Back Clinical Clinical Neurophysiology Support. El Paso, TX. ʻO kā Chiropractor,ʻo Kauka Alexander Jimenez e kamaʻilio nei neurophysiology lapaʻau. E ʻimi ʻo Kauka Jimenez i ke koʻikoʻi olakino a me nā hana hana o nā olonā nerve āpau, ka iwi kuamoo, ʻōnaehana lolo, a me ka lolo i loko o ka pōʻaiapili o nā maʻi visceral a me nā musculoskeletal. E ʻike ka poʻe maʻi i ka anatomy, genetics, biochemistry, a me ka physiology o ka ʻeha e pili ana i nā syndrome lapaʻau. E hoʻopili ʻia ka meaolaolaolaola e pili ana i ka nociceptive a me ka ʻeha. A e hoʻokūpaʻa ʻia ka hoʻokō ʻana o kēia ʻike i nā papahana hoʻomaʻamaʻa.
Haʻaheo loa kā mākou hui i ka lawe ʻana mai i ko mākou ʻohana a me nā mea maʻi ʻeha wale nō i nā protocols lapaʻau i hōʻoia ʻia. Ma ke aʻo ʻana i ke olakino holoʻokoʻa ma ke ʻano he ʻano nohona, hoʻololi mākou ʻaʻole wale i ke ola o kā mākou poʻe maʻi akā i ko lākou ʻohana pū kekahi. Hana mākou i kēia i hiki iā mākou ke hōʻea i nā El Pasoans he nui e pono ai iā mākou, ʻaʻohe mea pili i nā pilikia affordability. No nā pane i nā nīnau āu e ʻoluʻolu e kelepona iā Kauka Jimenez ma 915-850-0900.
"Nā rula hoʻoholo o ka hōʻailona, i ka hōʻanoʻana i ka hōʻeuʻeu a me ka wānana o ka hopena o nā mea e pono ai: kahi kūkākūkā o nā loiloi hou i loko o ka puke hoʻoponopono"
Hōʻuluʻulu Manaʻo
ʻO nā lula hoʻoholo lāʻau lapaʻau ka mea maʻamau i loko o ka palapala biomedical a hōʻike i hoʻokahi hoʻolālā o ka hoʻonui ʻana i ka hoʻoholo ʻana i ka lāʻau lapaʻau e hoʻomaikaʻi i ka pono a me ka maikaʻi o ka hāʻawi ʻana i ke olakino. I loko o ka pōʻaiapili o ka noiʻi hoʻoponopono ʻana, ua manaʻo nui ʻia nā lula hoʻoholo lapaʻau i ka hoʻokaʻawale ʻana i nā maʻi ma o ka wānana ʻana i kā lākou pane ʻana i nā lāʻau lapaʻau kūikawā. ʻO ka mea maʻamau, ʻo nā ʻōlelo aʻoaʻo no ka hoʻomohala ʻana i nā lula hoʻoholo lāʻau lapaʻau e hāʻawi i kahi kaʻina multistep (derivation, validation, impact analysis) me ka hoʻohana ʻana i ke ʻano i wehewehe ʻia. Ua haʻalele nā hana noiʻi no ka hoʻomohala ʻana i kahi lula hoʻoholo lapaʻau e pili ana i ka maʻi diagnostic mai kēia ʻaha kūkā. Ua hoʻohana nā puke hou i kēia laina o ka noiʻi i ke alakaʻi hoʻoholo hoʻoholo hoʻoholo ma ka terminology diagnostic-based clinical decision. ʻO ka hoʻololi ʻana i nā huaʻōlelo a me nā ʻano hana e pili ana i nā lula hoʻoholo lapaʻau hiki ke paʻakikī i nā kauka ke ʻike i ke kiʻekiʻe o nā hōʻike e pili ana i kahi lula hoʻoholo a hoʻomaopopo i ke ʻano o ka hoʻokō ʻia ʻana o kēia hōʻike no ka hoʻomaopopo ʻana i ka mālama maʻi. Hāʻawi mākou i kahi hiʻohiʻona pōkole o ka hoʻomohala ʻana i ka hoʻoholo hoʻoholo lāʻau lapaʻau i loko o ka pōʻaiapili o ka palapala hoʻoponopono a me ʻelua mau pepa kikoʻī i paʻi ʻia i kēia manawa ma Chiropractic and Manual Therapies.
Nā kānāwai palekana hōʻailona
Ua hoʻololi ʻia ka mālama olakino i kahi hoʻololi koʻikoʻi i ka hoʻomaʻamaʻa ʻana i nā hōʻike. He ala i manaʻo ʻia e hoʻonui i ka hoʻoholo hoʻoholo lāʻau ma o ka hoʻohui ʻana i nā hōʻike maikaʻi loa i loaʻa me ka loea lapaʻau a me nā makemake o nā maʻi.
ʻO ka mea hope loa, ʻo ka pahuhopu o ka hoʻomaʻamaʻa ʻana i nā hōʻike e hoʻomaikaʻi i ka hāʻawi ʻana i ke olakino. Eia nō naʻe, ʻo ka unuhi ʻana o nā hōʻike ʻepekema i loko o ka hoʻomaʻamaʻa ua hōʻoia i kahi hana paʻakikī.
ʻO nā lula hoʻoholo lāʻau lapaʻau (CDRs), i ʻike ʻia ʻo nā lula wānana lapaʻau, maʻa mau i ka palapala hoʻoponopono.
ʻO kēia nā mea hana i hoʻolālā ʻia no ka hoʻomaopopo ʻana i ka hoʻoholo hoʻoholo ma ka ʻike ʻana i nā mea wānana o ka hopena hōʻike diagnostic, prognosis, a i ʻole pane therapeutic.
Ma ka palapala hoʻoponopono, hoʻohana pinepine ʻia nā CDR e wānana i ka pane o ka mea maʻi i ka lāʻau lapaʻau. Ua manaʻo ʻia lākou e ʻike i nā pūʻulu pili pili pili i nā maʻi e hōʻike ana me nā maʻi heterogeneous ʻē aʻe e like me ka ʻāʻī kikoʻī ʻole a i ʻole ka haʻahaʻa. ʻeha kua, ʻo ia ka manaʻo a mākou e manaʻo ai e nānā.
Nā kānāwai palekana hōʻailona
ʻO ka hiki ke hoʻokaʻawale a i ʻole subgroup i nā poʻe maʻi me nā maʻi heterogeneous e like me ka ʻeha spinal i hōʻike ʻia ma ke ʻano he noiʻi mua a, no laila, ke kumu o ka nui o ka noiʻi noiʻi. ʻO ka hoʻopiʻi ʻana o ia ʻano hoʻokaʻawale ʻana ko lākou hiki ke hoʻomaikaʻi i ka maikaʻi o ka mālama ʻana a me ka maikaʻi ma o ka hoʻohālikelike ʻana i nā maʻi me nā lāʻau lapaʻau maikaʻi loa. I ka wā ma mua, ua hilinaʻi ka hoʻokaʻawale ʻana o nā mea maʻi i nā ala implicit i hoʻokumu ʻia i loko o ka moʻomeheu a i ʻole ka nānā ʻana ʻole. ʻO ka hoʻohana ʻana i nā CDR no ka hoʻomaopopo ʻana i ka hoʻokaʻawale ʻana he hoʻokahi hoʻāʻo ʻana i kahi ala i hoʻoikaika ʻia i nā hōʻike, ʻaʻole i hilinaʻi ʻia i ka manaʻo kumu ʻole.
Nā CDR ua hoʻomohala ʻia ma kahi kaʻina hana multistep e pili ana i nā haʻawina o ka derivation, validation, a me ka nānā ʻana o ka hopena, me kēlā me kēia me ke kumu i wehewehe ʻia a me nā pae hoʻohālike. E like me nā ʻano hōʻike a pau i hoʻohana ʻia no ka hoʻoholo ʻana e pili ana i nā maʻi, he mea koʻikoʻi ka nānā ʻana i ke ʻano haʻawina kūpono i ka loiloi ʻana i nā pono kūpono o ka hoʻokō.
Nā lawelawe o nā kānāwai palekana
Hiki iā ia ke hoʻokomo i nā mea ʻoi aku ma mua o ka noʻonoʻo ʻana o ka lolo kanaka
Hoʻohālikelikeʻia ka hoʻolālāʻana o ke CDR / CPR i ka manawa (ka helu mathematics)
Hiki ke ʻoi aku ka pololei ma mua o ka hoʻokolokolo hoʻokolokolo.
ʻO ka hope loa, ʻaʻole pili ka pono o kahi CDR me kona pololei akā me kona hiki ke hoʻomaikaʻi i nā hopena lapaʻau a hoʻonui i ka pono o ka mālama.[15] ʻOiai inā hōʻike ka CDR i ka hōʻoia ākea, ʻaʻole ia e hōʻoia e hoʻololi ia i ka hoʻoholo hoʻoholo lāʻau lapaʻau a i ʻole nā hoʻololi i hana ʻia e hopena i ka mālama maikaʻi.
ʻO nā hoʻololi e hana ai e hopena i ka mālama maikaʻi. McGinn et al.[2] ʻike ʻia ʻekolu mau wehewehe no ka hemahema o kahi CDR i kēia pae. ʻO ka mea mua, inā pololei ka hoʻoholo o ke kauka e like me ka hoʻoholo i hoʻomaopopo ʻia e CDR, ʻaʻohe pono o ka hoʻohana ʻana. ʻO ka lua, ʻo ka hoʻohana ʻana i kahi CDR hiki ke komo i nā helu paʻakikī a i ʻole nā kaʻina hana e hoʻonāwaliwali ai i nā kauka mai ka hoʻohana ʻana i ka CDR. ʻO ke kolu, ʻaʻole hiki ke hoʻohana i ka CDR ma nā wahi āpau a i ʻole nā kūlana. Eia hou, e hoʻokomo mākou i ka ʻoiaʻiʻo e pili ana nā haʻawina hoʻokolohua i nā poʻe maʻi ʻaʻole i hōʻike piha i ka poʻe i ʻike ʻia i ka mālama maʻamau a hiki i kēia ke kaupalena i ka waiwai maoli o kahi CDR. No laila, no ka hoʻomaopopo piha ʻana i ka pono o kahi CDR a me kona hiki ke hoʻomaikaʻi i ka hāʻawi ʻana i ka mālama olakino, pono ia e hana i kahi hoʻokolokolo pragmatic o kona hiki a me ka hopena ke hoʻohana ʻia i kahi kaiapuni e hōʻike ana i ka hana maoli. Hiki ke hana ʻia kēia me nā hoʻolālā noiʻi like ʻole e like me nā hoʻāʻo randomized, cluster-randomized trials, a i ʻole nā ala ʻē aʻe e like me ka nānā ʻana i ka hopena o kahi CDR ma mua a ma hope o kona hoʻokō ʻana.
ʻO ka pākēnaʻi o nāʻano hoʻonohonohoʻana no nā poʻe maʻi me nā hemahema lumbar ma ka hoʻohanaʻana i nā maʻi syndrome McKenzie, keʻano o kaʻeha, ka hoʻoponoponoʻana, a me ka hoʻopaʻaʻana i nā rula o nā kauā.
Nā Aims (1) no ka hoʻoholoʻana i ka māhele o nā maʻi me nā loli lumbar i hiki ke heluʻia ma ke kāohiʻia e McKenzie syndrome (McK) a me ka hōʻuluʻuluʻana o ka hōʻino (PPCs) me nāʻano hoʻonaʻauao Mechanical Diagnostic and Therapy (MDT), hoʻoponopono, nā pā'ū (CPRs) a me (2) no kēlā me kēia kanaka CPR a iʻole kāʻei CPR, e hoʻoholo i nā hoʻohālikelike kūpono i ka hoʻohanaʻana iā McK a me PPC.
He kūpilikiʻi kūpono ka CPRs i kahi iʻikeʻia ai kahi hui hoʻomanawanui a me nā hōʻailona hōʻailona a me nā hiʻona e pili ana i ka pilina kūlana o nā hopena o nā maʻi.
ʻElua mau CPR kaʻawale i kūkuluʻia e nā mea noiʻi no kaʻikeʻana i nā maʻi e pane maikaʻi i ka manipulation.33,34 Flynn et al. hoʻomohala i ka CPR manipulation kumu me ka hoʻohana ʻana i ʻelima mau pae, ʻo ia hoʻi, ʻaʻohe hōʻailona ma lalo o ke kuli, ka hoʻomaka ʻana o nā hōʻailona (<16 mau lā), haʻahaʻa haʻahaʻa haʻahaʻa haʻahaʻa manaʻoʻiʻo questionnaire36 helu no ka hana (<19), hypomobility o ka lumbar spine, a me ka ʻūhā i loko. rotation ROM (>35 no ka liʻiliʻi loa hoʻokahi ʻūhā).33
Ua hoʻololi ʻia ka CPR o Flynn e Fritz et al. i nā pae hoʻohālike ʻelua, ʻaʻole i loaʻa nā hōʻailona ma lalo o ke kuli a me ka hoʻomaka ʻana o nā hōʻailona (<16 mau lā), ma ke ʻano he koho pragmatic e hōʻemi i ke kaumaha o ke kauka no ka ʻike ʻana i nā maʻi ma ka mālama mua e pane aku i ka manipulation thrust.34 maikaʻi.
“Potentia.l Pitfalls of Clinical Prediction Rules”
He aha nā'ōlelo hoʻomalu hōʻailona?
ʻO ke kānāwai wānana lapaʻau (CPR) he hui pū ʻana o nā ʻike lapaʻau i hōʻike ʻia i ka helu ʻana i ka wānana kūpono i ka hoʻoholo ʻana i kahi kūlana i koho ʻia a i ʻole prognosis o kahi maʻi i hoʻolako ʻia me kahi lāʻau lapaʻau 1,2. Hoʻokumu ʻia nā CPR me ka hoʻohana ʻana i nā ʻano helu helu lehulehu, ua hoʻolālā ʻia e nānā i ka hiki ke wānana o nā pūʻulu i koho ʻia o nā ʻano lāʻau lapaʻau3,4, a ua manaʻo ʻia e kōkua i nā kauka e hoʻoholo wikiwiki i ka mea maʻamau i lalo o nā biases5. ʻO nā lula he algorithmic ma ke ʻano a hoʻokomo i ka ʻike condensed e hōʻike ana i ka helu liʻiliʻi o nā hōʻailona hōʻailona helu i ke kūlana i manaʻo ʻia.
