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Randomized Controlled Trial

Back Clinic Randomized Controlled Trial Chiropractic uye Functional Medicine Team. Chidzidzo umo vatori vechikamu vakakamurwa nemukana mumapoka akasiyana anoenzanisa marapirwo akasiyana kana kumwe kupindira. Kushandisa mukana wekuparadzanisa vanhu mumapoka zvinoreva kuti mapoka achafanana uye kuti migumisiro yemishonga yavanowana inogona kuenzaniswa zvakanyanya.

Panguva yekuedza, hazvizivikanwi kuti ndeupi kurapa kwakanakisisa. A Randomized Controlled Trial kana (RCT) kurongeka kunopa avo vatori vechikamu muchikwata chekuedza kana boka rinodzora. Sezvo chidzidzo ichi chiitwa, mutsauko unongotarisirwa kubva kuhutungamiri nemapoka ekuedza mumutambo unongorongedzwa usinganzwisisiki (RCT) ndiko kugadziriswa kwekugadziriswa kuri kuverengwa.

Advantages

  • Zviri nyore kupofumadza / mask kupfuura kuongorora zvidzidzo
  • Good randomization inosuka chero kusarura kwevanhu
  • Vanhu vevanhu vanobatanidzwa vanoonekwa zvakajeka
  • Migumisiro inogona kuongororwa nematunhu anozivikanwa anoverengeka

payakaipira

  • Hazviratidzi kukonzera
  • Dhura munguva uye mari
  • Kurasikirwa kwekutevera-kunonzi kunonzi kurapwa
  • Kuzvipira zvinoshandiswa: huwandu hwevanhu vanobatanidzwa hungave huri kumiririra yose

Kuti uwane mhinduro kumibvunzo ipi yaungave unayo ndapota fonera Dr. Jimenez pa915-850-0900

Shandisa Kukuvadza Utano Hwotungamiri hweKuderera Kwakarereka muEl Paso, TX

Shandisa Kukuvadza Utano Hwotungamiri hweKuderera Kwakarereka muEl Paso, TX

by | Kudzorera Pain, Chiropractic, chisingaperi Pain, Randomized Controlled Trial

Kurwadziwa kwepashure kunomiririra chimwe chezvichemo zvinowanzoitika munzvimbo dzehutano. Kunyange zvazvo kukuvara kwakasiyana-siyana uye mamiriro ezvinhu ane chokuita ne musculoskeletal uye nervous system zvinogona kukonzera kurwadziwa kwepashure, vazhinji vezvehutano vanotenda kuti kukuvara kwebasa kunogona kuva nekubatana kwakawanda kune kurwadziwa kwepashure. Semuenzaniso, kumira kusina kunaka uye kudzokorora kufamba kunogona kukonzera kukuvara kwebasa. Mune zvimwe zviitiko, tsaona dzezvakatipoteredza kubasa dzinogona kukonzera kukuvara kwebasa. Chero zvazvingava, kuongorora kwakabva kurwadza kwemusana kwemurwere kunyatsoona kuti ndeipi ingava nzira yekurapa yakanakisa yekudzorera hutano hwepakutanga hwemunhu kazhinji zvinonetsa.

 

Chokutanga uye chakakosha, kuwana vanachiremba vakarurama kune yako chaiyo sosi yekurwadziwa kwakadzika kumashure kunokosha kuti uwane zororo kubva kune zviratidzo zvako. Vazhinji vashandi vehutano vanokwanisa uye vane ruzivo mukurapa-ane chekuita nebasa kurwadziwa kwemusana, kusanganisira vanachiremba vechiropractic kana chiropractors. Somugumisiro, mazano akawanda ekurapa kwekukuvara kwebasa akaiswa kuti agadzirise marwadzo ekudzokera shure muhutano hwehutano. Chiropractic kuchengetedza inotarisa pakuongorora, kurapa, nekudzivirira kukuvara kwakasiyana-siyana uye mamiriro ezvinhu, akadai seLBP, akabatanidzwa ne musculoskeletal uye nervous system. Nekunyatsogadzirisa kusarongeka kwemusana, chiropractic kuchengetedza inogona kubatsira kuvandudza zviratidzo zvekurwadziwa kwepashure, pakati pezvimwe zviratidzo. Chinangwa chechinyorwa chinotevera ndechekukurukura mazano ehutano hwebasa rekutungamira kwemarwadzo ekudzokera shure.

 

Occupational Health Guidelines for the Management of Low Back Pain: An International Comparing

 

ngovepo

 

  • Background: Mutoro wakakura wehupfumi hwemagariro ekurwadziwa kwemusana unosimbisa kukosha kwekugadzirisa dambudziko iri, kunyanya mumamiriro ekushanda zvakanaka. Kugadzirisa izvi, nhungamiro dzebasa dzakapihwa munyika dzakasiyana siyana.
  • Chinangwa: Kuenzanisa inowanika pasi rose mazano ekugadzirisa marwadzo ekudzokera shure muhutano hwehutano hwehutano.
  • Nzira: Nhungamiro dzakaenzaniswa maererano nemaitiro anowanzo gamuchirwa emhando uchishandisa chiridzwa cheAGREE uye zvakare akapfupikiswa maererano nedare rekutungamira, mharidzo, boka rinotarisirwa, uye ongororo uye manejimendi kurudziro (kureva, zano, kudzokera kubasa zano, uye kurapwa).
  • Mhinduro uye Kugumisa: Mhedzisiro yacho inoratidza kuti nhungamiro dzakasiyana dzakasangana nemhando yemhando. Kukanganisa kwakajairika kune chekuita nekusavepo kwekuongorora kwekunze kwakakodzera muhurongwa hwekuvandudza, kusatarisisa kwezvipingamupinyi zvesangano uye zvinokonzeresa mutengo, uye kushaikwa kweruzivo pamusoro pekuti vapepeti nevagadziri vakazvimiririra. Paive nekubvumirana kwakawanda pane dzakawanda nyaya dzinokosha kuhutano hwebasa rekutungamira kwemarwadzo ekudzokera shure. Kurudziro yekuongorora yaisanganisira kuongororwa kwekuongorora, kuongorora mireza matsvuku uye matambudziko etsinga, uye kuona zvingangoita zvepfungwa uye zvebasa zvipingamupinyi zvekupora. Nhungamiro dzakabvumiranawo pamusoro pemazano ekuti kurwadziwa kwepashure ndiko kuzvidzora uye kuti kuramba uri kubasa kana kutanga (zvishoma nezvishoma) kudzokera kubasa, kana zvichidiwa nemabasa akagadziridzwa, inofanira kukurudzirwa uye kutsigirwa.

 

Dr. Alex Jimenez's Insight

Kutambudzika kunodzoka shure ndechimwe chezvinhu zvakapararira zvehutano zvakabatwa mu chiropractic mahofisi. Kunyange zvazvo nyaya inotevera ichitsanangura kurwadziwa kwakanyanya kwepashure semamiriro ekudzivirira, chinokonzerwa neLBP chomunhu chinogonawo kukonzera kurwadziwa nekurwadza uye kusagadzikana kwebato rakasatorwa. Zvakakosha kune munhu ane zviratidzo zvekurwadziwa kunorwadza kutsvaga kurapa kwakakodzera nechiropractor kunyatsoongorora uye kubata zvirwere zvehutano hwavo uye kuvadzivisa kudzoka munguva yemberi. Varwere vanonzwa kurwadziwa kunorwadza shure kwemwedzi inopfuura 3 vasingapfuuri ne3 muzana vanogona kudzokera kubasa. Chiropractic kuchengetedza ndeyekuchengeteka uye inobudirira kumwe kushandiswa kurapwa kusarudzwa kunogona kubatsira kudzorera basa rekutanga remusana. Uyezve, chiremba wechiropractic, kana chiropractor, anogona kupa mararamiro ehupenyu, zvakadai sekurapa kwehutano uye yehutano, kukurumidza kugadzirisa chirwere chacho. Kuporesa kuburikidza nekufambisa kunokosha kuti LBP iwanezve.

 

Low back pain (LBP) nderimwe rematambudziko ehutano munyika dzeindasitiri. Pasinei nehunhu hwayo hwakanaka uye kosi inonzwika, LBP inowanzobatanidzwa nekusakwanisa, kurasikirwa kwechigadzirwa nekuda kwezororo rekurwara, uye kudhura kwakanyanya kwevanhu. [1]

 

Nekuda kwesimba iroro, pane kudiwa kuri pachena kwemaitiro ekutonga anobudirira anoenderana nehumbowo hwesainzi hunobva muzvidzidzo zvemhando yehudhirowa. Kazhinji, izvi zvinongorongedzwa zviedzo (RCTs) pamusoro pekubudirira kwemaitiro ekurapa, zvidzidzo zvekuongorora, kana zvidzidzo zvinotarisirwa zvekucherechedza pamusoro pezvipingamupinyi kana migumisiro. Uchapupu hwezvesayenzi, hwakapfupikiswa mukuongorora kwakarongeka uye meta-kuongorora, hunopa hwaro hwakasimba hwemazano ekugadzirisa LBP. Mune bepa rakapfuura, Koes et al. akaenzanisa akasiyana-siyana aripo nhungamiro yekiriniki yekutarisira LBP yakanangwa kune vekutanga hutano nyanzvi, ichiratidza kuwirirana kwakakura.[2]

 

Matambudziko ekuchengetwa kwehutano hwemabasa akasiyana. Utungamiri hunonyanya kukoshesa kupa mazano kune mushandi neLBP uye kugadzirisa nyaya dzekuvabatsira kuti varambe vachishanda kana kudzokera kubasa (RTW) mushure mekurwara mazita. Nekudaro, LBP inyaya yakakoshawo mukutarisirwa kwehutano hwebasa nekuda kwekusakwanisa kushanda, kurasikirwa kwechigadzirwa, uye zororo rekurwara. Nhungamiro dzinoverengeka, kana zvikamu zvemirayiridzo, zvave kuburitswa zvichibata nezvenyaya dzehutungamiriri munzvimbo yehutano hwebasa. Sezvo humbowo huri munyika yose, zvingatarisirwa kuti mazano emitemo yakasiyana-siyana yebasa reLBP angave akada kufanana. Zvisinei, hazvina kujeka kana nhungamiro inosangana nezvinogamuchirwa zvemhando yepamusoro.

 

Iri pepa rinonyatsoongorora nhungamiro yebasa iripo pakugadzirisa LBP uye inoenzanisa maitiro avo ekuongorora uye mazano ekutungamirira.

 

Main Messages

 

  • Munyika dzakasiyana-siyana, mazano ehutano hwebasa anopiwa kuti avandudze hutungamiri hwemarwadzo ekudzokera shure mumamiriro ekushanda.
  • Kukanganisa kwakajairika kweiyi nhungamiro kune chekuita nekusavepo kwekuongorora kwekunze kwakakodzera muhurongwa hwekuvandudza, kusatarisisa kwezvipingamupinyi zvesangano nemitengo yemitengo, uye kushaikwa kweruzivo pamusoro pekuzvimiririra kwevapepeti nevagadziri.
  • Kazhinji, kurudziro yekuongorora mumirayiridzo yaisanganisira kuongororwa, kuongorora mireza yakatsvuka uye matambudziko etsinga, uye kuona zvingangoitika zvepfungwa uye zvebasa zvipingamupinyi zvekupora.
  • Pane kubvumirana kwakawanda pamusoro pemazano ekuti kurwadziwa kwepashure ndiko kuzvidzora uye kuti kuramba uri kubasa kana kutanga (zvishoma nezvishoma) kudzokera kubasa, kana zvichidiwa nemabasa akagadziridzwa, inofanira kukurudzirwa uye kutsigirwa.

 

nzira

 

Nhungamiro pamusoro pehutano hwehutano hwehutano hweLBP hwakatorwa kubva kune vanyori 'mafaira ega. Kudzorerwa kwakatariswa nekutsvaga kweMedline uchishandisa mazwi makuru anorwadza shure, nhungamiro, uye basa kusvika muna Gumiguru 2001, uye kutaurirana kwevanhu pachavo nenyanzvi mumunda. Mitemo yaifanirwa kuzadzisa zvinotevera zvinosanganisira maitiro:

 

  • Nhungamiro ine chinangwa chekutonga vashandi neLBP (muzvirongwa zvehutano hwemabasa kana kugadzirisa nyaya dzebasa) kana zvikamu zvakasiyana zvemitemo inobata nenyaya idzi.
  • Mazano anowanikwa muChirungu kana Dutch (kana kuturikirwa mumitauro iyi).

 

Nzira dzekuregera dzaiva:

 

  • Nhungamiro pamusoro pekudzivirira kwekutanga (kureva, kudzivirira kusati kwatanga zviratidzo) zveLBP ine chokuita nebasa (somuenzaniso, kusimudza mirayiridzo yevashandi).
  • Mazano ekurapa kwekutungamirirwa kweLBP mukutarisira kwekutanga. [2]

 

Hunhu hwemirayiridzo yaisanganisirwa yakaongororwa pachishandiswa chiridzwa cheAGREE, chishandiso chegeneric chakagadzirirwa zvakanyanya kubatsira vanogadzira nhungamiro nevashandisi kuongorora maitiro ehutano hwemakiriniki maitiro ekutungamira.[3]

 

Chimbo che AGREE chinopa hurongwa hwekuongorora kunaka kwezvinhu zve24 (tafura 1), imwe neimwe yakarongwa pachiyero chezvikamu zvina. Kushanda kuzere kunowanikwa pa www.agreecollaboration.org.

 

Vaongorori vaviri (BS neHH) vakayera vakazvimiririra kunaka kwegwaro uye vakazosangana kuti vakurukure kusawirirana uye kusvika pakubvumirana pazviyero. Pavakatadza kubvumirana, muongorori wechitatu (MvT) akayananisa misiyano yakasara uye akasarudza pazviyero. Kufambisa ongororo muongororo iyi, zviyero zvakashandurwa kuita dichotomous variables yekuti chinhu chega chega chemhando chaive kana kuti chisina kusangana.

 

Mazano ekuongorora akapfupikiswa uye akaenzaniswa nemazano pamusoro pemazano, kurapwa, uye kudzokera kumabasa ekushanda. Nhungamiro dzakasarudzwa dzakawedzera kucherechedzwa uye dzakasvika maererano nekomiti yekutungamira, kuratidzwa kwemaitiro, boka rinotarisirwa, uye nhanho iyo kurudziro yakavakirwa pauchapupu hwesainzi huripo. Idzi ruzivo rwese rwakatorwa zvakananga kubva kune yakadhindwa nhungamiro.

 

Purogiramu Inobatsira

 

  • Kutungamirirwa kwemarwadzo ekudzokera shure muhutano hwehutano hwehutano hunofanira kutevera uchapupu-based guidelines.
  • Nhepfenyuro yeramangwana yebasa rekugadzirisa marwadzo ekudzokera shure uye kuvandudzwa kweiyo nhungamiro kunofanirwa kufunga nezvemaitiro ekusimudzira kwakakodzera, kuita, uye kuongororwa kwemaitiro sekutaurwa kwekubatana kweAGREE.

 

Results

 

Kusarudzwa kweZvino

 

Tsvakurudzo yedu yakawana mazano gumi, asi mana akanga asina kubatanidzwa nokuti aibata nehutungamiri hweLBP mukutarisira kwekutanga, [15] yakanga yakananga kutungamirirwa kwevashandi vanorwara-vakanyorwa muhuwandu (kwete kunyanya LBP), [16] yakanga yakagadzirirwa kudzivirira kwekutanga kweLBP kubasa, [17] kana kusawanikwa muChirungu kana chiDutch.[18] Sarudzo yekupedzisira, saka, yaive nemirairo mitanhatu inotevera, yakanyorwa nezuva rekuburitswa:

 

(1) Kanadha (Quebec). Nzira yesainzi yekuongorora uye kutungamira kwemaitiro ane chekuita nemusana kusagadzikana. A monograph yevarapi. Chirevo cheQuebec Task Force pane Spinal Disorders. Quebec Canada (1987) [4]

 

(2) Australia (Victoria). Nhungamiro dzehutungamiri hwevashandi vane marwadzo ekudzokera shure. Victorian WorkCover Authority, Australia (1996) [5] (Iyi ivhezheni yakadzokororwa yegwara rakagadzirwa neSouth Australian WorkCover Corporation muna Gumiguru 1993.)

 

(3) USA. Occupational Medicine Practice Guidelines. American College yeOccupational uye Environmental Medicine. USA (1997) [6]

 

(4) New Zealand

 

(a)Inoshanda uye inoshanda! Kugadzirisa acute low back pain munzvimbo yebasa. Accident Compensation Corporation uye National Health Committee. New Zealand (2000) [7]

 

(b) Mutungamiri wevarwere kune acute low back pain management. Accident Compensation Corporation uye National Health Committee. New Zealand (1998) [8]

 

(c) Ongorora psychosocial yero mireza mune acute low back pain. Accident Compensation Corporation uye National Health Committee. New Zealand (1997) [9]

(5) Netherlands. Dutch guideline yekutarisira vanachiremba vebasa revashandi vane kurwadziwa kwepashure. Dutch Association yeOccupational Medicine (NVAB). Netherlands (1999) [10]

 

(6) UK

 

(a) Mirayiridzo yehutano yebasa rekugadzirisa marwadzo ekudzokera shure pabasa guru mazano. Faculty of Occupational Medicine. UK (2000) [11]

 

(b) Mirayiridzo yehutano yebasa rekugadzirisa marwadzo ekudzokera shure papepa rekushanda kune varapi. Faculty of Occupational Medicine. UK (2000) [12]

 

(c) Mirayiridzo yehutano yebasa rekugadzirisa marwadzo ekudzokera shure pabasa rekuongorora uchapupu. Faculty of Occupational Medicine. UK (2000) [13]

 

(d)The Back Book, The Stationery Office. UK (1996) [14]

Nhungamiro mbiri (4 uye 6) haigone kuongororwa yakazvimirira kubva kune mamwe magwaro avanoreva (4bc, 6bd), saka magwaro aya akaiswawo muongororo.

 

Kuongorora kwehutano hweMitungamiri

 

Pakutanga, pakanga paine chibvumirano pakati pevaongorori vaviri maererano ne106 (77%) ye138 chinhu ratings. Mushure memisangano miviri, kubvumirana kwakasvika kune zvese kunze kwezvinhu zvina, izvo zvaida kutongwa nemuongorori wechitatu. Tafura 1 inopa zviyero zvekupedzisira.

 

Zvose zvaisanganisira mirayiridzo yakaratidza nzira dzakasiyana-siyana dzekutarisira LBP muhutano hwebasa. Mune zvishanu pamatanho matanhatu, zvinangwa zvese zvemaitiro zvakatsanangurwa zvakajeka, [46, 1014] vavariro yevashandisi vehurongwa vakatsanangurwa zvakajeka, [514] zvinozivikanwa zviri nyore zvinongedzo zvakabatanidzwa, [4, 614] kana kuongororwa kwakadzama. maitiro akaunzwa kuti atarise uye aongorore zvinangwa.[49, 1114]

 

Mhedzisiro yekuongorora kweAGREE yakaratidza kuti hapana kana imwe yemitemo yakabhadhara zvakakwana kune zvingave zvipingamupinyi zvesangano uye zvinodhura mukuita mazano. Hazvina kujeka zvakare kune vese vanosanganisira gwara rekuti vaive vakazvimirira here kubva kuboka rinopa mari uye kuti paive nemakakatanwa ezvido zvenhengo dzemakomiti ebudiriro. Pamusoro pezvo, zvanga zvisina kujeka kune zvese zvinongedzo kana nyanzvi dzakaongorora kunze mitemo isati yaburitswa. Chete nhungamiro yeUK yakatsanangura zvakajeka nzira yakashandiswa kugadzira kurudziro uye yakapihwa yekuvandudza nzira.[11]

 

Tafura 1 Kuongororwa kweEpupational Health Guidelines

 

Kuvandudzwa kweMitungamiri

 

Tafura 2 inopa ruzivo rwemashoko pamusoro pekufambiswa kwemitemo.

 

Vashandisi vezvinangwa zvemirayiridzo vaive vanachiremba nevamwe vatapi vehutano mumunda wehutano hwemabasa. Mitemo yakati wandei yaitungamirwawo kuzivisa vashandirwi, vashandi [68, 11, 14], kana nhengo dzemasangano anofarira hutano hwebasa.[4] Nhungamiro yechiDutch yaingonangwa kuna chiremba wezvehutano hwepabasa.[10]

 

Makomiti ekutungamira aitarisira kugadzira nhungamiro aiwanzo siyana-siyana, kusanganisira chirango senge epidemiology, ergonomics, physiotherapy, general practice, occupational medicine, occupational therapy, orthopedics, uye vamiriri vemasangano evashandirwi nemasangano evashandi. Chiropractic uye osteopathic vamiririri vaiva mugwaro komiti yeNew Zealand nhungamiro.[79] The Quebec task force (Canada) yaisanganisirawo vamiriri vemishonga yekudzoreredza, rheumatology, hutano hwehupfumi, mutemo, neurosurgery, biomechanical engineering, uye raibhurari sainzi. Kusiyana neizvi, komiti yekutungamira yeDutch guideline yaisanganisira vanachiremba vebasa chete.[10]

 

Nhungamiro dzakapihwa segwaro rakasiyana, [4, 5, 10] sechitsauko mubhuku, [6] kana semagwaro akati wandei ane hukama.[79, 1114]

 

Iyo UK, [13] iyo USA, [6] neCanada [4] nhungamiro dzakapa ruzivo nezve zano rekutsvaga rinoshandiswa mukuzivikanwa kwemabhuku akakodzera uye kuyerwa kwehumbowo. Kune rimwe divi, maDutch[10] neAustralia[5] nhungamiro yakatsigira kurudziro yavo chete nemareferensi. Nhungamiro yeNew Zealand haina kuratidza hukama hwakananga pakati pemazano uye zvinonetsa [79]. Muverengi aiendeswa kune mamwe mabhuku kuti awane ruzivo.

 

Dhiwani 2 Nhoroondo Yenzira dzeZvirevo

 

Tafura 3 Occupational Guidelines Mapinduriro

 

Tafura 4 Occupational Guidelines Mapinduriro

 

Varwere Vagari Navanoona Mazano

 

Kunyange zvazvo mazano ose akatarisa kune vashandi vane LBP, zvakanga zvisinganyatsozivikanwi kana vakabata neLBP yakaoma kana isingagumi kana zvose. Acute uye isingaperi LBP yaiwanzosatsanangurwa, uye mapoinzi ekucheka akapihwa (semuenzaniso, <mwedzi mitatu). Zvaiwanzosajeka kana izvi zvaireva kutanga kwezviratidzo kana kusavapo kubasa. Zvisineyi, nhungamiro yeCanada yakaunza hurongwa hwekuronga (acute/subacute/ chronic) zvichibva pakuparadzirwa kwezvichemo zvehosha dzemusana nenguva kubva pakusaenda kubasa.[3]

 

Nhungamiro dzese dzinosiyanisa LBP yakananga uye isiri yakananga. Specific LBP inobata mamiriro angangove akakomba emureza mutsvuku sekutyoka, mapundu, kana kutapukirwa, uye nhungamiro dzeDutch neUK dzinosiyanisa radicular syndrome kana tsinga midzi marwadzo.[1013] Maitiro ese aienderana mukurudziro yavo yekutora nhoroondo yekiriniki uye kuita ongororo yemuviri, kusanganisira neurological screening. Muzviitiko zvekufungidzirwa chaiko pathology (mireza matsvuku), x-ray bvunzo dzakakurudzirwa nemirairo yakawanda. Pamusoro pezvo, New Zealand uye nhungamiro yeUS yakakurudzirawo kuongororwa kwex-ray apo zviratidzo zvisina kunaka mushure memavhiki mana. [6, 9] Nhungamiro yeUK yakataura kuti bvunzo dze x-ray hadziratidzirwe uye hadzibatsire hutano hwehutano hwebasa. murwere ane LBP (yakasiyana nechero zviratidzo zvekiriniki).[1113]

 

Mazhinji nhungamiro akafunga nezve psychosocial zvinhu seyero mireza sezvipingamupinyi mukupora izvo vanopa hutano vanofanirwa kugadzirisa. Iyo New Zealand [9] uye UK nhungamiro [11, 12] yakanyatso nyora zvinhu uye mibvunzo yakakurudzira yekuziva iwo psychosocial yellow mireza.

 

Nhungamiro dzese dzakataura kukosha kwenhoroondo yekiriniki inozivisa zvinhu zvemuviri uye zvepfungwa zvepanzvimbo yebasa zvinoenderana neLBP, kusanganisira zvinodiwa zvemuviri zvebasa (kubata nemaoko, kusimudza, kukotama, kumonyoroka, uye kuratidzwa kune muviri wese kudedera), tsaona kana kukuvara, uye zvinoonekwa zvinonetsa. mukudzoka kubasa kana hukama kubasa. Mirayiridzo yeDutch neCanada yaive nemazano ekuita ongororo yenzvimbo yebasa[10] kana ongororo yehunyanzvi hwebasa pazvinenge zvakakodzera.[4]

 

Nhaurirano yeZvirongwa zveKuongorora kweLBP

 

  • Kuongorora kuongorora (kwete-LBP chaiyo, radicular syndrome, yakananga LBP).
  • Usasanganise mireza matsvuku uye kuongorora kwetsinga.
  • Ziva maonero ehupfungwa uye zvipingamupinyi zvinogona kuitika kuti uwanezve.
  • Ziva nzvimbo dzebasa (zvepanyama uye zvepfungwa) izvo zvingave zvakabatana nechinetso cheLBP uye kudzokera kubasa.
  • X-Ray bvunzo dzinongowanikwa kune dzinofungidzirwa nyaya dzeiyo chaiyo pathology.

 

Mazano Pamusoro Pemazano uye Mazano, Kurapa, uye Kudzokera Kumagadzirirwo Emabasa

 

Mitemo yakawanda inokurudzirwa kuvimbisa mushandi uye kupa ruzivo pamusoro pekuzvigadzirisa kweLBP uye kufungidzira kwakanaka. Kurudziro yekudzokera kumabasa enguva dzose sezvinobvira yaiwanzopiwa zano.

 

Maererano nekurudziro yekudzokera kumabasa enguva dzose, mazano ose akasimbisawo kukosha kwekudzoka kubasa nekukurumidza sezvinobvira, kunyange kana kuchine imwe LBP uye, kana zvichidiwa, kutanga nemabasa akagadziridzwa mumatambudziko akaoma. Mabasa ebasa aigona ipapo kuwedzerwa zvishoma nezvishoma (maawa nemabasa) kutozosvikira kudzokera kubasa kwasvikwa. Nhungamiro dzeUS neDutch dzakapa dzakadzama nguva dzekudzokera kubasa. Maonero echiDutch akakurudzira kudzokera kubasa mukati memavhiki maviri nekuchinja kwemabasa pazvinenge zvakakodzera.[10] Hurongwa hwechiDutch hwakasimbisawo kukosha kwekutonga-nguva-nguva nezvekudzoka kubasa.[10] Nhungamiro yeUS yakaronga kuedza kwese kuchengetedza murwere padanho repamusoro rekuita, kusanganisira mabasa ebasa; zvinangwa zvenguva yehurema maererano nekudzoka kubasa zvakapiwa semazuva 02 ane mabasa akagadziridzwa uye mazuva 714 kana mabasa akagadziridzwa asina kushandiswa / aripo.[6] Mukusiyana nemamwe, gwara rekuCanada rakakurudzira kudzokera kubasa chete kana zviratidzo uye zvirambidzo zvekushanda zvave nani.[4]

 

Nzira dzekurapa dzinowanzokurudzirwa mumitemo yose yakabatanidzwa yaiva: mishonga yekunyaradza marwadzo, [5, 7, 8] zvishoma nezvishoma zvirongwa zvekurovedza muviri zvinofambira mberi, [6, 10] uye kuvandudzwa kwemarudzi akawanda.[1013] Nhungamiro yeU.S. yakakurudzira kuendeswa mukati memavhiki maviri kuchirongwa chekurovedza muviri chinosanganisira maekisesaizi e-aerobic, maekisesaizi ekugadzirisa tsandanyama dzehunde, uye chiyero chekurovedza muviri.[6] Nhungamiro yeDutch yakakurudzira kuti kana pasina kufambira mberi mukati memavhiki maviri ekusavapo kwebasa, vashandi vanofanira kuendeswa kune purogiramu yebasa regiredhi (zvishoma nezvishoma kuwedzera maekisesaizi) uye, kana pasina kuvandudzika nemavhiki mana, kuchirongwa chekugadzirisa zvinhu zvakawanda.[10] ] Nhungamiro yeUK yakakurudzira kuti vashandi vanoomerwa nekudzoka kumabasa enguva dzose nemavhiki mazana mana negumi nemaviri vanofanirwa kuendeswa kuchirongwa chekuvandudza chinoshanda. Iyi purogiramu yekudzorera inofanira kusanganisira dzidzo, kuvimbiswa uye mazano, chirongwa chinofambira mberi chakasimba chekurovedza muviri uye chirongwa chehutano, uye kugadzirisa marwadzo maererano nemitemo yekuzvibata; inofanira kuiswa munharaunda yebasa uye yakanangidzirwa zvakasimba kune kudzokera kubasa.[412-11] Mazita akawanda ezvingasarudzwa zvekurapa zvakaratidzwa mumirayiridzo yeCanada neAustralia [13, 4], kunyange zvazvo zvizhinji zveizvi zvakanga zvisina kuvakirwa. pauchapupu hwesainzi.

 

Nhepfenyuro yezvikurudziro pamusoro peRuzivo, Mazano, Kudzokera Kumabasa Matsanho, uye Kurapa kune Vashandi vane LBP

 

  • Simbisa mushandi uye upe ruzivo rwakakwana pamusoro pekuzvimisa kweLBP uye kufungidzira kwakanaka.
  • Rairira mushandi kuti aenderere mberi nemabasa akajairika kana kuti adzokere kuekisesaizi yenguva dzose uye kushanda nokukurumidza sezvinobvira, kunyange kana pachine mamwe marwadzo.
  • Vazhinji vashandi vane LBP vanodzokera kune mamwe kana mashoma mabasa enguva dzose nekukurumidza. Funga nezvekuchinja kwechinguvana kwemabasa ebasa (maawa / mabasa) chete kana zvichidikanwa.
  • Kana mushandi akakundikana kudzokera kubasa mukati memavhiki e212 (kune kusiyana kukuru muchiyero chenguva mumitemo yakasiyana-siyana), vataurire kune chirongwa chekuwedzera zvishoma nezvishoma chekurovedza muviri, kana kugadziriswa kwemarudzi akawanda (maitiro, dzidzo, kuvimbiswa, uye marwadzo ekutungamirira kutevera mitemo yehutsika). ) Aya mapurogiramu ekudzorera
    inofanira kuiswa mumamiriro ekushanda.

 

hurukuro

 

Utungamiri hweLBP muhutano hwehutano hwebasa hunofanira kugadzirisa hukama pakati pezvichemo zvakaderera shure uye basa nekugadzira mazano ane chinangwa chekudzoka kwakachengeteka kubasa. Ongororo iyi yakaenzanisa nhungamiro yehutano hwebasa iripo kubva kunyika dzakasiyana siyana. Mitemo haiwanzo kunyoreswa muMedline, saka kana tichitsvaga nhungamiro, taifanira kuvimba zvakanyanya nemafaira emunhu uye kutaurirana pachedu.

 

Maitiro Ehutano uye Kuvandudzwa kweMitemo

 

Kuongororwa kwechirongwa cheAITREE [3] kwakaratidza kusiyana kwehutano hwehutungamiri huri kuongororwa, izvo zvingangodaro zvingaratidza kushandiswa kwemazuva ekufambiswa nekubudiswa kwemitungamiri. ICanada nhungamiro, somuenzaniso, yakabudiswa mu1987 uye Australian guideline muna 1996. [4, 5] Mimwe mirayiridzo yakanga ichangobva kuitika uye yakawedzera huwandu hwomupupuriro hwehuwandu uye huripo kusvikira nhasi maitiro ehutungamiri.

 

Zvikanganiso zvakasiyana-siyana zvinowanzoenderana nehutano hwekufambiswa kwemirayiridzo yakaratidzwa nekuongororwa nechombo chechirongwa. Chokutanga, zvakakosha kujekesa kana mutungamiri wekuzvimiririra wehurumende kubva kumubatanidzwa wemari, uye kana pane kukakavara kwevanhu vanoita komiti inotungamirira. Hapana yemitemo yakabatanidzwa yakanyatsorondedzera nyaya idzi. Zvakare, yakarondedzera kubvunzurudzwa kwekunze kwechirongwa nemakiriniki uye mazano vekugadzirwa kwepamusoro kusati kwadhindwa kwaive kusinawo mazano ose akabatanidzwa munyaya iyi.

 

Mitsara yakawanda yakapa ruzivo rwakakwana pamusoro penzira yakakodzera mabhuku yakatsvakurudzwa uye yakashandurwa muzvirongwa. [4, 6, 11, 13] Mamwe mirayiridzo yakatsigira mazano avo nezviratidzo, [5, 7, 9, 10] asi izvi hazvibvumi kuongorora kubwinya kwemashoko kana mazano avo.

 

Mirayiridzo inobva kune uchapupu hwezvesayenzi, hunochinja munguva, uye zvinoshamisa kuti imwe chete inotungamirirwa inopa hurumende itsva. [11, 12] Zvichida pane zvigadziriswa zvakarongwa kune mamwe mazano asi hazvirevi zvakananga (uye zvakatarisa kutaura ipapo richave rakanaka remangwana hazvirevi kuti richaitika zvechokwadi). Kushaikwa kwekupa ruzivo kunogonawo kubata kwechokwadi kune zvimwe zvinotenderwa zvinotenderwa izvo zvatakaverenga zvisina kunaka. Kushandiswa kwechirongwa chechirongwa semutungamiri wekukudziridza uye kubudiswa kwemitemo kunofanira kubatsira kuvandudza hutungamiri hwehupenyu huri mberi.

 

Kuongorora uye Kutungamirirwa kweLBP

 

Nzira dzekuongorora dzinokurudzirwa mumitemo yehutano hwebasa dzakanga dzakanyanya kufanana nemazano emitemo yekiriniki, [2] uye, zvine musoro, musiyano mukuru waiva kusimbiswa kwekugadzirisa nyaya dzebasa. Nzira dzakataurwa dzekugadzirisa zvinhu zvepabasa mukuongororwa kweLBP yemushandi wega wega ane chokuita nekuzivikanwa kwemabasa akaoma, zvinhu zvinokanganisa, uye zvipingamupinyi zvekudzoka kubasa nenhoroondo dzebasa. Zviripachena, zvipingamupinyi izvi zvekudzokera kubasa hazvinei nekuremerwa kwemuviri chete, asiwo matambudziko epfungwa ane chekuita nebasa, kushanda pamwe nevaunoshanda navo, uye magariro kumabasa.[10] Kuongororwa kwemabasa ane chekuita nemagariro eyero mireza kunogona kubatsira kuona vashandi vari panjodzi yekurwadziwa kusingaperi nekuremara.[1113]

 

Chimwe chinhu chinonyanya kukosha chemitungamiri ndechekuti vaisagadzikana pamusoro pezvavanorayira kuti vatsigire mushandi neLBP, uye kukurudzira nekusigira kudzokera kubasa kunyange nezvimwe zviratidzo zvinoramba zvichiitika. Pane kubvumirana kwakawanda iyo vazhinji vashandi havafaniri kumirira kusvikira vasisina zvachose marwadzo vasati vadzokera kubasa. Mazita ezvokurapa anopiwa neCanada neAustralia mazano angaratidza kusasha kwehuchapupu panguva iyoyo, [4, 5] achisiya vashandi vemirayiridzo yavanosarudza ivo pachavo. Izvozvi, zvisinei, hazvina chokwadi kana mitsamba yakadaro inobatsira chaizvo pakuvandudza kutarisira, uye mumaonero edu mazano ekufambisa anofanirwa kunge akavakirwa pauchapupu hwezvesayenzi.

 

IUS, Dutch, uye UK occupational guidelines [6, 1013] inokurudzira kuti kushingaira kwehutano hwemarudzi akawanda ndiko kupindira kunovimbisa kwekudzoka kubasa, uye izvi zvinotsigirwa nehuchapupu hwakasimba kubva kuRCTs [19, 20] Zvisinei, tsvakurudzo yakawanda ichiri zvinodikanwa kuona zvakanangana zvemukati uye kusimba kweaya mapakeji ekurapa.[13, 21]

 

Pasinei nehumwe humbowo hwemupiro wezvinhu zvepabasa mune aetiology yeLBP, [22] nzira dzakarongeka dzekugadzirisa nzvimbo dzebasa dzinoshaikwa, uye hazvipiwi sekurudziro mumirayiridzo. Zvichida izvi zvinomiririra kushaikwa kwechivimbo muhumbowo hwezvese zvinokonzeresa zvinhu zvepabasa, kuomerwa kweshanduro kuita nhungamiro inoshanda, kana nekuti nyaya idzi dzinovhiringika nemutemo wenzvimbo (iyo yakapihwa mugwaro reUK [11]). Zvingave kuti kupindira kweergonomics inobatanidzwa, iyo inokurudzira kubvunzana nemushandi, mushandirwi, uye ergonomist, ichava kudzoka kunobatsira kupindira kwebasa. 23] yakasimbiswa muDutch uye UK mirayiridzo, [24] asi imwezve kuongororwa kweiyi nzira uye kushandiswa kwayo kunodiwa.

 

Kuvandudza Kwemangwana Mitsva muZvipational Health Care

 

Chinangwa chekuongororwa uku ndechokupa zvose zvakanyatsorongeka uye kuongororwa kwakakosha kwemashoko emabasa ekutungamirirwa kweLBP. Kuongorora kwakakosha kwemitungamiri inofanirwa kubatsira rubatsiro rwakananga mune ramangwana uye kugadziriswa kwakarongwa kwemitemo. Muchiri chichiri kubuda munharaunda yenzira yekufambisa tinotarisa matanho ose akapfuura seanoyemura; tinoziva chido chekuraira kwechipatara, uye tinoziva kuti vatungamiri vanosimudzira havagoni kumirira kutsvakurudza kuti vape nzira dzose uye uchapupu hunodiwa. Zvisinei, pane nzvimbo yekuvandudza uye mirayiridzo yeramangwana uye kuvandudzwa kunofanirwa kutarisa zvinotarisirwa pakuchengetedza kwakanaka, kushandiswa, uye kuongororwa kwevatungamiri sezvinoratidzirwa nekushandira pamwe.

 

Kushandiswa kwemitungamiri yacho hakupfuuri kuongororwa uku, asi zvakataurwa kuti hapana mimwe mitungamiri inonyorwa inotsanangurwa zvakananga maitiro ekushandisa, saka hazvizivikanwe kuti zvikamu zvitsva zvingave zvave zvasvika sei, uye zvii zvingave zvakakonzerwa . Izvi zvinogona kuva nzvimbo inobereka kutsvaga kutsvakurudza.

 

Kuvepo chaiko kweaya mazano ehutano hwebasa anoratidza kuti nhungamiro iripo yekiriniki yekutarisira yeLBP2 inoonekwa seisina kufanira kana kusakwana pakutarisirwa kwehutano hwebasa. Pane maonero akajeka pasi rose kuti zvinodikanwa zvemushandi ari kurwadziwa shure zvakabatanidzwa kune zvakasiyana-siyana zvebasa rebasa risingafukidzwi neyakajairwa kutungamira kwekutanga kutungamira uye, nekudaro, kudzidzira. Chinobuda ndechekuti, kunyangwe paine kukanganisa kwemaitiro, chibvumirano chakakura chinoonekwa pane dzakasiyana siyana dzehutano hwemabasa ekugadzirisa mushandi ane marwadzo ekumusana, mamwe acho ari matsva uye dambudziko raimboitwa maonero. Pane chibvumirano pamusoro peshoko rinokosha rokuti kurasikirwa kwebasa kwenguva refu kunokuvadza, uye kuti kukurumidza kudzoka kwebasa kunofanira kukurudzirwa uye kurerutswa; hapana chikonzero chekumirira kugadziriswa kwechiratidzo chakakwana. Kunyange zvazvo nzira dzinokurudzirwa dzichisiyana, pane kubvumirana kukuru pamusoro pekukosha kwekusimbiswa kwakanaka uye mazano, kuvapo (kwenguva pfupi) basa rakagadziridzwa, kugadzirisa zvinhu zvepabasa (kuita kuti vatambi vose vamire), uye kugadziriswa kwevashandi vane dambudziko rekudzokera kubasa.

 

KUTENDA

 

Ichi chidzidzo chakatsigirwa neDutch Health Care Insurance Council (CVZ), kupa DPZ kwete. 169 / 0, Amstelveen, Netherlands. JB Staal iye zvino ari kushanda paDhipatimendi reEpidemiology, Maastricht University, PO Box 616 6200 MD Maastricht, Netherlands. W van Mechelen zvakare chikamu cheChishopiti Chekuongorora pamusoro Pechiitiko Chekuita, Basa Nehutano, Muviri @ Kushanda TNO-VUmc.

 

Mukupedzisa, zviratidzo zvekurwadziwa kwepashure ndezvimwe zvezvinhu zvakasiyana-siyana zvehutano zvine chokuita nekukuvara kwebasa. Nemhaka yei, mitemo yakawanda yehutano yehutano yakagadzirirwa kutungamirirwa kwekutambudzika kwepamusoro. Chiropractic kuchengetedza, pakati pemamwe nzira dzokurapa, inogona kushandiswa kuitira kubatsira murwere kuwana rusununguko kubva kune LBP yavo. Uyezve, nyaya iri pamusoro apa yakaratidza kuchengetedzwa nekubudirira kwezvimwe zvakasiyana-siyana zvetsika pamwe nekusarudzwa kwekurapa mune zvekuongororwa, kurapwa uye kudzivirirwa kwezviitiko zvakasiyana-siyana zvinorwadza shure. Zvisinei, zvimwe zvidzidzo zvekutsvakurudza zvinotarisirwa kuitira kuti zvigadzirise zvakanakira nzira imwe neimwe yekurapa. Mashoko anotsanangurwa kubva kuNational Center for Biotechnology Information (NCBI). Kuwanda kweruzivo rwedu kunogumira kune chiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota ivai vakasununguka kubvunza Dr. Jimenez kana kuti tibvunzei kwatiri 915-850-0900 .

