulinganisa ikhwalithi. [6] Izindlela ze-GDC azizange zizivumelanise noma ziguqule ithuluzi lokulinganisa. Isizathu sale ndlela kwakuwukuthi izindlela ezithile zokwelapha (isb, transcutaneous electrical nerve stimulation [TENS], ultrasound) kanye nemiklamo yesilingo ingase ifinyelele ukuphuphuthekisa kwesiguli kanye/noma uchwepheshe.[10] I-GDC ayizange inciphise ukuhlolwa kwalezi zilinganiso zekhwalithi uma ngempela zibikwe ezifundweni zomtholampilo zokwelashwa kwezinkinga zekhanda. I-GDC iphinde yakubheka ngaphandle komkhakha wabo wobuchwepheshe ukuze iguqule, ngaphandle kokuqinisekisa, ithuluzi lokulinganisa elisetshenziswa kabanzi elisetshenziselwa ukuhlola izincwadi zomtholampilo.[6] Amathuluzi amasha ocwaningo okuhlaziya nokulinganisa kwezincwadi zokwelashwa kwezandla, nokho, adingeka ngokushesha futhi aqashelwa njengendawo yocwaningo lwangomuso esigabeni sengxoxo esingezansi.

 

Ithebula 1 Izilinganiso Ezifanelekile Zezilingo Ezilawulwayo Zokwelashwa Komzimba Zokulawulwa Kwezinkinga Zekhanda

 

Abahloli bezincwadi babengabahlanganyeli bephrojekthi abahlukene ne-GDC futhi bebengaphuphuthekisiwe mayelana nokutadisha ababhali, izikhungo, namajenali omthombo. Amalungu amathathu e-GDC (MD, RR, kanye ne-LS) aqinise izindlela zokulinganisa ikhwalithi ngokuqedela ukuhlolwa kwekhwalithi kusethi engaphansi engahleliwe yama-athikili ayi-10.[11-20] Izinga eliphezulu lesivumelwano laqinisekiswa kuzo zonke izilinganiso zekhwalithi. Isivumelwano esiphelele kuzo zonke izinto sifinyelelwe ezifundweni ezi-5: ezintweni ezingu-10 kwezingu-11 zezifundo ezi-4 kanye nezinto ezingu-8 kwezingu-11 zocwaningo olu-1 olusele. Konke ukungaboni ngaso linye kwaxazululwa kalula ngezingxoxo nangokuvumelana yi-GDC (Ithebula 1). Ngenxa yokuhlukahlukana kwezindlela zocwaningo kuzo zonke izivivinyo, akukho ukuhlaziywa kwemeta noma ukuhlanganisa izibalo kwemiphumela yocwaningo okwenziwe. Izilingo ezithola ngaphezu kwengxenye yesamba sesilinganiso esingaba khona (okungukuthi, ?6) zithathwe njengekhwalithi ephezulu. Izivivinyo ezithola u-0 kuye ku-5 zithathwe njengekhwalithi ephansi. Izifundo ezinamaphutha amakhulu e-methodological noma ukuphenya amasu okwelapha okukhethekile azifakwanga (isb, ukwelashwa okungabhekwa njengokubalulekile yi-GDC yokunakekelwa kwe-chiropractic yeziguli ezinekhanda elibuhlungu; Ithebula lesithasiselo 3).

 

Izilinganiso zekhwalithi zama-SRs zibandakanya umbandela ongu-9 ophendulwe ngoyebo (amaphuzu 1) noma cha (amaphuzu 0)/angazi (amaphuzu 0) kanye nempendulo yekhwalithi yento ethi J �awekho amaphutha,� �amaphutha amancane,� noma �amaphutha amakhulu� (Ithebula 2). Izilinganiso ezingase zibe khona zazisukela ku-0 kuye ku-9. Ukunqunywa kwekhwalithi iyonke yesayensi yama-SRs anamaphutha amakhulu, amaphutha amancane, noma awekho amaphutha, njengoba esohlwini lwekholomu J (Ithebula 2), kwakusekelwe ezimpendulweni zabalingani bezincwadi ezintweni ezingu-9 zangaphambilini. . Amapharamitha alandelayo asetshenziswe ukuze kutholwe ikhwalithi yesayensi iyonke ye-SR: uma impendulo ye-cha/angazi isetshenzisiwe, i-SR kungenzeka ibe namaphutha amancane kakhulu. Nokho, uma �Cha� esetshenziswe ezintweni B, D, F, noma H, ukubukezwa kwakungase kube namaphutha amakhulu.[21] Ukubuyekezwa okuhlelekile okuthole ngaphezu kwengxenye yesamba sesilinganiso esingaba khona (okungukuthi, ?5) esingenasici noma amaphutha amancane kulinganiselwe njengekhwalithi ephezulu. Ukubuyekezwa okuhlelekile okunamaphuzu angu-4 noma ngaphansi kanye/noma okunamaphutha amakhulu akufakiwe.

 

Ithebula 2 Izilinganiso Ezifanelekile Zokubuyekezwa Okuhlelekile Kokwelashwa Okungokomzimba Kokulawulwa Kwezinkinga Zekhanda

 

Ukubuyekezwa kwachazwa njengokuhlelekile uma kuhlanganisa indlela ecacile nephindaphindwayo yokusesha nokuhlaziya izincwadi futhi uma kuchazwe indlela yokufaka nokungafakwa kwezifundo. Izindlela, izindlela zokufakwa, izindlela zokulinganisa izinga lokufunda, izici zezifundo ezifakiwe, izindlela zokuhlanganiswa kwedatha, kanye nemiphumela yahlolwa. Abalinganisi bathole isivumelwano esiphelele sazo zonke izinto zokulinganisa ze-7 SRs[22-28] kanye nezinto ezingu-7 kwezingu-9 kuma-SRs angu-2 engeziwe.[29,30] Ukungezwani kuthathwe njengokuncane futhi kwaxazululwa kalula ngokubuyekezwa kwe-GDC nokuvumelana (Ithebula 2 ).

 

Ukuthuthukisa Izincomo Zokuzijwayeza

 

I-GDC yahumusha ubufakazi obufanele ekwelapheni kwe-chiropractic yeziguli zekhanda. Isifinyezo esiningiliziwe sama-athikili afanelekile sizothunyelwa kuwebhusayithi ye-CCA/Federation Clinical Practice Guidelines Project.

 

Ukuhlolwa okungahleliwe, okulawulwayo kanye nokutholakele kwabo kwahlolwa ukuze kwaziwe izincomo zokwelashwa. Ukunikeza ubufakazi obunamandla obuphelele (obuqinile, obulinganiselwe, obulinganiselwe, obuphikisanayo, noma obungenabo),[6] i-GDC icabangele inombolo, ikhwalithi, nokungaguquguquki kwemiphumela yocwaningo (Ithebula 3). Ubufakazi obunamandla babucatshangelwa kuphela lapho ama-RCT amaningi ekhwalithi ephezulu eqinisekisa okutholwe abanye abacwaningi kwezinye izilungiselelo. Ama-SR ekhwalithi ephezulu kuphela ahlolwe ngokuphathelene nendikimba yobufakazi kanye nokwazisa izincomo zokwelashwa. I-GDC icabangele izindlela zokwelapha ukuthi zibe nezinzuzo ezifakazelwe uma zisekelwa ubuncane bezinga elimaphakathi lobufakazi.

 

Ithebula 3 Amandla Obufakazi

 

Izincomo zokuzijwayeza zenziwa emihlanganweni yeqembu elisebenzayo lokusebenzisana.

 

Imiphumela

 

Ithebula 4 Isifinyezo Sezincwadi Zezilinganiso !zeqiniso Zobufakazi Bokungenelela Ngekhanda Le-Migraine eline-Aura noma elingenayo

 

Ithebula 5 Isifinyezo Sezincwadi kanye Nezilinganiso Zekhwalithi Zobufakazi Bokungenelela Kwezinhlungu Zekhanda Ezishubile

 

Ithebula lesi-6 Isifinyezo Sezincwadi kanye Nezilinganiso Zekhwalithi Zobufakazi Bokungenelela Kwekhanda Lekhanda Le-Cervicogenic

 

Ithebula 7 Isifinyezo Semibhalo Nezilinganiso Zekhwalithi Zokubuyekezwa Okuhlelekile Kokwelashwa Okungokomzimba Kokulawulwa Kwezinkinga Zekhanda

 

Literature

 

Kusukela ekuseshweni kwezincwadi, ekuqaleni kwatholakala izingcaphuno ezingama-6206. Ama-athikili angamashumi amabili nanye ahlangabezane nemibandela yokugcina yokufakwa futhi acatshangelwa ekuthuthukiseni izincomo zomkhuba (16 CCTs/RCTs[11-20,31-36] kanye ne-5 SRs[24-27,29]). Izilinganiso zekhwalithi zama-athikili afakiwe zinikezwa kuThebula 1 kanye no-2. Ithebula lesithasiselo Ithebula 3 liklelisa ama-athikili angafakwanga ekuhlolweni kokugcina yi-GDC kanye nezizathu zokungafakwa kwawo. Ukungabikho kokuphuphuthekisa kwesihloko kanye nodokotela kanye nezincazelo ezingagculisi zokungenelela kwakuvame ukubonwa imikhawulo yendlela yokuhlola okulawulwayo. Izinhlobo zekhanda ezihlolwe kulezi zilingo zihlanganisa i-migraine (Ithebula 4), uhlobo lwekhanda lokucindezeleka (Ithebula 5), ​​kanye nekhanda le-cervicogenic (Ithebula 6). Ngenxa yalokho, lezi zinhlobo zekhanda kuphela zimelelwa ubufakazi kanye nezincomo zokuzijwayeza kule CPG. Izifinyezo zobufakazi zama-SRs zinikezwe kuThebula 7.

 

Izincomo Zokuzilolonga: Ukwelashwa Kwe-Migraine

 

  • Ukuxhashazwa komgogodla kunconywa ukuphathwa kweziguli ezine-episodic noma i-migraine engapheli ene-aura noma ngaphandle kwayo. Lesi sincomo sisekelwe ezifundweni ezisebenzise imvamisa yokwelashwa 1 izikhathi ezi-2 ngesonto amaviki angu-8 (izinga lobufakazi, elilinganiselwe). I-RCT eyodwa yekhwalithi ephezulu, i-20 yekhwalithi ephansi ye-RCT, [1] kanye ne-17 yekhwalithi ephezulu ye-SR[1] isekela ukusetshenziswa kokuxhaphaza umgogodla ezigulini ezine-episodic noma i-migraine engapheli (Amathebula 24 ne-4).
  • Ukwelashwa kokubhucungwa kwamasonto onke kunconywa ukuze kuncishiswe imvamisa ye-episodic migraine kanye nokwenza ngcono izimpawu ezithintayo ezingase zihlotshaniswe nobuhlungu bekhanda (izinga lobufakazi, elimaphakathi). I-RCT eyodwa yekhwalithi ephezulu isekela lesi sincomo somkhuba (Ithebula 16). Abacwaningi basebenzisa i-massage yemizuzu engu-4 ngokugxila kuhlaka lwe-neuromuscular kanye ne-trigger yangemuva, ihlombe, intamo, nekhanda.
  • Ukunakekelwa kwe-Multimodal multidisciplinary (ukuvivinya umzimba, ukuphumula, ukucindezeleka kanye nokwelulekwa okunomsoco, ukwelapha nge-massage) kunconywa ukuphathwa kweziguli ezine-episodic noma i-migraine engapheli. Bheka njengokufanelekile (izinga lobufakazi, elimaphakathi). I-RCT eyodwa yekhwalithi ephezulu isekela ukuphumelela kokungenelela kwe-multi-modal multidisciplinary for migraine (Ithebula 32). Ukungenelela kubeka phambili indlela yokuphatha ejwayelekile ehlanganisa ukuzivocavoca, imfundo, ukuguqula indlela yokuphila, kanye nokuzilawula.
  • Kukhona idatha eyanele yomtholampilo yokuncoma noma ngokumelene nokusetshenziswa kokuzivocavoca yedwa noma ukuvivinya umzimba okuhlangene nemithi yokwelapha ye-multimodal yokuphatha iziguli ezine-episodic noma i-migraine engapheli (ukuzivocavoca kwe-aerobic, ububanzi bokunyakaza komlomo wesibeletho [cROM], noma ukwelula umzimba wonke). Ama-CCT amathathu ekhwalithi ephansi[13,33,34] afaka isandla kulesi siphetho (Ithebula 4).

 

Izincomo Zokuzijwayeza: I-Tension-Type Headache

 

  • Ukuhlanganisa i-craniocervical yomthwalo ophansi (isb., I-Thera-Band, I-Resistive Exercise Systems; I-Hygenic Corporation, i-Akron, i-OH) inconywa isikhathi eside (isb., izinyanga ezingu-6) ukuphathwa kweziguli ezinezinhlungu zekhanda ezingavamile noma ezingapheli (izinga lobufakazi, maphakathi). I-RCT eyodwa yekhwalithi ephezulu ibonise ukuthi ukuhlanganisa umthwalo ophansi kunciphisa kakhulu izimpawu zekhanda elibuhlungu ezigulini phakathi nesikhathi eside (Ithebula 36).
  • Ukuxhashazwa komgogodla akukwazi ukunconywa ekuphathweni kweziguli ezinekhanda le-episodic tension-type (izinga lobufakazi, elilinganiselwe). Kunobufakazi bezinga elilinganiselwe bokuthi ukuxhashazwa komgogodla ngemva kokwelashwa kwezicubu ezithambile kuqala akuhlinzeki ngenzuzo eyengeziwe ezigulini ezinezinhlungu zekhanda ezicindezelayo. I-RCT eyodwa yekhwalithi ephezulu [12] (Ithebula 5) nokubonwa okubikwe kuma-4 SRs [24-27] (Ithebula 7) asikisela ukuthi akukho nzuzo yokuxhaphaza umgogodla ezigulini ezinezinhlungu zekhanda le-episodic tension-type.
  • Isincomo asikwazi ukwenziwa noma ngokumelene nokusetshenziswa kokuguqulwa komgogodla (izikhathi ze-2 ngesonto amaviki e-6) ezigulini ezinekhanda elibuhlungu elingapheli. Ababhali be-1 RCT[11] balinganiswe njengekhwalithi ephezulu ngethuluzi lokuhlola ikhwalithi [6] (Ithebula 1), kanye nezifinyezo zalolu cwaningo ku-2 SRs [24,26] ziphakamisa ukuthi ukuxhaphazwa komgogodla kungase kuphumelele ekhanda elibuhlungu elingapheli. . Kodwa-ke, i-GDC ibheka i-RCT[11] enzima ukuyihumusha futhi ingahlangani (Ithebula 5). Ukuhlolwa akulawulwa ngendlela efanele ngokungalingani kwenani lokuhlangana kodokotela phakathi kwamaqembu ocwaningo (isb, ukuvakashelwa kwe-12 kwezifundo ekwelapheni kwezicubu ezithambile kanye neqembu lokuxhaphaza umgogodla vs ukuvakashelwa kwe-2 kwezifundo eqenjini le-amitriptyline). Ayikho indlela yokwazi ukuthi izinga eliqhathanisekayo lokunaka komuntu siqu ezifundweni eziseqenjini le-amitriptyline kungenzeka libe nomthelela emiphumeleni yocwaningo. Lokhu kucatshangelwa nokuhumusha okuvela kwamanye ama-SRs angu-2[25,27]kunikela kulesi siphetho (Ithebula 7).
  • Abukho ubufakazi obanele bokuncoma noma obumelene nokusetshenziswa kokudonsa ngesandla, ukuxhashazwa kwezicubu ezixhumeneyo, ukuhlanganisa kukaCyriax, noma ukuvivinya umzimba/ ukuqeqeshwa ngokomzimba ezigulini ezinekhanda elibuhlungu le-episodic noma elingapheli. Izifundo ezintathu ezingaqinisekisiwe zekhwalithi ephansi [19,31,35] (Ithebula 5), ​​i-RCT engalungile yekhwalithi ephansi engu-1, [14] kanye ne-1 SR[25] zifaka isandla kulesi siphetho (Ithebula 7).

 

Izincomo Zokuzilolonga: I-Cervicogenic Headache

 

  • Ukuxhaphaza umgogodla kunconywa ukuphathwa kweziguli ezinekhanda le-cervicogenic. Lesi sincomo sisekelwe ocwaningweni olu-1 olusebenzisa imvamisa yokwelashwa izikhathi ezi-2 ngesonto amaviki e-3 (izinga lobufakazi, elilinganiselwe). Ku-RCT yekhwalithi ephezulu, u-Nilsson et al [18] (Ithebula 6) ubonise umphumela omuhle kakhulu we-high-velocity, low-amplitude ukuguqulwa komgogodla weziguli ezinekhanda le-cervicogenic. Ukuhlanganiswa kobufakazi obuvela ku-2 SRs[24,29] (Ithebula 7) isekela lesi sincomo somkhuba.
  • Ukuhlanganisa ngokuhlanganyela kunconywa ukuphathwa kweziguli ezinekhanda le-cervicogenic (izinga lobufakazi, elilinganiselwe). U-Jull et al [15] uhlole imiphumela ye-Maitland yokuhlanganisa ngokuhlanganyela i-8 kuya ku-12 yokwelapha amaviki e-6 ku-RCT yekhwalithi ephezulu (Ithebula 6). Ukugqugquzela kulandele umkhuba womtholampilo ojwayelekile, lapho ukukhethwa kwamasu wejubane eliphansi kanye nesivinini esiphezulu kwakusekelwe ekuhloleni kokuqala nokuqhubekayo kokungasebenzi kahle kwamalungu omlomo wesibeletho weziguli. Imiphumela ezuzisayo yabikwa ngokuvama kwekhanda, ukuqina, kanye nobuhlungu bentamo nokukhubazeka. Ukuhlanganiswa kobufakazi obuvela ku-2 SRs[24,29] (Ithebula 7) isekela lesi sincomo somkhuba.
  • Ukuzivocavoca kwe-deep neck flexor kunconywa ukuphathwa kweziguli ezinekhanda le-cervicogenic (izinga lobufakazi, elilinganiselwe). Lesi sincomo sisekelwe ocwaningweni lwezikhathi ezi-2 nsuku zonke amaviki ayi-6. Ayikho inzuzo eyengeziwe eqhubekayo yokuhlanganisa ukuzivocavoca kwe-neck flexor kanye nokuhlanganisa okuhlangene kwekhanda le-cervicogenic. I-RCT eyodwa yekhwalithi ephezulu [15] (Ithebula 6) nokubonwa okunikezwa kuma-SRs angu-2[24,29] (Ithebula 7) kusekela lesi sincomo somkhuba.

 

Ukuphepha

 

Odokotela bakhetha izindlela zokwelapha ngokuhambisana nalo lonke ulwazi olutholakalayo lwezokwelapha lwesiguli esithile. Kuma-CCT/RCTS angu-16 [11-20,31-36] afakwe endikimbeni yobufakazi bale CPG, izifundo ze-6 kuphela [11,12,15,20,32,36] ezihlolwe ngokwanele noma ezixoxwe ngemiphumela emibi yesiguli noma ukuphepha. amapharamitha (Ithebula 1, ikholomu M). Sekukonke, izingozi ezibikiwe beziphansi. Izilingo ezintathu zibike ulwazi lokuphepha lokuxhaphaza umgogodla [11,12,20] u-Boline et al [11] ubike ukuthi i-4.3% yezifundo zabhekana nokuqina kwentamo ngemva kokuxhaphazwa kokuqala komgogodla okwanyamalala kuwo wonke amacala ngemva kwamaviki okuqala e-2 okwelashwa. Ubuhlungu noma ukwanda kwekhanda elibuhlungu ngemva kokuxhashazwa komgogodla (n = 2) kwakuyizizathu zokuyeka ukwelashwa ezishiwo nguTuchin et al.[20] Ayikho imiphumela engemihle etholwe yinoma yiziphi izifundo ezifundwe ngu-Bove et al[12] esebenzisa ukuguqulwa komgogodla ekwelapheni ikhanda lohlobo lwe-episodic tension-type. Izivivinyo zokwelashwa zokuhlola imiphumela yokusebenza ngempumelelo zingase zingabhalisi izinombolo ezanele zezifundo ukuze kuhlolwe izehlakalo ezimbi ezingavamile. Ezinye izindlela zocwaningo ziyadingeka ukuze �uthuthukise ukuqonda okuphelele kwebhalansi phakathi kwezinzuzo nobungozi.

 

Ingxoxo

 

Ukuxhashazwa komgogodla kanye nezinye izindlela zokwelapha ezisetshenziswa ngesandla ezivame ukusetshenziswa ku-chiropractic ziye zafundwa kuma-CCT amaningana ahluke kakhulu ekubhaliseni izifundo, ukuklama, kanye nekhwalithi jikelele. Iziguli kanye nezinhlobo zekhanda ezimelelwe ngokuhlelekile kusisekelo sobufakazi yi-migraine, uhlobo lwekhanda lokucindezeleka, kanye nekhanda le-cervicogenic. Imiphumela yesimo sezempilo eyinhloko ebikiwe ngokuvamile imvamisa yekhanda elibuhlungu, ukuqina, ubude besikhathi, kanye nezilinganiso zekhwalithi yokuphila. Ubufakazi abukho ngaphezu kwezinga elilinganiselwe ngalesi sikhathi.

 

Ubufakazi busekela ukusetshenziswa komgogodla wokuphathwa kwe-chiropractic yeziguli ezine-migraine noma i-cervicogenic headaches kodwa hhayi uhlobo lwekhanda lokucindezeleka. Nge-migraine, ukunakekelwa kwe-multidisciplinary kusetshenziswa i-massage ye-massage yemizuzu engu-45 kanye nokunakekelwa kwe-multimodal (ukuvivinya umzimba, ukuphumula, nokucindezeleka kanye nokwelulekwa okunomsoco) kungase kusebenze. Ngaphandle kwalokho, ukuhlanganisa ngokuhlanganyela noma ukuzivocavoca kwe-deep neck flexor kunconywa ukuthuthukisa izimpawu zekhanda le-cervicogenic. Kubonakala sengathi ayikho inzuzo eyengeziwe eqhubekayo yokuhlanganisa ukuhlanganisa okuhlangene kanye nokuzivocavoca kwentamo ejulile ye-flexor yeziguli ezinekhanda le-cervicogenic. Ubufakazi obulingene busekela ukusetshenziswa komthwalo ophansi wokuhlanganisa i-craniocervical ukuphathwa kwesikhathi eside kwekhanda lohlobo lokucindezeleka.

 

Ukulinganiselwa

 

Ukushiyeka kwalo mhlahlandlela kufaka phakathi inani nekhwalithi yobufakazi obusekelayo obutholakala ngesikhathi sokusesha. Azikho izifundo zokucwaninga ezisezingeni eliphakeme ezilawulwa ngokwanele zakamuva ezinemiphumela yomtholampilo ephindaphindekayo eshicilelwe ukunakekelwa kwe-chiropractic yeziguli zekhanda. Izifundo ziyadingeka ukuze siqhubekisele phambili ukuqonda kwethu kwemithi yokwelapha ethize yezandla ngokuzihlukanisa noma ngezinhlanganisela ezilawulwa kahle zokwelashwa kwe-migraine, uhlobo lwekhanda elicindezelayo, ikhanda elibuhlungu le-cervicogenic, noma ezinye izinhlobo zekhanda ezethula kubahlengikazi (isb, iqoqo, ubuhlungu bekhanda obungemuva kwenhlekelele) . Okunye ukushiyeka kwalokhu kuhlanganiswa kwezincwadi ukuthembela ezifundweni zocwaningo ezishicilelwe ezinosayizi abancane besampula (Amathebula 4-6), ama-paradigms okwelapha esikhashana, kanye nezikhathi zokulandelela. Izilingo zomtholampilo eziklanywe kahle ezinezibalo ezanele zezifundo, ukwelashwa kwesikhathi eside, nezikhathi zokulandelela kudingeka zixhaswe ngemali ukuze kuthuthukiswe ukunakekelwa kwe-chiropractic, kanye nokuxhaphaza umgogodla ikakhulukazi, ekulawuleni iziguli ezinezinkinga zekhanda. Njenganoma yikuphi ukubuyekezwa kwezincwadi kanye nesiqondiso somtholampilo, ulwazi oluyisisekelo nezincwadi ezishicilelwe ziyavela. Ucwaningo okungenzeka lwazise lo msebenzi kungenzeka lushicilelwe ngemva kokuphela kwalolu cwaningo.[37-39]

 

Okucatshangelwayo Kocwaningo Lwesikhathi esizayo

 

Ukuvumelana kwe-GDC ukuthi kunesidingo sokuqhubeka nezifundo ze-chiropractic neziguli ezinezinkinga zekhanda.

 

  • Kudingeka ucwaningo lwezempilo olusezingeni eliphezulu. Ucwaningo lwesikhathi esizayo ludinga imiklamo yocwaningo esebenzisa iziqhathanisi ezisebenzayo kanye nokungelashwa kanye/noma amaqembu e-placebo ukuze kuthuthukiswe isisekelo sobufakazi bokunakekelwa kwesiguli. Ukuphuphuthekisa isiguli ekungeneleleni ngokomzimba ukuze kulawuleke imiphumela yokulindela kuyadingeka futhi kuye kwahlolisiswa abacwaningi be-chiropractic kwezinye izimo zobuhlungu.[10] Ukuntuleka kwezifundo ezibikwe ngokuhlelekile kuveza inselele esebenzayo yokukhiqiza izincomo zokwelapha ezisekelwe ebufakazini. Zonke izifundo zesikhathi esizayo kufanele zihlelwe kusetshenziswa izindlela eziqinisekisiwe ezihlelekile (isb, Amazinga Ahlanganisiwe Wezilingo Zokubika [CONSORT] kanye Nokubikwa Okungafihli Kokuhlola Ngemiklamo Engahleliwe [TREND]).
  • Ukubika okuhlelekile kwedatha yokuphepha kuyadingeka ocwaningweni lwe-chiropractic. Zonke izivivinyo zomtholampilo kumele ziqoqe futhi zibike ngemiphumela engemihle engase ibe khona noma ukulimala ngisho noma kungekho okubonayo.
  • Thuthukisa amathuluzi anoveli obuningi bokuhlola ucwaningo lokwelapha ngezandla. Ukungaboni kusebenzela ukulawula imiphumela elindelekile kanye nemithelela engacacisiwe yokusebenzisana komhlinzeki wesifundo kuwo wonke amaqembu ocwaningo. Ngokuvamile akwenzeki ukuphuphuthekisa izihloko nabahlinzeki ezifundweni ezisebenzayo zezindlela zokwelapha ezenziwa mathupha. Naphezu kwemikhawulo engokwemvelo, kokubili ukuphuphuthekiswa kwezifundo nabahlinzeki bokunakekelwa kukalwe ezihlokweni zocwaningo yi-GDC, njengoba lezi zinto zifakwe kumathuluzi wokulinganisa wekhwalithi ephezulu.[6] Amathuluzi okucwaninga athuthukile okuhlaziya kanye nokulinganisa okulandelayo kwezincwadi zokwelashwa ngezandla adingeka ngokushesha.
  • Ukuqhubekisela phambili ucwaningo ngemiphumela esebenzayo ekunakekelweni kwe-chiropractic yekhanda elibuhlungu. Lesi siqondiso siveze ukuthi izifundo zekhanda zisebenzisa ububanzi obuhlukahlukene bezinyathelo ekuhloleni umphumela wokwelashwa emiphumeleni yezempilo. Imvamisa yekhanda elibuhlungu, ukuqina, kanye nobude yimiphumela esetshenziswa njalo (Amathebula 4-6). Imizamo engathi sína iyadingeka ukuze kufakwe izinyathelo eziqinisekisiwe zomphumela ogxile esigulini ocwaningweni lwe-chiropractic oluhambisana nentuthuko yokuphila kwansuku zonke kanye nokuqala kabusha kwezinqubo ezinenjongo.
  • Ukusebenza kahle kwezindleko. Azikho izifundo zocwaningo ezatholwa ngokusebenza kahle kwezindleko zokuxhaphaza umgogodla wokwelapha izinkinga zekhanda. Izivivinyo zomtholampilo zesikhathi esizayo zokuxhaphaza umgogodla kufanele zihlole ukusebenza kahle kwezindleko.

 

Ezinye izindlela zocwaningo ziyadingeka ukuthuthukisa ukuqonda okuphelele kwebhalansi phakathi kwezinzuzo nobungozi. Le CPG ayinikezi ukubuyekezwa kwakho konke ukwelashwa kwe-chiropractic. Noma yikuphi ukushiywa kubonisa izikhala ezincwadini zomtholampilo. Uhlobo, imvamisa, umthamo, nobude besikhathi sokwelashwa kufanele kusekelwe ezincomweni zesiqondiso, ulwazi lomtholampilo, nolwazi lwesiguli kuze kube yilapho kutholakala amazinga aphezulu obufakazi.

 

iziphetho

 

Kukhona isisekelo sobufakazi bokusekela ukunakekelwa kwe-chiropractic, kuhlanganise nokuxhaphaza umgogodla, ekulawuleni i-migraine kanye nekhanda lekhanda le-cervicogenic. Uhlobo, imvamisa, umthamo, nobude besikhathi sokwelashwa kufanele kusekelwe ezincomweni zomhlahlandlela, ulwazi lomtholampilo, nolwazi lwesiguli. Ubufakazi bokusetshenziswa kokuguqulwa komgogodla njengendlela yokungenelela eyedwa ezigulini ezinekhanda lohlobo lwe-tension zihlala zilingana. Kudingeka ucwaningo olwengeziwe.
Iziqondiso zokuzilolonga zixhumanisa ubufakazi obutholakalayo obungcono kakhulu ekusebenzeni okuhle komtholampilo futhi ziyingxenye ye-1 kuphela yendlela enolwazi lobufakazi yokuhlinzeka ngokunakekelwa okuhle. Lesi siqondiso sihloswe ukuba sibe yinsiza yokulethwa kokunakekelwa kwe-chiropractic ezigulini ezinekhanda elibuhlungu. �Iyidokhumenti ephilayo� futhi ingaphansi kokubuyekezwa lapho kuvela idatha entsha. Ngaphezu kwalokho, akuthathi indawo yesipiliyoni sikadokotela wezempilo kanye nobuchule. Lo mbhalo awuhloselwe ukusebenza njengezinga lokunakekelwa. Kunalokho, umhlahlandlela ufakazela ukuzibophezela komsebenzi wobungcweti ekuqhubekiseleni phambili inkambiso esekelwe ebufakazini ngokuzibandakanya ngokushintshisana ngolwazi kanye nenqubo yokudlulisa ukuze kusekelwe ukuhamba kolwazi locwaningo ukuze kwenziwe.