Hoʻokumu ʻia nā lula wānana lāʻau lapaʻau me ka hoʻohana ʻana i 3-step method14. ʻO ka mea mua, ua loaʻa iā mākou nā CPR me ka
i nā ʻano helu helu multivariate no ka nānā ʻana i ka hiki ke wānana o nā pūʻulu i koho ʻia o nā ʻano hoʻololi lapaʻau3. ʻO ka lua o ka hana e pili ana i ka hōʻoia ʻana i ka CPR i kahi hoʻokolokolo hoʻokele randomized e hōʻemi i ka hopena i koho ʻia nā mea wānana i ka wā o ka derivation e ka chance14. ʻO ke kolu o ka ʻanuʻu e pili ana i ka hana ʻana i ka loiloi hopena e hoʻoholo ai pehea e hoʻomaikaʻi ai ka CPR i ka mālama, hoʻemi i nā kumukūʻai, a wehewehe pololei i ka pahuhopu i manaʻo ʻia.
ʻOiai he mea nui ka hoʻopaʻapaʻa i kūkuluʻia i ka hana e hiki i ka CPR ke hoʻoikaika i kaʻoihana pilikino, i kaʻuʻike,ʻaʻohe mau kuhikuhi e hōʻike ana i nā kumuhana pili no ka CPRs no ka hoʻonuiʻiaʻana i loko o nā kaʻina hana o ke kaulike. Hoʻokumuʻia nā alakaʻi e hoʻonui i ke koʻikoʻi o ka hoʻonaʻauao a me ka hōʻikeʻana. Hōʻike ka mea hoʻoponopono hoʻoponopono e pili nei i nā kumuhana pili pono i nā CPR i hiki ai ke hōʻemi nui i ka hikiwawe o ka algorithm. I loko o keʻano o ka hoʻouluʻana, nui ka hoʻonohonohoʻana i nā CPR; no laila, ke hōʻike nei kaʻu mau manaʻo ma lalo o CPRs.
Nā Koina Paʻa
Hoʻolālā ʻia nā CPR e kuhikuhi i kahi hoʻonohonoho homogenous o nā hiʻohiʻona mai kahi heluna heterogeneous o nā mea maʻi i koho ʻia i koho ʻia 5,15. ʻO ka maʻamau, ʻo ka hopena o ka heluna kanaka kūpono he ʻāpana liʻiliʻi o kahi laʻana nui aʻe a hiki ke hōʻike i kahi pākēneka liʻiliʻi o ka nui o ka hihia o kēlā me kēia lā a ke kauka. ʻO ka hoʻonohonoho a me kahi o ka hōʻailona nui e pono e generalizable15,16, a me nā haʻawina kūpono e pono ai ka loiloi o ka CPR ma nā hui maʻi likeʻole, ma nā wahi likeʻole, a me kahi hui maʻi maʻamau iʻikeʻia e ka nui o nā clinicians16. Ma muli o ka nui o nā CPR i hoʻomohala ʻia ma muli o kahi pūʻulu ʻokoʻa e hōʻike ana i ka heluna kanaka maʻamau o nā maʻi, hiki ke kaupalena ʻia ka spectrum transportability17 o nā algorithm CPR o kēia manawa.
Hoʻohana nā lula wānana maʻi i nā ana hopena e hoʻoholo ai i ka pono o ka hana. Pono e loaʻa i nā ana hopena i hoʻokahi wehewehe hana5 a koi i ka pane kūpono e hopu i nā loli kūpono i ke kūlana14 maoli; Eia kekahi, pono e loaʻa i kēia mau ana ka helu ʻoki ʻoki maikaʻi ʻia16,18 a e hōʻiliʻili ʻia e kahi luna hoʻomalu makapō15. Ke hoʻopaʻapaʻa ʻia nei ke koho ʻana i kahi helu heleuma kūpono no ke ana ʻana i ka loli maoli 19-20. Hoʻohana ka hapa nui o nā ana hopena i kahi nīnau nīnau hoʻomanaʻo hoʻomanaʻo e like me ka helu honua o ka helu hoʻololi (GRoC), i kūpono ke hoʻohana ʻia i ka wā pōkole akā loaʻa ka manaʻo hoʻomanaʻo ke hoʻohana ʻia i nā analyses lōʻihi19-21.
ʻO kahi drawback kūpono no nā CPR ʻo ka mālama ʻole ʻana i ka maikaʻi o nā hoʻokolohua a me nā ana i hoʻohana ʻia ma ke ʻano he wānana i ka algorithm. No laila, pono ke kū'oko'a ka ho'ā'o kuana'ike a me nā ana i ka wā ho'ohālike16; pono e hana 'ia kēlā me kēia ma ke 'ano kūpono a 'ae 'ia4; ʻO nā kauka lapaʻau a i ʻole nā luna hoʻoponopono ʻikepili e makapō i nā ana hopena a me ke kūlana o ka mea maʻi22.
kumu
Nā Pitfalls kūpono o nā Rula Wanana Haumāna; ʻO ka puke pai o ka Manual & Manipulative Therapy Volume 16 Helu ʻelua [69]
Jeffrey J Hebert a me Julie M Fritz; Nā hoʻoholo o ka hoʻoholoʻana i nā hōʻailona, ka hoʻopauʻana i kaʻeha o ka'ōpū me ka wānana o ka hopena o nā mea e pono ai: kahi kūkākūkā o nā loiloi hou nei i ka puke hoʻoponopono
ʻO ke kaumaha o kekahi o nā hihia koʻikoʻi o nā manaʻo maʻamau i ka United States. Ke hōʻike nei nā hana i kēia manawa e pili ana ka hopena o ke kaumaha ma muli o ka pilina, keʻano olaola, ka pilina, a me keʻano o kaʻike. ʻO ke kaumaha ka maʻi nui o nā maʻi nui ma ka honua holoʻokoʻa me kahi hoʻokalakino waiwai a pilikino i kaʻaha kanaka. ʻO ka mea pōmaikaʻi, ke kaumaha,ʻo nā hihia koʻikoʻi paha, hiki ke mālamaʻia. Ma mua o ka hoʻomakaʻana o ka hanaʻana, hiki i ka maikaʻi.
ʻO ka hopena, akā, he pono no nā meaolaola ikaika loa e kōkua i ka hoʻomaikaʻiʻana i ka hōʻailona no ka holomua i ke kaʻina hana lāʻau lāʻau a me ka lāʻau no nā mea maʻi i kēlā maʻi. ʻO kēia nā hōʻailonaʻikepili a pilikino e pili ana i kahi hiki ke hoʻohanaʻia e wānana i ka likelika o ka hoʻomaka a iʻole ke ola o ka puʻuwai, e hoʻoikaika e like me ka paʻakikī a iʻole ke kahakiho, kuhikuhi i ka wānana a me kaʻikeʻana i ka paneʻana i nā hana hoʻoponopono. ʻO ke kumuhana o kēiaʻatikala ma lalo iho nei, e hōʻike i nāʻike hou, nā hopena a me nā manaʻo e hiki mai ana i ka wā e loaʻa ai nāʻano likeʻole nā mea kanu honua no ke kaumaha a me pehea e hiki ai i kēia mau mea ke kōkua i ka hōʻoiaʻana i ka hōʻoia a me ka mālamaʻana.
ʻO nā meaolaola no ka pilikia: Nāʻike hou, nā hopena o kēia wā a me nā mea e hiki mai ana
Hōʻuluʻulu Manaʻo
Ua loaʻa i kahi o ka noiʻi he haneli mau mea kanu no ka pilikia, akā,ʻaʻole i hoʻokumu i kā lākou kūlana ma nā maʻiʻehaʻeha a iʻole i hoʻokumu i nā mea maʻamau i hiki i nā poʻe maʻi a pehea e hoʻohana ai i nā'ikeolaola no ka hoʻonuiʻana i ka hōʻoia, ka maʻi a me kaʻike. ʻO kēia hemahema o ka neʻeʻana i ke kaʻina ma muli o keʻano a me ka nui o ka pōʻino, me keʻano heterogeneity ma loko o nā palapala noiʻi a me nā mea nui o nā biomarkers me ka mana, e like me ka nui o nā mea. Ke nānā nei mākou i nā palapala i hiki mai, kahi e hōʻike ai i nā mea markima e komo ana i nā inflammatory, neurotrophic a me nā hana hana kūmole, a me nā pūnaewele neurotransmitter a me nā neuroendocrine, e hōʻike ana i nā moho kūpaʻa loa. Hiki ke anaʻia kēia mau mea ma o nā moʻo a me nā epigenetic, transcriptomic a proteomic, metabolomic a me nā neuroimaging assessments. Hoʻohanaʻia ka hoʻohanaʻana i nā puke hou a me nā polokalamu noiʻi hoʻonaʻauao maʻamau no ka hoʻoholoʻana i keʻano, aʻo ia hoʻi, hiki ke hoʻohanaʻia nā biomarkers e wānana i ka paneʻana i ka lāʻau lapaʻau, ke kāohi i nā maʻi i nā hōʻailona kūikawā a me ka hoʻolālā i nā hiʻona no nā hana hou. Hoʻomaopopo mākou he nui ka'ōlelo no ka hoʻohaʻahaʻaʻana i ke kaumaha o ke kaumaha ma o ka uluʻana a me ka hoʻonuiʻana i kēia mauʻimi noiʻi.
Keywords:ka maʻi o ka naʻau, ka maʻi kaumaha nui, ka mumū, ka paneʻana, ka palekana, ka lāʻau lapaʻau
Introduction
Nā Luʻi o ke Ola Mental a me nā Haumāna Ola
ʻOiai ua loaʻa ka kaumaha o ka maʻi hōʻailona ma mua o nāʻano maʻi diagnostics'ē aʻe,ʻo 1 kaʻikeʻole o ka hilinaʻi i waena o ka maʻi kino a me ka noʻonoʻoʻana ma nā māhele likeʻole, me kahi kālā noiʻiENDNUMX a me ka publication.2 Ma waena o nā pilikia a me ke kīnā o ke kino o ka hoʻolālāʻokoʻa o ka hoʻopiliʻana, ka hōʻailona a me ka hōʻailona ma muli o kaʻikeʻole i nā hana e hoʻokumu nei i kēia mau pilikia. Hōʻikeʻia kēia i nā maʻi o ke kino, ka māhele e komo ana i kahi kaumaha nui loa i ke kino o ka manaʻo .3ʻO ke kaumaha o keʻano maʻamau,ʻo ka maʻi kaumaha nui (UN), he maʻi nui loa, a hiki i ka 3% o nā maʻi kekahiʻano o ke kū'ē palekana e hoʻolōʻihi a hoʻopilikiaʻia episodes.60 No nā maʻi o ka naʻau, a ma kahi ākea o ka maʻi noʻonoʻo, hiki paha ke hoʻomaikaʻiʻia nā hopena o ka maʻi ma o kaʻikeʻana i nāʻano likeʻole ma loko (a me nāʻaoʻao) o nā maʻi diagnostics, hiki ke hoʻopaʻaʻia. No ka hoʻomaopopoʻana i kēia, ua holo nei nā hoʻolālā honua e hoʻomohala i nāʻano hana hoʻohiwahiwa i ka holomua, e like me nā pae'āina noiʻi .4 Ua kūponoʻia nā mea hoʻohālikelike ke kumuhana no ka hoʻohaʻahaʻaʻana i nā maʻi naʻau .5
Hoʻonui i ka paneʻana i nā maʻi no ka pilikia
Ma keʻano he nui o nā koho lapaʻau no ka pilikia nui, kahi kokoke wale nō i ka hapakolu o nā maʻi me ka UN e hoʻokō i ke kalaʻana ma ka loaʻaʻana o ka hōʻailona kūpono e like me nā kūkākūkā likeʻole a me ka mālamaʻana i ka mālamaʻana, a laila e hāʻule ana nā pane o ka paneʻana i kēlā me kēia maʻamau hou .7ʻO ka mea'ē aʻe, pili i ke kaumaha o ka hoʻomalūʻana (TRD) me ka hoʻonuiʻana i ka hana hana, ka make, ka maʻi pōʻino a me nā hopena hou o ka wā lōʻihi.8,9 Pēlā, e loaʻa ai nā pono hou i nā hopena holoʻokoʻa. i loko o ka puʻuwai. Me ke kaumaha nui i pili i ka TRD, ua loiloi nā noiʻi ma kēia wahi. ʻAʻole i hoʻolālāʻia nā wehewehe o TRD, me nā mea i ho'āʻo muaʻia: 4 kekahi mau papahana hoʻokahi wale nō ho'āʻo hoʻonāʻana e hikiʻole ai ke hōʻiliʻili i kahi hōʻailona 50% (hōʻailona o ke kaumaha), akāʻo nā mea'ē aʻeʻaʻole e loaʻa ke kala piha aiʻole ka paneʻole i nā meaʻelua a wiliwili i nā antidepressants o nāʻano likeʻole i loko o ka hopena e manaʻoʻiaʻo TRD.4,10. Eia kekahi, ua hoʻonuiʻia ke kūlana a me nā wanana o ke kū'ēʻana i nā maʻi ma o ka hoʻohuiʻana i nā hiʻohiʻona pili kino o ka paʻakikī a me ka hoʻomauʻana i ka helu o nā hana maʻamau .9,11 Akā naʻe,ʻo kēia mau hua'ōlelo hoʻohālike hoʻohālike e unuhi ana i nā palapala noiʻi ma TRD i kahiʻoihana paʻakikī.
