Facetogenic Pain, Headaches, Neuropathic Pain Uye Osteoarthritis

El Paso, TX. Chiropractor Dr. Alexander Jimenez anotarisa mamiriro akasiyana-siyana anogona kukonzera kurwadziwa kusingaperi. Izvi zvinosanganisira:

• Osteoarthritis
• Facetogenic kurwadziwa
• Neuropathic kurwadziwa
• Headaches

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chirwere chemumajoini marwadzo chinhu chakaoma kunzwisisa chinobatanidza neurophysiological processing pamatunhu ose enzira yemarwadzo. Nzira dzekurapa dziripo kuti dzideredze marwadzo emajoini hadzina kunyanyoganhurwa, uye varwere vazhinji veArthritis vanongotaura kunyaradza marwadzo ane mwero nekurapa kwazvino. Kunzwisisa kuri nani kwemaitiro emutsinga anokonzera kurwadziwa kwemusculoskeletal uye kuziva zvinangwa zvitsva zvichabatsira kugadzira ramangwana remishonga yekurapa. Ichi chinyorwa chinoongorora kumwe kutsvagurudza kwazvino muzvinhu zvinokonzeresa marwadzo emajoini uye inovhara nzvimbo dzakadai se cannabinoids, proteinase-activated receptors, sodium chiteshi, cytokines, uye inononoka receptor inogona nzira. Iko kubuda kwekufungidzira kuti osteoarthritis inogona kunge ine neuropathic chikamu inokurukurwa zvakare.

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Sangano rehutano hwehutano rinosangana nezvinetso zve musculoskeletal sechikonzero chinonyanya kukonzerwa nekuremara munyika yemazuva ano, ichikanganisa mumwe wevatatu vatatu [1]. Zvinotonyanya kutyisa ndezvokuti kuwanda kwezvirwere izvi kuri kuwedzera apo ruzivo rwedu rwezvakakonzera zvikonzero zvarwo ruzhinji.

Fig. 1 A schematic inoratidzira zvimwe zvezvinangwa zvinozivikanwa kugadzirisa marwadzo emajoini. Neuromodulators inogona kusunungurwa kubva kumagetsi emagetsi pamwe chete nemasero emasero uye macrophages kuti achinje afferent mechanosensitivity. Endovanilloids, asidhi, uye kupisa kunotyisa kunogona kuita kuti nguva pfupi igamuchire inogona kuva vanilloid type 1 (TRPV1) ion migero inotungamira mukuburitswa kwealgogenic substance P (SP), iyo inozosunga kune neurokinin-1 (NK1) receptors. Mapuroteni anogona kutsemura uye kunyandura maprotease-activated receptors (PARs). Kusvika pari zvino, PAR2 uye PAR4 zvakaratidzwa kukurudzira majoini ekutanga afferent. Iyo endocannabinoid anandamide (AE) inogadzirwa painoda uye inogadzirwa kubva kuN-arachidonoyl phosphatidylethanolamine (NAPE) pasi peiyo enzymatic chiito che phospholipases. Chikamu cheAE chinobva chasunga kune cannabinoid-1 (CB1) receptors inotungamira kune neuronal desensitization. Unbound AE inokurumidza kutorwa neanandamide membrane transporter (AMT) isati yaputswa ne fatty acid amide hydrolase (FAAH) mu ethanolamine (Et) uye arachidonic acid (AA). The cytokines tumor necrosis factor-?(TNF-?), interleukin-6 (IL-6) uye interleukin1-beta (IL-1?) Inogona kusunga kune avo vanogamuchira kuti vawedzere kutapurirana marwadzo. Pakupedzisira, tetrodotoxin (TTX) -resistant sodium channels (Nav1.8) inobatanidzwa neuronal sensitization.

Varwere vanoshuva ivo Chronic pain to disappear; zvisinei, iye zvino anorongedzerwa analgesics haanyanyi kushanda uye anoperekedzwa neakawanda asingadiwi mhedzisiro. Saka nekudaro, mamirioni avanhu pasi rese ari kutambura nemhedzisiro yekurwadziwa kwemajoini, izvo pasina kurapwa kunogutsa [2].