 

Yakarongedzwa naDkt Alex Jimenez

 

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

 

Zvimwe Zvinyorwa: Kubva Painini

 

Maererano nehuwandu, inenge 80% yevanhu ichaona zviratidzo zvekurwadziwa shure shure kamwechete munguva yeupenyu hwavo hwose. Kutambudzika shure ndiko kunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Kazhinji kacho, kuora kwechimiro chemupaka nezera kunogona kukonzera marwadzo kumashure. Herniated discs inoitika apo ganda rakanyorova, segel-like re intervertebral disc rinodonha nekubvarura mukati maro, rinenge riri kunze kwekatekete, kubvongodza nekugumbura midzi midzi. Dhizinesi dzinozivikanwa dzinowanzoitika kumucheto kumashure, kana kuti nhengo dzomukati, asi dzinogonawo kuitika pamucheto wepervical, kana mutsipa. Kuiswa kwemitsipa inowanikwa mucheka shure nekuda kwekukuvara uye / kana mamiriro akaoma kunogona kutungamirira kune zviratidzo zve sciatica.

 

 

blog chinyorwa chekartoon paperboy makuru makuru

 

NHAURWA INOKOSHA INOKOSHA: Migraine Pain Treatment

 

 

DZIMWE MASHOKO: KUNYANYA KWENYAYA: El Paso, Tx | Vatambi

 

Hazvina kuchena
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Kugadzirwa kwepamuviri vs. Kukurudzirwa kweCervicogenic Headache muEl Paso, TX

by | Chiropractic, Neck Pain, Randomized Controlled Trial

Musoro wemusoro unonzi hutambudzi hwemusoro hunokonzerwa nehutano hwepfungwa pachahwo. Iyo mitatu mitatu yepfungwa huru yepamusoro misoro inosanganisira, migraine, marwadzo emusoro-soro uye misoro yemasumbu. Kutambudzika kwemukoko chiratidzo chinorwadza uye chinoparadza chinogonawo kuitika semugumisiro weimwe chikonzero chinokonzera. Musoro wemusoro unonzi hutambudzi hwemusoro hunoitika nekuda kwekukuvara uye / kana mamiriro. Kusaruramisa kwemusana, kana kugunun'una, pamwe nemucheto wemutsipa, kana mutsipa, kazhinji kunobatanidza nezviratidzo zvakasiyana-siyana zvepfungwa.

 

Cervicogenic misoro yechipfuva ndeye musoro wechipiri unokonzerwa nekukuvadzwa uye / kana chiitiko chinokonzera zvivako zvakakomberedza zvepervical spine, kana mutsipa. Vazhinji vashandi vehutano vacharumbidza kushandiswa kwezvinodhaka / mishonga kuti ibatsire kuvandudza misoro, zvisinei, dzimwe nzira dzakasiyana-siyana dzokurapa dzinogona kushandiswa zvakanaka uye dzinoshandiswa kugadzirisa musoro wechipiri. Chinangwa chehurukuro inotevera ndechekuratidzira hutachiwana hwepamusoro hwechibereki uye chepamusoro chekutengesa thoracic maererano nekugadzirisa nekuita muviri muvarwere vane cervicogenic musoro.

 

Urefu hweCervical uye Upper Thoracic Manipulation Versus Mobilization uye Kudzidzira Muzvirwere neCervicogenic Headache: Multi-Center Randomized Clinical Trial

 

ngovepo

 

  • Background: Kunyange zvazvo inowanzoshandiswa nzira dzekushandisa, hapana tsvakurudzo yakanyatsofananidza nekubudirira kwechirwere chechirchi uye chekunyengedzera kwekunyaradza nekuita maitiro muvanhu vane cervicogenic headache (CH). Chinangwa chechidzidzo ichi chaiva chokuenzanisa migumisiro yekushandiswa kwekukurudzira nekuita maitiro muvanhu vane CH.
  • Nzira: Vane zana negumi vatori vechikamu (n? =? 110) neCH vakasarudzika kuti vagamuchire ese emumuromo uye echironda kunyengedza (n? =? 58) kana kuunganidza uye kurovedza muviri (n? =? 52). Mhedzisiro mhedzisiro yaive kusimba kwemusoro sekuyerwa neNumeric Pain Rating Scale (NPRS). Sekondari mhedzisiro yaisanganisira kuwanda kwemusoro, kutemwa nemusoro, kuremara sekuyerwa neNeck Disability Index (NDI), kunwa mishonga, uye Global Rating yeKushandura (GRC). Nguva yekurapa yaive mavhiki e4 nekutevera-kuongorora pa1 vhiki, mavhiki e4, uye mwedzi mitatu mushure mekutanga kurapwa chikamu. Chinangwa chekutanga chakaongororwa ne3-nzira yakavhenganiswa-modhi ongororo yemusiyano (ANOVA), neboka rekurapa (kumisikidza maringe nekusimudzira uye kurovedza muviri) senge iri pakati pezvidzidzo zvinosiyana uye nguva (yekutanga, svondo rimwe, mavhiki mana nemwedzi mitatu) se izvo zviri mukati mezvidzidzo zvinosiyana.
  • Results: Iyo 2X4 ANOVA yakaratidza kuti vanhu vane CH avo vakagamuchira zvese remuromo wechibereko uye thoracic kudzvinyirira vakasangana nekudzikisira kwakakura kwazvo mukushungurudzika kwemusoro (p?
  • Mhedziso: Zvidzidzo zvitanhatu kusvika masere zvepamusoro pemakondomu nepamusoro-soro thoracic zvakaratidzwa kuti dzakagadzirisa kupfuura kukurudzira uye kurovedza muviri mune varwere vane CH, uye migumisiro yakachengetwa pamwedzi we3.
  • Trial registration: NCT01580280 April 16, 2012.
  • Keywords: Cervicogenic headache, Kushungurudza kwepfungwa, Kukurudzira, High velocity low amplitude thrust

 

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight

Mukufananidza nemusoro wemusoro, zvakadai migraine, musana wemasumbu uye kushungurudzika kwemusoro-musoro, humwe hutano hunoonekwa sehutambudzi hwemusoro hunokonzerwa nedzimwe chirwere kana chirwere. Muchiitiko che cervicogenic musoro, chinokonzera kurwadziwa kwepamusoro kunokonzerwa nekukuvadzwa uye / kana mamiriro pamwe nechepervical spine uye zvivako zvaro zvakapoteredza, kusanganisira vertebrae, intervertebral discs uye zvinyoro zvishoma. Mukuwedzera, vashandi vazhinji vezvehutano vanotenda kuti musoro wepamusoro unogona kugoverwa nehutano hwehutano mumutsipa wekervical, kana mutsipa. Cervicogenic misoro yechirwere inofanira kuve iyo inobva kune zviratidzo uye inogona kusiyana zvichienderana nemurwere. Chiropractic kuchengetedza inoshandisa maginha ekugadzirisa uye maitiro ekushandisa kuitira kunyatsogadzirisa chimiro chepakutanga uye basa remutsana, zvichibatsira kuderedza kushungurudzika uye kuomanikidza kuti uwedzere zviratidzo zvepachiviri chepervicogenic, pakati peimwe mhando yemusoro. Kuchengetedza chiropractic kunogona kushandiswawo kubatsira kubatsira kubata misoro yemusoro, yakadai semigraines.

 

kumashure

 

Iyo International Classification ye Headache Disorders inotsanangura cervicogenic headache (CH) se, musoro unokonzerwa nekusagadzikana kwecervical spine uye chikamu chayo bony, disc, uye / kana zvinyoro zvinyama zvinhu, kazhinji asi zvisingaite zvinowirirana nekurwadziwa kwemutsipa. [1 ] (p. 760) Kuwanda kweC CH kwakanzi kuri pakati pe0.4 ne20% yemusoro wevanhu [2, 3], uye yakakwira se53% mune varwere vane misoro mushure mekukuvara kwechiplash [4]. Izvo zvinonyanya kufadza CH zvinowanzo sanganisira: unilatality yemusoro kurwadziwa pasina divi-kusuduruka, kukwirisa kwekutambudzika nekunze kumanikidza pamusoro peiyo ipsilateral kumusoro mutsipa, mashoma emumuromo erudzi rwekufamba, uye kukonzera kwekurwiswa nemhando dzakasiyana dzinoomarara kana dzakatsiga kufamba kwemutsipa [4, 5].

 

Vanhu vane CH vanowanzobatwa nemishonga yepelin manipulative iyo inosanganisira kukurudzira uye kushandiswa [6]. Kubatana kwepamuviri kunosanganisira zvishoma nezvishoma, zvine rhythmical, zvisingagoni kushandiswa asi kushandiswa kunosanganisira high-velocity low-amplitude trust techniques. [7] Mukudzokorora kwezvinoitika, Bronfort uye vashandi pamwe chete vakatsanangura kuti mushonga wepelinical manipulative therapy (zvose kukurudzira uye kushandiswa) zvakashanda mukubata kwevakuru vane CH [8]. Zvisinei, havana kuudza kana kushandiswa kwakaguma nemigumisiro yakakwirira ichienzaniswa nekugadziriswa kwevatungamiri vehuwandu hwevanhu.

 

Tsvakurudzo dzinoverengeka dzakatsvaga mhedzisiro yekumanikidza kwepelinha mune manejimendi CH [9-13]. Haas et al. [10] akaongorora kushanda kwekushomeka kwechibereko mune zvidzidzo neCH. Jull et al. [11] yakaratidza kushanda kwekurapa kwekurapa kwekunyengera uye / kana kurovedza muviri mukutungamira kweCH. Nekudaro iro rekunyepedzera rerapi boka raisanganisira kudzvinyirira uye kuunganidza saka hazvigone kutsanangurwa kana mhedzisiro inobatsira yaive mhedzisiro yekumanikidza, kukurudzira kana kusangana.

 

Zvidzidzo zvishoma zvakaongorora mabhenefiti ekugadzirisa pamwe nekumisikidza manejimendi ekurwadziwa kwemutsipa wemutsipa uine kana pasina kurovedza muviri. Zvisinei, hapana zvidzidzo zvakanyatsofananidza migumisiro yekunyengera pamwe nekuunganidza uye kurovedza muviri kune varwere vane CH. Tichifunga nezve njodzi dzinofungidzirwa dzekumanikidza [14], zvakakosha kuti uone kana kumanikidza kunoguma nemhedzisiro yakagadziriswa zvichienzaniswa nekusimudzira manejimendi evarwere vane CH. Naizvozvo, chinangwa cheichi chisina kujairika chemakiriniki kuyedzwa kwaive kuenzanisa mhedzisiro yekumanikidza pamwe nekuunganidza uye kurovedza muviri mune varwere vane CH. Isu takafungidzira kuti varwere vanogamuchira kumanikidza pamusoro pe16-vhiki yekurapwa nguva vaizoona kuderedzwa kukuru mukusimba kwemusoro, kuwanda kwemusoro, kureba kwemusoro, kuremara, uye kunwa kwemushonga mukutevera-kwemwedzi mitatu kupfuura varwere vanowana remuromo wechibereko uye thoracic kukurudzira pamwe nekurovedza muviri. .

 

nzira

 

Vakwikwidzi

 

Mune ino mizhinji-yepakati yakarongedzwa kiriniki kuyedzwa, akateedzana varwere vane CH vanopa kune 1 we8 ekurapa ekurapa ekurapa makiriniki kubva kunzvimbo dzakasiyana siyana dzenzvimbo (Arizona, Georgia, New York, Ohio, Pennsylvania, South Carolina) vakanyoreswa pamusoro pemwedzi we29. nguva (kubva Kubvumbi 2012 kusvika Nyamavhuvhu 2014). Kuti varwere vakodzere kukodzera, vaifanirwa kupa nehutachiona hweC CH maererano neyakaongororwa nzira yekuongorora [5] yakagadzirwa neCervicogenic Headache International Study Group (CHISG) [5, 18, 19]. CH yakarongedzwa zvinoenderana ne''major criteria '' (isingasanganise humbowo hwekusimbisa neanesthetic anesthetic blockades) uye pain musoro wemarwadzo maitiro eCHISG. Naizvozvo, kuitira kuti iverengerwe muchidzidzo, varwere vaifanirwa kuratidza zvese zvinotevera maitiro: (1) unilaterality yemusoro wekurwadziwa pasina parutivi, kutanga kumusoro kwepashure mutsipa kana nzvimbo ye occipital, pakupedzisira ichipararira kune oculofrontotemporal nzvimbo pane chiratidzo chechiratidzo, (2) kurwadziwa kunokonzerwa nekufamba kwemutsipa uye / kana nzvimbo dzakaomarara, (3) yakaderedzwa nzira yekufamba mumutsipa wechibereko [20] (kureva., pasi pe kana kuenzana ne32 yekurudyi kana kuruboshwe kwekutenderera pane Flexion-Rotation Bvunzo [21 23], (4) marwadzo akakonzerwa nekumanikidza kwekunze pamusoro peimwechete yepamusoro yezvibereko zvechibereko (C0-3), uye (5) zvine mwero kusvika pakurwadza kwakanyanya, kusiri kurova uye kusiri kwekupembedza. Uye zvakare, vatori vechikamu vaifanira kuve nemusoro wemusoro weinenge 1 pavhiki kweinenge mwedzi mitatu, hushoma hwemusoro kusimba kwekutambudzika kwemapoinzi maviri (3 0 pachikero cheNPRS), hushoma hurema hwe10% kana chikuru (kureva., gumi mapoinzi kana akakura pachiyero che20 10 NDI), uye uve pakati pe0 ne50 hongu rs zera.

 

Varwere vaisarudzwa kana vachiratidza mamwe maziso emusoro (kureva, migraine, TTH), anotambura nemusoro wepamusoro, kana kuratidza chero mapegi matsvuku (kureva, chirwere, kuputika, zvirwere zvemagetsi, rheumatoid arthritis, osteoporosis, kuregererwa kwehutano hweropa kupfuura 140 / 90 mmHg, nhoroondo yakareba ye steroid kushandiswa, nezvimwewo), yakapiwa zviratidzo zviviri kana zvinopfuura zvakanaka zveurourologic zvinokonzerwa nehutano hwemitsipa inokonzera (musimba utera hunobatanidza boka guru remashure rekumusoro, rakaderera kumusoro kwepamusoro zvakadzika tendon reflex, kana kuderedza kana kusisipo kuti pinprick chero ipi zvayo yepamusoro kune dermatome), yakaratidzwa nekuongororwa kwechirwere chepervical stenosis, yakaratidzwa kumativi ose ekumusoro kwezviratidzo, yakanga ine uchapupu hwehutachiona hwehutano hwekubatana (hyperreflexia, kushungurudzika kwemanzwiro muruoko, kushaya musimba kuputsika kwemaoko, kusazorora panguva yekufamba , nystagmus, kurasikirwa kwemaonero anooneka, kusagadzikana kwekunzwa kwechiso, kushandurwa kunzwisisika, kuvapo kwemafuro echirwere es), aine nhoroondo yekuputika kwechiplash mukati mevhiki dzakatangira 6, aive nekuvhiyiwa kwepamusoro kumusoro kana mutsipa, akanga agamuchira kurapwa kwemusoro kana mutsipa kubva kune mumwe mushandi mukati memwedzi wapfuura, wakagamuchira kurapwa muviri kana chiropractic mishonga yemusoro kana kurwadziwa kwemutsipa mukati memwedzi yakapfuura ye3, kana kuti kutongerwa mutemo pamusoro pemusoro wavo kana mutsipa.

 

Mabhuku anonyanya kuitika anoratidza kuti kusati kwamboita kushandiswa kwechiberekero chekuita mishonga yechirungu haikwanise kuona avo vari pangozi yezvakakomba zvemapurisa kubva kumucherechedzo wechibereki [24, 25], uye zviratidzo chero zvipi zvayo zvinowanikwa munguva yekuedza kushandiswa kwepamberi zvingave zvisina kufanana nekuchinja mukubuda kweropa mu iro reteralal artery [26, 27]. Nokudaro, kusati kwamboita kushandiswa kwemakemikari yeropa rekare kusati kwaitwa muchidzidzo ichi; zvisinei, kuongorora mibvunzo yechipical artery disease kwaifanira kuva isina [24, 28, 29]. Ichi chidzidzo chakabvumirwa neInstitutional Review Board paLong Island University, Brooklyn, NY. Chidzidzo chacho chakanyoreswa pawww.clinicaltrials.gov nechirongwa chekuedza NCT01580280. Vose varwere vakaudzwa kuti vaizogadziriswa kana kugadziriswa uye kubhabhatidza uye vazopa mvumo yakagadziriswa vasati vanyora mubvunzo.

 

Kurapa Vanachiremba

 

Vanegumi nevaviri varapi vemuviri (kureva zera makore makumi matanhatu nematanhatu, SD 36.6) vakapinda mukuendeswa kwekurapa kwevarwere muchidzidzo ichi. Ivo vaive neavhareji ye5.62 (SD 10.3, yakatangira 5.66 3 makore) makore ehutano hwekiriniki, uye vese vakapedza chirongwa che20 h post-graduate certification chirongwa icho chaisanganisira kudzidziswa kunoshanda mumawoko ehunyanzvi anosanganisira kushandisa kwecervical uye thoracic manipulation. Kuchengetedza kwese kuongororwa, mhedzisiro kuongororwa, uye maitiro ekurapa akaenzaniswa, vese varapi vemuviri varikubata vaidikanwa kuti vadzidze bhuku rezviyero zvevashandisi uye vatore chikamu muchikamu chekudzidzisa che60 h nemupurisa mukuru.

 

Nzira dzekuongorora

 

Vese varwere vakapa ruzivo rwehuwandu, vakapedza iyo Neck Pain Medical Screening Mubvunzo, uye vakapedzisa akati wandei wega-chirevo matanho, akateverwa nenhoroondo yakaenzana uye kuongororwa kwepanyama pakutanga. Kuzvitaurira-zviyero zvaisanganisira kusimba kwemusoro sekuyerwa neNPRS (0 10), iyo NDI (0 )50), frequency frequency (huwandu hwemazuva ane musoro muvhiki rapfuura), kutemwa kwemusoro (maawa ese emusoro mukupedzisira vhiki), uye kunwa mishonga (nhamba yenguva iyo murwere akange atora marwadzo kana kupfuura-the-counter mishonga yekurwadziwa muvhiki yapfuura).

 

Chirongwa chemuviri chaiyo chakanga chisingarevi kune, asi chakakonzera zviyero zveC1-2 (atlanto-axial joint) kwete kurudyi uye kuruboshwe rwendo ROM uchishandisa Flexion-Rotation Test (FRT). Kuvimbika kwepakati-rater yeFR yakawanikwa yakaisvonaka (ICC: 0.93; 95% CI: 0.87, 0.96) [30].

 

Migumisiro yeMitemo

 

Mhedzisiro mhedzisiro chiyero chakashandiswa muchidzidzo ichi yaive yemurwere kusimba kwemusoro sekuyerwa neNPRS. Varwere vakabvunzwa kuti varatidze huwandu hwepakati pekurwadziwa kwepfungwa pamusoro pevhiki yapfuura vachishandisa 11-poindi chiyero kubva pa0 ( no pain ) kusvika 10 (painrworst imaginableable) pakutanga, 1-vhiki, 1-mwedzi, uye 3-mwedzi zvichitevera kekutanga kurapwa chikamu [31]. Iyo NPRS chishandiso chakavimbika uye chakaringana chekutarisa kurwadziwa kwakanyanya [32-34]. Kunyangwe pasina dhata iripo kune varwere vane CH, iyo MCID yeNPRS yakaratidzirwa kuve 1.3 mune varwere vane mechanical mitsipa kurwadziwa [32] uye 1.74 mune varwere vane akasiyana akasiyana maronda asingagumi mamiriro [34]. Naizvozvo, isu takasarudza kungosanganisira varwere vane chikamu cheNPRS chemapoinzi maviri (2%) kana kupfuura.

 

Sekondari mhedzisiro matanho aisanganisira iyo NDI, iyo Global Kukosha kweKuchinja (GRC), kutemwa nemusoro, kuwanda kwemusoro, uye kudya kwemushonga. Iyo NDI ndiyo chishandiso chinonyanya kushandiswa pakuongorora kuremara kwakazvimirira muvarwere vane kurwadziwa kwemutsipa [35-37]. Iyo NDI ibhuku rekuzvibvunza-mibvunzo ine gumi-zvinhu zvakatemwa kubva pa10 (hapana hurema) kusvika kushanu (hurema hwakazara) [0]. Mhinduro dzenhamba dzechinhu chimwe nechimwe dzakapfupikiswa nezvibodzwa zvese zviri pakati pe38 ne0; zvisinei, vamwe vaongorori vakasarudza kuwedzera mamaki matsva nemaviri, vobva vazivisa NDI pachiyero che 50 0% [100, 36]. Zvikoro zvepamusoro zvinomiririra huwandu hwekuremara. Iyo INI yakawanikwa iine yakanakisa bvunzo-kudzokorodza kuvimbika, yakasimba kuvaka kuvimbika, kusimba kwemukati kusagadzikana uye kupindura kwakanaka pakuongorora kuremara kune varwere vane michina yemutsipa kurwadziwa [39], remuromo radiculopathy [36, 33], whiplash inosanganisika kusagadzikana [40, 38, 41], uye musanganiswa wakasarudzika wemutsipa [42, 43]. Kunyangwe pasina zviongorori zvakaongorora psychometric zvimiro zveiyo NDI mune varwere vane CH, isu takasarudza kungoisa varwere chete vane NDI mamaki gumi (44%) kana kupfuura, nekuti ichi chibodzwa chakatemwa chinotora iyo MCID yeiyo NDI, iyo yakataurwa kuti inofungidzirwa ina, sere, uye mapfumbamwe mapoinzi (20 0) mune varwere vane musanganiswa wakasarudzika wemutsipa [50], mekutambudzika mutsipa [44], uye remuromo radiculopathy [45], zvichiteerana. Headache frequency yakayerwa sehuwandu hwemazuva ane musoro muvhiki rapfuura, kubva pa33 kusvika pamazuva manomwe. Kutemwa kwemusoro kwakayerwa seyakazara maawa ekurwadziwa nemusoro muvhiki rapfuura, aine nhanhatu nhanhatu dzinogona kuitika: (0) 7 1 h, (0) 5 2 h, (6) 10 3 h, (11) 15-4 h, (16) 20 5 h, kana (21) 25 kana anopfuura maawa. Kudya kwemishonga kwakayerwa sehuwandu hwenhambo dzenguva murwere atora mushonga kana kupfuura-the-counter analgesic kana anti-anogumbura mishonga muvhiki yapfuura yemusoro wavo, zvine sarudzo shanu: (6) kwete zvachose, (26) kamwe a vhiki, (1) kamwe chete pamazuva mashoma, (2) kamwe kana kaviri pazuva, kana (3) katatu kana kupfuura pazuva.

 

Varwere vakadzokera ku1-vhiki, 4-masvondo, uye mwedzi mizana ye3 kutevera apo zvakataurwa pamusoro apa zvakagadziriswa zvakare zvakare. Mukuwedzera, pa 1-vhiki, 4-masvondo uye 3-mwedzi inotevera, varwere vakapedzisa mubvunzo weCXC-GRC inotsanangurwa nechiyero chakatsanangurwa naJaeschke et al. [15] kuverenga maonero avo ekuvandudza basa. Nhamba yakakura kubva -46 (yakawanda kwazvo yakaipisisa) kusvika kune zero (inenge yakafanana) ku + 7 (yakawanda kwazvo zviri nani). Zvinyorwa zvinotsanangurwa zvekuwedzera kana kuvandudza zvinopiwa maitiro kubva -7 kusvika -1 uye + 6 kusvika + 1, maererano. MCID yeRCC haina kunyatsotaurwa asi huwandu hwe6 uye + 4 kakawanda hwave huri kuratidza kuchinja kwakanyatsonaka mumamiriro emurwere [5]. Zvisinei, zvinofanira kuonekwa kuti munguva ichangopfuura Schmitt naAbbott vakashuma kuti GRC inogona kusawirirana nekuchinja kwebasa muhuwandu hunova nekukuvadzwa kwechiuno neyemakumbo [46]. Zvose zvinogadziriswa matanho zvakakonzerwa nemunhu anoongorora asingaoni kugoverwa kweboka.

 

Pakushanya kwekutanga varwere vakapedza ese matanho emhedzisiro uye vakagamuchira yekutanga chikamu chekurapa. Varwere vakapedza zvikamu zvitanhatu zvekurapa zvekunyengedza kana kukurudzira pamwe chete nekurovedza muviri kwevhiki ina. Pamusoro pezvo, zvidzidzo zvakabvunzwa kana vakamboona zviitiko zvakashata major [6, 8] (kurohwa kana kusakwana kwehuropi) panguva yega yega yekutevera.

 

Randomization

 

Kutevera bvunzo yekutanga, varwere vaiwanzo kupihwa mukana wekubiridzira kana kukurudzira kana kurovedza muviri. Kugovaniswa kwakagoverwa kwakaitwa nekushandisa komputa-inogadzirwa yakasarudzika tafura yenhamba dzakagadzirwa nemunhu asina kubatanidzwa mukutora varwere pamberi pekutanga kwekudzidza. Mumwe nemumwe, akateedzana akaenzana manhamba emakadhi aine yakasarudzika kupihwa kwakagadzirirwa yega yega ye8 maseru ekuunganidza masosi. Iwo makadhi emakadhi akapetwa ndokuiswa mumavhopu akavharika akavharika. Vakapofomadzwa kuongororo yekutanga, murapi akavhura hamvuropu ndokuenderera mberi nekurapa zvinoenderana neboka rakapihwa. Varwere vakarairwa kuti varege kukurukura nezveimwe nzira yekurapa inogamuchirwa neyekuongorora murapi. Muongorori wekurapa akaramba ari bofu kune iro remurwere boka rekurapwa basa nguva dzese; zvisinei, zvichibva pachimiro chekupindira kwacho zvaisaita kupofomadza varwere kana kurapa varapi.

 

Manipulation Group

 

Manipulations anotarisa kurudyi uye kuruboshwe C1-2 mazwi uye maviri T1-2 mataurirwo akaitwa pane imwe chete yezvikamu zvitanhatu zvekurapa (Maonde. 6 uye? Na8) .1). Pane mamwe marapirwo ekurapa, varapi vanogona kudzokorora C2-2 uye / kana T1-2 manomano kana kunongedzera mamwe marondedzero emuzongoza (kureva, C1-2, C0-1, C2-3, T3-7, mbabvu 2 9) vachishandisa mashandisirwo . Kusarudzwa kwezvikamu zvepelinha kutariswa kwakasiiwa kungwaru kweanorapa uye yaive yakavakirwa pamubatanidzwa wemishumo yemurwere uye ongororo yebhuku. Kune ese ari maviri epamusoro emuromo wechibereko uye epamusoro thoracic manejimendi, kana pasina kubuda kana kutsemura ruzha rwakanzwikwa pakuedza kwekutanga, murapi akaisazve murwere uye akaita kechipiri kunyengera. Kuwanda kwekuedza kwe1 kwakaitwa pamurwere mumwe nemumwe zvakafanana nezvimwe zvidzidzo [9, 2-14]. Vanachiremba vakarairwa kuti manyorerwo acho anogona kunge achiperekedzwa nemisindo yakawanda inonzwika [50-53]. Varwere vakakurudzirwa kuchengetedza zvakajairwa zviitiko mukati memiganhu yekurwadziwa; zvisinei, kuunganidzwa uye kunyorerwa kwemaekisesaizi, kana chero kushandiswa kweimwe nzira, hazvina kupihwa kune iri boka.

 

Mufananidzo 1 HVLA Kurwiswa Kunokonzerwa Kurongeka kurudyi C1-2 Kukurukurirana | El Paso, TX Chiropractor

 

Mufananidzo 2 HVLA Kurwiswa Kunotungamirirwa Kunotungamirirwa kuBilaterally kuWpper Thoracic Spine | El Paso, TX Chiropractor

 

Iko kukanganisa kunongedza C1-2 kwakaitwa nemurwere mu supine. Kune iyi nzira, murwere akasiyiwa posterior arch yeatlasi yakasangana neyekumashure chikamu cheiyo proximal phalanx yemurapi akasara wechipiri chigunwe achishandisa cradle hold . Kuti uwane masimba kuruboshwe kuruboshwe kweC1-2, murwere akaiswa pachishandiswa kuwedzera, posterior-anterior (PA) switch, ipsilateral side-bend uye contralateral side-shift. Ndichiri kuchengetedza chinzvimbo ichi, murapi akaita imwechete yakakwira-velocity, yakaderera-amplitude inokanda kumanikidza kuruboshwe atlanto-axial mubatanidzwa uchishandisa kurudyi kutenderera mune arc yakatarisana neziso rezasi uye kududzira kutafura (Fig. 1). Izvi zvakadzokororwa uchishandisa maitiro akafanana asi yakanangiswa kurudyi C1-2 kutaura.

 

Iko kukanganisa kunongedza T1-2 kwakaitwa nemurwere mu supine. Kune iyi nzira, murwere akamubata / maoko ake uye maoko ake epamberi pechipfuva nemagokora akaenderana munzira yepamusoro. Iye murapi akabata nzira dzekuyambuka dzeyepasi vertebrae yechinongedzo chinofamba chikamu neiyo yepamusoro simba uye yepakati phalanx yedhijitari yechitatu. Iyo yekumusoro lever yakaiswa munzvimbo yechinangwa chekufamba nekuwedzera kutenderera kure uye nerutivi-kukotamira kune murapi nepo ruoko rwepazasi rwakashandisa chirevo uye kutsauka kweridhi kuti uwane kutenderera uchienda uye padivi-kukomberedza nguva, zvichiteerana. Iyo nzvimbo yakaderera kune xiphoid maitiro uye costochondral marginal yemushandi yakashandiswa senzvimbo yekubatana pamusoro pevarwere elbows kuendesa kumanikidza mukati mekunze kune yekumashure nzira inotarisana neT1-2 bilaterally (Fig. 2).

 

Kukurudzira uye Kudzidzira Girasi

 

Kukurudzira kunongedzera kurudyi uye kuruboshwe C1-2 mataurirwo uye mbiri mbiri T1-2 mataurirwo akaitwa pane imwe chete yezvikamu zvitanhatu zvekurapa. Pane mamwe marapirwo ekurapa, varapi vanogona kudzokorora iyo C6-8 uye / kana T1-2 kukurudzira kana kunongedzera kumwe kutaura kwepamuviri (kureva, C1-2, C0 / 1, C2-3, T3-7, mbabvu 2 9) vachishandisa kukurudzira. . Kusarudzwa kwezvikamu zvepelinha kutariswa kwakasiiwa kungwaru kweanorapa uye yaive yakavakirwa pamubatanidzwa wemishumo yemurwere uye kuongororwa kwebhuku. Nekudaro, kuitira kuti udzivise kubatana kana kutarisisa kana ichienzaniswa neboka rekunyepedzera, varapi vakarairwa kuunganidza chikamu chimwe chechibereko (kureva, kurudyi uye kuruboshwe) uye chikamu chimwe chete chemutsipa kana rumbidzo pamusangano wega wega wekurapa.

 

Kubatana kunotarisana neC1-2 kutsanangurwa kwakaitwa nenzira yakajairika. Pamusana pegadziriro iyi, muongorori akaita imwe 30 s bout yebato rekunze unilateral grade IV PA mobilizations kumativi ekufambisa eC1-2 sezvakatsanangurwa naMaitland [7]. Nzira imwechete yakadzokororwa kune imwe 30 s bout kusvika kune imwe yakarurama paanlanto-axial joint. Mukuwedzera, uye pamusangano mumwe chete, kuunganidza kunotungamirirwa kune chepamusoro thoracic (T1-2) musana nemuviri wepamusoro wakaitwa. Nokuda kweiyo nzira, muongorori akaita chirongwa che 30 chepakati pegwaro re IV PA mobilizations kumativi ekufambisa a T1-2 sezvakatsanangurwa naMaitland [7]. Nokudaro, takashandisa 180 (kureva,, katatu 30 s zvinyorwa zvinosvika 2 Hz) kushandiswa kwekupedzisira kwepamusoro pamusoro wega yega yega yekugadziriswa. Zvinonzwisisika, hakuna humwe hutsika huno uchapupu huripo hunoratidza kuti nguva yakareba yekugadzirisa inokonzerwa nekuderedza kunorwadziwa kudarika nguva shoma kana maitiro ekugadzirisa [59, 60].

 

Cranio-cervical flexion Exercises [11, 61-63] yakaitwa nemurwere mu supine, nemabvi akakotama uye chinzvimbo chemusoro chakamisikidzwa nekuisa iyo craniocervical uye cervical spines munzvimbo yepakati, senge tambo pakati subject foreheadshuma nechaini yakanga yakatwasuka, uye tambo yakatwasuka kubva ku tragus yenzeve yakavhiringidza mutsipa kureba. Mhepo-yakazadza kumanikidza biofeedback unit (Chattanooga Group, Inc., Hixson, TN) yakaiswa suboccipitally kuseri kwemutsipa wemurwere uye preinflated kune yekutanga basiti ye20 mmHg [63]. Pamitambo yekurovedza, varwere vaidikanwa kuti vaite craniocervical flexion chiito (noda nod yemusoro, yakafanana nekuratidzira hongu) [63] uye kuyedza kutarisisa kumanikidza kwe22, 24, 26, 28, uye 30 mmHg kubva yekutanga yekuzorora ye20 mmHg uye kubata iyo nzvimbo yakatsiga ye10 s [61, 62]. Kuita kwekugutsurira kwakaitwa nehunyoro uye unononoka maitiro. Zororo gumi rakabvumidzwa pakati pemiyedzo. Kana iko kumanikidza kwakatsauka pazasi pechinodzvinyirirwa, iko kumanikidza hakuna kuitiswa kwakadzikama, kuchinjirwa neyekunyepera kushanduka (sternocleidomastoid kana anterior scalene) yakaitika, kana kudzorerwa kwemutsipa kwakacherechedzwa kusati kwapera kweiyo 10 s isometric hold, yaionekwa sekutadza [10]. Yekupedzisira yakabudirira tarisiro yekumanikidza yakashandiswa kuona yega yega murwere maitiro ekurovedza umo matatu seti e63 kudzokorora aine 3 s isometric kubata yakaitwa. Pamusoro pekusimudzira uye cranio-remuromo flexion kurovedza, varwere vaifanirwa kuita 10 min yekuenderera mberi yekudzivirira maitiro (kureva, kushandisa Therabands kana mahara mahuremu) kumhasuru dzebhandi repafudzi panguva yega yega yekurapa chikamu, mukati mekutsungirira kwavo, uye kunyanya kutarisa kune yepasi trapezius uye serratus anterior [10].

 

Sample Size

 

Muenzaniso wokukura uye simba kuverenga kwakaitwa uchishandura software kubva kuMGH Biostatistics Center (Boston, MA). Kuverenga kwaive kwakavakirwa pakuona mutsauko we 2-kana (kana 20%) muNPRS (musoro wekudzivirira musoro) mumwedzi ye3 kutevera, achifunga kuparadzana kwakakwana kwemashoko matatu, test 2-tailed, uye alpha yemazinga akaenzana ku0.05. Izvi zvakagadzira kukura kwemuenzaniso wevarwere ve49 neboka. Kubvumira kuti pave nehuwandu hwekuregererwa kwekodzero ye10%, takaronga kuunganidza vasikana vechi108 muchidzidzo. Ichi chiyero chekukura chakakonzera chikuru kudarika 90% simba rekuona shanduko yakawanda inoshandiswa muzvikamu zveNPRS.

 

Data Analysis

 

Zvinyorwa zvinotsanangurwa, zvinosanganisira nguva dzakawanda dzezvinyorwa zvekugadzirisa uye zviyero zvehutano hwepakati uye kupararira kwezvimwe zvinoshandiswa zvinongororwa kuti zvidimbure data. Migumisiro yehutano pamusoro wemusoro uye simba nekuremara imwe neimwe yakaongororwa ne 2-by-4 yakasanganiswa-muenzaniso yekuenzanisa kwekusiyana (ANOVA), neboka rekurapa (kushandiswa pakusangana nekusimudzira nekuita basa) sezviri pakati-zvinotenderera zvinoshandiswa uye nguva (yekutanga, 1 vhiki, masvondo e4, uye mwedzi 3 kutevera) sezvinoitwa mukati-zvidzidzo zvinoshandiswa. AOVAs akaparadzana yakaitwa neNPRS (misoro yepamusoro) uye NDII (kuremara) sechinhu chinotarisana nacho. Pamusoro peOOVA imwe neimwe, pfungwa yekufarira ndiyo nzira ye2-maitiro (boka nenguva).

 

Kuzvimiririra t-bvunzo yakashandiswa kugadzirisa pakati peboka misiyano yezana shanduko kubva muzana rekutanga kusvika pamwedzi mitatu yekutevera mune ese musoro kusimba uye kuremara. Yakaparadzaniswa Mann Whitney U bvunzo dzakaitwa neiyo frequency frequency, GRC, kutemwa kwemusoro uye kudya kwemushonga seyakavimbika musiyano. Isu takaita Little's Kupotsa Zvakakwana paRandom (MCAR) bvunzo [3] kuona kana kushaikwa kwedatha mapoinzi ane chekuita nekudonha kwaishayikwa zvisina kurongeka kana kushayikwa nezvakarongeka zvikonzero. Chinangwa-cheku-kurapa kuongororwa kwakaitwa nekushandisa Tarisiro-Kuwedzeredza uko kunoshaya data kunoverengerwa uchishandisa regression equations. Zvirongwa zviviri zvakaenzanisirwa zvakaitwa kuongorora musiyano uripo pakati pekutanga uye yekutevera-nguva pakati-pemapoka vachishandisa kururamisa kweBonferroni padanho re alpha ye .64.

 

Takaita dichotomized varwere sevanopindura pamwedzi we3 kutevera vachishandisa chikamu chakacheka chepfungwa dze 2 dzehutano hwemusoro sezvinotaridzwa neNPRS. Numeri yaidiwa kurapa (NNT) uye 95% nguva dzekutenderera (CI) dzakaverengwawo pamwedzi we3 kutevera-shandisa uchishandisa imwe yerondedzero yemugumisiro wakabudirira. Kuongorora kwedhiyabhorosi kwakaitwa uchishandisa SPSS 21.0.

 

Results

 

Makumi maviri nemakumi mashanu nemumwe varwere vane chekunyunyuta kwekutanga kwemusoro vakaongororwa kuti vakwanise kukodzera. Izvo zvikonzero zvekusakodzera zvinogona kuwanikwa muFiri. 3, iyo inoyerera dhizaini yekutsvaga murwere nekuchengetwa. Pakati pevarwere 251 vakaongororwa, varwere ve110, vane zera rinoreva makore makumi matatu neshanu (SD 35.16) uye hurefu hwezviratidzo zvemakore 11.48 (SD 4.56), vakagutsa nzira yekukodzera, vakabvuma kutora chikamu, uye vakasarudzika kuita zvisirizvo (n ? =? 6.27) nekuunganidza uye kurovedza muviri (n? =? 58) mapoka. Baseline misiyano yeboka rega rega inogona kuwanikwa muTebhu 52. Varapi gumi nevaviri vanobva kumakiriniki e1 ekurapa ekurapa mumwe nemumwe akarapwa 8, 25, 23, 20, 14, 13, 7 kana 6 varwere, zvichiteerana; uyezve, mumwe wevane gumi nevaviri varapi akarapa angangoenzana chikamu chevarwere muboka rega rega. Pakanga pasina musiyano wakakosha (p? =? 2) pakati penhamba inorehwa yekupedzisa zvikamu zvekurapa zveboka rekunyengera (12, SD 0.227) uye boka rekukurudzira uye rekurovedza muviri (7.17, SD 0.96). Uye zvakare, iyo inorehwa nhamba yezvirongwa zvekurapa izvo zvakanangana neC6.90-1.35 kutaura yaive 1 (SD 2) yeboka rekunyepedzera uye 6.41 (SD 1.63) yekusimudzira uye yekurovedza boka, uye izvi zvaive zvisina kunyanya kusiyana (p? =? 6.52). Vane zana nevanomwe vevarwere zana negumi vakapedza zvese zviyero zvemhedzisiro kuburikidza nemwedzi mitatu (2.01% yekutevera). Zvishoma Kupotsa Zvakakwana paRandom (MCAR) bvunzo yakanga isina kukosha (p? =? 0.762); Naizvozvo, isu takashandisa iyo Tarisiro-Maximization imputation hunyanzvi kutsiva akashaikwa tsika nemazita akafanotaurwa emhedzisiro yemwedzi mitatu.

 

Mufananidzo 3 Flow Diagram yeVashandi Vokurehwa uye Kuchengetwa | El Paso, TX Chiropractor

 

Tafura 1 Baseline Variables, Nhamba dzevanhu neZvakakosha Mitezo | El Paso, TX Chiropractor

 

Iboka rakazara nekudyidzana kwenguva yeiyo yekutanga mhedzisiro yemusoro wekusimba yaive yakaenzana kukosha kune iyo NPRS (F (3,106)? =? 11.196; p?

 

Tafura 2 Kuchinja kweHemisache Kuwanda uye Kuremara | El Paso, TX Chiropractor

 

Tafura 3 Pakati yeVatengi Kuwana 50, 75, uye 100 Percent Kupera | El Paso, TX Chiropractor

 

Pamhedzisiro yechipiri rakakosha boka nekubatana kwenguva kwaive kweiyo NDI (F (3,106)? =? 8.57; p?

 

Mann Whitney U bvunzo dzakaratidza kuti varwere vekumusoro kwechiberekero uye chepamusoro thoracic manejimendi boka vakasangana nemusoro usingawanzo kutemwa nemusoro pa1 vhiki (p?

 

Isu hatina kuunganidza chero dhata pane zvinoitika zve minor zviitiko zvakashata [48, 49] (inononoka zviratidzo zvetsinga, kuwedzera kuomarara, kupenya kwekurwadziwa, kuneta kana zvimwe); zvisinei, hapana major zviitiko zvakashata [48, 49] (kurohwa kana kusakwana kwehuropi) zvakataurwa kune chero boka.