I mea e hoʻomaikaʻi ai i ka paneʻana i nā hōʻailona, he mea maʻalahi ke hoʻomaopopo i nāʻano pilikia o ka nonpondponse. Ua weheweheʻia kekahi mau meaʻike mua o TRD, me ka nele i ke kala hope loa ma hope o nā episetena mua, i ka manaʻo palekana, ka hopena a me ka hoʻomaka muaʻana o ka puʻuwai, a me keʻano (ʻo kahi haʻahaʻa haʻahaʻa, haʻawina haʻahaʻa haʻahaʻa a me nā neurotic kiʻekiʻe) a me nā kumu genetic.12 Ua hoʻopiliʻia kēia mau hopena ma nā hoʻokipa kūkākūkāʻana i nā hōʻike ma kahi kaʻawale no ka pharmacologic13 a me psychological14 maʻi no ke kaumaha. Ke hōʻikeʻia nei ka hopena o nā mea hōʻokoʻa a me nā hoʻopiʻi kālele-behavioral like me ka pono o ka pono, 15 akā, no ka mea, he mea likeʻole kaʻike o nā mea likeʻole. ʻOiai ua lōʻihi ka piliʻana o ka trauma i nā hopena o ka lāʻau maʻi a me ka hōʻoiaʻana o ka paneʻana i ka maʻi, nā hōʻailona mua o 16 e hōʻike ana i nā kānaka me ka moʻolelo o ka'ōpiopio o ka'ōpiopio e hiki ke pane aku i ka maikaʻi ma mua o nā maʻi o ka pharmacologic.17 Me kēia mea, ua komo i ka lawelaweʻana i kaʻoihana o ka lāʻau .18
Ke nānā nei kēia nānā i nā hōʻike e kākoʻo ana i ka pono o nā meaola biomarkers e like me nā lako hana pono e pono ai ka hoʻonuiʻana i ka pane no ka hoʻomalu.
Nā meaola: nā Pūnaewele a me nā Kumu
Hāʻawi nā mea biomarkers i kahi pahuhopu kūpono no ka hoʻomaopopoʻana i nā wānana o ka paneʻana i nā hana likeʻole .19ʻO ka hōʻike i kēia lā e kuhikuhi ana i nā mea kaha e hoʻomanaʻo ana i ka hana o ka inflammatory, neurotransmitter, neurotrophic, neuroendocrine a me nā pūnaha metabolic e hiki ke hiki iā lākou ke wānana i nā hopena o kaʻike kino a me ke kino. , akā he nui ke kuhiwaena ma waena o nā'ikea.20 Ma kēia hoʻolālā, ke nānā nei kā mākou i nā pūnaehana biologic.
No ka loaʻa ʻana o ka ʻike piha o nā ala molekiola a me kā lākou hāʻawi i nā maʻi psychiatric, ua manaʻo ʻia ia mea he mea nui e loiloi i nā biologic "ʻelua", i ka mea i kapa nui ʻia ma ke ʻano he kaʻina hana. 21 hōʻike ka 1 i kahi hōʻike o ka ʻokoʻa. pae biologic kahi e hiki ai ke loiloi i kēlā me kēia o nā ʻōnaehana ʻelima, a me nā kumuwaiwai kūpono o nā māka i hiki ke mālama ʻia kēia mau loiloi. Eia nō naʻe, e nānā ʻoiai hiki ke nānā ʻia kēlā me kēia ʻōnaehana i kēlā me kēia pae omics, ʻokoʻa ke kumu kūpono o ke ana ʻana i kēlā me kēia pae. ʻO kahi laʻana, hāʻawi ka neuroimaging i kahi pae no ka loiloi ʻole o ka hanana o ka lolo a i ʻole ka hana, ʻoiai ke nānā pono ʻana i ka protein i nā māka. Hoʻonui kaulana ʻia ʻo Transcriptomics22 a me metabolomics23, e hāʻawi ana i ka loiloi i nā helu nui he nui, a ke hoʻāʻo nei ka Project Microbiome Human e ʻike i nā microorganism āpau a me kā lākou hanana genetika i loko o nā kānaka. ; ʻo kahi laʻana, hiki ke hoʻāʻo ʻia i nā homone e like me ka cortisol i ka lauoho a i ʻole nā manamana lima (e hāʻawi ana i kahi hōʻailona hoʻomau) a i ʻole ka hou (e hāʻawi ana i kahi ana mau), 24 a me ke koko, ka wai cerebrospinal, ka mimi a me ka huha.
Hāʻawi ʻia i ka helu o nā kumuwaiwai putative, nā pae a me nā ʻōnaehana i pili i ke kaumaha, ʻaʻole ia he mea e kahaha ai i ka nui o ka nui o nā biomarkers me ka hiki ke unuhi. ʻO ka mea kikoʻī, ke noʻonoʻo ʻia nā pilina ma waena o nā māka, malia paha ʻaʻole hiki i ka nānā ʻana i hoʻokahi biomarkers ke kaʻawale ke loaʻa nā hua no ka hoʻomaikaʻi ʻana i ka hana lapaʻau. Ua noi ʻo Schmidt a me al26 i ka hoʻohana ʻana o nā paneli biomarker a, ma hope iho, ua wehewehe ʻo Brand et al27 i kahi papa hoʻonohonoho e pili ana i nā hōʻike maʻi mua a me nā preclinical mua no MDD, e hōʻike ana i nā pahuhopu biomarker he 16, ʻo kēlā me kēia mea he marker hoʻokahi. Hoʻopili lākou i ka nui o ka hina hina (i ka hippocampal, prefrontal Cortex a me nā basal ganglia mau wahi), nā hoʻololi o ka pōʻai o ka circadian, hypercortisolism a me nā hiʻohiʻona ʻē aʻe o ka hypothalamic - pituitary adrenal (HPA) , hoʻonui i ka glutamate, hoʻonui i ka superoxide dismutase a me ka lipid peroxidation, adenosine cyclic adenosine 5?, 3? -monophosphate a me ka mitogen-activated protein kinase pathway activity, hoʻonui i nā cytokines proinflam inflammatory, nā hoʻololi i ka tryptophan, kynurenine, insulin a me nā polymorphism genetical kikoʻī. ʻAʻole ʻae ʻia kēia mau māka e ka ʻae a hiki ke ana ʻia ma nā ʻano like ʻole; maopopo ia ka pono o ka hana nui a me ka ʻōnaehana pono e kamaʻilio i kēia hana nui i mea e hōʻoia ai i ko lākou pono pono kīwila.
Nā manaʻo o kēia hōʻike
Ma keʻano he loiloi nui ākea, eʻimi ana kēiaʻatikala e hoʻoholo i nā pono a pau o ka noiʻi biomarker i loko o ke kaumaha a me ka nui o ka mea e loaʻa ai i nā biomarkers ka mana unuhi hou no ka hoʻonuiʻana i ka pane i nā hōʻailona. Hoʻomaka kākou ma ke kūkākūkāʻana i nāʻike nui loa a me nā mea hoihoi i kēia māhele a kuhikuhi i ka mea heluhelu i nā manaʻo hou e pili ana i nā kaha like a me nā hoʻohālike. Ke hoʻopuka nei mākou i nā hopena o kēia manawa i kūpono i ka mālamalama o nāʻike, e like me nā pono no ka hoʻohaʻahaʻaʻana i ke kaumaha o ke kaumaha. I ka hopena, ke nānā nei mākou i mua o nā alaʻi noiʻi kūpono no ka hālāwaiʻana i nā pilikia o kēia wā a me nā hopena no kaʻoihana olakino.
Nāʻike hou
Loaʻa ka huliʻana i nā meaola pilikino maikaʻi no nā poʻe me ke kaumaha i ka hoʻokolokolo nuiʻana i ka hapalua o ka hala. ʻO nā maʻamau i hoʻohana pinepineʻiaʻia, ua hoʻohālikelikeʻia mai keʻano o ka monamine theory o ke kaumaha; i ka hopena, ua nui ka nānāʻana o nā kuʻi neuroendocrin. I nā makahiki i hala koke aku nei, ua puni nā kuhiakau nui loa i ke kuhiakau inflammatory o ke kaumaha. Eia nō naʻe, ua nui ka nui o nā hōʻike loiloi e pili ana i nā'ōnaehanaʻelima; e nānā i ka Papa 1 a me lalo no ka hōʻiliʻili o nāʻike hou mai nā pūnaewele biomarker. I ka anaʻana i nāʻano he nui, ua nānā nuiʻia nā proteins i laweʻia ma ke koko a hāʻawi i kahi kumu biomarker kūpono, kūpono-kūpono a hiki paha ke pili i ka mana unuhiʻana ma mua o nā kumu'ē aʻe; no laila, ua hāʻawiʻia aku nā kikoʻokoʻa i nā meaola biomarkers e hele nei i loko o ke koko.
I loko o kahi loiloi hou o ka ʻōnaehana, ua nānā ʻo Jani et al20 i nā biomarkers i hoʻokumu ʻia i ke koko no ke kaumaha i ka hui pū ʻana me nā hopena lapaʻau. Ma kahi o 14 mau noiʻi i hoʻopili ʻia (ʻimi ʻia a hiki i ka hoʻomaka mua o 2013), ua hoʻopaʻa ʻia nā biomarkers he 36 a he 12 mau wānana koʻikoʻi o nā manaʻo pane a me nā pane kino paha ma kahi o hoʻokahi hoʻokolokolo. ʻO kēlā mau mea i ʻike ʻia ma ke ʻano he mea e hōʻike ana i nā pilikia no ka nonresponse me nā proteins inflammatory: low interleukin (IL) -12p70, ka lakio o ka lymphocyte i ka helu monocyte; neuroendocrine markers (dexamethasone nonsuppression o ka cortisol, kiʻekiʻe hoʻopōʻaiapuni kortisol, hoʻēmi thyroid-stimulate hormone); nā māka neurotransmitter (haʻahaʻa serotonin a me noradrenaline); metabolic (haʻahaʻa lipoprotein kolesterol kiʻekiʻe) a me nā mea neurotrophic (hoʻemi ʻia ka protein B-calcium paʻa paʻa B). Ma waho aʻe o kēia, ua hōʻike ʻia nā loiloi ʻē aʻe i nā hui ma waena o nā biomarkers hou a me nā hopena lapaʻau. 100-19,28 30 ʻO kahi wehewehe pōkole o nā māka putative i kēlā me kēia ʻōnaehana i hōʻike ʻia i nā ʻāpana aʻe a ma ka Papa 2.
NāʻIke Iʻe Waiho i ka Paʻi
Mai ka pepa seminal a Smith e hōʻike ana i ke kuhiakau macrophage, ua loaʻa kēia 31 puke i hoʻonui ʻia i nā pae o nā māka proinflam inflammatory i nā mea maʻi kaumaha, i loiloi ʻia he nui. 32--37 He ʻumikūmālua mau proteins inflammatory i loiloi ʻia i loko o nā meta-analysis e hoʻohālikelike ana i ke kaumaha a me ke olakino. hoʻoholo i nā lehulehu.38--43
IL-6 (P <0.001 i nā kālailai meta a pau; 31 i hoʻopaʻa ʻia nā noiʻi) a me CRP (P <0.001; 20 mau haʻawina) e piʻi pinepine a hilinaʻi ʻia i ke kaumaha. 40 Ua ʻike ʻia ka alpha (TNF?) ʻĀhā kūpaka kiʻekiʻe. (P <0.001), 38 akā heterogeneity nui ka mea i hōʻoia i ka wā e helu ana no nā noiʻi hou (31 haʻawina) .40 IL-1? ʻoi aku ka pili pili ʻole me ke kaumaha, me nā meta-analysis e hōʻike ana i nā kiʻekiʻe kiʻekiʻe o ke kaumaha (P = 0.03), 41 mau kiʻekiʻe kiʻekiʻe wale nō ma nā aʻo ʻana o ʻEulopa42 a i ʻole nā ʻokoʻa mai nā kaohi. 40 Eia nō naʻe, ua hōʻike ʻia kahi ʻatikala hou e pili ana i nā hopena unuhi pili no IL- 1?, 44 i kākoʻo ʻia e ka hopena koʻikoʻi nui o ka IL-1 kiʻekiʻe? ribonucleic acid e wānana nei i kahi pane maikaʻi ʻole i nā antidepressants; 45 mau mea i loaʻa ma luna aʻe e pili ana i nā cytokine i loaʻa i ke koko. Ua hōʻike ka chemokine monocyte chemoattractant protein-1 i nā kiʻekiʻe i loko o nā mea komo kaumaha i hoʻokahi meta-analysis. 39 Interleukins IL-2, IL-4, IL-8, IL-10 a me interferon gamma ʻaʻole ʻokoʻa loa ma waena o nā mea maʻi kaumaha a me nā kaohi ma a pae meta-analytic, akā ua hōʻike i ka hiki i ka hoʻololi ʻana me ka lapaʻau: Ua hōʻike ʻia ʻo IL-8 i hoʻokiʻekiʻe ʻia i nā mea me ke kaumaha kaumaha a me nā ʻāpana ʻē aʻe, 46 mau ʻano like ʻole o ka loli i ka IL-10 a me ka interferon gamma i ka wā o ka mālama ʻana. ua kū ma waena o nā mea pane e pili ana i ka poʻe pane ʻole, 47 ʻoiai ua hōʻemi ʻo IL-4 a me IL-2 i ka laina me ke kala o ka hōʻailona.48 Ma nā meta-analysis, ua hōʻike ʻia nā hoʻemi liʻiliʻi e pili ana i ka lapaʻau no IL-6, IL-1?, IL- 10 a me CRP.43,49,50 Hoʻohui ʻia, TNF? hoʻoliʻiliʻi wale nō me ka mālama ʻana i nā mea pane, a hōʻike ʻia kahi helu kaha hiʻohilohi i ka hoʻonui ʻia ʻana o ka mumū i nā mea maʻi i pane hou ʻole i ka lāʻau.43 Kaulana nō naʻe, kokoke i nā noiʻi āpau e nānā ana i nā proteins inflammatory a me ka pane o ka lāʻau e hoʻohana ai i nā hoʻokolohua lāʻau pharmacologic. . No laila, ma ka liʻiliʻi kekahi mau hoʻololi līlū i ka wā o ka mālama ʻana e pili paha i nā antidepressants. ʻAʻole i hoʻokumu ʻia nā hopena kūpikipiki maoli o nā antidepressants like ʻole, akā hōʻike nā hōʻike e hoʻohana ana i nā pae CRP i nā kānaka e pane ʻokoʻa i nā lapaʻau kūikawā e pili ana i ka mumū o ka pae: ua hōʻike ʻo Harley et al51 i kahi CRP kiʻekiʻe kiʻekiʻe e wānana nei i kahi pane maikaʻi ʻole i ka psychological psychological (cognitive-- behavioral a interpersonal paha. psychotherapy), akā kahi pane maikaʻi i nortriptyline a i ʻole fluoxetine; Ua kope ʻo Uher et al52 i kēia loaʻa no nortriptyline a ʻike ʻia i ka hopena ʻē aʻe no escitalopram. I ka hoʻohālikelike ʻana, ua loaʻa ʻo Chang et al53 i kahi CRP kiʻekiʻe ma nā mea pane mua i fluoxetine a i ʻole venlafaxine ma mua o nā nonrespponder. Eia kekahi, ʻo nā mea maʻi me TRD a me CRP kiʻekiʻe i pane maikaʻi aku i ka TNF? antlixist infliximab ma mua o kēlā me nā pae ma ka pae maʻamau.54
ʻIke pūʻia nā hōʻike e hiki i ka manawa e hoʻoholo ai no nā kumu like ka heluna o ke kino kino (BMI) a me ka makahiki, heʻano hōʻino nā pane pāʻokoʻa i kahi o kahi hapakolu o nā maʻi me ke kaumaha.55,56 He mea nui loa ka pūnaewele inflammatory, a aia nā meaola nui e pili ana i nāʻano likeʻole o kēia pūnaewele. I kēia mau lā, ua hāʻawi mai kekahi mau mele cytokines a me nā mele hoʻomana i ka hōʻike o nā meaʻino i ke kaumaha. Hoʻopukaʻia kēia mau mea: ke kinolima hoʻopunipuni 1a, IL-1a, IL-7, IL-12p70, IL-13, IL-15, eotaxin, kahi granulocyte macrophage colony-stimulating factor, 57 IL-5,58 IL-16,59 IL-17,60 monocyte chemoattractant protein -4,61 kahemo a me ka chemokine i hoʻohuiʻia, 62 eotaxin-3, TNFB, 63 kahe i loaʻa i ka protein 10,64 sery amyloid A, 65 pūnohu admodular adhesion moleʻonui66 a me ka 1.67 pūnaewele holoʻokoʻa holopili.