Anopfuura zana akasiyana marudzi eArthritis ane osteoarthritis (OA) ari akanyanya kuwanda. OA chirwere chinodzikira zvishoma nezvishoma chinokonzera kurwadziwa kusingaperi uye kurasikirwa nebasa. Kazhinji, OA kusakwanisa kwejoinhi kugadzirisa kukuvadzwa zvine mutsindo mukupindura masimba akawandisa ari kuiswa pairi. Izvo zvipenyu uye zvepfungwa zvepfungwa zvinosanganisira kusingaperi OA kurwadziwa hazvinyatsonzwisiswi, kunyange zvazvo tsvakurudzo inoenderera mberi inozarura maitiro akaoma ezviratidzo zvechirwere [2]. Mishonga yemazuva ano, yakadai se-non-steroidal anti-inflammatory drugs (NSAIDs), inopa kumwe kuzorora kwezviratidzo, kuderedza marwadzo kwenguva pfupi, asi haideredze marwadzo mukati mehupenyu hwemurwere. Uyezve, NSAID yepamusoro-dose haigoni kutorwa kakawanda kwemakore akawanda, sezvo izvi zvinogona kutungamirira kuhupfu hwetsvo uye kubuda kweropa.

Sechinyakare, tsvakiridzo yeArthritis yakatarisa zvakanyanya pane articular cartilage seyakanyanya kunangwa yekuvandudza kwekurapa kweinoveli OA mishonga yekuchinja chirwere. Ichi chechondrogenic chakaratidza chiedza chitsva pane yakaoma biochemical uye biomechanical zvinhu zvinokonzera chondrocyte maitiro mumajoini ane chirwere. Zvisinei, sezvo articular cartilage iri aneural uye avascular, iyi tishu haigoni kuva iyo inokonzera kurwadziwa kweOA. Chokwadi ichi, pamwe chete nezvakawanikwa kuti hapana kuwirirana pakati pekukuvadzwa kwearticular cartilage uye kurwadziwa kwevarwere veOA [3,4] kana preclinical modhi yeOA [5], yakakonzera shanduko yekutarisa kugadzira mishonga yekudzora marwadzo anobudirira. . Ichi chinyorwa chichaongorora zvitsva zvitsva mukutsvakurudza kwemarwadzo ekubatana uye kusimbisa zvimwe zvezvinangwa zvinobuda zvinogona kunge zviri remangwana rekurwadziwa kweArthritis (yakapfupikiswa muFig. 1)

Cytokines

Zviito zveakasiyana cytokines mune akabatana neurophysiology zvidzidzo zvakaratidza zvakanyanya munguva pfupi yapfuura. Interleukin-6 (IL-6), semuenzaniso, inonzi cytokine inowanzosunga kune membrane-yakasungwa IL-6 receptor (IL-6R). IL-6 inogonawo kusaina nekusunga ine soluble IL-6R (SIL-6R) kugadzira iyo IL-6 / sIL-6R yakaoma. Iyi IL-6 / sIL-6R yakaoma inotevera lybinds kune transmembrane glycoprotein subunit 130 (gp130), nokudaro ichibvumira IL-6 kuisa chiratidzo mumaseru asingaite constitutively kuratidza membrane-yakasungwa IL-6R [25,26]. IL-6 uye SIL-6R ndivo vatambi vakakosha mu systemic kuzvimba uye arthritis, sekukwidziridzwa kwezvose kwakawanikwa muRA varwere 'serum uye synovial fluid. [27,29, 6]. Munguva ichangopfuura, Vazquez et al.vakacherechedza kuti kutonga pamwe chete kweIL-6 / sIL-30R mumabvi emakonzo kwakakonzera marwadzo anokonzera kuzvimba, sezvakaratidzwa nekuwedzera kwemhinduro yepinal dorsal horn neurons kune mechanical stimulation yemabvi nezvimwe zvikamu. yeshure [6]. Spinal neuron hyperexcitability yakaonekwawo apo IL-6 / sIL-130R yakashandiswa munharaunda kune musana. Spinal kushandiswa kwe soluble gp6 (iyo yaizomop up IL-6/sIL-6R complexes, nokudaro kuderedza trans-signaling) inhibited IL-6/sIL-130R-induced central sensitization. Zvisinei, kushandiswa kwakanyanya kwe soluble gpXNUMX chete hakuna kuderedza mhinduro dzeuronal kune yakatosimbiswa kuzvimba kwekubatana.

