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. 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).

 

 

 

Migumisiro yeMitemo

 

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

 

 

 

 

 

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

 

 

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.

 

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

 

 

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