Nāʻike i loaʻa i ka hopena
Ma muli o keʻano kūpono o nā kumu o ka ulu (neurotropic growth growth) (e like me nā mea e pili ana i ka angiogenesis), ke nānā aku nei mākou i nā meaolaola neurogenic malalo o ka ho'ākākaʻokoʻa o nā mea ulu.
ʻO ke kumu neurotrophic i loaʻa i ka lolo (BDNF) ka mea i aʻo pinepine ʻia o kēia mau mea. Hōʻike nā loiloi hou he nui i ka attenuations o ka protein BDNF i ka serum, i hoʻonui ʻia ma ka ʻaoʻao o ka lāʻau antidepressant.68--71 ʻO ka mea hou loa o kēia mau anamanaʻo e hōʻike nei i kēia mau BDNF aberrations i ʻōlelo ʻia i nā mea maʻi kaumaha loa, akā ʻike ʻia nā antidepressants hoʻonui i nā pae o kēia protein a hiki i ka loaʻa ʻole o ke kala lapaʻau.70 proBDNF ua aʻo liʻiliʻi ʻia ma mua o ka ʻano makua o BDNF, akā ʻokoʻa ke ʻano o nā mea ʻelua (e pili ana i nā hopena o ka receptor kinase B receptor). Hōʻike nā hōʻike i ka wā e hoʻemi ʻia ka BDNF oʻo i ke kaumaha, proBDNF e hoʻonui ʻia paha. 72 Ua hoʻonui ʻia ke kumu o ka ulu o ke ake e like me ka haʻahaʻa o ke kaumaha ma mua o nā kaohi ma kahi meta-analysis, akā ʻaʻole paha i hoʻololi ʻia e ka lāʻau antidepressant ʻoi loa i hoʻonāukiuki ʻia i nā mea maʻi me ke kaumaha kaumaha loa.73 Ua loaʻa nā hōʻike like i ka meta-analysis no ka glial celllaina neurotrophic laina laina.74
He kuleana ko ka vascular endothelial factor factor (VEGF) i ka paipai ʻana i ka angiogenesis a me ka neurogenesis me nā lālā ʻē aʻe o ka ʻohana VEGF (e like me, VEGF-C, VEGF-D) a ua hoʻohiki ʻo ia no ke kaumaha.75 Me nā hōʻike kūlike ʻole, i hōʻike ʻia i kēia manawa nā kiʻekiʻe o VEGF i ke koko o nā mea maʻi kaumaha i ka hoʻohālikelike ʻia i nā kaohi (ma o 16 mau noiʻi; P <0.001) .76,77 Eia nō naʻe, ua ʻike ʻia ka VEGF haʻahaʻa ma TRD78 a ua wānana nā pae kiʻekiʻe i ka pane ʻole i ka mālama antidepressant.79 ʻAʻole maopopo ia. no ke aha e hoʻokiʻekiʻe ʻia ai nā pae o ka protein VEGF, akā pili ʻia paha ia i ka hana proinflam inflammatory a me / a i ʻole ka hoʻonui ʻia o ka pale o ke kahe o ke kahe o ke koko i nā mokuʻehaʻeha e hōʻemi i ka ʻōlelo i ka wai cerebrospinal. ; ʻaʻole ʻike ʻia kahi noiʻi hou i pili ma waena o ka serum VEGF a i ʻole BDNF me ka pane a i ʻole ke kaumaha o ke kaumaha, ʻoiai ke emi nei me ka hoʻomaʻamaʻa antidepressant. nā kaʻina hana neurotrophic.80 ʻO ke kumu ulu ulu fibroblast (a i ʻole FGF-81) he lālā o ka ʻohana ulu ulu fibroblast a ʻoi aku ke kiʻekiʻe ma ke kaumaha ma mua o nā pūʻulu mālama .1 Eia naʻe, ʻaʻole kūlike nā hōʻike; ua ʻike kekahi ua ʻoi aku ka haʻahaʻa o kēia protein i MDD ma mua o nā kaohi olakino, akā ua hōʻemi ʻia ma kahi ʻē aʻe me ka lāʻau antidepressant.82,83
ʻO nā mea ulu hou iʻikeʻoleʻia i loko o ke kaumaha,ʻo ia ka tyrosine kinase 2 a me ka tymsine kinase-1 flam-like e like me ka fms-like me ka SVEGFR-1) e hana like me ka VEGF, a me nā kikowaena tyrosine kinase (hiki i BDNF) i ho'ēmiʻia i loko o ka puʻuwai.86 Hoʻonui i ka hapa nui o ka hapanui o kaʻohana VEGF, akāʻaʻole i aʻoʻia ma nā hōʻailona hoʻonāwaliwali iʻikeʻia.
Nāʻikepili Biomakal Pūnaehana i loko o ka pilikia
ʻO nā mea kanu nui e pili ana i nā maʻi o ka maʻi maʻamau,ʻo ia ka leptin, adiponectin, ghrelin, triglycerides, lipoprotein kiʻekiʻe (HDL), glucose, insulin and albumin.87 Ua nānā houʻia nā mau pilina ma waena o kēia mau mea a me ke kaumaha: leha ka leptin88 me ka ghrelin89 i ke kaumaha. ma mua o nā mana ma kaʻaoʻao a hiki i ka hoʻonuiʻia me ka hoʻoponopono āpau antivepressant a iʻole kalaʻia paha. Hiki ke hoʻonuiʻia ke kūʻana o ka insulin i loko o ke kaumaha,ʻoiai ma nā mea liʻiliʻi. Uaʻikeʻia keʻano o ka hoʻonāukiukiʻana o ka hanana. ua hōʻikeʻia ka hyperglycemia90 a me ka hypoalbuminemia91 i loko o nā hanana.
Ke hele pinepine nei nā noiʻi ʻana o nā mokuʻāina metabolic me ka hoʻohana pinepine ʻana i nā panela metabolomics o nā moleki liʻiliʻi me ka lana o ka manaʻo e loaʻa kahi inoa biochemical ikaika no nā maʻi psychiatric. I loko o kahi noi hou e hoʻohana ana i ka hoʻohālikelike ʻike naʻau, kahi set of metabolites e hōʻike ana i ka hoʻonui ʻia ʻana o ka glucose i hōʻike mua ʻia i kahi hōʻailona MDD, ua kākoʻo ʻo 94 i nā noi mua. 95
NāʻImi Neurotransmitter Findings in Depression
ʻOiai ka nānā i uku ʻia i nā monoamines i ke kaumaha ua hāʻawi ʻia i nā kūleʻa kūleʻa maikaʻi, ʻaʻole i ʻike ʻia nā māka neurotransmitter ikaika e hoʻomaikaʻi i ka hoʻomaʻamaʻa e pili ana i ke koho ʻana o nā pahuhopu monoamine o nā antidepressants. Nā kuhikuhi hana hou i ka serotonin (5-hydroxytr Egyptamine) 1A mea loaʻa he mea nui no ka ʻike ʻelua a me ka wānana ʻana o ke kaumaha, e kakali ana i nā ʻenehana a me nā ʻano kiʻi hou.96 Aia kekahi mau hana kūpono hou e pili ana iā 5-hydroxytr Egyptamine; ʻo kahi laʻana, me ka hoʻohana ʻana i kahi hoʻomalu hoʻokuʻu lohi o 5-hydroxytr Egyptophan.97 Hoʻonui i ka lawe o ka hoʻopili ʻana o ka dopamine me nā neurotransmitters e hoʻomaikaʻi i nā hopena noʻonoʻo e like me ka hoʻoholo ʻana a me ka hoʻoikaika ʻana.98 Pēlā nō, hiki i nā neurotransmitters glutamate, noradrenaline, histamine a me ka serotonin ke hoʻopili a hana ma ke ʻano he pane o ke kaumaha e pili ana i ke kaumaha; hiki i kēia ke hoʻemi i ka hana 5-hydroxytr Egyptamine ma o ka 'follo . Hōʻike kahi loiloi hou i kēia kumumanaʻo a hōʻike i TRD, hiki ke hoʻohuli ʻia kēia (a me 5-HT i hoʻihoʻi ʻia) ma o ka hoʻomaʻamaʻa multimodal e kuhikuhi ana i nā neurotransmitters he nui.99 ʻO ka mea e mahalo ai, ʻaʻole piʻi pinepine ka hoʻonui ʻana o ka serotonin me nā pono antidepressant therapeutic. 100 ʻOiai kēia , nā metabolites neurotransmitter e like me 3-methoxy-4-hydroxyphenylglycol, o noradrenaline, a i ʻole acidic homovanillic, o ka dopamine, i loaʻa pinepine ʻia e hoʻonui me ka hoʻoliʻiliʻi o ke kaumaha me ka lapaʻau antidepressant101,102 a i ʻole nā pae haʻahaʻa o kēia mau metabolites wānana i kahi pane maikaʻi aʻe i Hoʻomaʻo SSRI.102,103
Nā Neuroendocrine Nānā i loko o ka Pōʻino
ʻO Cortisol ka mea hōʻike kūikawā o ka HPA maʻamau i aʻoʻia i loko o ke kaumaha. Hoʻolahalaha nā loiloi nui i nā papa helu likeʻole o ka hana HPA; ʻo ka mea holoʻokoʻa, pili kēia i ka pilikia me ka hypercortisolemia a ua hoʻopiʻi pinepineʻia ka pane o cortisol.104,105 Ua kākoʻoʻia kēia ma ka nānā houʻana o nā hanu cortisol mauka i anaʻia i ka lauoho, e kākoʻo ana i ke kuhiakau o ka hyperactivity cortisol i loko o ka pilikia akāʻo ka hypoactivity i nā maʻi'ē aʻe me ka weliweli disorder.106 Eia hou,ʻo ka mea nui, hiki i nā kiʻekiʻe cortisol kiʻekiʻe ke hōʻike mua i kahi paneʻoleʻana i ka psychological107 a me ka hōʻailona antidepressant108. ʻO ka mōʻaukala,ʻo ka hōʻailona neuroendocrine maikaʻi loa o ka paneʻana i ka lawelaweʻiaʻana,ʻo ia ka test suppression dexamethasone, kahi i pili ai ka cortisol nonsuppression ma hope o ka hoʻoponopono dexamethasone me ka likelike o ka hoʻokuʻu hopeʻana. Akā naʻe,ʻaʻole i manaʻoʻia kēiaʻano i ka lawa kūpono no ka polokalamu noi. Hoʻohālikelikeʻia ka helmone e hoʻokuʻuʻana i ka corticotrophin a me ka horrenone adrenocorticotropin a me ka vasopressin e hoʻonuiʻia i loko o ke kaumaha aʻikeʻia ka mea i hoʻokoeʻia i dehydroepiandrosterone; hiki ke hoʻokiʻekiʻeʻia ka lakene o ka cortisol i ka dehydroepiandrosterone ma keʻano he mea pale ma TRD, e hoʻomau ana ma hope o ka hoʻokuʻuʻana .109 Neuroendocrine hormone dysfunctions ua pili lōʻihi i ka pilikia, a hiki i ka hypothyroidism ke hoʻokūkū i kahi hana i loko o ka moodā kaumaha.110ʻOiai, kūlike me ka hana kūpono no ka hoʻonāukiuki .111
Ma loko o ka mea i luna, he mea nui e noʻonoʻo i nā ala hōʻailona ma waena o nā ʻōnaehana, e like me glycogen synthase kinase-3, kinogen-activated protein kinase a me cyclic adenosine 3?, 5? -Monophosphate, pili i ka synaptic plasticity112 a hoʻololi ʻia e antidepressants.113 Eia hou hiki ke ana ʻia nā moho biomarker i hiki ke hoʻohana ʻia i neuroimaging a i ʻole genetics. I ka pane ʻana i ka nele o ka ʻokoʻa a koʻikoʻi o ka ʻokoʻa genomic ma waena o nā lehulehu kaumaha a me nā nondepressed, 114 puke genetics hoʻokokoke ʻana e like me nā helu polygenic115 a i ʻole telomere length116,117 hiki ke hōʻoia ʻoi aku ka maikaʻi. Ke nānā nei nā biomarkers hou i ke kaulana e nānā nei i nā pōʻai circadian a i ʻole nā biomarkers kronobiologic e hoʻohana nei i nā kumuwaiwai like ʻole. Hiki i ka Actigraphy ke hāʻawi i kahi loiloi pahuhopu o ka hiamoe a me ka hana ala a hoʻomaha ma o kahi wikiwiki, a hiki i nā hāmeʻe hana ke hoʻonui i nā kumu hou aʻe e like me ka hōʻike māmā. ʻOi aku paha ka maikaʻi o kēia no ka ʻike ʻana ma mua o nā hōʻike kumuhana hoʻohana maʻamau o nā mea maʻi a hiki ke hāʻawi i nā mea wānana i ka pane o ka hoʻomaʻamaʻa.118 ʻO ka nīnau a nā biomarkers e hoʻohiki nei no ka hoʻohana unuhi ʻana he nīnau paʻakikī ia, i hoʻonui ʻia ma lalo.