Iyo yenguva pfupi yekugamuchira mukana (TRP) chiteshi haisi-yakasarudzika cation nzira dzinoita sekubatanidza kweakasiyana physiological uye pathophysiological maitiro. Mukuwedzera kune thermosensation, chemosensation, uye mechanosensation, TRP nzira dzinobatanidzwa mukugadzirisa marwadzo nekuputika. Semuenzaniso, TRP vanilloid-1 (TRPV1) ion migero yakaratidzwa kuti inobatsira pakurwadziwa kwekubatana kwekubatana sezvo thermal hyperalgesia yakanga isingatauri mu TRPV1 mono arthritic mice [31]. Saizvozvo, TRP ankyrin-1 (TRPA1) ion migero inobatanidzwa muArthritic mechano hypersensitivity sekuvharwa kwemugamuchiri nevashori vanosarudza attenuated mechanical pain muFreunds yakakwana adjuvant model inflammation [32,33]. Humwe humbowo hwekuti TRPV1 inogona kunge yakabatanidzwa muurourotransmission yeOA kurwadziwa kunobva kune zvidzidzo umo neuronal TRPV1 kutaura kwakasimudzwa mune sodium monoiodoacetate modhi yeOA [34]. Uye zvakare, systemic manejimendi yeTRPV1 anopikisa A-889425 yakadzora iyo yakamutswa uye yakasarudzika chiitiko chepinini-wide dynamic range uye nociception-specific neurons mune monoiodoacetate modhi [35]. Idzi data dzinoratidza kuti endovanilloids inogona kubatanidzwa mukati mekuita sensitization maitiro ane chekuita nekurwadziwa kweOA.

Parizvino panozivikanwa kuve nemapolymorphisms mana mujini inokodha TRPV1, zvichitungamira kune shanduko muchimiro cheiyo ion chiteshi uye kusashanda zvakanaka. Imwe yepolymorphism (rs8065080) inoshandura kunzwisiswa kweTRPV1 kune capsaicin, uye vanhu vakatakura iyi polymorphism havanyanyi kunzwa kupisa hyperalgesia [36]. Ongororo ichangoburwa yakaongorora kana varwere veOA vane rs8065080 polymorphism vakawana kuchinjwa kwemarwadzo ekuona kunoenderana neiyo genetic anomaly. Chikwata chekutsvagisa chakawana kuti varwere vane asymptomatic ibvi OA vainyanya kutakura rs8065080 gene pane varwere vane majoini anorwadza. [37]. Ongororo iyi inoratidza kuti varwere veOA vane mashandiro akajairika; TRPV1 migero ine njodzi yakawedzera yekurwadziwa kwemajoini uye inosimbisa zvakare mukana wekubatanidzwa kweTRPV1 muOA marwadzo ekuona.

mhedziso

Nepo chipingamupinyi chekurapa marwadzo eArthritis chichiripo, kusvetuka kukuru kuri kuitwa mukunzwisisa kwedu kweneurophysiological process inokonzera kuzvarwa kwemarwadzo emajoini. Zvinangwa zvitsva zviri kuramba zvichiwanwa, ukuwo nzira dziri kuseri kwenzira dzinozivikanwa dziri kuramba dzichitsanangurwa nekunatswa. Kutarisa imwe chaiyo receptor kana ion chiteshi haigone kuve mhinduro yekujairira marwadzo emajoini, asi pane nzira yepolypharmacy inoratidzwa umo varevereri vakasiyana-siyana vanoshandiswa mukubatana panguva dzakatarwa dzechirwere. Kusunungura dhizaini inoshanda padanho rega rega renzira yekurwadziwa kuchavandudzawo ruzivo rwedu rwekuti kurwadziwa kwemajoini kunogadzirwa sei. Semuenzaniso, kuziva vamiririri vepakati pemarwadzo ekubatana kuchatibvumira kudzora nociception mukati mekubatana uye zvichida kudzivisa pakati pemigumisiro ye systemically administed pharmacotherapeutics.

FACETOGENIC PAIN

FACET SYNDROME & FACETOGENIC MARWARO

• Facet syndrome is an articular disorder inoenderana ne lumbar facet majoini uye innervations yavo uye inoburitsa zvese zvemukati uye zvinopenya zvinorwadza zve facetogenic.
• Kutenderedza zvakanyanya, kuwedzera, kana kuchinjika kwemusana (kudzokororwa kuwedzeredza) kunogona kuguma nekuderera kwekuchinja kune shwashwa rejoini. Mukuwedzera, zvinogona kusanganisira kuchinja kwekuchinja kune mamwe maitiro, kusanganisira intervertebral disc.