 

hurukuro

 

Nyaya yeChinyorwa Zviwanikwa

 

Kuziva kwedu, kudzidza uku ndiko kwekutanga kurongwa kwechipatara kutarisisa kuenzanisa kushanda kwesimba remuromo wechibereko uye thoracic kukurudzira uye kurovedza muviri kune varwere vane CH. Mhedzisiro yacho inoratidza zvikamu zve6 kusvika ku8 zvekubiridzira kwemasvondo mana, zvakanangiswa zvakanyanya kune ese epamusoro emuromo wechibereko (C4-1) uye yepamusoro thoracic (T2-1) spines, zvakakonzera kuvandudzika kukuru mukusimba kwemusoro, kuremara, kutemwa nemusoro, kuwanda kwemusoro , uye kunwa mishonga pane kukurudzira pamwe chete nekurovedza muviri. Iyo poindi inofungidzira yepakati-yeboka shanduko mumusoro kusimba (2 mapoinzi) uye kuremara (2.1 mapoinzi kana 6.0%) yakapfuura iyo yakataurwa maMCID pazviyero zviviri izvi. Kunyangwe iyo MCID yeiyo NDI mune varwere vane CH isati yaferefetwa, zvinofanirwa kucherechedzwa kuti fungidziro yepasi ye12.0% CI yekuremara (95 mapoinzi) yaive zvishoma pazasi (kana kufungidzirwa muzviitiko zviviri) iyo MCID iyo yakawanikwa iine 3.5 [3.5], 65 [5], uye 66 [7.5] mapoinzi kuvarwere vane marwadzo emutsipa, 45 [8.5] mapoinzi kuvarwere vane remuromo remuromo, uye 33 [3.5] mapoinzi kuvarwere vane musanganiswa, isina-yakatarwa kurwadziwa kwemutsipa. Zvisinei, inofanira kuonekwa kuti mapoka maviri aya akaita kliniki yekuvandudza. Uye zvakare, iyo NNT inoratidza kune vese varwere vana vanobatwa nekumanikidza, pane kuunganidza, mumwe murwere anowedzera anozadzisa kiriniki yakakosha yekudzora kurwadziwa pamwedzi mitatu yekutevera.

 

Simba uye Utera hweChidzidzo

 

Kubatanidzwa kwe12 kurapa maitiro emakiriniki emunharaunda e8 mune 6 nyika dzakasiyana-siyana dzinowedzera huwandu huwandu hwekuwana kwedu. Kunyange zvazvo kusiyana kukuru kwakaratidzwa kusvika kumwedzi ye3, hazvizivikanwe kana zvikomborero izvi zvingadai zvakatsigirwa kwenguva refu. Mukuwedzera, takashandisa mashizha makuru, mashoma-amplitude manipulation techniques akashandisa bidirectional inoshandiswa pakushandura nekushandura panguva imwechete uye Maitland based grade IV PA masangano ekugadzira; saka, hatigoni kuva nechokwadi kuti izvi zvinowanzogadziriswa kune mamwe marudzi ehutano hwemapiritsi ehutano. Vamwe vangafunga kuti boka rekuenzanisira ringadai risina kuwana rubatsiro rwakakwana. Takatsvaga kuenzanisa kutarisana mukati uye kunze kwekufanirwa kwekugadziriswa kwemapoka ose uye kwakapa tsanangudzo yakajeka yehutano hunoshandiswa huchabvumirawo kudzokorora. Uyezve, isu hatina kuenzanisa zviitiko zviduku zvakashata uye takabvunzwa pamusoro pezviitiko zviviri zvinogona kukuvadza. Chimwe chiyamuro ndechekuti takabatanidza mimwe miviri yechipiri. Vaongorori vezvokurapa pamusoro pemhando ipi yavanofunga kuti yaizove yakakwirira haina kuunganidzwa uye inogona kunge inogona kukanganisa migumisiro.

 

Simba uye Kushaya Utera Mukubatana Nezvimwe Zvidzidzo: Kusiyana Kunokosha Muzviitiko

 

Jull et al. [11] akaratidza kurapwa kwehutano hwehutano hwekunyengedza uye maitiro muhutungamiri hweC; zvisinei, ichi chirongwa chekurapa chaisanganisira kusimbisa nekugadzirisa. Izvo zvidzidzo zvezvino zvinogona kupa uchapupu hwokuti kutungamira kwevarwere vane CH kunofanira kusanganisira imwe nzira yekugadzirisa pasinei nokuti inowanzotaurwa kuti chirwere chechibereki chinofanira kudziviswa nekuda kwechiitiko chezviitiko zvakakomba zvakashata [67, 68]. Uyezve, zvakaratidzwa kuti vanhu vanowana kugadzirwa kwemutsipa kwemarwadzo emutsipa uye misoro havasati vamboona chirwere chinonzi vertebrobasilar kupfuura kana vakagamuchira kurapwa nachiremba wavo wezvokurapa [69]. Uyezve, mushure mekuongorora zvakare nyaya dze 134, Puenedura et al. akagumisa kuti nekusarudzwa kwakakodzera kwevarwere nekunyatsorongedza mavara emavhogi matsvuku uye zvinopesana, huwandu hwezviitiko zvinotambudza zvinosangana nehutachiona hunogona kudzivirirwa [70].

 

Zvinoreva Zvidzidzo: Zvinogona Kunotsanangurwa uye Zvazvinoreva kune Vanachiremba nevatongi

 

Kubva pamigumisiro yezvino zvidzidzo zvechiremba vanofanirwa kufunga nezvekubatanidza kugadzirwa kwepaginal kune vanhu vane CH. Imwe nzira yekuongorora yakangobva kuwanikwa yakagadziriswa nekugadzirisa kushandiswa kwekubatsira kwevatano vane CH asi vakanga vasingakwanisi kutsanangura nzira ipi yakakosha [8]. Uyezve, makiriniki emitemo yakarondedzera kuti kushandiswa, kuunganidza uye kubhizimisa zvose zvakashanda kune vatungamiri vevarwere vane CH; zvisinei, mutungamiri haana kuita mazano pamusoro pehukuru hweimwe nzira. [71] Zvigumisiro zvemazuva ano zvinogona kubatsira vanyori vekuongororwa kwakagadziriswa nekugadziriswa kwekliniki pakupa mamwe mazano pamusoro pekushandiswa kwekupererwa kwepelinha munzvimbo ino.

 

Mibvunzo Isingagoni Kupindurwa Nekutsvaga Kwemangwana

 

Maitiro epasi ekuti nei kumanikidza kungave kwakaguma nekuvandudza kukuru kunoramba kuchitsanangurwa. Izvo zvave zvichitaurirwa kuti yakakwira-velocity kusuduruka kwe vertebrae ine simba rekusimudzira risingasviki 200 ms inogona kuchinjisa akasiyana madhivhisi mareti [72] nekumisikidza ma mechanoreceptors nema proprioceptors, nokudaro achichinja alpha motorneuron mafaro ekugwinya uye anotevera mhasuru chiitiko [72-74]. Kugadziriswa kunogona zvakare kukurudzira anogamuchira mune yakadzika paraspinal musculature, uye kukurudzira kungave kunowanzoita kuti zviite zvinogamuchirwa mumhasuru dzepamusoro [75]. Biomechanical [76, 77], musana kana segmental [78, 79] uye yepakati kudzika inodzivirira marwadzo nzira [80-83] mamodheru ndidzo tsananguro dzinonzwisisika dze hypoalgesic mhedzisiro dzinoonekwa zvichitevera mashandisiro. Munguva pfupi yapfuura, iyo biomechanical mhedzisiro yekumanikidza yave iri pasi pekuongororwa kwesainzi [84], uye zvinofungidzirwa kuti makiriniki mabhenefiti anowanikwa mukudzidza kwedu ane hukama neiyo neurophysiological mhinduro inosanganisira yenguva yekunzwa summation parunyanga runyanga rwepelinha [78]; zvisinei, uyu muenzaniso wakasarudzika parizvino unotsigirwa chete pane zvakawanikwa kubva kunonoka, kuyedza kunokonzeresa marwadzo muzvidzidzo zvine hutano [85, 86], kwete varwere vane CH. Zvidzidzo zvenguva yemberi zvinofanirwa kuongorora akasiyana emanyowa ekurapa matekiniki ane akasiyana madosi uye anosanganisira 1-gore rekutevera. Uyezve, zvidzidzo zvenguva yemberi kuongorora iyo neurophysiological mhedzisiro yekumanikidza uye kukurudzira kuchave kwakakosha kuona kuti nei pangave kana pangave nemusiyano mumakiriniki mhedzisiro pakati pemishonga iyi miviri.

 

mhedziso

 

Migumisiro yechirongwa chemazuva ano yakaratidza kuti varwere vane CH vakagamuchira kervical uye kugadziriswa kwetroracic zvakagadziriswa zvakanyanya zvikuru mukudzvinyirira musoro, kuremara, kuora musoro kwepamusoro, kushaya musoro kwepamusoro, uye kushandisa mishonga pakuenzanisa neboka rakagamuchirwa nekugadzirisa; uyezve, migumisiro yacho yakachengetwa pamwedzi we3 kutevera. Zviongorori zvenguva inotevera zvinofanira kuongorora kubudirira kwemhando dzakasiyana siyana uye maitiro ekushandiswa uye kunosanganisira nguva yakareba yekutevera.

 

KUTENDA

 

Hapana wevanyori vakagamuchira chero mari yekudzidza uku. Vanyori vanoda kuonga vose vatori vechikamu chekudzidza.

 

Mashoko Omuzasi

 

  • Kukwikwidzana: Dr. James Dunning ndiye Mutungamiri weAmerican Academy of Manipulative Therapy (AAMT). AAMT inopa mapurogiramu ekurovedza mapurogiramu ekuperesa kwemusana, kugadzirwa kwemumumvuri, kuomeswa kwevasingadi, kushandiswa kwekupedzisira, kugadzirisa kwekupedzisira, kushandiswa kwechiridzwa-zvinyorwa zvinyorwa zvishoma nezvishoma uye kurapwa kwechiremba kuvarapi vezvemapirisa, maosteopaths uye vanachiremba vezvechiremba. Drs. James Dunning, Raymond Butts, Thomas Perreault, uye Firas Mourad ndivo vadzidzisi vakuru veAAMT. Vamwe vanyori vanotaura kuti havana kukwikwidzana.
  • Mipiro yevanyori: JRD yakabatanidzwa mumubereki, kuumbwa, kuwanikwa kwezvinhu, nhamba yekuongorora nekunyorwa kwezvinyorwa. RB uye IY vakabatanidzwa mukugadzira, kuunganidza deta, kuongororwa kwenhamba nekudzokorora kwezvinyorwa. FM yakabatanidzwa mukugadzira, kuongororwa kwenhamba, kududzira deta nekudzokororwa kwezvinyorwa. MH akapindira mumubereki, kugadzira nekudzokorora kwezvinyorwa. CF neJC vaibatanidzwa munhamba yekuongorora, kududzira dhesi, uye kugadziriswa patsva kwezvinyorwa zvekukosha kwemagetsi. TS, JD, DB, uye TH vaibatanidzwa mukuunganidza deta uye kuvandudzwa kwezvinyorwa. Vose vanyori vanoverenga uye vanobvumirana nemashoko ekupedzisira.

 

Information Contributor

 

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

 

Mukupedzisa,Kurwadziwa kwepamusoro kunokonzerwa nemusoro wechipiri nekuda kwenyaya yehutano pamwe chete nezvivakwa zvakapoteredzwa zvepervical spine, kana mutsipa, zvinogona kukonzera zvinorwadza uye zvinoderedza zviratidzo zvinogona kukanganisa hupenyu hwemurwere. Kugunun'una kwepamuviri uye kukurudzira kunogona kuchengetedzwa uye kunyatso shandiswa kubatsira kuvandudza cervicogenic misoro yemusoro zviratidzo. Ruzivo rwunotsanangurwa kubva kuNational Center yeBiotechnology Ruzivo (NCBI). Chiyero cheruzivo rwedu chinogumira kuchiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kutibata nesu pa 915-850-0900 .

 

Yakarongedzwa naDkt Alex Jimenez

 

 

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

 

Zvimwe Zvinyorwa: Kubva Painini

 

Maererano nehuwandu, inenge 80% yevanhu ichaona zviratidzo zvekurwadziwa shure shure kamwechete munguva yeupenyu hwavo hwose. Kutambudzika shure ndiko kunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Kazhinji kacho, kuora kwechimiro chemupaka nezera kunogona kukonzera marwadzo kumashure. Herniated discs inoitika apo ganda rakanyorova, segel-like re intervertebral disc rinodonha nekubvarura mukati maro, rinenge riri kunze kwekatekete, kubvongodza nekugumbura midzi midzi. Dhizinesi dzinozivikanwa dzinowanzoitika kumucheto kumashure, kana kuti nhengo dzomukati, asi dzinogonawo kuitika pamucheto wepervical, kana mutsipa. Kuiswa kwemitsipa inowanikwa mucheka shure nekuda kwekukuvara uye / kana mamiriro akaoma kunogona kutungamirira kune zviratidzo zve sciatica.

 

blog chinyorwa chekartoon paperboy makuru makuru

 

NHAURWA INOKOSHA INOKOSHA: Migraine Pain Treatment

 

 

DZIMWE MASHOKO: KUNYANYA KWENYAYA: El Paso, Tx | Vatambi

 

Hazvina kuchena
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53. Lau HM, Mapapiro Chiu TT, Lam TH. Kubudirira kwekunyengedza kwechirwere kune varwere vane chirwere chisingaperi chemutsipa-chirongwa chinongorongedzwaMan Ther2011;16(2):141�7. doi: 10.1016/j.math.2010.08.003.�[PubMed] [Cross Ref]
54. Beffa R, Mathews R. Ko iko kugadziridza kunokomberedza chakabatana chakanangwa? Kuferefetwa kwenzvimbo yekunzwika kwemheremhereJ Manipulative Physiol Ther. 2004;27(2): e2. doi: 10.1016 / j.jmpt.2003.12.014.[PubMed] [Cross Ref]
55. Dunning J, Mourad F, Barbero M, Leoni D, Cescon C, Butts R. Kubatana uye kuwanda kwenzwi panguva yekumusoro kwechibereko.BMC Musculoskelet Kusawirirana2013;14:24. doi: 10.1186/1471-2474-14-24.�[PMC free article] [PubMed] [Cross Ref]
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62. Falla D, Jull G, Dall'Alba P, Rainoldi A, Merletti R. An electromyographic ongororo yeakadzika emuromo wechibereko flexor mukuita kweiyo craniocervical flexion.Phys Ther. 2003;83(10): 899-906. [PubMed]
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64. Rubin LH, Witkiewitz K, Andre JS, Reilly S. Maitiro ekubata akashaikwa data mune hunhu neuroscience: Usarase mwana Rat kunze nemvura yekugeza.J Undergrad Neurosci Dzidzisa2007;5(2): A71 7. [PMC free article] [PubMed]
65. Jorritsma W, Dijkstra PU, de Vries GE, Geertzen JH, Reneman MF. Kutsvaga kwakakodzera shanduko uye kupindura kwekurwadziwa kwemutsipa uye chiyero chekuremara uye Neck Disability IndexEur Spine J. 2012;21(12):2550�7. doi: 10.1007/s00586-012-2407-8.�[PMC free article] [PubMed] [Cross Ref]
66. Stratford PW, Riddle DL, Binkley JM, Spadoni G, Westaway MD, Padfield B. Uchishandisa Neck Disability Index kuita sarudzo maererano nemurwere mumwe nemumwe.Vanorwara Vanogona1999;51: 107-12.
67. Ernst E. Kugadziriswa kwecervical spine: kurongeka kwekuongorora kwemakesi ezviitiko zvakakomba zvakashata, 1995-2001. Med J Aust2002;176(8): 376-80. [PubMed]
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69. Cassidy JD, Boyle E, Cote P, Iye Y, Hogg-Johnson S, Sirivha FL, et al. Ngozi ye vertebrobasilar sitiroko uye chiropractic kuchengetedza: mhedzisiro yehuwandu hwevanhu-based kesi-kutonga uye kesi-crossover kudzidza.Musana (Phila Pa 1976) 2008;33(4 Suppl):S176�83. doi: 10.1097/BRS.0b013e3181644600.�[PubMed] [Cross Ref]
70. Puentedura EJ, Kurume J, Anders J, Perez A, Landers MR, Wallmann HW, et al. Kuchengetedzwa kwechirwere chepervical spine manipulation: zviitiko zvakashata zvinodzivirirwa uye mashandisiro ari kuitwa nenzira kwayo? Ongororo ye134 kesi mishumoJ Man Manip Ther2012;20(2):66�74. doi: 10.1179/2042618611Y.0000000022.[PMC free article] [PubMed] [Cross Ref]
71. Vacheche JD, Cleland JA, Elliott JM, Teyhen DS, Wainner RS, Whitman JM, et al. Kutambudzika kwemutsipa: kiriniki yekudzidzira nhungamiro yakabatana neyekudyidzana kwepasi rose kwekushanda, kuremara, uye hutano kubva kuchikamu chemazino cheAmerican Physical Therapy Association.J Orthop Yemitambo Phys Ther. 2008;38(9):A1�A34. doi: 10.2519/jospt.2008.0303.�[PubMed] [Cross Ref]
72. Sarudza JG, Kang YM. Paraspinal mhasuru spindle mhinduro kune iyo nguva yekugadziriswa kwepasipasi pasi pesimba rekudzoraJ Manipulative Physiol Ther. 2006;29(1):22�31. doi: 10.1016/j.jmpt.2005.11.014.[PubMed] [Cross Ref]
73. Herzog W, Scheele D, Conway PJ. Mhinduro dzeElectromyographic dzekumashure uye mhasuru dzemakumbo dzakabatana nemushonga wepelinha wekurapaMusana (Phila Pa 1976) 1999;24(2):146�52. doi: 10.1097/00007632-199901150-00012.�[PubMed] [Cross Ref]
74. Indahl A, Kaigle AM, Reikeras O, Holm SH. Kubatana pakati pe porcine lumbar intervertebral disc, majojapophysial majoini, uye mhasuru dzemuviri.Musana (Phila Pa 1976) 1997;22(24):2834�40. doi: 10.1097/00007632-199712150-00006.�[PubMed] [Cross Ref]
75. Bolton PS, Budgell BS. Kugunun'una kwepamuviri uye musana wekusimudzira zvinokanganisa akasiyana axial sensory mabhedhaMed Kufungidzira2006;66(2):258�62. doi: 10.1016/j.mehy.2005.08.054.�[PubMed] [Cross Ref]
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Chiropractic Headache Treatment Guidelines muEl Paso, TX

Chiropractic Headache Treatment Guidelines muEl Paso, TX

by | Chiropractic, Randomized Controlled Trial

Kusuruvara kwepfungwa chimwe chezvikonzero zvakapararira zvekufurirwa kwehofisi. Vakawanda vevanhu vanovaona pane imwe nguva muhupenyu hwavo uye vanogona kukanganisa chero ani zvake, pasinei nezera, rudzi uye hutano. I International Headache Society, kana IHS, inoronga misoro sekutanga, iyo isingakonzerwi neimwe kukuvadzwa uye / kana mamiriro, kana yechipiri, kana pane chikonzero chinokonzera shure kwavo. Kubva migraines kuti kusungurwe misoro uye kushungurudzika misoro, vanhu vanotambura nekunetseka kwemusoro nguva dzose vangawana zvakaoma kupinda mumabasa avo ezuva nezuva. Vakawanda vezvehutano vanobata marwadzo edzimusoro, zvisinei, chiropractic kuchengetedza yava chinhu chakakurumbira chinoshandiswa kurapwa kwezvinhu zvakasiyana-siyana zvehutano. Chinangwa chenyaya inotevera ndechekuratidza uchapupu-hwakatungamirirwa nheyo dzechiropractic kurapwa kwevanhu vakuru vane musoro.

 

Zviratidzo-Kubva Mirayiridzo yeChiropractic Treatment of Adults vane Musoro

 

ngovepo

 

  • Chinangwa: Chinangwa chechirongwa ichi ndechekupa uchapupu-ruzivo rwekuita mazano ekurapa kwechiropractic yemusoro kune vanhu vakuru.
  • Nzira: Kutsvakurudza mabhuku kwakarongeka kwezviongorori zvekliniki zvakarongedzwa zvakabudiswa kuburikidza naAgasti 2009 zvakakodzera chiropractic tsika zvaiitwa uchishandiswa maDatabases MEDLINE; EMBASE; Vakabatanidzwa uye Vanobatana neMishonga; iyo Cumulative Index kune Nursing uye Allied Health Zvinyorwa; Manual, Alternative, uye Natural Therapy Index System; Alt HealthWatch; Index yeChiropractic Literature; uye Cochrane Library. Nhamba, hutano, uye kusagadzikana kwezvakawanikwa zvakaonekwa kuti zvinopa simba rose reuchapupu (rakasimba, rinononoka, risina kukwana, kana rinopesana) uye kuumba tsika yekuita mazano.
  • Results: Zvinyorwa makumi maviri nemumwe zvakasangana nekugadziriswa zvirongwa uye zvakashandiswa kukudziridza mazano. Uchapupu hwakanga huri kupfuura huwandu hwakanaka. Kune migraine, kushandiswa kwepelinha uye miviri yakasiyana-siyana inosanganisira masheji inokurudzirwa kutarisira varwere vane episodic kana vasingaperi migraine. Nokuda kwehutano-hutano hwemusoro, kusanganisa kwemagunha hakugoni kukurudzirwa kutungamirirwa kwepisodic-type-head headache. A kukurudzira hakugoni kuitwa kana kupikisa kushandiswa kwepelinha kune varwere vane chirwere chisingaperi chisingabatsiri. Kutsika-miviri kunokwidziridzwa kunogona kubatsira kwenguva yakareba kurairirwa kwevarwere vane episodic kana chronic tension-type headaches. Pamusoro pemusoro wepervicogenic, kugona kwepasina kunorudzirwa. Kubatanidza pamwe chete kana mukati memutsipa wakadzikama maitiro zvinogona kuvandudza zviratidzo. Ikoko hakusi kuwedzera kuwedzerwa kubatsirana kwekubatanidza kushamwaridzana pamwe nekudzika shati flexor exercises kune varwere vane cervicogenic headache. Zviitiko zvakashata zvakanga zvisingatauri mumatambudziko akawanda emakiriniki; uye kana vaive, pakanga pasina kana kana vari vaduku.
  • Mhedziso: Uchapupu hunoratidza kuti chiropractic kuchengetedza, kusanganisira kugadzirwa kwemusana, kunowedzera migraine
    uye cervicogenic musoro. Mhando, nguva yakawanda, muyero, uye nguva yemishonga (s) inofanira kunge yakabva pane zvinotungamirirwa mazano, kliniki ruzivo, nekuwana. Uchapupu hwekushandiswa kwemasimba emagunha sekupindira kwega kwega kune varwere vane mhirizhonga-musoro wemusoro unoramba uripo. (J Manipulative Physiol Ther 2011; 34: 274-289)
  • Key Indexing Terms: Kugunun'una kwepamuviri; Migraine Matambudziko; Mhirizhonga-Nyora Musoro; Post-traumatic Headache; Practice Guideline; Chiropractic

 

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight

Musoro, kana kurwadza musoro, kusanganisira migraine nedzimwe mhando dzemusoro, ndeimwe yemhando dzakawanda dzinorwadza dzinoratidzwa pakati pevanhu vakawanda. Izvozvo zvinogona kuitika kune imwe kana mativi maviri emusoro, zvinogona kusarudzwa kune imwe nzvimbo kana kuti dzinogona kutenderera musoro kubva pane imwe pfungwa. Kunyange zvazvo zviratidzo zvemusoro zvinogona kusiyana zvichienderana nemhando yemarwadzo edzimhosva uye nekuda kwechikonzero chehutano hwehutano, misoro inonzi inofungidzirwa kuti inonyunyuta zvachose pasinei nekutsungirira kwavo uye mafomu. Musoro, kana kurwadza musoro, kunogona kuitika semugumisiro wekusapisa kwepelinha, kana kugunun'una, pamwe nehurefu hwepamusoro. Kuburikidza nekushandiswa kwepelinha uye maitiro ekushandisa, chiropractic kuchengetedza inogona kuchengeteka uye inogadzirisa zvirwere zvepfungwa, kuderedza kushungurudzika uye kumanikidzwa kune zvivako zvakapoteredza musana, kuti pakupedzisira kubatsire kugadzirisa zvirwere zvekurwadziwa kwepfungwa uyewo hutano hwakakwana uye hukama.

 

Musoro unowanzoitika kune vanhu vakuru. Kudzokorora misoro kunoshatisa hupenyu hwemhuri, mararamiro emagariro evanhu, uye kubasa kwebasa. [1,2] Munyika yose, maererano neWorld Health Organization, migraine oga ndeye 19th pakati pezvose zvinokonzera makore akagara nehurema. Musoro ndewechitatu pazvikonzero zvekutsvaga chiropractic kuchengetedza muNorth America. [3]

 

Kurongeka kwakagadziriswa chinhu chikuru chekutarisira uye kurapwa, uye huwandu hwakasiyana-siyana hwemusoro huripo hunorondedzerwa muInternational Classification ye Headache Disorders 2 (International Headache Society [IHS]). [4] Zvikamu izvi zvinotarisirwa kuchipatara pamwe nekushandiswa kwekutsvakurudza. Musoro wepamusoro-soro, kushungurudzika-rudzi uye migraine, kunofungidzirwa semusoro wepamusoro unove episodic kana kusingaperi mune zvakasikwa. Episodic migraine kana kushungurudzika kwemusoro-musoro kunowanikwa zvishoma kudarika mazuva 15 pamwedzi, asi misoro isingagumi inowedzera kupfuura mazuva 15 pamwedzi kunyanya 3 (migraine) kana kuti 6 mwedzi (mutsauko wemusoro-soro). [4] Musoro wemusoro unonzi zvinokonzera matambudziko emakiriniki mumusoro kana mumitsipa inogonawo kuva episodic kana kusingaperi. Cervicogenic misoro ndeyemusoro wemusoro inowanzobatwa nechiropractors uye inosanganisira kurwadziwa kunobva kune imwe nzvimbo mumutsipa uye kunonzwisiswa mu1 kana dzimwe nzvimbo dzepamusoro. IHS inobvuma cervicogenic musoro sechirwere chakasiyana, [4] uye uchapupu hwokuti misoro inogona kuonekwa nehutano hwemutsipa kana chironda chinobva pane zvakaitika uye zvipatara zvinowanikwa (nhoroondo yekutambudzika kwemutsipa, kushandiswa kwemakumbo kwemitsipa, kurwadziwa kwechiedza chechivharo chekufamba, uye [4,5] Apo myofascial inorwadza ndoga ndicho chikonzero, murwere anofanirwa kutarisirwa seanenge ane musoro wepfungwa. [4] Izvozvi zvinotarisirwa kuti zviongororwe asi hazvina kupokana mumabhuku. [XNUMX]

 

Mishonga inogadziriswa inoshandiswa nechiropractors kutarisira varwere vane misoro inosanganisira kugadzirwa kwepelinha, kuunganidza, kushandiswa kwemagetsi-kushandiswa kugadzirwa kwemumumvuri, dzidzo pamusoro pekuchinja mararamiro ezvimwe zvinhu, maitiro ekurapa mararamiro, kupisa / mazaya, kuisa massage, zvakanyanya kufema tissue therapies dzakadai sedgger point therapy, uye kusimbisa uye kutambanudza maitiro. Pane tariro inowedzera yezvehutano, kusanganisira chiropractic, kugamuchira nekushandisa ruzivo rwekutsvakurudza, kutora kukwana kwakakwana kwehutano hwehuchapupu hunotsvaga hunozivisa kugadzirisa chirongwa. Somugumisiro, chinangwa cheCanada Chiropractic Association (CCA) neCanada Federation of Chiropractic Regulatory uye Educational Accrediting Boards (Project) Clinic Practice Guidelines Project ndeyekudziridza mazano ekuita zvinoenderana nouchapupu hunowanikwa. Chinangwa chechirongwa ichi ndechekupa uchapupu-ruzivo rwekuita mazano ekurapa kwechiropractic yemusoro kune vanhu vakuru.

 

nzira

 

The Guidelines Development Committee (GDC) yakaronga uye yakagadziridza maitiro akarongeka ekutsvaga mabhuku, kuongorora, kuongorora, kuongorora, uye kududzira. Nzira dzinoenderana nemaitiro akakurudzirwa ne �Kuongororwa kweMitemo Yekutsvagisa neKuongorora� kubatana (www.agreecollaboration.org). Iyi nhungamiro chishandiso chinotsigira varapi. Izvo hazvina kuitirwa seyakajairwa kurapwa. Iyo yedhairekitori inobatanidza iripo yakadhindwa humbowo kuchipatara tsika uye inongova 1 chikamu cheuchapupu-hwakadzikiswa nzira yekurapa kwevarwere.

 

Dhina Zvinyorwa uye Tsvakurudzo

 

Kutsvaga kwakagadziriswa uye kuongororwa kwemabhuku ekurapa kwakaitwa kuburikidza nenzira dzakarondedzerwa neChorane Cooperation Rezve Review Group [6] naOxman naGuyatt. [7] Tsananguro yekutsvaga yakagadzirwa muM MEDLINE nekuongorora mitemo yeMSH inobatanidza chiropractic uye mamwe mazano uye gare gare modified for other database. Shanduro yekutsvakurudza mabhuku yaive yakawanda. Chiropractic mishonga yakatsanangurwa seyo kusanganisira nzira dzakajairika dzokurapa dzinoshandiswa nevashandi uye dzakanga dzisingangoregi kurapwa kwezvirwere zvakapiwa chete nechiropractors. Mushonga wakakura wakakandwa kunosanganisira kurapa kunogona kugoverwa muchiropractic kutarisira pamwe chete neaigonawo kuendeswa mumamiriro ekutarisira nevamwe vadzidzisi vezvehutano mune imwe tsvakurudzo yekuongorora (Appendikisi A). Kugadzirisa kwepamuviri kwakarondedzerwa se-high-velocity low-amplitude yakakonzerwa kumusana. Kunze kwekurapa kunosanganisira kushaya maitiro anorema kana maitiro ekudzivirira maitiro, pharmacotherapy, majekesheni e-botulinum toxin, kugadziriswa kana maitiro ekurapa, uye kugadziriswa.

 

Kutsvaga kwemabhuku kwakapedzwa kubva munaKubvumbi kusvika Chivabvu 2006, kwakagadziriswa muna 2007 (chikamu 1), uye kwakagadziridzwa zvakare muna Nyamavhuvhu 2009 (chikamu 2). Databases yakatsvaga yaisanganisira MEDLINE; EMBASE; Allied uye Inowirirana Mushonga; iyo Yekuwedzera Index kune Nursing uye Allied Hutano Mabhuku; Chinyorwa, Imwe nzira, uye Natural Therapy Index System; Alt HealthWatch; Index kuChiropractic Literature; uye raCochrane Library (Appendikisi A). Kutsvaga kwaisanganisira zvinyorwa zvakaburitswa muChirungu kana neChirungu zvinyorwa. Iyo yekutsvaga nzira yakatemerwa kune vakuru (? 18 makore); kunyangwe hazvo zvidzidzo zvekutsvagisa nemusoro wenyaya wekubatanidza zvinosanganisira huwandu hwakareba hwemazera, senge vakuru nevechiri kuyaruka, vakadzoserwa vachishandisa nzira yekutsvaga. Referensi zvinyorwa zvakapihwa mune zvakarongeka ongororo (SRs) zvakaongororwa zvakare neGDC kudzikisira akakodzera zvinyorwa kubva mukushaikwa.

 

Uchapupu Hutsanangudzo Criteria

 

Mitsva yekutsvaga yakaongororwa zvemagetsi, uye kuongororwa kwakawanda-nhanho kwakashandiswa (Appendikisi B): nhanho 1A (zita), 1B (isingabvumirwe); danho 2A (zvinyorwa zvizere), 2B (yakazara zvinyorwa-maitiro, kukosha); uye nhanho 3 (yakazara zvinyorwa-zvekupedzisira GDC kuongorora kunge kiriniki zvemukati nyanzvi). Duplicate zvinyorwa zvakabviswa, uye zvinyorwa zvinoenderana zvakatorwa semagetsi asuye / kana makopi akaomarara kuti anyatsoongorora. Vaongorori vakasiyana, vachishandisa nzira imwecheteyo, vakapedza zvinyorwa zvemabhuku mu2007 na2009 nekuda kwenguva iyo pakati pekutsvaga.

 

Chengeteredzwa keriniki miedzo (CCTs); miedzo yakarongeka, yakarongedzwa (RCTs); uye maitiro ekugadzirisa (SRs) akasarudzwa sehumwe huchapupu hwehutungamiri huno hunoenderana nemamiriro ezvinhu ezvino ekududzira kliniki yekuwana. Iko GDC haina kukoshesa zvidzidzo zvekucherechedza, nyaya dzenyaya, kana nyaya dzinopomerwa nekuda kwemamiriro avo asina kudzora uye zvishoma nezvishoma pasi methodological quality vs CCTs. Iyi nzira isinganzwisisi nzira dzakagadziriswa dzeRS dzakabudiswa neCochrane Back Review Group. [8] Kana dzakawanda SRs dzakabudiswa nevanyori vakadaro pane imwe nhaurwa, bhuku rekupedzisira chete ndiro rakaverengwa uye rinoshandiswa kuti rive pachena. Kuongororwa kwakagadziriswa kweSR kwave kusatorwawo kuitira kuti usaverengeka kuverenga kaviri kwemigumisiro yekutsvakurudza.

 

Kuongorora Zvinyorwa uye Kushandurwa

 

Hunhu ratidziro dzeCCTs kana maRCTs aisanganisira gumi nematanhatu mhinduro dzakapindurwa nemae (zvibodzwa 11) kana no (zvibodzwa 1) / handizive (mamakisi 0) (Tafura 0). Iyo GDC yakanyora 1 yekuwedzera nzira yekufarira: (2) mashandisirwo evashandisi eiyo IHS yekuongorora nzira yekunyora zvinyorwa uye (1) kuongororwa kwemhedzisiro (Tafura 2, makoramu L uye M). Kushandiswa kweiyo IHS nzira [1] yaive inoenderana neiyi Clinical Practice Guideline (CPG) maitiro ekusimbisa kuongororwa kwehunyanzvi mukati nepakati pezvidzidzo zvekutsvaga. Zvidzidzo zvakasarudzika kana IHS yekuongorora nzira isina kuiswa nevatsvagiri vechinhu kuiswa muchidzidzo (Appendikisi C); uye kana pamberi pa4, pamberi pekervicogenic musoro uchisanganisirwa muhurongwa hweHS, nzira dzekuongorora dzeCervicogenic Headache International Study Boka [2004] hadzina kushandiswa. Zvimwe zvinokanganisa zvakaongororwa sevamiririri vengozi (s) pamwe nekurapwa. Hapana chekuyera (s) chakashandiswa kune mumwe munhu maitiro, uye zvingangodaro zviyero zvemhando zvakatangira kubva pa9 kusvika pa0. Zvese zviri zviviri kupofumadza zvidzidzo nevatapi venhepfenyuro zvakaverengerwa muzvinyorwa zvekutsvagisa neGDC, sezvo zvinhu izvi zvakanyorwa mune yehunhu hwekupima mhando. [11] Maitiro eGDC haana kugadzirisa kana kushandura chishandiso chekupimisa. Pfungwa yemaitiro aya yaive yekuti dzimwe nzira dzekurapa (semuenzaniso, transcutaneous magetsi etsinga dzinosimudzira [TENS], ultrasound) uye dhizaini dhizaini inogona kuwana murwere uye / kana murapi anopofomadza. [6] Iyo GDC haina kudzikamisa kuongororwa kweaya mabhenji emhando yemhando kana zvirokwazvo iwo akataurwa muzvidzidzo zvekiriniki zvekurapa kusagadzikana kwemusoro. GDC yakazvitorawo kunze kwehunyanzvi hwavo kugadzirisa, pasina kusimbiswa, chishandiso chakashandiswa zvakanyanya kuyera zvinyorwa zvemakiriniki. [10] Zvishandiso zvitsva zvekutsvagisa uye kuyera kwemanyorerwo ehunyanzvi mabhuku, zvisinei, anodiwa nekukurumidza uye anoonekwa senzvimbo yekutsvaga mune ramangwana muchikamu chehurukuro pazasi.

 

Tetera 1 Maitiro Akakodzera Maitiro Akadzivirirwa Ezvinhu Zvokurapwa Kwemutambo wekutungamirirwa kweHemacheache Matambudziko

 

Vanoongorora mabhuku vaive vabatsiri vepurojekiti vakaparadzaniswa neGDC uye vaive vasina kufefeterwa sekudzidza vanyori, masangano, uye magazini enhau. Nhengo nhatu dzeGDC (MD, RR, uye LS) dzakatsigira nzira dzekupimisa mhando nekuzadzisa ongororo yemhando yepamusoro paseti yezvinyorwa gumi. [10-11] Chikamu chepamusoro chechibvumirano chakasimbiswa pamatanho emhando. Chibvumirano chakazara pazvinhu zvese chakawanikwa muzvidzidzo zvishanu: mune gumi zvezvinhu gumi nezviviri zvezvidzidzo zvina uye zvisere zvezvinhu gumi neimwe zvechi20 chekudzidza chasara. Kusanzwisisika kwese kwakagadziriswa zviri nyore kuburikidza nekukurukurirana uye nekubvumirana neGDC (Tafura 5). Nekuda kweiyo heterogeneity yenzira dzekutsvagisa pamiedzo, hapana meta-ongororo kana kuwanda kwenhamba yemhedzisiro yekuedzwa kwakaitwa. Miedzo yakarova inopfuura hafu yehuwandu hwehuwandu hunokwanisika (kureva ,,? 10) yaionekwa semhando yepamusoro. Miedzo yekumisikidza 11 kusvika ku4 yaionekwa senge yakaderera mhando. Zvidzidzo zvine zvikanganiso zvakakura zvemaitiro kana kuongorora maitiro ekurapa akasarudzika (semuenzaniso, kurapwa kusingatariswe kwakakodzera neGDC yekurapa chiropractic kwevarwere vane musoro; Appendikisi Tafura 8).

 

Hunhu hwehuwandu hweSRs hwaisanganisira 9 zviyero zvakapindurwa hongu (mamaki 1) kana kwete (mamakisi 0) / handizive (mamakisi 0) uye mhinduro yehunhu yechinhu J no zvikanganiso, zvishoma zvikanganiso, kana major zvikanganiso (Tafura 2). Kuyera kunogona kuitika kwakatangira pa0 kusvika pa9. Kumisikidzwa kwehuwandu hwesainzi hweSR ine zvikanganiso zvakakura, zvidiki zvikanganiso, kana pasina zvikanganiso, sezvakanyorwa mukoramu J (Tafura 2), yaive yakavakirwa pamhinduro dzevanyori vemabhuku kuzvinhu zvipfumbamwe zvakapfuura. . Iyi inotevera parameter yakashandiswa kuwana iyo yakazara sainzi mhando yeiyo SR: kana iyo / isingazive mhinduro yakashandiswa, iyo SR ingangove iine zvidiki zvikanganiso pakanyanya. Zvisinei, kana No yakashandiswa pazvinhu B, D, F, kana H, ongororo yacho inogona kunge iine zvikanganiso zvakakura. [9] Ongororo dzakarongeka dzichitora inopfuura hafu yehuwandu hwehuwandu hunokwanisika (kureva ,, 21) isina kana zvidiki zvikanganiso zvakaverengerwa semhando yepamusoro. Ongororo dzakarongeka dzichitora 5 kana zvishoma uye / kana nezvikanganiso zvakakura zvakabviswa.

 

Tafura 2 Inofanirwa Kuyera Kuongororwa Kwekugadziriswa kweMutano Wenyama Kwekugadzirisa Kwemusoro Matambudziko

 

Ongororo dzakatsanangurwa senge dzakarongeka kana dzaisanganisira nzira yakajeka uye inodzokororwa yekutsvaga uye kuongorora zvinyorwa uye kana kuiswa uye nzira dzekuregedza dzezvidzidzo zvakatsanangurwa. Maitiro, maitiro ekubatanidza, nzira dzekuyera mhando yemhando, hunhu hwezvisanganisira zvidzidzo, nzira dzekugadzirisa data, uye mhedzisiro yakaongororwa. MaRaters akawana chibvumirano chakazara chezviyero zvese zve7 SRs [22-28] uye ye7 yezvinhu 9 zveiyo 2 zvimwe maSR. [29,30] Kusanzwanana kwakanzi kudiki uye kwakagadziriswa zviri nyore kuburikidza nekuongororwa kweGDC uye kubvumirana (Tafura 2 ).

 

Kukurudzira Mazano Okuita

 

GDC yakashandura humwe uchapupu hunobatsira kuchiropractic kurapwa kwevarwere vemusoro. Tsanangudzo yakazara yezvinyorwa zvakakosha ichaendeswa kune webasaiti reCCA / Federation Clinical Practice Guidelines Project.

 

Randomized, kutongedzwa miedzo uye zvavakawana zvakaongororwa kuudza mazano ekurapa. Kupa simba rose reuchapupu (rakasimba, rinononoka, risina kukwana, rinopesana, kana risina uchapupu), [6] GDC yakarangarira nhamba, hutano, uye kusagadzikana kwemigumisiro yekutsvakurudza (Tafura 3). Uchapupu hwakasimba hwaiongororwa bedzi apo vazhinji vezvikwata zvepamusoro zveRCTs zvakatsigira zvitsva zvevamwe vaongorori mune dzimwe nzvimbo. Yese SRs yakakwirira yakarongedzwa maererano nemuviri wehuchapupu uye kuzivisa mazano ekurapa. Iko GDC yakaronga kurapwa kwemaitiro ekuti ibatsirwe rubatsiro (s) kana ikatsigirwa nehuwandu hwehuwandu hwehupupuri hwehupupuriro.

 

Tafura 3 Simba reUchapupu

 

Zvirongwa zvekuita zvakagadzirwa mumisangano yakabatana yekushanda.

 

Results

 

Tafura 4 Zvinyorwa Pfupiso ye! Uhu Kuongororwa kweUchapupu hweKupindira kweMigraine Headache kana kuti pasina Aura

 

Tafura 5 Literature Summary and Quality Ratings of the Evidence for Interventions for Stroke-Type Type Headache

 

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

 

Tafura 7 Literature Summary and Quality Ratings Yokuongorora Kwakagadzikana Kurapa Kwemitambo yekutungamirirwa kweHemacheche Matambudziko

 

Literature

 

Kubva pakutsvaga mabhuku, pakutanga 6206 zvinyorwa zvakaonekwa. Zvinyorwa makumi maviri nemumwe zvakasangana nemagumo ekupedzisira ekubatanidzwa uye zvaionekwa mukudzidzira maitiro mazano (16 CCTs / RCTs [11-20,31-36] uye 5 SRs [24-27,29]). Kuyera kwehutano hwezvinyorwa zvinowanikwa zvinowanikwa muTables 1 uye 2. Mashoko Okuwedzera Table 3 inonyora nyaya dzisingabatanidzwi pakuongorora kwekupedzisira neGDC uye kufunga (s) kwekuregererwa kwavo. Kutadza kwechidzidzo uye chiremba kupofumadza uye kusagutsikana kutsanangurwa kwekusungirirwa kwemari kwaiwanzoonekwa nzira dzekugadzirisa dzematambudziko akadzorwa. Musoro wemhando dzinoongororwa mumatambudziko aya zvaisanganisira migraine (Tafura 4), hutano hwemusoro (Table Table 5), uye cervicogenic musoro (Table 6). Nekudaro, izvi chete misoro yepamusoro inomiririrwa nehuchapupu uye kuita zvinorayirwa mune iyi CPG. Uchapupu hwemashoko eRS anopiwa muTebhenekeri 7.