Nā hopena o kēia manawa
No kēlā me kēiaʻano neurobiological pūnaewele hou e loiloi ana, aia nā hōʻike ma kahi'ōlelo likeʻole: aia nā mea pilikino e pili ana e pili ana i kekahi mau hiʻohiʻona me ke kaumaha. Hōʻaleʻa pinepineʻia kēia mau māka i loko o kahi hōʻailona, paʻakikī. ʻAʻole i kuhi ka'ōlelo hōʻike, a he mea nui paha kekahi o nā kumu'ē aʻe a he mau mea nui kekahi ma kahi o nā maʻi wale nō. Hiki ke hoʻohana ponoʻia ka poʻe biomarkers ma o nā ala likeʻole (e like me ka poʻe e wānana ana ma hope o ka paneʻana i ka hōʻailona,ʻo ia ka mea e hōʻike ana i nā hōʻailona kūpono e like me ka mea iʻoi aku ka maikaʻi a iʻole nā mea e hoʻololi a me nā hana kūponoʻole nāʻoihana hōʻailona). Pono nā kūmole no ka hoʻonuiʻana i ke kūlike a me ka hoʻohana ponoʻana o nā loiloi kūlohelohe i nā kānaka psychiatric.
ʻO keʻanoʻo Biomarker
ʻO ka hoʻololiʻana o nā mea kanu ma ka manawa a me nā hanana a pau e pili ana i kekahi mauʻano (eg, proteomics) ma mua o nā mea'ē aʻe (genomics). Loaʻaʻole nā kūlana maʻamau no nā mea he nui aʻaʻole iʻae likeʻoleʻia. ʻOiaʻiʻo,ʻo ka hopena o nā hopena o ka hopena o nā mea e kahakila pinepine ai ma luna o ka hoʻohui mele a me nāʻano likeʻole physiologic ma waena o nā kānaka i hikiʻole ke heluʻia. ʻO kēia keʻano o ka loiloi o ka hana biomarker, a me kaʻikeʻana i nā meaʻino, nā paʻakikī e wehewehe. Ma muli o ka heluna o nā meaola kūikawā, hikiʻole ke anaʻia i ka nui aʻole i ka papa piha piha me nā mea likeʻole.
Ua hōʻikeʻia he mau kumu he nui no ka hoʻololiʻana i nā pilikino i nā'ōnaehana biologic i nā maʻi me nā maʻi hoʻohālike. Ma muli o nā mea e pili ana i ka noiʻi e like me ka lōʻihi a me keʻano o ka mālamaʻana (e like paha me ka hoʻonāukiukiʻana o kekahi pūnaewele),ʻo ia ka lā o ka lā i anaʻia, ka lāhui, ka hana, ka hana 119 (e like me ka hana microbiome, ʻaʻole e koi i kahi mea hoʻolālā wikiwiki), 120 mea puhi a me ka hoʻohana waiwai, 121 a me nā mea pilikino (e like me ka comorbid inflammatory, maʻi maʻi a me nā maʻi'ē aʻe). Eia kekahi laʻana,ʻoiai uaʻikeʻia ka hoʻonuiʻiaʻana o ka maʻi i loko o nā mea kaumaha a he kanaka olakino'ē aʻe paha i hoʻohālikelikeʻia me nā lālā i hōʻikeʻoleʻia,ʻo nā kānaka kaumaha i loaʻa i kahi maʻi piliʻole i ka piliʻole i nāʻanoʻoihana o ka cytokine. hiki i ka hopena o ka pilina ma waena o nā mea kanu, ke kaumaha, a me ka paneʻana i nā mea e hōʻike ai.
Ka pilikia. ʻO nā hopena a me nā'ōlelo kūlohelohe, he mau hana koʻikoʻi e pili ana i ke kaumaha (physiologic a psychological), aʻo ka pilikia ma ka manawa o ka koina biologic kālepa,ʻaʻole i maʻalahiʻia i nā noiʻi noiʻi ma muli o ka loli o kēia kumuhana i waena o nā poʻe i hiki ke hoʻonuiʻia e nā nā hōʻailona pōʻino. Ke hana nei nā mea hoʻonāukiuki a me nā maʻi āpau e like me ka hopena paʻakikī, me ka hoʻonaniʻana i nā pane o kaʻeleʻele i loko o ka pōkole a me ka lōʻihi .123,124 Hōʻaho kēiaʻike i ka hopena o ke kaumaha o ka wā kahiko, i pili i nā loina ukali makuaʻole e kū kaʻawale ana i ka pilikia iʻikeʻia. ʻO kekahi kanaka makua.125,126 I ka wā o ka'ōpiopio,ʻikeʻia ka hoʻonuiʻiaʻana o ka hoʻolālā i nā keiki i hoʻopilikia waleʻia i kēia manawa .127 Ma keʻano likeʻole, ua hiki i nā kānaka me ke kaumaha a me ka moʻolelo o ka'ōpiopio o ke kamaliʻi ka hoʻopiʻiʻana i ka cortisol pane i ka pilikia, ke hoʻohālikelikeʻia i ka poʻe i ke kaumaha. ʻaʻole ka hopena o ka wā kahiko.128 Hōʻeuʻeu HPA axis i hoʻokomoʻia e pili ana i ka hanaʻimi, 129 a me ka hoʻohaʻahaʻa i ka hoʻohālike a me ka hoʻololiʻana i nā genes pili i ka HPA.130 Stress kekahi mau hopenaʻeha pōkole a lōʻihi hoʻi ma ka neurogenesis131 a me nā mea'ē aʻe mechanics.132ʻAʻole i maopopo maopopo i keʻano o ka hopena o ke kamaliʻi e pili ana i nā meaola biologic i loko o ka pilikia akā, hiki i ka pilikia o ka hoʻomakaʻana o ke ola ma mua o kekahi mau kānaka e hoʻomanawanui i nā manaʻo koʻikoʻi i ka wā'ōpio i hoʻonuiʻia i psychologically a / a biologically.
ʻO ka hanaʻana i kaʻike. Hana pinepineʻia nā maʻi o nā neurocognitive i nā poʻe me nā maʻi hoʻohālike, i loko o ka UNI i hoʻoponoponoʻoleʻia .133 Hōʻaia nāʻikepili'ekepili me ka hoʻopiʻi kū'ē.134 Neurobiologically, hiki i ka pūnaewele HPA axis129 a me nā neurotrophic pūnaeweleENDNUMX ke kuleana nui i kēia pilina. He mea nui ka hoʻopiʻiʻana o nā neurotransmitters noradrenaline a me dopamine i nā hana likeʻole e like me ke aʻoʻana a me ka hoʻomanaʻo .135 Ua hoʻohuiʻia nā pane pākuʻi nui me ka emiʻana o ka puʻuwai, a ka hopena paha e pili ana i ka hana i loko o nā hanana depressive, 136 a me ka hoʻokuʻuʻana, ma o nāʻano likeʻole .137ʻOiaʻiʻo, Krogh et al138 ke kono nei i ka CRP e pili loa aku i ka hana i ka hoʻoholoʻana ma mua o ka hōʻailona o ke kaumaha.
ʻO ka makahiki, ke kāne, a me ka BMI. ʻO ke kaʻawaleʻana a me ka heleʻana, a me ke kuhikuhiʻana o nāʻano pilikino likeʻole i waena o nā kāne a me nā wāhine, uaʻano loli loa ia i kaʻike i kēia lā. ʻO keʻano o ka hoʻohālikeʻana o nā kāne a me nā wāhine me ke kūpilikiʻi o ka pilikia.140 Hōʻikeʻia kahi hoʻolālā o nā maʻiʻehaʻeha e hōʻike ana i ka hoʻoholoʻana no ka makahiki a me ka wahineʻaʻole i pili i nāʻokoʻa o ka hoʻomanawanuiʻana i nā cytokines inflammatory (ʻoiai ua hoʻoemiʻia ka hui ma waena o IL-6 a me ke kaumaha ma ka uluʻana o ka makahiki, e like me nā kumumanaʻo e hoʻonui ka līlū i ka makahiki) .41,141 VEGF kaʻokoʻa ma waena o nā mea maʻi a me nā mana i ka nānāʻana i nā'ōpiopio'ōpio, akāʻo ka male, BMI a me nā kumu haumānaʻaʻole i pili i kēia mau hoʻohālikelike ma kahi pae-analytic level.77 Heoi, hikiʻole ke hoʻololi i ka BMI ma nā hoʻokolohua mua o ka mumū a me ke kaumaha e hōʻanoho i nāʻano likeʻole i hōʻikeʻia ma waena o kēia mau pūʻulu. Hoʻonuiʻia ka hōʻikeʻana o ke kikowaena o ke kino o kaʻiʻo o ka cytokine a me ka pili pūʻana i nā mea hana maʻamau .41 Nā mea lawelawe psychotropic hiki ke hoʻohui i loaʻa i ka waiwai waiwai a me ka BMI kiʻekiʻe, a ua pili kēia mau mea me ke kū'ē i nā pilikia i ke kaumaha, he wahi nui kēia e nānā ai.
ʻO ka lāʻau. ʻO ka nui o nā noiʻi biomarker i ke kaumaha (nā ʻāpana ʻelua a me ka longitudinal) i hōʻiliʻili i nā laʻana i nā mea komo lima ʻole e hōʻemi i ka heterogeneity. Eia nō naʻe, lawe ʻia ka hapa nui o kēia mau loiloi ma hope o ka holoi ʻia ʻana mai ka lāʻau lapaʻau, kahi e waiho ai i ka mea hilahila nui o ke koena o nā loli i ka physiology, i hoʻonui ʻia e ka nui o nā ʻano lāʻau i loaʻa i loaʻa paha nā hopena ʻokoʻa i ka pehu. Ua kāpae kekahi mau noiʻi ʻana i ka psychotropic, akā ʻaʻole hoʻohana i nā lāʻau ʻē aʻe: i ka mea nui, ʻae pinepine ʻia ka lāʻau pale oral oral i nā mea noiʻi noiʻi a ʻaʻole i kaohi ʻia no nā loiloi, i hōʻike ʻia nei e hoʻonui i ka pae o ka hormone a me ka cytokine. 143,144 Hōʻike kekahi mau noiʻi i ka antidepressant loaʻa nā hopena i nā lāʻau i ka pane o ka hoʻonāukiuki, 34,43,49,145--147 HPA-axis, 108 neurotransmitter, 148 a me ka hana neurotrophic149. Eia nō naʻe, he ʻano ʻokoʻa a paʻakikī hoʻi nā lāʻau lapaʻau hikiwawe no ke kaumaha, e ʻōlelo ana aia paha he hopena biologic discrete o nā ʻano lapaʻau ʻokoʻa, kākoʻo ʻia e ka ʻikepili o kēia manawa. Ua manaʻo ʻia e pili ana i nā hopena monoamine, hiki i nā lāʻau lapaʻau e kuhikuhi ana i ke serotonin (ʻo ia hoʻi, SSRIs) ke hoʻokau i ka Th2 mau loli i loko o ka mumū, a me nā noradrenergic antidepressants (e like me, SNRIs) hopena i kahi hoʻololi Th1 ʻAʻole hiki ke hiki hoʻoholo i nā hopena o kēlā me kēia a i ʻole nā lāʻau hoʻohui i nā biomarkers. Kūkākūkā ʻia paha kēia mau mea e nā kumu ʻē aʻe e like me ka lōʻihi o ka mālama ʻana (mau hoʻokolohua loiloi i ka hoʻohana lāʻau lōʻihi), laʻana heterogeneity a ʻaʻole stratifying i nā mea komo e ka pane i ka lāʻau.
Hōʻahā
Ke Kaulā. E like me ka hoʻopiʻiʻana i luna, nāʻokoʻa (ma waena a ma loko o nā haʻawina) i nāʻano o ia mau hōʻailona (a me nā hui pū) e lawe ana nā mea e komo ana a ua lawe muaʻia e hoʻolauna i ka hanelike i nāʻike noiʻi, akā ma nā noiʻi biomarker. Ma waho o kēia, he nui nāʻano hana'ē aʻe a me nā hiʻohiʻona eʻokoʻa ana i nā haʻawina, pēlā e hoʻonui ai i ka pilikia me ka unuhiʻana a me ka hoʻoiliʻana i nāʻike. Hoʻopuka pū kēia me nā meaʻenehana maʻaola (e like me nā pahu hopena) a me nāʻano o ka hōʻiliʻili, mālamaʻana, a me nā hōʻailona hōʻailona ma ka puʻuwai. Uaʻikeʻo Hiles et al141 i kekahi mau kumu o ke kū'ēʻole i nā puke e pili ana i ka hoʻolālā aʻikeʻiaʻo ka pololei o ka hōʻailona maʻi, BMI a me nā maʻi conorbid ka mea nui i ka heluʻana no ka hoʻomohalaʻana i nā mumū o waena i waena o nā poʻe kaumaha a me nā poʻe i piliʻole.