 

Izicelo Ezisebenzayo

 

  • Lesi siqondiso siyinsiza yokulethwa kokunakekelwa kwe-chiropractic ezigulini ezinekhanda elibuhlungu.
  • Ukuxhaphaza umgogodla kunconywa ukuphathwa kweziguli ezine-migraine noma i-cervicogenic headaches.
  • Ukungenelela kwe-Multimodal multidisciplinary kuhlanganise ne-massage kungase kuzuze iziguli ezine-migraine.
  • Ukuhlanganisa ngokuhlanganyela noma ukuzivocavoca kwe-deep neck flexor kungase kuthuthukise izimpawu zekhanda le-cervicogenic.
  • Ukuhlanganisa i-craniocervical enomthwalo ophansi kungase kuthuthukise uhlobo lwekhanda lokucindezeleka.

 

Ukubonga

 

Ababhali babonga abalandelayo ngokufaka kulo mhlahlandlela: Ron Brady, DC; Greyden Bridge, DC; H James Duncan; Wanda Lee MacPhee, DC; Keith Thomson, DC, ND; UDean Wright, DC; kanye no-Peter Waite (Amalungu e-Clinical Practice Guidelines Task Force). Ababhali babonga abalandelayo ngosizo lokuhlolwa kokuseshwa kwezincwadi kweSigaba I: Simon Dagenais, DC, PhD; kanye noThor Eglinton, MSc, RN. Ababhali babonga lokhu okulandelayo ngosizo mayelana nokuseshwa kwezincwadi okwengeziwe kweSigaba II kanye nesilinganiso sobufakazi: Seema Bhatt, PhD; UMary-Doug Wright, MLS. Ababhali babonga u-Karin Sorra, PhD ngosizo ngosesho lwezincwadi, isilinganiso sobufakazi, nokusekelwa kokuhlela.

 

Imithombo yoxhaso kanye Nokungqubuzana Kwezintshisekelo okungenzeka

 

Uxhaso lunikezwe yi-CCA, i-Canadian Chiropractic Protective Association, kanye neminikelo ye-chiropractic yesifundazwe evela kuzo zonke izifundazwe ngaphandle kweBritish Columbia. Lo msebenzi ubuxhaswe yi-CCA kanye neFederation. Akukho ukungqubuzana kwezintshisekelo okubikiwe kulolu cwaningo.

 

Ekuphetheni, ikhanda elibuhlungu ngesinye sezizathu ezivame kakhulu ukuthi abantu bafune usizo lwezokwelapha. Nakuba ochwepheshe abaningi bezempilo bengakwazi ukuphatha ubuhlungu bekhanda, ukunakekelwa kwe-chiropractic kuyindlela eyaziwayo yokwelapha ehlukile evame ukusetshenziselwa ukwelapha izinkinga zezempilo ezihlukahlukene, kuhlanganise nezinhlobo eziningana zekhanda elibuhlungu. Ngokusho kwalesi sihloko esingenhla, ubufakazi bubonisa ukuthi ukunakekelwa kwe-chiropractic, okuhlanganisa ukulungiswa komgogodla kanye nokuphathwa ngesandla, kungathuthukisa ikhanda kanye ne-migraine. Ulwazi olubalulwe ku-National Center for Biotechnology Information (NCBI). Ububanzi bolwazi lwethu bukhawulelwe ku-chiropractic kanye nokulimala komgogodla nezimo. Ukuze uxoxe ngesihloko, sicela ukhululeke ukubuza uDkt. Jimenez noma usithinte ku 915-850-0900 .

 

Ikhethwe nguDkt Alex Jimenez

 

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

 

Izihloko Ezengeziwe: Ubuhlungu Emuva

 

Ngokwezibalo, cishe i-80% yabantu izothola izimpawu zobuhlungu beqolo okungenani kanye kukho konke ukuphila kwabo. Ukuhlungu obusemhlane isikhalazo esivamile esingaba umphumela ngenxa yokulimala okuhlukahlukene kanye/noma izimo. Izikhathi eziningi, ukuwohloka kwemvelo komgogodla ngeminyaka kungabangela ubuhlungu emuva. Ama-discs we-Herniated kwenzeka lapho isikhungo esithambile, esifana nejeli se-intervertebral disc siphusha izinyembezi endaweni ezungezile, indandatho yangaphandle ye-cartilage, ukucindezela nokucasula izimpande zemizwa. Ama-Disc herniations avame ukwenzeka emhlane ophansi, noma i-lumbar spine, kodwa kungenzeka futhi eduze nomgogodla womlomo wesibeletho, noma intamo. Ukufakwa kwezinzwa ezitholakala emhlane ophansi ngenxa yokulimala kanye/noma isimo esishubile kungaholela ezimpawini ze-sciatica.

 

isithombe sebhulogi kakhathuni paperboy izindaba ezinkulu

 

ISIHLOKO ESIBALULEKILE ESENGEZIWE:�I-Neck Pain Treatment El Paso, TX Chiropractor

 

 

IZIHLOKO EZININGI: ENGEZIWE NGENXA: El Paso, Tx | Abasubathi

 

Akukho lutho
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Vala i-Accordion
I-Migraine Headache Pain I-Chiropractic Therapy e-El Paso, TX

I-Migraine Headache Pain I-Chiropractic Therapy e-El Paso, TX

by | I-Chiropractic, Isivivinyo Esilawulwa Ngokungahleliwe

Ubuhlungu bekhanda be-Migraine bubhekwa njengenye yezifo ezikhungathekisa kakhulu uma kuqhathaniswa nezinye izinkinga zezempilo ezivamile. Ngokuvamile okubangelwa ukucindezeleka, izimpawu ze-migraines, kuhlanganise nobuhlungu bekhanda obuqeda amandla, ukuzwela ukukhanya nomsindo kanye nesicanucanu, kungaba nomthelela omkhulu empilweni ye-migraineur. Kodwa-ke, ucwaningo luye lwathola ukuthi ukunakekelwa kwe-chiropractic kungasiza ekunciphiseni imvamisa kanye nobukhulu bobuhlungu bakho be-migraine. Ochwepheshe abaningi bezokunakekelwa kwempilo baye babonisa ukuthi ukungahambi kahle komgogodla, noma ukuguqulwa kwe-subluxation, kungase kube umthombo wobuhlungu bekhanda le-migraine. Inhloso yalesi sihloko esingezansi ukukhombisa izinyathelo zomphumela we-chiropractic spinal manipulative therapy for migraine.

 

I-Chiropractic Spinal Manipulative Therapy for Migraine: Three?Armed, Single?Blinded, Placebo, Randomized Controlled Trial

 

abstract

 

  • Ingemuva nenjongo: Ukuphenya ukusebenza kwe-chiropractic spinal manipulative therapy (CSMT) ye-migraineurs.
  • Izindlela: Lokhu kwakuyisivivinyo esingahle sibe abathathu? abahlomile, abangashadile, abangaboni kahle, be-placebo, abalawulwa ngokungahleliwe (RCT) bezinyanga ze-17 ubude okufaka phakathi i-104 migraineurs enokuhlasela okungenani okukodwa kwe-migraine ngenyanga. I-RCT yenziwa esibhedlela sase-Akershus University, e-Oslo, eNorway. Ukwelashwa okusebenzayo kwakuhlanganisa i-CSMT, kuyilapho i-placebo yayiwukusulwa komgunyathi konqenqema olungemuva lwe-scapula kanye/noma isifunda se-gluteal. Iqembu elilawulayo laqhubeka nokuphathwa kwemithi evamile. I-RCT yayinezinyanga ezi-1 ezigijimayo, ukungenelela kwezinyanga ezi-3 kanye nezinyathelo zomphumela ekupheleni kokungenelela kanye nokulandelelwa kwezinyanga ezi-3, 6 neziyi-12. Iphuzu lokugcina eliyinhloko laliyinani lezinsuku ze-migraine ngenyanga, kanti amaphuzu okuphela kwesibili kwakuwubude be-migraine, ukuqina kwe-migraine kanye nenkomba yekhanda, kanye nokusetshenziswa kwemithi.
  • Ezenye: Izinsuku ze-Migraine zehliswe kakhulu phakathi kwawo womathathu la maqembu kusukela kwesisekelo kuya kokwelashwa? (P <0.001). Umphumela uqhubekile ku-CSMT kanye neqembu le-placebo kuwo wonke amaphuzu esikhathi sokulandelela, kuyilapho iqembu lokulawula libuyele kusisekelo. Ukwehliswa kwezinsuku ze-migraine akuzange kuhluke kakhulu phakathi kwamaqembu (P> 0.025 yokuxhumana). Ubude be-Migraine kanye nenkomba yekhanda lekhanda liye lancishiswa kakhulu ku-CSMT kuneqembu lokulawula ngasekupheleni kokulandelela (P = 0.02 kanye ne-P = 0.04 yokuxhumana, ngokulandelana). Izehlakalo ezimbi zazimbalwa, zithambile futhi zedlula. Ukungaboni kwasekelwa ngokuqinile kuyo yonke i-RCT.
  • Iziphetho: Kuyenzeka ukwenza i-RCT yokwelapha esebenzisa i-placebo efihliwe. Umphumela we-CSMT obonwe ocwaningweni lwethu mhlawumbe kungenxa yempendulo ye-placebo.
  • Amagama angukhiye: i-chiropractic, ikhanda elibuhlungu, i-migraine, isilingo esilawulwa ngokungahleliwe, ukwelapha okukhohlisayo komgogodla

 

UDkt-Jimenez_White-Coat_01.png

Ukuqonda kukaDkt Alex Jimenez

Ubuhlungu bentamo nekhanda kuyisizathu sesithathu esivame kakhulu abantu abafuna ukunakekelwa kwe-chiropractic. Ucwaningo oluningi luye lwabonisa ukuthi i-chiropractic spinal manipulative therapy iyindlela ephephile futhi ephumelelayo yokwelashwa kwe-migraines. Ukunakekelwa kwe-Chiropractic kungalungisa ngokucophelela noma yikuphi ukungahambi kahle komgogodla, noma i-subluxation, etholakala ngobude bomgogodla, oye waboniswa njengomthombo wekhanda elibuhlungu le-migraine. Ukwengeza, ukulungiswa komgogodla kanye nokuxhaphaza ngesandla kungasiza ekunciphiseni ukucindezeleka nokucindezeleka kwemisipha ngokunciphisa inani lokucindezela elibekwe ngokumelene nezakhiwo eziyinkimbinkimbi zomgogodla ngenxa yokungahambi kahle komgogodla, noma ukuxutshwa. Ngokulungisa kabusha umgogodla kanye nokunciphisa ukucindezeleka nokucindezeleka kwemisipha, ukunakekelwa kwe-chiropractic kungathuthukisa izimpawu ze-migraine futhi kunciphise imvamisa yazo.

 

Isingeniso

 

Izindleko zenhlalo? yezomnotho ye-migraine zinkulu kakhulu ngenxa yokusabalala kwayo okuphezulu nokukhubazeka ngesikhathi sokuhlaselwa [1, 2, 3]. Ukwelashwa kwe-acute pharmacological ngokuvamile kuyindlela yokwelapha yokuqala ye-migraine kubantu abadala. I-Migraineurs enokuhlaselwa njalo, umphumela onganele kanye/noma ukuphikisana nemithi eyingozi yilabo abangase bakwazi ukuthola ukwelashwa kwe-prophylactic. Ukwelashwa kwe-Migraine prophylactic kuvame ukuba yi-pharmacological, kodwa ukwelapha okwenziwa ngesandla akuyona into engavamile, ikakhulukazi uma ukwelashwa kwemithi kwehluleka noma uma isiguli sifisa ukugwema imithi [4]. Ucwaningo luye lwaphakamisa ukuthi ukwelapha okuguquguqukayo komgogodla kungase kukhuthaze izinhlelo ze-neural inhibitory emazingeni ahlukene omgogodla ngoba kungase kusebenze izindlela ezihlukahlukene ezivimbela ukwehla ezimaphakathi [5, 6, 7, 8, 9, 10].

 

I-Pharmacological randomized controlled trials (RCTs) ivamise ukuphuphuthekiswa kabili, kodwa lokhu akwenzeki kuma-RCT okwelapha okwenziwa mathupha, njengoba umelaphi ongenele engeke aphuphuthekiswe. Okwamanje akukho ukuvumelana ngenqubo yomgunyathi kuma-RCT okwelapha okwenziwa ngesandla alingisa i-placebo kuma-RCT ekhemisi [11]. Ukuntuleka kwenqubo efanele ye-sham kuwumkhawulo omkhulu kuwo wonke ama-RCTs okwelapha angaphambilini [12, 13]. Muva nje, senze inqubo ye-sham chiropractic spinal manipulative therapy (CSMT) inqubo, lapho abahlanganyeli abane-migraine bengakwazi ukuhlukanisa phakathi kwe-CSMT yangempela kanye ne-sham ehlolwe ngemva kokungenelela komuntu ngamunye kwe-12 esikhathini esiyinyanga ye-3 [14].

 

Inhloso yokuqala yalolu cwaningo kwakuwukwenza i-RCT ye-placebo ye-placebo ye-placebo ene-methodological standard efana ne-RCT yemithi.

 

Inhloso yesibili kwakuwukuhlola ukusebenza kahle kwe-CSMT ngokumelene nokukhohlisa komgunyathi (i-placebo) kanye ne-CSMT ngokumelene nokulawula, okungukuthi ababambiqhaza abaqhubekile nokuphatha kwabo okujwayelekile kwezemithi.

 

izindlela

 

I-Study Design

 

Ucwaningo bekuyi-RCT emithathu?ehlomile, eyodwa?impumputhe, ye-placebo phakathi nezinyanga eziyi-17. I-RCT yayinesisekelo sokuqala senyanga engu-1, izikhathi zokwelashwa eziyi-12 ezinyangeni ezingu-3 ezinezinyathelo zokulandelela ekupheleni kokungenelela, 3, 6 kanye nezinyanga ezingu-12 kamuva.

 

Ababambiqhaza, ngaphambi kwesisekelo sokuqala, bahlelwe ngokungahleliwe ngokulinganayo emaqenjini amathathu: i-CSMT, i-placebo (ukukhwabanisa kwe-sham) nokulawula (baqhubeka nokuphathwa kwabo okujwayelekile kwemithi).

 

Ukuklanywa kocwaningo kuhambisane nezincomo ze-International Headache Society (IHS) kanye ne-CONSORT (Isithasiselo S1) [1, 15, 16]. IKomidi Lesifunda LaseNorway leZimilo Zokucwaninga Ngezokwelapha kanye Nezinsizakalo Zedatha Yesayensi Yezenhlalakahle YaseNorway zigunyaze iphrojekthi. I-RCT ibhaliswe ku-ClinicalTrials.gov (inombolo ye-ID: NCT01741714). Iphrothokholi yesilingo esigcwele ishicilelwe ngaphambilini [17].

 

Abahlanganyeli

 

Abahlanganyeli baqashwe kusukela ngoJanuwari kuya kuSepthemba 2013 ikakhulukazi ngoMnyango Wezezinzwa, Isibhedlela sase-Akershus University. Abanye ababambiqhaza baphinde baqashwa ngabaSebenzi Jikelele base-Akershus nase-Oslo Counties noma ukukhangisa kwabezindaba. Bonke ababambiqhaza bathole imininingwane ethunyelwe mayelana nephrojekthi elandelwa yingxoxo yocingo.

 

Abahlanganyeli abafanelekayo kwakungama-migraineurs aneminyaka engu-18�70 ubudala anokuhlaselwa okungenani okukodwa kwe-migraine ngenyanga futhi babevunyelwe ukuba babe nekhanda elibuhlungu elihambisana nokucindezeleka? kodwa kungabikho elinye ikhanda eliyinhloko. Bonke abahlanganyeli baxilongwa yi-chiropractor enolwazi ekuxilongeni ikhanda ngesikhathi sokuxoxisana futhi ngokusho kwe-International Classification of Headache Disorders?II (ICHD?II) 2. Isazi sezinzwa sithole wonke ama-migraineurs esibhedlela sase-Akershus University.

 

Izindlela zokukhishwa zaziphikisana nokwelashwa komgogodla, i-radiculopathy yomgogodla, ukukhulelwa, ukucindezeleka kanye ne-CSMT phakathi nezinyanga ze-12 ezedlule. Ababambiqhaza abathole ukwelapha okwenziwa ngesandla [18], bashintsha imithi yabo ye-prophylactic migraine noma abakhulelwa ngesikhathi se-RCT batshelwa ukuthi bazohoxiswa esifundweni ngaleso sikhathi futhi babhekwe njengokuyeka? Abahlanganyeli bavunyelwe ukuqhubeka futhi bashintshe imithi ye-migraine acute phakathi nesikhathi sokufunda.

 

Abahlanganyeli abafanelekile bamenyelwe kunhlolokhono nokuhlolwa ngokomzimba okuhlanganisa uphenyo olunzulu lwekholomu yomgogodla owenziwe yi-chiropractor (AC). Abahlanganyeli abahlelwe ngokungahleliwe ku-CSMT noma iqembu le-placebo babe nokuhlolwa okugcwele kwe-radiographic yomgogodla.

 

I-Randomization kanye neMasking

 

Ngemuva kokutholwa kwemvume ebhaliwe, ababambiqhaza bahlelwa ngokungahleliwe kwenye yezingalo ezintathu zocwaningo ngokudweba indawo eyodwa. Izinkatho ezinezinombolo ezivaliwe ngezingalo ezintathu zocwaningo ngayinye yahlukaniswa yaba amaqeqebana amane ngokobudala nobulili, okungukuthi iminyaka eyi-18�39 noma engu-40�70, kanye namadoda noma abesifazane.

 

Ngemva kweseshini ngayinye yokwelashwa, ababambiqhaza ku-CSMT kanye neqembu le-placebo bagcwalise uhlu lwemibuzo lokuthi bayakholelwa yini ukuthi ukwelashwa kwe-CSMT kwamukelwe, nokuthi babeqiniseka kangakanani ukuthi ukwelashwa okusebenzayo kwamukelwe esikalini sesilinganiso sezinombolo esingu-0�10, lapho i-10 imele ukuqiniseka okuphelele. [14].

 

Kokubili i-block randomization kanye nohlu lwemibuzo oluyimpumputhe beluphethwe ngokukhethekile yiqembu langaphandle elilodwa.

 

Ukungenelela

 

Iqembu le-CSMT lathola ukwelashwa okuguquguqukayo komgogodla lisebenzisa indlela ye-Gonstead, ukuthintana okuthile, isivinini esiphezulu, i-amplitude ephansi, umgogodla we-lever omfishane ongenayo iposi? ukuhlolwa kwe-chiropractic kuseshini ngayinye yokwelashwa [19].

 

Iqembu le-placebo lithole ukuguqulwa komgunyathi, ukuthintana okubanzi okungaqondile, ijubane eliphansi, i-low?amplitude sham push maneuver kumugqa oqondile ongahlosile nongelona? ]. Konke ukuthintana okungekona okokwelapha kwenziwa ngaphandle kwekholomu yomgogodla ngokuxega okwanele kwamalungu futhi ngaphandle kokuqina kwezicubu ezithambile ukuze kungabikho ukugoba ngokuhlanganyela. Izindlela ezihlukile zokukhohlisa zomgunyathi zase zisethiwe ngaphambili futhi zashintshaniswa ngokulinganayo phakathi kwabahlanganyeli be-placebo ngokomthetho olandelwayo phakathi nenkathi yokwelashwa yamaviki ayi-14 ukuze kuqiniswe ukufaneleka kocwaningo. Inqubo ye-placebo ichazwe ngokuningiliziwe kuphrothokholi yesilingo etholakalayo [12].

 

Iseshini ngayinye yokungenelela ithathe i-15 min futhi amaqembu womabili athole ukuhlolwa okufanayo kwesakhiwo nokunyakaza ngaphambi nangemva kokungenelela ngakunye. Akukho okunye ukungenelela noma iseluleko esinikezwe ababambiqhaza ngesikhathi sesivivinyo. Womabili amaqembu athole ukungenelela esibhedlela sase-Akershus University ngodokotela oyedwa onolwazi (AC).

 

Iqembu lokulawula laqhubeka nokuphathwa kwemithi evamile ngaphandle kokuthola ukungenelela okwenziwa ngumphenyi wezokwelapha.

 

imiPhumela

 

Abahlanganyeli bagcwalise idayari yekhanda lokuxilonga eqinisekisiwe kulo lonke ucwaningo futhi bayibuyisela njalo ngenyanga [20]. Endabeni yedayari engabuyiswanga noma idatha engekho, ababambiqhaza bathintwe ngocingo ukuze baqinisekise ukuthotshelwa komthetho.

 

Iphuzu lokugcina eliyinhloko kwakuyinani lezinsuku ze-migraine ngenyanga (izinsuku ezingu-30/inyanga). Okungenani i-25% yokunciphisa izinsuku ze-migraine kusukela ekuqaleni kuze kube sekupheleni kokungenelela, ngezinga elifanayo eligcinwe ku-3, i-6 kanye ne-12 ukulandelwa kwezinyanga ze-XNUMX kulindeleke eqenjini le-CSMT.

 

Amaphuzu okuphela kwesibili kwakuwubude be-migraine, amandla e-migraine kanye ne-headache index (HI), kanye nokusetshenziswa kwemithi. Okungenani ukuncipha okungama-25% kobude besikhathi, amandla kanye ne-HI, kanye nokuncishiswa okungenani okungama-50% kokusetshenziswa kwemithi bekulindeleke kusukela ekuqaleni kuze kube sekupheleni kokungenelela, ngezinga elifanayo ligcinwe ekulandeleni kwezinyanga ezingu-3, ​​6 neziyi-12 eqenjini le-CSMT.

 

Alukho ushintsho obelulindelwe endaweni yokuqala neyesibili ku-placebo naseqenjini lokulawula.

 

Usuku lwe-migraine lwachazwa njengosuku lapho i-migraine ene-aura, i-migraine ngaphandle kwe-aura noma i-migraine engenzeka. Ukuhlasela kwe-Migraine okuhlala isikhathi esingaba ngu->24 h kwabalwa njengokuhlasela okukodwa ngaphandle kwalapho izinhlungu? izikhawu zamahhala ezingamahora angu-48 zenzekile [21]. Uma isiguli silala ngesikhathi sokuhlaselwa kwe-migraine futhi sivuka ngaphandle kwe-migraine, ngokuhambisana ne-ICHD?III?, Isikhathi sokuhlasela sabhalwa njengokuphikelela kuze kufike isikhathi sokuvuka [22]. Ubuncane besikhathi sokuhlasela kwe-migraine bekuyi-4 h ngaphandle uma kusetshenziswe i-triptan noma umuthi oqukethe i-ergotamine, lapho singazange sichaze ubude besikhathi obuncane. I-HI ibalwa njengezinsuku ezivamile ze-migraine ngenyanga (izinsuku ezingu-30) � kusho ubude be-migraine (h / usuku) � ukuqina kwesilinganiso (0�10 isikali sokulinganisa izinombolo).

 

Amaphuzu okugcina ayisisekelo nesesibili akhethwe ngokusekelwe ku-Task Force ye-IHS Clinical Trial Subcommittee's Clinical Trial Subcommittee imihlahlandlela yokuhlolwa komtholampilo [1, 15]. Ngokusekelwe ekubuyekezweni kwangaphambilini nge-migraine, ukunciphisa kwe-25% kubhekwa njengesilinganiso esilondolozayo [12, 13].

 

Ukuhlaziywa kwemiphumela kubalwe phakathi nezinsuku ezingu-30 ngemva kweseshini yokugcina yokungenelela kanye nezinsuku ezingu-30 ngemva kwamaphuzu esikhathi sokulandelela, okungukuthi, izinyanga ezi-3, 6 neziyi-12, ngokulandelana.

 

Zonke izenzakalo ezimbi (AEs) zabhalwa ngemva kokungenelela ngakunye ngokuhambisana nezincomo ze-CONSORT kanye ne-IHS Task Force kuma-AEs ekuhlolweni kwe-migraine [16, 23].

 

Ukuhlaziywa kwesitatimende

 

Sisekelwe ukubala kwamandla ocwaningweni lwakamuva lwe-topiramate kuma-migraineurs [24]. Sicabange umehluko ojwayelekile ekunciphiseni inani lezinsuku ze-migraine ngenyanga phakathi kwe-asebenzayo kanye ne-placebo, naphakathi kwamaqembu asebenzayo kanye nokulawula kwezinsuku ze-2.5, ne-SD ye-2.5 yokunciphisa eqenjini ngalinye. Njengoba ukuhlaziya okuyinhloko kuhlanganisa ukuqhathanisa kweqembu okubili, izinga lokubaluleka lalibekwe ku-0.025. Ngamandla we-80%, usayizi wesampula weziguli ze-20 wawudingeka eqenjini ngalinye ukuze kutholwe umehluko omkhulu ekunciphiseni kwezinsuku ze-2.5.

 

Izici zesiguli ekuqaleni kwethulwa njengezindlela kanye ne-SD noma amaza kanye namaphesenti eqenjini ngalinye futhi kuqhathaniswa namasampuli azimele t?test kanye ? 2 isivivinyo.

 

Amaphrofayili esikhathi awo wonke amaphuzu okuphela aqhathaniswe phakathi kwamaqembu. Ngenxa yezilinganiso eziphindaphindwayo zesiguli ngasinye, amamodeli axubile alayini abala ukuhluka kwangaphakathi komuntu ngamunye alinganiselwa kuwo wonke amaphuzu wokugcina. Imithelela engaguquki yesikhathi (esingezona umugqa), ukwabiwa kweqembu nokusebenzisana phakathi kwakho kokubili kufakiwe. Imiphumela engahleliwe yeziguli kanye nemithambeka yafakwa kumodeli. Njengoba izinsalela zazitshekile, kwasetshenziswa ukuchazwa kwe-bootstrap okusekelwe kumasampula eqoqo angu-1000. Ukuqhathanisa ngakubili kwenziwa ngokuthola amaphuzu esikhathi ahlukene phakathi kweqembu ngalinye ngesikhathi ngasinye namanani e-P ahambisanayo kanye nezikhawu zokuzethemba ezingu-95%. Ukusetshenziswa kwemithi emaqenjini kubikwe ngemithamo evamile ene-SD, futhi amaqembu aqhathaniswe nokuhlolwa okuzimele kwamasampula okumaphakathi. Umthamo wachazwa njengokuphathwa okukodwa kwe-triptan noma i-ergotamine; paracetamol 1000 mg codeine; izidakamizwa ezingezona ze-steroidal eqeda ukuvuvukala (tolfenamic acid, 200 mg; diclofenac, 50 mg; aspirin, 1000 mg; ibuprofen, 600 mg; naproxen, 500 mg); kanye ne-morphinomimetics (tramadol, 50 mg). Asikho nesisodwa isiguli esishintshe ingalo yocwaningo futhi akekho noyedwa kwabayeke phakathi owagcwalisa idayari yekhanda ngemuva kokuhoxa ocwaningweni. Ngakho-ke, ukuhlaziywa kwephrothokholi kuphela okwakubalulekile.

 

Ukuhlaziya kuye kwaphuphuthekiswa ekwabiweni kokwelashwa futhi kwenziwa ku-SPSS v22 (IBM Corporation, Armonk, NY, USA) kanye ne-STATA v14 (JSB) (StataCorp LP, College Station, TX, USA). Kusetshenziswe izinga lokubaluleka elingu-0.025 endaweni yokugcina?

 

Ethics

 

Iziqondiso ezinhle zomtholampilo zalandelwa [25]. Ulwazi lomlomo nolubhaliwe mayelana nephrojekthi lwanikezwa ngaphambi kokufakwa kanye nokwabiwa kweqembu. Imvume ebhaliwe itholwe kubo bonke ababambiqhaza. Abahlanganyeli eqenjini le-placebo neqembu lokulawula bathenjiswe ukwelashwa kwe-CSMT ngemva kwe-RCT, uma ukungenelela okusebenzayo kutholakala ukuthi kusebenza kahle. Umshwalense uhlinzekwe ngoHlelo LwaseNorway Lwesinxephezelo Ezigulini (Isinxephezelo Sokulimala Kwesiguli), inhlangano kazwelonke ezimele enxephezela iziguli ezilinyazwe ngokwelashwa okunikezwa yisevisi yezempilo yase-Norway. Umthetho wokumisa wachazwa wokuhoxiswa kwabahlanganyeli kulolu cwaningo ngokuvumelana nezincomo kusandiso se-CONSORT Sokubika Okungcono Kokulimaza [26]. Wonke ama-AE aqashwe ngesikhathi sokungenelela futhi asebenza njengoba kwenzeka ngokuvumelana nezincomo ze-CONSORT kanye ne-IHS Task Force kuma-AEs ekuhlolweni kwe-migraine [16, 23]. Esimeni se-AE enzima, umhlanganyeli uzohoxiswa ocwaningweni futhi adluliselwe ku-General Practitioner noma umnyango wezimo eziphuthumayo esibhedlela kuye ngomcimbi. Umphenyi (AC) ubetholakala ngomakhalekhukhwini nganoma yisiphi isikhathi phakathi nesikhathi sokwelashwa socwaningo.

 

Imiphumela

 

Umfanekiso ?1 ubonisa ishadi lokugeleza le-104 migraineurs elifakwe ocwaningweni. Izici eziyisisekelo kanye nezibalo zabantu zazifana kuwo wonke amaqembu amathathu (Ithebula 1).