 

Dzidzira Mazano: Kurapa kweMigraine

 

  • Kugadzirisa kwepamuviri kunokurudzirwa kuti vatungamiri vevarwere vane episodic kana vasingagumi migraine vane kana vasina kanara. Izvi zvinokurudzirwa kubva pane zvidzidzo zvakashandisa maitiro ekurapa 1 nguva 2 pavhiki kwemavhiki e8 (unhu hwehuchapupu, huwandu). Imwe yepamusoro yeRCT, [20] 1 yepamusoro-soro RCT, [17] uye 1 high-quality SR [24] inotsigira kushandiswa kwepelinha kune varwere vane episodic kana kusingaperi migraine (Tables 4 ne7).
  • Kupera kwemasvondo kwevhiki nevhiki kunorudzirwa kuti kuderedze episodic migraine nguva uye nekuvandudza zviratidzo zvehutano zvingangobatanidza kurwadziwa kwepfungwa (uhu hunhu, huwandu). Imwe yepamusoro yepamusoro RCT [16] inotsigira chirevo ichi chekuita (Table Table 4). Vatsvakurudzi vakashandisa muto we45-kutarisa nekutarisa neuromuscular and trigger point framework ye kumashure, fudzi, mutsipa, uye musoro.
  • Multimodal multidisciplinary kutarisira (kuedza, kuporesa, kushungurudzika uye kurapa kunovaka muviri, kurapa kurapa) kunokurudzirwa kutarisira varwere vane episodic kana vasingaperi migraine. Ratidza sezvakakodzera (uchapupu hwehutano, huwandu). Imwe yepamusoro yepamusoro RCT [32] inobatsira kubudirira kwemamiriyoni akawanda emitemo inopindira kune migraine (Tafura 4). Kupindira kunotungamirira kushandiswa kwehutungamiri huzhinji hunosanganisira kurovedza muviri, dzidzo, kuchinja mararamiro, uye kuzvitonga.
  • Pane huwandu hwekliniki dzedzinhare dzinoratidzira kana kuti dzipikise kushandiswa kwekurovedza muviri chete kana kuti kurovedza muviri pamwe chete nemishonga miviri yepamusoro yekurapa kwevarwere vane episodic kana chisingagumi migraine (aerobic exercise, kervical range of motion [cROM], kana muviri wose kutambanudza). Zvishoma zvitatu zveCCTs [13,33,34] zvinobatsira pakupedzisira (Table 4).

 

Dzidzira Mazano: Mhirizhonga-Nyora Musoro

 

  • Low-load craniocervical mobilization (semuenzaniso, Thera-Band, Resistive Exercise Systems; Hygenic Corporation, Akron, OH) inokurudzirwa kwenguva yakareba (semuenzaniso, mwedzi mitanhatu) manejimendi evarwere vane episodic kana -chronic tension-mhando misoro (humbowo hwehuviri, zvine mwero). Imwe yepamusoro-soro RCT [6] yakaratidza kuti yakaderera-mutoro kuunganidza kwakadzora zvakanyanya zviratidzo zvekupokana-mhando misoro yevarwere munguva yakareba (Tafura 36).
  • Kugadzirisa kwepamuviri hakugoni kukurudzirwa kutarisira varwere vane episodic-type-head headache (uchapupu wepamusoro, kuenzanisa). Ikoko kune huwandu hwehutano hwehutachiona hunokonzerwa nemaspinal mushure mekutanga kushandura mhando dzakanyanyisa hutachiona hunopa humwe humwe rubatsiro kune varwere vane mitsipa yakashata. Imwe yepamusoro yeRCT [12] (Tafura 5) uye zvinyorwa zvichitsanangurwa mu4 SRs [24-27] (Table Table 7) zvinoratidza kuti hapana kubatsirwa kwepfungwa dzepelinha kune varwere vane maziso episodic-type-tension.
  • A kukurudzira hakugoni kuitwa kana kupikisa kushandiswa kwemagunha (2 dzimwe nguva kwevhiki kwevhiki dze6) kune varwere vane mvere dzisingagumi-nyoro dzemusoro. Vanyori ve1 RCT [11] vakaratidzirwa sehupamhi hwepamusoro nehutano hwehutano hwepamhando [6] (Tafura 1), uye zvinyorwa zvechidzidzo ichi mu 2 SRs [24,26] zvinoratidza kuti kudzvinyirira kwepamuviri kunogona kuve kwakagadzikana nekusingaperi kwemusoro-tema musoro. Zvisinei, GDC inofunga kuti RCT [11] yakaoma kududzira uye kusingazivi (Table 5). Mhosva yacho haina kukodzera kutariswa nekusawirirana muhuwandu hwehutano-chiremba chinosangana pakati pezvikwata zvekudzidza (semuenzaniso, 12 kushanyira kune zvinyorwa mumapfupa akanyorovedza marwadzo pamwe nemasana ekugadzirisa boka vs 2 kushanyira nyaya dziri mumamitriptyline boka). Hapana nzira yekuziva kana nhamba yakaenzana yekutarisa kwevanhu munyaya ye amitriptyline boka ingave yakakanganisa zvidzidzo zvidzidzo. Izvi zvinyorwa uye kududzirwa kubva kune 2 imwe SRS [25,27] inobatsira pakupedzisira (Table Table 7).
  • Pane humwe hunopupu husina kukwana hunoratidzira kana kuti hunopesana nekushandiswa kwebhuku rinoshandiswa, kushandiswa kwechigunwe chekunyengera, kuunganidza kwaCyriax, kana kurovedza muviri / kudzidzira muviri kune varwere vane episodic kana chronic tension-type headache. Zvitatu zvisingabatsiri zvidzidzo zvisinganzwisisiki [19,31,35] (Tafura 5), 1 yakashata-negative hasi RCT, [14] uye 1 SR [25] inobatsira pakupedzisira (Table Table 7).

 

Dzidzira Mazano: Cervicogenic Headache

 

  • Kugadzirwa kwemasana kunokurudzirwa kuti vatungamiri vevarwere vane cervicogenic musoro. Izvi zvinokurudzirwa pachirongwa che 1 chakashandisa maitiro ekurapa kwe2 nguva pavhiki kwemavhiki e3 (uchapupu hwehutano, huwandu). Mune unhu hwakanaka hweRCT, Nilsson et al [18] (Tafura 6) yakaratidza unhu hwakanaka hwekukurumidza-kutsika, pasi-amplitude kugadzirwa kwepelinha kwevarwere vane cervicogenic musoro. Uchapupu hwehuwandu kubva ku2 SRs [24,29] (Tafura 7) inotsigira iri tsika yekukurudzira.
  • Kushamwaridzana kwakabatanidzwa kunorudzirwa kune vatungamiri vevarwere vane cervicogenic musoro (uchapupu hwepamusoro, kuenzanisa). Jull et al [15] akaongorora migumisiro yeMaitland akabatanidza kuunganidza 8 kune 12 mishonga kwemavhiki e6 mune yepamusoro RCT (Tafura 6). Kukurudzira kwakatevedzerwa nenzira yekuchirapa, iyo kusarudzwa kwepasi-velocity uye-high-velocity techniques zvaive zvakatangira kuongororwa kwekutanga uye kunofambira mberi kwechirwere chevashandi vemakwenzi echirwere chisingaiti. Zvibereko zvinobatsira zvakataurwa pamusoro pemusoro wepamusoro, kuwedzera, pamwe nekurwadziwa kwemutsipa nekuremara. Uchapupu hwehuwandu kubva ku2 SRs [24,29] (Tafura 7) inotsigira iyi tsika yekukurudzira.
  • Deep neck flexor maitiro inokurudzirwa kutungamirirwa nevarwere vane cervicogenic headache (uchapupu wezinga, kuenzanisa). Izvi zvinokurudzirwa kubva pakudzidza nguva dze2 zuva nezuva kwevhiki dze 6. Hakuchina kuwedzera kuwedzerwa kubatsirana kwekubatanidza yakadzika shingo flexor maitiro uye kubatana kwekubatana kwe cervicogenic headache. Imwe yepamusoro yeRCT [15] (Tafura 6) uye zvinyorwa zvinowanikwa mu2 SRs [24,29] (Tafura 7) kutsigira mutsika iyi inokurudzira.

 

chengetedzo

 

Varapi vanosarudza maitiro ekurapa pamwe chete nechero ruzivo rwekiriniki kune murwere akapiwa. Pakati pe16 CCTs / RCTS [11-20,31-36] inosanganisirwa mumuviri weuchapupu hweiyi CPG, zvidzidzo zvitanhatu chete [6] zvakaongororwa zvakaringana kana kukurukura mhedzisiro yemurwere kana chengetedzo parameter (Tafura 11,12,15,20,32,36, ikholamu M). Pakazara, njodzi dzakataurwa dzaive shoma. Zvitatu zvezviedzo zvakazivisa ruzivo rwekuchengetedzeka kwemagunha. [1] Boline et al [11,12,20] vakataura kuti 11% yezvidzidzo yakawana kuomarara kwemutsipa mushure mekutanga kwekumanikidza kwepelinha kwakanyangarika kune ese zviitiko mushure memavhiki ekutanga e4.3 ekurapwa. Kusuwa kana kuwedzera mumusoro mushure mekunyengedza musana (n = 2) zvaive zvikonzero zvekuregera kurapwa kwakataurwa naTuchin et al. [2] Hapana mhedzisiro yakaverengerwa nechero zvidzidzo zvakadzidzwa naBove et al [20] vachishandisa musana kugadziriswa kwekurapa episodic tension-mhando misoro. Miedzo yekurapa kuti uongorore mhedzisiro yekubudirira inogona kusakwanisa kunyoresa nhamba dzakaringana dzezvidzidzo kuti zviongorore zviitiko zvezviitiko zvisingawanzo kuitika. Dzimwe nzira dzekutsvagisa dzinodikanwa kuti dzigadzirise kunzwisiswa kuzere kwechiyero pakati pezvakanaka nenjodzi.

 

hurukuro

 

Kurapa kwemasana uye mamwe mazano ekurapa anowanzoshandiswa mu chiropractic ave akadzidza mune dzimwe nhengo dzeCCTs dzisinganzwisisiki mukunyorwa kwezvinyorwa, kugadzirwa, uye huwandu hwehutano. Mwoyo murefu uye misoro yakanyatsogadziriswa inomiririra muhumwe hunopupu hunonzi migraine, mhirizhonga-musoro wemusoro, uye cervicogenic musoro. Mhedzisiro yehutano yemamiriro ehutano inoshuvarurwa ndeyekuti inowanzobata musoro, kuwedzera, nguva, uye mararamiro ehupenyu. Icho uchapupu hahupfu kune huwandu hwakanaka panguva ino.

 

Uchapupu hunosimbisa kushandiswa kwemagunha kwechiropractic kutarisira varwere vane migraine kana cervicogenic misoro asi kwete misoro-inonzi headaches. Kune migraine, kutarisirwa kwezvinhu zvakasiyana-siyana uchishandisa vhiki nevhiki 45-miniti yekurapa kurapwa uye kutarisirwa kwemamiriyoni (kuedza, kusununguka, uye kushungurudzika nekupa mazano ekudya) zvinogonawo kushanda. Zvimwe, kubatanidza pamwe chete kana kudzika mukati memutsipa mafomu zvinoshandiswa kurudzirwa kuvandudza zviratidzo zve cervicogenic musoro. Ikoko kunoratidzika kusina kuwedzera kuwedzerwa kubatsirana kwekubatanidza kuunganidza pamwe nekudzika shingo flexor maitiro kune varwere vane cervicogenic musoro. Uchapupu hwakajeka hunotsigira kushandiswa kwemaodzora-masimba ekugadzirisa maitiro ekugadzirisa kwenguva refu kwehutano-hutsika hwemusoro.

 

Nokuremara

 

Kukanganisa kwechirevo ichi kunosanganisira huwandu uye hutano hunotsigira uchapupu hunowanika panguva yekutsvaga. Pasina kunyatsogadziriswa zvakakodzwa zvidzidzo zvekutsvakurudza zvakakosha nekuwanikwa kwechirwere chechipatara zvakabudiswa nekuda kwechiropractic kuchengetwa kwevatano vemawere. Dzidzo dzinodiwa kuti tifambise kunzwisisa kwatinoita mazano ekurapa mukutarisa kana kuti mumakambani akachengetedzwa zvakanaka pakuchengetedzwa kwemigraine, hutano hwemusoro-soro, cervicogenic headache, kana mamwe mhando dzepamusoro dzinounza kuvakiriniki (semuenzaniso, musumbu, mushure mutsva) . Imwe kukanganisa kwemabhuku aya ndeye kuvimba kwezvinyorwa zvitsvakurudzo zvitsvakurudzo nemazana mashoma ekuenzanisa (Tables 4-6), nguva pfupi yekurapa paradigms, uye nguva yekutevera. Zvakanyatsogadziriswa kliniki miedzo ine nhamba yakakwana yezvidzidzo, kurapwa kwemazuva mazhinji, uye nguva yekutevera inoda kubhadharwa kufambisa chiropractic kuchengetedza, uye kushandiswa kwepelinha kunyanya, kwekutarisira kwevarwere vane matambudziko epfungwa. Sezvakaitwa nekuongorora kwebhuku uye chirongwa chekurapa kwekliniki, nheyo yehutano uye mabhuku akabudiswa ari kuchinja. Zvidzidzo zvinogona kunge zvakanyatsozivisa basa iri zvingave zvakabudiswa mushure mekupedzisira kwekudzidza. [37-39]

 

Kufunga nezveKutsvakurudza Kwemangwana

 

Iko GDC kubvumirana ndeyekuti kune chido chekuwedzera chiropractic zvidzidzo nevarwere vane matambudziko epfungwa.

 

  • Zvimwe zvepamusoro-soro zvekuchirapa zvinotsvakwa. Ongororo yeramangwana inoda kudzidza zvishandiso uchishandise zvakaenzanisa uye nontreatment uye / kana placebo boka (s) kukurudzira uchapupu hwehutano hwekutarisira kurapa. Mwoyo mupofu unofuridzira kupindira kwemuviri kuti utarisire kutarisira mitezo inodiwa uye wakatsvakurudzwa nevatsvakurudzi mu chiropractic kune mamwe marwadzo. [10] Kushayikwa kwekugadziriswa kwezvidzidzo zvakarondedzerwa kunopa dambudziko rakakosha pakuita uchapupu hunotungamirirwa nekurapa mazano. Zvose zvidzidzo zvemangwana zvinofanira kugadziriswa kuburikidza nekushandisa nzira dzakagadziriswa dzakagadziriswa (semuenzaniso, Consolidated Standards of Reporting Trials [KUSIMBISA] uye Kuparara Kwekuona kweZvitsauko neZviitiko Zvisina Kunyoreswa [TREND]).
  • Kuburitswa kwehutano hwekuchengetedza dambudziko kunodiwa mukutsvakurudza chiropractic. Zvose zviyero zvemakiriniki zvinofanira kuunganidza uye kugadzirisa pamusoro pemigumisiro inogona kuitika kana kukuvadza kunyange kana pasina kuonekwa.
  • Shandisa inovheti zviyero zvekutarisa manotsi ekuongorora. Kupofumadza kunotungamirira kutarisira matambudziko nemigumisiro isingabatsiri yekugadzirisa-kugoverana kunobatanidzwa mumapoka ekudzidza. Zvinowanzosakwanisi kupofumadza zvidzidzo nevatapi muzvidzidzo zvinobudirira zvekurapa mazano. Pasinei nokukanganisa kwezvakaitwa, zvose zvakapofumadza zvidzidzo nevanotarisira vanoverengerwa zvakarongwa munyaya dzekutsvakurudza neGDC, sezvo zvinhu izvi zvakabatanidzwa mune zvepamusoro-shanduro zvishandiso. [6] Zvishandiso zvekutsvakurudza zvakapfurikidza zvekuongorora nekuenzanisa kwakatevera kwebhuku re manual therapy nokukurumidza inoda.
  • Kupfuurira mberi tsvakurudzo pamagumisiro ekushanda mune chiropractic kutarisira misoro. Iyi nhungamiro yakaratidza kuti misoro yepamusoro inoshandisa nzira dzakasiyana-siyana dzehutano mukuongorora maitiro ekurapa pamigumisiro yehutano. Musoro wehutachiona, simba, uye nguva ndeye mhinduro dzinoshandiswa nguva dzose (Tables 4-6). Kuedza kwakakomba kunofanirwa kusanganisira kugadziriswa kwehutano-hukuru hwehutano matanho mu chiropractic tsvakurudzo inobatanidza nekuvandudzika kwehupenyu hwezuva nezuva nekudzoka kwezvinhu zvinogadzirisa zvirongwa.
  • Mutengo-kubudirira. Hapana tsvakurudzo dzekutsvakurudza dzakanga dzadzorerwa pamutengo-kubudirira kwepfungwa dzepeminwa yekurapa kushungurudzwa kwepfungwa. Mumazuva ano zviongorori zvinokonzerwa nekudzvinyirira kwepamuviri zvinofanira kuongorora mari-inoshanda.

 

Dzimwe nzira dzokutsvakurudza dzinodiwa kuti dzikudziridze kunyatsonzwisisa kweruzhinji pakati pezvikomborero uye njodzi. Iyi CPG haina kupa rekuongorora kwezvose chiropractic mishonga. Chero kusvibiswa kunoratidzira zvikwereti mumakiriniki mabhuku. Mhando, maitiro, kuwedzerwa, uye nguva yehutano (s) inofanira kunge yakabva pane zvinotungamirirwa mazano, kliniki ruzivo, uye ruzivo rwemuurwere kusvikira hupamhi hwehupupuri huripo.

 

mhedziso

 

Pano pane nheyo yehupupuriro yekutsigira chiropractic kuchengetedza, kusanganisira kushandiswa kwepelinha, kwekutarisira migraine uye cervicogenic musoro. Mhando, nguva yakawanda, muyero, uye nguva yehutano (s) inofanira kunge yakavakirwa pane zvinotungamirirwa mazano, kliniki ruzivo, uye ruzivo rwomurwere. Uchapupu hwekushandiswa kwemasimba emagunha sekupindira kwega kwega kune varwere vane mhirizhonga-musoro wemusoro unoramba uripo. Kutsvakurudza kwakawanda kunodiwa.
Mirayiridzo yekudzidzira inobatanidza hwakanakisisa humbowo huripo kune hwakanaka kiriniki yekudzidzira uye inongova chikamu chimwe chete cheuchapupu-hwakajeka nzira yekupa chengeto yakanaka Iyi nhungamiro inoitirwa kunge iri sosi yekuendesa kwechiropractic kuchengetedza kune varwere vane musoro. Iri igwaro "rinorarama" uye rinotarisirwa kuti riongororwe pamwe nekubuda kwe data idzva. Uyezve, haisi chinotsiva chiitiko chekiriniki uye hunyanzvi. Iyi gwaro haina kuitirwa kuti ishandire seyakajairwa kurapwa. Asi, gwara rinoratidza kuzvipira kwehunyanzvi kusimudzira hunhu-hwakavakirwa maitiro kuburikidza nekuchinjana ruzivo uye kutamisa maitiro kutsigira kufamba kweruzivo rwekutsvagisa kuita.

 

Applications Applications

 

  • Iyi nhungamiro inobatsira pakupa chiropractic kutarisira kune varwere vane misoro.
  • Kugadzikana kwepamuviri kunokurudzirwa kuti vatungamiri vevarwere vane migraine kana cervicogenic musoro.
  • Multimodal interdisciplinary intervention inosanganisira massage inogona kubatsira varwere vane migraine.
  • Kubatanidza pamwe chete kana kumutsipa mutsipa mafomu zvinogona kuwedzera zviratidzo zve cervicogenic musoro.
  • Kutsika-mutoro kunokwidziridzwa kwepamusoro kunogona kuwedzera hutano hwemusoro.

 

KUTENDA

 

Vanyori vanotenda zvinotevera nekuisa pane ino nhungamiro: Ron Brady, DC; Greyden Bridge, DC; H James Duncan; Wanda Lee MacPhee, DC; Keith Thomson, DC, ND; Dean Wright, DC; naPeter Waite (Nhengo dzeKiriniki Yekudzidzira Maitiro Ekutungamira Task Force). Vanyori vanotenda zvinotevera nerubatsiro neChikamu I ongororo yekutsvaga mabhuku: Simon Dagenais, DC, PhD; uye Thor Eglinton, MSc, RN. Vanyori vanotenda zvinotevera nerubatsiro neChikamu II chekuwedzera kutsvaga kwemabhuku uye chiyero cheuchapupu: Seema Bhatt, PhD; Mary-Doug Wright, MLS. Vanyori vacho vanotenda Karin Sorra, PhD nerubatsiro rwekutsvagisa mabhuku, chiyero cheuchapupu, uye rutsigiro rwekunyora.

 

Marizi Mitsara uye Zvimwe Zvimwe Nharo dzekufarira

 

Mari yekubhadhara yakapiwa neCCA, Canada Chiropractic Protective Association, uye mapurogiramu epachipiri emapurojekiti kubva kumativi ose enyika kunze kweBritain Columbia. Iri basa raibhadharwa neCCA uye Federation. Hapana nharo dzekufarira dzakataurwa pamusoro pekudzidza uku.

 

Mukupedzisa, Musoro ndeimwe yezvikonzero zvakakosha vanhu vanotsvaka kurapwa. Kunyange zvazvo vakawanda vashandi vezvehutano vanogona kubata mishonga yepamusoro, chiropractic kuchengetedza inonyanya kuzivikanwa sarudzo inoshandiswa kakawanda inoshandiswa kubata mhando dzakasiyana-siyana dzeutano, kusanganisira mhando dzakasiyana dzemusoro. Maererano nenyaya iri pamusoro apa, humwe uchapupu hunoratidza kuti chiropractic kuchengetedza, kusanganisira mitezo yemusana uye maitiro ekushandisa, inogona kuvandudza misoro uye migraine. Mashoko anotsanangurwa kubva kuNational Center for Biotechnology Information (NCBI). Kuwanda kweruzivo rwedu kunogumira kune chiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota ivai vakasununguka kubvunza Dr. Jimenez kana kuti tibvunzei kwatiri 915-850-0900 .

 

Yakarongedzwa naDkt Alex Jimenez

 

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

 

Zvimwe Zvinyorwa: Kubva Painini

 

Maererano nehuwandu, inenge 80% yevanhu ichaona zviratidzo zvekurwadziwa shure shure kamwechete munguva yeupenyu hwavo hwose. Kutambudzika shure ndiko kunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Kazhinji kacho, kuora kwechimiro chemupaka nezera kunogona kukonzera marwadzo kumashure. Herniated discs inoitika apo ganda rakanyorova, segel-like re intervertebral disc rinodonha nekubvarura mukati maro, rinenge riri kunze kwekatekete, kubvongodza nekugumbura midzi midzi. Dhizinesi dzinozivikanwa dzinowanzoitika kumucheto kumashure, kana kuti nhengo dzomukati, asi dzinogonawo kuitika pamucheto wepervical, kana mutsipa. Kuiswa kwemitsipa inowanikwa mucheka shure nekuda kwekukuvara uye / kana mamiriro akaoma kunogona kutungamirira kune zviratidzo zve sciatica.

 

blog chinyorwa chekartoon paperboy makuru makuru

 

NYAYA INOKOSHA INOKOSHA: eckNeck Pain Treatment El Paso, TX Chiropractor

 

 

DZIMWE MASHOKO: KUNYANYA KWENYAYA: El Paso, Tx | Vatambi

 

Hazvina kuchena
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51. Sjogren T, Nissinen KJ, Jarvenpaa SK, Ojanen MT, Vanharanta H, Malkia EA. Migumisiro yebasa rekurovedza muviri kunopindira pamusana pemusoro wemusoro uye mitsipa uye mafudzi emapfudzi uye kumusoro kwepamusoro masimba emashandi evashandi vehofisi: masumbu akawandisa anorongedzwa kutarisana-kutongwa. Pain 2005; 116: 119-28.
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53. Solomon S, Elkind A, Freitag F, Gallagher RM, Moore K, Swerdlow B, et al. Kuchengetedza uye kubudirira kwekakanial electrotherapy mukurapwa kwekurwadziwa musoro musoro. Musoro we1989; 29: 445-50.
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60. Lew HL, Lin F, Fuh JL, Wang SJ, Clark DJ, Walker WC. Zviratidzo uye kurapwa kwepfungwa mushure mekukuvadzwa kwehupfungwa kwehupombwe: kuongororwa kwakajeka. Am J Phys Med Rehabil 2006; 85: 619-27.

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Migraine Headache Pain Chiropractic Therapy in El Paso, TX

Migraine Headache Pain Chiropractic Therapy in El Paso, TX

by | Chiropractic, Randomized Controlled Trial

Migraine misoro yakanyatsotaridzirwa kuti ndeimwe yezvirwere zvinogumbura zvikuru kana ichienzaniswa nedzimwe nhau dzehutano dzakafanana. Kazhinji zvichikonzerwa nekudzvinyirira, zviratidzo zvemigraines, kusanganisira kunetseka kwemusoro kunokonzera simba, kunzwisiswa kwechiedza uye inzwi pamwe chete nekunyunyuta, kunogona kuchinja zvakanyanya mararamiro emuupenyu. Zvisinei, tsvakurudzo dzekutsvakurudza dzakawana kuti chiropractic kuchengetedza inogona kubatsira kuderedza kuwandisa uye kuoma kwemarwadzo ako emagraine. Nyanzvi dzakawanda dzehutano dzakaratidza kuti chirwere chemusana, kana kuti subluxation, chingave chinokonzera migraine kurwadziwa musoro musoro. Chinangwa chechinyorwa chiri pasi apa ndechekuratidzira zvinogadzirisa matanho echiropractic spinal manipulative therapy for migraine.

 

Chiropractic Spinal Manipulative Therapy yeMigraine: Vatatu? Vakashongedzerwa, Vakaroora? Vakapofomadzwa, Placebo, Randomized Inodzorwa Trial

 

ngovepo

 

  • Mamiriro uye chinangwa: Kuongorora kubhidzira kwechiropractic spinal manipulative therapy (CSMT) ye migraineurs.
  • Nzira: Uyu aimbove matatu matatu ane zvombo, asina kuroorwa, akapofomadzwa, placebo, akaongororwa maitiro (RCT) emwedzi gumi nematanhatu, kusanganisira 17 migraineurs ane kamwechete kurwisa migraine pamwedzi. Iyo RCT yakaitiswa kuAkershus University Hospital, Oslo, Norway. Kushanda kwekurapa kwaisanganisira CSMT, nepo placebo yaive sham push maneuver yekumucheto kwekupedzisira kweiyo scapula uye / kana iyo gluteal dunhu. Boka rinodzora rakaenderera mberi neyakajairwa manejimendi manejimendi Iyo RCT yaive ne104? Mwedzi inomhanya? Mukati, 1 mwedzi kupindira uye mhedzisiro matanho pakupera kwekupindira uye pa3, 3 uye 6 mwedzi inotevera. Mhedzisiro yekupedzisira? Poindi yaive huwandu hwemazuva emigraine pamwedzi, nepo kumagumo echipiri aive mapoira ekureba, migraine kusimba uye musoro we index, uye mushonga wekushandisa.
  • Results: Migraine mazuva akange akaderedzwa zvakanyanya mukati memapoka ese matatu kubva pekutanga kusvika pakutumira kurapwa (P <0.001). Mhedzisiro yakaramba ichienderera muCSMT neboka re placebo panguva dzese dzinotevera? Kumusoro nguva, nepo boka rekutonga rakadzokera kune yekutanga. Iko kuderedzwa kwemazuva emigraine kwanga kusiri kwakasiyana zvakanyanya pakati pemapoka (P> 0.025 yekubatana). Migraine nguva uye misoro index yakaderedzwa zvakanyanya mu CSMT kupfuura boka rinodzora kusvika kumagumo ekutevera? (P = 0.02 uye P = 0.04 yekudyidzana, zvichiteerana). Zviitiko zvakashata zvaive zvishoma, zvinyoro uye zvakapfuura. Kupofumadza kwakasimbiswa kwazvo mukati meRCT.
  • Mhedziso: Izvo zvinokwanisika kuitisa bhuku? Therapy RCT ine yakavanda placebo. Mhedzisiro yeCSMT yakacherechedzwa muchidzidzo chedu ingangoita nekuda kwemhinduro ye placebo.
  • Keywords: chiropractic, headache, migraine, randomized controlled trial, spinal manipulative therapy

 

Dr-Jimenez_White-Coat_01.png

Dr. Alex Jimenez's Insight

Kusuruvara kwemutsipa uye kuora musoro kunowanzoita kuti vanhu vawane chiropractic. Tsvakurudzo dzakawanda dzekutsvakurudza dzakaratidza kuti chiropractic spinal manipulative therapy ndiyo yakachengeteka uye inobudirira mamwe maitiro ekurapa kusarudza kwemigraines. Chiropractic kuchengetedza inogona kunyatsogadzirisa chero upi noupi hwepelinha, kana kuti subluxation, inowanikwa pamwe nehupamhi hwepona, iyo yakaratidzwa sechikonzero chemusoro wemusoro. Mukuwedzera, kuchinja kwepamuviri uye nzira dzekushandisa zvinogona kubatsira kuderedza kushungurudzika uye kushungurudzika kwemaviri kuburikidza nekuderedza kuwandisa kwezvinokonzerwa kunzvimbo dzakaoma dzomusana pamusana pemusana wemasipiresi, kana kugadziriswa. Nokugadzirisa mutsara pamwe chete nekuderedza kushungurudzika uye kushungurudzika kwemaviri, chiropractic kuchengetedza kunogona kuwedzera migraine zviratidzo uye kuderedza nguva yavo.

 

ziviso

 

Hupfumi hwehupfumi hwemigraine hwakakura kwazvo nekuda kwehuwandu hwekuwanda uye hurema panguva yekurwiswa [1, 2, 3]. Acute pharmacological kurapwa inowanzo kuve yekutanga kurapwa sarudzo ye migraine muvakuru. Migraineurs nekurwiswa kazhinji, kusakwanira maitiro uye / kana kupesana nemushonga wakanyanya ndivo vanogona kukwikwidza kurapwa kweprophylactic. Migraine prophylactic kurapwa kazhinji kacho mishonga, asi kurapa kwemanyorerwo hakusi kujairika, kunyanya kana kurapwa kwemishonga kukundikana kana kana murwere achida kudzivirira mushonga [4]. Kutsvagurudza kwakaratidza kuti musana wekurapa musana unogona kukurudzira neural inhibitory masisitimu pamatanho akasiyana emusana nekuti anogona kumisikidza akasiyana epakati ekudonhedza nzira dzekudzivirira [5, 6, 7, 8, 9, 10].

 

Pharmacological randomized inodzorwa miedzo (RCTs) inowanzo kuve yakapetwa zvakapetwa kaviri, asi izvi hazvigoneke mumanheru? Therapy RCTs, sezvo murapi anopindira asingakwanise kupofomadzwa. Parizvino hapana kubvumirana pamusoro pemaitiro ekunyadzisa mumawoko ekurapa maRCT ayo anoteedzera placebo mune zvemishonga maRCTs [11]. Kusava neyakakodzera nzira yekunyadzisa ndiko kuremedza kukuru mune ese epamberi echinyorwa? Therapy RCTs [12, 13]. Munguva pfupi yapfuura, takagadzira sham chiropractic spinal manipulative therapy (CSMT) maitiro, apo vatori vechikamu vane migraine vakatadza kusiyanisa pakati peicho chaicho uye shamhu CSMT yakaongororwa mushure meumwe neumwe we12 kupindira kwega kwega pamwedzi we3? [14].

 

Chinangwa chekutanga chechidzidzo ichi ndechekuitisa bhuku? Kurapa matatu? Akashongedzerwa, asina kuroorwa, akapofumadzwa, placebo RCT yemigraineurs ine nzira yemhando yakafanana neiyo yemasikirini maRCT.

 

Chinangwa chechipiri chaiva chekuongorora kushanda kweCSMT nekushambadzira sham (placebo) uye CSMT kupikisana nekudzivirira, kureva vatori vechikamu vakaramba vachiita zvekugadzirwa kwemishonga.

 

nzira

 

Chigadziro Chekudzidza

 

Chidzidzo chacho chaive chechitatu? Chakashongedzwa, chisina kuroorwa, chakapofomadzwa, placebo RCT pamusoro pemwedzi gumi nemanomwe. Iyo RCT yaive ne17? Mwedzi yekutanga, 1 marapirwo ekurapa pamusoro pemwedzi mitatu nematanho ekuteedzera pakupera kwekupindira, 12, 3 uye 3 mwedzi gare gare.

 

Vatori vechikamu vaive, vasati vatangira, vakagadziriswa zvakafanana mumapoka matatu: CSMT, placebo (sham manipulation) uye kutonga (vakaenderera mberi nehutano hwavo hwemishonga).

 

Izvo zvakagadziriswa zvekudzidza zvakapindirana nemazano eInternational Headache Society (IHS) uye CONSORT (Appendix S1) [1, 15, 16]. Dare reNorway Regional Committee yeAradic Research Stucs uye Norwegian Social Science Data Services vakabvumira basa racho. RCT yakanyoreswa kuClinikiTrials.gov (ID kwete: NCT01741714). Zvose zvakaitwa purogiramu yakabudiswa kare [17].

 

Vakwikwidzi

 

Vatori vechikamu vakanyorerwa kubva munaJanuary kusvikira kuSeptember 2013 zvikuru kuburikidza neDhipatimendi reNeurology, Akershus University Hospital. Vamwe vatori vechikamu vakanyorerwawo kuburikidza neGeneral Practitioners kubva kuAkershus uye Oslo Counties kana kushambadzira kwemashoko. Vose vatori vechikamu vakagamuchira zvinyorwa pamusoro peprojekti yakateverwa nehurukuro yefoni.

 

Vanokodzera vatori vechikamu vaive migraineurs yemakore 18-70 ekuzvarwa vaine imwechete migraine kurwisa pamwedzi uye vakabvumidzwa kuve nemhirizhonga inowirirana? Mhando yemusoro asi hapana imwe yekutanga misoro. Vese vatori vechikamu vakaongororwa nechiropractor vane ruzivo mukubatwa nemusoro panguva yekubvunzurudzwa uye zvinoenderana neInternational Classification yeHedache Disorders? II (ICHD? II) 2. Imwe nyanzvi yezveuropi yakanga yaona kuti vese vane migraineurs kubva kuAkershus University Hospital.

 

Maitiro ekuregedza aipesana nemushonga wepelinha wekurapa, musana radiculopathy, nhumbu, kushushikana uye CSMT mukati memwedzi yapfuura ye12. Vatori vechikamu vakagamuchira bhuku remanyorerwo [18], vakachinja yavo yeprophylactic migraine mushonga kana kuve nepamuviri panguva yeRCT vakaudzwa kuti vaizobviswa pachidzidzo panguva iyoyo uye voonekwa sekudonha? Vatori vechikamu vakabvumidzwa kuenderera uye nekuchinja zvakanyanya migraine mishonga munguva yese yekudzidza.

 

Vadzidzi vakakodzera vakadanwa kuhurukuro uye kuongororwa kwepanyama kunosanganisira kunyatsoongorora maginhi kutsva nekuongorora nechiropractor (AC). Vavatori vechikamu vakashandurwa kuCSMT kana boka re placebo rakange rakazara mushure mekuongorora maitiro.

 

Randomization uye Masking

 

Mushure mekunge mvumo yakanyorwa yawanikwa, vatori vechikamu vakaenzanisirwa zvakaenzana mune imwe yeatatu mawoko ekudzidza nekukweva rimwe chete. Yakaverengerwa mijenya yakavharwa nemaoko matatu ekufunda yakakamurwa kuita zvikamu zvina nezera uye murume kana murume, kureva 18 39 kana 40-70 makore, nevarume kana vakadzi.

 

Mushure memusangano wega wega wekurapa, vatori vechikamu muCSMT neboka re placebo vakapedzisa bvunzo remubvunzo wekuti vaitenda here kurapwa kweCSMT kwakagamuchirwa, uye kuti vaive nechokwadi sei chekuti kurapwa kwakabvumwa pachikero chehuwandu hwehuwandu hwe0, apo gumi vakamiririra chokwadi chechokwadi. [10].

 

Zvose bhodhi randomization uye mubvunzo wekupofumadza wakanyatsotarisirwa nesangano rimwe rekunze.

 

Zvinyorwa

 

Boka reCSMT rakagamuchira mushonga wepelinha yekushandisa maronda uchishandisa nzira yeGonstead, yakanangana nehukama, velocity, yakaderera? Amplitude, ipfupi-lever musana isina posvo? Kugadziriswazve kunodzoserwa kwakanangiswa kumusana kwepasirese biomechanical dysfunction (yakazara musana nzira) sezvinoonekwa neyakajairwa. chiropractic miedzo pane yega yega yekurapa chikamu [19].

 

Boka re placebo rakagashira kunyengedza, rakapamhamha risingasarudzane, yakaderera velocity, yakaderera? Amplitude sham inosundira maneuver mune isiri-yechinangwa uye isiri yekurapa nzira yekuraira yekumucheto kwekupedzisira kweiyo scapula uye / kana iyo gluteal dunhu [14 ]. Ese easina kurapa ekutaurirana akaitwa kunze kwepamuviri mbichana pamwe neakakwana majoini slack uye pasina zvinyoro nyowani pre-tension kuti pasave nemabatanidzwa akabatana akaitika. Dzimwe nzira dzekunyepedzera dzekunyepedzera dzaive dzakagadzwa uye nekuchinjaniswa zvakaenzana pakati pevatori vechikamu venzvimbo dzinoenderana neprotocol panguva yegumi nemaviri? Vhiki yekurapa nguva yekusimbisa huchokwadi hwekudzidza. Maitiro e placebo anotsanangurwa zvakadzama mune iripo muyedzo protocol [12].

 

Purogiramu yega yega yekupindira yakagadzirirwa 15 min uye mapoka ose maviri akawana maitiro akafanana uye maitiro ekufambisa mberi mushure mokunge apindira. Hapana rimwe shanduro kana zano rakapiwa kuvatori vechikamu munguva yekutongwa. Mapoka acho maviri akawana rubatsiro muAkershus University Hospital nemumwe chiropractor ane ruzivo (AC).

 

Boka rekutonga rakaramba richiita basa ravo rinowanzogadziriswa mune zvemishonga risina kubvumirwa nekupindira kwechipatara.

 

Migumisiro

 

Vadzidzi vacho vakazadza kugadziriswa kwekuongorora musoro wezvinyorwa mukuongorora uye kuvadzorera pamwedzi wega wega [20]. Mune mamiriro ekudhindwa kwemasayari kana kudarika deta, vatori vechikamu vakafambirwa nefoni kuti vawane kuchengetedza.

 

Mhedzisiro yekupedzisira? Poindi yaive nhamba yemazuva emigraine pamwedzi (30 mazuva / mwedzi). Zvichida 25% kuderedzwa kwemazuva emigraine kubva padanho rekutanga kusvika kumagumo ekupindira, nezinga rakaenzana rakachengetedzwa pa3, 6 uye 12 mwedzi inotevera? Kumusoro kwaitarisirwa muboka reCSMT.

 

Sekondari kumagumo? Mapoinzi aive emigraine nguva, migraine kusimba uye musoro index (HI), uye mushonga wekushandisa. Angangoita 25% kudzikira murefu, kusimba uye HI, uye ingangoita 50% kudzikiswa mumushonga wemishonga yaitarisirwa kubva kune yekutanga kusvika kumagumo ekupindira, nezinga rakaenzana rakachengetwa pamwedzi mitatu, mitanhatu nemwedzi gumi nemiviri inotevera muboka reCSMT.

 

Hapana shanduko yaitarisirwa kune ekutanga uye echipiri kumagumo? Poindi mu placebo neboka rinodzora.

 

Zuva remigraine rakatsanangurwa sezuva iro migraine ine aura, migraine isina aura kana inogona kuitika migraine yakaitika. Migraine kurwisa kusingaperi kwe> 24 h yakaverengerwa kurwisa kumwe kunze kwekunge marwadzo? Mahara nguva dze? 48 h yakanga yaitika [21]. Kana murwere akarara panguva yekurwiswa kwemigraine akamuka asina migraine, zvinoenderana neICD? III?, Iyo nguva yekurwiswa yakanyorwa ichiramba ichidaro kusvika panguva yekumuka [22]. Nguva shoma yekurwiswa kwemigraine yaive 4 h kunze kwekunge triptan kana mushonga une ergotamine waishandiswa, mune iyo kesi isu hatitaure hushoma hurefu. HI yakaverengerwa seinoreva migraine mazuva pamwedzi (mazuva makumi matatu) - zvinoreva migraine nguva (h / zuva) - zvinoreva kusimba (30 0 nhamba yekuyera chiyero).

 

Iwo ekutanga uye echipiri magumo? Mapoinzi akasarudzwa zvichibva paTask Force yeiyo IHS Clinical Trial Subcommittee's kiriniki yekuyedza mirayiridzo [1, 15]. Kubva pane wongororo dzakapfuura pamusoro pemigraine, 25% kuderedzwa kwaifungidzirwa sekufungidzira kwakachengetedza [12, 13].

 

Mhedzisiro yekuongorora yakaverengerwa mukati memazuva makumi matatu mushure mekupedzisira chikamu chekupindira uye nemazuva makumi matatu mushure menguva yekutevera-nguva, kureva 30, 30 uye 3 mwedzi, zvichiteerana.

 

Zvose zviitiko zvinotambudza (AEs) zvakanyorwa shure kwega rega kupindira maererano nemazano eCONSORT uye IHS Task Force paAEs mu migraine miedzo [16, 23].

 

Nhamba yekuongorora

 

Takaisa simba rekuverenga pachidzidzo chechangobva kuitwa che topiramate mu migraineurs [24]. Takafungidzira kuvhara kwemazuva ekuderedzwa kwemazuva emagraine pamwedzi pakati pekushanda uye placebo, uye pakati pekushanda uye mapoka ekudzora mazuva e2.5, ane SD ye2.5 yekuderedza muboka rimwe nerimwe. Sekutsvakurudza kwekutanga kunosanganisira mabhii maviri eboka, kukosha kwekukosha kwakagadzirirwa pa 0.025. Nokuda kwesimba re80%, muenzaniso wekukura kwevarwere ve20 yaidiwa mumapoka ega kuti aone kusiyana kukuru mukuderedza kwemazuva 2.5.

 

Hunhu hwevarwere pane yekutanga hwakapihwa senzira uye SD kana frequency uye zvikamu muboka rega rega uye zvichienzaniswa nemasampuli akazvimirira t? Bvunzo uye? 2 bvunzo.