CERVICAL FACET SYNDROME & FACETOGENIC MARWARO

• Axial neck pain (kashoma kupenya kupfuura mapendekete), inowanzoitika unilaterally.
• Pain pamwe uye / kana kukanganiswa kwekuwedzera nekushandura
• Tenderness pa palpation
• Kunotyisa kurwadziwa kwepakati penzvimbo kana kuti kumapfudzi kana kumusoro kumashure, uye kazhinji hausi kumhanya mukati kana pasi pasi ruoko kana kuti kuminwe sekuti seni yeyenii inogona.

LUMBAR FACET SYNDROME & FACETOGENIC MARWARO

• Marwadzo kana kupfava muzasi musana.
• Mharaunda yekunakidza / kusagadzikana pamwe chete nemumusana mucheka kumashure.
• Marwadzo, kuoma, kana kuomerwa nemamwe mafambiro (sekumira wakatwasuka kana kusimuka kubva pachigaro.
• Pain on hyperextension
• Marwadzo anoratidzwa kubva kumusoro kwechiuno chepamusoro majoini anogona kuenderera muchiuno, muhudyu, uye nechepamusoro lateral chidya.
• Marwadzo anotsanangurwa kubva kuzasi lumbar facet majoini anogona kupinda mukati mukati mehudyu, nechemberi uye/kana kumashure.
• L4-L5 uye L5-S1 facet majoini anogona kureva marwadzo anosvika kune distal lateral gumbo, uye muzviitiko zvisingawanzo, kutsoka.

MHURIDZO-YOKWEDZWA KWEMAZI

Uchapupu-hwakagadziriswa muKubata kweMapiritsi Utano maererano neKliniki Kuona

12. Pain Kubva kubva kuLumbar Facet Joints

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Kunyangwe kuvepo kweiyo facet syndrome kwainge kwabvunzwa kwenguva refu, iko zvino kwave kugamuchirwa sekiriniki. Zvichienderana nematanho ekuongorora, iyo zygapophysial majoini anoverengera ari pakati pe5% ne15% yematambudziko eakareba, axial low back pain. Kazhinji kazhinji, marwadzo e-facetogenic anokonzerwa nekudzokorora kushushikana uye / kana kuwedzeredza kwakaderera-level trauma, zvichitungamira mukuzvimba uye kutambanudza kwejoint capsule. Chichemo chinowanzoitika ndeche axial low back pain ine marwadzo anotaurwa anoonekwa muhudyu, muhudyu, uye chidya. Hapana kuongororwa kwemuviri kunowanikwa kune pathognomonic yekuongororwa. Chiratidzo chakasimba che lumbar facetogenic kurwadziwa kuderedzwa kwemarwadzo mushure meanesthetic blocks ye rami mediales (medial matavi) e rami dorsales iyo innervate majoini epaface. Nokuti nhema-zvakanaka uye, zvichida, nhema-negative migumisiro inogona kuitika, zvigumisiro zvinofanira kududzirwa zvakanyatsonaka. Mune varwere vane jekiseni-yakasimbiswa zygapophysial marwadzo ekubatana, kupindira kwemaitiro kunogona kuitwa mumamiriro ezvinhu emhando dzakasiyana-siyana, mishonga yekurapa yakawanda inosanganisira pharmacotherapy, kurapa kwepanyama, uye nguva dzose yekurovedza muviri, uye, kana zvichiratidzwa, psychotherapy. Parizvino, chiyero chegoridhe chekurapa facetogenic marwadzo ndeye radiofrequency kurapwa (1 B+). Uchapupu hunotsigira intra-articular corticosteroids hushoma; saka, izvi zvinofanirwa kuchengetwa kune avo vasingapindure kune radiofrequency kurapwa (2 B1).