 

Umfanekiso 1 Ishadi Lokugeleza Kokufunda

Umfanekiso 1: Ishadi eligelezayo lokufunda.

 

Ithebula 1 Isisekelo Sezimo Zezibalo Nezibalo Zemitholampilo

 

Izinyathelo Zomphumela

 

Imiphumela kuwo wonke amaphuzu okuphela kwethulwe ku-Fig. ?2ad kanye neThebula 2, 3, 4.

 

Umfanekiso we-2

Umfanekiso 2: (a) Izinsuku zokuqaqamba kwekhanda; (b) ubude bekhanda elibuhlungu; (c) ukushuba kwekhanda; (d) inkomba yekhanda. Amaphrofayli esikhathi emaphuzwini okuqala nakwesibili, izindlela namabha amaphutha amele izikhathi zokuthenjwa ezingamaphesenti angama-95. BL, isisekelo; control, control group (�); I-CSMT, i-chiropractic spinal manipulative therapy (?); i-placebo, ukukhwabanisa kwe-sham (?); PT, emva?ukwelashwa; 3 m, 3?ukulandelela kwezinyanga; 6 m, 6?ukulandelela kwezinyanga; 12 m, 12?ukulandelela kwezinyanga; I-VAS, isikali esibonakalayo se-analogue.

 

Ithebula 2 I-Regression Coefficients kanye ne-SE

 

Ithebula 3 Izindlela kanye ne-SD

 

Ithebula 4 Kusho Imithamo ye-SD Yemithi

 

Iphuzu lokugcina? Izinsuku ze-Migraine zehliswe kakhulu phakathi kwawo wonke amaqembu kusukela kwesisekelo kuya kokwelashwa? (P <0.001). Umphumela uqhubekile ku-CSMT kanye namaqembu e-placebo ku-3, i-6 kanye ne-12 izinyanga zokulandela, kanti izinsuku ze-migraine zibuyele ezingeni lesisekelo eqenjini lokulawula (Fig. ?2a). Imodeli exubile eqondile ayizange ibonise umehluko omkhulu obalulekile ekushintsheni kwezinsuku ze-migraine phakathi kwe-CSMT namaqembu e-placebo (P = 0.04) noma phakathi kwe-CSMT neqembu lokulawula (P = 0.06; Ithebula 2). Kodwa-ke, ukuqhathanisa okukabili ngamaphuzu esikhathi ngasinye kubonise umehluko omkhulu phakathi kwe-CSMT neqembu elilawulayo ngaso sonke isikhathi amaphuzu kusukela ngemva kokwelashwa (Ithebula 3).

 

Amaphuzu okuphela kwesibili. Kube nokuncishiswa okuphawulekayo kusukela kwesisekelo kuya kokuthunyelwe? Ukwelashwa esikhathini se-migraine, ukuqina kanye ne-HI ku-CSMT (P = 0.003, P = 0.002 kanye ne-P <0.001, ngokulandelana) kanye ne-placebo (P <0.001, P = 0.001 kanye ne-P <0.001 3, ngokulandelana) amaqembu, futhi umphumela waqhubeka ekulandeleni kwezinyanga ezingu-6, ​​12 neziyi-XNUMX.

 

Umehluko obalulekile kuphela phakathi kwe-CSMT namaqembu okulawula kwakushintsha ubude be-migraine (P = 0.02) naku-HI (P = 0.04; Ithebula 2).

 

Ekulandeleni izinyanga eziyi-12, ushintsho ekusetshenzisweni kwe-paracetamol beluphansi kakhulu eqenjini le-CSMT uma kuqhathaniswa ne-placebo (P = 0.04) kanye namaqembu okulawula (P = 0.03) (Ithebula 4).

 

Ukuphuphuthekisa. Ngemva kweseshini ngayinye yokungenelela ye-12, > i-80% yabahlanganyeli bakholelwa ukuthi bathole i-CSMT kungakhathaliseki ukuthi yiliphi iqembu. Isilinganiso sezinkinga zokukholelwa ukuthi ukwelashwa kwe-CSMT kwamukelwe kwaba > i-10 kuzo zonke izikhathi zokwelashwa kuwo womabili amaqembu (wonke P <0.001).

 

Imiphumela emibi. Isamba esingama-703 sezikhathi zokungenelela ezingaba khona ze-770 zahlolwa ama-AE (355 eqenjini le-CSMT kanye nama-348 eqenjini le-placebo). Izizathu zokuhlolwa kwe-AE okugejiwe kube izikhathi zokuyeka noma zokugeja zokungenelela. Ama-AE ayevame kakhulu ku-CSMT kunezikhathi zokungenelela ze-placebo (83/355 vs. 32/348; P <0.001). Ukuzwela kwendawo kwakuyi-AE evamile kakhulu ebikwe yi-11.3% (95% CI, 8.4�15.0) eqenjini le-CSMT kanye no-6.9% (95% CI, 4.7�10.1) eqenjini le-placebo, kanti ukukhathala ngosuku lokungenelela nobuhlungu bentamo kubikwe ngo-8.5% no-2.0% (95% CI, 6.0�11.8 no-1.0�4.0), kanye no-1.4% no-0.3% (95% CI, 0.6�3.3 kanye no-0.1�1.9), ngokulandelanayo. Wonke amanye ama-AE (ubuhlungu obuphansi beqolo, ubuso obundikindiki, isicanucanu, ukuhlasela kwe-migraine okucasuliwe nokukhathala ezingalweni) kwakungavamile (<1%). Awekho ama-AE anzima noma abucayi abikiwe.

 

Ingxoxo

 

Ngokwazi kwethu, lena i-RCT yokuqala yamanuwali? I-RCT yethu emithathu?ehlomile, eyodwa?eyimpumputhe, ye-placebo ihlole ukusebenza kahle kwe-CSMT ekwelapheni i-migraine ngokumelene ne-placebo (i-sham chiropractic) kanye nokulawula (ukwelashwa okujwayelekile kwe-pharmacological). Imiphumela yabonisa ukuthi izinsuku ze-migraine zehliswe kakhulu phakathi kwamaqembu amathathu kusukela ekuqaleni kuya kokwelashwa kwangemuva. Umphumela uqhubekile ku-CSMT namaqembu e-placebo kuwo wonke amaphuzu esikhathi sokulandelela, kuyilapho iqembu lokulawula libuyele kusisekelo. Ama-AE abemnene futhi edlula, okuhambisana nezifundo zangaphambilini.

 

Umklamo wocwaningo unamathele ezincomo zama-RCT ekhemisi njengoba zinikezwe i-IHS kanye ne-CONSORT [1, 15, 16]. Ama-RCT okwelapha enziwa ngesandla anezithiyo ezintathu ezinkulu uma eqhathaniswa nama-RCT ekhemisi. Okokuqala, akunakwenzeka ukuphuphuthekisa umphenyi maqondana nokwelashwa okusetshenzisiwe. Okwesibili, ukuvumelana ngokwelashwa kwe-placebo okungenayo akukho [11]. Okwesithathu, imizamo yangaphambili yokufaka iqembu le-placebo iyekile ukuqinisekisa ukuphuphuthekisa, ngakho-ke, kuyaziwa ukuthi ukwelashwa okusebenzayo kanye ne-placebo kwakufihliwe [27]. Ngenxa yalezi zinselele sinqume ukwenza i-RCT emithathu?ehlomile, eyodwa?impumputhe eyodwa, ehlanganisa neqembu elilawulayo elaqhubeka nokwelashwa okujwayelekile kwemithi ukuze sithole inkomba yobukhulu bempendulo ye-placebo.

 

Kuye kwaphakanyiswa ukuthi, kuma-RCT e-pharmacological double?blind placebo RCTs, ama-50% kuphela azokholelwa ukuthi athola ukwelashwa okusebenzayo eqenjini ngalinye, uma ukuphuphuthekisa kuphelele. Kodwa-ke, lokhu kungase kungabi iqiniso kuma-RCT okwelapha okwenziwa ngesandla, ngoba isivuseleli esisebenzayo nese-placebo singase sikholise kakhulu kunethebhulethi [28]. Umphenyi oyedwa wehlisa ukuhlukahluka komphenyi ngokunikeza ulwazi olufanayo kubo bonke ababambiqhaza futhi ngokuvamile kunconywa ukuthi ukungenelela kwe-placebo kufanele kufane nokwelashwa okusebenzayo ngokwenqubo, imvamisa yokwelashwa kanye nesikhathi esichithwe nomphenyi ukuze kuvunyelwe okulindelwe okufanayo kuwo womabili amaqembu. [28]. Ukubaluleka kokuphuphuthekisa kwethu ngempumelelo kugcizelelwa yiqiniso lokuthi wonke ama-RCT okwelapha angaphambilini ekhanda alinayo i-placebo. Ngakho-ke, sikholelwa ukuthi imiphumela yethu okukhulunywe ngayo ngezansi isebenza ezingeni elifanayo ne-RCT yemithi [14].

 

Idatha elindelekile ithembeke kakhulu kunedatha ye-retrospective mayelana nokuchema kokukhumbula; kodwa-ke, ukungathobeli? kungaba inselele, ikakhulukazi ekupheleni kocwaningo. Sikholelwa ukuthi ukuxhumana njalo phakathi kwabahlanganyeli kanye nomphenyi, okuhlanganisa ukuthintana kwanyanga zonke esikhathini sokulandelela, cishe kugcine ukuthobelana okuphezulu phakathi nocwaningo lwethu.

 

Nakuba isampula yethu yocwaningo iphelile ngabahlanganyeli abangu-104 kumaqembu amathathu, ukuqagela kokubala kwamandla kanye nezinga lokuqeda eliphezulu lisekela idatha ezuziwe ukuthi ivumelekile kubantu abaphenyiwe. Indlela ye-Gonstead isetshenziswa yi-59% ye-chiropractors [19] futhi, ngaleyo ndlela, imiphumela iyakwazi ukujwayelekile kulo msebenzi. Isiqiniseko sokuxilonga singamandla ethu amakhulu njengoba cishe bonke ababambiqhaza baxilongwa udokotela wezinzwa ngokusho kwe-ICHD?II [2]. Ngokuphambene nama-RCT angaphambilini e-chiropractic migraine athole abahlanganyeli ngokusebenzisa imidiya efana namaphephandaba kanye nesikhangiso somsakazo [12], iningi labahlanganyeli bethu laqashwa eMnyangweni Wezinzwa, i-Akershus University Hospital, okubonisa ukuthi i-migraineurs ingase ibe nokuhlaselwa okuvamile / okunzima. okunzima ukuyelapha kunomphakathi jikelele, njengoba bethunyelwe nguDokotela Jikelele wabo kanye/noma udokotela wezinzwa. Ngakho-ke, ucwaningo lwethu lumele ngokuyinhloko inani labantu basemtholampilo wemfundo ephakeme, futhi umphumela wawungase uhluke ukube ababambiqhaza bebebuthwe kubantu abaningi. Iphesenti yobuhlungu bentamo itholakale iphezulu ezigulini ezine-migraine [29] futhi, ngakho-ke, amaphesenti aphezulu obuhlungu bomgogodla obungewona?

 

Ama-RCT amathathu e-pragmatic chiropractic therapy esebenzisa indlela ehlukahlukene aye aqhutshwa ngaphambilini kuma-migraineurs [12, 30, 31, 32]. I-RCT yase-Australia ibonise ngaphakathi? Ukunciphisa kweqembu kumvamisa ye-migraine, ubude nokuqina kwe-40%, i-43% ne-36%, ngokulandelana, ekulandeleni kwezinyanga ze-2 [30]. Ucwaningo lwaseMelika lwathola imvamisa ye-migraine nokuqina kokunciphisa ngaphakathi kweqembu nge-33% ne-42%, ngokulandelana, ekulandeleni kwenyanga ye-1 [31]. Olunye ucwaningo lwase-Australia, okwakuwukuphela kwe-RCT yokufaka iqembu lokulawula, okungukuthi i-ultrasound ekhishwe, ithole ngaphakathi? Ukunciphisa imvamisa ye-migraine kanye nobude be-35% no-40%, ngokulandelana, ekulandeleni kwezinyanga ze-2 eqenjini le-CSMT, uma kuqhathaniswa nokwehliswa kwangaphakathi kweqembu ngo-17% no-20% eqenjini elilawulayo, ngokulandelana [32]. Ukunciphisa izinsuku ze-migraine kwakufana neyethu (i-40%) eqenjini le-CSMT kusukela kwesisekelo kuya ekulandeleni kwezinyanga ze-3, kanti ubude be-migraine nokuqina kwancishiswa kancane ekulandeleni kwezinyanga ze-3, okungukuthi i-21% ne-14%, ngokulandelana. Ukuqhathaniswa kokulandelela isikhathi eside akunakwenzeka ngoba akukho ucwaningo lwangaphambilini olwaluhlanganisa isikhathi esanele sokulandelela. Idizayini yethu yocwaningo ehlanganisa ukuqinisekiswa okuqinile kwangaphakathi kusivumela ukuthi sihumushe umphumela obonwa njengempendulo ye-placebo.

 

I-RCT yethu yayinama-AE ambalwa uma iqhathaniswa nezifundo zokwelashwa eziphathwayo zangaphambilini, kodwa ezinomlingiswa wesikhashana ofanayo nomnene [33, 34, 35, 36, 37, 38, 39]. Kodwa-ke, akuzange kunikezwe amandla anele ukuthola ama-AE angajwayelekile angajwayelekile. Uma kuqhathaniswa, ama-AEs ku-pharmacological migraine prophylactic placebo RCTs avamile kufaka phakathi ama-AE angewona?

 

Isiphetho

 

Ukuphuphuthekisa kwakusekelwe ngokuqinile kulo lonke i-RCT, ama-AE ayembalwa futhi amnene, futhi umphumela ku-CSMT kanye neqembu le-placebo cishe kwakuyimpendulo ye-placebo. Ngenxa yokuthi abanye abaphathwa yikhanda abayibekezeleli imithi ngenxa ye-AEs noma i-co?morbid disorder, i-CSMT ingase icatshangelwe ezimeni lapho ezinye izinketho zokwelapha zingasebenzi noma zingabekezeleleki kahle.

 

Ukudalulwa Kokungqubuzana Kwezintshisekelo

 

Bonke ababhali bagcwalise ifomu lokudalula i-International Committee of Medical Journal Editors ifomu futhi bamemezele akukho ukungqubuzana kwezezimali noma okunye.

 

Ukusekela Ulwazi

 

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

 

Ukubonga

 

Ababhali bafuna ukuzwakalisa ukubonga kwabo okuqotho eSibhedlela saseNyuvesi i-Akershus, esinikeze ngomusa izinsiza zocwaningo, kanye neChiropractor Clinic 1, Oslo, Norway, eyenze konke ukuhlolwa kwe-x?ray. Lolu cwaningo lusekelwe izibonelelo ezivela ku-Extrastiftelsen, i-Norwegian Chiropractic Association, i-Akershus University Hospital kanye neNyuvesi yase-Oslo eNorway.

 

Ekuphetheni, izimpawu ezicindezelayo ze-migraines, kuhlanganise nobuhlungu obukhulu bekhanda kanye nokuzwela ukukhanya nokuzwakala kanye nesicanucanu, kungathinta izinga lokuphila komuntu, ngenhlanhla, ukunakekelwa kwe-chiropractic kuye kwaboniswa ukuthi kuyindlela yokwelapha ephephile futhi ephumelelayo yekhanda elibuhlungu. ubuhlungu. Ngaphezu kwalokho, lesi sihloko esingenhla sibonise ukuthi ama-migraineurs athola izimpawu ezincishisiwe kanye nezinsuku ze-migraine ngenxa yokunakekelwa kwe-chiropractic.�Ulwazi olubhekiswe ku-National Center for Biotechnology Information (NCBI). Ububanzi bolwazi lwethu bukhawulelwe ku-chiropractic kanye nokulimala komgogodla nezimo. Ukuze uxoxe ngesihloko, sicela ukhululeke ukubuza uDkt. Jimenez noma usithinte ku 915-850-0900 .

 

Ikhethwe nguDkt Alex Jimenez

 

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

 

Izihloko Ezengeziwe: Ubuhlungu Emuva

 

Ngokwezibalo, cishe i-80% yabantu izothola izimpawu zobuhlungu beqolo okungenani kanye kukho konke ukuphila kwabo. Ukuhlungu obusemhlane isikhalazo esivamile esingaba umphumela ngenxa yokulimala okuhlukahlukene kanye/noma izimo. Izikhathi eziningi, ukuwohloka kwemvelo komgogodla ngeminyaka kungabangela ubuhlungu emuva. Ama-discs we-Herniated kwenzeka lapho isikhungo esithambile, esifana nejeli se-intervertebral disc siphusha izinyembezi endaweni ezungezile, indandatho yangaphandle ye-cartilage, ukucindezela nokucasula izimpande zemizwa. Ama-Disc herniations avame ukwenzeka emhlane ophansi, noma i-lumbar spine, kodwa kungenzeka futhi eduze nomgogodla womlomo wesibeletho, noma intamo. Ukufakwa kwezinzwa ezitholakala emhlane ophansi ngenxa yokulimala kanye/noma isimo esishubile kungaholela ezimpawini ze-sciatica.

 

isithombe sebhulogi kakhathuni paperboy izindaba ezinkulu

 

ISIHLOKO ESIBALULEKILE ESENGEZIWE:�I-Neck Pain Treatment El Paso, TX Chiropractor

 

 

IZIHLOKO EZININGI: ENGEZIWE NGENXA: El Paso, Tx | Abasubathi

 

Akukho lutho
Okubhekwayo
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Vala i-Accordion
I-Psychology, Ikhanda elibuhlungu, Ubuhlungu Emuva, Ubuhlungu obungapheli kanye ne-Chiropractic e-El Paso, TX

I-Psychology, Ikhanda elibuhlungu, Ubuhlungu Emuva, Ubuhlungu obungapheli kanye ne-Chiropractic e-El Paso, TX

by | Ukuhlungu obusemhlane, I-Chiropractic, Ubuhlungu obungapheliyo, migraine, Ukuvuselelwa Kwemvelo, Isivivinyo Esilawulwa Ngokungahleliwe, Ukucindezeleka, Ukwelashwa

Wonke umuntu uzwa ubuhlungu ngezikhathi ezithile. Ubuhlungu umuzwa ongokomzimba wokungakhululeki obangelwa ukulimala noma ukugula. Uma udonsa umsipha noma usika umunwe wakho, isibonelo, isignali ithunyelwa ngezimpande zemizwa iye ebuchosheni, ikubonise ukuthi kukhona okungahambi kahle emzimbeni. Ubuhlungu bungahluka kuwo wonke umuntu futhi kunezindlela ezimbalwa zokuzwa nokuchaza ubuhlungu. Ngemva kokulimala noma ukugula kuphulukisa, ubuhlungu buzodamba, noma kunjalo, kwenzekani uma ubuhlungu buqhubeka ngisho nangemva kokuba usupholile?

 

Ubuhlungu obungapheliyo kuvame ukuchazwa njenganoma yibuphi ubuhlungu obuhlala ngaphezu kwamasonto ayi-12. Ubuhlungu obungapheli bungasukela kokuncane kuye kobunzima futhi bungaba umphumela wokulimala kwangaphambilini noma ukuhlinzwa, i-migraine nekhanda elibuhlungu, isifo samathambo, ukulimala kwezinzwa, ukutheleleka kanye ne-fibromyalgia. Ubuhlungu obungapheli bungathinta isimo somuntu esingokomzwelo nesingokwengqondo, kwenze kube nzima kakhulu ukukhulula izimpawu. Ucwaningo luye lwabonisa ukuthi ukungenelela kwengqondo kungasiza inqubo yokubuyisela ubuhlungu obungapheli. Ochwepheshe abaningana bezokunakekelwa kwempilo, njengodokotela we-chiropractic, banganikeza ukunakekelwa kwe-chiropractic kanye nokungenelela kwengqondo ukusiza ukubuyisela impilo kanye nokuphila kahle kweziguli zabo. Inhloso yalesi sihloko esilandelayo ukukhombisa indima yokungenelela kwengqondo ekulawuleni iziguli ezinezinhlungu ezingapheli, kuhlanganise nobuhlungu bekhanda kanye nobuhlungu emuva.

 

 

Iqhaza Lokungenelela Kwezengqondo Ekulawulweni Kweziguli ezinobuhlungu obungapheli

 

abstract

 

Ubuhlungu obungapheli bungaqondwa kangcono ngombono we-biopsychosocial lapho ubuhlungu bubhekwa njengento eyinkimbinkimbi, enezici eziningi ezivela ekusebenzisaneni okunamandla kwesimo somzimba wesiguli, imicabango, imizwelo, ukuziphatha, namathonya ezenhlalo namasiko. Umbono we-biopsychosocial ugxile ekubukeni ubuhlungu obungapheli njengokugula esikhundleni sesifo, ngaleyo ndlela uqaphela ukuthi kuyisipiliyoni esizimele nokuthi izindlela zokwelapha zihloselwe ukuphatha, kunokuba ukwelashwa, ubuhlungu obungapheli. Izindlela zamanje ezingokwengqondo zokuphatha ubuhlungu obungapheli zihlanganisa ukungenelela okuhloswe ukufeza ukuzilawula okwenyukayo, ukuguqulwa kokuziphatha, nokuguqulwa kwengqondo kunokuqeda ngokuqondile indawo yobuhlungu. Izinzuzo zokufaka phakathi ukwelashwa kwengqondo ezindleleni eziningi zokuphatha ubuhlungu obungapheli zihlanganisa, kodwa azikhawulelwe, ukwanda kokuphatha ubuhlungu, izinsiza ezithuthukisiwe zokubhekana nobuhlungu, ukunciphisa ukukhubazeka okuhlobene nobuhlungu, nokunciphisa ukucindezeleka ngokomzwelo � ukuthuthukiswa okwenziwayo. ngezindlela ezihlukahlukene eziphumelelayo zokuzilawula, ukuziphatha, kanye namasu okuqonda. Ngokuqaliswa kwalezi zinguquko, izazi zokusebenza kwengqondo zingasiza ngokuphumelelayo iziguli ukuba zizwe kangcono ukulawula ubuhlungu bazo futhi zibenze bakwazi ukuphila ngendlela evamile ngangokunokwenzeka naphezu kobuhlungu. Ngaphezu kwalokho, amakhono afundwa ngokungenelela kwengqondo anika amandla futhi enze iziguli zibe abahlanganyeli abakhuthele ekulawuleni ukugula kwazo futhi zigxilise amakhono abalulekile iziguli ezingawasebenzisa ukuphila kwazo zonke.

 

Amagama angukhiye: ukuphathwa kobuhlungu obungapheli, i-psychology, ukwelashwa kobuhlungu obuhlukahlukene, ukwelashwa kokuziphatha kwengqondo yobuhlungu

 

UDkt Jimenez White Coat

Ukuqonda kukaDkt Alex Jimenez

Ubuhlungu obungapheli buye kwanqunywa ukuthi buthinte impilo engokwengqondo yalabo abanezimpawu eziphikelelayo, ekugcineni baguqule isimo sabo sengqondo nengokomzwelo. Ngaphezu kwalokho, iziguli ezinezimo ezinqwabelene, okuhlanganisa ukucindezeleka, ukukhathazeka nokucindezeleka, zingenza ukwelashwa kube inselele. Indima yokunakekelwa kwe-chiropractic ukubuyisela kanye nokugcina nokuthuthukisa ukuqondanisa kwangempela komgogodla ngokusebenzisa ukulungiswa komgogodla kanye nokuphathwa ngesandla. Ukunakekelwa kwe-Chiropractic kuvumela umzimba ukuba uziphilise ngokwemvelo ngaphandle kwesidingo sezidakamizwa / imithi kanye nokungenelela kokuhlinzwa, nakuba lezi zingabhekiselwa kuzo yi-chiropractor uma kudingeka. Kodwa-ke, ukunakekelwa kwe-chiropractic kugxile emzimbeni wonke, kunokuba kube nokulimala okukodwa kanye / noma isimo kanye nezimpawu zayo. Ukulungiswa komgogodla kanye nokuphathwa ngesandla, phakathi kwezinye izindlela zokwelapha kanye namasu avame ukusetshenziswa udokotela we-chiropractor, kudinga ukuqwashisa ngesimo sengqondo nengokomzwelo yesiguli ukuze kuhlinzekwe ngempumelelo impilo nempilo yonke. Iziguli ezivakashela umtholampilo wami zinokucindezeleka ngokomzwelo ngenxa yobuhlungu bazo obungapheli ngokuvamile zisengozini yokuba nezinkinga ezingokwengqondo ngenxa yalokho. Ngakho-ke, ukunakekelwa kwe-chiropractic kungaba ukungenelela kwengqondo okuyisisekelo ekulawuleni ubuhlungu obungapheli, kanye nalabo ababoniswe ngezansi.

 

Isingeniso

 

Ubuhlungu buyinto yonke indawo yomuntu. Kulinganiselwa ukuthi cishe ama-20%�35% abantu abadala abhekana nobuhlungu obungapheli.[1,2] I-National Institute of Nursing Research ibika ukuthi ubuhlungu buthinta abantu baseMelika abaningi kunesifo sikashukela, isifo senhliziyo, nomdlavuza kuhlangene.[3] Ubuhlungu buphawulwe njengesizathu esiyinhloko sokufuna usizo lwezokwelapha e-United States.[4] Ngaphezu kwalokho, izidambisi zinhlungu ziyimithi yesibili evame ukunikezwa emahhovisi odokotela nasezindlini zezimo eziphuthumayo.[5] Ngokuqhubekayo nokuqinisa ukubaluleka kokuhlolwa okwanele kobuhlungu, I-Joint Commission on the Accreditation of Healthcare Organizations yakhipha igunya elidinga ukuthi ubuhlungu buhlolwe njengophawu lwesihlanu olubalulekile phakathi nokuvakasha kwezokwelapha.[6]

 

I-International Association for the Study of Pain (IASP) ichaza ubuhlungu ngokuthi �imizwa engajabulisi neyemizwa ehlobene nokulimala kwangempela noma okungaba khona kwezicubu, noma okuchazwa ngokwalowo monakalo.[7] Incazelo ye-IASP igqamisa ubunjalo bobuhlungu obuyi-multidimensional and subjective, isipiliyoni esiyinkimbinkimbi esiyingqayizivele kumuntu ngamunye. Ubuhlungu obungapheli ngokuvamile buhlukaniswa kusukela ebuhlungwini obukhulu ngokusekelwe ekungapheleni kwabo noma ukuphikelela, izindlela zabo zokunakekela umzimba, kanye/noma umthelela wabo olimazayo empilweni yomuntu. Ngokuvamile, kuyamukelwa ukuthi ubuhlungu obuqhubekayo ngaphezu kwesikhathi esilindelekile sokuphulukiswa kwezicubu ezilandela ukulimala noma ukuhlinzwa kubhekwa njengobuhlungu obungapheli. Kodwa-ke, isikhathi esinqunyiwe esakha isikhathi sokuphulukiswa esilindelekile siyahlukahluka futhi ngokuvamile kunzima ukusiqinisekisa. Ukuze kube lula ukuhlukanisa, imihlahlandlela ethile iphakamisa ukuthi ubuhlungu obuqhubekayo ngaphezu kwewindi lezinyanga ezingu-3�6 bubhekwa njengobuhlungu obungapheli.[7] Noma kunjalo, ukuhlukaniswa kwezinhlungu ngokusekelwe kuphela ubude besikhathi kuyindlela eqinile futhi, kwezinye izimo, umbandela ongenamthetho. Ngokuvamile, izici ezengeziwe ezifana ne-etiology, ukushuba kobuhlungu, nomthelela zicatshangelwa eceleni kwesikhathi lapho kuhlukaniswa ubuhlungu obungapheli. Enye indlela yokubonakalisa ubuhlungu obungapheli iye yasekelwe endleleni yayo yokugcina umzimba; okungukuthi, ubuhlungu okucatshangwa ukuthi buvela ngenxa yokuhlelwa kabusha kwe-peripheral kanye nendawo ephakathi. Izimo ezivamile zobuhlungu obungapheli zihlanganisa ukuphazamiseka kwe-musculoskeletal, izimo zobuhlungu be-neuropathic, ubuhlungu bekhanda, ubuhlungu bomdlavuza, nobuhlungu be-visceral. Ngobubanzi, izimo zobuhlungu zingase ngokuyinhloko zibe yi-nociceptive (ukukhiqiza ubuhlungu bemishini noma amakhemikhali), i-neuropathic (okubangelwa ukulimala kwezinzwa), noma okuphakathi (okubangelwa ukungasebenzi kahle kwama-neurons wesimiso sezinzwa esimaphakathi).[8]

 

Ngeshwa, isipiliyoni sobuhlungu sivame ukubonakala ngokuhlupheka okungadingekile ngokomzimba, ngokwengqondo, kwezenhlalo, kanye nezezimali. Ubuhlungu obungapheli buye baqashelwa njengembangela ehamba phambili yokukhubazeka kwesikhathi eside kubantu baseMelika benkathi yokusebenza.[9] Ngenxa yokuthi ubuhlungu obungapheli buthinta umuntu ezindaweni eziningi zokuphila kwakhe futhi kuwumthwalo omkhulu wezezimali emphakathini wethu. Izindleko ezihlangene eziqondile nezingaqondile zobuhlungu ziye zalinganiselwa ukuthi zisukela ku-$125 billion kuya ku-$215 billion, ngonyaka.[10,11] Imiphumela esabalele yobuhlungu obungapheli ihlanganisa imibiko eyengeziwe yokucindezeleka ngokomzwelo (isb, ukucindezeleka, ukukhathazeka, nokukhungatheka), ukwanda kwamazinga okukhubazeka okuhlobene nobuhlungu, ukuguqulwa okuhlobene nobuhlungu ekuqapheliseni, nokunciphisa izinga lokuphila. Ngakho-ke, ubuhlungu obungapheli bungaqondwa kangcono ngombono we-biopsychosocial lapho ubuhlungu bubhekwa njengento eyinkimbinkimbi, enezici eziningi ezivela ekusebenzisaneni okunamandla kwesimo somzimba wesiguli, imicabango, imizwelo, ukuziphatha, namathonya ezenhlalo namasiko.