 

Iwo ma profiles enguva kumagumo ese? Mapoinzi akaenzaniswa pakati pemapoka. Nekuda kwekudzokorora zviyero zvemurwere wega wega, mitsara yakavhenganiswa mamodheru ekuverengera emukati meimwe misiyano yakafungidzirwa kumagumo ese? Mapoinzi. Yakagadziriswa mhedzisiro ye (isiri? Mutsara) nguva, kugoverwa kweboka uye kudyidzana pakati pezviviri zvakabatanidzwa. Mhedzisiro mhedzisiro yevarwere uye materu akapinda mumuenzaniso. Sezvo zvakasara zvaive zvakamonyororwa, iyo bootstrap inference inoenderana ne1000 masumbu sampuli yakashandiswa. Kufananidza kwepaviri kwakaitwa nekutora nguva yega yega kusiyanisa mukati meboka rega rega panguva imwe neimwe neyakaenzana P? Kukosha uye 95% nguva dzekuvimba. Mishonga yekushandisa mukati memapoka yakataurwa nema mean doses ane SD, uye mapoka akaenzaniswa neyakazvimiririra sampuli yepakati bvunzo. Dhizi yakatsanangurwa sekutonga kumwe kwetriptan kana ergotamine; paracetamol 1000 mg - codeine; non? steroidal anti? uye morphinomimetics (tramadol, 200 mg). Hapana wevarwere akachinja ruoko rwekudzidza uye hapana kana rimwe remadonhwe akazadzwa nemusoro wedhitaari mushure mekubva pachidzidzo. Nekudaro, kuongororwa kweprotocol chete ndiko kwakakodzera.

 

Ongororo dzakapofumadzwa kugoverwa kwekurapa uye kuitiswa muSPSS v22 (IBM Corporation, Armonk, NY, USA) uye STATA v14 (JSB) (StataCorp LP, College Station, TX, USA). Chiyero chakakosha che0.025 chakashandiswa kumagumo ekutanga? Poindi, kumwe kunhu chiyero che0.05 chakashandiswa.

 

Ethics

 

Zvakanaka zvemakiriniki maitiro emitemo yakateverwa [25]. Mashoko ehurukuro uye akanyorwa pamusoro pechirongwa akapiwa nguva isati yatorwa uye kugoverwa kweboka. Chibvumirano chakanyorwa chakawanikwa kune vose vatori vechikamu. Vagari vemu-placebo uye boka rekudzora vakavimbiswa mushonga weCSMT mushure meRCT, kana kupindira kushanda kwawanikwa kwakabudirira. Inishuwarenzi yakapiwa kuburikidza neNorway System of Compensation kwa Varwere (Mwoyo Mukukuvara Kupihwa), musangano wehurumende unozvimirira unobhadhara varwere vakakuvara nemishonga inopiwa nehutano hweNorway. Mutemo wekumisa wakatsanangurwa wokubvisa vatori vechikamu kubva muchidzidzo ichi maererano nemazano ari muCONSORT extension yeGood Reporting of Harms [26]. Zvose zveEE zvakaongororwa panguva yekupindira uye zvakashanda sezvazvakaitika maererano nemazano eCONSORT uye IHS Task Force paAEs mu migraine trials [16, 23]. Mukana weEE yakanyanya, muiti wacho aizotorerwa kubva pachidzidzo ndokutaurirwa kuDhipatimendi reGeneral Practitioner kana chipatara chirwere ichi chinoenderana nechiitiko chacho. Mucherechedzi (AC) aivepo nefoni yefoni chero nguva panguva yekurapa kwenguva yekudzidza.

 

Results

 

Mufananidzo? 1 inoratidza kuyerera chati ye104 migraineurs inosanganisirwa muchidzidzo. Baseline uye huwandu hwehunhu hwaive hwakafanana mumapoka matatu (Tafura 1).

 

Mufananidzo 1 Chidzidzo Chekuyerera Chidzidzo

Mufananidzo 1: Chidzidzo chekuyerera chati.

 

Tafura 1 Baseline Demographic uye Clinical Characteristics

 

Migumisiro yeMitemo

 

Mhedzisiro kumagumo ese? Mapoinzi anoratidzwa muFiri. 2a d uye Matafura 2, 3, 4.

 

Mufananidzo 2

Mufananidzo 2: (a) Mazuva ekurwadziwa nemusoro; (b) kutemwa nemusoro; (c) kusimba kwemusoro; (d) musoro indekisi. Nguva profiles mukutanga uye sekondari magumo? Poindi, zvinoreva uye zvikanganiso mabara anomiririra 95% nguva dzekuvimba. BL, yekutanga; kutonga, kudzora boka ( ); CSMT, chiropractic musana wekumanikidza kurapa (?); placebo, sham manipulation (?); PT, post? Kurapwa; 3 m, 3? Mwedzi unotevera? Kumusoro; 6 m, 6? Mwedzi unotevera? Kumusoro; 12 m, 12? Mwedzi unotevera? VAS, inoonekwa analogue chiyero.

 

Tafura yeHNUMX Regression Coefficients uye SE

 

Itafura 3 Zvinoreva uye SD

 

Tafura 4 Inonzi SD Doses yemishonga

 

Kumagumo ekutanga? Poindi. Migraine mazuva akange akaderedzwa zvakanyanya mukati memapoka ese kubva kune yekutanga uye kutumira? Kurapwa (P <0.001). Mhedzisiro yakaramba ichienderera muCSMT uye mapoka e placebo pa3, 6 uye 12 mwedzi anoteera kumusoro, nepo migraine mazuva achidzokera padanho rekutanga muboka rinodzora (Fig. 2a). Iyo yakasarudzika yakavhenganiswa modhi haina kuratidza yakawandisa yakakura misiyano mukuchinja mumigraine mazuva pakati peCSMT nemapoka e placebo (P = 0.04) kana pakati peiyo CSMT neboka rinodzora (P = 0.06; Tafura 2). Zvisinei, kuenzanisa kwepakati nepakati pane imwe nguva nguva pfungwa dzakaratidza kusiyana kukuru pakati peCSMT neboka rinodzora panguva dzose pfungwa dzinotanga pamushure? Kurapwa (Tafura 3).

 

Sekondari kuguma? Mapoinzi. Pakanga paine kuderedzwa kukuru kubva pekutanga kusvika post? Kurapwa mune migraine nguva, kusimba uye HI mune CSMT (P = 0.003, P = 0.002 uye P <0.001, zvichiteerana) uye iyo placebo (P <0.001, P = 0.001 uye P < 0.001, zvichiteerana) mapoka, uye mhedzisiro yakaenderera pa3, 6 uye 12 mwedzi inotevera? Kumusoro.

 

Zvimwe chete zvakasiyana zvakasiyana pakati peCSMT nemapoka ekudzora zvakashandurwa munguva yemigraine (P = 0.02) uye muHI (P = 0.04; Tafura 2).

 

Pamwedzi gumi nemiviri inotevera, kumusoro, shanduko mukushandisa kweparacetamol yaive yakadzikira zvakanyanya muboka reCSMT kana ichienzaniswa neiyo placebo (P = 12) uye masimba (P = 0.04) mapoka (Tafura 0.03).

 

Kupofumadza. Mushure meimwe neimwe yezvikamu gumi nembiri zvekupindira,> 12% yevatori vechikamu vakatenda kuti vakagamuchira CSMT zvisinei nekupihwa boka. Iwo mikana yekufungidzira kuti kurapwa kweCSMT kwakagamuchirwa> 80 panguva dzese dzekurapa mumapoka ese maviri (ese P <10).

 

Matambudziko akaipa. Yakazara makumi manomwe nemakumi matatu ematanhatu mazana manomwe emakumi mapfumbamwe ekupindira akaongororwa maAEs (703 muboka reCSMT uye 770 muboka re placebo). Zvikonzero zvekushaikwa kweAE kuongororwa zvakadonhedzwa kunze kana kupotsa zvikamu zvekupindira. AEs dzaive dzakanyanya kuwanda muCSMT kupfuura iyo placebo yekupindira zvikamu (355/348 vs. 83/355; P <32). Hunyoro hwemunharaunda ndiyo yainyanyozivikanwa AE yakataurwa ne348% (0.001% CI, 11.3-95) muboka reCSMT uye 8.4% (15.0% CI, 6.9-95) muboka re placebo, nepo kuneta pazuva rekupindira uye kurwadziwa kwemutsipa. zvakataurwa ne4.7% uye 10.1% (8.5% CI, 2.0-95 uye 6.0 11.8), uye 1.0% uye 4.0% (1.4% CI, 0.3 95 uye 0.6 3.3), zvichiteerana. Mamwe maAEs (marwadzo ekudzokera kumashure, kumeso kusanzwa, kuda kurutsa, kukonzeresa migraine kurwisa uye kuneta mumaoko) zvaive zvisingawanzo (<0.1%). Hapana maAE akasimba kana akakomba akataurwa.

 

hurukuro

 

Kuzivo yedu, iyi ndiyo yekutanga bhuku? Kurapa RCT ine yakanyorwa yakabudirira kupofumadza. Vedu vatatu? Vakapakata zvombo, vasina kuroorwa, vakapofomadzwa, placebo RCT vakaongorora kushanda kweCSMT mukurapa kwemigraine maringe ne placebo (sham chiropractic) uye kutonga (kwakajairwa kurapwa kwemishonga). Mhedzisiro yacho yakaratidza kuti migraine mazuva akange akaderedzwa zvakanyanya mukati memapoka ese matatu kubva pekutanga kusvika post? Kurapwa. Mhedzisiro yacho yakaramba ichienderera mu CSMT uye mapoka e placebo panguva dzese dzinoteedzera-kumusoro nguva dzepo, nepo boka rekutonga rakadzokera kune yekutanga. AEs dzaive dzakapfava uye dzichipfuura, zvinoenderana nezvakamboitwa zvidzidzo.

 

Idzo dhizaini yekutevedzera yakanamatira kune kurudziro yeiyo pharmacological RCTs sekupihwa kwakapihwa neiyo IHS neCONSORT [1, 15, 16]. Manual? Therapy RCTs ine zvipingamupinyi zvikuru zvitatu kana zvichienzaniswa nemaRacological emishonga. Chekutanga, hazvigoneke kupofumadza muongorori maererano neyakaiswa kurapwa. Kechipiri, kubvumirana pamusoro pekurapa inert placebo kuri kushomeka [11]. Chechitatu, kuyedza kwekare kusanganisa boka re placebo kwakasiya kusimbisa kupofomadza, nekudaro, zvinoramba zvisingazivikanwe kana kurapa uye kurapa kwepa placebo kwakavanzwa [27]. Nekuda kwematambudziko aya takasarudza kuitisa matatu-ane zvombo, asina kuroorwa? Akapofumadza RCT, iyo yaisanganisira boka rekutonga rakaramba richiitwa kurapwa kwemishonga kuitira kuti tiwane chiratidzo chehukuru hwekupindura kwenzvimbo.

 

Izvo zvave zvataurwa kuti, mune pharmacological mbiri? Mapofu eacabo placebo, chete 50% vanozotenda kuti vanogashira kurapwa muboka rega, kana iko kupofomadza kwakakwana. Nekudaro, izvi zvinogona kunge zvisiri zvechokwadi mune echinyorwa? Therapy RCTs, nekuti iyo inoshanda uye placebo yemuviri inosimudzira inogona kuve inogutsa kupfuura piritsi [28]. Mumwe muongorori anoderedza musiyano wevatsvagiri nekupa ruzivo rwakafanana kune vese vatori vechikamu uye zvinowanzo kurudzirwa kuti kupindira kwenzvimbo kunofanirwa kufanana nekurapa kunoenderana nemaitiro, kurapwa nguva uye nguva inopedzwa nemuferefeteri kubvumidza tarisiro yakafanana mumapoka ese ari maviri. [28]. Kukosha kwekubudirira kwedu kupofumadza kunosimbiswa nenyaya yekuti ese epamberi echinyorwa? Kurapa RCTs pamusoro wemusoro kushaya placebo. Nekudaro, isu tinotenda kuti mhedzisiro yedu yakurukurwa pazasi inoshanda padanho rakafanana neRC yemishonga [14].

 

Anotarisirwa data akavimbika kupfuura ekudzokorora data maererano neyekurangarira kusarura. zvisinei, kusateedzera kunogona kuve kwakaoma, kunyanya panopera chidzidzo. Isu tinotenda kubatana kunowanzoitika pakati pevatori vechikamu nemuongorori, kusanganisira kusangana kwemwedzi nemwedzi mune inotevera nguva, pamwe kwakachengetedza kutevedzera kwakanyanya mukudzidza kwedu kwese.

 

Kunyangwe yedu sampuro yekudzidza yakaguma nevane vatori vechikamu 104 mumapoka matatu, iyo simba rekuverenga fungidziro uye yakakwira yekupedzisa chiyero inotsigira iyo data yakawanikwa kuve inoshanda kune vakaongororwa vanhu. Iyo nzira yeGonstead inoshandiswa ne59% yechiropractors [19] uye, nekudaro, mhedzisiro inogoneka kune iro basa. Kuongorora kwechokwadi ndiko kumwe kwesimba redu guru sezvo vangangoita vese vatori vechikamu vaive vaonekwa neurologist maererano neICD? II [2]. Kupesana neyekare chiropractic migraine RCTs iyo yakatora vatori vechikamu kuburikidza nemidhiya senge mapepanhau uye kushambadzira redhiyo [12], ruzhinji rwevatori vechikamu vakatorwa kubva kuDhipatimendi reNeurology, Akershus University Hospital, zvichiratidza kuti ma migraineurs anogona kunge aine kakawanda / kwakanyanya kurwiswa. izvo zvakaoma kurapa kupfuura huwandu hwevanhu, sezvavakatumirwa naGeneral Practitioner uye / kana kudzidzira neurologist. Nekudaro, kudzidza kwedu kunomiririra kunyanya vekiriniki vepamusoro, uye mhedzisiro yacho ingave yanga yakasiyana dai vatori vechikamu vakatorwa kubva kuruzhinji rwevanhu. Iko muzana wemarwadzo emutsipa akawanikwa ave akakwirira kune varwere vane migraine [29] uye, nokudaro, iyo yakakwira muzana yeasina kujairika marwadzo emuzongoza muchidzidzo chedu anogona kunge achivhiringidza maitiro ayo akaonekwa pamazuva emigraine.

 

Zvitatu pragmatic chiropractic bhuku? Kurapa maRCTs achishandisa nzira dzakasiyana siyana akamboitirwa migraineurs [12, 30, 31, 32]. RCT yeAustralia yakaratidza mukati meboka kuderedzwa kwemigraine frequency, nguva uye kusimba kwe40%, 43% uye 36%, zvichiteerana, pamwedzi miviri inotevera? [2]. Chidzidzo cheAmerica chakawana migraine frequency uye simba rekudzora mukati meboka ne30% uye 33%, zvichiteerana, pamwedzi 42 inotevera? [1]. Chimwe chidzidzo cheAustralia, icho chaingova chega cheRCT chekusanganisira boka rekutonga, kureva rakatemwa ultrasound, rakawana mukati? Kuderedzwa kweboka kwemigraine frequency uye nguva ye31% uye 35%, zvichiteerana, pamwedzi miviri inotevera muboka reCSMT, zvichienzaniswa neyemukati meboka? kuderedzwa kwe40% uye 2% muboka rekutonga, zvichiteerana [17]. Kuderedzwa kwemazuva emigraine kwainge kwakafanana nekwedu (20%) muboka reCSMT kubva kune yekutanga kusvika kumwedzi mitatu inotevera, nepo migraine nguva uye kusimba zvakadzikira pamwedzi mitatu inotevera, kureva 32% uye 40%, zvichiteerana. Yenguva refu yekutevedzera kuenzanisa haigoneke sezvo kana pazvidzidzo zvakapfuura zvaisanganisira yakakwana yekutevera nguva. Yedu dhizaini dhizaini inosanganisira yakasimba yemukati kutendeseka inotibvumidza isu kududzira maitiro anoonekwa seye placebo mhinduro.

 

RCT yedu yakanga iine maAE mashoma kana ichienzaniswa neyekutanga bhuku? Rerapi zvidzidzo, asi zvakafanana zvakapfuura uye zvinyoro hunhu [33, 34, 35, 36, 37, 38, 39]. Zvisinei, yakanga isina kukwana zvakakwana kuti ione zvisingawanzoitiki maAE akakomba. Mukuenzanisa, AEs mune zvemishonga migraine prophylactic placebo RCTs zvakajairika kusanganisira asiri-akapfava uye asiri-epfupi maAE [40, 41].

 

mhedziso

 

Kupofumadza kwakasimbiswa kwazvo mukati meRCT, maAE aive mashoma uye akapfava, uye mhedzisiro muboka reCSMT neboka re placebo ingangove mhinduro ye placebo. Nekuti vamwe vanonzi migraineurs havashiviriri mishonga nekuda kweASs kana kusagadzikana kwekutambudzika, CSMT inogona kutariswa mumamiriro ezvinhu apo dzimwe nzira dzekurapa dzisingashande kana kusashivirirwa zvakanaka.

 

Kuzivisa kwekupesana kwechido

 

Vose vanyori vakapedza International International Committee of Medical Journal Editors fomu yekuzivisa pachena uye havazive mari kana zvimwe zvinetso zvekufarira.

 

Kutsigira Ruzivo

 

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

 

KUTENDA

 

Vanyori vanoda kuratidza kuonga kwavo kwechokwadi kuAkershus University Hospital, iyo nemutsa yakapa nzvimbo dzekutsvagisa, uye Chiropractor Clinic 1, Oslo, Norway, iyo yakaita zvese x ray ray kuongororwa. Ichi chidzidzo chakatsigirwa nezvipo kubva kuExtrastiftelsen, iyo Norwegian Chiropractic Association, Akershus University Hospital uye University of Oslo kuNorway.

 

Mukupedzisa, iyo inonetesa zviratidzo zvemigraines, kusanganisira iyo yakanyanya kurwadziwa kwemusoro uye kunzwisisika kwechiedza uye kurira pamwe nekusvotwa, zvinogona kukanganisa hupenyu hwemunhu, nerombo rakanaka, chiropractic kuchengetedza yakaratidzirwa kuve yakachengeteka uye inoshanda yekurapa sarudzo yemigraine musoro kurwadziwa. Uyezve, chinyorwa chiri pamusoro chakaratidza kuti migraineurs yakawana zviratidzo zvakadzikira uye mazuva emigraine semhedzisiro yechiropractic kuchengetedza. Ruzivo rwunotsanangurwa kubva kuNational Center yeBiotechnology Information (NCBI). Chiyero cheruzivo rwedu chinogumira kuchiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kutibata nesu pa 915-850-0900 .

 

Yakarongedzwa naDkt Alex Jimenez

 

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

 

Zvimwe Zvinyorwa: Kubva Painini

 

Maererano nehuwandu, inenge 80% yevanhu ichaona zviratidzo zvekurwadziwa shure shure kamwechete munguva yeupenyu hwavo hwose. Kutambudzika shure ndiko kunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Kazhinji kacho, kuora kwechimiro chemupaka nezera kunogona kukonzera marwadzo kumashure. Herniated discs inoitika apo ganda rakanyorova, segel-like re intervertebral disc rinodonha nekubvarura mukati maro, rinenge riri kunze kwekatekete, kubvongodza nekugumbura midzi midzi. Dhizinesi dzinozivikanwa dzinowanzoitika kumucheto kumashure, kana kuti nhengo dzomukati, asi dzinogonawo kuitika pamucheto wepervical, kana mutsipa. Kuiswa kwemitsipa inowanikwa mucheka shure nekuda kwekukuvara uye / kana mamiriro akaoma kunogona kutungamirira kune zviratidzo zve sciatica.

 

blog chinyorwa chekartoon paperboy makuru makuru

 

NYAYA INOKOSHA INOKOSHA: eckNeck Pain Treatment El Paso, TX Chiropractor

 

 

DZIMWE MASHOKO: KUNYANYA KWENYAYA: El Paso, Tx | Vatambi

 

Hazvina kuchena
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39. Maiers M, Evans R, Hartvigsen J, Schulz C, Bronfort G. Zviitiko zvakashata pakati pevakuru vakagamuchira kushandiswa kwepelinha uye kuita zvekuita mune imwe nzira yekuongorora mishonga.Man Ther 2015; 20: 335 341. [PubMed]
40. Jackson JL, Cogbill E, Santana? Davila R, and said Kufananidza kushanda meta? Kuongororwa kwemishonga yeprophylaxis yemigraine musoro.PLoS One 2015; 10: e0130733. [PubMed]
41. Ferrari MD, Roon KI, Lipton RB, Goadsby PJOral triptans (serotonin 5? HT (1B / 1D) agonists) mune yakaoma migraine kurapwa: meta? Ongororo yemakumi mashanu emiedzo..Lancet 2001; 358: 1668 1675. [PubMed]
Close Accordion
Psychology, Headache, Back Pain, Chronic Pain and Chiropractic in El Paso, TX

Psychology, Headache, Back Pain, Chronic Pain and Chiropractic in El Paso, TX

by | Kudzorera Pain, Chiropractic, chisingaperi Pain, Migraine, Physical Rehabilitation, Randomized Controlled Trial, kushushikana, Mishonga

Munhu wose anonzwa kurwadziwa nguva nenguva. Njodzi inzwa kusuruvara kwepanyama kunokonzerwa nokukuvara kana kurwara. Paunosveta mutsara kana kutema munwe wako, somuenzaniso, chiratidzo chinotumirwa kuburikidza nehutano hwemitsipa kusvika kuuropi, zvichikuzivisa iwe kuti chimwe chinhu chakaipa mumuviri. Marwadzo angave akasiyana kune munhu wese uye kune nzira dzakawanda dzekunzwa uye kutsanangura kurwadziwa. Mushure mekukuvara kana chirwere chinoporesa, marwadzo achapera, zvisinei, chii chinoitika kana marwadzo achienderera mberi mushure mokunge mapora?

 

Kurwara kwenguva refu inowanzotsanangurwa sehurombo chero hupi hunopedza mavhiki mashoma e12. Kuora mwoyo kwenguva refu kunogona kubva pane zvishoma kusvika kune yakaoma uye inogona kuva mugumisiro wekukuvadzwa kwakapfuura kana kuvhiyiwa, migraine uye musoro, arthritis, utachiona hwemhutu, utachiona uye fibromyalgia. Kurwara kwenguva refu kunogona kukanganisa mafungiro evanhu uye mupfungwa, zvichiita kuti zvive zvakaoma kudzikinura zviratidzo. Ongororo dzekutsvakurudza dzakaratidza kuti kupindira kwepfungwa kunogona kubatsira chirwere chisingaperi chekugadzirisa. Nyanzvi dzinoverengeka dzehutano, sachiremba wechiropractic, inogona kupa chiropractic kutarisana pamwe nekugadzirisa kwepfungwa kubatsira kubatsiridza hutano hwakakwana uye hukama hwevarwere vavo. Chinangwa chenyaya inotevera ndechekuratidzira basa rekupindira kwepfungwa mupfungwa dzevarwere vane kurwadziwa kusingaperi, kusanganisira misoro uye kurwadziwa shure.

 

 

Basa Rokupindira Kwemapfungwa mukati Mutevedzeri wevarwere vane Chronic Pain

 

ngovepo

 

Kurwadziwa kusingaperi kunogona kunzwisiswa zvakanyanya kubva kune biopsychosocial maonero kuburikidza nawo marwadzo anoonekwa seyakaomarara, ruzivo rwakasiyana-siyana rwunobuda mukubatana kwesimba remamiriro emurwere, pfungwa, manzwiro, maitiro, uye hunhu hwemagariro. Maonero ebiopsychosocial anotarisa pakuona kurwadziwa kusingaperi sechirwere kwete chirwere, nekudaro nekuziva kuti chiitiko chekuzviisa pasi uye nzira dzekurapa dzakanangana nehutungamiriri, kwete mushonga, wekurwadziwa kusingaperi. Maonero epano epfungwa kune manejimendi ekurwadziwa kusingaperi anosanganisira kupindira kunovavarira kuwana kuwedzera kuzvitonga, shanduko yemaitiro, uye shanduko yekuziva pane kunyatso bvisa locus yemarwadzo. Kubatsirwa kwekusanganisira kurapwa kwepfungwa munzira dzakasiyana siyana kune manejimendi ekurwadziwa kusingaperi kunosanganisira, asi hakuganhurwe, kuwedzera kuzvidzora kwekurwadziwa, zviwanikwa zvekurwadziwa kwekurwadziwa, kuremara kwakabatana nekurwadziwa, uye kudzikisira kushungurudzika kwepamoyo - kugadzirisa kunoitwa. kuburikidza nemhando dzakasiyana dzekuzvidzora-maitiro, maitiro, uye maitiro ekuziva. Kuburikidza nekumisikidza kweshanduko idzi, vanachiremba vepfungwa vanogona kunyatsobatsira varwere kunzwa zvakanyanya mukuraira kwekurwadziwa kwavo uye kuvagonesa kurarama seyakajairika hupenyu sezvinobvira kunyangwe vachirwadziwa. Zvakare, hunyanzvi hunodzidziswa kuburikidza nekupindirana kwepfungwa kunopa simba uye kugonesa varwere kuti vave vatori vechikamu vanoshingairira mukutonga kwehurwere hwavo uye kupinza hunyanzvi hwakakosha uhwo varwere vanogona kushandisa muhupenyu hwavo hwese.

 

Keywords: chirwere chisingaperi chisingararamiro, kunyanya kwepfungwa, kushungurudzika kunorwadza kwemarudzi akawanda, kugadzirisa tsika dzehutano hwekurwadziwa

 

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight

Kuora mwoyo kwenguva refu kwave kwakagadzirirwa kuchinja hutano hwepfungwa hwevaya vane zviratidzo zvinoramba zvichiratidza, pakupedzisira kuchinja maitiro avo ose mupfungwa uye mupfungwa. Mukuwedzera, varwere vane mamiriro ekuputika, kusanganisira kushungurudzika, kuzvidya mwoyo uye kuora mwoyo, vanogona kuita kuti kurapa kuoma. Basa rechiropractic kuchengetedza nderekudzorera pamwe nekuchengetedza nekuvandudza kugadzirisa kwepakutanga kwemupenya kuburikidza nekushandura kwemagunha uye nzira dzekushandisa. Chiropractic kuchengetedza inobvumira muviri kuti uzviporese pachawo usina chidimbu chemishonga / mishonga uye kupindira kwokuvhiya, kunyange izvi zvinogona kutumirwa nechiropractor kana zvichidikanwa. Zvisinei, chiropractic inotarisa pamuviri pamwe chete, kwete pane kukuvara kamwe uye / kana mamiriro uye zviratidzo zvayo. Kuchinja kwepamuviri uye nzira dzekushandisa, pakati pezvimwe nzira dzokurapa uye maitiro anowanzoshandiswa nechiropractor, zvinoda kuzivikanwa mupfungwa nemafungiro ehutano kuitira kuti zvive nehutano hwehutano hwakanaka uye hutano hwakanaka. Varwere vanoshanyira kliniki yangu nekunetseka mupfungwa kubva mukurwadziwa kwavo kusingaperi vanowanzosangana nematambudziko epfungwa semugumisiro. Nokudaro, chiropractic kuchengetedza inogona kuva kupindira kwepfungwa mupfungwa kwekusingaperi kurwadziwa kwekutarisira, pamwe chete neavo vakaratidzwa pasi apa.

 

ziviso

 

Marwadzo ihwohwo hunowanzoitika muhupenyu hwevanhu. Inofungidzirwa kuti ingangoita 20% -35% yevakuru vanowana kurwadziwa kusingaperi. [1,2] Sangano reNational Institute of Nursing Research rinoti marwadzo anokanganisa vanhu vazhinji vekuAmerican kupfuura chirwere cheshuga, chirwere chemwoyo, uye gomarara zvakabatana. [3] Marwadzo akataurwa sechikonzero chikuru chekutsvaga kurapwa muUnited States. [4] Zvakare, marwadzo ekudzora ndiwo echipiri anowanzo kupihwa mishonga mumahofisi echiremba nemakamuri ekukurumidzira. [5] Zvakare zvichisimbisa kukosha kwekuongororwa kwakaringana kwekutambudzika, iyo Joint Commission pamusoro peKubvumidzwa kweMasangano Ehutano akapa chirevo chekuti marwadzo aongororwe sechiratidzo chechishanu chakakosha panguva yekushanya kwekurapa. [6]

 

Sangano reInternational Association for the Study of Pain (IASP) rinorondedzera kurwadziwa se chinhu chisingafadzi chekunzwa uye chekushushikana chinosangana neicho chaicho kana chingangoitika kukuvara kwenyama, kana kutsanangurwa maererano nekukuvara kwakadai. [7] Tsanangudzo yeIASP inoratidza huwandu hwakawanda uye hunhu hwekutambudzika, chiitiko chakaomarara chakasarudzika kune mumwe nemumwe. Kurwadziwa kusingaperi kunowanzo kusiyaniswa kubva pakurwadziwa kwakanyanya kunoenderana nekusingaperi kana kushingirira, nzira dzekuchengetedza muviri, uye / kana zvinokanganisa hupenyu hwomunhu. Kazhinji, zvinogamuchirwa kuti kurwadziwa kunopfuurira kupfuura inotarisirwa nguva yenguva yekurapa kwemashure zvichitevera kukuvara kana kuvhiyiwa kunoonekwa sekurwadziwa kusingaperi. Zvisinei, iyo yakatarwa nguva inoumbwa inoita inotarisirwa nguva yekuporeswa inosiyana uye inowanzo kunetsa kuziva. Kuti zvive nyore kupatsanura, mimwe mirayiridzo inoratidza kuti kurwadziwa kunopfuurira kupfuura mwero wenguva yemwedzi mitatu nehafu kunoonekwa sekurwadziwa kusingaperi. Zvakangodaro, kuisirwa marwadzo kunoenderana chete nehurefu kunoshanda zvakanyanya uye, mune dzimwe nguva, nzira yekumanikidza. Zvimwe zvinowanzoitika, zvimwe zvinhu zvakaita seyetiology, kurwadziwa kwakanyanya, uye kukanganisa kunoonekwa pamwe nekureba pakutsanangura kurwadziwa kusingaperi. Imwe nzira yekuratidzira kurwadziwa kusingaperi yakavakirwa pahunhu hwayo hwekugadzirisa mashandiro; ndiko kuti, kurwadziwa kunofungidzirwa kubuda semhedzisiro uye pakati pekugadzirisazve. Mamiriro ezvinhu akajairika ekurwadziwa anosanganisira tsandanyama musculoskeletal, mamiriro europathic marwadzo, kutemwa nemusoro, kurwadziwa nekenza, uye kurwadziwa kwekuona. Zvimwe zvakanyanyisa, marwadzo mamiriro anogona kunge ari ekupedzisira nociceptive (kuburitsa michina kana chemakemikari kurwadziwa), neuropathic (inokonzerwa nekukuvara kwetsinga), kana pakati (zvichikonzerwa nekusagadzikana mueuroni dzepakati tsinga system). [3]

 

Nehurombo, ruzivo rwekurwadziwa runowanzo kuverengerwa nekusafanira kwemuviri, wepfungwa, wemagariro, uye wemari kutambura. Kurwadziwa kusingaperi kwakazivikanwa sechikonzero chinonyanya kukonzera kuremara kwenguva refu muvanhu vemuAmerica vanoshanda. [9] Nekuti kurwadziwa kusingaperi kunokanganisa munhu munzvimbo dzakasiyana dzehupenyu hwake zvakare zvinoita mutoro wakakura wezvemari kurudzi rwedu. Mari yakasanganiswa yakanangana uye isina kunangana yemarwadzo yakafungidzirwa kutangira pamadhora mazana mabhiriyoni zana nemakumi maviri neshanu kusvika kumadhora mazana maviri nemakumi maviri neshanu, pagore. [125] Zvinowanikwa mukurwadziwa kusingaperi zvinosanganisira mishumo yakawedzera yekushushikana kwepfungwa (semuenzaniso, kushushikana, kushushikana, nekushungurudzika), kuwedzera huwandu hwehurema hwakanangana nekurwadziwa, shanduko dzine hukama nemarwadzo mukuziva, uye hwakadzora hupenyu hwehupenyu Nekudaro, kurwadziwa kusingaperi kunogona kunzwisiswa zvakanyanya kubva pakuona kweiyo biopsychosocial kuburikidza nekurwadziwa kunoonekwa seyakaomarara, ruzivo rwakasiyana-siyana rwunobuda mukubatana kwesimba remamiriro emurwere, pfungwa, manzwiro, maitiro, uye hunhu hwemagariro.

 

Pain Management

 

Tichifunga nezvekupararira kwehuwandu hwehutambudziro uye huwandu hwemhando dzakasiyana-siyana, hutano hwakanaka hwekutarisira marwadzo huchave hwakazara, hunobatanidza, uye hutsika dzakasiyana-siyana. Nzira dzezvino dzekutungamirirwa kwekusuruvara kusingaperi zvinowedzera kuderedza kuderedza uye kunyatsoshandiswa, muviri, kana nzira yemishonga yekurapa. Current Nzira vanoziva kukosha multidisciplinary kurapwa framework kuti nangananga kwete chete nociceptive zvinobatanidzwa marwadzo asiwo zvishande-evaluative, uye motivational-kuvhiringidzika zvinhu pedyo zvakaenzana kusingafadzi uye impacting sequelae. Imwe maitiro ekudzivirira maitiro ekurwadziwa kusingaperi anowanzobatanidza kurapwa kwemazwi akawanda akadai sekubatanidzwa kweealgesics, chirwere chepanyama, maitiro ekuzvibata, uye kurapa kwepfungwa. Nzira inowedzera yakawanda yakawanda uye inonzwisisika inotaura nezvekutambudzika kwepamusoro pamakemikari, maitiro, mafungiro-anogadzirisa, uye zvinoshanda. Iyi nzira dzakaratidzwa kutungamirira kune zvakanakisisa uye zvisingagumi kwenguva refu zvinogadzirisa uye zvinangwa zvinosanganisira mishumo yekurwadziwa, mafungiro, kudzorerwa kwemazuva ose, kushanda kwemaitiro, uye mishonga kana kushandiswa kweutano; nzira dzakasiyana-siyana dzave dzichiratidzwawo kuti dzinodhura-dzakawanda kupfuura nzira dzisina kufanana. [12,13] Kukurukurwa kwekuongorora uku kuchave kunyanya kujekesa kubatsirwa kwepfungwa dzepfungwa mumutungamiri wekusuruvara kusingaperi.

 

Dr. Jimenez achiita chirwere chepanyama pane murwere.

 

Varwere vanowanzo kutanga vaenda kuhofisi yechiremba mukutsvaga kurapwa kana kurapwa kwechirwere chavo / kurwadziwa kwakanyanya. Kune vazhinji varwere, zvinoenderana neetiology uye pathology yemarwadzo avo pamwe neiyo biopsychosocial zvinokanganisa marwadzo ekurwadziwa, kurwadziwa kwakanyanya kunogadzirisa nekufamba kwenguva, kana kutevera marapirwo anoitirwa kunanga chinofungidzirwa chikonzero chekurwadziwa kana kutapurirana kwacho. Zvakadaro, vamwe varwere havangakwanise kugadzirisa marwadzo avo kunyangwe paine nzira dzakawanda dzekurapa uye dzekuwedzera uye vanozoshanduka kubva pakurwadziwa kwakanyanya kuenda kuchimiro chekurwadziwa kusingaperi. Semuenzaniso, kutsvagurudza kwakaratidza kuti vangangoita makumi matatu muzana evarwere vanouya kuna chiremba wavo wekutanga wekuchengeta zvichemo zvine chekuita nemarwadzo ekurwadziwa musana zvicharamba zvichirwadza uye, kune vamwe vazhinji, zviito zvakakomba zvekutadza uye kutambura mwedzi gumi nemaviri gare gare. [30] Sezvo marwadzo uye ayo mhedzisiro ichiramba ichikura uye ichiratidza mune akasiyana mafiro ehupenyu, kurwadziwa kusingaperi kunogona kunyanya kuve dambudziko rezvepfungwa, uko kwakawanda biopsychosocial maficha anogona kushandira kuenderera nekuchengetedza marwadzo, zvichidaro kuramba kuchikanganisa hupenyu hweanokanganisa. Iko panguva ino apo maitiro ekutanga ekurapa anogona kusiyanisa kusanganisira zvimwe zvekurapa zvikamu, kusanganisira nzira dzepfungwa dzekutarisira kurwadziwa.

 

Mafungiro epfungwa ekutungamira kwekutambudzika kusingaperi pakutanga akawana mukurumbira mukupera kwema1960 nekumuka kweMelzack neWall s ategate-control dzidziso yekurwadziwa [15] uye inotevera subsequentneuromatrix dzidziso yekurwadziwa. [16] Muchidimbu, idzi dzidziso dzinofunga kuti psychosocial uye zvepanyama maitiro anopindirana kukanganisa maonero, kutapurirana, uye kuongorora kwekutambudzika, uye nekuziva kukanganisa kweaya maitiro sekugadzirisa zvinhu zvinobatanidzwa mumatunhu ekurwadziwa kusingaperi kana kwenguva refu. Nenzira imwecheteyo, dzidziso idzi dzakashanda senzira yekumisikidza shanduko munzira yekurapa uye isina kujairika yekurapa kurwadziwa, iyo inotongwa zvakanyanya nemaonero ehupenyu. Vanachiremba nevarwere zvakafanana vakawana kuwedzera kuwedzerwa uye kukoshesa kuomarara kwekugadzirisa kurwadziwa uye kugadzirisa; Nekudaro, kugamuchirwa uye kusarudzika kwemazhinji multimimensional kufunga kwekurwadziwa kwakasimbiswa. Parizvino, iyo biopsychosocial modhi yemarwadzo ndiyo, pamwe, ndiyo inogamuchirwa kwazvo nzira yeheuristic yekunzwisisa kurwadziwa. [17] Maonero ebiopsychosocial anotarisa pakuona kurwadziwa kusingaperi sechirwere kwete chirwere, nekudaro nekuziva kuti chiitiko chekuzviisa pasi uye nzira dzekurapa dzakanangana nehutungamiriri, kwete mushonga, wekurwadziwa kusingaperi. [17] Sezvo kushandiswa kwenzira yakatetepa uye yakazara kune manejimendi ekurwadziwa kusingaperi kwave kuoneka, kupindirana kwepfungwa-kwakaona kusimuka kunoshamisa mukuzivikanwa uye kuzivikanwa senzira yekurapa. Mhando dzekupindira kwepfungwa dzinoshandiswa sechikamu chehurongwa hwakawanda hwekurwadziwa kwekurwadziwa hunosiyana zvinoenderana neyekurapa maitiro, marwadzo etiology, uye hunhu hwevarwere. Saizvozvowo, kutsvagisa nezve kugona kwehunyanzvi hwepfungwa hwekurwadziwa kusingaperi kwakaratidza kusiyanisa, kunyangwe kuri kuvimbisa, mhedzisiro pane akasiyana misiyano yakadzidzwa. Iyi pfupiso ichatsanangura muchidimbu zvinowanzo shandiswa zvepfungwa zvakavakirwa pakurapa sarudzo uye nemabatiro azvo pane akakosha mhedzisiro.

 

Iye zvino mafungiro anosvika kune kutungamira kwekunetseka kwenguva refu kunosanganisira mazano anobatsira kuwedzera kuzviwedzera-kutarisira, kushanduka kwetsika, uye kushanduka kwekuziva pane kutsvaga zvakananga nzvimbo yekurwadziwa. Sezvo vakadaro, vanongoronga maitiro anowanzoratidzirwa maitiro, manzwiro, uye kugona kwezvinhu zvinokonzerwa nekurwadziwa kusingaperi uye zvinhu zvinowedzera pakugadzirisa kwayo. Yakagadzirirwa nehutano hwakapiwa naHoffman et al [18] uye Kerns et al, [19] zvinotevera zvinowanzoshandiswa kwepfungwa-based based domains zvinongororwa: maitiro epfungwa, maitiro ekurapa, kugadzirisa maitiro ekurapa, uye kugamuchirwa kwakagadzirirwa.

 

Psychophysiological Techniques

 

Biofeedback

 

Biofeedback inzira yekudzidza iyo varwere vanodzidza kushandura mhinduro (nenzira yehupenyu data) maererano nemamwe mabasa ehupenyu. Semuenzaniso, murwere angashandisa zvigadzirwa zvebiofeedback kuti adzidze kuziva nzvimbo dzekutambudzika mumuviri wavo uye achidzidza kudzima nzvimbo idzi kuderedza kusuruvara kwemisimba. Mhinduro inopiwa nemhando dzakasiyana-siyana dzezviyero zvinogona kupa ruzivo pamusoro pehuroyi hwemagetsi, kushanda kweropa, kubuda kweropa, mutsipa wehutundu, electrodermal basa, moyo wevhiri, nekushisa kweganda, pakati pemamwe mabasa ehupenyu nenzira yakakurumidza. Chinangwa che biofeedback chinosvika ndeyekuti murwere adzidze nzira yekuisa mararamiro ekuzvidzivirira kwehutano nekuzadzikisa kuzvipira pane zvimwe zvipimo zvezvemuviri kuti pakupedzisira kuwedzere kushanduka kwepanyama kuburikidza nekuziva kukuru uye kudzidziswa kwakananga. Nokudaro murwere achishandisa unyanzvi hwekuzvimiririra mukuedza kuderedza chimwe chinhu chisingadiwi (semuviri, marwadzo) kana kusavhiringidza kwehupenyu kune chimwe chinhu chisingadiwi (semuenzaniso, kushushikana kwepfungwa). Nyanzvi dzakawanda dzepfungwa dzakadzidziswa maitiro e-biofeedback uye dzinopa idzi maitiro sechikamu chemishonga. Biofeedback yakasarudzwa senzira inobatsira yekurwadziwa kunobatanidza musoro uye temporomandibular disorders (TMD). [20] Meta-kuongororwa kweongororo ye 55 yakaratidza kuti kupindira kwebiofeedback (kusanganisira zvakasiyana-siyana zvakasiyana-siyana zvebiofeedback) zvakagadzirisa zvakakosha maererano nehuwandu hwemagraine kurwisa uye maonero ehutachiona hutano hunozvienzanisa kana huenzaniswa nemamiriro ezvinhu ekudzivirira. [21] Zvidzidzo zvakapa rubatsiro rwekusimbisa biofeedback kune TMD, kunyange zvazvo kuwedzera kwekuvandudza kwehutano maererano nekurwadziwa nekuremara kwakagadzikana kwakawanikwa nekuda kwezvirevo zvinosanganisira biofeedback nemagariro maitiro ekudzidzira unyanzvi, pasi pekufungidzira kuti nzira yakabatana yekurapa inonyatsonzwisisika inotaura nezvemagariro ezvinetso zvebiopsychosocial zvinogona kusangana nemubairo we TMD. [22]

 

Maitiro ekuita

 

Relaxation Training

 

Zvinowanzogamuchirwa kuti kudzvinyirira chinhu chikuru chinobatanidzwa mukuwedzera uye kuchengetedza kushungurudzika kusingaperi. [16,23] Kushungurudzika kunogona kunyanya kuve nekugadzikana kwepanyika, kwepanyama, kana kwepfungwa / mupfungwa, kunyange zvazvo zvirongwa izvi zvakanyatsopindirana. Chinangwa chekuzorodza kudzidziswa ndechekudzikisa hutano hwehutano (muviri nemafungiro) kuburikidza nekushandurwa kwemararamiro ehutachiona hwepasympathetic uye kuburikidza nekuwana ruzivo rwakanyanya rwehupenyu uye hwepfungwa dzinotaura, zvichiita kuti kugadziriswa mukurwadziwa uye kuwedzerwa kudzora pamusoro pemarwadzo. Varwere vanogona kudzidziswa nzira dzakasiyana-siyana dzokuzorodza uye vanozviita ivo pachavo kana pamwe chete pamwe chete, pamwe chete nezvimwe zvinowanzoitwa adjuvant kune dzimwe nzira dzekuzvibata uye kugadzirisa maitiro ekugadzirisa marwadzo. Izvo zvinotevera zvitsanangudzo zvishomanana zvemaitiro ekuzorodza anowanzodzidziswa nevanodzidza nezvepfungwa.