Kauka. Ua kākau maikaʻiʻia ka nui o ka heluna o nā kānaka pōʻinoENDNUMX a he mea koʻikoʻi nui ia i ka hoʻokaʻawaleʻana i nāʻike i loko o nā palapala noiʻi. He mea hiki paha i loko o nā mea hōʻoia, nā pilikino pilikino likeʻole i hoʻopaʻaʻia i nā waihona o nā kānaka i hikiʻole ke kūpaʻa i ka manawa. Hiki keʻikeʻia ka hui pūʻulu o ka hui pūʻulu o nā poʻe i pilikia me ka pilikia ma o ka hui pūʻana o nā mea noʻonoʻo a me nā mea pilikino. Ma lalo iho nei, hoʻopuka mākou i ka hiki no kaʻimiʻana i nā hui liʻiliʻi i ka hālāwaiʻana i nā luʻi e kauʻia ai ka biomarker a me ka huliau.
Nā'āpana i loko o ka pilikia
Ma kēia manawa, ʻaʻohe subgroups homogenous i waena o nā episodes depressed a i ʻole nā maʻi i hiki ke hilinaʻi ʻokoʻa ma waena o nā mea maʻi e pili ana i nā hōʻike ʻōuli a i ʻole ka pane ʻana i ka lāʻau. 152 ʻO ke ola ʻana o kahi subgroup kahi i ʻōlelo pinepine ʻia nā biologic aberrations e kōkua e wehewehe i ka heterogeneity ma waena o nā noi mua a hiki iā ia ke catalyze i ke ala i ka hoʻomaʻamaʻa stratified. Kunugi et al153 ua hāʻawi i kahi ʻāpana o ʻehā mau subtypes kūpono e pili ana i ke ʻano o nā ʻōnaehana neurobiological ʻokoʻa e hōʻike ana i nā subtypes e pili ana i ka haukapila i ke kaumaha. hōʻike nui ʻia me ka anhedonia (a hiki ke pane maikaʻi iā, e laʻa, aripiprazole) a me kahi subtype inflammatory i hōʻike ʻia e ka hoʻokiʻekiʻe kiʻekiʻe. Ua hōʻike ʻia nā ʻatikala he nui e pili ana i ka mumū i ka hihia no ka loaʻa ʻana o kahi subtype infinā i loko o ke kaumaha .55,56,154,155 pili pono o ka hoʻokiwikā kiʻekiʻe ʻaʻole i hoʻoholo ʻia a ua hoʻāʻo ʻia kekahi mau hoʻāʻo pololei e ʻike i nā mea e komo ai i kēia cohort. Ua manaʻo ʻia e hiki i nā poʻe me ke kaumaha atypical ke loaʻa i nā kiʻekiʻe kiʻekiʻe o ka mumū ma mua o ka melancholic subtype, 156 ʻaʻole paha i kūlike me nā ʻike e pili ana i ka axis HPA i nā melancholic a me nā subtypes atypical o ke kaumaha. TRD37 a i ʻole ke kaumaha me nā ʻōuli somatic koʻikoʻi 157 ua kau ʻia hoʻi ma ke ʻano he subtype hoʻoweliweli kūpono, akā ʻo neurovegetative (hiamoe, makemake, nalowale libido), ʻano (me ke ʻano haʻahaʻa, suicidality a me ka ukiuki) a me nā ʻōuli ʻike (me ka ʻino a me ka hewa) 158 āpau ʻike ʻia e pili ana i nā moʻolelo biologic. ʻO nā moho hou aʻe no kahi subtype hoʻowahāwahā e hoʻopili i ka ʻike o nā ʻano maʻi e like me nā hōʻailona 159,160 a i ʻole kahi metabolic syndrome. 158
Hiki i ka pilikino i (hypo) mania keʻike i ka biologically ma waena o nā maʻi e loaʻa ana i ka pilikia. Ke hōʻike neiʻo'Evidence i nā maʻi o ka maʻi pīpilikia i kahi hui nui o nā maʻi o ke kino, me ka maʻi pipili bipolar iʻikeʻia ma mua o kaʻike muaʻia .161 Uaʻikeʻia i kēia manawa he pilikia nui i ka psychiatry maʻi, me ka ka manawa maʻamau no ka hoʻoponoponoʻana i ka hōʻailona pinepine i ka makahiki 10162 a me kēia hoʻolālā e hoʻonui ai i ka paʻakikī a me ke kumukūʻai o ka maʻi āpau.163 Me ka hapa nui o nā maʻi me ka maʻi pipili e hōʻike mua ana me hoʻokahi aʻoi aku paha o nā pilikia kaumaha a me ka hoʻopilikiaʻole i ke kaumaha. hiki i nā mea e wehewehe ana i waena o ka pilikia a me ka bipolar ka hopena nui loa .164 Uaʻikeʻoleʻia nāʻino o keʻano kelepona ma kekahi mau papahana o ka UN Manaʻo ma mua, a me kaʻikeʻana o nā hōʻike i hōʻike i kaʻokoʻa o ka hana axis HPA109 a iʻole inflammation165,166 ma waena o ka bipolar a unipo nui ke kaumaha. Eia nō naʻe, heʻano liʻiliʻi kēia mau hoʻohālike, loaʻa nā kiʻi liʻiliʻi liʻiliʻi,ʻikeʻia nā hopena o nā kūlana maʻamauʻole a iʻole nā heluna i hōʻiliʻiliʻia iʻikeʻoleʻia e ka hōʻailona. ʻAʻole nō hoʻi e nānā kēia mauʻimi i keʻano o ka paneʻana i kēia mau pilina.
ʻO nā disorders167 a me ka resistance resistance168ʻaʻole i hana i nā kūkulu a hoʻomoe i ka hoʻomauʻana, kahi e hoʻonui ai i ka luʻi o kaʻike inoa subtype. Ma waho aʻe o ke kāpiliʻana, pono ia eʻike he nui nā meaʻino kūlohelohe iʻikeʻia i ke kaumaha e like me nā mea maʻi me nā mea'ē aʻe. No laila, he mea koʻikoʻi ka hoʻonaʻauao transdiagnostic.
Nā Palekana Uihana
Kō koho Biomarker. Hōʻike ka nui o nā biomarkers kūpono i kahi pahuhopu no psychobiology i ka hoʻoholo ʻana i nā māka e hoʻopili ʻia i ke ala a no wai hoʻi. I mea e hoʻonui ai i ka hōʻaʻano, he kakaikahi paha kēia o kēia mau biomarkers i kūpono i ka hoʻokolokolo pono ʻana i ke kaumaha, a no ka hapanui, ʻaʻole i maopopo pono i kā lākou kūlana kūpono i nā heluna olakino a me nā haukapila. ʻOiai ʻo kēia, ua hoʻāʻo kekahi mau mea e hoʻāʻo e hoʻolaha i nā paneli biomarker e hoʻohiki ana. Ma waho aʻe o Brand et al 16 set o nā māka me ka hiki ikaika, 27 Lopresti a me al outline i kahi keu ākea o nā oxidative stress markers me ka hiki no ka hoʻomaikaʻi hoʻomaikaʻi pane.28 Papakostas a me ua wehewehe i kahi priori i kahi ʻeiwa mau peni serum e kau ana ʻōnaehana biologic (BDNF, cortisol, soluble TNF? receptor type II, alpha1 antitrypsin, apolipoprotein CIII, mea ulu ulu epidermal, myeloperoxidase, prolactin and resistin) i ka hōʻoia ʻana a me nā hoʻohālikelike replication me MDD. I ka hui ʻana, ua hiki i kahi ana ʻāpana o kēia mau pae ke hoʻokaʻawale ma waena o MDD a me nā hui kaohi me 80% 90% pololei.169 Ke hāpai nei mākou ʻaʻole i uhi ʻia kēia mau moho āpau i kēia kahua; ʻike i ka Papa 2 no ka wehewehe palena ʻole o biomarkers me ka hiki no ke kaumaha, i loaʻa nā mea ʻelua me kahi hōʻike hōʻike a me nā mea kaha kiʻi.
Technology. Ma muli o ka piʻiʻana o ka technologic, hiki i kēia manawa (ʻoiaʻiʻo, kūpono) ke anaʻana i ka lehulehu o nā biomarkers ma ka manawa likeʻole ma kahi haʻahaʻa haʻahaʻa a me kaʻike kiʻekiʻe aʻe ma mua o ka hihia ma mua. I kēia manawa, hiki i kēia mana e hoʻonui i ka nui o nā pūnaewele ma mua o ko mākou hiki ke nānā pono a wehewehe i kaʻikepili,ʻo 170 kekahi mea e hoʻomauʻia me ka piʻiʻana o nā kiʻi biomarker a me nā hōʻailona hou e like me metabolomics. ʻO kēia ke kumu o ka maopopoʻole o ka hana kūikawā a me nā hoʻokaʻawaleʻana ma waena o nā marker, a me ka lawaʻole o kaʻikeʻana i nā pilina pili e pili ana i nāʻano biologic (like, genetic, transcription, protein) i loko a ma waena o nā kānaka. ʻO nāʻike nui e hoʻohana i nā hōʻailona hōʻona a me nā kūlana kūkākūkā e kōkua me ka hoʻoponoponoʻana i kēia, a ke hāpaiʻia nei nāʻano hou; Hoʻokahi hiʻohiʻona ka hoʻolālāʻana i kahiʻikepili i kūkuluʻia i ka hōʻuluʻuluʻana i kaʻikepili no kaʻikeʻana i nā hōʻailona hana pono hou e pili ana i kā lākou mau hoʻohālike ma waena o nā kikowaena a me ka hoʻohui i nā hua'ōlelo o ka'ōnaehana me kaʻikepili pūnaewele.171 Ke hoʻohanaʻia nei nāʻano hoʻonaʻauao maʻamau a kōkua i nā hōʻailona e hoʻohana ana i ka biomarker ʻikeʻikepili i nā hualoaʻa hopena i nā noi me kaʻikepili nui.172
Hui pūʻia nā mea kanu'āina. Ke nānā nei i kahi pūʻulu biomarkers i ka manawa like kahi koho i ka nānā ʻana i nā māka kaʻawale e hiki ke hāʻawi i kahi kikoʻī kikoʻī i loko o ka pūnaewele paʻakikī o nā ʻōnaehana biologic a i ʻole nā pūnaewele.26 Eia kekahi, e kōkua me ka hoʻokaʻawale ʻana i nā hōʻike i kēia palapala i kēia lā (keu, kahi o nā pūnaewele biomarker a hoʻomaopopo maikaʻi ʻia nā pilina), hiki i nā ʻikepili biomarker ke hōʻuluʻulu a kuhikuhi ʻia paha. Hoʻokahi pahuhopu i ka ʻike ʻana i ke ʻano optimum o ka hana ʻana i kēia, a koi paha ia i nā hoʻomaikaʻi ʻana i ka ʻenehana a me / a i ʻole nā ʻano kālailai novel (e ʻike i ka ʻikepili nui). ʻO ka mōʻaukala, ua loaʻa nā lakio ma waena o ʻelua mau biomarkers ʻokoʻa i nā mea hoihoi. 109,173 Kakaikahi nā hoʻāʻo e hoʻākoakoa i ka ʻikepili biomarker ma kahi pālākiō nui, e like me nā mea e hoʻohana nei i ka ʻāpana kumu nui o nā pūnaewele cytokine proinflammatory.174 Ma kahi meta-analysis, nā cytokine proinflam inflammatory i hoʻololi i loko o kahi helu hoʻokahi hopena hopena no kēlā me kēia noi, a hōʻike ākea i ka nui o ka mumū ma mua o ka hoʻomaʻamaʻa antidepressant, e wānana ana i ka pane ʻole ma nā noiʻi waho. He luʻi a he manawa kūpono hoʻi nā panalāʻau biomarker āpau no ka noiʻi e hiki mai ana e ʻike i nā hopena kūpono a hilinaʻi ʻia e hiki ke hoʻopili ʻia e hoʻomaikaʻi ai i nā hopena lapaʻau.43 Ua hoʻopaʻa ʻia kahi noiʻi na Papakostas et al i kahi ala ʻē aʻe, e koho ana i kahi paneli o nā heterogeneous serum biomarkers (o ka hoʻohaunaele, ʻO ka axis HPA a me nā ʻōnaehana metabolic) i hōʻike ʻia he ʻokoʻa ma waena o ke kaumaha a me ka mālama ʻana i kēlā me kēia kanaka i kahi noiʻi i hala a hoʻohui ʻia i kēia mau mea i kahi helu kūloko i ʻokoʻa i nā ʻāpana kūʻokoʻa ʻelua a me kahi hui kaohi me> 80% ʻike a kikoʻī.