 

Ukuphathwa kobuhlungu

 

Njengoba kunikezwe ukusabalala kobuhlungu kanye nemvelo yaso enezinhlangothi eziningi, uhlobo olufanele lokulawula ubuhlungu luyoba olubanzi, oluhlanganisayo, kanye nemikhakha eyahlukene. Izindlela zamanje zokuphatha ubuhlungu obungapheli ziye zanda ngokudlulela kwe-reductionist kanye nendlela yokwelashwa eqinile yokuhlinzwa, ngokomzimba, noma ye-pharmacological. Izindlela zamanje ziqaphela ukubaluleka kohlaka lokwelapha oluxubile olungabheki nje kuphela izici ze-nociceptive zobuhlungu kodwa futhi nezici zokucabangela-ukuhlola, kanye nezici ezishukumisayo ezihambisana ne-sequelae engathandeki ngokulinganayo futhi enomthelela. Ukuphathwa kwezinhlaka ezihlukene zobuhlungu obungapheli ngokuvamile kuhlanganisa ukwelashwa kwe-multimodal njengenhlanganisela ye-analgesics, ukwelapha ngokomzimba, ukwelapha ngokuziphatha, kanye nokwelashwa kwengqondo. Indlela ye-multimodal ngendlela eyanele futhi ebanzi ikhuluma ngokuphathwa kobuhlungu emazingeni amangqamuzana, okuziphatha, aqondayo, nasebenzayo. Lezi zindlela ziye zaboniswa ukuthi ziholela emiphumeleni ephakeme futhi ehlala njalo ye-subjective nenhloso ehlanganisa imibiko yobuhlungu, isimo sengqondo, ukubuyiselwa kokusebenza kwansuku zonke, isimo somsebenzi, kanye nemithi noma ukusetshenziswa kokunakekelwa kwezempilo; izindlela ze-multimodal nazo ziye zaboniswa ukuthi zibiza kakhulu kunezindlela ezingavamile.

 

UDkt. Jimenez enza ukwelapha ngokomzimba esigulini.

 

Iziguli ngokujwayelekile zizokwethula ehhovisi likadokotela zifuna ukwelashwa noma ukwelashelwa ukugula/ubuhlungu obukhulu. Ezigulini eziningi, kuye ngokuthi i-etiology kanye ne-pathology yobuhlungu babo kanye namathonya e-biopsychosocial ekuhlangenwe nakho kobuhlungu, ubuhlungu obukhulu buzoxazulula ngokuhamba kwesikhathi, noma ukulandela ukwelashwa okuhloswe ukukhomba imbangela yobuhlungu noma ukudluliselwa kwayo. Noma kunjalo, ezinye iziguli ngeke zifinyelele ukuxazululwa kobuhlungu bazo naphezu kokungenelela okuningi kwezokwelapha nokuhambisanayo futhi zizoshintsha zisuka esimweni sobuhlungu obukhulu ziye esimweni sobuhlungu obungapheli, obungenakuphulukiswa. Ngokwesibonelo, ucwaningo luye lwabonisa ukuthi cishe i-30% yeziguli ezethula kudokotela wazo wokunakekelwa okuyinhloko ngezikhalazo ezihlobene nobuhlungu obukhulu bokubuyela emuva zizoqhubeka nokuzwa ubuhlungu futhi, kwabanye abaningi, ukulinganiselwa okukhulu komsebenzi kanye nokuhlupheka kwezinyanga ze-12 kamuva.[14] Njengoba ubuhlungu nemiphumela yako iqhubeka nokukhula futhi ibonakala ezicini ezihlukahlukene zokuphila, ubuhlungu obungapheli bungase bube ngokuyinhloko inkinga ye-biopsychosocial, lapho izici eziningi ze-biopsychosocial zingase ziqhubekisele phambili futhi zigcine ubuhlungu, ngaleyo ndlela ziqhubeke zibe nomthelela omubi empilweni yomuntu othintekile. Kuleli qophelo lapho uhlobo lokwelashwa lwangempela lungase luhluke ukuze lufake ezinye izingxenye zokwelapha, kuhlanganise nezindlela ezingokwengqondo zokulawula ubuhlungu.

 

Izindlela ezingokwengqondo zokulawula ubuhlungu obungapheli zaqala ukuduma ngasekupheleni kwawo-1960 ngokuvela kwethiyori yokulawula isango lika-Melzack kanye ne-Wall[15] kanye nethiyori ye-neuromatrix yobuhlungu eyalandela.[16] Kafushane, le mibono ibeka ukuthi izinqubo zengqondo nezengqondo zisebenzisana ukuze zithinte umbono, ukudluliselwa, nokuhlolwa kobuhlungu, futhi ziqaphele ithonya lalezi zinqubo njengezici zokulondoloza ezihilelekile ezifundeni zobuhlungu obungapheli noma obude. Okungukuthi, le mibono yasebenza njengezisusa ezibalulekile zokuqalisa uguquko endleleni ebusayo nengashintshile ekwelapheni ubuhlungu, obuswa kakhulu imibono yezinto eziphilayo. Odokotela kanye neziguli ngokufanayo bathola ukuqashelwa okwandayo nokwazisa ngobunkimbinkimbi bokucubungula nokugcinwa kobuhlungu; ngenxa yalokho, ukwamukelwa nokuthandwa kwemibono eminingi yobuhlungu kwasungulwa. Njengamanje, imodeli yobuhlungu ye-biopsychosocial, mhlawumbe, indlela eyamukelwa kabanzi ye-heuristic yokuqonda ubuhlungu.[17] Umbono we-biopsychosocial ugxile ekubukeni ubuhlungu obungapheli njengokugula esikhundleni sokugula, ngaleyo ndlela uqaphela ukuthi kuyisipiliyoni esizimele nokuthi izindlela zokwelapha zihloselwe ukuphatha, kunokwelapha, ubuhlungu obungapheli.[17] Njengoba ukusetshenziswa kwendlela ebanzi futhi ebanzi yokuphatha ubuhlungu obungapheli kubonakala, ukungenelela okusekelwe ngokwengqondo kuye kwafakazela ukuphakama okuphawulekayo kokuthandwa nokuqashelwa njengezokwelapha ezihambisanayo. Izinhlobo zokungenelela kwengqondo eziqashwe njengengxenye yohlelo lokwelapha ubuhlungu obuhlukahlukene ziyahlukahluka kuye ngokuthi umelaphi, i-etiology yobuhlungu, nezici zesiguli. Ngokufanayo, ukucwaninga ngokusebenza kokungenelela okusekelwe engqondweni yobuhlungu obungapheli kubonise ukuguquguquka, nakuba kuthembisa, imiphumela eziguquguqukayo ezibalulekile ezifundwayo. Lokhu kubuka konke kuzochaza kafushane izinketho zokwelapha ezisekelwe ngokwengqondo ezisetshenziswa njalo kanye nempumelelo yazo emiphumeleni ebalulekile.

 

Izindlela zamanje ezingokwengqondo zokuphatha ubuhlungu obungapheli zihlanganisa ukungenelela okuhlose ukuzuza ukuzithiba okwenyukayo, ukuguqulwa kokuziphatha, nokuguqulwa kwengqondo kunokuqeda ngokuqondile indawo yobuhlungu. Ngakho-ke, baqondise ezingxenyeni zokuziphatha, ezingokomzwelo, nezengqondo ezivame ukunganakwa zobuhlungu obungapheli kanye nezici ezibangela ukugcinwa kwazo. Ukwaziswa ngohlaka olunikezwa u-Hoffman et al[18] kanye no-Kerns et al,[19] lezi zizinda ezivame ukusetshenziswa ezisekelwe engqondweni ziyabuyekezwa: amasu e-psychophysiological, izindlela zokuziphatha zokwelashwa, ukwelashwa kokuziphatha kwengqondo, nokungenelela okusekelwe ekwamukelweni.

 

Amasu e-Psychophysiological

 

I-Biofeedback

 

I-Biofeedback iwuhlelo lokufunda lapho iziguli zifunda khona ukuhumusha impendulo (ngendlela yedatha yokuphila) mayelana nemisebenzi ethile yomzimba. Isibonelo, isiguli singase sisebenzise imishini ye-biofeedback ukuze sifunde ukubona izindawo ezicindezelayo emzimbeni waso futhi kamuva sifunde ukukhululeka lezo zindawo ukuze kuncishiswe ukungezwani kwemisipha. Impendulo inikezwa amathuluzi okulinganisa ahlukahlukene anganikeza ulwazi mayelana nomsebenzi kagesi wobuchopho, umfutho wegazi, ukugeleza kwegazi, ithoni yemisipha, umsebenzi we-electrodermal, ukushaya kwenhliziyo, nezinga lokushisa lesikhumba, phakathi kweminye imisebenzi yomzimba ngendlela esheshayo. Umgomo wezindlela ze-biofeedback uwukuba isiguli sifunde indlela yokuqalisa izinqubo zokuzilawula ngokomzimba ngokufinyelela ukulawula ngokuzithandela phezu kwezimpendulo ezithile zomzimba ukuze ekugcineni kwandiswe ukuguquguquka komzimba ngokuqwashisa okukhulu nokuqeqeshwa okuthile. Ngakho-ke isiguli sizosebenzisa amakhono athile okuzilawula emzamweni wokunciphisa isenzakalo esingafuneki (isb, ubuhlungu) noma ukusabela komzimba okungahambi kahle esenzakalweni esingafunwa (isb, impendulo yokucindezeleka). Ochwepheshe bezengqondo abaningi baqeqeshelwe amasu e-biofeedback futhi bahlinzeka ngalezi zinsizakalo njengengxenye yokwelapha. I-Biofeedback iqokwe njengokwelashwa okuphumelelayo kobuhlungu obuhlobene nekhanda kanye nokuphazamiseka kwe-temporomandibular (TMD).[20] Ukuhlaziywa kwe-meta yezifundo ze-55 kwembula ukuthi ukungenelela kwe-biofeedback (okuhlanganisa izindlela ezihlukahlukene ze-biofeedback) kunikeze ukuthuthukiswa okuphawulekayo mayelana nemvamisa yokuhlaselwa kwe-migraine kanye nemibono yokuphathwa kwekhanda ukuzenza kahle uma kuqhathaniswa nezimo zokulawula.[21] Ucwaningo luye lwanikeza ukusekelwa okunamandla kwe-biofeedback ye-TMD, nakuba ukuthuthukiswa okuqinile mayelana nobuhlungu nokukhubazeka okuhlobene nobuhlungu kutholakale kuzivumelwano ezihlanganisa i-biofeedback nokuqeqeshwa kwamakhono okuziphatha kwengqondo, ngaphansi kokucatshangwa ukuthi indlela yokwelapha ehlangene ikhuluma ngokuningiliziwe ne-gamut. zezinkinga ze-biopsychosocial ezingase kuhlangatshezwane nazo ngenxa ye-TMD.[22]

 

Izindlela Zokuziphatha

 

Ukuqeqeshwa Ukuphumula

 

Kuyamukelwa ngokuvamile ukuthi ukucindezeleka kuyisici esibalulekile esihilelekile ekukhulisweni nasekugcinweni kobuhlungu obungapheli.[16,23] Ukucindezeleka kungase kube ikakhulukazi isisekelo semvelo, ngokomzimba, noma esingokwengqondo/ngokomzwelo, nakuba ngokuvamile lezi zindlela zihlanganiswe ngokuyinkimbinkimbi. Ukugxila ekuqeqesheni ukuphumula ukunciphisa amazinga okucindezeleka (ngokomzimba nengqondo) ngokusebenzisa uhlelo lwezinzwa olune-parasympathetic kanye nokuthola ukuqwashisa okukhulu kwezimo zomzimba nezengqondo, ngaleyo ndlela kufinyelelwe ukuncipha kobuhlungu nokulawula okwandayo phezu kobuhlungu. Iziguli zingafundiswa amasu amaningana okuphumula futhi ziwasebenzise ngabanye noma ngokubambisana, kanye nezingxenye ze-adjuvant kwezinye izindlela zokuphatha ubuhlungu bokuziphatha kanye nezingqondo. Okulandelayo izincazelo ezimfushane zezindlela zokuphumula ezivame ukufundiswa izazi zokusebenza kwengqondo ezigxile ekulawuleni ubuhlungu obungapheli.

 

Ukuphefumula kwe-diaphragmatic. Ukuphefumula kwe-diaphragmatic kuyindlela eyisisekelo yokuphumula lapho iziguli ziyalwa ukuba zisebenzise imisipha ye-diaphragm yazo ngokuphambene nemisipha yesifuba sazo ukuze zihlanganyele ekuzilolongeni ukuphefumula okujulile. Ukuphefumula ngokudonsa i-diaphragm kuvumela amaphaphu ukuba andise aye phansi (okuphawulwa ukwanda kwesisu ngesikhathi sokuhogela) futhi ngaleyo ndlela kwandise ukungena komoyampilo.[24]

 

Ukuphumula kwemisipha okuqhubekayo (PMR). I-PMR ibonakala ngokuzibandakanya ekuhlanganiseni ukungezwani kwemisipha nokuzivocavoca kwemisipha ethile noma amaqembu emisipha kuwo wonke umzimba.[25] Isiguli sivame ukuyalwa ukuthi sihlanganyele ekuzilolongeni kwengcindezi/ukuphumula ngendlela elandelanayo kuze kube yilapho zonke izingxenye zomzimba sezinakiwe.

 

Ukuqeqeshwa kwe-Autogenic (AT). I-AT iyindlela yokuzithiba yokuphumula lapho isiguli siphinda umusho ngokuhambisana nokubuka ngeso lengqondo ukuze senze isimo sokuphumula.[26,27] Le ndlela ihlanganisa ukugxilisa ingqondo kokungenzi lutho, ukubona ngeso, nezindlela zokuphefumula ezijulile.

 

Ukubona ngeso/Isithombe esiqondisiwe. Le nqubo ikhuthaza iziguli ukuthi zisebenzise zonke izinzwa zazo ekucabangeni indawo ecacile, ezolile, nephephile ukuze zithole umuzwa wokuphumula nokuphazamiseka ebuhlungu nemicabango nemizwelo ehlobene nobuhlungu.[27]

 

Ngokuqoqiwe, amasu okuphumula ngokuvamile atholakale enenzuzo ekulawuleni izinhlobo ezihlukahlukene zezimo ezibuhlungu nezingapheli kanye nokuphathwa kwe-sequelae ebalulekile yobuhlungu (isb, ikhwalithi yokuphila ehlobene nempilo).[28�31 ] Izindlela zokuphumula zivame ukwenziwa ngokuhambisana nezinye izindlela zokulawula ubuhlungu, futhi kukhona ukunqwabelana okukhulu ezindleleni ezicatshangelwayo zokuphumula kanye ne-biofeedback, isibonelo.

 

I-Operant Behaviour Therapy

 

Ukwelashwa kokuziphatha okusebenzayo kobuhlungu obungapheli kuqondiswa izimiso zokulungisa izimo zokusebenza zangempela ezihlongozwa u-Skinner[32] futhi zacwengwa ngu-Fordyce[33] ukuze zisebenze ekulawuleni ubuhlungu. Izimiso eziyinhloko zemodeli yesimo sokusebenza njengoba zihlobene nobuhlungu bubambe ukuthi ukuziphatha kobuhlungu kungagcina kuguquke futhi kugcinwe njengokubonakaliswa kobuhlungu obungapheli ngenxa yokuqiniswa okuhle noma okungalungile kokuziphatha okubuhlungu okunikeziwe kanye nesijeziso sokuguquguquka okwengeziwe, okungezona. -ukuziphatha kobuhlungu. Uma ukuqinisa kanye nemiphumela elandelayo kwenzeka ngokuvama okwanele, kungasebenza ukubeka isimo sokuziphatha, ngaleyo ndlela kwandise amathuba okuphinda ukuziphatha esikhathini esizayo. Ngakho-ke, ukuziphatha okunemibandela kwenzeka njengomkhiqizo wokufunda wemiphumela (oqobo noma elindelwe) yokuzibandakanya ekuziphatheni okunikeziwe. Isibonelo sokuziphatha okunemibandela ukuqhubeka nokusetshenziswa kwemithi � ukuziphatha okuba umphumela wokufunda ngokuzihlanganisa ngokuphindaphindiwe ukuthi ukuphuza imithi kulandelwa ukususwa kwenzwa ephikisayo (ubuhlungu). Ngokufanayo, ukuziphatha okubuhlungu (isb., izinkulumo zobuhlungu, amazinga aphansi okusebenza) kungaba ukuziphatha okunesimo okuqhubekisela phambili ubuhlungu obungapheli kanye nemiphumela yabo. Ukwelashwa okuqondiswa yizimiso zokuziphatha okusebenzayo kuhloswe ukucisha ukuziphatha okubuhlungu kwe-maladaptive ngokusebenzisa izimiso zokufunda ezifanayo okungenzeka ukuthi lezi ziye zasungulwa. Ngokuvamile, izingxenye zokwelapha zokwelashwa kokuziphatha okusebenzayo zihlanganisa ukusebenza okulinganiselwe, amashejuli emithi ehambisana nesikhathi, kanye nokusetshenziswa kwezimiso zokuqinisa ukuze kwandiswe ukuziphatha kahle nokunciphisa ukuziphatha okubuhlungu kwe-maladaptive.

 

Ukwenza kusebenze okuhleliwe. Ochwepheshe bezengqondo bangakwazi ukusebenzisa izinhlelo zokusebenza ezilinganiselwe zeziguli ezibuhlungu ezingapheli eziye zanciphisa kakhulu amazinga azo omsebenzi (okwandisa amathuba okunciphisa umzimba) futhi kamuva zizwe amazinga aphezulu obuhlungu lapho behlanganyela emsebenzini. Iziguli ziyalwa ukuthi zinqamule ngokuphephile umjikelezo wokungasebenzi kanye nokukhishwa kwemibandela ngokuzibandakanya emsebenzini ngendlela elawulwayo nenesikhathi esinqunyelwe. Ngale ndlela, iziguli zingandisa kancane kancane ubude besikhathi namandla omsebenzi ukuze zithuthukise ukusebenza. Ochwepheshe bezengqondo bangakwazi ukwengamela inqubekelaphambili futhi banikeze ukuqiniswa okufanele kokuhambisana, ukulungiswa kwemibono engalungile noma ukuchazwa okungalungile kobuhlungu obubangelwa umsebenzi, lapho kufanele khona, futhi baxazulule izinkinga-izithiyo zokunamathela. Le ndlela ivame ukufakwa ngaphakathi kwemithi yokuphatha ubuhlungu be-cognitive-behavioral.

 

Amashejuli emithi ancikene nesikhathi. Isazi sokusebenza kwengqondo singaba umhlinzeki wezempilo obalulekile owengamele ukuphathwa kwemithi yobuhlungu. Kwezinye izimo, izazi zokusebenza kwengqondo zinethuba lokuxhumana kaningi futhi ngokujulile neziguli kunodokotela futhi ngaleyo ndlela zingasebenza njengabahlanganyeli ababalulekile bendlela yokwelapha edidiyelwe yemikhakha eminingi. Izazi zokusebenza kwengqondo zingasungula amashejuli emithi athatha isikhathi eside ukuze kuncishiswe amathuba okuncika emithini yezinhlungu ukuze kutholakale ukulawula okwanele phezu kobuhlungu. Ngaphezu kwalokho, izazi zokusebenza kwengqondo zikuhlomele kahle ukubandakanya iziguli ezingxoxweni ezibalulekile mayelana nokubaluleka kokubambelela okufanele emithini nezincomo zezokwelapha kanye nezithiyo ezicatshangelwayo zokuxazulula izinkinga zokubambelela okuphephile.

 

Ukugwema ukwesaba. Imodeli yokugwema ukwesaba yobuhlungu obungapheli i-heuristic evame ukusetshenziswa kumongo wobuhlungu obungapheli obuphansi emuva (LBP).[34] Le modeli isuselwa kakhulu ezimisweni zokuziphatha zokusebenza ezichazwe ngaphambilini. Empeleni, imodeli yokugwema ukwesaba ibeka ukuthi lapho izinhlungu ezinzima zichazwa ngokuphindaphindiwe njengezibonakaliso eziyingozi noma izimpawu zokulimala okungathi sína, iziguli zingase zibe sengozini yokuzibandakanya ekuziphatheni kokugwema okuqhutshwa ukwesaba kanye nokuqonda okuqinisa ngokwengeziwe inkolelo yokuthi ubuhlungu buyisifo esibuhlungu. isignali yengozi futhi iqhubekisele phambili ukuqeda isimo somzimba. Njengoba umjikelezo uqhubeka, ukugwema kungase kufinyelele ezinhlotsheni ezibanzi zomsebenzi futhi kuphumele ekuqapheni ngokweqile kwemizwelo engokomzimba ebonakala ngezincazelo eziyinhlekelele ezingakaziwa kahle zokuzwa komzimba. Ucwaningo lubonise ukuthi izinga eliphezulu lokulimaza izinhlungu lihlotshaniswa nokugcinwa komjikelezo.[35] Ukwelashwa okuhloselwe ukuphula umjikelezo wokugwema ukwesaba kusebenzisa ukuchayeka okuhleliwe okuhleliwe emisebenzini esatshwayo ukuze kuqinisekiswe imiphumela esatshwayo, evame ukuba yinhlekelele, yokuzibandakanya emisebenzini. Ukuchayeka ngokwezigaba ngokuvamile kulekelelwa nge-psychoeducation mayelana nobuhlungu kanye nezici zokuhlela kabusha ingqondo eziqondise ukuqonda okungalungile kanye nokulindelwe mayelana nomsebenzi nobuhlungu. Izazi zokusebenza kwengqondo zisesimweni esihle kakhulu sokwenza lezi zinhlobo zokungenelela ezilingisa eduze izindlela zokwelapha zokuchayeka ngokuvamile ezisetshenziswa ekwelapheni okunye ukuphazamiseka kokukhathazeka.

 

Nakuba izindlela zokwelapha zokuchayeka ezilinganiselwe ziye zaboniswa ukuthi ziyasebenza ekwelapheni uhlobo oluyinkimbinkimbi lwe-syndrome yesifunda (CRPS-1) [36] kanye ne-LBP[37] kumiklamo yecala elilodwa, isilingo esikhulu esilawulwa ngokungahleliwe esiqhathaniswa nesigaba esihleliwe. ukwelashwa okuvezwayo okuhlangene nokwelashwa kohlelo lwezinhlungu ezihlukahlukene ngokwelashwa kohlelo lwezinhlungu ezihlukahlukene yedwa kanye neqembu lokulawula uhlu lokulinda lithole ukuthi lezi zindlela zokwelapha ezimbili ezisebenzayo zibangele ukuthuthukiswa okuphawulekayo emiphumeleni yomphumela wokuqina kobuhlungu, ukwesaba ukunyakaza / ukulimala, ubuhlungu bokuzenzela, ukudangala, kanye nezinga lomsebenzi.[38] Imiphumela evela kulolu cwaningo iphakamisa ukuthi kokubili ukungenelela kwakuhlotshaniswa nokusebenza okuphawulekayo kokwelashwa kangangokuthi ukwelashwa kokuchayeka okulinganiselwe akuzange kubonakale kubangela izinzuzo zokwelashwa ezengeziwe.[38] Inothi eliyisixwayiso ekuchazeni le miphumela liqokomisa ukuthi isilingo esilawulwa ngokungahleliwe (RCT) sasihlanganisa izimo ezihlukahlukene zobuhlungu obungapheli obudlulele ngaphezu kwe-LBP ne-CRPS-1 futhi azizange zifake kuphela iziguli ezinezinga eliphezulu lokwesaba okuhlobene nobuhlungu; ukungenelela kwethulwe futhi ngamafomethi weqembu kunefomethi ngayinye. Nakuba ukwelapha kokuchayeka kwe-in-vivo kuphakeme ekwehliseni inhlekelele ebangela izinhlungu kanye nemibono yokulimaza kwemisebenzi, ukwelapha kokuchayeka kubonakala kuphumelela njengokungenelela komsebenzi olinganiselwe ekuthuthukiseni ukukhubazeka kokusebenza kanye nezikhalazo eziyinhloko.[39] Olunye uhlolo lomtholampilo luqhathanise ukuphumelela kokuhlukaniswa okusekelwe ekwelapheni (TBC) ukwelapha ngokomzimba kuphela ku-TBC okukhuliswe ngomsebenzi osezingeni noma ukuchayeka ngokwezinga ezigulini ezine-LBP ebukhali nencane kakhulu.[40] Imiphumela yembula ukuthi kwakungekho umehluko emiphumeleni yeviki le-4 kanye nenyanga ye-6 yokunciphisa ukukhubazeka, ukuqina kobuhlungu, ukulimaza ubuhlungu, nokukhubazeka ngokomzimba phakathi kwamaqembu okwelapha, nakuba ukuchayeka okulinganiselwe kanye ne-TBC kunikeze ukunciphisa okukhulu kwezinkolelo zokugwema ukwesaba ezinyangeni ze-6. .[40] Okutholwe kulolu cwaningo lomtholampilo kusikisela ukuthi ukuthuthukisa i-TBC ngomsebenzi osezingeni noma ukuchayeka okulinganiselwe akuholeli emiphumeleni ethuthukisiwe ngokuphathelene nezinyathelo ezihlobene nokuthuthukiswa kwe-LBP engapheli ngaphezu kwentuthuko efinyelelwa nge-TBC kuphela.[40]

 

Izindlela Zokuziphatha Ngokwengqondo

 

Ukwelashwa kwengqondo-yokuziphatha (CBT) ukungenelela kobuhlungu obungapheli kusebenzisa izimiso zengqondo ukwenza izinguquko eziguquguqukayo ekuziphatheni kwesiguli, ukuqonda noma ukuhlola, kanye nemizwelo. Lokhu kungenelela kuvame ukuhlanganisa i-psychoeducation eyisisekelo mayelana nobuhlungu kanye nesifo esithile sobuhlungu sesiguli, izakhi eziningana zokuziphatha, ukuqeqeshwa kwamakhono okubhekana nesimo, izindlela zokuxazulula izinkinga, kanye nengxenye yokuhlela kabusha ingqondo, nakuba izingxenye zokwelashwa eziqondile zihluka kuye ngokomtholampilo. Izingxenye zokuziphatha zingase zihlanganise amakhono ahlukahlukene okuphumula (njengoba kubuyekezwe esigabeni sezindlela zokuziphatha), imiyalelo yokulinganisa umsebenzi/ukwenziwa kusebenze okuhleliwe, amasu okuvuselela ukuziphatha, kanye nokukhuthazwa kokuqalisa kabusha umsebenzi womzimba uma kunomlando obalulekile wokugwema umsebenzi kanye nokukhishwa kwe-conditioning okulandelayo. Inhloso eyinhloko ekuqeqeshweni kwamakhono okubhekana nokubona amasu amanje okubhekana ne-maladaptive (isb, ukulimaza, ukugwema) isiguli esihlanganyela kuwo kanye nokusebenzisa kwaso amasu okubhekana nezimo eziguquguqukayo (isb, ukusebenzisa izitatimende ezinhle, ukusekelwa komphakathi). Njengesexwayiso, izinga lapho isu livumelana nezimo noma ukungalungi kahle kanye nokusebenza okucatshangwayo kwamasu athile okubhekana nakho kuyahlukahluka kuye ngomuntu ngamunye.[41] Kuso sonke isikhathi sokwelashwa, amasu okuxazulula izinkinga ayacijwa ukuze kusizwe iziguli emizamweni yazo yokubambelela kanye nokuzisiza ukuthi zandise amandla azo. Ukuhlelwa kabusha kwengqondo kuhilela ukuqashelwa kokwaziwa kwamanje kwe-maladaptive isiguli esihlanganyela kukho, ukubekela inselele ukuqonda okungekuhle okuhlonziwe, nokuhlelwa kabusha kwemicabango ukuze kukhiqizwe eminye imicabango elinganiselayo, eguquguqukayo. Ngokusebenzisa izivivinyo zokuhlela kabusha ingqondo, iziguli ziya ngokuya ziba nekhono ekuboneni ukuthi imizwa yazo, ukuqonda, nokuhumusha kulungisa kanjani ubuhlungu bazo ngezindlela ezinhle nezimbi. Ngenxa yalokho, kucatshangwa ukuthi iziguli zizothola umbono omkhulu wokulawula ubuhlungu bazo, zikwazi kangcono ukuphatha ukuziphatha kwazo nemicabango njengoba zihlobene nobuhlungu, futhi zikwazi ukuhlola ngokuguquguqukayo incazelo ezichaza ubuhlungu babo. . Izingxenye ezengeziwe ngezinye izikhathi ezifakwe ekungeneleleni kwe-CBT zihlanganisa ukuqeqeshwa kwamakhono omphakathi, ukuqeqeshwa kokuxhumana, nezindlela ezibanzi zokulawula ukucindezeleka. Ngokungenelela kwe-CBT okugxile ezinhlungwini, iziguli eziningi zithola inzuzo ekuthuthukisweni ngokuphathelene nempilo yazo engokomzwelo nokusebenza kahle, futhi ekugcineni ikhwalithi yokuphila yazo ebonwa emhlabeni wonke ehlobene nempilo.

 

UDkt. Alex Jimenez uhlanganyela ekuzilolongeni kokuqina nokusebenza komzimba.