 

Kufuridzira kwemafupa. Kufema kwemafupa ndiyo nzira inokosha yekuzorodza inoshandiswa nevarwere kuti vashandise mishonga yechipfupa chavo sepikisano nemisungo yepachifuva chavo kuti vaite mukudzidzira kufema zvakanyanya. Kuputika nekugadzirisa chidimbu kunobvumira mapapu kuti awedzere (akaratidzirwa nekuwedzera kwemuviri panguva yekuputika) uye nokuwedzera kuwedzerwa kweokisijeni. [24]

 

Kufambira mberi kwemuviri mushure (PMR). PMR inoratidzirwa nekubatana nekubatana kwemaviri emusana uye kupumha kwemaitiro emhando dzakasiyana-siyana mumasumbu yose. [25] Murwere anowanzorayirirwa kuti apinde mumatambudziko / kuporesa maitiro nenzira yakasiyana kusvikira zvikamu zvose zvemuviri zvakataurwa.

 

Autogenic kudzidziswa (AT). AT is self-regulatory process relaxation in which a patient repeat a sentence in conjunction with visualization to stimulate state of relaxation. [26,27] Iyi nzira inosanganisira kusanganisa, kutaridzika, uye maitiro ekufema zvakadzika.

 

Mifananidzo yekuonekwa / Kutungamirirwa. Iyi nzira inokurudzira vashandi kushandisa masimba avo ose mukufungidzira nzvimbo yakajeka, yakachengeteka, uye yakachengeteka kuti vawane pfungwa yekuzorodza nekuvhiringidzika kubva mukurwadziwa kwavo nemafungiro anokonzera marwadzo uye manzwiro. [27]

 

Pamwe chete, matekinoroji ekuzorora akawanzo kuwanikwa achibatsira mukutungamira kwemhando dzakasiyana siyana dzeakanyanya uye asingagumi marwadzo mamiriro pamwe nekutungamira kweakakosha marwadzo sequelae (semuenzaniso, hutano hwakanangana nehutano hwehupenyu). [28-31 ] Maitiro ekuzorodza anowanzoitwa pamwe chete nedzimwe nzira dzekurwadziwa kwekurwadziwa, uye pane kuwanda kwakanyanya munzira dzinofungidzirwa dzekuzorora uye biofeedback, semuenzaniso.

 

Operant Behavior Therapy

 

Anoshanda maitiro ekurapa kwekurwadziwa kusingaperi anotungamirwa neyekutanga inoshanda mamiriro ekugadzirisa akarongwa naSkinner [32] uye yakanatswa neFordyce [33] kuti ishandiswe pakurapa kwekutambudzika. Iwo makosi makuru eanoshanda mamiriro ekugadzirisa sezvaari zvine chekuita nemarwadzo anobata kuti maitiro ekurwadziwa anogona kupedzisira achinjika mukati nekuchengetwa semarwadzo ekurwadziwa asingaperi semhedzisiro yekusimbisa kana kusasimbisa kwehunhu hwehunhu hwakapihwa pamwe nekurangwa kweanowirirana, asiri -kurwadziwa maitiro. Kana kusimbiswa uye mhedzisiro inotevera ikaitika ine huwandu hwakakwana, vanogona kushandira kugadzirisa hunhu, zvichidaro vachiwedzera mukana wekudzokorora hunhu mune ramangwana. Naizvozvo, maitiro akagadziriswa anoitika sechigadzirwa chekudzidza mhedzisiro (chaiyo kana kutarisirwa) yekuita mune yakapihwa maitiro. Muenzaniso wehunhu hwakagadziriswa kuenderera mberi nekushandisa mishonga - hunhu hunoguma nekudzidza kuburikidza nesangano rakadzokororwa iro rinotora mushonga rinoteverwa nekubviswa kwekunzwa kunzwa (kurwadziwa). Saizvozvowo, maitiro ekurwadziwa (semuenzaniso, mazwi ekutaura ekurwadziwa, mashoma ezviitiko zviitiko) anogona kuve maitiro akaomarara ayo anoshanda kuti awedzere kurwadziwa kusingaperi uye sequelae yayo. Marapirwo anotungamirwa nemaitiro ehunhu anoshanda anovavarira kudzima maradaptive maratidziro ehunhu kuburikidza nemitemo imwecheteyo yekudzidza iyo inogona kunge yakagadzwa nayo. Pakati pese, zvekurapa zvikamu zveanoshanda maitiro ekurapa anosanganisira akaomeswa mashandisirwo, nguva inopesana nemishonga zvirongwa, uye kushandiswa kwesimbisiro misimboti yekuwedzera hunhu hwakanaka uye kudzikisira maladaptive marwadzo maitiro.

 

Graded activation. Nyanzvi dzezvepfungwa dzinogona kushandisa zvirongwa zvekuita zvakagadzirirwa zvevarwere vasingaperi vanorwara vanopedza zvakanyanya mabasa avo (kuwedzerwa hutano hwekugadziriswa kwemuviri) uye vanozoona maitiro ekurwadziwa pavanoita basa. Varwere vanorayirirwa kuti vadzivirire zvakachengeteka kushandiswa kwekusaita uye kudonhedzera kuburikidza nekuita mubasa munzira yakarongedzwa uye isina nguva. Nenzira iyi, varwere vanogona kuwedzera zvishoma nezvishoma kureba kwemazuva uye kuwedzera kwebasa rekuvandudza kushanda. Nyanzvi dzezvepfungwa dzinokwanisa kutarisira kufambira mberi uye dzinopa kusimbisa kwakakodzera kwekutevedza, kururamisa kwemafungiro kana kusanzwisiswa kwemarwadzo anobva kubasa, kana zvakakodzera, uye dambudziko-kugadzirisa zvipingamupinyi zvekuteerera. Nzira iyi inowanzobatanidzwa mukati mekufungisisa-maitiro ekurwadziwa maitiro ekurapa.

 

Nguva-inokonzera mishonga yemishonga. Nyanzvi yezvepfungwa inogona kunge yakagadziriswa inokosha yekuchengetedza utano hwehutano mukutarisira kutungamira kwemishonga inorwadza. Mune zvimwe zviitiko, vanachiremba vepfungwa vane mukana wekukurukurirana zvakanyanya nevadziviriri kune vanorwara kupfuura vanachiremba uye naizvozvo vanogona kushanda sevashandi vanokosha vehutano hwakasiyana-siyana hwekurapa. Nyanzvi dzezvepfungwa dzinogona kuisa zvirongwa zvekurapa mishonga nguva yekuderedza kuderedza mukana wekuvimba nemarwadzo ekurwadziwa kwekuwana zvakakwana kudzora kurwadziwa. Uyezve, vanoona nezvepfungwa vakanyatsokwanisa kugadzirisa varwere mukukurukurirana kunokosha pamusoro pekukosha kwekuchengetedza kwakakodzera mishonga uye mazano ekurapa uye dambudziko-kugadzirisa zvipingamupinyi zvakanzwisisika zvekuchengetedzwa kwakachengeteka.

 

Kutya-kudzivisa. Iko muenzaniso wekutya-kudzivisa wekutambura kusingaperi inoshandiswa kakawanda mumamiriro ezvinhu ekurwadziwa kusingaperi kwemarwadzo ekurwa (LBP). [34] Muenzaniso uyu unonyanya kunyanya kubva pamitemo yehutsika inotsanangurwa kare. Muchidimbu, muenzaniso wekutya-kudzivisa unoita kuti apo kurwadziwa kwakanyanya kunowanzonzi kusinganzwisiswi sechiratidzo chekukuvadza kana zviratidzo zvekukuvadza kwakakomba, varwere vangave vari pangozi yekuita zvinotyisa zvinodzivisa kuzvidzivirira uye zvinyorwa zvinowedzera kusimbisa kutenda kuti kurwadziwa ngozi zviratidzo uye kupfuurira kukurudzira muviri. Sezvo kuenderera mberi kuchienderera mberi, kudzivisa kunogona kuita kuti zvive zvakasiyana siyana zvebasa uye zvinokonzera kugadziriswa kwekunzwa kwepanyama kunoratidzwa nekusanzwisiswa kwakaipa kwekududzirwa kwekunzwa kwenyama. Kutsvakurudza kwakaratidza kuti kunetseka kwakanyanya kwekurwadziwa kunosanganiswa nekuchengetedza mhirizhonga. [35] Mishonga inotarisirwa kuputsa kutya-kudzivisa purogiramu inoshandisa nzira yakarongeka yakaiswa kune mabasa anotya kuti asisimbise vanotya, kazhinji njodzi, migumisiro yekuita mabasa . Kunyatsotsanangurwa kunowedzera kuwedzererwa nehupfungwa hwepfungwa pamusoro pekutambudzika nekugadzirisa kugadzirisa zvinhu zvinotarisa maladaptive cognitions uye zvinotarisirwa pamusoro pebasa nekurwadziwa. Nyanzvi dzezvepfungwa dziri munzvimbo yakanakisisa yekuita mhando idzi dzemishandisirwo dzinonyanya kufanana nekuratidzwa kwezvirwere zvinowanzoshandiswa mukurapa mamwe matambudziko ekuzvidya mwoyo.

 

Kunyange zvazvo zvikamu zvakajeka zvekurapa zvirwere zvakave zvichiratidzwa kuti zvinobudirira mukurapa kwakaoma nzvimbo yekurwadziwa chirwere chirwere chepakutanga I (CRPS-1) [36] uye LBP [37] mune imwe chete-maitiro ekugadzirisa, muedzo wakakura wakaenzaniswa nemaitiro akaenzaniswa nemaitiro akabatanidzwa kurapwa kwemishonga pamwe chete nehutano hwakasiyana-siyana hwepurogiramu yehutano nehutachiona hwehutano hwepurogiramu yehutano chete uye neboka rekuchengetedza boka rinowanikwa kuti zvirwere zviviri zvakashanda zvakaguma nekuvandudzika kukuru pamigumisiro yemigumisiro yekurwadziwa, kutya kwekufamba / kukuvara, marwadzo ekuzvidzivirira, kushungurudzika, uye basa rekuita. [38] Zviwanikwa zvekuedzwa izvi zvinoratidza kuti zvose zvinyorwa zvakabatanidzwa nekubudirira kwekurapa kwakadai sokuti kurapwa kwemafuro akavharidzirwa kusina kuonekwa kuti kunokonzera kuwedzerwa kwezvipatara zvinowanikwa. [38] Inyevero yekududzira mukududzirwa kweizvi Migumisiro inotarisa kuti maitiro anongorongedzwa anorongwa (RCT) akabatanidza zvakasiyana-siyana zvehupenyu husingaperi huripo e rakatenderera kunze kweRBP neRCPS-1 uye harina kungosanganisira varwere vane huwandu hwakanyanya hwekutya kunotarisana; kupindira kwakaparidzirwawo muzvikwata zveboka kwete pane zvigadziro zvevanhu. Kunyange zvazvo kurapwa kwe-in-vivo kwakakosha pakuderedza kushungurudza kunoparadza uye pfungwa dzekukuvadza kwezviitiko, kurapwa kwemashoko kunoratidzika kunge kwakakosha sekuita mabasa ekugadziriswa mukuvandudza hutachiona hwehutano nekunyunyuta kukuru. [39] Imwe mishonga yechipatara yakaenzanisa nekubudirira kwehutano- based classification (TBC) chirwere chepanyama chete kuTBC chakawedzerwa nemabasa akashandiswa kana kuti kuiswa pachena kwevarwere vane LBP yakaoma uye yakaoma. [40] Migumisiro yakaratidza kuti pakanga pasina kusiyana kwei-4-vhiki uye mamiriyoni e6 emigumisiro yekuderedza kwekuremara , kurwadziwa kunorwadza, kurwadziwa kunoparadza, uye kushaya muviri pakati pemapoka ekurapa, kunyange zvazvo kuiswa pachena uye TBC yakaunza kuderedza kukuru kwekutya-kuzvidzivirira kwemitambo pamwedzi we6. [40] Tsvaga kubva kuchirongwa chechipatara zvinoratidza kuti kusimbisa TBC nemabasa akashandiswa kana kuiswa pachena kwete kutungamirira kumigumisiro yakagadziriswa maererano nezviyero zvakabatanidzwa nekugadzirwa kwekr onic LBP kunze kwekuvandudzwa kwakaitwa neTBC chete. [40]

 

Nzira dzekufunga-Maitiro

 

Kufungisisa-maitiro ekurapa (CBT) marapirwo ekurwadziwa kusingaperi anoshandisa maitiro epfungwa kuita shanduko dzinochinja mune maitiro evarwere, kuziva kana kuongororwa, uye manzwiro. Aya mapindiro anowanzo kuve neakakosha psychoeducation pamusoro pekutambudzika uye chirwere chevarwere, mamwe maitiro ehunhu, kudzidzira hunyanzvi kudzidzisa, nzira dzekugadzirisa matambudziko, uye chikamu chekugadzirisa kugadzirisa, kunyangwe iwo chaiwo marapirwo anosiyana zvichienderana nachiremba. Maitiro ekuzvibata anogona kusanganisira akasiyana hunyanzvi hwekuzorora (sekuongororwa muchikamu chehunhu hwekuita), chiitiko chekuita mirairidzo / yakashongedzwa mashandiro, maitiro ekumisikidza maitiro, uye kusimudzira kwekutangazve kwechiitiko chemuviri kana paine nhoroondo yakakosha yekudzivirira kwezviitiko uye zvinotevera deconditioning. Chinangwa chekutanga pakudzidzira hunyanzvi kudzidziswa ndechekuona maradaptive ekugadzirisa marongero (semuenzaniso, kukanganisa, kudzivirira) izvo murwere arikuita pamwe chete nekushandisa kwavo nzira dzekugadzirisa dzinoenderana (semuenzaniso, kushandiswa kwezvakanaka kuzvitaurira, rutsigiro rwemagariro). Seyambiro yekunyevera, mwero wekuti zano rinoshanduka kana kushanduka-shanduka uye kugona kunoonekwa kwehumwe hurongwa hwekutarisana kunosiyana kubva pamunhu kusvika pamunhu. [41] Mukurapa kwese, hunyanzvi hwekugadzirisa matambudziko hunokudzwa kubatsira varwere mukuomerera kwavo uye nekuvabatsira kuwedzera kugona kwavo. Kugadziriswa kwepfungwa kunosanganisira kucherechedzwa kwezvazvino maladaptive cognitions murwere ari kuita mukati, kupokana kweakazivikanwa asina kunaka cognitions, uye kugadzirisa pfungwa dzekuti dziunze zvine mwero, dzinochinja dzimwe pfungwa. Kuburikidza nekuziva kwekugadzirisa maitiro, varwere vanowedzera kugona pakuziva manzwiro avo, kuziva kwavo, uye kududzira kunochinja marwadzo avo munzira dzakanaka nedzisina kunaka. Nekuda kweizvozvo, zvinofungidzirwa kuti varwere vanowana mukana wakakura wekutonga pamusoro pemarwadzo avo, kuve nani kugona kubata maitiro avo nepfungwa pavanenge vachienderana nekurwadziwa, uye nekukwanisa kuyananisa zvakaringana zvinoreva zvavanoreva pakurwadziwa kwavo. . Zvimwe zvinowedzerwa dzimwe nguva zvinosanganisirwa mukupindira kweBBT kunosanganisira kudzidziswa kwehunyanzvi hwemagariro, kudzidziswa kwekutaurirana, uye nzira dzakapamhama dzekutarisira kushungurudzika. Via nekurwadziwa-kwakanangana neCBT kupindira, varwere vazhinji vanobatsirwa nekuvandudzwa zvine chekuita neyavo manzwiro uye mashandiro ehupenyu hwakanaka, uye pakupedzisira hupenyu hwavo hwese hwunoonekwa hune hukama nehutano.

 

Dr. Alex Jimenez achiita basa rekuita muviri uye kuita zvekuita.

 

Kupindira kweBBT kunoendeswa mukati mekutsigira uye nekunzwira tsitsi nharaunda inoedza kunzwisisa kurwadziwa kwemurwere kubva pakuona biopsychosocial uye nenzira yakabatana. Varapi vanoona basa ravo se 'vadzidzisi' kana 'vadzidzisi' uye meseji inosvitswa kuvarwere ndeyekudzidza kugadzirisa marwadzo avo nekuvandudza mashandiro avo ezuva nezuva uye hupenyu hwehupenyu zvinopesana nekurapa kana kupedza marwadzo. Chinangwa chepamusoro ndechekuwedzera kunzwisiswa kwevarwere nezvekurwadziwa kwavo uye nekuedza kwavo kugadzirisa marwadzo uye sequelae yayo nenzira yakachengeteka uye inochinja; Naizvozvo, kudzidzisa varwere kuzviongorora maitiro avo, pfungwa, nemanzwiro chinhu chakakosha pakurapa uye zano rinoshanda rekusimudzira kuzvishandira. Pamusoro pezvo, murapi anoedza kusimudzira tarisiro, yechokwadi, uye inokurudzira mamiriro umo murwere anogona kuwedzera kuve neunyanzvi pakuziva nekudzidza kubva mukubudirira kwavo nekudzidza kubva nekuvandudza pakuedza kusingabudirire. Nenzira iyi, varapi nevarwere vanoshanda pamwechete kuti vaone kubudirira kwevarwere, zvipingamupinyi pakuteerera, uye kukudziridza kuchengetedza uye kudzokororazve-zvirongwa zvekudzivirira mumamiriro anovaka, anoshanda pamwe, uye akavimbika. Chinhu chinokwezva cheyekuziva kwehunhu maitiro ndeyekusimbisa kwemurwere semunhu anoshanda mukutora marwadzo ekugadzirisa kana chirongwa chekutonga.

 

Kutsvakurudza kwakawana kuti CBT inobatsira kurapa kurwadziwa kusingaperi uye sequelae sezvinoratidzwa nekuchinja kukuru munharaunda dzakasiyana-siyana (kureva, zviyero zvekutambura kurwadziwa, mafungiro / kunetseka, kugadzirisa kugadzirisa uye kuongorora, maitiro ekurwadziwa uye chiitiko chebasa, uye hutano hunoshanda ) Kana ichienzaniswa nemamwe mushonga unoshandiswa kana kuti maitiro ekudzora, CBT yakaguma nekuvandudzika kunoshamisa, kunyange zviduku zvishoma (simba rekuita ~ 42), maererano nehutano hwehupenyu, kugadzirisa kugadzirisa uye kuongorora , uye hutano hunoita basa. [0.50] Meta-analysis yakakurumbira ye 42 yakabudiswa zvidzidzo zvichienzaniswa nehutano hwehutano (BT) uye CBT inorwisana nehutano sezvinowanzochengetedza mamiriro ezvinhu uye kushandiswa kwekutonga mamiriro ezvinhu panguva dzakasiyana-siyana. [52] Iyi meta-analysis akagumisa kuti deta yavo haina kukweretesa BT kunze kwekunatsiridza marwadzo nguva pfupi mushure mekurapa kana ichienzaniswa nekurapwa sezvinowanzogadzirisa mitemo. [43] NezveC CB T, vakagumisa kuti CBT haina zvigaro zvinokonzerwa nekuremara kunorwadza, uye mafungiro; zvisinei, pane zvakakwana deta iripo yekuongorora tsanangudzo chaiyo yehutano hwehutano pamigumisiro yakasarudzwa. [43] Pasi pose, zvinoita sekuti CBT neBT ndiyo nzira yekurapa inobatsira yekuvandudza mafungiro; migumisiro yakasara yakasimba pakutevera-data data points. Zvisinei, sezvo kunoratidzwa wongororo akawanda uye Meta-Analyses, yakaoma chokufunga nezvacho kuongorora kubudirira CBT kuti basa echirwere marwadzo hwokungotsvaka nyaya zvinobudirira delivery, kushaya dzakafanana kurapwa zvinoriumba, kusiyana pakukurukura mhiri vanachiremba uye kurapwa vanhu varipo, uye kuchinjwa mumagumisiro emigumisiro ezvakawanikwa mukati mekutsvakurudza miedzo. [43] Kuwedzera kumanikidzika kududzirwa kwekubudirira kwekutsvaga kune mamiriro ekutsungirira uye zvimwe zvinoshandiswa zvinogona kuzvimiririra zvisingabatsiri zvinokonzera kurapwa.

 

Kubvuma-Kutarisana Nzira

 

Kugamuchirwa-kwakavakirwa nzira dzinowanzo kuve dzinoonekwa seyechitatu-wave yekuziva-maitiro ekurapa. Kubvuma uye kuzvipira kurapa (CHITSAI) ndiyo yakajairika pane inogamuchirwa-based psychotherapies. ACT inosimbisa kukosha kwekufambisa kufambira mberi kwevatengi kuenda mukuwana hupenyu hunokosheswa uye hunogutsa nekuwedzera kushanduka kwepfungwa pane kunyatso tarisa pakugadzirisa kugona. [44] Muchirevo chemarwadzo asingagumi, ACT inotarisa nzira dzisingabatsiri dzekudzivirira uye kudzivirirwa kwehupenyu nekusimudzira maitiro anosimbisa kushanduka kwepfungwa. Matanho matanhatu epamutemo eAIT anosanganisira: kugamuchirwa, kusanzwisisa, kuvapo, pachezvako sechirevo, hunhu, uye chiito chakazvipira. [45] Muchidimbu, kugamuchirwa kunokurudzira varwere vasingaperi kurwadziwa kuti vagamuchire marwadzo uye sequelae pane kuyedza kuchichinja, mukuita kudaro vachikurudzira murwere kuti amise kurwa kusine maturo kwakanangana nekupedza kurwadziwa kwavo. Kufungisisa kwekuziva (deliteralization) maitiro anoshandiswa kugadzirisa mashandiro epfungwa pane kudzora kuwanda kwavo kana kugadzirisa zvirimo. Nenzira iyi, kusanzwisisika kusanzwisisika kunogona kungochinja zvisingadiwe zvinoreva kana mashandiro epfungwa dzakashata uye nekudaro kudzikisira chinamato uye inotevera mhinduro yemanzwiro uye maitiro kune akadaro pfungwa. Maitiro epakati ekuvapo anosimbisa kusangana kusingatonge pakati pezvauri uye zvakavanzika pfungwa nezviitiko. Maitiro anoshandiswa semagwara ekusarudza maitiro uye dudziro dzinoonekwa neidzo tsika munhu anovavarira kuzvisimbisa muhupenyu hwezuva nezuva. Chekupedzisira, kuburikidza nezviito zvekuzvipira, varwere vanogona kuona shanduko yemaitiro inoenderana nehunhu hwega. Nekudaro, ACT inoshandisa iwo matanhatu epamutemo misimboti pamwe chete neumwe kutora nzira yakazara mukuwedzera kusagadzikana kwepfungwa uye kudzikira kwekutambudzika. Varwere vanokurudzirwa kuti vaone kurwadziwa sekusingadzivisike uye nekuzvigamuchira nenzira isina mhosva kuitira kuti varambe vachiwana zvinoreva kubva kuhupenyu kunyangwe paine marwadzo. Izvo zvinowirirana musimboti maitiro anoratidzira kufunga nekugashira maitiro uye kuzvipira uye maitiro ekuchinja maitiro. [45]

 

Migumisiro yekutsvakurudza pamusoro pekubudirira kwe-ACT-based approaches yevatungamiri vehurombo husingaperi vari kuvimbisa, zvisinei zvichiri kurongedza kuongorora zvakare. RCT iri kuenzanisa CHIT nechokuchengetedza chirongwa chekuchengetedza yakaratidza kuchinja kwakanyanya mukurwadziwa kunorwadza, kuremara kwakabatana, kurwadziwa kwehupenyu, kutya kwekufamba, uye kushungurudzika kwepfungwa kwakachengetwa pamwedzi we7 kutevera. [46] Chiedzo chikuru chakataurwa chakakosha [47] Meta-analysis yakangobva kuongorora kupindira-yakagadziriswa (ACT uye pfungwa-based based stress) muvarwere vane kurwadziwa kusingaperi akawana kuti, kazhinji, kugamuchirwa-kwakagadzirwa nemishonga kunounza kuguma kwakanaka kwevarwere vane marwadzo asingagumi. [48] Kunyanya, meta-tsananguro yakajekesa maduku kusvika pakati mapasikirwo makuru ekurwadziwa zvakanyanya, kuora mwoyo, kuzvidya mwoyo, kurarama mumuviri, uye hupenyu hwehupenyu , neine zviduku zvinowanikwa apo kuongororwa kwekliniki miedzo yakasarudzwa uye chete RCTs yakaiswa mune izvozvi kuongorora. [48] Zvimwe nzira dzekugamuchira-based based i nclude contextual cognitive-behavioral therapy uye pfungwa-based based cognitive therapy, kunyange kutsvakurudza kwakajeka pamusoro pekubudirira kwezvirapa izvi zvekutungamira marwadzo asingagumi achiri mucheche.

 

Zvatinotarisira

 

Chinhu chakakosha uye chakanyanya kufuratirwa chinowanikwa pasi pechinhu munzira dzese dzekurapa kufunga nezve tarisiro yemurwere yekubudirira kurapwa. Kunyangwe paine kufambira mberi kwakawanda mukuumbwa uye kuendesa kweanoshanda ekurapa kwakasiyana siyana kwehurombo husingaperi, kusimbisa kushoma kwakaiswa pakuziva kukosha kwezvaunotarisira kuti ubudirire uye nekutarisa kuedza mukusimudzira zvinotarisirwa nevarwere. Iko kucherechedzwa kwekuti placebo yekurwadziwa kunoonekwa neanoshanda maficha anotungamira kune anovimbika, anoonekwa, uye anogona kugadziriswa shanduko pamwe neurobiological underpinnings parizvino ari vanguard yekurwadziwa kwekutsvagisa. Ongororo dzakawanda dzakasimbisa kuti, kana ikafemerwa nenzira inogonesa zvinotarisirwa (kuburikidza nekunyepedzera kwezvinotarisirwa zvakajeka uye / kana kugadzirisa), analgesic placebos inogona kukonzera shanduko dzinoonekwa uye dzinoyemurika pakurwadziwa kwekufungisisa padanho rekuzvizivisa wega pamwe neyeuropi marwadzo ekugadzirisa marwadzo. [49,50] Analgesic placebos akave akatsanangurwa zvakawandisa seyakarapwa kurapwa kana maitiro anoitika mukati mepfungwa dzezvepfungwa uye nekushandisa mhedzisiro pane chiitiko chemunhu uye / kana physiology. [51] Ikozvino kufunga kwepa placebo kunosimbisa kukosha kwenzvimbo dzepfungwa nemagariro mukati mayo ma placebos akaiswa. Pasi pemamiriro epfungwa nezvetsika uye tsika yekurapa zvinotarisirwa nevarwere. Naizvozvo, hazvishamise kuti mitezo ye placebo yakanyatsoiswa mukati mese kurapwa kwese; saizvozvowo, varapi nevarwere zvakafanana vangangobatsirwa nekuziva kuti imomo mune imwe nzira iyo kurapwa kwazvino kunosvika pakurwadziwa kunogona kukwidziridzwa.

 

Izvo zvave zvichiratidzwa kuti mhedzisiro tarisiro inove yakakosha pesvedzero inofambisa shanduko dzakanaka dzinowanikwa kuburikidza nenzira dzakasiyana siyana dzekuzorora kudzidziswa, hypnosis, kurapwa kwekuratidzira, uye nzira zhinji dzekuziva dzinotungamira pakurapa. Nekudaro, nzira inonzwisisika kune manejimendi ekurwadziwa kusingaperi inowedzera simba pasimba revatarisiri vebudiriro. Zvinosuruvarisa, kazhinji, varapi vezvehutano vanoregeredza kugadzirisa nekusimbisa kukosha kwezvinotarisirwa nevarwere sezvinhu zvakakosha zvinoita kuti ubudirire manejimendi isingaperi. Iye zeitgeist munharaunda medu ndeyeyekurapa kurapwa kwezvirwere zvinokonzeresa tarisiro yekuti marwadzo (kunyangwe kurwadziwa kusingaperi) anofanirwa kubviswa kuburikidza nekufambira mberi kwekurapa. Izvi zvese zvinowanzo kuve nezvitarisirwa zvinosiya varwere vazhinji vakaodzwa mwoyo nezvazvino marapirwo uye zvinopa mukutsvaga kusingaperi kwe'cure . Kuwana iyo "cure " ndiko kusarudzika kwete pane mutemo zvine chekuita nekusingaperi kwemarwadzo mamiriro. Mumamiriro edu ekunze, uko kurwadziwa kusingaperi kunoshungurudza mamirioni eAmerica gore rega rega, zviri mukuda kwedu kusimudzira uye kuramba tichikurudzira shanduko yemifungo iyo inotarisa pakurongeka kwekutambudzika kusingaperi. Nzira inoshanda uye inovimbisa yekuzadzikisa izvi ndeyekushandisa zvakanyanya zvinotarisirwa nevarwere (zvinokwanisika) uye kudzidzisa varwere vanorwadziwa pamwe neruzhinji rwevanhu (20% yeavo pane imwe nguva ramangwana vanozove varwere vanorwadziwa) pane izvo zvinotarisirwa chaizvo nezve manejimendi ekurwadziwa. Zvichida, izvi zvinogona kuitika pakutanga kuburikidza neazvino, humbowo-hwakavakirwa padzidzo maererano ne placebo uye zvisina kunyatso kurapa mhedzisiro zvekuti varwere vanogona kugadzirisa zvisirizvo zvitendero zvavanogona kunge vakambobata. Naizvozvo varapi vanogona kuvavaririra kusimudzira tarisiro yevarwere mukati memamiriro ekurapa (nenzira chaiyo) uye kudzikisira tarisiro dzisina tariro dzinodzivisa kubudirira pakurapa, nekudaro, kudzidza kuwedzera kwavo kwazvino kurapa kwakasiyana siyana kuburikidza nekuedza kunotungamirwa pakubata pane iyo yekuvandudza kwenzvimbo inokwanisa kubereka, kunyangwe mukati memushonga unoshanda. Nyanzvi dzezvepfungwa dzinogona kugadzirisa nyaya idzi nevarwere uye nekuvabatsira kuva varevereri vekurapa kwavo kubudirira.

 

Vanokanganisa Emotional Painhamo

 

Chinhu chinowanzo chinetsa chevatariri vekurwadziwa kusingaperi ndiko kukura kwakakura zvisina tsarukano kwekushushikana kwepfungwa. Kutsvagurudza kwakaratidza kuti kushushikana uye kusagadzikana kwekushushikana kwakakwira kusvika katatu zvakapetwa pakati pevarwere venguva refu kurwadziwa kupfuura pakati pehuwandu hwevanhu. [52,53] Kazhinji, varwere vanorwadziwa vane chirwere chepfungwa vanonzi vanorwara vakaomarara nevapi vehutano, pamwe zvichideredza mhando yekutarisirwa kwavachawana. Varwere vane kushushikana vane mhedzisiro yehurombo kune zvese kushushikana uye kurapwa kwekurwadziwa, zvichienzaniswa nevarwere vane imwechete kuongororwa kwehurombo kana kushushikana. [54,55] Nyanzvi dzezvepfungwa dzakanyatsokodzera kugadzirisa vazhinji vevanorwara nepfungwa vanowanzosangana nevanhu vasingarware uye nekudaro vanovandudza marwadzo. mhedzisiro yekurapa uye kudzikisira kushungurudzika kwevarwere. Nyanzvi dzezvepfungwa dzinogona kugadzirisa zviratidzo zvakakosha (semuenzaniso, anhedonia, yakaderera kurudziro, zvipingamupinyi-kugadzirisa zvipingamupinyi) zvekushushikana izvo zvinokanganisa nyore nyore kurapwa pamwe nekushushikana kwepfungwa. Zvakare, zvisinei nekusagadzikana kwepfungwa, varapi vepfungwa vanogona kubatsira varwere venguva refu vanorwara kuita shanduko dzakakosha dzavangangosangana nadzo (semuenzaniso, kurasikirwa nebasa, kuremara), matambudziko avanogona kusangana nawo (semuenzaniso, pfungwa yekuzviparadzanisa kunounzwa nemarwadzo), uye kushungurudzika mupfungwa (semuenzaniso, kushushikana, kutsamwa, kusuruvara, kuora mwoyo) zvakabatanidzwa muchiitiko chavo. Nekudaro, vanachiremba vezvepfungwa vanogona kukanganisa nzira yekurapa kuburikidza nekuderedza pesvedzero yeanogadzikana epamoyo anotariswa sechikamu cherapi.

 

mhedziso

 

Kubatsirwa kwekusanganisira kurapwa kwepfungwa mune nzira dzakasiyana-siyana dzehutungamiri kune vanotungamirirwa nekurwadziwa kusingaperi kune zvakawanda. Izvi zvinosanganisira, asi hazvirevi, kuwedzerwa kuzvirongedza kwekutambudzika, kunatsiridza kurwadziwa-kutarisana nezvinhu, kuora mwoyo kwakagadzikana-kunetseka, nekuderedza kushungurudzika mupfungwa-kuvandudzwa kunoitwa nenzira dzakasiyana-siyana dzehutano hwekugadzirisa, hutsika, uye kuziva maitiro. Nokubudirira kwekushandurwa kwezvinhu izvi, mupfungwa wepfungwa anogona kubudirira kubatsira varwere kunzwa nehana mukuraira kwekurwadziwa kwavo uye kuvabvumira kuti vararame sezvinowanzoita hupenyu sezvinobvira pasinei nekurwadziwa. Uyezve, unyanzvi hwakadzidza kuburikidza nekupindira kwepfungwa kunopa simba uye hunoita kuti varwere vave vashandi vanoita basa mukurwara kwehutano hwavo uye kuwedzera unyanzvi hunodiwa nevarwere vanogona kushandisa muupenyu hwavo hwose. Zvimwe zvinobatsira zvehutano hwakabatana uye hukuru hwehutungamiri hwehurombo husingaperi hunogona kusanganisira kuwedzerwa kwekudzoka kubasa, kuderedza kwehutano hwehutano, nekuwedzera kwehutano hwakabatana hupenyu hwemamiriyoni evarwere munyika yose.

 

Mufananidzo weomudzidzisi anopa mazano kuvarwere.

 

Mashoko Omuzasi

 

kuburitsa: Hapana kukakavara kwekufarira kwakaziviswa maererano nepepa rino.

 

Mukupedzisa, kupindira kwepfungwa kunogona kushandiswa zvakasimba kubatsira kubvisa zviratidzo zvekurwadziwa kusingaperi pamwe nekushandiswa kwemamwe mararamiro, zvakadai sechiropractic kuchengetedza. Uyezve, chidzidzo chekutsvakurudza pamusoro apa chakaratidza kuti maitiro ehupfungwa ehutano angakwanisa sei kugadzirisa matanho ehupenyu husingaperi hwekutambudzika. Mashoko anotsanangurwa kubva kuNational Center for Biotechnology Information (NCBI). Kuwanda kweruzivo rwedu kunogumira kune chiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota ivai vakasununguka kubvunza Dr. Jimenez kana kuti tibvunzei kwatiri 915-850-0900 .

 

Yakarongedzwa naDkt Alex Jimenez

 

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

 

Zvimwe Zvinyorwa: Kubva Painini

 

Maererano nehuwandu, inenge 80% yevanhu ichaona zviratidzo zvekurwadziwa shure shure kamwechete munguva yeupenyu hwavo hwose. Kutambudzika shure ndiko kunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Kazhinji kacho, kuora kwechimiro chemupaka nezera kunogona kukonzera marwadzo kumashure. Herniated discs inoitika apo ganda rakanyorova, segel-like re intervertebral disc rinodonha nekubvarura mukati maro, rinenge riri kunze kwekatekete, kubvongodza nekugumbura midzi midzi. Dhizinesi dzinozivikanwa dzinowanzoitika kumucheto kumashure, kana kuti nhengo dzomukati, asi dzinogonawo kuitika pamucheto wepervical, kana mutsipa. Kuiswa kwemitsipa inowanikwa mucheka shure nekuda kwekukuvara uye / kana mamiriro akaoma kunogona kutungamirira kune zviratidzo zve sciatica.

 

blog chinyorwa chekartoon paperboy makuru makuru

 

NHAURWA INOKOSHA INOKOSHA: Kutarisira Kushungurudzika Kwebasa

 

 

ZVIMWE ZVINOKOSHA ZVINOKOSHA: KUDZIDZA KUNYANYA: Kutsaona Kwemotokari Kurapa El Paso, TX Chiropractor

 

Hazvina kuchena
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Close Accordion
Kufungisisa Kwepfungwa Nezvokugadzikana KweMusoro muEl Paso, TX

Kufungisisa Kwepfungwa Nezvokugadzikana KweMusoro muEl Paso, TX

by | Chiropractic, Mamiriro Ekutongwa, Physical Rehabilitation, Randomized Controlled Trial, kushushikana, Mishonga

Kana iwe wakambova nemusoro, iwe hausi woga. Inenge 9 kunze kwevanhu vane 10 muUnited States vanotambura nemusoro. Kunyange zvazvo vamwe vari pakati, dzimwe nguva, dzimwe dzisina kugadzikana uye dzinoputika, uye zvimwe zvinokonzera marwadzo anokonzera uye kushungurudza, kubvisa kubvisa musoro musoro inokurumidza kupindura kune vakawanda. Asi, iwe unogona sei kunyatsobudirira kugadzirisa musoro?

 

Ongororo dzekutsvakurudza dzakaratidza kuti chiropractic kuchengetedza ndiyo nzira yakanakisisa yekurapa kusarudzwa kwemhando dzakawanda dzemusoro. Mharidzo ye2014 mu Journal of Manipulative uye Physiological Therapeutics (JMPT) yakawana kuti kugadziriswa kwemapapu uye maitiro ezvinyorwa zvinoshandiswa mukuchengetedza chiropractic kwakagadzirisa migumisiro yemiganho yekurapa kusagadzikana kwehuro nekurwadziwa kwemutsipa pamwe nekuvandudza mararamiro emhando dzakasiyana-siyana dzokurapa kurwadziwa kwemutsipa. Uyezve, imwe 2011 JMPT yakawana kuti chiropractic inogona kuvandudza uye kuderedza kuwanda kwe migraine uye cervicogenic musoro.

 

Kurapa Kwokurapa Kunobata Sei Musoro Wechena?

 

Chiropractic inotarisa mukurapa kwekukuvara kwakasiyana siyana uye / kana mamiriro ehutachiona uye hutsinye hwese, kusanganisira misoro. A chiropractor anoshandura maginha ekugadzirisa uye maitiro ekushandisa kuitira kunyatsogadzirisa kurongeka kwepamusoro. Kugunun'una, kana kusaruramiswa kwemusana, kwakaratidzwa kuita kuti zviratidzo, zvakadai somutsipa uye kurwadziwa shure, uye musoro uye migraine. Kuenzanisa kwepakati kunogona kuvandudza ruvara rwemhepo uye pamwe nekuderedza kunetseka kwepfungwa. Mukuwedzera, chiremba wechiropractic inogona kubatsira kubata mapepa emusoro nemamwe zviratidzo zvinorwadza nekupa mazano ekudya, kupa maitiro uye ergonomics mazano uye kukurudzira kushandiswa kwepfungwa uye mazano ekushandisa. Chiropractic kuchengetedza inogona kugadzirisa kukanganiswa kwemashure pamwe nemadziro akakomberedzwa emusana, kudzorera mushonga wepakuvamba.

 

Dr. Alex Jimenez anoita chiropractic kugadzirisa murwere.

 

Dr. Alex Jimenez anopa mazano ekufananidzira kuti atsungirire.

 

Uyezve, chirwere chechiropractic chinogona kubata nekuchengetedza dzimwe nhau dzehutano hwepwere, kusanganisira zviratidzo zvemutsipa uye nechepamusoro-marwadzo pamusana pemakondomu emakondomu uye emakumbo ake, pakati pekukuvara uye / kana mamiriro. A chiropractor anonzwisisa kuti kusarudzwa kwepelinha, kana kugunun'una, kunogona kukanganisa nzvimbo dzakasiyana dzomuviri uye vachabata muviri wose sekwese panzvimbo yekuisa pfungwa pachiratidzo chete. Chiropractic mishonga inogona kubatsira muviri wemunhu zvakasununguka kudzorera hutano hwepakutanga uye hukama hwakanaka.

 

Murovedzeri uye nekushivirira kwechiremba pakunatsiridza nzvimbo.

 

Zvinonyatsozivikanwa kuti chiropractic kuchengetedza inoshanda kune zvakasiyana-siyana zvekukuvara uye / kana mamiriro ezvinhu, zvisinei, pamusoro pemakore mashomanana apfuura, zvidzidzo zvekutsvakurudza zvakawana kuti chiropractic inogona kusimbisa hupenyu hwedu nekugadzirisa dambudziko redu. Zvimwe zvezviongorori zvitsva zvinotsvakurudza zvakaratidza kuti chirwere chechiropractic chinogona kugadzirisa maitiro ezvirwere mumuviri, kuchinja maitiro emwoyo, uyewo kuderedza kuwedzera kweropa. Tsvakurudzo ye 2011 inobva kuJapan yakaratidza kuti chiropractic inogona kunge ine simba guru pane muviri wako kupfuura iwe unotenda.