Nuiʻike. Pono paha ka hoʻohana ʻana i ka ʻikepili nui no ka hoʻoponopono ʻana i nā pilikia o kēia wā e hōʻike ʻia ana e pili ana i ka heterogeneity, ka loli o ka biomarker, e ʻike ana i nā māka maikaʻi a me ka lawe ʻana mai i ka māla i ka unuhi, noi noi i loko o ke kaumaha. Eia nō naʻe, e like me ka mea i hōʻike ʻia ma luna, lawe mai kēia i nā pilikia ʻenehana a me ʻepekema.175 Ua hoʻomaka koke nā ʻepekema olakino e hoʻohana nei i ka hōʻiliʻili ʻike nui, he ʻumi mau makahiki a ʻoi paha ma hope o ka ʻoihana. Eia nō naʻe, ke holomua nei nā noiʻi e like me iSPOT-D152 a me consortia e like me ka Psychiatric Genetics Consortium176 me ko mākou ʻike i nā ʻano biologic i ka psychiatry. Ua hoʻomaka ʻia e hoʻohana i nā algorithms aʻo-mīkini, i loko o kekahi mau haʻawina kakaikahi, i nā biomarkers no ke kaumaha: kahi ʻimi noiʻi hou i hōʻuluʻulu ʻia i ka ʻikepili mai> 5,000 poʻe komo o 250 biomarkers; ma hope o ka nui o ka imputation o ka ʻikepili, alakaʻi ʻia kahi regression ikaika i aʻo ʻia i ka mīkini, e hōʻike ana i 21 mau biomarkers hiki. Ma hope o nā loiloi regression hou aʻe, ʻekolu mau biomarkers i koho ʻia e hui ikaika loa me nā ʻōuli depressive (ka loli nui o ka nui o ke koko, ka glucose serum a me nā pae bilirubin). Pau ka manaʻo o nā mea kākau e hiki ke hoʻohana pono ʻia ka ʻike nui no ka hana ʻana i kahi kuhiakau. 177 Ke hoʻomaka nei nā papahana phenotyping biomarker nui a kōkua e holomua i kā mākou huakaʻi i ka wā e hiki mai ana o ka neurobiology o ke kaumaha.
Nā Hope i ka wā e hiki mai ana
HōʻikeʻIke Kūkākūkā Biomarker
ʻO nā mea i loaʻa i nā puke a hiki i kēia lā koi i ka hana hou ʻana i nā noi nui. Heʻoiaʻiʻo maoli kēia no nā meaola biomarkers, e like me ka chemokine thymus a me ka chemokine regulated activation a me ka mea ulu ʻo tyrosine kinase 2, i ko mākou ʻike, ʻaʻole i hoʻokolokolo ʻia i loko o nā laʻana kaumaha a me nā laʻana olakino olakino. Pono nā noiʻi ʻikepili nui e hoʻāʻo i nā panela biomarker ākea a hoʻohana i nā ʻenehana aniani sophisticated e ʻike piha i nā pilina ma waena o nā māka a me kēlā mau mea i hoʻololi iā lākou i nā lehulehu a me nā nonclinical populasyon. Hoʻohui ʻia, hana kope nui ʻia o ka loiloi i nā mea nui i hoʻokumu ʻia i nā hui biomarkers i hoʻopili loa ʻia a hiki iā lākou ke hoʻomaopopo i ka hoʻohana ʻana o nā compompites ma psychiatry biologic, kahi e hoʻonui ai i ka homogeneity o nā hopena e hiki mai ana.
Ka Discovery o nā Homogenous Subtypes
Ma muli o ka kohoʻana o ka biomarker, hiki i nā papa helu he nui no nā ala likeʻole e hiki ai ke noiʻi. Hoʻohuiʻia,ʻikeʻia nā hōʻike e kū nei e hōʻike pono i nā moʻolelo pilikino, akā ua hoʻololi maoliʻia i loko o kahi kaʻina o nā kānaka e ulu nei i kēia wā mai ka pilikia. Hiki ke hoʻonohonoho i kēia ma loko a ma'ō aku paha o nā kāpili diagnostical, aʻo ia ka mea eʻike ai i kahi kū'ēʻole o nāʻike i hiki ke mālamaʻia ma kēia puke. Hiki ke hoʻohālikelikeʻia ka hoʻonohonohoʻana i kahi lālā o ka huiʻenehana (a iʻole nā'āpana o lalo) i kahi hōʻiliʻili nui o nā pūnaewele pūnaewele pilikino ma ke kaumaha. Hōʻike kēia i loko o ka nui o ka heluna kanaka; hiki i nā hōʻuluʻulu o ka papa hana lōʻihi ke hōʻike i nāʻanoʻokoʻa kūlohelohe e like me, e like me ka hoʻoukuʻana.
Nā Nānā Kūikawā Kūlohelohe i ka Uila a me ka pane
ʻO nā maʻamau a pau i kauohaʻia no ke kaumaha e pono ke heluʻia ma muli o kā lākou hopena o nā meaola lāʻau, a me ka heluʻana no ka maikaʻi o nā ho'āʻo lāʻau. Hiki i kēia ke hana i nā hana e pili ana i nā meaola biomarkers a me nā hōʻikeʻikeʻike eʻike i nā hualoaʻa i nāʻano hōʻailona antidepressant i kekahiʻanoʻoi aku keʻano, a hiki paha i ka hopena o ka pilikiaʻole a me ka bipolana. He mea pono paha kēia no nā hōʻailona kūpono hou a me nā hōʻailona i hōʻikeʻia i kēia manawa.
ʻO ka wehewehe hopeʻana no ka pane o ka maʻi
ʻO ka hoʻohanaʻana i nāʻano hana i luna nei e hopena i ka maikaʻi o ka hikiʻana i ke kū'ēʻana i nā kū'ē i ka hopena. Hiki ke kōkua i nā papahana kūpono aʻo ka hoʻomauʻana (ʻoi aku, lōʻihi) i kēia. ʻO kaʻikeʻana i nā pono kūpono o ka noho maʻi (e like me ka maikaʻi o ke ola a me ka hana hana i nā lā a pau) hiki ke hāʻawi i kahi hoʻonui piha o ka heluʻana i nā hopena e pili ana i nā meaola. ʻOiaiʻo ka hanana biologic wale nō ka mea hikiʻole keʻike i keʻano o nā mea nāna i pane i nā mea kūʻole, hiki ke hoʻohuiʻia me nāʻike pilikino me nā helu pilikino i ka hoʻomohalaʻana i kahiʻano hōʻike o ka paneʻole o ka pane. Inā hoʻokumuʻia kahi hiʻohiʻona kūpono e wānana i ka pane (a no ka poʻe pōʻino a iʻole ka mea hoʻopilikia) a ua hoʻokūpaʻaʻia i ka manawa, hiki i ka hoʻolālā unuhi ke hoʻokumu iā ia i ka hoʻohanaʻana i ka hoʻokolokolo nuiʻana.
I nā hōʻailona Stratified
I kēia manawa, ʻaʻole kuhikuhi ʻōnaehana nā mea maʻi me ke kaumaha e loaʻa i kahi papahana kōkua hoʻomākaukau leʻa. Inā hōʻoia ʻia, hiki ke hoʻohana ʻia kahi hoʻolālā hoʻokolohua stratified e hoʻāʻo i kahi hiʻohiʻona e wānana i ka pane ʻole a / a i ʻole e hoʻoholo i kahi e pono ai ka mea maʻi e hoʻokolokolo ʻia i kahi laʻana mālama ʻanuʻu. Hiki ke hoʻohana ʻia kēia i nā hoʻonohonoho maʻamau maʻamau a me nā hoʻonohonoho kūlohelohe, ma waena o nā ʻano hana like. ʻO ka mea hope loa, hiki ke hoʻomohala ʻia kahi hiʻohiʻona ola kino e hāʻawi i kēlā me kēia kanaka i ka lāʻau kūpono kūpono loa, e ʻike ai i ka poʻe e hoʻomohala nei i ke kaumaha refactory a hāʻawi i ka mālama a me ka nānā ʻana i kēia mau maʻi. ʻO nā mea maʻi i ʻike ʻia me ka makaʻu no ka pale ʻana i ka lāʻau e kauoha ʻia i kahi concomitant psychological a me pharmacologic therapy a i ʻole ka hui pū ʻana o ka pharmacotherapy. Ma ke ʻano he laʻana kuhi, hiki ke hōʻike ʻia i nā mea komo me ka cyinfine cyinfine kiʻekiʻe ʻole e loaʻa i ka psychological ma mua o ka lāʻau pharmacologic therapy, ʻoiai ʻo kahi subset o nā mea maʻi me ka mumū kiʻekiʻe hiki ke loaʻa i kahi agena anti-inflammatory i hoʻonui ʻia i ka maʻamau maʻamau. ʻIke like i ka stratification, hiki ke hiki i nā hoʻolālā koho pilikino pilikino i ka wā e hiki mai ana. ʻO kahi laʻana, ʻo kekahi mea kaumaha paha i kahi TNF kiʻekiʻe nui? pae, akā ʻaʻohe ʻano biologic ʻē aʻe, a hiki ke pōmaikaʻi ʻia mai ka hana pōkole me kahi TNF? ʻO ka antagonist.54 Hoʻomaʻamaʻa ʻia kahi lawelawe pilikino i ka nānā ʻana i ka ʻōlelo biomarker i ka wā o ka mālama ʻana e hoʻomaopopo i nā loli hiki ke komo, ka lōʻihi o ka hoʻomau ʻana e koi ʻia ai ʻike i nā māka mua o ka hoʻi hou.
Nā Palapala Aʻo Novel
Nui a hewahewa nā ʻano hana hiki ke lilo i pono no ke kaumaha, ʻaʻole i nānā pono ʻia, e like me nā hana novel a repurposed hoʻi mai nā ʻano lāʻau lapaʻau ʻē aʻe. ʻO kekahi o nā pahuhopu i makemake nui ʻia i loko o nā lāʻau anti-inflammatory e like me celecoxib (a me nā mea hoʻopaʻa cyclooxygenase-2), TNF? antagonists etanercept a me infliximab, minocycline a i ʻole aspirin. ʻIke ʻia kēia mau mea hoʻohiki. 178 Antiglucocorticoid compound, e like me ketoconazole179 a me metyrapone, 180 i ʻimi ʻia no ke kaumaha, akā loaʻa nā drawbacks ʻelua me kā lākou ʻaoʻao a me ka hopena o ka ponorapone. Hiki paha i ka Mifepristone181 a me ka corticosteroids fludrocortisone a me spironolactone, 182 a me dexamethasone a me hydrocortisone183 ke mālama pono i ke kaumaha i ka wā pōkole. ʻO ka pahuhopu glutamate N-methyl-d-aspartate receptor antagonists, me ketamine, paha e hōʻike i nā hana maikaʻi i ke kaumaha loaʻa nā hopena antidepressant184 ma o nā ala neurobiological pili. 3
I kēia ala, ua hoʻohana ʻia nā hopena biochemical o antidepressants (ʻike i ka ʻāpana lapaʻau) no nā pono lapaʻau i loko o nā ʻano hoʻopaʻapaʻa ʻē aʻe: ʻo nā gastroenterological, neurologic a me nā maʻi hōʻailona nonspecific .188 ʻO nā hopena anti-inflammatory o nā antidepressants e hōʻike i kahi ʻāpana o ka hana no kēia mau pono. Ua ʻōlelo ʻia hoʻi ka lithium e hoʻoliʻiliʻi i ka hoʻowahāwahā ʻana, ma o nā ala glycogen synthase kinase-3 ʻO ka nānā ʻana i kēia mau hopena i hiki ke hōʻike informative no ka pūlima biomarker depression a, a ʻo ia hoʻi, hiki i nā biomarkers ke pani i nā māka pani no ka hoʻomohala lāʻau hou.
Dr. Alex Jimenez's Insight
ʻO ke kaumaha ka hopena o ka maʻi noʻonoʻo e hōʻikeʻia ana e nā hōʻailona koʻikoʻi e pili ana i keʻano, e like me ka nele o ka hoihoi i nā hana. Akā, uaʻikeʻia nā noiʻi noiʻi hou, he mea hiki keʻike i ka hōʻino ma o ka hoʻohanaʻana i nā meaʻoi aʻe ma mua o nā maʻi o ka mea maʻi wale nō. Wahi a nā kānaka noiʻi, e hoʻomaopopo ana i nā mea hiki ke loaʻa pono i nā meaolaola e hiki ai ke hōʻoia pono i ka hilahila ka mea e pono ai ka hoʻonuiʻana i ke olakino a me ka maikaʻi o ka mea maʻi. Ma keʻano, nā hopena hōʻoia e hōʻike ana i nā poʻe me nā maʻi nui o ke kino, aiʻole ka UN, i nā mea haʻahaʻa o ka acetyl-L-carnitine, a iʻole LAC, i loko o ko lākou koko ma mua o nā kūlana maikaʻi. I ka hopena, hoʻokumu i nā meaola hoʻomanaʻo no ke kaumaha e hiki ke kōkua i ka hoʻoholoʻana i ka mea e pilikia ana i ka hoʻomohalaʻana i ka maʻi a me ke kōkua i nāʻoihana ola kino e koho i kahi koho maikaʻi loa no ka mea maʻi me ke kaumaha.