 

Ukungenelela kwe-CBT kulethwa ngaphakathi kwendawo esekelayo nezwelayo elwela ukuqonda ubuhlungu besiguli ngokombono we-biopsychosocial nangendlela edidiyelwe. Abelaphi babona indima yabo �njengothisha�� noma �abaqeqeshi� futhi umlayezo odluliswa ezigulini owokufunda ukulawula kangcono izinhlungu zazo nokwenza ngcono ukusebenza kwazo kwansuku zonke kanye nezinga lempilo yazo esikhundleni sokuhlose ukwelapha noma ukuqeda izinhlungu. Umgomo omkhulu uwukukhulisa ukuqonda iziguli ngobuhlungu bazo kanye nemizamo yazo yokulawula ubuhlungu kanye nemiphumela yabo ngendlela ephephile nevumelana nezimo; ngakho-ke, ukufundisa iziguli ukuthi zizihlole ngokwazo indlela eziziphatha ngayo, imicabango, kanye nemizwa yazo kuyingxenye ebalulekile yokwelapha kanye nesu eliwusizo lokuthuthukisa ukusebenza kahle kwazo. Ukwengeza, umelaphi uzama ukugqugquzela isimo esinethemba, esingokoqobo, nesikhuthazayo lapho isiguli singaba nekhono elikhulayo lokubona nokufunda empumelelweni yaso nokufunda nasekuthuthukiseni imizamo engaphumelelanga. Ngale ndlela, abelaphi neziguli basebenza ndawonye ukuze bahlonze impumelelo yesiguli, izithiyo zokubambelela ngokuqinile emithethweni, kanye nokuthuthukisa izinhlelo zokulondoloza kanye nokuvimbela ukuphindelela esimweni sokwakha, sokubambisana, nesithembekile. Isici esikhangayo sendlela yokuziphatha kwengqondo ukugunyazwa kwesiguli njengomhlanganyeli osebenzayo wohlelo lwakhe lokubuyisela ubuhlungu noma uhlelo lokuphatha.

 

Ucwaningo luye lwathola i-CBT njengendlela yokwelapha ephumelelayo yobuhlungu obungapheli kanye ne-sequelae yayo njengoba iphawulwe izinguquko eziphawulekayo ezizindeni ezihlukahlukene (okungukuthi, izinyathelo zokuhlangenwe nakho kobuhlungu, isimo sengqondo / umthelela, ukubhekana nokuqonda kanye nokuhlola, ukuziphatha kobuhlungu kanye nezinga lomsebenzi, kanye nomsebenzi wendima yomphakathi. ) uma kuqhathaniswa nezimo zokulawula uhlu lokulinda.[42] Uma kuqhathaniswa nezinye izindlela zokwelapha ezisebenzayo noma izimo zokulawula, i-CBT ibangele ukuthuthukiswa okuphawulekayo, nakuba imiphumela emincane (usayizi womphumela ~ 0.50), ngokuphathelene nokuhlangenwe nakho kobuhlungu, ukubhekana nokuqonda kanye nokuhlola, kanye nomsebenzi wendima yomphakathi.[42] Ukuhlaziywa kwemeta kwakamuva kwezifundo ezishicilelwe ezingama-52 kuqhathaniswe nokwelashwa kokuziphatha (BT) kanye ne-CBT ngokumelene nokwelashwa njengezimo ezivamile zokulawula kanye nezimo zokulawula ezisebenzayo ngezikhathi ezihlukahlukene.[43] Lokhu kuhlaziywa kwemeta kuphethe ngokuthi idatha yabo ayizange inikeze ukusekelwa kwe-BT ngaphezu kokuthuthukiswa ebuhlungu ngokushesha ngemva kokwelashwa uma kuqhathaniswa nokwelashwa njengezimo zokulawula ezivamile.[43] Ngokuphathelene ne-CBT, baphetha ngokuthi i-CBT inemiphumela emihle elinganiselwe yokukhubazeka kobuhlungu, nemizwelo; noma kunjalo, kunedatha eyanele etholakalayo ukuze iphenye ithonya elithile lokuqukethwe kokwelashwa emiphumeleni ekhethiwe.[43] Sekukonke, kubonakala sengathi i-CBT ne-BT kuyindlela yokwelapha ephumelelayo yokuthuthukisa isimo sengqondo; imiphumela ehlala iqinile ezindaweni zokulandelela idatha. Kodwa-ke, njengoba kuqokonyiswe ukubuyekezwa okuningana kanye nokuhlaziywa kwe-meta, isici esibalulekile okufanele sicatshangelwe ekuhloleni ukuphumelela kwe-CBT yokuphatha ubuhlungu obungapheli kugxile ezindabeni zokulethwa okuphumelelayo, ukuntuleka kwezingxenye zokwelashwa ezifanayo, umehluko ekulethweni kwabo bonke odokotela kanye nokwelashwa. inani labantu, nokuhlukahluka kwemiphumela eguquguqukayo onentshisekelo kuyo kuzo zonke izivivinyo zocwaningo.[13] Okuqhubeka kube nzima ukuchazwa kokutholwa kokusebenza ngempumelelo yizici zesiguli kanye neziguquko ezengeziwe ezingase zithinte umphumela wokwelashwa ngokuzimela.

 

Izindlela Ezisekelwe Ekwamukeleni

 

Izindlela ezisuselwe ekwamukelweni zivame ukukhonjwa njengezindlela zokwelapha zegagasi lesithathu zokwelashwa kwengqondo-yokuziphatha. I-Acceptance and commitment therapy (ACT) iyindlela evamile yokwelashwa kwengqondo esekelwe ekwamukelweni. I-ACT igcizelela ukubaluleka kokwenza lula inqubekelaphambili yekhasimende ekufinyeleleni ukuphila okuyigugu nekwanelisayo ngokwandisa ukuguquguquka kwengqondo kunokugxila ngokuqinile ekuhleleni kabusha ukuqonda.[44] Esimweni sobuhlungu obungapheli, i-ACT ihlose amasu okulawula angasebenzi kanye nokugwema okuhlangenwe nakho ngokukhuthaza amasu asungula ukuguquguquka kwengqondo. Izinqubo eziyisithupha ezibalulekile ze-ACT zihlanganisa: ukwamukela, ukuwohloka komqondo, ukuba khona, ubuwena njengomongo, izindinganiso, kanye nesenzo esizibophezele.[45] Kafushane, ukwamukelwa kukhuthaza iziguli ezibuhlungu ezingapheli ukuba zamukele ngenkuthalo ubuhlungu kanye ne-sequelae yabo kunokuzama ukukushintsha, ngokwenza kanjalo kukhuthaza isiguli ukuba siyeke ukulwa okungenamsebenzi okuqondiswe ekuqedeni ubuhlungu babo. Kusetshenziswa amasu e-cognitive defusion (deliteralization) ukuze kulungiswe ukusebenza kwemicabango kunokunciphisa ukuvama kwayo noma ukuhlela kabusha okuqukethwe kwayo. Ngale ndlela, ukuwohloka komqondo kungase kumane kuguqule incazelo engathandeki noma umsebenzi wemicabango engemihle futhi ngaleyo ndlela kunciphise ukunamathela kanye nokusabela okungokomzwelo nokuziphatha okulandelayo emicabangweni enjalo. Inqubo ewumnyombo yokuba khona igcizelela ukusebenzisana okungahluleli phakathi kwemicabango nemicimbi yomuntu siqu neyimfihlo. Amanani asetshenziswa njengemihlahlandlela yokukhetha ukuziphatha nezincazelo ezibonakala ngalezo zindinganiso umuntu alwela ukuzifaka kuzo ekuphileni kwansuku zonke. Ekugcineni, ngesenzo sokuzinikela, iziguli zingabona izinguquko zokuziphatha ezihambisana nezindinganiso zomuntu ngamunye. Ngakho-ke, i-ACT isebenzisa izimiso eziyisithupha ezibalulekile ngokuhlangana ukuze ithathe indlela ephelele ekwandiseni ukuguquguquka kwengqondo nokunciphisa ukuhlupheka. Iziguli zikhuthazwa ukuba zibheke ubuhlungu njengento engenakugwenywa futhi zamukele ngendlela engahluleli ukuze ziqhubeke zithola injongo yokuphila naphezu kokuba khona kobuhlungu. Izinqubo ezingumongo ezihlobene ziyisibonelo sezinqubo zokucabangela nokwamukela kanye nokuzibophezela nezinqubo zokushintsha ukuziphatha.[45]

 

Imiphumela yocwaningo mayelana nokusebenza kwezindlela ezisekelwe ku-ACT zokuphatha ubuhlungu obungapheli ziyathembisa, nakuba zisaqinisekisa ukuhlolwa okwengeziwe. I-RCT eqhathanisa ne-ACT nesimo sokulawula sohlu lokulinda ibike ukuthuthukiswa okuphawulekayo enhlekeleleni yobuhlungu, ukukhubazeka okuhlobene nobuhlungu, ukwaneliseka kokuphila, ukwesaba ukunyakaza, nokucindezeleka kwengqondo okwagcinwa ekulandeleni kwezinyanga ezingu-7.[46] Uhlolo olukhudlwana lubike ukuthuthukiswa okuphawulekayo kobuhlungu, ukucindezeleka, ukukhathazeka okuhlobene nobuhlungu, ukukhubazeka, ukuvakasha kwezokwelapha, isimo somsebenzi, nokusebenza komzimba.[47] Ukuhlaziywa kwe-meta kwakamuva okuhlola ukungenelela okusekelwe ekwamukeleni (UMTHETHO kanye nokunciphisa ukucindezeleka okusekelwe engqondweni) ezigulini ezinobuhlungu obungapheli bathola ukuthi, ngokuvamile, ukwelapha okusekelwe ekwamukeleni kuholela emiphumeleni emihle yeziguli ezinezinhlungu ezingapheli.[48] Ngokuqondile, ukuhlaziywa kwe-meta kwembule amasayizi amancane kuya kwamaphakathi omphumela wokuqina kobuhlungu, ukucindezeleka, ukukhathazeka, impilo enhle, kanye nekhwalithi yokuphila, nemiphumela emincane etholakala lapho ukuhlolwa komtholampilo okulawulwayo kungabandakanywa futhi ama-RCT kuphela afakwe ekuhlaziyeni.[48] Okunye ukungenelela okusekelwe ekwamukeleni kuhlanganisa ukwelapha kwengqondo-yokuziphatha okuhambisana nomxholo kanye nokwelashwa kwengqondo okusekelwe engqondweni, nakuba ucwaningo olunamandla mayelana nokusebenza kwalezi zindlela zokwelapha zokuphatha ubuhlungu obungapheli zisaqala.

 

Ukulindela Izinto

 

Isici esiyisisekelo esibalulekile nesinganakwa kakhulu kuzo zonke izindlela zokwelapha ukucatshangelwa kokulindela kwesiguli impumelelo yokwelashwa. Naphezu kwentuthuko eminingi ekwakhiweni nasekulethweni kokwelashwa okuphumelelayo kwemikhakha ehlukahlukene yobuhlungu obungapheli, kugcizelelwe okuncane kakhulu ekuboneni ukubaluleka kokulindelwe empumelelweni nasekugxileni emizamweni yokuthuthukisa okulindelwe kweziguli. Ukuqashelwa ukuthi i-placebo yobuhlungu ibonakala ngezakhiwo ezisebenzayo eziholela ezinguqukweni ezinokwethenjelwa, ezibonakalayo, nezilinganisekayo ezine-neurobiological underpinnings okwamanje ku-vanguard yocwaningo lobuhlungu. Ucwaningo oluningi luye lwaqinisekisa ukuthi, uma lenzelwa ngendlela ekhulisa okulindelekile (ngokusebenzisa izinto ezilindelekile ezicacile kanye/noma ukumisa isimo), ama-placebos ane-analgesic angabangela izinguquko ezibonakalayo nezilinganisekayo ekuboneni ubuhlungu ezingeni lokuzibika ngokwakho kanye nesifo sezinzwa. izinga lokucubungula izinhlungu.[49,50] Ama-placebos ane-analgesic achazwe kabanzi njengezindlela zokwelapha ezilingisayo noma izinqubo ezenzeka ngaphakathi komongo wengqondo nenhlalakahle futhi zibe nemiphumela kokuhlangenwe nakho komuntu ngamunye kanye/noma ngokomzimba.[51] Umqondo wamanje we-placebo ugcizelela ukubaluleka komongo wengqondo nenhlalakahle lapho ama-placebo ashumekiwe. Isisekelo somongo wengqondo nenhlalakahle kanye nesiko lokwelashwa kukhona okulindelwe yiziguli. Ngakho-ke, akumangazi ukuthi umphumela we-placebo ugxiliswe ngokuyinkimbinkimbi cishe kukho konke ukwelashwa; kanjalo, odokotela kanye neziguli ngokufanayo bazozuza ngokuqaphela ukuthi lapho kukhona indlela eyengeziwe lapho izindlela zokwelapha zamanje zobuhlungu zingathuthukiswa.

 

Kuye kwahlongozwa ukuthi imiphumela elindelekile iwumthelela oyinhloko oqhuba izinguquko ezinhle ezitholwa ngezindlela ezihlukahlukene zokuqeqesha ukuphumula, i-hypnosis, ukwelashwa kokuchayeka, nezindlela eziningi zokwelapha ezigxile engqondweni. Ngakho-ke, indlela enengqondo yokuphathwa kobuhlungu obungapheli igxile emandleni eziguli ezilindelwe impumelelo. Ngokudabukisayo, ngokuvamile, abahlinzeki bezempilo abakunaki ukukhuluma ngokuqondile futhi bagcizelele ukubaluleka kokulindelwe yiziguli njengezici ezibalulekile ezinomthelela ekulawulweni ngempumelelo kobuhlungu obungapheli. I-zeitgeist emphakathini wethu iwukuthi ukwanda kwezokwelapha kwezifo kubangela ukulindela okuvamile ukuthi ubuhlungu (ngisho nobuhlungu obungapheli) kufanele buqedwe ngentuthuko yezokwelapha. Lokhu okulindelekile okuvame ukwenzeka kushiya iziguli eziningi ziphoxekile ngemiphumela yokwelashwa yamanje futhi kunomthelela ekufuneni okungapheli �ukwelapha�. Ukuthola �ikhambi� kuyinto ehlukile kunomthetho maqondana nezimo zobuhlungu obungapheli. Esimweni sethu sezulu samanje, lapho ubuhlungu obungapheli buhlukumeza izigidi zabantu baseMelika minyaka yonke, kuyisithakazelo sethu esingcono kakhulu ukugxilisa nokuqhubeka nokugqugquzela ukuguqulwa komqondo kunalokho okugxile ekulawulweni okuphumelelayo kobuhlungu obungapheli. Indlela esebenzayo nethembisayo yokufeza lokhu iwukwenza ngokugcwele iziguli� okulindelekile okuhle (okungokoqobo) nokufundisa iziguli ezibuhlungu kanye nomphakathi (amaphesenti angu-20 azo esikhathini esizayo ayoba iziguli ezibuhlungu) mayelana nalokho okulindelwe okungokoqobo. mayelana nokuphathwa kobuhlungu. Mhlawumbe, lokhu kungenzeka ekuqaleni ngemfundo yamanje, esekelwe ebufakazini mayelana ne-placebo kanye nemiphumela yokwelapha engaqondile njengokuthi iziguli zingakwazi ukulungisa izinkolelo ezingalungile okungenzeka bezinabo ngaphambilini. Kamuva odokotela bangahlose ukuthuthukisa okulindelwe kweziguli ngaphakathi kwezimo zokwelashwa (ngendlela engokoqobo) futhi banciphise ukulindela okungenathemba okuvimba empumelelweni yokwelashwa, ngakho-ke, ukufunda ukuthuthukisa ukwelashwa kwabo kwamanje kwemikhakha eminingi ngemizamo eqondiswe ekusebenziseni intuthuko ye-placebo engaveza, ngaphakathi �ngokwelashwa okusebenzayo�. Izazi zokusebenza kwengqondo zingabhekana kalula nalezi zinkinga neziguli zazo futhi zizisize zibe abameli bempumelelo yazo yokwelashwa.

 

I-Emotional Concomitants of Pain

 

Isici esivame ukuba yinselele yokuphathwa kobuhlungu obungapheli ukusabalala okuphezulu ngokungangabazeki kokucindezeleka okungokomzwelo okuhlangene. Ucwaningo luye lwabonisa ukuthi ukudangala nokukhathazeka kukhuphuke ngokuphindwe kathathu phakathi kweziguli ezinezinhlungu ezingapheli kunabantu abaningi. izinga lokunakekelwa abazokuthola. Iziguli ezinokucindezeleka zinemiphumela emibi kakhulu kokubili ukucindezeleka nokwelashwa kobuhlungu, uma kuqhathaniswa neziguli ezinokuxilongwa okukodwa kobuhlungu noma ukucindezeleka. imiphumela yokwelashwa kanye nokunciphisa ukuhlupheka ngokomzwelo kweziguli. Izazi zokusebenza kwengqondo zingabhekana nezimpawu ezibalulekile (isb, i-anhedonia, isisusa esiphansi, izithiyo zokuxazulula izinkinga) zokucindezeleka eziphazamisa kalula ukubamba iqhaza kokwelashwa nokucindezeleka ngokomzwelo. Ngaphezu kwalokho, kungakhathaliseki ukugula kwengqondo, izazi zokusebenza kwengqondo zingasiza iziguli ezinezinhlungu ezingapheli ukuthi zenze izinguquko ezibalulekile ezingase zibhekane nazo (isb., ukulahlekelwa umsebenzi, ukukhubazeka), ubunzima bomuntu siqu okungenzeka zihlangabezane nazo (isb, umuzwa wokuhlukaniswa obangelwa ubuhlungu), kanye ukuhlupheka ngokomzwelo (isb, ukukhathazeka, intukuthelo, ukudabuka, ukudumala) okuthintekayo ekuhlangenwe nakho kwabo. Ngakho-ke, izazi zokusebenza kwengqondo zingaba nomthelela omuhle enkambweni yokwelashwa ngokunciphisa umthelela wezinto ezihambisana nemizwa okukhulunywa ngazo njengengxenye yokwelapha.

 

Isiphetho

 

Izinzuzo zokufaka ukwelashwa kwengqondo ezindleleni eziningi zokuphatha ubuhlungu obungapheli ziningi. Lokhu kufaka phakathi, kodwa akukhawulelwe, ukwandisa ukuzilawula kobuhlungu, izinsiza ezithuthukisiwe zokubhekana nobuhlungu, ukunciphisa ukukhubazeka okuhlobene nobuhlungu, nokunciphisa ukucindezeleka ngokomzwelo-ukuthuthukiswa okwenziwa ngezindlela ezihlukahlukene eziphumelelayo zokuzilawula, ukuziphatha, nokuqonda. amasu. Ngokuqaliswa kwalezi zinguquko, isazi sokusebenza kwengqondo singasiza ngokuphumelelayo iziguli ukuba zizwe kangcono ekulawuleni ubuhlungu bazo futhi zibenze bakwazi ukuphila ngendlela evamile ngangokunokwenzeka naphezu kobuhlungu. Ngaphezu kwalokho, amakhono afundwa ngokungenelela kwengqondo anika amandla futhi enze iziguli zibe abahlanganyeli abakhuthele ekulawuleni ukugula kwazo futhi zigxilise amakhono abalulekile iziguli ezingawasebenzisa ukuphila kwazo zonke. Izinzuzo ezengeziwe zendlela ehlanganisiwe nephelele yokuphatha ubuhlungu obungapheli ingase ihlanganise amanani akhuphukayo okubuyela emsebenzini, ukunciphisa izindleko zokunakekelwa kwezempilo, nokwandisa izinga lokuphila elihlobene nempilo ezigidini zeziguli emhlabeni wonke.

 

Isithombe somqeqeshi onikeza isiguli iseluleko sokuqeqesha.

 

Imibhalo yaphansi

 

Ukudalula: Akukho ukungqubuzana kwezintshisekelo okumenyezelwe mayelana naleli phepha.

 

Ekuphetheni, ukungenelela kwengqondo kungasetshenziswa ngokuphumelelayo ukusiza ukukhulula izimpawu zobuhlungu obungapheli kanye nokusetshenziswa kwezinye izindlela zokwelapha, njengokunakekelwa kwe-chiropractic. Ngaphezu kwalokho, ucwaningo locwaningo olungenhla lubonise ukuthi ukungenelela okuqondile okungokwengqondo kungathuthukisa kanjani izinyathelo zomphumela wokuphathwa kobuhlungu obungapheli. Ulwazi olubalulwe ku-National Center for Biotechnology Information (NCBI). Ububanzi bolwazi lwethu bukhawulelwe ku-chiropractic kanye nokulimala komgogodla nezimo. Ukuze uxoxe ngesihloko, sicela ukhululeke ukubuza uDkt. Jimenez noma usithinte ku 915-850-0900 .

 

Ikhethwe nguDkt Alex Jimenez

 

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

 

Izihloko Ezengeziwe: Ubuhlungu Emuva

 

Ngokwezibalo, cishe i-80% yabantu izothola izimpawu zobuhlungu beqolo okungenani kanye kukho konke ukuphila kwabo. Ukuhlungu obusemhlane isikhalazo esivamile esingaba umphumela ngenxa yokulimala okuhlukahlukene kanye/noma izimo. Izikhathi eziningi, ukuwohloka kwemvelo komgogodla ngeminyaka kungabangela ubuhlungu emuva. Ama-discs we-Herniated kwenzeka lapho isikhungo esithambile, esifana nejeli se-intervertebral disc siphusha izinyembezi endaweni ezungezile, indandatho yangaphandle ye-cartilage, ukucindezela nokucasula izimpande zemizwa. Ama-Disc herniations avame ukwenzeka emhlane ophansi, noma i-lumbar spine, kodwa kungenzeka futhi eduze nomgogodla womlomo wesibeletho, noma intamo. Ukufakwa kwezinzwa ezitholakala emhlane ophansi ngenxa yokulimala kanye/noma isimo esishubile kungaholela ezimpawini ze-sciatica.

 

isithombe sebhulogi kakhathuni paperboy izindaba ezinkulu

 

ISIHLOKO ESIBALULEKE KANYE: Ukuphatha Ingcindezi Yasemsebenzini

 

 

IZIHLOKO EZIBALULEKE KANYE: ENGEZIWE NGENXA YENZA: Ukwelashwa Kokulimala Kwengozi Yemoto El Paso, TX Chiropractor

 

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Vala i-Accordion
Ukungenelela Kwengqondo Ngekhanda Elibuhlungu Elingapheli e-El Paso, TX

Ukungenelela Kwengqondo Ngekhanda Elibuhlungu Elingapheli e-El Paso, TX

by | I-Chiropractic, Izimo zenziwe, Ukuvuselelwa Kwemvelo, Isivivinyo Esilawulwa Ngokungahleliwe, Ukucindezeleka, Ukwelashwa

Uma uke waphathwa yikhanda, awuwedwa. Cishe abantu abangu-9 kwabangu-10 e-United States baphathwa yikhanda elibuhlungu. Nakuba ezinye ziphakathi, ezinye zivamile, ezinye zibuthuntu futhi zishaya, futhi ezinye zibangela ubuhlungu obuqeda amandla kanye nesicanucanu, ukususa ubuhlungu bekhanda kuyimpendulo esheshayo kwabaningi. Kodwa, ungakwazi kanjani ukukhulula ubuhlungu bekhanda ngokuphumelelayo?

 

Ucwaningo luye lwabonisa ukuthi ukunakekelwa kwe-chiropractic kuyindlela yokwelapha ehlukile ephumelelayo yezinhlobo eziningi zekhanda. Umbiko we-2014 ku-Journal of Manipulative and Physiological Therapeutics (JMPT) wathola ukuthi ukulungiswa komgogodla kanye nokuphathwa ngesandla okusetshenziselwa ukunakekelwa kwe-chiropractic kuthuthukisa izinyathelo zomphumela wokwelapha ubuhlungu obungapheli nobubuhlungu bentamo kanye nokuthuthukisa izinzuzo zezindlela ezihlukahlukene zokwelashwa ubuhlungu bentamo. Ngaphezu kwalokho, ucwaningo lwe-2011 JMPT lwathola ukuthi ukunakekelwa kwe-chiropractic kungathuthukisa futhi kunciphise imvamisa ye migraine kanye nekhanda le-cervicogenic.

 

I-Chiropractic Care Iphatha Kanjani Ikhanda Lekhanda?

 

Ukunakekelwa kwe-Chiropractic kugxile ekwelapheni izinhlobonhlobo zokulimala kanye / noma izimo zesistimu ye-musculoskeletal kanye nezinzwa, kuhlanganise nekhanda elibuhlungu. Isazi se-chiropractor sisebenzisa ukulungiswa komgogodla kanye nokuxhaphaza ngesandla ukuze kulungiswe ngokucophelela ukulungiswa komgogodla. I-subluxation, noma ukungahambi kahle komgogodla, kuboniswe ukuthi kubangele izimpawu, njengentamo kanye ukuhlungu obusemhlane, nekhanda elibuhlungu kanye migraine. Umgogodla olinganiselayo ungathuthukisa umsebenzi womgogodla kanye nokunciphisa ukucindezeleka kwesakhiwo. Ukwengeza, udokotela we-chiropractic angasiza ekwelapheni ubuhlungu bekhanda nezinye izimpawu ezibuhlungu ngokunikeza iseluleko sokudla okunempilo, ukunikeza iseluleko sokuma kanye ne-ergonomics nokuncoma ukuphathwa kokucindezeleka kanye nezeluleko zokuzivocavoca. Ukunakekelwa kweChiropractic ekugcineni kungadambisa ukungezwani kwemisipha eduze kwezakhiwo ezizungezile zomgogodla, kubuyisele umsebenzi wokuqala womgogodla.

 

UDkt Alex Jimenez wenza ukulungiswa kwe-chiropractic esigulini.

 

UDkt Alex Jimenez unikeza iseluleko sokufaneleka esigulini.

 

Ngaphezu kwalokho, ukunakekelwa kwe-chiropractic kungaphatha ngokuphepha nangempumelelo ezinye izinkinga zempilo yomgogodla, kuhlanganise nezimpawu zentamo kanye nobuhlungu obuphansi emuva ngenxa yomlomo wesibeletho kanye ne-lumbar herniated discs, phakathi kokunye ukulimala kanye / noma izimo. Isazi se-chiropractor siyaqonda ukuthi ukungahambi kahle komgogodla, noma i-subluxation, kungathinta kanjani izindawo ezahlukene zomzimba futhi bazophatha umzimba wonke kunokuba bagxile ebonakalisweni kuphela. Ukwelashwa kwe-Chiropractic kungasiza umzimba womuntu ngokwemvelo ukubuyisela impilo nempilo yawo yasekuqaleni.

 

Ukusebenzisana komqeqeshi nesiguli esikhungweni sokuhlunyeleliswa kwezimilo.

 

Kuyaziwa ukuthi ukunakekelwa kwe-chiropractic kuphumelela ezinhlobonhlobo zokulimala kanye / noma izimo, noma kunjalo, eminyakeni embalwa edlule, izifundo zocwaningo zithole ukuthi i-chiropractic ingathuthukisa inhlalakahle yethu ngokulawula ukucindezeleka kwethu. Iningi lalezi zifundo zocwaningo lwakamuva libonise ukuthi ukunakekelwa kwe-chiropractic kungashintsha ukusebenza komzimba, kuthinte ukushaya kwenhliziyo, futhi kunciphise nomfutho wegazi. Ucwaningo lwe-2011 oluvela eJapane lubonise ukuthi i-chiropractic ingaba nethonya elikhulu kakhulu emzimbeni wakho kunokuba ukholelwa.

 

Ukucindezeleka kuyinkomba ebalulekile yempilo, futhi izimpawu zobuhlungu obungapheli zingathinta kakhulu ukuphila kahle. Abacwaningi baseJapane bafuna ukuhlola ukuthi i-chiropractic ingashintsha amazinga okucindezeleka kumadoda nabesifazane be-12 abanezinhlungu zentamo nekhanda. Kodwa ososayensi baseJapane babefuna ukuthola isithombe esinenhloso eyengeziwe yokuthi ukuguqulwa komgogodla we-chiropractic kanye nokuphathwa ngesandla kuthinta kanjani isimiso sezinzwa, ngakho-ke basebenzisa ama-PET scans ukuqapha umsebenzi wobuchopho kanye nokuhlolwa kwe-salvia ukuqapha izinguquko ze-hormone.

 

Ngemuva kokunakekelwa kwe-chiropractic, iziguli zaziguqule umsebenzi wobuchopho ezindaweni zobuchopho ezibhekene nokucubungula ubuhlungu nokusabela kokucindezeleka. Futhi babenciphise kakhulu amazinga e-cortisol, okubonisa ukuncipha kwengcindezi. Abahlanganyeli baphinde babika amaphuzu aphansi ezinhlungu kanye nezinga eliphezulu lempilo ngemva kokwelashwa. Ukungenelela kwengqondo, njengokunakekelwa kwe-chiropractic, kuyindlela eyisisekelo yokulawula ukucindezeleka kanye namasu. Ukucindezeleka okungapheli kungaholela ezinkingeni zezempilo ezihlukahlukene, kuhlanganise nobuhlungu bentamo nomhlane kanye nekhanda elibuhlungu kanye ne-migraine. Okunye ukungenelela kokucabangela nakho kungasiza ngokuphepha nangempumelelo ukuthuthukisa izimpawu. Inhloso yalesi sihloko esilandelayo ukukhombisa ukuphumelela kokunye ukungenelela kwengqondo, okwaziwa ngokuthi ukunciphisa ukucindezeleka okusekelwe engqondweni, ekubonweni kobuhlungu obukhulu kanye nekhwalithi yokuphila ezigulini ezitholwe ngaphambilini zinekhanda elibuhlungu elingapheli.