 

Kushungurudzika ndiyo chiratidzo chinokosha cheutano, uye zviratidzo zvinorwadza zvisingaperi zvinogona kuchinja hutano. Vatsvakurudzi muJapan vakatsvaka kuongorora kana chiropractic inogona kugadzirisa zvinetso zvevarume nevakadzi ve12 vane kurwadziwa kwemutsipa uye musoro. Asi masayendisiti kuJapan aida kutsvaga mifananidzo yakajeka yekuti chiropractic marinha ekugadzirisa uye maitiro ekunyora anogadzirisa hurongwa hwemagetsi, saka vakashandisa PET kuongorora kuongorora uropi uye sarvia miedzo yekucherechedza kuchinja kwehomoni.

 

Mushure mekuchira chiropractic, varwere vakashandura uropi muhutano hwehuropi hunoita kuti utambudzi hwekugadzirisa uye kushungurudzika kuite. Vaivawo vakaderedza zvakanyanya cortisol, zvichiratidzira kuderedza kushungurudzika. Vatori vechikamu vakataurawo nezvehutano hwepamusoro uye huwandu hwehupenyu mushure mokurapa. Kupindira kwepfungwa, zvakadai sechiropractic kutarisira, ndiyo inokosha yekugadzirisa maitiro nemaitiro. Kushungurudzika kwenguva refu kunogona kutungamirira kune zvakasiyana-siyana zvehutano, kusanganisira kurwadziwa kwehuro uye mushure pamwe nemusoro uye migraine. Mamwe mapindiro ekufungisisa anogonawo kubudirira uye kubudirira kubatsira kubatsiridza zviratidzo. Chinangwa chehurukuro inotevera ndechekuratidza kubudirira kweimwe kupindira kwepfungwa, inozivikanwa sekutarisa-kunokonzerwa nekuderedza kushungurudzika, pamanzwiro ekurwadziwa uye simba rehupenyu kune varwere vakamboonekwa vane musana unopera.

 

Kubudirira Kwepfungwa-Kubva Kudzvinyirira Kushushikana Pamusoro Panoona Kunetseka uye Uhu hwehupenyu muvarwere vane Musoro usina kuchena

 

ngovepo

 

Chinangwa chechidzidzo ichi chaiva chokutsvaga kubudirira kweMangariro-Inotemesa kudzvinyirira (MBSR) pamusoro pekunzwisisika kunorwadza uye hutano hwehupenyu kune varwere vane hutano husingaperi. Nokudaro, varwere makumi mana kubva pakuonekwa kwechirwere chetsuro uye chirwere chekuongorora chirwere cheMunyika yepamusoro yeHemis Headache (IHS) chemigraine uye chronic-tension-type headache yakasarudzwa uye yakarongerwa kuboka rekupindira uye boka rekutonga, maererano. Vadzidzi vakapedzisa kurwadziwa uye mararamiro ehupenyu (SF-36). Boka rekupindira rakanyoresa purogiramu yemasere e-MBSR iyo yakabatanidza kufungisisa uye tsika dzezuva nezuva, pamusi wevhiki, svondo re 90-maminitsi. Migumisiro ye covariance kuongorora pamwe nekuparadzaniswa kwepamberi yekuedzwa kwakaonesa kunatsiridza marwadzo uye hutano hwehupenyu muboka rinopindira richifananidzwa neboka rinodzora. Zvakawanikwa kubva pakurongwa uku zvakaratidza kuti MBSR inogona kushandiswa kusingabatsiri mune zvemasikirwo yekuvandudza mararamiro ehupenyu nekuvandudza mazano ekugadzirisa marwadzo kune varwere vane hutano husingaperi. Uye inogona kushandiswa pamwe chete nedzimwe nzira dzokurapa dzakadai sedhemotherapy.

 

Keywords: kusuruvara kusingaperi, migraine musoro, pfungwa, hupenyu hwehupenyu, kushushikana musoro musoro

 

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight

Kuora musoro musoro kunopedza zviratidzo zvinokanganisa zvinokanganisa vanhu vakawanda. Kune marudzi akasiyana-siyana emusoro, kunyange zvakadaro, ruzhinji rwavo runowanzotaurirana. Kushungurudzika kwenguva refu kunogona kukonzera hutano hwakasiyana-siyana hwehutano husina kunyatsogadziriswa, kusanganisira kushungurudzika kwemasisita, izvo zvinogona kutungamirira kusaruramisa kwepelinha, kana kugadziriswa, pamwe nezvimwe zviratidzo, zvakadai semutsipa uye mushure, kurwadziwa musoro uye migraines. Kunyanya kushungurudzika maitiro ekugadzirisa uye nzira dzekugadzirisa zvinogona kubatsira pakuvandudza nekugadzirisa zvinetso zvinosanganiswa zvine chokuita. Kufungisisa kwepfungwa sezvinonzi chiropractic kuchengeta uye pfungwa-based based stress reduction zvakatsungirirwa kubatsira zvakanatsi kuderedza kushungurudzika uye kuderedza zviratidzo zvisingagumi zvepfungwa.

 

ziviso

 

Kutemwa nemusoro ndiko kumwe kwekunyunyuta kwakajairika kunoongororwa mumakiriniki evana vakura uye evana. Iyo yakanyanya kuwanda yemisoro iyi ndeye migraine uye tension-mhando misoro (Kurt & Kaplan, 2008). Musoro unorongerwa muzvikamu zviviri zvemusoro kana zvepuraimari uye zvechipiri musoro wemusoro. Makumi mapfumbamwe muzana emusoro musoro ndiwo anonyanya kutemwa nemusoro, pakati peiyo migraine uye kusagadzikana musoro misoro ndiyo yakajairika mhando (International Headache Society [IHS], 2013). Zvinoenderana nedudziro, migraine musoro unowanzo kuve unilateral uye kupuruzira mune zvakasikwa uye unotora kubva pa4 kusvika maawa 72. Zviratidzo zvinosanganisirwa zvinosanganisira kusvotwa, kurutsa, kuwedzera kunzwisisika kuchiedza, kurira uye kurwadziwa, uye zvinowanzo wedzera nekuwedzera chiitiko chemuviri. Zvakare, kushushikana musoro musoro kunoonekwa neyakaenzana, isingarwadziwi kurwadziwa, kumanikidza kana kuomarara, kurwadziwa kwakapinza, kunge bhandeji kana ngowani, uye kuenderera kwehurombo hunyoro kusvika pakati nepakati, kudzivirira zviitiko zveupenyu hwezuva nezuva (IHS, 2013).

 

Stovner et al. (2007) vachishandisa iyo IHS yekuongorora nzira, inofungidzirwa zvikamu zvevanhu vakuru vane chinetso chinorwara nemusoro nezve 46% yemusoro mukati, 42% ye tension-type headache. Izvi zvinoratidza kuti kuitika uye kuwanda kwematambudziko-mhando misoro yakakwira zvakanyanya kupfuura zvaifungidzirwa. Inofungidzirwa kuti vangangoita gumi nemaviri kusvika gumi nemasere muzana yevanhu vane migraines (Stovner & Andree, 12). Vakadzi vanowanzo kuve nemagraines zvichienzaniswa nevarume, migraine kuwanda kuri nezve 18% yevarume uye 2010% yevakadzi (Tozer et al., 6).

 

Migraine uye tension-mhando misoro yemusoro zvakajairika uye zvakanyatsoratidzwa mhinduro kune zvepfungwa uye zvemuviri zvinonetsa (Menken, Munsat, & Toole, 2000). Migraine inogara ichidzora uye inoshungurudza kurwadziwa kusingaperi uye ine mhedzisiro yakaipa pahunhu hwehupenyu, hukama uye kugadzirwa. IWorld Health Organisation (WHO) yakazivisa migraine yakaoma seimwe yezvirwere zvinonyanya kuora zvinegumi nepfumbamwe (IHS, 2013; Menken et al., 2000).

 

Kunyangwe paine kuvandudzwa kwemishonga yakawanda yekurapa uye kudzivirira kwekurwadziswa kwemigraine, huwandu hwevarwere vanovawana husingashande uye vamwe vanovawana vasina kukodzera nekuda kwemhedzisiro yavo uye mhedzisiro-kazhinji kazhinji zvinotungamira mukumira kwekutanga kurapwa. Nekuda kweizvozvo, kufarira kukuru mukuvandudza kweasina-pharmacologic kurapwa kunogona kucherechedzwa (Mulleners, Haan, Dekker, & Ferrari, 2010).

 

Biological zvinhu zvega hazvigone kutsanangura kusagadzikana kune chiitiko chemusoro, kutanga kwekurwiswa uye nezvayo, kuwedzera kurwiswa kwemusoro, kuremara kwakanangana nemusoro uye zvakare hupenyu hwevarwere vane hutachiona husingaperi. Zviitiko zvehupenyu zvisina kunaka zviri (senge psychosocial factor) inowanzo kuzivikanwa sechinhu chakakosha mukusimudzira nekuwedzera kwemusoro (Nash & Thebarge, 2006).

 

Iyo chirongwa cheMindfulness-Yakavakirwa Stress kudzikisira (MBSR) iri pakati pekurapa, uko kwakadzidzwa mumakumi maviri emakore apfuura pane akasiyana maronda asingagumi. MBSR yakagadzirwa naKabat-Zinn uye inoshandiswa munzvimbo dzakasiyana siyana dzevanhu vane kusagadzikana kwakanangana nekushushikana uye kurwadziwa kusingaperi (Kabat-Zinn, 1990). Kunyanya mumakore achangopfuura, ongororo dzakawanda dzakaitwa kuti dziongorore ekurapa mhedzisiro yeMBSR. Zvizhinji zvidzidzo zvakaratidza zvakakosha zviitiko zveMBSR pamamiriro akasiyana epfungwa kusanganisira kudzikiswa kwezviratidzo zvepfungwa zvekushushikana, kushushikana, rumination, kushushikana uye kushushikana (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; Teasdale et al. , 2002), kurwadziwa (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) uye hupenyu hwehupenyu (Brown & Ryan, 2003; Carlson et al., 2003; Flugel et al., 2010; Kabat-Zinn, 1982; La Cour & Petersen, 2015; Morgan, Ransford, Morgan, Driban, & Wang, 2013; Rosenzweig et al., 2010).

 

Bohlmeijer et al. (2010) yakaita meta-ongororo yezvisere zvakasarudzika zvakadzorwa zvidzidzo pamhedzisiro yechirongwa cheMBSR, yakagumisa kuti MBSR ine madiki mhedzisiro kuora mwoyo, kushushikana uye kushushikana kwepfungwa kune vanhu vane chirwere chisingaperi chekurapa. Zvakare Grossman et al. (2004) mune meta-ongororo ye20 yakadzorwa uye isingadzorwe zvidzidzo pamhedzisiro yechirongwa cheMBSR pane hutano hwepanyama uye hwepfungwa hweanorapa uye asiri ekurapa masampuli, yakawana saizi yekuita yekuenzanisira yezvidzidzo zvinodzorwa pahutano hwepfungwa. Hapana masimba ekukura kwezviratidzo zvakasiyana sekushushikana uye kushushikana zvakataurwa. Ongororo ichangoburwa inosanganisira 16 zvidzidzo zvinodzorwa uye zvisingadzorwe, Ongororo iyi inoshuma kuti kupindira kweMBSR kunodzora kurwadziwa, uye kuongororwa kwakawanda kwekutongwa (6 kwe8) kunoratidza kudzikisira kwakanyanya mukurwadziwa kusimba kwekupindira boka zvichienzaniswa neboka rinodzora (Reiner, Tibi, & Lipsitz, 2013).

 

Mune kumwe kuongorora, vaongorori vakawana hunhu hwakakura hwezvimwe zvidimbu zvehunhu hwehupenyu semuenzaniso huremo hwekukura uye kurwadziwa kwemuviri, zvisingaenzaniswi masize ekurwadziwa uye akakosha epakati kusvika kune makuru size mhedzisiro yekudzikira kwakazara kushushikana uye kushushikana (La Cour & Petersen, 2015) . Zvakare mukudzidza naRosenzweig et al. (2010) pavarwere vane kurwadziwa kusingaperi kusanganisira avo vanotambura nemagraine, paive nekusiyana kukuru mukurwadziwa kwakanyanya, kurwadziwa-kwakanangana nekukanganisa kushanda pakati pevarwere. Zvisinei, avo vanotambura nemigraine vakaona kuvandudzwa kwakadzika kwazvo mukurwadziwa uye akasiyana maitiro ehupenyu hwehupenyu. Pakati pese, akasiyana mapoka ekurwadziwa kusingaperi akaratidzira kusimudzira kwakanyanya mukushungurudzika uye marwadzo-ane chekuita nekukanganisika kwekuita mune ino kudzidza. Zvimwe zvidzidzo zviviri zvakaitwa naKabat-Zinn uye vachishandisa nzira dzeMBSR dzekurapa varwere vane kurwadziwa kusingaperi, kusanganisira huwandu hwevarwere vane maronda asingaperi. Statistical ongororo yakaratidza kudzikisira kukuru kwekurwadziwa, kupindira kwekurwadziwa nemabasa ezuva nezuva, zvekurapa uye zvepfungwa zviratidzo uye zviratidzo, kushushikana uye kushushikana, kusagadzikana kwemuviri, kurwadziwa kwekukanganiswa nemabasa ezuva nezuva, kushandiswa kwechirwere uye zvakare kuwedzera mukuvimba (Kabat-Zinn, 1982; Kabat-Zinn et al., 1985).

 

Pamusana pokurwadziwa uye kurasikirwa kwebasa uye kuderedzwa kwekushanda kwebasa nekuwedzera kushandiswa kwehutano, hutachiona hutachiona hunokonzera mari kune mumwe munhu uye munzanga, zvinoratidzika kuti hutachiona hutachiona ndedambudziko guru rehutano uye kutsvaga nzira dzekutonga uye kubata chirwere ichi chinogona kuva che kukosha kukuru. Chinangwa chikuru chechidzidzo ichi chaiva chekuongorora kubudirira kweBMSR mune kuwedzera kwechirongwa chemasipromotherapy muchipatara chemuenzaniso wevanhu vepachipatara vane varwere vane hutachiona hwemusoro kusaratidza kubudirira kwechirongwa ichi senzira yekurwadziwa nekugadzirwa kwehupenyu hwevarwere ane musoro usingagumi.

 

nzira

 

Vatori vechikamu uye Nzira

 

Uku kuyedzwa kusinganzwisisike kwakatarwa maviri- boka retpretest-posttest dhizaini yekudzidza. Zvakare mvumo yakawanikwa kubva kuEthics Committee yeZahedan University yeMedical Sciences. Vatori vechikamu vakasarudza kuburikidza neyakareruka sampling nzira kubva kuvarwere vane chisingaperi migraine uye tension-mhando misoro, inoonekwa nachiremba wezveuropi uye chiremba wepfungwa vachishandisa IHS yekuongorora nzira-inotaurwa kuzvipatara zveyunivhesiti zveZahedan University yeMedical Sciences, Zahedan-Iran.

 

Mushure mokuongorora chirwere chega chega nekusangana nekugadziriswa nekuregererwa kwekutora uye kutora hurukuro yekutanga, 40 kunze kwe makumi masere nevanomwe vepachirwere vepachirwere vane hutano husingaperi vakasarudzwa uye pasina nguva vakaiswa mumapoka maviri akaenzana ekupindira uye kutonga. Izvo zvose kutonga uye mapoka ekupindira akawana pharmacotherapy inowanikwa pasi pekutarisa kweurorologist. Panguva yekurapa zvidzidzo zvitatu nyaya, nekuda kwekushayikwa kwekugara kwenguva dzose kana kuti kusarirwa, zvinosarudzwa kana kusabviswa kubva pachidzidzo.

 

Inclusion Criteria

 

  • (1) Chibvumirano chakazivikanwa chekutora chikamu mumisangano.
  • (2) Makore mashoma emakore 18.
  • (3) Chidzidzo chechidiki chechikoro chepakati-chikoro.
  • (4) Kuongororwa kwepfungwa dzisingagumi (inonyanya kusagadzikana migraine uye kushungurudzika-musoro musoro) neurologist uye maererano neHS diagnostic criteria.
  • (5) 15 kana mamwe mazuva pamwedzi kwepfuura mwedzi ye3 uye mwedzi mitanhatu yakaitika nhoroondo ye migraines uye kushungurudza-musoro musoro

 

Kusagadziriswa Criteria

 

  • (1) Vaya vanga vasingadi kuramba vachipinda muchidzidzo kana kusiya chidzidzo kune chero chikonzero.
  • (2) Zvimwe zvinetso zvinorwadza zvisingaperi.
  • (3) Psychosis, delirium uye kugadzirisa matambudziko.
  • (4) Mhosva dzezvinetso zvevanhu vanopesana nekushanda pamwe chete.
  • (5) Zvinodhaka nezvinodhaka.
  • (6) Mafungiro emafungiro

 

Kupindira Mapoka

 

Zvirongwa zveTherapy (MBSR) zvakaitirwa 1.5 kumaawa 2 pavhiki kuitira nhengo dzeboka rekupindira (drug pamwe neBSS); Nepo pasina MBSR yakaitwa yeboka rinodzora (zvinongowanikwa zvinodhaka zvinoshandiswa) kusvika pakuguma kwekutsvakurudza. Iyo MBSR yakaitirwa mavhiki e8. Muchidzidzo ichi, chirongwa che 8-session session MBSR (Chaskalon, 2011) yakashandiswa. Kuti uite kufungisisa kumba kwaunenge uchidzidzisa vatori vechikamu mumisangano, zviyero zvakakosha zvakapiwa mune CD uye kabhuku. Kana imwe yezvidzidzo zvisingabatanidzi muhurukuro kana masangano, pakutanga kwechikamu chinotevera mushonga anokwanisa kupa zvinyorwa zvakanyorwa zvezvikamu kune zvidzidzo, kunze kwekudzokorora mhedziso yapfuura. Chirongwa cheMBS uye nhaurirano zvakaendeswa kuvarwere vari mumasangano masere anosanganisira: kunzwisisa kurwadziwa uye kugadziriswa kwaro, kukurukura pamusoro pehukama hukama, kutsamwa nemanzwiro nemarwadzo, Kunzwisisa mafungiro akaipa, mafungiro nemanzwiro, kuunza pfungwa yeAcceptance, kufema nzvimbo , maminitsi matatu ekufema, nzvimbo yekufema, kushandiswa kwemaitiro, kufungidzira muviri, kuongorora, kugara nekufungisisa, kufamba-fungisisa, kufamba-famba, kuverenga nhetembo dzine chokuita nekufunga uye zvakarekurukura chengetedza izvo zvakagadzirwa pamusoro payo yose, kurukura zvirongwa nezvikonzero zvakanaka zvekuchengeta tsika. Varwere vakagamuchirawo ruzivo pamusoro pekudzidza kuti vanoona sei ramangwana rezvekudzoka pamwe chete nemazano uye zvirongwa zvekugadzirisa kutanga kuonekwa kwechirwere chekurwadziwa nekurwiswa uye kuzvitungamirira kune mamiriro matsva.

 

Kudzora Boka

 

Varwere vakanga vanga vari muboka rekutonga vairamba vachiita zvekare pharmacotherapy (kusanganisira zvinodhaka uye zvisingaitiki zvinodhaka) neurologist yavo kusvikira pakupera kwekutsvakurudza.

 

Instruments

 

Maturu maviri makuru akashandiswa mu pre-bvunzo uye post-bvunzo kuunganidza data, kuwedzera kune fomu rehuwandu hwehuwandu. Musoro wemusoro log wakashandiswa kuona iko kunzwisisika kwekutambudzika uchishandisa zvikamu zvitatu: (1) 10-poindi likert-scale ratings, (2) kuwanda kwemaawa ekurwadziwa pazuva uye (3) marwadzo kuwanda mukati memwedzi. Chikamu chega chega chinotorwa kubva pa0 kusvika pa100, nhanho yepamusoro iri zana.Sezvo murwere mumwe nemumwe achiyera kurwadziwa kwavo kunonzwisisika mubhuku remibvunzo, kuvimbika uye kuvimbika hazvitariswe. Uye imwe yacho yaive pfupi-fomu 100 remibvunzo (SF-36). Bvunzo remibvunzo rinoshanda mumazera akasiyana siyana nezvirwere zvakasiyana. Kuvimbika uye kuvimbika kwebvunzo kwakabvumidzwa naWare et al (Ware, Osinski, Dewey, & Gandek, 36). Iyo SF-2000 inoongorora maonero ehunhu hwehupenyu muzvikamu zvisere zvinosanganisira: kushanda kwemuviri (PF), zvinokanganisa basa nekuda kwehutano hwepanyama (RP), kurwadziwa mumuviri (PB), hutano huzhinji (GH), simba uye simba (VT ), Kugarisana nevamwe (SF), kutadza kuita basa nekuda kwematambudziko epfungwa (RE) uye kukanganisa hutano (AH). Chishandiso chine zvakare zviyero zviviri zvepfupi zvePhysical Component Summary (PCS) uye Mental Component Summary (MCS) zvibodzwa. Chiyero chega chega chinotorwa kubva pa36 kusvika pa8, chinhanho chepamusoro chinoshanda chiri zana. Kubatika uye kuvimbika kweSF-0 kwakaongororwa muvanhu veIran. Yemukati kuenderana coefficients yaive pakati pe100 ne100 yezvisere subscales uye test-retest coefficients yaive pakati pe36.

 

Data Analysis

 

Kuti uongorore ruzivo, kunze kwekushandiswa kwezviratidzo zvinotsanangurwa, kuenzanisa migumisiro yemapoka ekupindira uye ekudzora, kuongorora kwekushandiswa kwevhisi yakashandiswa kusarudza kubudirira uye kubviswa kwepamberi yekuongorora mhinduro pa 95% chivimbo chepamusoro.

 

Kuregera

 

Panguva yekurapa zvidzidzo zvitatu nyaya, nekuda kwekushayikwa kwekugara kwenguva dzose kana kuti kusarirwa, zvinosarudzwa kana kusabviswa kubva pachidzidzo. Makumi makumi matatu nemanomwe kubva kune 40 varwere vakapedza kudzidza ikozvino uye iyo yakaungana deta yakazoongororwa.

 

Results

 

Kuongorora kwekuenzanisa kwekupararira kwevanhu pakati pemapoka acho maviri kwakaitwa uchishandiswa chi-square uye yakazvimirira t-test. Dhiyabhorosi dhiyabhorosi yemapoka maviri aya anoratidzwa muTebhu 1. Kupararira kwezera, makore ezedzidzo, zvepabonde uye hutano hwemhuri dzaive zvakafanana muboka rimwe nerimwe.

 

Tafura 1 Dhiyabhorosi Zviratidzo zveVatori vechikamu

Tafura 1: Nhamba dzevanhu vanoverengera dzevatori vechikamu.

 

Tafura 2 inoratidza mhedzisiro yekuongororwa kwecovariance (ANCOVA). Kuedzwa kweLevene kwanga kusiri-kwakakosha, F (1, 35) = 2.78, P = 0.105, zvichiratidza kuti fungidziro yehukama hwekusiyana wainge wagamuchirwa. Uku kutsvaga kunoratidza kuti misiyano yemapoka akaenzana uye hapana mutsauko wakaonekwa pakati pemapoka maviri.

 

Tafura 2 Migumisiro yeKovarice Analysis

Tafura 2: Migumisiro yekodvariance yekuongorora kwehubudirira hweMBSR pamarwadzo ekurwadziwa.

 

Mhedzisiro huru yekupindira kweMBSR yaive yakakosha, F (1, 34) = 30.68, P = 0.001, zvishoma? 2 = 0.47, zvichiratidza kuti kurwadziwa kwakanyanya kwaive kwakaderera mushure mekupindira kweMBSR (Zvinoreva = 53.89, SD.E = 2.40) kupfuura control group (Zvinoreva = 71.94, SD.E = 2.20). Iyo covariate (pre-bvunzo yemarwadzo) yaive yakakosha, F (1, 34) = 73.41, P = 0.001, yakasarudzika? 2 = 0.68, zvichiratidza kuti mwero wekurwadziwa kusati kwatanga kupindira kweMBSR kuve nemhedzisiro padanho rekutambudzika . Mune mamwe mazwi, kwaive nehukama hwakanaka mune zvinorwadza zvibodzwa pakati pekutanga-kuyedzwa uye post-bvunzo. Naizvozvo, yekutanga ongororo yekufungidzira inosimbiswa uye kurapwa kweMBSR pakuona kwakasimba kwaive kushanda kune varwere vane kusingaperi kwemusoro uye kunogona kudzikisira kusimba kwekurwadziwa kunonzwisisika muvarwere ava. Ese akakosha maitiro anotaurwa pa p <0.05.

 

Pfungwa yechipiri yeyikudzidza ndeyekubudirira kwehutano hweMBSR pamusoro pehupenyu hwevarwere vane hutano husingaperi. Kuti kuongororwe kubudirira kwehutano hweMBSR pamusoro pehupenyu hwevarwere vane misoro yakagadzikana uye kubvisa zvinoshandiswa zvinokanganisa uye zvakagadziriswa, kushandiswa kwemashoko, multivariate covariance analysis (MANCOVA) yehupamhi hwehupenyu hwehupenyu hunoshandiswa iyo Tafura 3 inoratidza migumisiro yekuongororwa muboka rinopindira.

 

Tafura 3 Migumisiro yeCovariance Analyse

Tafura 3: Migumisiro yekodvariance yekuongorora kwehubudirira hweMBSR pamusoro pehupenyu hwehupenyu.

 

Itafura 3 inoratidza migumisiro yekuongororwa kwe covariance (MANCOVA). Mashoko anotevera anodiwa kuti anzwisise mhinduro inowanikwa muTebhu 3.

 

Chiyero chebhokisi chakange chisina kukosha, F = 1.08, P = 0.320, zvichiratidza kuti mutsauko covariance matrices akafanana mumapoka maviri uye nekudaro fungidziro yehukama inosangana. Zvakare F (10, 16) = 3.153, P = 0.020, Wilks Lambda = 0.33, zvishoma? 2 = 0.66, zvichiratidza kuti paive nemusiyano wakakura pakati pekutanga-kuyedzwa kwemapoka mune akasiyana anoenderana.

 

Kuongororwa kweLevene kwanga kusiri-kukosha mune zvimwe zvinoenderana zvinosanganisa zvinosanganisira [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; MaPC: F (1, 35) = 2.371, P = 0.133; VT: F (1, 35) = 4.52, P = 0.141; AH: F (1, 35) = 1.03, P = 0.318], zvichiratidza kuti kufungidzira kwehukama hwekusiyana kwakange kwatenderwa muzvikamu zvemhando yehupenyu uye bvunzo dzeLevene zvaive zvakakosha mune zvimwe zvinoenderana zvinosanganisira [RE: F (1, 35) = 4.27, P = 0.046; SF: F (1, 35) = 4.82, P = 0.035; MCS: F (1, 35) = 11.69, P = 0.002], zvichiratidza kuti kufungidzira kwehukama hwekusiyana kwakaputswa muzvikamu zvehupenyu hwehupenyu.

 

Mhedzisiro huru yekupindira kweMBSR yaive yakakosha kune zvimwe zvezvinhu zvinoenderana zvinosanganisira [RP: F (1, 25) = 5.67, P = 0.025, zvishoma? 2 = 0.18; BP: F (1, 25) = 12.62, P = 0.002, zvishoma? 2 = 0.34; GH: F (1, 25) = 9.44, P = 0.005, zvishoma? 2 = 0.28; PCS: F (1, 25) = 9.80, P = 0.004, zvishoma? 2 = 0.28; VT: F (1, 25) = 12.60, P = 0.002, zvishoma? 2 = 0.34; AH: F (1, 25) = 39.85, P = 0.001, zvishoma? 2 = 0.61; MCS: F (1, 25) = 12.49, P = 0.002, kusarura? Zvinoreva = 2, SD.E = 0.33; BP: Zvinoreva = 61.62, SD.E = 6.18; GH: Zvinoreva = 48.97, SD.E = 2.98; PCS: Zvinoreva = 48.77, SD.E = 2.85; VT: Zvinoreva = 58.52, SD.E = 2.72; AH: Zvinoreva = 44.99, SD.E = 2.81; MCS: Zvinoreva = 52.60, SD.E = 1.97] pane boka rekutonga [RP: Zvinoreva = 44.82, SD.E = 2.43; BP: Zvinoreva = 40.24, SD.E = 5.62; GH: Zvinoreva = 33.58, SD.E = 2.71; PCS: Zvinoreva = 36.05, SD.E = 2.59; VT: Zvinoreva = 46.13, SD.E = 2.48; AH: Zvinoreva = 30.50, SD.E = 2.56; MCS: Zvinoreva = 34.49, SD.E = 1.80].

 

Kunyange zvakadaro, mhedzisiro huru yekupindira kweMBSR yaive isina kukosha kune zvimwe zvinoenderana zvinosanganisira [PF: F (1, 25) = 1.05, P = 0.314, zvishoma? 2 = 0.04; RE: F (1, 25) = 1.74, P = 0.199, zvishoma? 2 = 0.06; SF: F (1, 25) = 2.35, P = 0.138, zvishoma? 2 = 0.09]. Iyi mhedzisiro inoratidza, kunyange hazvo nzira mune izvi zvidiki zvehupenyu hwehupenyu zvaive zvepamusoro [PF: Zvinoreva = 75.43, SD.E = 1.54; RE: Zvinoreva = 29.65, SD.E = 6.02; SF: Zvinoreva = 51.96, SD.E = 2.63] kupfuura boka rinodzora [PF: Zvinoreva = 73.43, SD.E = 1.40; RE: Zvinoreva = 18.08, SD.E = 5.48; SF: Zvinoreva = 46.09, SD.E = 2.40], Asi Misiyano yeMireza yakanga isina kukosha.

 

Mukupfupisa, Covariance ongororo (MANCOVA) mhedzisiro muTafura 3 inoratidza musiyano wakakosha muhuwandu hwezvikamu zvebhaisikopo rebasa nekuda kwehutano hwepanyama (RP), kurwadziwa mumuviri (BP), hutano huzhinji (GH), simba uye simba (VT) ), Bata hutano (AH) uye huwandu hwehupamhi hwehutano hwepanyama (PCS) uye hutano hwepfungwa (MCS). Uye zvakare zvinoratidza kuti pakange pasina musiyano wakakura musiyano muzvikamu zvepasi zvekushanda kwemuviri (PF), kuremerwa kwebasa nekuda kwematambudziko emanzwiro (RE) nekushanda kwevanhu (SF) muboka rekupindira. Ese akakosha maitiro anotaurwa pa p <0.05.

 

hurukuro

 

Ichi chidzidzo chakanangana nekuongorora kushanda kweMBSR pane kunzwisisika kwekurwadziwa uye hutano hwehupenyu kune varwere vane chirwere chisingaperi chemusoro. Zvigumisiro zvakaratidza kuti kurapwa kweMBSR kwaive kwakanyatsobudirira pakuderedza kwekutambudzika kwekushushikana kwekuona. Zvigumisiro zvekudzidza ikozvino zvinoenderana nemigumisiro yevamwe vatsvakurudzi avo vakashandisa nzira imwechete yekurwadziwa kusingaperi (semuenzaniso 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). Semuenzaniso, muzvidzidzo zviviri zvakaitiswa naKabat-Zinn, uko chirongwa cheMBSR chakashandiswa pakurapa varwere vane kurwadziwa kusingaperi navanachiremba, varwere vakati wandei vane misoro isingarware vakasanganisirwa. Chidzidzo chekutanga chedzidzo mbiri, chakaratidza kudzikisira kukuru kwekurwadziwa, kupindira kwekurwadziwa nemabasa ezuva nezuva, zviratidzo zvekurapa uye kusagadzikana kwepfungwa, kusanganisira kushushikana uye kushushikana (Kabat-Zinn, 1982). Mhedzisiro yechidzidzo chechipiri yakaratidza kudzikisira kukuru kwekutambudzika, kusagadzikana kwemuviri, kushushikana, kushushikana, kupindira kwekurwadziwa nemabasa ezuva nezuva, zviratidzo zvekurapa, kushandiswa kwemishonga, uye zvakare kuratidza kuwedzera kwekuzvivimba (Kabat-Zinn et al., 1985) .

 

Uyewo, zvakawanikwa zvekudzidza ikozvino zvinopindirana nemigumisiro yaRosenzweig et al. (2010), mitsva yavo inoratidza kuti chirongwa cheMBS chinoshanda pakuderedza, kurwadziwa mumuviri, hupenyu hwehupenyu uye hutano hwepfungwa dzevarwere vane marwadzo akasiyana-siyana asingagumi uye pfungwa dzinobudirira pamanzwiro uye mupfungwa zvinokonzera marwadzo maonero nekuzviisa pasi kuburikidza nekufungisisa mabasa. Kunyangwe zviitiko zveRosenzweig et al. (2010) yakaratidza kuti pakati pevarwere vane kurwadziwa kusingaperi kunokonzerwa nekuderedza kusuruvara kwemuviri nekuvandudzwa kwehupenyu hwehupenyu hwaibatanidza nevarwere vane fibromyalgia, vhudzi rine musoro. Mune imwe dzidzo yakaitwa naFlugel et al. (2010), kunyange zvazvo kuchinja kwakanaka kwaionekwa muhuwandu uye kuwedzera kwehurwadzo, kuderedza kunorwa kwakanga kusingaverengeki.

 

Mune kumwe kudzidza, kurwadziwa kwakanyanya kwakadzikira mushure mekupindira kwevarwere vane kushushikana kwepfungwa. Mukuwedzera, boka reMBSR rakaratidza zvikwiriso zvakakwirira mukuziva kwepfungwa pakuenzanisa neboka rinodzora (Omidi & Zargar, 2014). Mune chidzidzo chekutyaira naWells et al. (2014), mhedzisiro yavo yakaratidza kuti MBSR ine mishonga yekurapa yaikwanisika kune varwere vane migraines. Kunyangwe idiki diki yekuyera sosi yekudzidza iyi yemutyairi haina kupa simba rekuona musiyano wakakura mukushungurudzika kwekutambudzika uye migraine frequency, mhedzisiro yakaratidza kupindira uku kwakabatsira pakubata kwemusoro kwenguva, kuremara, kushanda nesimba.

 

Mukutsanangura mhedzisiro yekubudirira kwepfungwa dzakanangana nemarapirwo ekurwadziwa zvinogona kutaurwa, mhando dzepfungwa dzekurwadziwa kusingaperi senge yekutya-kudzivisa modhi yakaratidza kuti nzira idzo vanhu vanodudzira nadzo manzwiro avo ekurwadziwa uye kupindura kwavari dzakakosha mamiriro ruzivo rwekurwadziwa (Schutze, Rees, Preece, & Schutze, 2010). Kurwadziwa kunoshungurudza kwakabatana zvakanyanya nekutya uye kuzvidya moyo kunokonzerwa nekurwadziwa, nzira dzekuziva dzinogona kukonzereswa nekutya kurwadziwa uye zvakare kuremara kwakanangana nekurwadziwa kunosanganisirwa uye zvakare nekuti kusaziva kwekuziva kwekutambudzika kunotsanangura 7 kusvika ku31% ye kusiyanisa kwekutambudzika kwakanyanya. Naizvozvo, chero mashandiro anogona kudzikamisa marwadzo kukuvadza kana kuita shanduko mukugadzirisa kwawo kunogona kudzora maonero ekurwadziwa kwakanyanya uye hurema hunokonzerwa neizvozvo. Schutz et al. (2010) vanopokana kuti kufunga kushoma ndiko kutanga kwekutambudzika kunoparadza. Muchokwadi, zvinoita sekunge tsika yemunhu yekuita otomatiki yekugadzirisa mashandiro pane kuita ruzivo-rwakatarisana nekutarisisa kushomeka kushanduka, uye kushaya kwekuziva kwenguva iripo (Kabat-Zinn, 1990), ichaita kuti vanhu funga zvakanyanya nezve marwadzo uye nekudaro fungisisa njodzi yacho. Nekudaro, kufunga kushoma kunotendera kukura kwekusaziva kwekuziva kwehurombo (Kabat-Zinn, 1990).

 

Chimwe chikonzero chingangoita ndechekuti kugamuchirwa kwekutambudzika uye kugadzirira kwekuchinja kunowedzera mafungiro akanaka, zvichitungamira pakuderedzwa kwekurwadziwa zvakanyanya kuburikidza nemhedzisiro pane endocrine system uye kugadzirwa kweopioid isingagumi uye kudzikisira muhurema hune hukama nemarwadzo kana kugadzirira vanhu kuti vashandise nzira dzinoshanda dzekugadzirisa kurwadziwa (Kratz, Davis, & Zautra, 2007). Chimwe chikonzero chinogoneka chekutsanangura mhedzisiro yechidzidzo chazvino mukubudirira kwaro pakuderedza marwadzo chingave chokwadi chekuti kurwadziwa kusingaperi kunovandudzwa nekuda kwekunyanyisa kushushikana kupindura system (Chrousos & Gold, 1992). Mhedzisiro yacho inokanganisa maitiro epanyama uye epfungwa. Kungwarira kunogona kubvumidza mukana wekunze kwekortex uye nekuvandudza iyo, nzvimbo dzehuropi dzinobatanidza mabasa epanyama uye epfungwa (Shapiro et al., 1995). Mhedzisiro yacho kugadzirwa kwesimudziro shoma iyo inoderedza kusimba uye chiitiko chekurwadziwa mumuviri nepfungwa. Nekudaro, zvishuwo zvekurwadziwa zvinoitika sekunzwa kwekurwadziwa chaiko kwete pane kusazivikanwa. Mhedzisiro ndeyekuvharwa kwenzira dzemarwadzo dzinogona kudzikamisa marwadzo (Astin, 2004).

 

Kufungisisa kwepfungwa Kunoderedza Marwadzo Kupfurikidza nenzira dzeBrain dzinoverengeka uye nzira dzakasiyana dzakadai sekushandurwa kwekutarisisa munzira dzekufungisisa dzinogona kufadza zvese zvinonzwisisika uye zvine hukama nezvikamu zvekurwadziwa kwekuona. Kune rimwe divi, kufunga kunodzora kugadziriswazve kune kunetseka pfungwa uye manzwiro anofambidzana nekurwadziwa kwekuona uye kusimbisa kurwadziwa. Zvakare, kufunga kunoderedza zviratidzo zvepfungwa senge comorbid kushushikana uye kushushikana uye kunowedzera parasympathetic chiitiko, icho chinogona kusimudzira kudzika kwemhasuru kuzorora uko kunogona kudzikamisa kurwadziwa. Chekupedzisira, kufunga kunogona kudzora kushushikana uye kushushikana kwepfungwa-inoenderana psychophysiologic activation nekusimbisa kugadzirisa mamiriro asina kunaka uye hunyanzvi hwekuzvidzora Chikamu chepamusoro chekufunga chakafanofungidzira kudzikira kwakadzika kwekushushikana, kushushikana, kufunga kwakaipisisa nekuremara. Kumwe kutsvagurudza kwakaratidza kuti kufunga kune basa rakakosha mukuziva uye kutonga kwepfungwa, uye kunogona kubatsira mukugadzirisa mamiriro ezvinhu asina kunaka (Zeidan et al., 2011; Zeidan, Grant, Brown, McHaffie, & Coghill, 2012).

 

Chinangwa chechipiri chechidzidzo ichi chaive chekuona kushanda kwechirongwa cheMBSR pahunhu hwehupenyu kune varwere vane hutachiona husingaperi. Chidzidzo ichi chakaratidza kuti kurapwa uku kwaive kwakanyatso shanda pahunhu hwehupamhi hwehupenyu, kusanganisira kushomeka kwebasa nekuda kwehutano mamiriro, kurwadziwa mumuviri, hutano huzhinji, simba uye kusimba, hutano hwepamoyo uye zviyero zvehutano hwepanyama uye hwepanyama. Nekudaro, chirongwa cheMBSR hachikwanise kuwedzera zvakanyanya hupenyu hwehupenyu mukushanda kwemuviri, kutadza kuita nekuda kwematambudziko emanzwiro uye mashandiro enharaunda. Zvinotaridza sezviri pachena kubva kuongororo dzapfuura nedzazvino uyezve kubva kuchidzidzo chezvino kuti MBSR haina zvainoita panyama nemagariro mabasa. Izvi zvinogona kunge zvakadaro nekuti mhedzisiro pamarwadzo emurwere mune varwere vane musoro idiki, uye iyo shanduko inononoka. Kune rimwe divi, varwere vane kurwadziwa kusingaperi vanowanzo dzidza kusaitira hanya marwadzo kuti vaite zvakajairika (La Cour & Petersen, 2015). Kunyangwe, shanduko dzave dziri munzira yaidikanwa uye dzakawedzera zvinorehwa mazana eboka rekupindira zvichienzaniswa neboka rinodzora. Izvi zvakawanikwa zvinowirirana nezvakawanikwa zvekare (Brown & Ryan, 2003; Carlson et al., 2003; Flugel et al., 2010; Kabat-Zinn, 1982; La Cour & Petersen, 2015; Morgan et al., 2013; Reibel et. al., 2001; Rosenzweig et al., 2010).

 

Nezve izvo zvirimo zvezvikamu zveMBSR, chirongwa ichi chinosimbisa mashandisirwo ehunyanzvi ekudzora kushushikana, kubata nemarwadzo uye kuziva kwemamiriro ezvinhu. Kupa kurwa uye kubvuma mamiriro azvino, pasina mutongo, ndiyo pfungwa huru yechirongwa (Flugel et al., 2010). Muchokwadi, shanduko mukugamuchirwa pasina kutonga dzakabatana nekuvandudza kwehupenyu hwehupenyu (Rosenzweig et al., 2010). MBSR inoitirwa kuwedzera ruzivo rwenguva iripo. Iyo yekurapa chirongwa inzira nyowani uye pachezvako yekutarisana nekushushikana kune mumwe munhu. Kunetsa kunetsekana chikamu chehupenyu uye hakugone kuchinjwa, asi hunyanzvi hwekugadzirisa uye maitiro ekupindura kunetseka kunogona kuchinjwa (Flugel et al., 2010). McCracken naVelleman (2010) vakaratidza kuti kushanduka kwekuziva uye kufunga kwepamusoro kwakabatana nekutambura kushoma uye kuremara kune varwere. Varwere vane kurwadziwa kusingaperi nematanho epamusoro ekufunga vanotaura kushoma kwekushushikana, kushushikana, kushushikana uye kurwadziwa uye nekuvandudza mukuzvibata pamwe nehupenyu hwehupenyu. Morgan et al. (2013) kudzidza varwere veArthritis vakawana mhedzisiro yakafanana, zvekuti varwere vane huwandu hwakakwira hwekufunga vanotaura kudzikira kushushikana, kushushikana uye kuzvibata kwepamusoro uye hupenyu hwehupenyu. Sezvambotaurwa pamusoro apa zvaitarisirwa kuti kuderedzwa kwekurwadziwa muvarwere kunotungamira kudzikisira kutya uye kushushikana kwakabatana nemarwadzo uye nokudaro kunoderedza mhedzisiro yekukanganisa kushanda. Zvakare, mhedzisiro yezvidzidzo zvakati wandei (Cho, Heiby, McCracken, Lee, & Mwedzi, 2010; McCracken, Gauntlett-Gilbert, & Vowles, 2007; Rosenzweig et al., 2010; Schutz et al., 2010) zvinosimbisa kuwanikwa uku. .