Facetogenic Marwadzo anobuda muchiuno chechiuno chinowanzokonzera marwadzo ekudzokera shure muhuwandu hwevanhu vakuru. Goldthwaite ndiye akatanga kutsanangura chirwere ichi muna 1911, uye Ghormley anowanzonzi ndiye akatanga izwi rokuti �facet syndrome muna 1933. , synovial membrane, hyaline cartilage, uye bone.35

Kazhinji kazhinji, imhaka yekudzokorora kushushikana uye/kana kuwanda kwakaderera-level trauma. Izvi zvinotungamira mukuzvimba, izvo zvinogona kuita kuti chikamu chechikamu chizadzwe nemvura uye kuzvimba, zvichikonzera kutambanudza kwejojo ​​capsule uye kunotevera kurwadziwa chizvarwa.27 Kukuvadza kunoshandura zvakapoteredza nhengo yakabatanidzwa kunogonawo kutsamwisa musana wepelinha kuburikidza nekunyanya kuderedza, zvichiita sciatica. Mukuwedzera, Igarashi et al.28 vakawana kuti kupisa kwemakotokines akabudiswa kuburikidza ne ventral joint capsule muvarwere vane zygapophysial kugadzikana kwekubatana kungave kwakagadzirisa zvinetso zveuropathic kune vanhu vane spinal stenosis. Zviratidzo zve zygapophysial marwadzo akabatana zvinosanganisira spondylolisthesis / lysis, chirwere chechirwere chinokanganisa, uye yakwegura.5

IC KUDZIDZA KWEZVO

Huwandu hwehuwandu hwekuchinja kwehutachiona muzvikamu zvefatisheni pane kuongororwa kweradiology kunoenderana nezera rinorehwa rezvidzidzo, mashandiro eradiology anoshandiswa, uye tsananguro yekusajairika. Dhigenerative facet joints inogona kuonekwa zvakanaka kuburikidza ne computed tomography (CT) kuongorora.49

NEUROPATHIC PAIN

• Urombo hwakatangwa kana hunokonzerwa nechirwere chepakutanga kana kusakosha mukati mehutano hwemanyore.
• Neuropathic kurwadziwa kazhinji isingaperi, yakaoma kurapa, uye kazhinji inoshingirira kune yakajairwa analgesic manejimendi.

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Neuropathic pain inokonzerwa nechirwere kana chirwere chesomatosensory system, kusanganisira peripheral fibers (A?, A? uye C fibers) uye central neurons, uye inobata 7-10% yevanhu vakawanda. Zvikonzero zvakawanda zvekurwadziwa kweuropathic zvakatsanangurwa. Chiitiko chayo chinogona kuwedzera nekuda kwekuchembera kwehuwandu hwepasirese, kuwedzera kwechirwere cheshuga mellitus, uye nekuvandudza kupona kubva kugomarara mushure mechemotherapy. Zvechokwadi, kusaenzana pakati pekunakidza uye inhibitory somatosensory signaling, kuchinjwa kweion channels, uye kusiyana kwemaitiro ekurwadziwa kwemashoko mukati mehutano hwemagetsi ose akave akabatanidzwa mukurwadziwa kweuropathic. Uyezve, mutoro wekurwadziwa kweuropathic kusingaperi kunoratidzika kunge kwakabatana nekuoma kwezviratidzo zveuropathic, migumisiro yakaipa, uye zvisarudzo zvakaoma zvekurapa. Zvinonyanya kukosha, hupenyu hwehupenyu hunokanganisa kune varwere vane kurwadziwa kweuropathic nekuda kwekuwedzera kwemishonga yemishonga uye kushanyira kune vatapi vehutano uye kurwara kubva mukurwadziwa pachako uye chirwere chinokurudzira. Pasinei nematambudziko, kufambira mberi mukunzwisisa pathophysiology yemarwadzo europathic iri kukurudzira kukurudzirwa kwemaitiro matsva ekuongorora uye kupindira kwevanhu, izvo zvinosimbisa kudiwa kwemaitiro akawanda ekugadzirisa marwadzo europathic.

PATHOGENESIS WEMUNYARA WEMUNYANYA

• MASHOKO ANOKUDZIDZA

• Mushure meperipheral nerve lesion, neuroni dzinowedzera kunzwisiswa uye kukudziridza kunakidzwa kusingaite uye kukwidziridzwa kwekunzwa kwekukurudzira.
• Izvi zvinozivikanwa se ... Peripheral Sensitization!