 

Ukusebenza Kokuncishiswa Kwengcindezi Okusekelwe Engqondweni Kubukhulu Bobuhlungu Okucatshangwayo kanye Nekhwalithi Yempilo Ezigulini Eziphethwe Ikhanda Elibuhlungu

 

abstract

 

Inhloso yalolu cwaningo kwakuwukunquma ukuphumelela kokunciphisa Ukucindezeleka Okusekelwe Ekucabangeni (MBSR) ekubonweni kobuhlungu obukhulu kanye nekhwalithi yokuphila ezigulini ezinekhanda elibuhlungu elingapheli. Ngakho-ke, iziguli ezingamashumi amane ezisekelwe ekuxilongweni kwe-neurologist kanye ne-diagnostic criteria ye-International Headache Society (IHS) ye-migraine kanye nekhanda elibuhlungu elingapheli likhethiwe futhi labelwa ngokungahleliwe eqenjini lokungenelela kanye neqembu lokulawula, ngokulandelana. Abahlanganyeli bagcwalise uhlu lwemibuzo Lobuhlungu kanye nekhwalithi yokuphila (SF-36). Iqembu lokungenelela libhalise ohlelweni lwe-MBSR lwamasonto ayisishiyagalombili oluhlanganisa ukuzindla nokusebenza kwansuku zonke kwasekhaya, ngesonto, iseshini yemizuzu ye-90. Imiphumela yokuhlaziywa kwe-covariance ngokuqedwa kokuhlolwa kwangaphambili kubonise ukuthuthukiswa okuphawulekayo kobuhlungu kanye nekhwalithi yokuphila eqenjini lokungenelela uma kuqhathaniswa neqembu lokulawula. Okutholakele kulolu cwaningo kwembule ukuthi i-MBSR ingasetshenziswa ukungenelela okungezona ezemithi ukuze kuthuthukiswe izinga lokuphila nokuthuthukiswa kwamasu okubhekana nobuhlungu ezigulini ezinekhanda elibuhlungu elingapheli. Futhi ingasetshenziswa ngokuhlanganiswa nezinye izindlela zokwelapha ezifana ne-pharmacotherapy.

 

Amagama angukhiye: ubuhlungu obungapheli, ikhanda elibuhlungu, ukucabangela, izinga lempilo, ikhanda elibuhlungu

 

UDkt Jimenez White Coat

Ukuqonda kukaDkt Alex Jimenez

Ikhanda elibuhlungu elingapheli yizimpawu eziqeda amandla ezithinta abantu abaningi. Kunezinhlobo eziningi ezahlukene zekhanda elibuhlungu, noma kunjalo, iningi lazo livame ukwabelana nge-trigger evamile. Ukucindezeleka okungapheli kungabangela izinkinga ezihlukahlukene zezempilo ezingalawulwa kahle, okuhlanganisa ukungezwani kwemisipha, okungase kuholele ekungaqondisweni kahle komgogodla, noma ukuzithoba, kanye nezinye izimpawu, ezifana nobuhlungu bentamo neqolo, ubuhlungu bekhanda kanye ne-migraines. Izindlela namasu okulawula ukucindezeleka ekugcineni angasiza ekuthuthukiseni nasekulawuleni izimpawu ezihambisana nokucindezeleka. Ukungenelela kwengqondo njengokunakekelwa kwe-chiropractic kanye nokunciphisa ukucindezeleka okusekelwe engqondweni kuye kwanqunywa ukusiza ngokuphumelelayo ukunciphisa ukucindezeleka nokunciphisa izimpawu zekhanda elingapheli.

 

Isingeniso

 

Ubuhlungu bekhanda ngesinye sezikhalazo ezivame ukuphenywa emitholampilo yabantu abadala kanye neyezingane. Iningi lalezi zinhlungu zekhanda yi-migraine kanye nohlobo lwekhanda elicindezelayo (Kurt & Kaplan, 2008). Izinhlungu zekhanda zihlukaniswa zibe izigaba ezimbili zekhanda eliyinhloko noma eliyinhloko nelesibili. Amaphesenti angamashumi ayisishiyagalolunye ekhanda elibuhlungu yikhanda eliyinhloko, phakathi kwazo i-migraine kanye nokucindezeleka kwekhanda yizinhlobo ezivame kakhulu (International Headache Society [IHS], 2013). Ngokusho kwencazelo, ikhanda elibuhlungu le-migraine ngokuvamile lihlangene kanye ne-pulsating ngokwemvelo futhi lihlala kusukela emahoreni angu-4 kuya kwangu-72. Izimpawu ezihambisanayo zihlanganisa isicanucanu, ukuhlanza, ukwanda kokuzwela ekukhanyeni, umsindo nobuhlungu, futhi ngokuvamile kwanda ngokwanda kokuzivocavoca umzimba. Futhi, ubuhlungu bekhanda lokucindezeleka bubonakala ubuhlungu obuhlangene, obungaguquki, ingcindezi noma ukucinana, ubuhlungu obungaqondile, njengebhandeji noma isigqoko, nokuqhubeka kobuhlungu obuncane kuya kokulinganisela, okuvimbela imisebenzi yokuphila yansuku zonke (IHS, 2013).

 

U-Stovner et al. (2007) besebenzisa i-IHS diagnostic criteria, balinganisela amaphesenti abantu abadala abanenkinga yekhanda elisebenzayo mayelana ne-46% yekhanda elibuhlungu ngokujwayelekile, i-42% yekhanda lohlobo lokucindezeleka. Lokhu kusikisela ukuthi isigameko kanye nokusabalala kwekhanda lohlobo lwe-tension liphezulu kakhulu kunalokho okwakubikezelwe. Kulinganiselwa ukuthi cishe amaphesenti angu-12 kuya kwangu-18 abantu abane-migraines (Stovner & Andree, 2010). Abesifazane banamathuba amaningi okuba ne-migraines uma kuqhathaniswa namadoda, ukuvama kwe-migraine cishe ku-6% kwabesilisa kanye ne-18% kwabesifazane (Tozer et al., 2006).

 

I-Migraine kanye nohlobo lwekhanda lokucindezeleka yizimpendulo ezivamile futhi ezibhalwe kahle ezinkingeni ezingokwengqondo nezomzimba (Menken, Munsat, & Toole, 2000). I-Migraine ubuhlungu obungapheli ngezikhathi ezithile futhi obunzima futhi bunomthelela omubi ezingeni lempilo, ubudlelwano kanye nokukhiqiza. I-World Health Organization (WHO) imemezele i-migraine enzima njengenye yezifo ezikhubaza kakhulu ezinezinga leshumi nesishiyagalolunye (IHS, 2013; Menken et al., 2000).

 

Naphezu kokuthuthukiswa kwemithi eminingi yokwelapha nokuvimbela ukuhlaselwa yi-migraine, iziguli eziningi ziyithola ingasebenzi kanti ezinye ziyithola ingafaneleki ngenxa yemiphumela yazo engemihle kanye nemiphumela engemihle evame ukuholela ekuyekisweni kokwelashwa kusenesikhathi. Njengomphumela, intshisekelo enkulu ekuthuthukisweni kwemithi yokwelapha engeyona eyekhemisi ingabonwa (Mulleners, Haan, Dekker, & Ferrari, 2010).

 

Izici zezinto eziphilayo zizodwa azikwazi ukuchaza ubungozi ekuhlangenwe nakho kwekhanda elibuhlungu, ukuqala kokuhlasela kanye nenkambo yako, ukuhlaselwa okunamandla kwekhanda elibuhlungu, ukukhubazeka okuhlobene nekhanda kanye nezinga lempilo ezigulini ezinekhanda elingapheli. Izehlakalo zempilo ezingezinhle (njengesici esingokwengqondo nenhlalakahle) ezivamise ukwaziwa njengesici esibalulekile ekukhuleni nasekukhuliseni ikhanda elibuhlungu (Nash & Thebarge, 2006).

 

Uhlelo lwe-Mindfulness-Based Stress Reduction (MBSR) luphakathi kwezokwelapha, eziye zafundwa emashumini amabili eminyaka adlule ezinhlobonhlobo zobuhlungu obungapheli. I-MBSR ithuthukiswe nguKabat-Zinn futhi isetshenziswe ezinhlobonhlobo zabantu abanezinkinga ezihlobene nokucindezeleka nobuhlungu obungapheli (Kabat-Zinn, 1990). Ikakhulukazi eminyakeni yamuva, izifundo eziningi zenziwe ukuze kuhlolwe imiphumela yokwelapha ye-MBSR. Ucwaningo oluningi lubonise imiphumela ebalulekile ye-MBSR ezimweni ezingokwengqondo ezahlukene ezihlanganisa ukunciphisa izimpawu ezingokwengqondo zokucindezeleka, ukukhathazeka, ukuvuthwa, ukukhathazeka nokucindezeleka (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), ubuhlungu (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) kanye nezinga lempilo (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. (I-2010) yenza ukuhlaziywa kwemeta yezifundo eziyisishiyagalombili ezilawulwa ngokungahleliwe emiphumeleni yohlelo lwe-MBSR, yaphetha ngokuthi i-MBSR inemiphumela emincane yokucindezeleka, ukukhathazeka nokucindezeleka kwengqondo kubantu abanezifo zezokwelapha ezingapheli. Futhi uGrossman et al. (2004) ekuhlaziyweni kwe-meta yezifundo ezilawulwayo nezingalawuleki ze-20 emiphumeleni yohlelo lwe-MBSR empilweni engokomzimba nengokwengqondo yamasampula ezokwelapha nezingezona ezezokwelapha, kutholwe usayizi womphumela wokulingene wezifundo ezilawulwayo empilweni yengqondo. Abekho osayizi bomphumela bezimpawu ezithile ezinjengokucindezeleka nokukhathazeka okubikiwe. Ukubuyekezwa kwakamuva kuhlanganisa izifundo ze-16 ezilawulwayo nezingalawulwa, Lokhu kubuyekezwa kubika ukuthi ukungenelela kwe-MBSR kunciphisa ubuhlungu obukhulu, futhi izifundo zokuhlola ezilawulwa kakhulu (i-6 ye-8) zibonisa ukunciphisa okuphezulu kokuqina kobuhlungu beqembu lokungenelela uma kuqhathaniswa neqembu lokulawula (Reiner, Tibi, & Lipsitz, 2013).

 

Kwesinye isifundo, abacwaningi bathola osayizi ababalulekile bomphumela wezinye izilinganiso zekhwalithi yokuphila ngokwesibonelo isikali sokuphila kanye nobuhlungu bomzimba, osayizi abangabalulekile bomphumela wobuhlungu kanye nemiphumela ebalulekile ephakathi kuya kobukhulu yokukhathazeka okujwayelekile nokucindezeleka (La Cour & Petersen, 2015) . Futhi ocwaningweni lukaRosenzweig et al. (2010) ezigulini ezinezinhlungu ezingapheli kuhlanganise nalabo abahlukunyezwa yi-migraine, kwakukhona umehluko omkhulu ekuqineni kobuhlungu, ukulinganiselwa kokusebenza okuhlobene nobuhlungu phakathi kweziguli. Kodwa-ke, labo abahlushwa i-migraine bathola ukuthuthukiswa okuphansi kakhulu kobuhlungu kanye nezici ezihlukene zekhwalithi yokuphila. Ngokuvamile, amaqembu ahlukene obuhlungu obungapheli abonise ukuthuthukiswa okuphawulekayo ekuqineni kobuhlungu kanye nemikhawulo yokusebenza ehlobene nobuhlungu kulolu cwaningo. Ezinye izifundo ezimbili zenziwa nguKabat-Zinn futhi zisebenzisa izindlela ze-MBSR zokuphatha iziguli ezinobuhlungu obungapheli, kuhlanganise nenani leziguli ezinekhanda elibuhlungu elingapheli. Ukuhlaziywa kwezibalo kubonise ukunciphisa okukhulu kobuhlungu, ukuphazamiseka kobuhlungu emisebenzini yansuku zonke, izimpawu nezimpawu zezokwelapha nezengqondo, ukukhathazeka nokucindezeleka, isithombe esibi somzimba, ukuphazamiseka kobuhlungu emisebenzini yansuku zonke, ukusetshenziswa kwezidakamizwa kanye nokwanda kokuzethemba (Kabat-Zinn, 1982; Kabat-Zinn et al., 1985).

 

Ngenxa yobuhlungu nokulahlekelwa umsebenzi kanye nokuncipha kokukhiqiza komsebenzi kanye nokusetshenziswa okwengeziwe kokunakekelwa kwezempilo, ikhanda elibuhlungu elingapheli libeka izindleko kumuntu ngamunye nasemphakathini, kubonakala sengathi ubuhlungu bekhanda obungapheli buyinkinga enkulu yezempilo futhi ukuthola izindlela zokulawula nokwelapha le nkinga kungaba ukubaluleka okukhulu. Inhloso eyinhloko yalolu cwaningo kwakuwukuhlola ukusebenza kahle kwe-MBSR ngaphezu kwe-pharmacotherapy evamile kusampula yabantu basemtholampilo yeziguli ezinekhanda elibuhlungu elingapheli ukukhombisa ukuphumelela kwale nqubo njengendlela yokuphatha ubuhlungu nokuthuthukiswa kwekhwalithi yokuphila ezigulini. nekhanda elibuhlungu elingapheli.

 

izindlela

 

Abahlanganyeli kanye nenqubo

 

Lolu uhlolo olulawulwa ngokungahleliwe lwedizayini yocwaningo lwamaqembu amabili �pretest-posttest�. Kuphinde kwatholakala imvume eKomidini Lezimiso Zokuziphatha lase-Zahedan University of Medical Science. Abahlanganyeli bakhethe ngokusebenzisa indlela elula yokusampula ezigulini ezine-migraine engapheli kanye nekhanda elibuhlungu, elitholwe udokotela wezinzwa kanye nodokotela wengqondo esebenzisa i-IHS diagnostic criteria-okubhekiswe ezibhedlela zasenyuvesi yaseZahedan University of Medical Sciences, Zahedan-Iran.

 

Ngemva kokuhlola isiguli ngasinye ukuze kuhlangatshezwane nenqubo yokufakwa kanye nokukhishwa ngaphandle nokuthatha inhlolokhono yokuqala, i-40 kweziguli eziyinhloko ezingamashumi ayisishiyagalombili nesikhombisa ezinekhanda elibuhlungu elingapheli zikhethiwe futhi zabelwa ngokungahleliwe zibe ngamaqembu amabili alinganayo okungenelela nokulawula. Kokubili amaqembu okulawula nokungenelela athola i-pharmacotherapy evamile ngaphansi kokuqondisa kwe-neurologist. Phakathi neseshini yokwelapha izifundo ezintathu, ngenxa yokuntuleka kokuba khona njalo noma imibandela yokukhishwa, yaphuma noma yakhishwa ngaphandle ocwaningweni.

 

Izinyathelo Zokufaka

 

  • (1) Imvume enolwazi lokubamba iqhaza kumaseshini.
  • (2) Ubudala obuncane beminyaka eyi-18.
  • (3) Iziqu zemfundo ezincane zeziqu zesikole esiphakathi.
  • (4) Ukuxilongwa kwekhanda elibuhlungu elingapheli (i-migraine eyinhloko engapheli kanye nekhanda lokucindezeleka) yi-neurologist futhi ngokusho kwe-IHS criteria yokuxilonga.
  • (5) Izinsuku ezingu-15 noma ngaphezulu ngenyanga ngaphezu kwezinyanga ze-3 kanye nomlando wezinyanga eziyisithupha we-migraines kanye nohlobo lwekhanda lokucindezeleka

 

Izinyathelo zokungabikho

 

  • (1) Izifundo ebezingazimisele ukuqhubeka nokubamba iqhaza ocwaningweni noma zishiye ucwaningo nganoma yisiphi isizathu.
  • (2) Ezinye izinkinga zobuhlungu obungapheli.
  • (3) I-Psychosis, i-delirium kanye nokuphazamiseka kwengqondo.
  • (4) Amacala obunzima bokusebenzelana nabanye abantu okuphazamisa ukusebenza kweqembu.
  • (5) Ukusebenzisa kabi izidakamizwa nezidakamizwa.
  • (6) Ukuphazamiseka kwemizwa

 

Amaqembu angenelela

 

Izikhathi zokwelapha (MBSR) zabanjwa nge-1.5 kumahora we-2 ngesonto kumalungu eqembu lokungenelela (izidakamizwa kanye ne-MBSR); Nakuba kungekho MBSR eyenzelwe iqembu lokulawula (izidakamizwa ezivamile kuphela ezisetshenziswa) kuze kube sekupheleni kocwaningo. I-MBSR yenziwa amasonto angu-8. Kulolu cwaningo, uhlelo lwe-MBSR lwe-8-session (Chaskalon, 2011) lusetshenzisiwe. Ukwenza umsebenzi wasekhaya wokuzindla ngenkathi uqeqesha ababambiqhaza ngezikhathi, izinyathelo ezidingekayo zihlinzekwe nge-CD kanye nencwajana. Uma esinye sezifundo singazange sibambe iqhaza kuseshini noma iseshini, ekuqaleni kweseshini elandelayo umelaphi uzohlinzeka ngamanothi abhaliwe ezikhathi ezifundweni, ngaphezu kokuphinda izifinyezo zeseshini yangaphambilini. Uhlelo lwe-MBSR nezingxoxo zethulwe ezigulini ezimisweni eziyisishiyagalombili ezihlanganisa: ukuqonda ubuhlungu kanye ne-aetiology yayo, xoxa ngokucindezeleka kobudlelwane, intukuthelo nemizwelo ngobuhlungu, Ukuqonda imicabango ezenzakalelayo engalungile, ukuhlonza imicabango nemizwa, ukwethula umqondo Wokwamukela, indawo yokuphefumula. , indawo yokuphefumula yemizuzu emithathu, ukuvivinya umzimba kokugxilwa kokuphefumula, izehlakalo ezijabulisayo nezingajabulisi nsuku zonke, ukwenza kusebenze ukuziphatha, ukunaka umsebenzi ovamile, ukujwayela ukuskena umzimba, Ukuvivinya umzimba ukubona nokuzwa, ukuzindla uhlezi, ukuhamba kahle, ukufunda izinkondlo ezihlobene nokucabanga futhi kuxoxwe ngendlela qhubekani nalokho okuthuthukiswe kuso sonke isifundo, xoxani ngezinhlelo nezizathu ezinhle zokulondoloza umkhuba. Iziguli ziphinde zathola ulwazi mayelana nokufunda indlela yokubona noma yikuphi ukubuyela emuva esikhathini esizayo kanye namasu nezinhlelo okusekelwe kuzo ukutholwa kusenesikhathi kokuhlaselwa yizinhlungu zezimpawu kanye nokuziqondisa wena ezimweni ezintsha.

 

Iqembu Lokulawula

 

Iziguli ezazihlelwe ngokungahleliwe eqenjini lokulawula zaziqhubeka ne-pharmacotherapy evamile (kuhlanganise nezidakamizwa ezithile nezingaqondile) yi-neurologist yazo kuze kube sekupheleni kocwaningo.

 

zomculo

 

Amathuluzi amabili ayinhloko asetshenziswe ekuhlolweni kwangaphambili nangemuva kokuhlolwa ukuze kuqoqwe idatha, ngaphezu kwefomu lemininingwane yabantu. Ilogi yekhanda elibuhlungu lalisetshenziselwa ukucacisa ubukhulu obubonakalayo bobuhlungu besebenzisa izingxenye ezintathu: (1) izilinganiso ze-likert-scale ze-10-point, (2) inani lamahora obuhlungu ngosuku kanye (3) imvamisa yobuhlungu phakathi nenyanga. Ingxenye ngayinye inikezwa amaphuzu ukusuka ku-0 kuya ku-100, izinga eliphakeme kakhulu liyi-100. Njengoba isiguli ngasinye silinganisa ukuqina kwaso okucatshangelwayo kuhlu lwemibuzo, ukufaneleka nokwethembeka akucatshangelwa. Futhi enye kwakuwuhlu lwemibuzo olufushane lwe-36 (SF-36). Uhlu lwemibuzo lusebenza emaqenjini eminyaka ahlukahlukene kanye nezifo ezahlukahlukene. Ukuthembeka nokuba semthethweni kohlu lwemibuzo kuvunywe u-Ware et al (Ware, Osinski, Dewey, & Gandek, 2000). I-SF-36 ihlola umbono wezinga lempilo kuma-subscales angu-8 ahlanganisa: ukusebenza ngokomzimba (PF), ukulinganiselwa kwendima ngenxa yempilo yomzimba (RP), ubuhlungu bomzimba (PB), impilo jikelele (GH), amandla kanye namandla (VT) ), ukusebenza komphakathi (SF), ukulinganiselwa kwendima ngenxa yezinkinga ezingokomzwelo (RE) futhi kuthinte impilo (AH). Ithuluzi futhi linezilinganiso ezimbili ezifingqiwe zezikolo ze-Physical Component Summary (PCS) kanye ne-Mental Component Summary (MCS). Isikali ngasinye sithola amaphuzu ukusuka ku-0 kuye ku-100, izinga eliphakeme kakhulu lesimo sokusebenza ngu-100. Ukufaneleka nokuthembeka kwe-SF-36 kwahlolwa kubantu base-Iranian. Ama-coefficient angaphakathi wokuvumelana abephakathi kuka-0.70 no-0.85 kuma-subscales angu-8 futhi ama-coefficients wokuhlola kabusha abephakathi kuka-0.49 no-0.79 ngesikhawu seviki elilodwa (Montazeri, Goshtasebi, Vahdaninia, & Gandek, 2005).

 

Ukuhlaziya Data

 

Ukuze kuhlaziywe idatha, ngaphezu kokusetshenziswa kwezinkomba ezichazayo, ukuqhathanisa imiphumela yamaqembu okungenelela nokulawula, ukuhlaziywa kwe-covariance kusetshenziselwa ukucacisa ukusebenza kahle nokususwa kwemiphumela yokuhlolwa kwangaphambili ku-95% izinga lokuzethemba.

 

Shiya phansi

 

Phakathi neseshini yokwelapha izifundo ezintathu, ngenxa yokuntuleka kokuba khona njalo noma imibandela yokukhishwa, yaphuma noma yakhishwa ngaphandle ocwaningweni. Iziguli ezingamashumi amathathu nesikhombisa kwezingama-40 zaphothula ucwaningo lwamanje futhi idatha eqoqiwe yabe isihlaziywa.

 

Imiphumela

 

Ukuhlaziywa kokuqhathanisa ukusatshalaliswa kwabantu phakathi kwamaqembu amabili kwenziwe kusetshenziswa i-chi-square ne-t-test ezimele. Idatha yezibalo zabantu bamaqembu womabili iboniswa kuThebula 1. Ukusatshalaliswa kweminyaka yobudala, iminyaka yokufunda, ubulili nesimo somshado bekufana eqenjini ngalinye.

 

Ithebula 1 Izimpawu Zezibalo Zabahlanganyeli

Ithebula 1: Izici zezibalo zabahlanganyeli.

 

Ithebula 2 libonisa imiphumela yokuhlaziywa kwe-covariance (ANCOVA). Ukuhlolwa kuka-Levene kwakungabalulekile, F (1, 35) = 2.78, P = 0.105, okubonisa ukuthi ukuqagela kokuhlukahluka kokuhluka kwakuvunyelwe. Lokhu kuthola kubonisa ukuthi ukuhlukana emaqenjini kuyalingana futhi akukho mehluko obonwe phakathi kwamaqembu amabili.

 

Ithebula 2 Imiphumela ye-Covarice Analysis

Ithebula 2: Imiphumela yokuhlaziywa kwe-covariance ekusebenzeni kwe-MBSR ekuqineni kobuhlungu.

 

Umphumela oyinhloko wokungenelela kwe-MBSR wawubalulekile, F (1, 34) = 30.68, P = 0.001, ingxenye?2 = 0.47, okubonisa ukuthi ukuqina kobuhlungu kwakuphansi ngemva kokungenelela kwe-MBSR (Mean = 53.89, SD.E = 2.40) kune iqembu lokulawula (Mean = 71.94, SD.E = 2.20). I-covariate (ngaphambi kokuhlolwa kobuhlungu) nayo yayibalulekile, F (1, 34) = 73.41, P = 0.001, ingxenye?2 = 0.68, ebonisa ukuthi izinga lokuqina kobuhlungu ngaphambi kokungenelela kwe-MBSR kwaba nomthelela omkhulu ezingeni lokuqina kobuhlungu. . Ngamanye amazwi, kwakukhona ubuhlobo obuhle kumaphuzu obuhlungu phakathi kokuhlolwa kwangaphambili kanye nokuhlolwa kwangemva kokuhlolwa. Ngakho-ke, i-hypothesis yokuqala yocwaningo iqinisekisiwe futhi ukwelashwa kwe-MBSR ekuqineni okubonakalayo kwakuphumelela ezigulini ezinekhanda elibuhlungu elingapheli futhi kunganciphisa ubukhulu bobuhlungu obubonakalayo kulezi ziguli. Wonke amanani abalulekile abikwa ku-p<0.05.

 

I-hypothesis yesibili yalolu cwaningo ukuphumelela kwenqubo ye-MBSR ngekhwalithi yokuphila ezigulini ezinekhanda elibuhlungu elingapheli. Ukuhlola ukuphumelela kwenqubo ye-MBSR ngekhwalithi yokuphila ezigulini ezinekhanda elingapheli futhi kuqedwe okuguquguqukayo okudidayo kanye nomphumela wokuhlolwa kwangaphambili, ukuhlaziywa kwedatha, ukuhlaziywa kwe-multivariate covariance (MANCOVA) kobukhulu bekhwalithi yokuphila isetshenziswa. lelo Thebula lesi-3 libonisa imiphumela yokuhlaziya eqenjini lokungenelela.

 

Ithebula 3 Imiphumela Yokuhlaziywa Kwe-Covariance

Ithebula 3: Imiphumela yokuhlaziywa kwe-covariance ekusebenzeni kwe-MBSR ngekhwalithi yokuphila.

 

Ithebula 3 libonisa imiphumela yokuhlaziywa kwe-covariance (MANCOVA). Ulwazi olulandelayo luyadingeka ukuze kuqondwe imiphumela ethulwe kuThebula lesi-3.

 

Ukuhlolwa kwebhokisi bekungabaluleki, F = 1.08, P = 0.320, okubonisa ukuthi ukuhluka�amatrices e-covariance ayafana emaqenjini amabili ngakho-ke ukucatshangelwa kwe-homogeneity kuyafinyelelwa. Futhi F (10, 16) = 3.153, P = 0.020, Wilks� Lambda = 0.33, ingxenye ?2 = 0.66, okubonisa ukuthi kwaba umehluko omkhulu phakathi kokuhlolwa kwangaphambilini kwamaqembu kokuhluka okuncikile.

 

Ukuhlolwa kukaLevene kwakungabalulekile kwezinye zezinto ezincikile ezihlanganisa i-[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; Ama-PC: F (1, 35) = 2.371, P = 0.133; I-VT: F (1, 35) = 4.52, P = 0.141; AH: F (1, 35) = 1.03, P = 0.318], okubonisa ukuthi ukucatshangwa kwe-homogeneity kokuhluka kwakuvunyelwe ezilinganisweni zekhwalithi yokuphila kanye nokuhlolwa kwe-Levene kwakubalulekile kwezinye izinto eziguquguqukayo ezincikile ezihlanganisa i-[RE: F (1, 35) = 4.27, P = 0.046; SF: F (1, 35) = 4.82, P = 0.035; I-MCS: F (1, 35) = 11.69, P = 0.002], ebonisa ukuthi ukucatshangwa kwe-homogeneity yokuhlukahluka kuye kwaphulwa ezilinganisweni ezingaphansi zekhwalithi yokuphila.

 

Umphumela oyinhloko wokungenelela kwe-MBSR wawubalulekile kwezinye iziguquguquko ezincike ku- [RP: F (1, 25) = 5.67, P = 0.025, ingxenye ?2 = 0.18; BP: F (1, 25) = 12.62, P = 0.002, ingxenye ?2 = 0.34; GH: F (1, 25) = 9.44, P = 0.005, ingxenye ?2 = 0.28; Ama-PC: F (1, 25) = 9.80, P = 0.004, ingxenye ?2 = 0.28; VT: F (1, 25) = 12.60, P = 0.002, ingxenye ?2 = 0.34; AH: F (1, 25) = 39.85, P = 0.001, ingxenye ?2 = 0.61; I-MCS: F (1, 25) = 12.49, P = 0.002, ingxenye ?2 = 0.33], le miphumela ibonisa ukuthi izilinganiso ze-RP, BP, GH, PCS, VT, AH, ne-MCS zaziphakeme ngemva kokungenelela kwe-MBSR [RP: Kusho = 61.62, SD.E = 6.18; BP: Kusho = 48.97, SD.E = 2.98; GH: Kusho = 48.77, SD.E = 2.85; Ama-PC: Kusho = 58.52, SD.E = 2.72; VT: Kusho = 44.99, SD.E = 2.81; AH: Kusho = 52.60, SD.E = 1.97; I-MCS: Kusho = 44.82, SD.E = 2.43] kuneqembu lokulawula [RP: Mean = 40.24, SD.E = 5.62; BP: Kusho = 33.58, SD.E = 2.71; GH: Kusho = 36.05, SD.E = 2.59; Ama-PC: Kusho = 46.13, SD.E = 2.48; VT: Kusho = 30.50, SD.E = 2.56; AH: Kusho = 34.49, SD.E = 1.80; MCS: Kusho = 32.32, SD.E = 2.21].

 

Noma kunjalo, umphumela oyinhloko wokungenelela kwe-MBSR wawungabalulekile kwezinye iziguquguquko ezincike ku- [PF: F (1, 25) = 1.05, P = 0.314, ingxenye ?2 = 0.04; RE: F (1, 25) = 1.74, P = 0.199, ingxenye ?2 = 0.06; SF: F (1, 25) = 2.35, P = 0.138, ingxenye ?2 = 0.09]. Le miphumela ebonisa, nakuba izindlela kulezi zilinganiso zekhwalithi yokuphila zaziphakeme [PF: Mean = 75.43, SD.E = 1.54; RE: Kusho = 29.65, SD.E = 6.02; SF: Kusho = 51.96, SD.E = 2.63] kuneqembu lokulawula [PF: Mean = 73.43, SD.E = 1.40; RE: Kusho = 18.08, SD.E = 5.48; SF: Kusho = 46.09, SD.E = 2.40], Kodwa umehluko weMean wawungabalulekile.