 

Ongororo dzinoverengeka dzakaitwa kuti dziongorore kubudirira kwemhando dzakasiyana-siyana dzepfungwa dzinochengetwa pamarwadzo asingagumi, kusanganisira varwere vane misoro. Kusiyana nedzimwe tsvakurudzo dzakarongedza zvikamu zvisingaenzaniswi zvevarwere vane marwadzo asingagumi, zvakakosha zvekudzidza uku ndezvokuti, zvave zvichiitwa chete kune vanorwara vane musoro usingagumi.

 

Mukupedzisira, zvinofanirwa kubvumwa kuti kune zvimwe zvisingakwanisike muchidzidzo ichi senge saizi diki yemuenzaniso, kushomeka kwechirongwa chenguva refu yekutevera, kushandisa kwevatori vechikamu mishonga yekurapa; uye kunyangwe paine kuyedza kwevaongorori, kushomeka kwemishonga yakakwana yemishonga kune vese vatori vechikamu kunogona kuvhiringidza mhedzisiro yekuedza uye kuita kuti zviome kuwedzeredza mhedzisiro. Sezvo chidzidzo chiripo ichi chiri chekutanga cherudzi rwacho muvarwere vane chirwere chisingaperi muIran, zvinokurudzirwa kuti zvidzidzo zvakafanana zvinofanirwa kuitwa mundima iyi, zviine hukuru hwemuenzaniso sezvinobvira. Uye zvimwe zvidzidzo zvinotsvaga kudzikama kwemhedzisiro yekurapa mune yenguva-refu yekutevera-nguva yenguva.

 

mhedziso

 

Maererano nezvakawanikwa zvekudzidza uku zvinogona kugumiswa kuti nzira dzeMBS dzinowanzobudirira pazvinonzwisisika zvinorwadza uye hunhu hwehupenyu hwevarwere vane hutano husingaperi. Kunyangwe kwakanga kusina kuwirirana kunokosha mune zvimwe zvikamu zvehupenyu hwehupenyu, zvakadai sekushanda kwepanyama, kurerutsa kunokonzerwa nematambudziko emanzwiro uye mararamiro evanhu, asi kuchinja kukuru kwechirevo kwakakosha kuchidzidzo. Nokudaro kubatanidzwa kweBMSR kurapwa nekodzero yekurapa kurapwa muhutano hwehutano hwevarwere vane hutano husingaperi hunogona kurayirwa. Mutsvakurudzi anotendawo kuti pasinei nekukanganisa nekushayikwa kwekutsvakurudza kwezvino, chidzidzo ichi chinogona kuva nzira itsva yekurapa kwepfungwa dzisingagumi uye inogona kupa hutsva hutsva mundima iyi yekurapa.

 

KUTENDA

 

Iyi tsvakurudzo yakatsigirwa (seyiyo tsananguro) muchidimbu neZahedan University yeAradic Sciences. Tinoda kuonga vatori vechikamu vose mukudzidza, vaporesi vomunharaunda, vashandi vezvipatara- Ali -ebn-abitaleb, Khatam-al-anbia na Ali asghar- nekuda kwekutsigirwa kwavo uye rubatsiro.

 

Mukupedzisa,Irchiropractic kuchengetedza ndeye yakachengeteka uye inoshanda imwe nzira yekurapa sarudzo inoshandiswa kubatsira kuvandudza pamwe nekugadzirisa isingagumi misoro zviratidzo nekungwarira uye zvinyoronyoro kugadzirisa musana pamwe nekupa kushushikana manejimendi nzira uye matekinoroji. Nekuti kushushikana kwave kuchisanganiswa nemhando dzakasiyana dzehutano, kusanganisira subluxation, kana kusarongeka kwemuzongoza, uye kusingaperi kwemusoro, kupindira kwepfungwa senge chiropractic kuchengetedza uye nekufunga-kwakavakirwa kunetsekana kwekushushikana (MBSR) kwakakosha kune kusingaperi kwemusoro. Pakupedzisira, chinyorwa chiri pamusoro chakaratidza kuti MBSR inogona kunyatsoshandiswa sekupindira kwepfungwa kwekusingaperi kwemusoro uye nekuvandudza hutano hwese uye hutano. Ruzivo rwunotsanangurwa kubva kuNational Center yeBiotechnology Ruzivo (NCBI). Chiyero cheruzivo rwedu chinogumira kuchiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kutibata nesu pa 915-850-0900 .

 

Yakarongedzwa naDkt Alex Jimenez

 

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

 

Zvimwe Zvinyorwa: Kubva Painini

 

Maererano nehuwandu, inenge 80% yevanhu ichaona zviratidzo zvekurwadziwa shure shure kamwechete munguva yeupenyu hwavo hwose. Kutambudzika shure ndiko kunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Kazhinji kacho, kuora kwechimiro chemupaka nezera kunogona kukonzera marwadzo kumashure. Herniated discs inoitika apo ganda rakanyorova, segel-like re intervertebral disc rinodonha nekubvarura mukati maro, rinenge riri kunze kwekatekete, kubvongodza nekugumbura midzi midzi. Dhizinesi dzinozivikanwa dzinowanzoitika kumucheto kumashure, kana kuti nhengo dzomukati, asi dzinogonawo kuitika pamucheto wepervical, kana mutsipa. Kuiswa kwemitsipa inowanikwa mucheka shure nekuda kwekukuvara uye / kana mamiriro akaoma kunogona kutungamirira kune zviratidzo zve sciatica.

 

blog chinyorwa chekartoon paperboy makuru makuru

 

NHAURWA INOKOSHA INOKOSHA: Kutarisira Kushungurudzika Kwebasa

 

 

ZVIMWE ZVINOKOSHA ZVINOKOSHA: KUDZIDZA KUNYANYA: Kutsaona Kwemotokari Kurapa El Paso, TX Chiropractor

 

Hazvina kuchena
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Close Accordion
Kuchenjerera Kwemusoro neCervical Disc Herniation muEl Paso, TX

Kuchenjerera Kwemusoro neCervical Disc Herniation muEl Paso, TX

by | Mamiriro Ekutongwa, Herniated Disc, Randomized Controlled Trial, kushushikana, Mishonga

kushushikana inokonzerwa nemuviri wemunhu "kurwisana kana kutiza," chiitiko chekuzvidzivirira chinokonzerwa nenyasha dzekunzwira tsitsi (SNS). Kushungurudzika chinhu chinokosha chekugara. Apo kushungurudzika kunobatsira kurwisana kana kupindura kwendiza, musanganiswa wemakemikari nemahomoni zvakachengetwa muropa rekuyerera, izvo zvinogadzirira muviri kuti uone dambudziko. Kunyange zvazvo kupera kwenguva pfupi kushungurudzika kunobatsira, zvakadaro, kwenguva refu kushungurudzika kunogona kutungamirira kune zvakasiyana-siyana zvehutano. Uyezve, kushungurudzika munharaunda yemazuva ano kwachinja uye zvave zvakaoma kuti vanhu vagadzirise kushungurudzika kwavo uye varambe vachifunga.

 

Kushungurudzika Kunobatsira Sei Mutumbi?

 

Kushungurudzika kunogona kuonekwa kuburikidza nenzira nhatu dzakasiyana-siyana: manzwiro; muviri uye zvakatipoteredza. Kushungurudzika mupfungwa kunosangana nemamiriro ezvinhu akaipa anokanganisa pfungwa dzedu nekuita zvisarudzo. Kushungurudzika kwemuviri kunosanganisira kudya kwakashata uye kusava nehope. Uye pakupedzisira, kushungurudzika kwezvakatipoteredza kunoitika kunobva pane zvakaitika kunze. Paunoona chero ipi zvayo yemhando dzezvinonetsa, hurongwa hwekutambudzika huchaita kuti "kurwisana kana kutiza," kurega adrenaline uye cortisol kuwedzera kukurumidza kwemwoyo uye kusimudzira pfungwa dzedu kutiita kuti tive vakangwarira kuitira kuti titarisana nemamiriro ezvinhu mberi kwedu .

 

Zvisinei, kana kuonekwa kunetseka kunogara kuripo, SNS yekurwisana kana kupindura kwemhepo kunogona kuramba kuchiita. Kushungurudzika kwenguva refu kunogona kutungamirira kune zvakasiyana-siyana zvehutano, zvakadai sokuzvidya mwoyo, kuora mwoyo, kushungurudzika kwemasumbu, kurwadziwa kwemutsipa uye kumashure, zvinetso zvekudya, kuwedzera kuwedzera uye zvinetso zvekurara uyewo kusakanganwa mupfungwa nekufungisisa. Mukuwedzera, kushungurudzika kwemisungo pamwe nomukaka nokuda kwekumanikidzika kunogona kukonzera kusaruramisa kwemusana, kana kuti subluxation, iyo inogona kutungamirira kukonzera kudzivirira.

 

Headache uye Disc Herniation kubva kunetseka

 

Dhayi rearniated rinowanikwa apo ganda rakanyorova, segel-like re intervertebral disc rinopfurikidza nekubvarura mukati maro, rinoteterera remheteti, rinogumbura uye rinokonzera mutsara wesimbi uye / kana nhengo midzi. Disc herniation inowanzoitika mumutsipa wekervical, kana mutsipa, uye mumakumbo emakumbo, kana kumashure kumashure. Zviratidzo zvemabhadharo e-herniated zvinotarisana nenzvimbo yekudzvinyirira pamwe nomukaka. Uturu hwemitsipa uye marwadzo ekudzokera shure pamwe chete nekushaya simba, kushungurudzika uye kushaya simba pamwe chete nepamusoro nepamusoro kune dzimwe zviratidzo zvinowanzobatanidzwa ne disc disclaimer. Musoro uye migraine zvakare zviratidzo zvinowanzobatanidza nekudzvinyirira uye ma-disnied discs pamwe nemucheto wepervical, semugumisiro wekushungurudzika kwemusana uye kusasarudzwa kwemusana.

 

Kufungisisa Kwepfungwa Dzekutambudzika Kwepfungwa

 

Kushungurudzika manejimendi kwakakosha pakuvandudza pamwe nekuchengetedza hutano hwese uye hutano. Zvinoenderana nezvidzidzo zvekutsvagisa, kupindira kwepfungwa, senge chiropractic kuchengetedza uye kufunga-kunetseka kunetseka (MBSR), pakati pevamwe, kunogona zvakachengeteka uye zvinobudirira kubatsira kudzikisira kushushikana. Chiropractic kuchengetedza inoshandisa kugadziriswa kwemuzongoza uye manyorerwo ekunyatso dzoreredza kuenderana kwepakutanga kwemuzongoza, kubvisa marwadzo uye kusagadzikana pamwe nekurerutsa mhasuru kushushikana. Pamusoro pezvo, chiropractor inogona kusanganisira marongero ehupenyu kubatsira kubatsira kuwedzera zviratidzo zvekushushikana. MBSR inogona zvakare kubatsira kudzikisa kushushikana, kushushikana uye kushushikana.

 

Taura nesu Nhasi

 

Kana uri kuona zviratidzo zvekunetseka nemusoro kana kuti migraine pamwe nemarwadzo emutsipa uye kumashure anokonzerwa ne disc disclaimer, kupindira kwepfungwa zvakadai sechiropractic kuchengetwa kunogona kunge yakachengeteka uye yakagadzikana kurapwa kwekunetseka kwako. Dhiyabhorosi Alex Jimenez kushungurudza kushanda kwepfungwa kunogona kukubatsira kuti uwane hutano hwakakwana uye hukama hwakanaka. Kutsvaka nzira dzakakodzera dzekufunga kunogona kukupa ruzivo rwunofanirwa. Chinangwa chenyaya inotevera ndechekuratidzira migumisiro yekufunga-yakakonzerwa nekuderedzwa mupfungwa muvarwere vane dambudziko remusoro. Usangobata zviratidzo zvacho, enda kune zvinobva panhau yacho.

 

Migumisiro Yechenjeri-Yakadzika Kuderedza Kushushikana Pamusoro Pokunetseka Kwepfungwa uye Mafungiro Ehutano Muvarwere vane Mhirizhonga Musoro

 

ngovepo

 

Background: Zvirongwa zvekuvandudza nzvimbo yehutano hwevarwere vane chirwere chinosangana nemarwadzo, akadai senyoka, vanowanzove vachiri mucheche. Kufunga-based based stress reduction (MBSR) chirwere chitsva chepfungwa chinoratidzika sechakabudirira mukurapa kurwadziwa kusingaperi uye kushungurudzika. Ichi chiongorori chakaongorora kubudirira kweMBSR mukurapa kwekunzwisisa kunetseka uye utano hwepfungwa hwekwereti uyo ane dambudziko rekushaya musoro.

 

Zvinhu uye Nzira: Ichi chidzidzo nderwendo rwechipatara rusinganzwisisiki. Vatanhatu makumi matanhatu vane chirwere chinokonzerwa nehutano hwepamusoro maererano neInternational Headache Classification Subcommittee vakangoerekana vapiwa muboka reTrament As Usual (TAU) kana boka rekuongorora (MBSR). Bhuku re MBSR rakagamuchira masereji masere ekirasi vese vaine madiki 12-min. Zvirongwa zvaive zvakatangira paMBS protocol. Brief Symptom Inventory (BSI) uye Yakanzwisisika Stress Scale (PSS) yakashandiswa mushure mekupedzisira uye shure kwenguva refu uye pamwedzi 3 kutevera mapoka ose.

 

Results: Zvinoreva huwandu hwakazara hweBSI (global solidity index; GSI) muboka reMBSR yaive 1.63 0.56 kupindira kusati kwadzikira zvakanyanya kusvika ku0.73 0.46 uye 0.93 0.34 mushure mekupindira uye pamasangano ekuteedzera, zvichiteerana ( P <0.001). Mukuwedzera, boka reMBSR rakaratidza zvishoma zvishoma pakuona kunetseka pakuenzanisa neboka rinodzora pakuongorora kwekupedzisira. Izvo zvinoreva kushushikana kusati kwaonekwa kupindira kwaive 16.96 2.53 uye yakashandurwa ikave 12.7 2.69 uye 13.5 2.33 mushure mekupindira uye panguva dzekutevera, zvichiteerana (P <0.001). Kune rimwe divi, zvairehwa neGSI muboka re TAU yaive 1.77 0.50 pakufunga kwekutanga iyo yakadzikiswa zvakanyanya kuita 1.59 0.52 uye 1.78 0.47 pakuposita uye nekutevera, zvichiteerana (P <0.001). Zvakare, zvinorehwa nekushushikana kunoonekwa muboka re TAU pakumhangara kwaive 15.9 2.86 uye izvo zvakashandurwa kuita 16.13 2.44 uye 15.76 2.22 pakuposta nekutevera, zvichiteerana (P <0.001).

 

mhedziso: MBSR inogona kuderedza kushungurudzika uye kuvandudza utano hwepfungwa huzhinji kune varwere vane dambudziko rekushaya musoro.

 

Keywords: Utano hwepfungwa, kusuruvara kwepfungwa, pfungwa-based based stress reduction (MBSR), kunetseka kunonzwisisika, kurapwa sezvinowanzoitwa (TAU)

 

Dr Jimenez White Coat

Dr. Alex Jimenez's Insight

Chiropractic kuchengetedza inoshanda yekugadzirisa kurapwa kwepfungwa nokuti inotarisa pamusana, iyo ndiyo nheyo yenheyo yenheyo. Chiropractic inoshandisa kugadziriswa kwepelinha uye nzira dzekushandisa kuitira kunyatsogadzirisa kuwirirana kwemupaka kuitira kuti muviri ugozviratidza kuti unoporesa. Kusaruramisa kwepelinha, kana kugunun'una, kunogona kukonzera kukanganiswa kwemashure pamwe nomukomana uye kunotungamirira kune zvakasiyana-siyana zvehutano, kusanganisira misoro uye migraine, uye disc disclaimer uye sciatica. Chiropractic kuchengetedza inogonawo kusanganisira mararamiro ekuvandudza mararamiro, zvakadai sekupa mazano ezvekudya uye maitiro anokurudzira, kuti uwedzere kuwedzera migumisiro yaro. Kufungidzira-based based stress reduction kunogonawo kubudirira kubudirira nekugadzirisa kutarisira uye zviratidzo.

 

ziviso

 

Kushungurudzwa musoro kunokonzera 90% yemusoro wemusoro. Panenge ne3% yevanhu vari kutambura nekusagadzikana kwepfungwa musoro. [1] Mhirizhonga misoro inowanzobatanidzwa nehutsika hwehupenyu hwehupenyu uye hurefu hwakanyanya hwepfungwa dzisina kugadzikana. [2] Mumakore achangopfuura, meta dzakawanda-dzinoongorora kuongorora maitiro ekurwadziwa kwakagadziriswa anoshandiswa nhasi vakaratidza kuti kurapwa kwezvokurapa, izvo zvingave zvinobudirira mukurwadziwa kwakanyanya, hazvibudiriri nekurwadziwa kusingaperi uye zvingangodaro, zvichikonzera zvinetso zvinowedzera. Nzira dzakawanda dzemarwadzo ekurwadziwa dzakagadzirirwa uye dzinobatsira pakurwadziwa kwakanyanya asi kana dzichishandiswa munguva refu dzinogona kuumba zvinetso zvakadai sekushandisa zvinodhaka nekudzivisa mabasa anokosha. [3] Chimwe chinhu chinowanikwa mumatambudziko akawanda ekurwadziwa ndeokuti vanosimbisa pane kana kudzivisa kurwadziwa kana kurwisana kuti kuderedze kurwadziwa. Kurwadziwa kwekutambudzika kwepfungwa kunogona kusinganzwisisike. Painkillers uye mazano ekugadzirisa zvinorwadza zvinogona kuwedzera kusawirirana uye kunzwisisika kunorwadza. Nokudaro, kurapwa kunowedzera kugamuchirwa nekutsungirira kune marwadzo, kunyanya kurwadziwa kusingaperi, kunobudirira. Kufunga-based based stress reduction (MBSR) inonzi psychotherapy itsva inoita seinobudirira mukuvandudza mararamiro emagariro uye kugadzikana kwepfungwa mune varwere vane marwadzo asingagumi. [4,5,6,7,8] Mumakore makumi maviri adarika, Kabat-Zinn et al. muUnited States vakabudirira kushandisa mafungiro ekuzorodza marwadzo uye zvirwere zvakabatana nemarwadzo. [9] Zvidzidzo zvenguva pemaitiro ekugamuchirwa, zvakadai sekufunga, zvinoratidza kuvandudzika kwekuita kune varwere vane kurwadziwa kusingaperi. Kungwarira kunogadzirisa marwadzo usingashandisi pfungwa dzese dzenharo, manzwiro uye manzwiro, uye hukama hwepfungwa hunoparadzana nehumukati nekunze ruzivo. [10] Zvidzidzo zvakawana kuti chirongwa cheMBS rinogona kuderedza zvikuru zvirwere zvehutano zvine chokuita nemarwadzo asingagumi sefibromyalgia, rheumatoid arthritis, isingaperi mushuloskeletal kurwadziwa, kusagadzikana kunorwadza shure, uye multiple sclerosis. [7,11,12,13] MBSR ine kuchinja kukuru mukurwadziwa kwakanyanya, kushungurudzika, kuora mwoyo, kunyunyuta kunetseka, kufanana, kumira, kunaka kwekurara, kuneta, uye kubata muviri. [6,14,15,16,17] Asi mapurogiramu ekuvandudza mararamiro ehutano evarwere vane chirwere chinokonzerwa nemarwadzo, akadai sekurwadziwa musoro musoro, vanowanzove vachiri mucheche. Nokudaro, chidzidzo chacho chakaitwa kuti chiongorore migumisiro yeBSSR pamusana pekufungidzika kunetseka uye hutano hwehutano mune varwere vane dambudziko rekushaya musoro.

 

Zvinhu uye Nzira

 

Iyi kiriniki yakarongedzwa kiriniki kutongwa kwakaitwa mu2012 muShahid Beheshti Hospital muKashan City. Yekutsvagisa Ethics Committee yeKashan University yeMedical Sciences yakabvumidza chidzidzo ichi (IRCT Kwete: 2014061618106N1). Ivo vatori vechikamu vechidzidzo vaisanganisira vanhu vakuru vane tension headache avo vakaendeswa nevarapi vezvepfungwa uye neurologists muKashan. Maitiro ekubatanidzwa aive anotevera: Kuva nemusoro wekushushikana zvichiteerana neInternational Headache Classification Subcommittee, inoda kutora chikamu muchidzidzo ichi, isina chirwere chekuongororwa kwe organic brain disorder kana psychotic disorder, uye isina nhoroondo yekurapwa kwepfungwa munguva yapfuura 6 mwedzi. Varwere vasina kupedzisa kupindira uye vakapotsa zvinopfuura zvikamu zviviri vakasiyiwa muchidzidzo. Vatori vechikamu, avo vakasaina fomu rekubvuma rine ruzivo, vakapedzisa matanho sekufungidzira. Zvekufungidzira saizi yekuyera, isu takareva kune kumwe kuongorora uko shanduko mukureva kwekuwanda kwekuneta yaive 62 9.5 munguva yekuzvigadzirira uye 54.5 11.5 munguva yekumashure yekurapa. [18] Zvino, nekushandisa muyero saizi kuverenga, vatori vechikamu makumi matatu nematatu (vane njodzi yekukwezva) muboka rega rega vane? = 33 uye 0.95 ? = 1 dzakaparadzaniswa. Mushure mekuyera saizi kuverenga, 0.9 varwere vane tension headache vakasarudzwa kuburikidza neyakareruka sampling zvinoenderana neyakaisirwa maitiro. Ipapo, varwere vakadaidzwa uye vakakokwa kuti vatore chikamu muchidzidzo ichi. Kana murwere akabvuma kutora chikamu, iye aibva akokwa kuti apinde muchirongwa chekupfupikisa uye kana pasina mumwe murwere akasarudzwa zvakafanana. Zvino vachishandisa tafura yenhamba isina kujairika, ivo vakagoverwa kungave kuboka rekuyedza (MBSR) kana kuboka rinodzora raibata senguva dzose. Pakupedzisira, varwere ve66 vakasarudzika kubva muboka rega uye varwere ve3 vakasanganiswa (60 varwere muboka rega rega). Boka re TAU rakarapwa chete nemishonga yekudzvinyirira uye kiriniki manejimendi. Boka reMBSR rakagamuchira MBSR kudzidziswa mukuwedzera kune TAU. Varwere veboka reMBSR vakadzidziswa kwemavhiki masere nekiriniki yezvepfungwa nePhD degree. Iyo Pfupi Chiratidzo Inventory (BSI) uye Yakanzwisisika Stress Scale (PSS) yakapihwa pamberi pekutanga kurapwa chikamu muboka reMBSR, mushure memusangano wechisere (posttest), uye mwedzi mitatu mushure mekuyedzwa (kuteedzera) mumapoka ese ari maviri. Boka re TAU rakakokwa kuShahid Beheshti Hospital kunozadza mibvunzo. Mufananidzo 30 unoratidza Consolidated Maitiro Ekubika Miedzo (CONSORT) dhizaini inoratidza kuyerera kwevadzidzi vechidzidzo.

 

Mufananidzo 1 CONSORT Diagram Ichiratidza Kuyerera Kwechidzidzo Vadzidzi

Mufananidzo 1: KUTAURA chirevo chinoratidza kutenderera kwevadzidzi vanenge vachidzidza.

 

Kupindira

 

Boka rekupindira (MBSR) rakadzidziswa muShahid Beheshti Hospital. Iwo masere masere evhiki (120 min) akaitwa zvinoenderana neyakajairwa MBSR protocol sekuvandudzwa kwakaitwa Kabat-Zinn. [11] Zvimwe zvikamu zvakaitwa kune ivo vatori vechikamu avo vakapotsa imwe kana maviri zvikamu. Pakupera kwekudzidziswa uye nemwedzi mitatu gare gare (kuteedzera), ese maMBSR uye maTUU mapoka akakokwa ku Shahid Beheshti Hospital (nzvimbo yekutongwa kweMBSR) uye vakarairwa kupedzisa mibvunzo. Munguva yezvikamu zveMBSR, vatori vechikamu vakadzidziswa kuti vazive mafungiro avo, nemanzwiro avo, uye nemanzwiro epanyama zvisina mhosva. Kungwarira kurovedza muviri kunodzidziswa senzira mbiri dzekufungisisa - zvepamutemo uye zvisina kurongwa. Yemaitiro erudzi maitiro anosanganisira akadzidziswa kugara pasi kufungisisa, kuongorora muviri, uye kufunga nezveyoga. Mukufungisisa zvisina kurongwa, kutarisisa nekuziva hazvitariswi pane zvinoitwa zvezuva nezuva chete, asi zvakare nepfungwa, manzwiro, uye kunzwa kwemuviri kunyangwe zvichinetsa uye zvichirwadza. Izvo zvese zvemukati memisangano zvakataurwa muTafura 3.

 

Tafura 1 Agendas for Sessions ye MBSR

Tafura 1: Agendas yezvikamu zvekufunga-zvakakonzerwa nekuderedza kunetseka.

 

Meji Tools

 

Kushandiswa kweMusoro kweMusoro weChechetti Subcommittee Diary Scale for Headache

 

Musoro waive uchienzaniswa nehuwandu hwemashoko ehutu hwemusoro. [19] Varwere vakabvunzwa kuti vanyore marwadzo ekunyanyisa kwemaari pane imwe nhamba ye 0-10. Kusava nemarwadzo uye kunyanya kunetseka kwepfungwa kunokonzerwa ne 0 uye 10, maererano. Izvo zvinoreva kuora musoro kwemavhesi muvhiki zvakabatanidzwa nekuparadzanisa chikamu chekuoma kwezvizhinji ne7. Uyezve, zvinoreva kusuruvara kwepfungwa mumwedzi kwakaverengwa nekuparadzanisa chikamu chekuoma kwezvizhinji ne30. Izvo zvishoma uye zvikamu zvakanyanya zvekuchema kwepfungwa zvakange zviri 0 uye 10, maererano. Headache diary yakapiwa vashanu varwere uye nyanzvi yezvepfungwa uye chiremba wezvepfungwa akasimbisa zvakagadzirwa nehutano hwechiridzwa. [20] Kuvimbika kweiyo yePersian version yechiyero ichi kwakaverengwa se0.88. [20]

 

Chiratidzo pfupi Inventory (BSI)

 

Zviratidzo zvepfungwa zvakaongororwa neBSI. [21] Iko kuverenga kune zvinhu makumi mashanu nematatu uye zvipfumbamwe zvakapetwa zvinoongorora zviratidzo zvepfungwa. Chinhu chimwe nechimwe chinoverenga pakati pe53 ne9 (semuenzaniso: Ndine shungu kana kugumbuka mudumbu mangu). BSI ine yepasi rose yakasimba index (GSI) yakawana huwandu hwakazara hwezvinhu makumi mashanu nematatu. Kuvimbika kwebvunzo kwakazivisa mamakisi e0. [4] Muchidzidzo chedu, GSI test retest fungidziro yaive .53 yakavakirwa pamuenzaniso wevarwere makumi matanhatu vane tension headache avo vakapedza iyo BSI.

 

Kuona Kunetseka Kwepfungwa (PSS)

 

Kunetsekana kwakanzwisisika kwakaongororwa uchishandisa iyo PSS, [21,23] chiyero chechinhu-gumi chinoongorora mwero wezviitiko zvisingadzoreke uye zvisingafungidzike zvehupenyu mumwedzi wapfuura (semuenzaniso: Wainzwa kuti wanga usingakwanise kudzora zvinhu zvakakosha muhupenyu hwako. ?). Vakapindura vanotaura kuwanda kwechinhu mukati memwedzi wapfuura pachiyero che10-poindi, kubvira 5 (never) kusvika 0 (kazhinji). Kugovera kunopedziswa nekumisikidza zvibodzwa zvezvinhu zvina zvakanaka zvine mavara [4] uye kupfupisa zvese zviyero zvezvinhu. Chiyero zvikero zvinotangira kubva pa4,5,7,8-0. Zvikoro zvepamusoro zvinoratidza huwandu hwepamusoro hwekushushikana. Iyo inofungidzira kuti vanhu zvinoenderana nekwavo kwekubata zviwanikwa vanoongorora danho rekutyisidzira kana kunetsa zviitiko Chikamu chepamusoro chinoratidza mwero wakakura wekufungisisa. [Yakakwana] test retest kuvimbika uye kushanduka uye kusarura huchokwadi zvakataurwa zvakare. [40] Mukudzidza kwedu, alpha coefficients yeCronbach yekutarisa kusagadzikana kwemukati kwechiyero ichi yakaverengerwa kuva 19.

 

Izvo zvinodzokororwa matanho ekuongororwa kwekusiyana kwakaitwa kuenzanidza maBlue MBSR neTUU pamusoro pehutano hwekufungidzirwa kunetseka neGSI pakutangira, kutora shure, uye mwedzi we3 kutevera. Uyewo, chi-chiyero chepamusoro chakashandiswa kuenzanisa nhamba dzevanhu mumapoka maviri. P inokosha kudarika 0.05 yaifungidzirwa inokosha mukuedzwa kwose.

 

Results

 

Pakati pezvidzidzo zve66, vatori vechikwata 2 vanobva muboka reMBSR vakanga vasisipo nekuda kwekushayikwa kupfuura zvikamu zve2. Uyezve, vatatu vatora chikamu vakaiswa kunze kwekuti havana kuzadzisa mibvunzo yepamushure pekuedzwa kana kutevera uyo mumwe wavo aibva kuboka reMBS uye vatatu vatora kubva ku TAU. Tafura 2 yakaratidza maitiro evanhu vane zvidzidzo uye zvigumisiro zvekuongorora randomization. Migumisiro ye t-kuedza kwekusiyana pakati peboka reMBSR ne TAU panguva yakasiyana-siyana uye Chi-square test mune zvimwe zvinoshandiswa zvakaratidza kuti pakange pasina misiyano yakakura pakati pezvinyorwa zvevanhu mumapoka maviri uye zvidzidzo zvacho zvakapiwa mapoka maviri.

 

Tafura 2 Dhiyabhorosi Zviratidzo zveZvikamu

Tafura 2: Nhamba dzehuwandu hwehuwandu hwemashoko a, b.

 

Tafura 3 inopa zvinorehwa zvinorehwa uye zvakasiyana-siyana kusiyana kwezvimwe zvinotarisirwa (zvinonzwisisika kunetseka neGSI) uye kuenzanisa migumisiro yemigumisiro munguva yekutangira nguva, mushure mekurapa, uye mwedzi we 3 kutevera.

 

Tafura 3 Zvinoreva, Kusiyanisa Kwakafanana uye Kuenzanisa Mitezo yeMigumisiro

Tafura 3: Zvinoreva, kukanganisa kwakakwana, uye kuenzanisa migumisiro yehutachiona pakutanga kufambidzana, kushandiswa shure, uye kutevera-matanho mumabhangi eMBSR uye TAU a, b.

 

Tafura 3 inoratidza kuwedzera kuderedzwa kwekunetseka kwakatambirwa uye GSI muboka rekupindira (MBSR) zvichienzaniswa neboka re TAU, nepo kudzikisira kwekugashira kwakatambirwa uye GSI isina kucherechedzwa muboka re TAU. Mhedzisiro yacho yakaratidza kukosha kwenguva uye kudyidzana pakati penguva nemhando yekurapa pane shanduko yezvikoro (P <0.001).

 

Mifananidzo? 2 uye? 3 yazvino inoreva kutambira kunetsekana uye GSI mamaki eMBSR uye TAU mapoka panguva dzepashure uye dzekutevera-nhanho.

 

Mufananidzo 2 CONSORT Diagram Ichiratidza Kuyerera Kwechidzidzo Vadzidzi

Mufananidzo 2: KUTAURA chirevo chinoratidza kutenderera kwevadzidzi vanenge vachidzidza.

 

Mufananidzo 3 Mafungiro Anokonzerwa Kunetseka muMBSR uye Kuronga Ma Groups

Mufananidzo 3: Nenzira yekuona kunetseka muMBSR uye kutonga mapoka mumasangano ekutanga, ekupedzisira, nekutevera.

 

hurukuro

 

Ichi chidzidzo chakafananidza kubudirira kweMBSR uye Treatment As Usual (TAU) mukuona kunetseka uye utano hwepfungwa hwevarwere vane dambudziko rekushaya musoro. Kunyange zvazvo MBSR ichizivikanwa semushonga unobudirira wezvirwere zvepfungwa uye marwadzo, kune chikonzero chekuongorora kubatsira kwayo mukurapa kwehutano hwepfungwa mupfungwa kune varwere vane dambudziko remusoro, izvo ndezvimwe zvekunyunyuta kwevanhu.

 

Zvakawanikwa zvekudzidza kwedu zvinoratidzira hutano hwehutano hwehutano muGSI index yeBSI. Mune zvimwe zvidzidzo, kuve nekuvandudzika kwakakosha kuburikidza nehupindiro hweMBSR hwakataurwa pamusoro pezvikamu zvose zveC36-item Short Form Health Survey (SF-36). [20,24] Zvidzidzo zvakaratidza kuderedza kuderedzwa kwezvinetso zvepfungwa mune Symptom Checklist-90-Revised (SCL- 90-R) subscale zvakadai sokuzvidya mwoyo uye kuora mwoyo kweMBSR mushure mokupindira uye 1-gore kutevera. [5] Reibel et al. yakaratidza MBSR kune varwere vane marwadzo asingagumi vakarondedzera kuderera kwezviratidzo zvehutano zvakadai sokuzvidya mwoyo, kuora mwoyo, uye kurwadziwa. [5] Zvave zvichiratidza kuti kusuruvara kwepfungwa uye kushungurudzika kunopesana nekuderera mukutaridzirwa kugadziriswa kushandiswa kwakafanana nekuchengetedzwa kwekucherechedza uye kushanda memori. [25] Manzwiro asina kunaka anogona kukurudzira kutambura kunosangana nekunzwa kurwadziwa.

 

MBSR inoshandisa nzira dzinotevera dzekuvandudza mamiriro emurwere: Chekutanga, kufunga kunotungamira mukuwedzera kuziva nezve izvo zviri kuitika mune imwe nhambo, uine hunhu hwekubvuma, pasina kubatwa mune zvakajairwa pfungwa, manzwiro, uye maitiro maitiro. Kuwedzera kwekuziva uku kunobva kwaunza nzira nyowani dzekupindura nekugadzirisa zvinoenderana newe uye nenyika yakatenderedza. [3] Kungwarira kunosimbisa pfungwa yako pachayo inopfuura mifungo, manzwiro, uye kunzwa kwemuviri sekurwadziwa. Kungwarira kurovedza muviri, vatengi vakadzidza vanokudziridza kuzvicherechedzo . Nekwaniso iyi, vanogona kucherechedza zvavanofunga nemanzwiro avo nenzira isingadzoreke uye isina mhosva iyo yaimbodziviswa, iyo yaimbodzivirira pfungwa nemanzwiro zvichionekwa nenzira isingashande uye isina kutonga. Vatengi vanodzidza kucherechedza pfungwa vasina hazvo kuzviita, kudzorwa navo, kana kudavirwa navo. [3]

 

Chechipiri, kufunga kunobatsira mutengi kuti awedzere kushingaira mukutora matanho mumitemo inokosha inokosha kwavari. Vazhinji nevatengi vane marwadzo asingagumi vanoda kushungurudzwa pasina pane kurarama hupenyu hunokosha hwekusarudza kwavo. Asi chirongwa cheMBSR chakavadzidzisa kuita basa rinokosha pasinei nemarwadzo. Zvidzidzo zvakaratidza kutarisa uye manzwiro ekurwadziwa kunorwadza zvine basa rinokosha mukuramba uchirwadziwa. [26] Mwoyo nemanzwiro ekugadzirisa zvinhu zvinogona kutarisa kurwadziwa nekuzvidya mwoyo pamusoro pazvo zvinogona kuwedzera kurwadziwa nekuvhiringidza varwere mabasa. [27,28]

 

Chechitatu, zvakawanikwa kubva kune dzimwe tsvakurudzo zvinoratidza kuti MBSR inogona kuchinja basa reropi iyo inokonzera kukanganisa mitemo uye nzvimbo dzinotungamira maitiro atinoita pamagariro anokonzera, uye izvi zvinogona kuita kuti zviratidzo zvemuviri zvive zvakadai sekufema, kushaya mwoyo, uye [29,30] Kufungidzira tsika kunowedzera kugadzirisa kuitika kune pfungwa dzinoshungurudza uye manzwiro anonyadzisa uye anosimbisa kurwadziwa kunzwisisika. [31] Uyewo kufunga kunogona kuderedza pfungwa dzepfungwa dzakagadziriswa dzinokonzerwa nekuzvidya mwoyo uye kusagadzikana kwemaitiro kuburikidza nekusimbisa kukwanisa kuongororazve uye kudzidzisa mazano ekufunga. [32]

 

Simba rekudzidza iyi kushandiswa kwehutano hunobudirira hwepfungwa mukuderedza kushungurudzika kwekunyunyuta kusina kudzidza, asi chirwere chinowanzobatwa nehutano. Zvinorehwa nekudzidza kwedu zviri kushandisa psychotherapy ine nyore iyo isingakonzere chikonzero chekufungisisa uye inoshandiswa nyore sehutano hunoshandiswa nemurwere ane hutano hwemusoro. Saka, vashandi vehutano vanofananidza nekunyunyuta uye murwere achakwanisa kushandisa mushonga uyu. Uyewo, MBSR ichashandura mararamiro emurwere uyo angave akawedzerwa nechinetso chake. Chimwe chikamu chikuru chekudzidza uku kwaiva kusashaikwa kwekuenzanisa pakati peMBSR uye yegoridhe yepamusoro yepfungwa dzepfungwa dzakadai sekuziva kugadzirisa maitiro therapy (CBT). Zvinoratidzwa kuti zvidzidzo zvemangwana zvinoda kuenzanisa kushanda kweMBSR nedzimwe tsika dzedzinza uye itsva dzekuita maitiro muvarwere vane dambudziko rekushaya musoro.

 

mhedziso

 

Kudzidza kwedu kunotsigira pfungwa yokuti varwere vanotambura nehutano hwemusoro vanogona kusimbisa hutano hwavo hwepfungwa nekupinda muchirongwa cheMBSR. Mukupfupisa, zvikamu zvekudzidza ikozvino zvinoratidza kuti MBSR inogona kuderedza kushungurudzika-kunetseka kunetseka uye kupindira mumabasa ezuva nezuva munguva pfupi. Iyo yakasiyana-siyana yemafungiro ekufungisisa ari nyore kudzidziswa uye hapana chikonzero chekuoma kunzwisisa kwezvakanaka.

 

Sangano rezvemari uye kubatsiririra: Nil.

 

Kurwisana kwekufarira: Hakuna kukakavara kwekufarira.

 

Munyori Wechipo

 

AO yakazvipira mukufungidzira kwebasa racho, kuitisa chidzidzo, uye kubvumirana kwezvinhu zvose zvebasa racho. FZ yakabatanidzwa mukugadzirisa kwebasa racho, kuongororazve zvinyorwa, kubvumirwa kwekupedzisira kwebhuku racho uye kubvumirana kwezvinhu zvose zvebasa racho.

 

Kutenda

 

Vanyori vanoonga kuvashandi veShahid Beheshti Hospital uye vatori vechikamu. Vanyori vanoratidzawo kuvonga kwaKatat-Zinn kubva kuCent for Mindfulness (CFM) paYunivhesiti yeMassachusetts avo vakagamuchira nemakopi emagetsi emitemo yeMSR.

 

Mukupedzisa,Stressapo kushushikana-kwenguva pfupi kunobatsira, kushushikana kwenguva refu kunogona kupedzisira kwaendesa kune akasiyana ehutano nyaya, kusanganisira kushushikana uye kushushikana pamwe nemutsipa uye musana kurwadziwa, musoro uye disc herniation. Neraki, kupindira kwepfungwa, kwakadai sechiropractic kuchengetedza uye kufunga-kwakavakirwa kuderedzwa kunetseka (MBSR) kwakachengeteka uye kunoshanda manejimendi manejimendi dzimwe nzira dzekurapa. Chekupedzisira, chinyorwa chiri pamusoro chakaratidza humbowo-hwakavakirwa mhedzisiro iyo MBSR inogona kudzora kushushikana uye nekuvandudza hutano hwepfungwa kune varwere vane kushushikana kwepfungwa. Ruzivo rwunotsanangurwa kubva kuNational Center yeBiotechnology Ruzivo (NCBI). Chiyero cheruzivo rwedu chinogumira kuchiropractic pamwe nekukuvara kwepamuviri nemamiriro. Kuti ukurukure nyaya yacho, ndapota inzwa wakasununguka kubvunza Dr. Jimenez kana kutibata nesu pa 915-850-0900 .

 

Yakarongedzwa naDkt Alex Jimenez

 

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

 

Zvimwe Zvinyorwa: Kubva Painini

 

Maererano nehuwandu, inenge 80% yevanhu ichaona zviratidzo zvekurwadziwa shure shure kamwechete munguva yeupenyu hwavo hwose. Kutambudzika shure ndiko kunyunyuta kunowanzoitika kunogona kuguma nekuda kwekukuvara kwakasiyana siyana uye / kana mamiriro. Kazhinji kacho, kuora kwechimiro chemupaka nezera kunogona kukonzera marwadzo kumashure. Herniated discs inoitika apo ganda rakanyorova, segel-like re intervertebral disc rinodonha nekubvarura mukati maro, rinenge riri kunze kwekatekete, kubvongodza nekugumbura midzi midzi. Dhizinesi dzinozivikanwa dzinowanzoitika kumucheto kumashure, kana kuti nhengo dzomukati, asi dzinogonawo kuitika pamucheto wepervical, kana mutsipa. Kuiswa kwemitsipa inowanikwa mucheka shure nekuda kwekukuvara uye / kana mamiriro akaoma kunogona kutungamirira kune zviratidzo zve sciatica.

 

blog chinyorwa chekartoon paperboy makuru makuru

 

NHAURWA INOKOSHA INOKOSHA: Kutarisira Kushungurudzika Kwebasa

 

 

ZVIMWE ZVINOKOSHA ZVINOKOSHA: KUDZIDZA KUNYANYA: Kutsaona Kwemotokari Kurapa El Paso, TX Chiropractor

 

Hazvina kuchena
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