• CENTRAL MECHANISMS

• Semhedzisiro yekuenderera mberi kwekuita kwekuita munharaunda, neuroni dzinogadzira yakawedzera kumashure chiitiko, yakawedzera minda yekugamuchira, uye yakawedzera mhinduro kune afferent impulses, kusanganisira yakajairika tactile stimuli.
  Izvi zvinozivikanwa se ... Central Sensitization!

Chronic neuropathic pain inowanzoitika kune vakadzi (8% inopesana ne5.7% muvarume) uye muvarwere> 50 yemakore (8.9% maringe ne5.6% mune avo <49 yemakore), uye kazhinji inobata pasi kumashure uye makumbo ezasi. , mutsipa nemakumbo nemaoko24. Lumbar uye cervical inorwadza radiculopathies ingangove inonyanya kukonzera kusingaperi marwadzo neuropathic. Zvichienderana nemashoko aya, tsvakurudzo ye> 12,000 varwere vane kurwadziwa kusingaperi nemhando dzose dze nociceptive uye neuropathic pain, inotaurwa kune nyanzvi dzemarwadzo muGermany, yakaratidza kuti 40% yevarwere vose vakawana zvimwe zviratidzo zvekurwadziwa kweuropathic (zvakadai sokupisa manzwiro, chiveve, uye kurira); varwere vane chirwere chisingaperi chekudzokera shure uye radiculopathy vainyanya kukanganiswa25.

Mupiro wekliniki yeurorosiology kusvika kunzwisisiro yehutano-hutsika hutsika maitiro.

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Kusvika pari zvino, zvidzidzo zvekiriniki neurophysiological nezve tension-type headache (TTH) yakaitwa nezvinangwa zviviri zvikuru: (1) kuona kana mamwe maitiro europhysiological angangoita sezviratidzo zveTTH, uye (2) kuongorora physiopathology yeTTH. Nezve poindi yekutanga, mhedzisiro iripo inoodza mwoyo sezvo zvimwe zvisiri izvo zvinowanikwa muTTH varwere zvinogonawo kugara zvichionekwa mune migraineurs. Kune rimwe divi, kiriniki neurophysiology yakaita basa rakakosha mukukakavadzana nezvepathogenesis yeTTH. Zvidzidzo pamusoro pekudzvinyirirwa kwekunze kweiyo temporalis muscle contraction zvakaona kusashanda kweiyo brainstem excitability uye suprasegmental control. Mhedziso yakafanana yakasvika pachishandiswa trigeminocervical reflexes, iyo isina kukwana muTTH yakaratidza kuderedza inhibitory basa rebrainstem interneurons, richiratidza maitiro asina kujairika ekupedzisira marwadzo ekudzivirira. Sezvineiwo, iyo neural excitability abnormality muTTH inoita senge chiitiko chakajairwa, kwete kuganhurwa kumatunhu ane cranial. Yakaremara DNIC-senge nzira dzakanyatsoratidzwa zvakare mumatunhu e somatic ne nociceptive flexion reflex zvidzidzo. Zvinosuruvarisa, zvidzidzo zvakawanda zveuurophysiological paTTH zvakakanganiswa nekukanganisa kwakakomba kwemaitiro, izvo zvinofanirwa kudziviswa mukutsvakurudza kunotevera kujekesa nzira dzeTTH zviri nani.

References:

Neurophysiology yekurwa kweArthritis. McDougall JJ¹ Linton P.

www.researchgate.net/publication/232231610_Neurophysiology_of_Arthritis_Pain

Marwadzo anobva ku-lumbar facet joints. Van Kleef M¹, Vanelderen P, Cohen SP, Lataster A, Van Zundert J, Mekhail N.

Neuropathic kurwadziwaLuana Colloca,¹Taylor Ludman,¹Didier Bouhassira,²Ralf Baron,³Anthony H. Dickenson,⁴David Yarnitsky,⁵Roy Freeman,⁶Andrea Truini,⁷Nadine Attal, Nanna B. Finnerup,⁹Christopher Eccleston,^10,11Eija Kalso,¹²David L. Bennett,¹³Robert H. Dworkin,¹⁴uye Srinivasa N. Raja¹⁵

Mupiro wekliniki yeurorosiology kusvika kunzwisisiro yehutano-hutsika hutsika maitiro. Rossi P1, Vollono C, Valeriani M, Sandrini G.