 

Kafushane, imiphumela yokuhlaziywa kwe-Covariance (MANCOVA) kuThebula 3 ibonisa umehluko ophawulekayo wezibalo ezilinganisweni zezilinganiso zokunciphisa indima ngenxa yempilo yomzimba (RP), ubuhlungu bomzimba (BP), impilo jikelele (GH), amandla kanye namandla (VT). ), Okuthinta impilo (AH) kanye nesamba sobukhulu bezempilo yomzimba (PCS) nempilo yengqondo (MCS). Futhi kubonisa ukuthi kwakungekho umehluko ophawulekayo wezibalo ezilinganisweni ezincane zokusebenza ngokomzimba (PF), ukulinganiselwa kwendima ngenxa yezinkinga zomzwelo (RE) kanye nokusebenza komphakathi (SF) eqenjini lokungenelela. Wonke amanani abalulekile abikwa ku-p<0.05.

 

Ingxoxo

 

Lolu cwaningo luhlose ukuhlola ukuphumelela kwe-MBSR ekubonakaleni kobuhlungu obukhulu kanye nekhwalithi yokuphila ezigulini ezinekhanda elibuhlungu elingapheli. Imiphumela yabonisa ukuthi ukwelashwa kwe-MBSR kwakuphumelela kakhulu ekunciphiseni ukuqonda kokuqina kobuhlungu. Imiphumela yocwaningo lwamanje ihambisana nemiphumela yabanye abacwaningi ababesebenzise indlela efanayo yobuhlungu obungapheli (isb. 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). Isibonelo, ezifundweni ezimbili eziqhutshwa yi-Kabat-Zinn, lapho uhlelo lwe-MBSR lusetshenziselwa ukwelapha iziguli ezinezinhlungu ezingapheli ngodokotela, iziguli eziningi ezinekhanda elibuhlungu elingapheli nazo zifakiwe. Ucwaningo lokuqala lwezifundo ezimbili, lubonise ukunciphisa okukhulu kobuhlungu, ukuphazamiseka kobuhlungu emisebenzini yansuku zonke, izimpawu zezokwelapha kanye nokuphazamiseka kwengqondo, kuhlanganise nokukhathazeka nokucindezeleka (Kabat-Zinn, 1982). Imiphumela yocwaningo lwesibili ibonise ukunciphisa okukhulu kobuhlungu, isithombe esibi somzimba, ukukhathazeka, ukucindezeleka, ukuphazamiseka kobuhlungu emisebenzini yansuku zonke, izimpawu zezokwelapha, ukusetshenziswa kwemithi, futhi kubonise ukwanda kokuzethemba (Kabat-Zinn et al., 1985) .

 

Futhi, okutholwe kocwaningo lwamanje kuhambisana nemiphumela kaRosenzweig et al. (2010), imiphumela yabo ibonisa ukuthi uhlelo lwe-MBSR lusebenza kahle ekunciphiseni, ubuhlungu bomzimba, izinga lokuphila kanye nenhlalakahle yengqondo yeziguli ezinezinhlungu ezihlukahlukene ezingapheli kanye nokucabangela kuphumelela ezingxenyeni ezingokomzwelo nezinzwa zombono wobuhlungu ngokuzilawula ukunakwa. ngemisebenzi yokuzindla. Nakuba imiphumela kaRosenzweig et al. (2010) ibonise ukuthi phakathi kweziguli ezinezinhlungu ezingapheli umthelela omncane ekunciphiseni ubuhlungu bomzimba kanye nokuthuthukiswa kwekhwalithi yokuphila kwakuhlobene neziguli ezine-fibromyalgia, ikhanda elibuhlungu. Kolunye ucwaningo olwenziwe nguFlugel et al. (2010), nakuba izinguquko ezinhle zabonwa emvamisa kanye nokuqina kobuhlungu, ukunciphisa ubuhlungu kwakungabalulekile ngezibalo.

 

Kwesinye isifundo, ubunzima bobuhlungu buyancipha kakhulu ngemva kokungenelela ezigulini ezinekhanda elibuhlungu. Ukwengeza, iqembu le-MBSR libonise amaphuzu aphezulu ekuqapheliseni okucabangelayo uma liqhathaniswa neqembu lokulawula (Omidi & Zargar, 2014). Ocwaningweni lokuhlola olwenziwa ngu-Wells et al. (2014), imiphumela yabo ibonise ukuthi i-MBSR ngokwelashwa kwemithi yayingenzeka ezigulini ezine-migraines. Nakuba ubukhulu besampula encane yalolu cwaningo lomshayeli aluzange lunikeze amandla okuthola umehluko omkhulu ebuhlungu obukhulu kanye nemvamisa ye-migraine, imiphumela yabonisa ukuthi lokhu kungenelela kwaba nomphumela onenzuzo ekuphathweni kwekhanda, ukukhubazeka, ukuzimela.

 

Ekuchazeni imiphumela yokuphumelela kwemithi yokwelapha esekelwe engqondweni yobuhlungu kungashiwo ukuthi, amamodeli angokwengqondo obuhlungu obungapheli njengemodeli yokugwema ukwesaba abonise ukuthi izindlela abantu abahumusha ngazo imizwa yabo yobuhlungu futhi baphendule kuzo ziyizinqumo ezibalulekile ku isipiliyoni sobuhlungu (Schutze, Rees, Preece, & Schutze, 2010). Inhlekelele yobuhlungu ihlotshaniswa kakhulu nokwesaba nokukhathazeka okubangelwa ubuhlungu, izindlela zokucabanga okungabangelwa ukwesaba ubuhlungu kanye nokukhubazeka okuhlobene nobuhlungu futhi ngenxa yokuthi ukuhlolwa kwengqondo okungalungile kobuhlungu kuchaza i-7 kuya ku-31% yobuhlungu. ukuhluka kokuqina kobuhlungu. Ngakho-ke, noma iyiphi indlela enganciphisa ubuhlungu obuyinhlekelele noma yenza izinguquko enqubweni yayo inganciphisa umbono wokuqina kobuhlungu nokukhubazeka okubangelwa yilokho. Schutz et al. (2010) baphikisa ngokuthi ukunaka okuncane kuyisiqalo sobuhlungu obudala inhlekelele. Eqinisweni, kubonakala sengathi ukuthambekela komuntu ukuzibandakanya ezinqubweni zokucubungula okuzenzakalelayo esikhundleni sezinqubo ezisekelwe olwazini ngokunaka ukungaguquguquki okwanele, kanye nokuntula ukuqaphela isikhathi samanje (Kabat-Zinn, 1990), kuzodala ukuthi abantu cabanga kabanzi ngobuhlungu futhi ngaleyo ndlela ulinganisele ngokweqile ingozi ewumphumela wabo. Ngakho-ke, ukucabangela okuncane kuvumela ukuthuthukiswa kokuhlolwa okungalungile kwengqondo kobuhlungu (Kabat-Zinn, 1990).

 

Esinye isizathu esingase sibe ukuthi ukwamukela ubuhlungu nokulungela ushintsho kukhulisa imizwelo eyakhayo, okuholela ekunciphiseni ubuhlungu obunamandla ngokusebenzisa imiphumela ohlelweni lwe-endocrine kanye nokukhiqizwa kwama-opioid angapheli kanye nokunciphisa ukukhubazeka okuhlobene nobuhlungu noma ukulungiselela abantu ukuba basebenzise amasu asebenzayo okubhekana nobuhlungu (Kratz, Davis, & Zautra, 2007). Esinye isizathu esingaba khona sokuchaza imiphumela yocwaningo lwamanje ekusebenzeni kwalo ekunciphiseni ubuhlungu kungaba yiqiniso lokuthi ubuhlungu obungapheli buthuthukiswa ngenxa yesistimu yokuphendula ukucindezeleka ngokweqile (Chrousos & Gold, 1992). Umphumela uba ukuphazamiseka kwezinqubo zomzimba nezengqondo. Ukucabangela kungavumela ukufinyelela ku-cortex yangaphambili futhi kuyithuthukise, izindawo zobuchopho ezihlanganisa imisebenzi yomzimba nengqondo (Shapiro et al., 1995). Umphumela uwukudalwa kokuvuselela okuncane okunciphisa ukushuba kanye nesipiliyoni sobuhlungu bomzimba nengqondo. Ngakho-ke, imizwa yobuhlungu ibonakala njengokuzwa ubuhlungu bangempela kunokuqashelwa okungalungile. Umphumela uwukuvalwa kwemigudu yobuhlungu enganciphisa ubuhlungu (Astin, 2004).

 

Ukuzindla Ngokucabangela Kwehlisa Ubuhlungu Ngokusebenzisa Izindlela Zobuchopho eziningana nezindlela ezihlukahlukene ezifana nokushintsha ukunaka emikhubeni yokuzindla kungase kuhlabe umxhwele kokubili izingxenye zezinzwa nezithinta umbono wobuhlungu. Ngakolunye uhlangothi, ukucabangela kunciphisa ukuphinda kusebenze emicabangweni nemizwa ecindezelayo ehambisana nokuqonda kobuhlungu nokuqinisa ubuhlungu. Futhi, ukucabangela kunciphisa izimpawu ezingokwengqondo ezifana nokukhathazeka kwe-comorbid nokucindezeleka futhi kwandisa umsebenzi we-parasympathetic, ongakhuthaza ukuphumula okujulile kwemisipha okungase kunciphise ubuhlungu. Okokugcina, ukucabangela kungase kunciphise ukucindezeleka nokusebenza kwemizwa okuhlobene nokungasebenzi kahle kwe-psychophysiologic ngokuqinisa kabusha isimo esingesihle kanye namakhono okuzilawula. Izinga eliphezulu lokucabanga libikezele amazinga aphansi okukhathazeka, ukucindezeleka, ukucabanga okuyinhlekelele nokukhubazeka. Olunye ucwaningo lubonise ukuthi ukucabangela kunendima ebalulekile ekulawuleni ingqondo nemizwa, futhi kungase kube usizo ekuhleleni kabusha izimo ezingezinhle (Zeidan et al., 2011; Zeidan, Grant, Brown, McHaffie, & Coghill, 2012).

 

Inhloso yesibili yalolu cwaningo kwakuwukucacisa ukusebenza kahle kohlelo lwe-MBSR ngekhwalithi yokuphila ezigulini ezinekhanda elibuhlungu elingapheli. Lolu cwaningo lubonise ukuthi lokhu kwelashwa kuphumelele kakhulu kwikhwalithi yezilinganiso zokuphila, okuhlanganisa ukulinganiselwa kwendima ngenxa yesimo sezempilo, ubuhlungu bomzimba, impilo evamile, amandla kanye nobungqabavu, impilo yomzwelo kanye nezikali zezempilo ezingokomzimba nezengqondo jikelele. Kodwa-ke, uhlelo lwe-MBSR alukwazanga ukwandisa kakhulu izinga lempilo ekusebenzeni ngokomzimba, ukulinganiselwa kwendima ngenxa yezinkinga ezingokomzwelo nokusebenza komphakathi. Kubonakala kubonakala ezifundweni zangaphambilini nezamanje kanye nasocwaningweni lwamanje ukuthi i-MBSR ayinawo umthelela emisebenzini yomzimba nezenhlalo. Lokhu kungenxa yokuthi imiphumela emazingeni obuhlungu ezigulini ezinekhanda elibuhlungu mincane, futhi lolo shintsho luhamba kancane. Ngakolunye uhlangothi, iziguli ezinezinhlungu ezingapheli ziye zafunda ukungazinaki ubuhlungu ukuze zisebenze ngokujwayelekile (La Cour & Petersen, 2015). Nakuba, izinguquko bezilokhu zisendleleni oyifunayo futhi zandisa amaphuzu amaphakathi eqembu lokungenelela uma kuqhathaniswa neqembu lokulawula. Lokhu okutholakele kuhambisana nokutholwe ngaphambilini (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., al., 2001; Rosenzweig et al., 2010).

 

Ngokuphathelene nokuqukethwe kwezikhathi ze-MBSR, lolu hlelo lugcizelela ukusetshenziswa kwamasu okunciphisa ukucindezeleka, ukubhekana nobuhlungu nokuqwashisa isimo. Ukuyeka ukulwa nokwamukela isimo samanje, ngaphandle kokwahlulela, umqondo oyinhloko wohlelo (Flugel et al., 2010). Eqinisweni, izinguquko ekwamukelweni ngaphandle kokwahlulela zihlotshaniswa nokuthuthukiswa kwezinga lempilo (Rosenzweig et al., 2010). I-MBSR ihloselwe ukwandisa ukuqwashisa ngalesi sikhathi samanje. Uhlelo lokwelapha luyindlela entsha neyomuntu siqu yokubhekana nengcindezi kumuntu ngamunye. Izingcindezi zangaphandle ziyingxenye yokuphila futhi azikwazi ukuguqulwa, kodwa amakhono okubhekana nesimo nendlela yokuphendula ukucindezeleka kungashintshwa (Flugel et al., 2010). UMcCracken no-velleman (2010) babonise ukuthi ukuguquguquka kwengqondo nokucabangela okuphezulu kuhlotshaniswa nokuhlupheka okuncane nokukhubazeka ezigulini. Iziguli ezinobuhlungu obungapheli obunamazinga aphezulu okucabanga zibike ukudangala okuncane, ukucindezeleka, ukukhathazeka nobuhlungu kanye nokwenza ngcono kokuzenzela kanye nezinga lempilo. UMorgan et al. (2013) ukutadisha iziguli ze-arthritis zithole imiphumela efanayo, ukuze iziguli ezinamazinga aphezulu okucabanga zibike ukucindezeleka okuphansi, ukucindezeleka kanye nokuzikhandla okuphezulu kanye nekhwalithi yokuphila. Njengoba kuphawuliwe ngenhla bekulindeleke ukuthi ukunciphisa ubuhlungu ezigulini kuholele ekunciphiseni ukwesaba nokukhathazeka okuhambisana nobuhlungu futhi ngaleyo ndlela kunciphisa ukulinganiselwa kokusebenza okubangelwayo. Futhi, imiphumela yezifundo ezimbalwa (Cho, Heiby, McCracken, Lee, & Moon, 2010; McCracken, Gauntlett-Gilbert, & Vowles, 2007; Rosenzweig et al., 2010; Schutz et al., 2010) iqinisekisa lokhu okutholakele. .

 

Kuye kwenziwa izifundo eziningana ukuze kuhlolwe ukuphumelela kwezinhlobo ezahlukene zokwelapha ezisekelwe engqondweni ebuhlungu obungapheli, kuhlanganise neziguli ezinekhanda elibuhlungu. Ngokungafani nolunye ucwaningo oluhlola amasethi ahlukahlukene eziguli ezinezinhlungu ezingapheli, inzuzo yalolu cwaningo ukuthi, yenziwe kuphela ezigulini ezinekhanda elibuhlungu elingapheli.

 

Ekugcineni, kufanele kuvunywe ukuthi kukhona ukulinganiselwa kulolu cwaningo njengosayizi omncane wesampula, ukuntuleka kohlelo lokulandelela lwesikhathi eside, ababambiqhaza� ukusetshenziswa kwemithi kanye nokwelashwa okungenasizathu; futhi naphezu kwemizamo yabacwaningi, ukuntuleka kwe-pharmacotherapy efanayo ngokugcwele kubo bonke ababambiqhaza kungadida imiphumela yokuhlola futhi kwenze kube nzima ukwenza imiphumela ibe jikelele. Njengoba ucwaningo lwamanje lungolokuqala lwayo ezigulini ezinekhanda elibuhlungu elingapheli e-Iran, kuphakanyiswa ukuthi izifundo ezifanayo kufanele zenziwe kulo mkhakha, ngamasayizi amasampula amakhulu ngangokunokwenzeka. Futhi izifundo ezengeziwe ziphenya ukuzinza kwemiphumela yokwelashwa ezikhathini zokulandela zesikhathi eside.

 

Isiphetho

 

Ngokusho kokutholwe kwalolu cwaningo kungaphetha ngokuthi izindlela ze-MBSR ngokuvamile zisebenza kahle ekubonakaleni kobuhlungu obukhulu kanye nekhwalithi yokuphila yeziguli ezinekhanda elibuhlungu elingapheli. Nakuba kwakungekho umehluko ophawulekayo wezibalo kwezinye izici zekhwalithi yokuphila, njengokusebenza ngokomzimba, ukulinganiselwa kwendima ngenxa yezinkinga ezingokomzwelo nokusebenza komphakathi, kodwa izinguquko eziphelele zencazelo zazifiswa ocwaningweni. Ngakho-ke ukuhlanganiswa kokwelashwa kwe-MBSR nokwelashwa okuvamile kwezokwelapha ku-protocol yokwelashwa kweziguli ezinekhanda elibuhlungu elingapheli kungalulekwa. Umcwaningi futhi ukholelwa ukuthi naphezu kokushiyeka nokushiyeka kocwaningo lwamanje, lolu cwaningo lungaba indlela entsha yokwelashwa kwekhanda elibuhlungu futhi linganikeza umbono omusha kulo mkhakha wokwelapha.

 

Ukubonga

 

Lolu cwaningo lusekelwe (njengethisisi) ngokwengxenye yi-Zahedan University of Medical Sciences. Sithanda ukubonga bonke ababambe iqhaza ocwaningweni, abelaphi bendawo, abasebenzi basezibhedlela- Ali -ebn-abitaleb, Khatam-al-anbia kanye no-Ali asghar- ngokuseseka nosizo lwabo.

 

Ekuphetheni,Ukunakekelwa kwe-chiropractic kuyindlela yokwelapha ehlukile ephephile nesebenzayo esetshenziselwa ukusiza ukuthuthukisa kanye nokulawula izimpawu zekhanda elingapheli ngokulungisa kabusha umgogodla ngokucophelela nangobumnene kanye nokuhlinzeka ngezindlela nezindlela zokulawula ukucindezeleka. Ngenxa yokuthi ukucindezeleka kuye kwahlotshaniswa nezinkinga ezihlukahlukene zezempilo, kuhlanganise ne-subluxation, noma ukungahambi kahle komgogodla, kanye nekhanda elibuhlungu elingapheli, ukungenelela kwengqondo njengokunakekelwa kwe-chiropractic nokunciphisa ukucindezeleka okusekelwe engqondweni (MBSR) kubalulekile ekubhekaneni nekhanda elibuhlungu elingapheli. Ekugcineni, isihloko esingenhla sibonise ukuthi i-MBSR ingasetshenziswa ngokuphumelelayo njengendlela yokungenelela kwengqondo ekhanda elibuhlungu elingapheli kanye nokuthuthukisa impilo nempilo yonke jikelele. Ulwazi olubalulwe ku-National Center for Biotechnology Information (NCBI). Ububanzi bolwazi lwethu bukhawulelwe ku-chiropractic kanye nokulimala komgogodla nezimo. Ukuze uxoxe ngesihloko, sicela ukhululeke ukubuza uDkt. Jimenez noma usithinte ku 915-850-0900 .

 

Ikhethwe nguDkt Alex Jimenez

 

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

 

Izihloko Ezengeziwe: Ubuhlungu Emuva

 

Ngokwezibalo, cishe i-80% yabantu izothola izimpawu zobuhlungu beqolo okungenani kanye kukho konke ukuphila kwabo. Ukuhlungu obusemhlane isikhalazo esivamile esingaba umphumela ngenxa yokulimala okuhlukahlukene kanye/noma izimo. Izikhathi eziningi, ukuwohloka kwemvelo komgogodla ngeminyaka kungabangela ubuhlungu emuva. Ama-discs we-Herniated kwenzeka lapho isikhungo esithambile, esifana nejeli se-intervertebral disc siphusha izinyembezi endaweni ezungezile, indandatho yangaphandle ye-cartilage, ukucindezela nokucasula izimpande zemizwa. Ama-Disc herniations avame ukwenzeka emhlane ophansi, noma i-lumbar spine, kodwa kungenzeka futhi eduze nomgogodla womlomo wesibeletho, noma intamo. Ukufakwa kwezinzwa ezitholakala emhlane ophansi ngenxa yokulimala kanye/noma isimo esishubile kungaholela ezimpawini ze-sciatica.

 

isithombe sebhulogi kakhathuni paperboy izindaba ezinkulu

 

ISIHLOKO ESIBALULEKE KANYE: Ukuphatha Ingcindezi Yasemsebenzini

 

 

IZIHLOKO EZIBALULEKE KANYE: ENGEZIWE NGENXA YENZA: Ukwelashwa Kokulimala Kwengozi Yemoto El Paso, TX Chiropractor

 

Akukho lutho
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Vala i-Accordion
Ukucabangela Ikhanda Elibuhlungu kanye Ne-Cervical Disc Herniation e-El Paso, TX

Ukucabangela Ikhanda Elibuhlungu kanye Ne-Cervical Disc Herniation e-El Paso, TX

by | Izimo zenziwe, I-Disc Herniated, Isivivinyo Esilawulwa Ngokungahleliwe, Ukucindezeleka, Ukwelashwa

Ukucindezeleka kuwumphumela wokusabela komzimba womuntu “ngokulwa noma ukundiza, indlela yokuzivikela yangaphambi komlando eqalwa uhlelo lwezinzwa oluzwelayo (SNS). Ukucindezeleka kuyingxenye ebalulekile yokuphila. Lapho izingcindezi zenza impi noma impendulo yendiza isebenze, ingxube yamakhemikhali namahomoni igcinwa ekugelezeni kwegazi, okulungiselela umzimba ngenxa yengozi ebonwayo. Nakuba ukucindezeleka kwesikhashana kuyasiza, nokho, ukucindezeleka kwesikhathi eside kungaholela ezinkingeni zezempilo ezihlukahlukene. Ngaphezu kwalokho, izingcindezi emphakathini wanamuhla zishintshile futhi kuba nzima kakhulu kubantu ukulawula ukucindezeleka kwabo nokugcina ingqondo.

 

Ukucindezeleka Kuwuthinta Kanjani Umzimba?

 

Ukucindezeleka kungatholakala ngemigudu emithathu ehlukene: imizwa; umzimba kanye nemvelo. Ukucindezeleka ngokomzwelo kuhilela izimo ezimbi ezithinta ingqondo yethu nokwenza izinqumo. Ukucindezeleka komzimba kuhlanganisa ukudla okungafanele kanye nokungalali kahle. Futhi ekugcineni, ukucindezeleka kwemvelo kwenzeka ngokusekelwe kokuhlangenwe nakho kwangaphandle. Uma uhlangabezana nanoma iyiphi yalezi zinhlobo zezingcindezi, isimiso sezinzwa esinozwela sizovusa impendulo "yokulwa noma indiza", ikhiphe i-adrenaline ne-cortisol ukukhulisa ukushaya kwenhliziyo futhi ikhulise izinzwa zethu ukuze zisenze siphapheme ngokwengeziwe ukuze sibhekane nesimo esiphambi kwethu. .

 

Kodwa-ke, uma izingcindezi ezicatshangelwayo zihlala zikhona, ukulwa kwe-SNS noma impendulo yendiza ingahlala isebenza. Ukucindezeleka okungapheli kungase kuholele ezinkingeni zezempilo ezihlukahlukene, njengokukhathazeka, ukucindezeleka, ukuqina kwemisipha, ubuhlungu bentamo nomhlane, izinkinga zokugaya ukudla, ukuzuza kwesisindo kanye nezinkinga zokulala kanye nokukhubazeka kwenkumbulo nokugxila. Ukwengeza, ukungezwani kwemisipha emgogodleni ngenxa yokucindezeleka kungabangela ukungahambi kahle komgogodla, noma ukuguqulwa kwe-subluxation, okungase kuholele ku-disc herniation.

 

Ikhanda elibuhlungu kanye ne-Disc Herniation kusuka ku-Stress

 

I-disc ye-herniated yenzeka lapho isikhungo esithambile, esifana ne-gel se-intervertebral disc siphusha ukukhala kwendandatho yayo yangaphandle, ye-cartilage, ecasulayo futhi icindezela umgogodla kanye / noma izimpande zemizwa. I-Disc herniation ivame ukwenzeka kumgogodla womlomo wesibeletho, noma intamo, kanye ne-lumbar spine, noma i-low back. Izimpawu zama-disc herniated zincike endaweni yokucindezela eduze komgogodla. Ubuhlungu bentamo nobuhlungu bomhlane obuhambisana nokuba ndikindiki, ukuzwa okuzwakalayo kanye nobuthakathaka eduze kwamaphethelo aphezulu naphansi ngezinye zezimpawu ezivame kakhulu ezihlobene ne-disc herniation. Ubuhlungu bekhanda kanye ne-migraine nazo ziyizimpawu ezivamile ezihambisana nokucindezeleka kanye nama-discs e-herniated eduze nomgogodla womlomo wesibeletho, ngenxa yokucindezeleka kwemisipha nokungahambi kahle komgogodla.

 

Ukungenelela Kokucabangela Ukulawulwa Kwengcindezi

 

Ukulawula ingcindezi kubalulekile ekuthuthukiseni nasekugcineni impilo nempilo yonke. Ngokwezifundo zocwaningo, ukungenelela kwengqondo, njengokunakekelwa kwe-chiropractic kanye nokunciphisa ukucindezeleka okusekelwe engqondweni (MBSR), phakathi kwabanye, kungasiza ngokuphepha nangempumelelo ukunciphisa ukucindezeleka. Ukunakekelwa kwe-Chiropractic kusebenzisa ukulungiswa komgogodla kanye nokuphathwa ngesandla ukuze kubuyiselwe ngokucophelela ukulungiswa kwangempela komgogodla, ukukhulula ubuhlungu nokungakhululeki kanye nokunciphisa ukungezwani kwemisipha. Ukwengeza, isazi se-chiropractor singase sihlanganise ukuguqulwa kwendlela yokuphila ukusiza ukuthuthukisa izimpawu zokucindezeleka.�Umgogodla olinganiselayo ungasiza isimiso sezinzwa sisabele ekucindezelekeni ngokuphumelelayo. I-MBSR ingasiza futhi ukunciphisa ukucindezeleka, ukukhathazeka nokucindezeleka.

 

Xhumana Nathi Namuhla

 

Uma uhlangabezana nezimpawu zokucindezeleka ngekhanda elibuhlungu noma migraine kanye nobuhlungu bentamo nomhlane obuhambisana ne-disc herniation, ukungenelela kwengqondo okufana nokunakekelwa kwe-chiropractic kungaba yindlela yokwelapha ephephile nephumelelayo yokucindezeleka kwakho. Izinsizakalo zokulawula ukucindezeleka zikaDkt. Alex Jimenez zingakusiza uzuze impilo nempilo yonke. Ukuthola usizo olufanele lokucabangela kungakuthola ukukhululeka okufanele. Inhloso yalesi sihloko esilandelayo ukukhombisa imiphumela yokunciphisa ukucindezeleka okusekelwe engqondweni ezigulini ezinekhanda elibuhlungu. Ungagcini nje ukwelapha izimpawu, finyelela emthonjeni wenkinga.

 

Imiphumela Yokuncishiswa Kwengcindezi Okusekelwe Ekucabangeni Ekucindezelekeni Okucatshangwayo kanye Nempilo Yengqondo Ezigulini Ezihlukunyezwa Ikhanda Eliqinile

 

abstract

 

Ingemuva: Izinhlelo zokwenza ngcono isimo sezempilo seziguli ezigulayo ezihlobene nobuhlungu, njengekhanda elibuhlungu, ngokuvamile zisakhula. Ukunciphisa ukucindezeleka okusekelwe ekucabangeni (MBSR) kuyindlela entsha yokwelashwa kwengqondo ebonakala iphumelela ekwelapheni ubuhlungu obungapheli nokucindezeleka. Lolu cwaningo luhlole ukusebenza kahle kwe-MBSR ekwelapheni ukucindezeleka okubonakalayo kanye nempilo yengqondo yeklayenti elinekhanda elibuhlungu.

 

Izimpahla nezindlela: Lolu cwaningo luyisivivinyo somtholampilo esingahleliwe. Iziguli ezingamashumi ayisithupha ezinezinhlungu zekhanda lokucindezeleka ngokwe-International Headache Classification Subcommittee zabelwa ngokungahleliwe eqenjini le-Treatment As Usual (TAU) noma iqembu lokuhlola (MBSR). Iqembu le-MBSR lithole abafundi abafunda nabo besonto abayisishiyagalombili abanezikhathi ze-12-min. Izikhathi bezisekelwe kuphrothokholi ye-MBSR. I-Brief Symptom Inventory (BSI) kanye ne-Perceived Stress Scale (PSS) zasetshenziswa esikhathini sangaphambi nangemva kokwelashwa kanye nasezinyangeni ezi-3 zokulandelelwa kwawo womabili amaqembu.

 

Ezenye: Isilinganiso samaphuzu aphelele we-BSI (inkomba yobunzima bomhlaba wonke; i-GSI) eqenjini le-MBSR lalingu-1.63 � 0.56 ngaphambi kokungenelela okuncishiswe kakhulu ku-0.73 � 0.46 no-0.93 � 0.34 ngemva kokungenelela nasezindaweni zokulandelela, ngokulandelana ( P <0.001). Ukwengeza, iqembu le-MBSR libonise amaphuzu aphansi ekucindezelekeni okucatshangwayo uma kuqhathaniswa neqembu lokulawula ekuhlolweni kwangemva kokuhlolwa. Incazelo yengcindezi ecatshangelwayo ngaphambi kokungenelela yayingu-16.96 � 2.53 futhi yashintshwa yaba ngu-12.7 � 2.69 kanye no-13.5� 2.33 ngemva kokungenelela kanye namaseshini okulandelela, ngokulandelanayo (P <0.001). Ngakolunye uhlangothi, isilinganiso se-GSI eqenjini le-TAU sasingu-1.77 � 0.50 ekuhlolweni kwangaphambili okwehliswe kakhulu kwaba ngu-1.59 � 0.52 kanye no-1.78 � 0.47 ekuhlolweni nasekulandeleni, ngokulandelanayo (P <0.001). Futhi, isilinganiso sokuxineka okucatshangwayo eqenjini le-TAU ekuhlolweni kokuqala kwaba ngu-15.9 � 2.86 futhi lokho kwashintshwa kwaba ngu-16.13 � 2.44 kanye no-15.76 � 2.22 ekuhlolweni kwangemuva nasekulandeleni, ngokulandelana (P <0.001).

 

Isiphetho: I-MBSR inganciphisa ukucindezeleka futhi ithuthukise impilo yengqondo evamile ezigulini ezinekhanda elibuhlungu.

 

Amagama angukhiye: Impilo yengqondo, ikhanda elibuhlungu, ukuncishiswa kokucindezeleka okusekelwe engqondweni (MBSR), ukucindezeleka okubonwayo, ukwelashwa njengenjwayelo (TAU)

 

UDkt Jimenez White Coat

Ukuqonda kukaDkt Alex Jimenez

Ukunakekelwa kwe-Chiropractic kuyindlela yokwelapha ephumelelayo yokulawula ukucindezeleka ngoba igxile emgogodleni, okuyisisekelo sesimiso sezinzwa. I-Chiropractic isebenzisa ukulungiswa komgogodla kanye nokuphathwa ngesandla ukuze ubuyisele ngokucophelela ukulungiswa komgogodla ukuze uvumele umzimba ukuba uziphilise ngokwemvelo. Ukungalungi kahle komgogodla, noma i-subluxation, kungadala ukungezwani kwemisipha emgogodleni futhi kuholele ezinkingeni zezempilo ezahlukahlukene, okubandakanya ikhanda elibuhlungu kanye ne-migraine, kanye ne-disc herniation kanye sciatica. Ukunakekelwa kwe-Chiropractic kungabandakanya nokuguqulwa kwendlela yokuphila, njengeseluleko sokudla okunomsoco kanye nezincomo zokuzivocavoca, ukuze kuthuthukiswe imiphumela yako. Ukunciphisa ukucindezeleka okusekelwe ekucabangeni nakho kungasiza ngempumelelo ekulawuleni ukucindezeleka nezimpawu.

 

Isingeniso

 

Ikhanda elibuhlungu lihlanganisa amaphesenti angama-90 ekhanda eliphelele. Cishe u-3% wabantu uhlushwa yikhanda elibuhlungu elingapheli.[1] Ikhanda elibuhlungu livame ukuhlotshaniswa nezinga lempilo eliphansi kanye namazinga aphezulu okuphatheka kabi ngokwengqondo.[2] Eminyakeni yamuva, ukuhlaziywa kwe-meta okuningana okuhlola ukwelapha ubuhlungu obumisiwe obusetshenziswa namuhla kubonise ukuthi ukwelashwa kwezokwelapha, okungase kuphumelele ebuhlungu obunzima, akuphumelelanga ngobuhlungu obungapheli futhi kungase, empeleni, kubangele izinkinga ezengeziwe. Imithi eminingi yokwelapha izinhlungu iklanyelwe futhi iwusizo ezinhlungwini ezinzima kodwa uma isetshenziswa ngokuhamba kwesikhathi ingase idale izinkinga ezengeziwe ezifana nokusebenzisa kabi izidakamizwa nokugwema imisebenzi ebalulekile.[3] Isici esivamile ezindaweni eziningi zokwelapha ubuhlungu ukuthi zigcizelela ekugwemeni ubuhlungu noma ukulwa nokunciphisa ubuhlungu. Ubuhlungu bekhanda elicindezelayo bungabekezeleleka. Ama-Painkillers namasu okulawula ubuhlungu angandisa ukungabekezelelani nokuzwela ebuhlungu. Ngakho-ke, ukwelashwa okwandisa ukwamukelwa nokubekezelela ubuhlungu, ikakhulukazi ubuhlungu obungapheli, buyasebenza. Ukunciphisa ukucindezeleka okusekelwe engqondweni (MBSR) kuyindlela entsha yokwelashwa kwengqondo ebonakala iphumelela ekuthuthukiseni ukusebenza ngokomzimba kanye nempilo yengqondo ezigulini ezinobuhlungu obungapheli [4,5,6,7,8] Emashumini amabili eminyaka adlule, i-Kabat -Zinn et al. e-US kusetshenziswe ngempumelelo ukucabangela ukukhulula ubuhlungu nokugula okuhlobene nobuhlungu.[9] Ucwaningo lwakamuva lwezindlela ezisekelwe ekwamukeleni, njengokucabangela, zibonisa ukusebenza okuthuthukisiwe ezigulini ezinobuhlungu obungapheli. Ukucabangisisa kulungisa ubuhlungu ngokusebenzisa ukuqwashisa okungagcini nje kwemicabango, imizwa kanye nemizwa, kanye nobudlelwano obuqhelelene ngokomzwelo nolwazi lwangaphakathi nolwangaphandle.[10] Ucwaningo luthole ukuthi uhlelo lwe-MBSR lunganciphisa kakhulu ukugula kwezokwelapha okuhlobene nobuhlungu obungapheli obufana ne-fibromyalgia, i-rheumatoid arthritis, ubuhlungu obungapheli be-musculoskeletal, ubuhlungu obungapheli obuphansi, kanye ne-multiple sclerosis [7,11,12,13] MBSR inezinguquko eziphawulekayo ekuqineni kobuhlungu. , ukukhathazeka, ukucindezeleka, izikhalazo ze-somatic, inhlalakahle, ukuzivumelanisa nezimo, izinga lokulala, ukukhathala, nokusebenza ngokomzimba.[6,14,15,16,17] Kodwa izinhlelo zokuthuthukisa isimo sezempilo seziguli ezigulayo ezihlobene nobuhlungu, ezifana nokucindezeleka kwekhanda elibuhlungu, ngokuvamile zisencane. Ngakho-ke, ucwaningo lwenziwa ukuze kuhlolwe imiphumela ye-MBSR ekucindezelekeni okubonakalayo kanye nempilo yengqondo evamile ezigulini ezinekhanda lokucindezeleka.

 

Izimpahla nezindlela

 

Lokhu kuhlolwa komtholampilo okulawulwa ngokungahleliwe kwenziwa ngo-2012 esibhedlela i-Shahid Beheshti e-Kashan City. Ikomidi Lezimiso Zokucwaninga leNyuvesi yaseKashan Yesayensi Yezokwelapha ligunyaze lolu cwaningo (Inombolo ye-IRCT: 2014061618106N1). Abahlanganyeli ocwaningweni bahlanganisa abantu abadala abanekhanda elicindezelayo abathunyelwe odokotela bengqondo kanye ne-neurologists eKashan. Inqubo yokufaka yayimi kanje: Ukuba nekhanda elibuhlungu ngokusho kwe-International Headache Classification Subcommittee, ezimisele ukubamba iqhaza ocwaningweni, engenakho ukuxilongwa kwezokwelapha kwe-organic brain disorder noma psychotic disorder, kanye nokungabi nomlando wokwelashwa kwengqondo ngesikhathi se-6 eyandulele. izinyanga. Iziguli ezingazange ziqedele ukungenelela futhi zaphuthelwa izikhathi ezingaphezu kwezimbili azifakiwe kulolu cwaningo. Abahlanganyeli, abasayine ifomu lemvume enolwazi, bagcwalise izinyathelo njengokuhlola kuqala. Ukuze silinganisele usayizi wesampula, sibhekisele kolunye ucwaningo lapho izinguquko ezilinganisweni zenani lokukhathala zazingu-62 � 9.5 esikhathini sokwelashwa ngaphambi kanye no-54.5 � 11.5 esikhathini sangemva kokwelashwa.[18] Bese-ke, ngokusebenzisa isampula yesibalo sesayizi, ababambiqhaza abangama-33 (abasengozini yokwehla) eqenjini ngalinye abane-? = 0.95 kanye no-1� ? = 0.9 bahlukaniswa. Ngemuva kokubala usayizi wesampula, iziguli ze-66 ezinekhanda elicindezelayo zikhethwe ngesampula esilula ngokuya ngenqubo yokufaka. Khona-ke, iziguli zabizwa futhi zamenywa ukuba zihlanganyele ocwaningweni. Uma isiguli sivuma ukuhlanganyela, bese simenywa ukuba sithamele iseshini yokwaziswa kocwaningo futhi uma kungesona esinye isiguli esikhethiwe ngendlela efanayo. Bese besebenzisa ithebula lenombolo engahleliwe, babelwa eqenjini lokuhlola (MBSR) noma eqenjini elilawulayo eliphatha njengokujwayelekile. Ekugcineni, iziguli ze-3 zazikhishwe eqenjini ngalinye futhi iziguli ze-60 zifakiwe (iziguli ze-30 eqenjini ngalinye). Iqembu le-TAU lalashwa kuphela ngemithi elwa nokucindezeleka nokuphathwa komtholampilo. Iqembu le-MBSR lathola ukuqeqeshwa kwe-MBSR ngaphezu kwe-TAU. Iziguli zeqembu le-MBSR zaqeqeshwa amasonto e-8 yisazi sokusebenza kwengqondo emitholampilo ene-PhD degree. I-Brief Symptom Inventory (BSI) kanye ne-Stress Scale Scale (PSS) ebonwayo (PSS) yaphathwa ngaphambi kweseshini yokuqala yokwelapha eqenjini le-MBSR, ngemva kweseshini yesishiyagalombili (posttest), kanye nezinyanga ze-3 ngemva kokuhlolwa (ukulandelwa) kuwo womabili amaqembu. Iqembu le-TAU limenyelwe esibhedlela i-Shahid Beheshti ukuze ligcwalise uhlu lwemibuzo. Umfanekiso 1 ubonisa umdwebo Wamazinga Ahlanganisiwe Ezilingo Zokubika (CONSORT) obonisa ukuhamba kwabahlanganyeli bocwaningo.

 

Umfanekiso 1 CONSORT Umdwebo Obonisa Ukugeleza Kwababambiqhaza Bocwaningo

Umfanekiso 1: Umdwebo we-CONSORT obonisa ukugeleza kwabahlanganyeli bocwaningo.

 

Intervention

 

Iqembu lokungenelela (MBSR) laqeqeshwa esibhedlela iShahid Beheshti. Iseshini yamasonto onke eyisishiyagalombili (imizuzu eyi-120) ibibanjwe ngokulandela umthetho olandelwayo we-MBSR othuthukiswe yi-Kabat-Zinn.[11] Kwabanjwa amaseshini engeziwe kubahlanganyeli abaphuthelwe iseshini eyodwa noma ezimbili. Ekupheleni kokuqeqeshwa kanye nezinyanga ze-3 kamuva (ukulandelela), amaqembu amabili e-MBSR kanye ne-TAU amenywa esibhedlela sase-Shahid Beheshti (indawo yecala le-MBSR) futhi ayalwa ukuba agcwalise imibuzo. Phakathi neseshini ye-MBSR, abahlanganyeli baqeqeshwe ukuba baqaphele imicabango yabo, imizwa yabo, kanye nezinzwa zomzimba ngaphandle kokwahlulela. Ukuzivocavoca kwengqondo kufundiswa njengezinhlobo ezimbili zemikhuba yokuzindla � ehlelekile nengakahleleki. Ukuzivocavoca kohlobo oluhlelekile kufaka ukuzindla okuqeqeshiwe okuhlezi, ukuskena umzimba, kanye ne-yoga enengqondo. Ekuzindleni okungakahleleki, ukunaka nokuqwashisa akugxili nje kuphela emisebenzini yansuku zonke, kodwa futhi emicabangweni, emizweni, nasekuzweni okungokomzimba ngisho kuyinkinga futhi kubuhlungu. Konke okuqukethwe kwamaseshini kushiwo kuThebula loku-1.

 

Ithebula 1 Ama-Ajenda Ezikhathi ze-MBSR

Ithebula 1: Ama-ajenda amaseshini okunciphisa ukucindezeleka okusekelwe ekucabangeni.

 

Amathuluzi Wokulinganisa

 

I-International Headache Classification Isilinganiso Sedayari Sokuhlukaniswa Kwekhanda Lokuphathwa Kwekhanda

 

Ikhanda elibuhlungu likalwa ngedayari yesikali sekhanda elibuhlungu.[19] Iziguli zacelwa ukuthi zibhale idayari yokuqina kobuhlungu esikalini sokulinganisa esingu-0-10. Ukungabikho kobuhlungu kanye nekhanda elibuhlungu elikhubaza kakhulu lalibonakala nge-0 kanye ne-10, ngokulandelana. Incazelo yobunzima bekhanda elibuhlungu ngesonto ibalwa ngokuhlukanisa isamba sezibalo zobunzima ngo-7. Ngaphezu kwalokho, incazelo yobunzima bekhanda ngenyanga ibalwa ngokuhlukanisa isamba samaphuzu obunzima ngo-30. Izibalo ezincane neziphezulu ubuhlungu bekhanda bekungu-0 no-10, ngokulandelana. Idayari yokuqaqamba kwekhanda yanikezwa iziguli ezinhlanu kanti udokotela wezinzwa kanye nodokotela wezengqondo baqinisekisa ukufaneleka kokuqukethwe kwethuluzi.[20] I-coefficient yokwethembeka yenguqulo yesi-Persian yalesi sikali ibalwa njenge-0.88.[20]

 

I-Inventory yezimpawu ezimfushane (BSI)

 

Izimpawu zengqondo zahlolwa nge-BSI.[21] I-inventory ihlanganisa izinto ezingama-53 kanye nezilinganiso ezingaphansi eziyi-9 ezihlola izimpawu ezingokwengqondo. Into ngayinye ithola amaphuzu phakathi kuka-0 no-4 (isibonelo: Nginesicanucanu noma ngiphatheke kabi esiswini). I-BSI ine-global severity index (GSI) ithole amaphuzu aphelele wezinto ezingama-53. Ukuthembeka kokuhlolwa kuye kwabika amaphuzu angu-0.89.[22] Ocwaningweni lwethu, isilinganiso sokuhlolwa kwe-GSI sasingu-.90 sisekelwe kusampula yeziguli ezingu-60 ezinekhanda elicindezelayo eliqede i-BSI.

 

I-Perceived Stress Scale (PSS)

 

Ukucindezeleka okucatshangwayo kwahlolwa kusetshenziswa i-PSS,[21,23] isikali sezinto ezingu-10 esihlola izinga lezimo zokuphila ezingalawuleki nezingalindelekile phakathi nenyanga edlule (isibonelo: Unomuzwa wokuthi awukwazi ukulawula izinto ezibalulekile ekuphileni kwakho. ?). Abaphendula babika ukuvama kwento phakathi kwenyanga edlule esikalini samaphoyinti angu-5, kusukela ku-0 (akukaze) kuye ku-4 (kaningi). Ukushaya amaphuzu kuqedwa ngokuhlehla amaphuzu kwezinto ezine ezinamagama akhuthazayo[4,5,7,8] kanye nokufingqa wonke amaphuzu wento. Izilinganiso zesikali zisukela ku-0-40. Amaphuzu aphezulu akhombisa amazinga aphezulu okucindezeleka. Kuthatha ngokuthi abantu kuye ngezinsiza zabo zokubhekana nesimo bahlola izinga lezehlakalo ezisongelayo noma eziyinselele. Amaphuzu aphezulu akhombisa izinga elikhulu lengcindezi ebonwayo. Ukuthembeka kokuhlolwa okwanele nokuvumelana nokubandlulula nakho kuye kwabikwa.[19] Ocwaningweni lwethu, ama-alpha coefficients ka-Cronbach okuhlola ukuvumelana kwangaphakathi kwalesi sikali abalwe kwaba ngu-0.88.

 

Ukuhlaziywa kwezinyathelo eziphindaphindiwe zokuhlukahluka kwenziwa ukuze kuqhathaniswe namaqembu e-MBSR kanye ne-TAU ngezinyathelo zokucindezeleka okubonwayo kanye ne-GSI ngesikhathi sokwelashwa, ukwelapha, kanye nokulandelwa kwezinyanga ze-3. Futhi, ukuhlolwa kwe-Chi-square kwasetshenziswa ukuqhathanisa izibalo zabantu kula maqembu amabili. Inani le-P elingaphansi kuka-0.05 lithathwe njengelibalulekile kukho konke ukuhlola.

 

Imiphumela

 

Phakathi kwezihloko ze-66, abahlanganyeli be-2 abavela eqenjini le-MBSR bakhishwe ngenxa yokulahlekelwa izikhathi ezingaphezu kwe-2. Futhi, abahlanganyeli abathathu abazange bafakwe ngenxa yokuthi abazange bagcwalise imibuzo ekuhlolweni kwangemva kokuhlolwa noma ekulandeleni ukuthi ubani omunye wabo owayevela eqenjini le-MBSR kanye nabahlanganyeli abathathu beqembu le-TAU. Ithebula 2 libonise izici zezibalo zezihloko kanye nemiphumela yokuhlola okungahleliwe. Imiphumela yokuhlolwa kwe-t yokuhluka phakathi kwamaqembu e-MBSR kanye ne-TAU ekuguquguqukeni kweminyaka yobudala kanye nokuhlolwa kwe-Chi-square kwezinye iziguquko kubonise ukuthi kwakungekho umehluko omkhulu phakathi kokuguquguquka kwezibalo zabantu emaqenjini amabili futhi izifundo zabelwa amaqembu amabili ngokungahleliwe.

 

Ithebula 2 Izimpawu Zezibalo Zezifundo

Ithebula 2: Izici zezibalo zezifundo a,b.

 

Ithebula lesi-3 linikeza amaphuzu amaphakathi kanye nokuphambuka okujwayelekile kokuguquguqukayo okuncikile (ingcindezi ebonwayo kanye ne-GSI) nokuqhathaniswa kwezilinganiso zemiphumela ngesikhathi sokwelashwa ngaphambi kwesikhathi, isikhathi sangemva kokwelashwa, kanye nokulandelwa kwezinyanga ezi-3.

 

Ithebula lesi-3 lisho, ukuchezuka okujwayelekile kanye nokuqhathaniswa kwezilinganiso zomphumela

Ithebula 3: Izindlela, ukuphambana okujwayelekile, nokuqhathaniswa kwezinyathelo zomphumela ekuphathweni kwangaphambili, ukwelapha, kanye nezigaba zokulandelela kumaqembu e-MBSR kanye ne-TAU a,b.

 

Ithebula le-3 libonisa ukunciphisa okwengeziwe kokucindezeleka okutholiwe kanye ne-GSI eqenjini lokungenelela (MBSR) uma kuqhathaniswa neqembu le-TAU, kuyilapho ukunciphisa ukucindezeleka okutholiwe kanye ne-GSI akuzange kubonwe eqenjini le-TAU. Imiphumela yembula umphumela obalulekile wesikhathi nokusebenzisana phakathi kwesikhathi kanye nohlobo lokwelashwa ekushintsheni kwamaphuzu (P <0.001).

 

Amanani ?2 kanye no-?3 amanje asho ukucindezelwa okutholiwe kanye nezikolo ze-GSI ze-MBSR kanye namaqembu e-TAU ezigabeni zangemuva kokuhlolwa nezokulandelisa.

 

Umfanekiso 2 CONSORT Umdwebo Obonisa Ukugeleza Kwababambiqhaza Bocwaningo

Umfanekiso 2: Umdwebo we-CONSORT obonisa ukugeleza kwabahlanganyeli bocwaningo.

 

Umfanekiso we-3 Kusho Ukucindezeleka Okubonwayo ku-MBSR Namaqembu Okulawula

Umfanekiso 3: Kusho ukucindezeleka okubonwayo ku-MBSR kanye namaqembu okulawula ekuhlolweni kwangaphambili, ekuhlolweni, nasekulandeleni.

 

Ingxoxo

 

Lolu cwaningo luqhathanise ukusebenza kahle kwe-MBSR kanye Nokwelashwa Njengokuvamile (TAU) ekucindezelekeni okubonakalayo kanye nempilo yengqondo yeziguli ezinekhanda elibuhlungu. Nakuba i-MBSR ibhekwa njengokwelashwa okuphumelelayo kwezimpawu zokucindezeleka nobuhlungu, kunesidingo sokuhlola ukusebenza kwayo ekwelapheni izinkinga zempilo yengqondo ezigulini ezinekhanda elibuhlungu, okungenye yezikhalazo ezivamile kubantu.

 

Okutholwe ocwaningweni lwethu kukhombisa impilo yengqondo ejwayelekile ethuthukisiwe kunkomba ye-GSI ye-BSI. Kwesinye isifundo, ukuthuthukiswa okuphawulekayo kokungenelela kwe-MBSR kubikwe kuzo zonke izinkomba ze-36-item Short Form Health Survey (SF-36) [20,24] Ucwaningo lubonise ukunciphisa okuphawulekayo kwezinkinga ezingokwengqondo ku-Symptom Checklist-90-Revised. I-SCL-90-R) i-subscale efana nokukhathazeka nokudangala kwe-MBSR ngemva kokungenelela kanye nokulandelwa konyaka ongu-1.[5] Reibel et al. ibonise i-MBSR ezigulini ezinezinhlungu ezingapheli zibike ukwehla kwezimpawu zezokwelapha ezifana nokukhathazeka, ukucindezeleka, nobuhlungu.[5] Kuye kwaboniswa ukuthi ubuhlungu bekhanda elibuhlungu nokukhathazeka kuhambisana nokushoda ekucubunguleni kwengqondo okulawulwayo njengokunaka okuqhubekayo kanye nenkumbulo yokusebenza.[25] Imizwa engemihle ingase ikhulise ukuhlupheka okuhambisana nokubona ubuhlungu.

 

I-MBSR isebenzisa izindlela ezilandelayo zokuthuthukisa isimo sengqondo sesiguli: Okokuqala, ukucabangela kuholela ekwandiseni ukuqwashisa okwenzekayo ngesikhathi ngasinye, ngesimo sengqondo sokwamukela, ngaphandle kokubanjwa emicabangweni evamile, imizwelo, kanye namaphethini okuziphatha. Ukuqwashisa okwandayo bese kuveza izindlela ezintsha zokuphendula kanye nokubhekana nesimo ngokuphathelene nawe kanye nomhlaba wonke.[3] Ukucabangela kwakha umuzwa wokuzicabangela omkhulu kunemicabango yomuntu, imizwa, kanye nomuzwa womzimba onjengobuhlungu. Izivivinyo zokuqaphela, amaklayenti afundile athuthukisa �isibukeli uqobo�. Ngaleli khono, bangakwazi ukubona imicabango nemizwa yabo ngendlela engaphenduli nengahluleli eyayigwenywe ngaphambilini, leyo imicabango nemizwa eyayigwenywe ngaphambili ibonwa ngendlela engaphenduli nengahluleli. Amakhasimende afunda ukuqaphela imicabango ngaphandle kokwenza okuthile ngayo, ukulawulwa yiyo, noma ukuyikholelwa.[3]

 

Okwesibili, ukunaka kusiza iklayenti ukuthi lithuthukise ukuphikelela ekuthatheni izinyathelo eziqondisweni ezibalulekile ezibalulekile kulo. Amaklayenti amaningi anobuhlungu obungapheli afuna ukungabi nabuhlungu kunokuba aphile izimpilo ezibalulekile azikhethele wona. Kodwa uhlelo lwe-MBSR lwabaqeqesha ukuba bahlanganyele esenzweni esibalulekile naphezu kobuhlungu. Ucwaningo luye lwabonisa ukunaka kanye nokusabela okungokomzwelo ebuhlungu kunendima ebalulekile ekubeni ubuhlungu obungapheli.[26] Izingxenye ezingokomzwelo nezingokwengqondo zingakwazi ukulinganisa ubuhlungu nokukhathazeka ngakho okungase kuqinise ubuhlungu futhi kuphazamise imisebenzi yeziguli.[27,28]

 

Okwesithathu, okutholakele kwezinye izifundo kubonisa ukuthi i-MBSR ingashintsha umsebenzi wobuchopho obunesibopho sokuthinta ukulawulwa kanye nezindawo ezilawula indlela esisabela ngayo emifuleni ecindezelayo, futhi lokhu kungase kujwayele ukwenza imisebenzi yomzimba efana nokuphefumula, ukushaya kwenhliziyo, kanye ukusebenza kokuzivikela komzimba.[29,30] Ukuzijwayeza ukucabangela kunciphisa ukuphinda kusebenze emicabangweni ecindezelayo nemizwa ehlanganisayo futhi eqinisa ukuqonda kobuhlungu.[31] Futhi ukucabangela kungase kunciphise ukuqalisa kokusebenza kwengqondo kwengqondo okuhlobene nengcindezi kanye nokungasebenzi kahle kwemizwa ngokuqinisa ukuhlaziya okuhle kanye namakhono okulawula imizwelo.[32]

 

Amandla alolu cwaningo ukusetshenziswa kokwelashwa kwengqondo okusebenzayo okusha ekunciphiseni ukucindezeleka esikhalazweni esingafundwanga kangako, kodwa kuyinkinga yezokwelapha evamile. Imithelela yocwaningo lwethu isebenzisa ukwelashwa kwengqondo okulula okungenzi isidingo esiningi somqondo futhi isetshenziswa kalula njengekhono lokubhekana nesiguli esinekhanda elicindezelayo. Ngakho-ke, ochwepheshe bezempilo abahlobene nalesi sikhalazo kanye nesiguli bazokwazi ukusebenzisa lokhu kwelashwa. Futhi, i-MBSR izoshintsha indlela yokuphila yesiguli esizokhuliswa yinkinga yakhe. Umkhawulo oyinhloko walolu cwaningo kwakuwukuntuleka kokuqhathanisa phakathi kwe-MBSR kanye nemithi ye-psychotherapies evamile yegolide efana nokwelashwa kokuziphatha kwengqondo (CBT). Kuphakanyiswa ukuthi izifundo zesikhathi esizayo zidinga ukuqhathanisa ukusebenza kahle kwe-MBSR nezinye izindlela zokwelapha zendabuko nezintsha zokuziphatha ezigulini ezinekhanda elibuhlungu.

 

Isiphetho

 

Ucwaningo lwethu lusekela umbono wokuthi iziguli eziphethwe yikhanda elicindezelayo zingathuthukisa impilo yazo yengqondo evamile ngokubamba iqhaza ohlelweni lwe-MBSR. Kafushane, imiphumela yocwaningo lwamanje iphakamisa ukuthi i-MBSR inganciphisa ukukhathazeka okuhlobene nobuhlungu nokuphazamiseka emisebenzini yansuku zonke ngesikhathi esifushane. Izici eziyingqayizivele zokuzivocavoca kwengqondo ziwukuqeqeshwa okulula futhi asikho isidingo samakhono ayinkimbinkimbi okuqonda.

 

Ukwesekwa kwezezimali noxhaso: Nil.

 

Ukungqubuzana kwezintshisekelo: Azikho izingxabano zentshisekelo.

 

Igalelo Lombhali

 

I-AO yaba nesandla ekuqanjweni komsebenzi, ekuqhubeni isifundo, futhi yavumelana ngazo zonke izici zomsebenzi. I-FZ ibe nesandla ekuqanjweni komsebenzi, ibuyekeza okusalungiswa, ukugunyazwa kwenguqulo yokugcina yombhalo wesandla futhi kuvunyelwene ngazo zonke izici zomsebenzi.

 

Ukuvuma

 

Ababhali babonga kakhulu kubasebenzi baseSibhedlela i-Shahid Beheshti nabahlanganyeli. Ababhali baphinde bazwakalise ukubonga kwabo ku-Kabat-Zinn ovela ku-Center for Mindfulness (CFM) eNyuvesi yaseMassachusetts abanikeze ngomusa amakhophi e-elekthronikhi emihlahlandlela ye-MBSR.

 

Ekuphetheni,� nakuba ukucindezeleka kwesikhashana kuwusizo, ukucindezeleka kwesikhathi eside kungagcina kuholele ezinkingeni zezempilo ezihlukahlukene, okuhlanganisa ukukhathazeka nokucindezeleka kanye nobuhlungu bentamo nomhlane, ikhanda elibuhlungu kanye ne-disc herniation. Ngenhlanhla, ukungenelela kwengqondo, okufana nokunakekelwa kwe-chiropractic kanye nokunciphisa ukucindezeleka okusekelwe engqondweni (MBSR) kuyindlela ephephile futhi ephumelelayo yokulawula ukucindezeleka ezinye izinketho zokwelapha. Ekugcineni, lesi sihloko esingenhla sibonise imiphumela esekelwe ebufakazini yokuthi i-MBSR inganciphisa ukucindezeleka futhi ithuthukise impilo yengqondo evamile ezigulini ezinekhanda elibuhlungu. Ulwazi olubalulwe ku-National Center for Biotechnology Information (NCBI). Ububanzi bolwazi lwethu bukhawulelwe ku-chiropractic kanye nokulimala komgogodla nezimo. Ukuze uxoxe ngesihloko, sicela ukhululeke ukubuza uDkt. Jimenez noma usithinte ku 915-850-0900 .

 

Ikhethwe nguDkt Alex Jimenez

 

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

 

Izihloko Ezengeziwe: Ubuhlungu Emuva

 

Ngokwezibalo, cishe i-80% yabantu izothola izimpawu zobuhlungu beqolo okungenani kanye kukho konke ukuphila kwabo. Ukuhlungu obusemhlane isikhalazo esivamile esingaba umphumela ngenxa yokulimala okuhlukahlukene kanye/noma izimo. Izikhathi eziningi, ukuwohloka kwemvelo komgogodla ngeminyaka kungabangela ubuhlungu emuva. Ama-discs we-Herniated kwenzeka lapho isikhungo esithambile, esifana nejeli se-intervertebral disc siphusha izinyembezi endaweni ezungezile, indandatho yangaphandle ye-cartilage, ukucindezela nokucasula izimpande zemizwa. Ama-Disc herniations avame ukwenzeka emhlane ophansi, noma i-lumbar spine, kodwa kungenzeka futhi eduze nomgogodla womlomo wesibeletho, noma intamo. Ukufakwa kwezinzwa ezitholakala emhlane ophansi ngenxa yokulimala kanye/noma isimo esishubile kungaholela ezimpawini ze-sciatica.

 

isithombe sebhulogi kakhathuni paperboy izindaba ezinkulu

 

ISIHLOKO ESIBALULEKE KANYE: Ukuphatha Ingcindezi Yasemsebenzini

 

 

IZIHLOKO EZIBALULEKE KANYE: ENGEZIWE NGENXA YENZA: Ukwelashwa Kokulimala Kwengozi Yemoto El Paso, TX Chiropractor

 

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