Panina
Hōʻike ka'olikala ma kahi oʻelua hapa kolu o nā maʻi me ke kaumaha e loaʻaʻole i ka hoʻokuʻuʻana i kahi maʻi mua a hiki i ka piʻiʻana o ka nonponse e hoʻonui ai i ka helu o nā hōʻailona i hoʻopiʻiʻia. ʻO ka hāʻawiʻana i nā hopena hemahema he nui nā hopena no ka uku a me kēlā me kēia hui, e like me ka pilikia a me ka pōʻino, ka pilikia o ka pepehi kanaka, ka nele o ka huahana a me nā waiwai mālama ola. ʻO ka nui o nā puke i loko o ka pilikia e hōʻike ana i kahi nui o nā meaola biomarkers me ka mea hiki ke hoʻonui i ka lāʻau no nā poʻe me ke kaumaha. Ma waho aʻe o nā hōʻailona neurotransmitter a me nā neuroendocrine i pili i ka hoʻonuiʻiaʻana o ka noi no nā makahiki he nui,ʻike i nā manaʻo hou i ka pane inflammatory (a me ka pūnaewele paʻa honua ma mua), nā mea pili i ka maʻi me nā mea ulu e like me ka mea nui i loko o ka pilikia. Eia nō naʻe, ua nui nā hōʻike likeʻole e hōʻike ana he nui nā pilikia e pono ana e kāohiʻia ma mua o ka hikiʻana i nā noiʻi biomarker ke hoʻohanaʻia i mea e hoʻomaikaʻi ai i ka mālamaʻana a me ka mālamaʻana o nā poʻe me ke kaumaha. Ma muli o ka pōʻaiapili o nā'ōnaehana biologic, hoʻolālā like likeʻole o nā hōʻailona likeʻole i loko o nā'āpana nui he nui ka pōmaikaʻi i kaʻikeʻana i ka pilina ma waena o nāʻike kumu lāʻau a me nāʻikepili ma waena o kēlā me kēia kanaka. ʻO ka hoʻonuiʻana i ke anaʻana o nā māmā neurobiological a me nā meaʻoi aku o ke kaumaha o ka pilikia e hiki ke hoʻoikaika i kaʻike. Hōʻike kēia hōʻike i ka nui o ka nānāʻana i nā mea hiki ke hoʻololi paha (e like me ka maʻi, ka makahiki, kaʻikeʻana a me ka lāʻau lapaʻau) i ka hōʻiliʻiliʻana i kaʻike o ka pilina o ke kaumaha a me nā hana o ke kū'ē. He mea hiki paha i kekahi mau hōʻailona ke hōʻike i nā'ōlelo hoʻohiki nui loa no ka wānanaʻana i ka pane a ke kākoʻo a i ke kū'ēʻana i nā hōʻailona maʻamau i kahi hui waena o nā maʻi, aʻo ka mahele likeʻole o nāʻike pilikino a me nāʻikepili e hoʻonui i ka hiki ke hoʻomaopopo i ka hopena i nā hopena maikaʻiʻole. Ke hoʻokumu nei i kahi papahana kaiaolawai e pili ana i ka hoʻonuiʻana i ka diagnostic pono a me ka hōʻailona, a no ka hoʻomaʻemaʻeʻana i nā hōʻailona ma kahi hana mua loa o ka maʻiʻehaʻeha a me ka hoʻolālāʻana i nā pahuhopu papahana kūpono. Hiki i kēia mau hopena ke hoʻopaʻaʻia i lalo o nā hui liʻiliʻi o nā maʻi maʻi kaumaha. ʻO nā ala e pili ana i kēia mau mea hiki ke hōʻoia i nā lālā noiʻi no ka hoʻohuiʻana i nā maʻi syndrome kokoke i nā kumuhana neurobiological ma lalo.6 Ma muli o ka hoʻohālikelikeʻana i ka heterogeneity, hiki iā ia ke hoʻololi i kahi pale i keʻano o ka manaʻo ma waena o ka ola kino a me ka noʻonoʻo. Ua maopopo i ka nui o ka hana,ʻo ka hoʻokumuʻana i ka pilina ma waena o nā meaola a me nā pilikia o ke kaumaha, he nui nā hopena no ka hoʻohaʻahaʻaʻana i ke kaumaha o ke kaumaha ma kahi kūlana a me ka lāhui.
mau hoomaikai ana
Hōʻike kēia hōʻike i ka noiʻi kūʻokoʻa i kālā ʻia e ka National Institute for Health Research (NIHR) Biomedical Research Center ma South London a me Maudsley NHS Foundation Trust a me King's College London. ʻO nā manaʻo i hōʻike ʻia ʻo ia nā mea kākau a ʻaʻole pono nā NHS, ka NIHR a i ʻole ka ʻOihana Ola.
Nāʻaoʻao hemahema
Hōʻike. Ua loaʻaʻo AHY i nā makahiki 3 i hala hope loa i loaʻa ai ka hanohano no ka'ōleloʻana mai Astra Zeneca (AZ), Lundbeck, Eli Lilly, Sunovion; nā mea hoʻohanohano no ka nīnauʻana mai Allergan, Livanova a me Lundbeck, Sunovion, Janssen; a me ke kākoʻo noiʻi noiʻi mai nā keʻena kālāʻo Janssen a me UK (NIHR, MRC, Wellcome Trust). Ua loaʻaʻo AJC i nā makahiki 3 i hala hope loa no ka'ōleloʻana mai Astra Zeneca (AZ), no ka noiʻana mai Allergan, Livanova a me Lundbeck, a me ka kākoʻo noiʻi noiʻi mai Lundbeck a me nā keʻena hoʻokele kālā UK (NIHR, MRC, Wellcome Trust).
ʻAʻole i hōʻike nā mea kākau i nā manaʻo paio'ē aʻe i kēia hana.
I ka hopena,- ʻoiai ua loaʻa i nā noiʻi noiʻi he nui he mau haneli o nā biomarkers no ke kaumaha, ʻaʻole nui ka poʻe i hoʻokumu i kā lākou kuleana i ka maʻi depressive a i ʻole pehea e hoʻohana pono ʻia ai ka ʻike biologic e hoʻonui ai i ka hōʻailona, ka lapaʻau ʻana a me ka wānana. Eia nō naʻe, loiloi ka ʻatikala ma luna i nā puke i loaʻa ma nā biomarkers i pili i nā kaʻina hana ʻē aʻe a hoʻohālikelike i nā ʻike maʻi i ka manaʻo kaumaha. Eia kekahi, ʻo nā mea i loaʻa hou ma nā biomarkers no ke kaumaha e kōkua maikaʻi paha i ka diagnose kaumaha i mea e ukali ai me ka lāʻau maikaʻi. Ua ʻike ʻia ka ʻike mai ka National Center for Biotechnology Information (NCBI). E kūkākūkā i kēia kumuhana, e ʻoluʻolu e nīnau iā Dr. Jimenez a i ʻole e leka uila iā mākou ma915-850-0900 .
Hoʻopūʻia e Dr. Alex Jimenez
Nā Pāhana Hou: Back Pain
Paʻi hope ʻo ia kekahi o nā kumu nui loa o ka hemahema a ua hala nā lā ma ka hana ma ka honua holoʻokoʻa. ʻOiai he meaʻoiaʻiʻo, ua hoʻokauʻia kaʻeha hope ma keʻano he kumu kumuʻelua no ka heleʻana o ke keʻena o ke kauka,ʻoi aku ma mua wale nō nā maʻi āpau kiʻekiʻe. Ma kahi o 80 pakeneka o ka heluna eʻike i kekahiʻano o kaʻeha hope loa ma kahi o hoʻokahi manawa ma ko lākou ola. ʻO ka'ōiwi kahi hanana paʻapū i hanaʻia i ka iwi, nā hono, nā ligaments a me nāʻiʻo, i waena o nā mea'ē aʻe. Ma muli o kēia, nāʻeha a me nā kūlana hōʻeha, e like me nā kīlei'aniani, hiki ke hopena i nā hōʻailona o ke kaumaha hope. ʻO nāʻeha a me nāʻeha a me nā pōpilikia pū kaʻa paha he kumu pinepine ia o kaʻehaʻeha, akā, i kekahi manawa,ʻoi aku kaʻoi loa o nā hana i loaʻa i nā hopenaʻeha. ʻO ka mea pōmaikaʻi, hiki i nā koho hoʻoponopono'ē aʻe, e like me ka mālamaʻana i ka chiropractic, ke kōkua i ka pale i kaʻeha ma o ka hoʻohanaʻana i nā hoʻololiʻana o ka'ōpū a me nā lima lima, me ka hoʻomaikaʻi maikaʻi i nā maʻi.
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Arthritis ʻO ka ʻeha he mea paʻakikī e pili ana i ka hana neurophysiological paʻakikī ma nā pae āpau o ke ala ʻeha. ʻO nā koho lapaʻau i loaʻa no ka hoʻēmi ʻana i ka ʻeha hui he palena palena wale nō, a ʻo ka hapa nui o nā mea maʻi arthritis e hōʻike wale nei i ka hoʻomaha ʻeha haʻahaʻa me nā lāʻau lapaʻau o kēia manawa. ʻO ka hoʻomaopopo maikaʻi ʻana i nā mīkini neural e pili ana i ka ʻeha musculoskeletal a me ka ʻike ʻana i nā pahuhopu hou e kōkua i ka hoʻomohala ʻana i nā lāʻau lapaʻau e hiki mai ana. Hōʻike kēia ʻatikala i kekahi o nā noiʻi hou loa i nā mea e hoʻopili ai i ka ʻeha a me ka uhi ʻana i nā wahi e like me cannabinoids, proteinase-activated receptors, sodium channels, cytokines, a me transient receptor potential channels. Kūkākūkā pū ʻia ke kuhiakau e puka mai ana he ʻano neuropathic ka osteoarthritis.
Introduction
ʻO ka hui olakino o ka honua i hoʻonohonoho i nā maʻi puʻupuʻu i ka maʻi puʻupuʻu e like me ka hopena pinepine o ke kīnā i ke ao hou, e pili ana i kahi oʻekolu mau mākua [1]. ʻO kaʻoi aku o keʻano hopohopo,ʻo ka piʻiʻana o kēia mau maʻi e ulu aʻe ana aʻo kaʻike o kā lākou kumu kumuhana he kūpono loa.
Fig. 1 He schematic e hōʻike ana i kekahi o nā pahuhopu i ʻike ʻia e hoʻololi i ka ʻeha hui. Hiki ke hoʻokuʻu ʻia nā neuromodulators mai nā hopena nerve a me nā mast cell a me nā macrophages e hoʻololi i ka mechanosensitivity afferent. Hiki i nā Endovanilloids, ka waikawa, a me ka wela wela ke ho'āla i nā kaila ion transient receptor potential vanilloid type 1 (TRPV1) e alakaʻi ana i ka hoʻokuʻu ʻana o ka mea algogenic P (SP), a laila hoʻopaʻa i nā mea hoʻokipa neurokinin-1 (NK1). Hiki i nā Proteases ke hoʻokaʻawale a hoʻoulu i nā mea hoʻokipa protease-activated (PARs). A hiki i kēia manawa, ua hōʻike ʻia ʻo PAR2 a me PAR4 i ka sensitize i nā afferent mua. Hoʻokumu ʻia ka endocannabinoid anandamide (AE) ma ke koi a synthesized mai N-arachidonoyl phosphatidylethanolamine (NAPE) ma lalo o ka hana enzymatic o phospholipases. Hoʻopili kekahi ʻāpana o AE i nā mea hoʻokipa cannabinoid-1 (CB1) e alakaʻi ana i ka desensitization neuronal. Lawe koke ʻia ʻo AE unbound e kahi mea lawe membrane anandamide (AMT) ma mua o ka wāwahi ʻia ʻana e kahi fatty acid amide hydrolase (FAAH) i loko o ka ethanolamine (Et) a me ka waikawa arachidonic (AA). ʻO ka cytokines tumor necrosis factor-?(TNF-?), interleukin-6 (IL-6) a me interleukin1-beta (IL-1?) Hiki ke hoʻopaʻa i ko lākou mau mea loaʻa e hoʻonui i ka lawe ʻana i ka ʻeha. ʻO ka mea hope loa, ʻo ka tetrodotoxin (TTX)-resistant sodium channels (Nav1.8) i komo i ka neuronal sensitization.
Makemake nā poʻe maʻi no ko lākou maʻi eha e nalowale; akā naʻe, ʻaʻole maikaʻi nā analgesics i kuhikuhi ʻia i kēia manawa a hele pū ʻia me ka nui o nā hopena ʻaoʻao makemake ʻole. E like me ia, miliona o ka poʻe ma ka honua holoʻokoʻa e ʻeha nei i nā hopena hoʻonāwaliwali o ka ʻeha hui, no ka mea ʻaʻohe lāʻau lapaʻau kūpono [2].
ʻOi aku ma mua o 100 mau ʻano ʻokoʻa o ka maʻi ʻāʻī i loaʻa i ka osteoarthritis (OA) ka mea maʻamau. ʻO ka OA kahi maʻi hui degenerative e hoʻoulu ai i ka ʻeha mau a me ka nalowale o ka hana. ʻO ka mea maʻamau, ʻo ka OA ka hiki ʻole o ka hui ke hoʻoponopono pono i ka pōʻino i ka pane ʻana i nā ikaika nui i kau ʻia ma luna. ʻAʻole i hoʻomaopopo maikaʻi ʻia nā kumu olaola a me psychosocial e pili ana i ka ʻeha OA mau loa, ʻoiai ke hoʻomau nei ka noiʻi e wehe i ke ʻano paʻakikī o nā hōʻailona maʻi [2]. ʻO nā lāʻau lapaʻau o kēia manawa, e like me nā lāʻau anti-inflammatory non-steroidal (NSAIDs), hāʻawi i kahi hōʻoluʻolu hōʻailona, hoʻemi i ka ʻeha no nā manawa pōkole, akā ʻaʻole e hoʻēmi i ka ʻeha ma ke ola o ka mea maʻi. Eia kekahi, ʻaʻole hiki ke lawe pinepine ʻia nā NSAID kiʻekiʻe i nā makahiki he nui, no ka mea hiki ke alakaʻi i ka ʻawaʻawa a me ke kahe o ka ʻōpū.
ʻO ka mea maʻamau, ua kālele nui ʻia ka noiʻi ʻana i ka arthritis ma ka cartilage articular ma ke ʻano he pahuhopu mua no ka hoʻomohala ʻana i nā lāʻau lapaʻau OA no ka hoʻololi ʻana i ka maʻi. Ua hoʻomālamalama hou kēia chondrogenic i nā kumu biochemical a me biomechanical paʻakikī e hoʻohuli i ka ʻano chondrocyte i nā hui maʻi. Eia nō naʻe, ʻoiai ʻo ka cartilage articular he aneural a avascular, ʻaʻole paha kēia ʻiʻo ke kumu o ka ʻeha OA. ʻO kēia ʻoiaʻiʻo, i hui pū ʻia me nā ʻike ʻaʻohe pilina ma waena o ka pōʻino o ka cartilage articular a me ka ʻeha i nā maʻi OA [3,4] a i ʻole nā hiʻohiʻona preclinical o OA [5], ua hoʻololi i ka manaʻo e hoʻomohala i nā lāʻau lapaʻau no ka mālama ʻana i ka ʻeha. . E nānā ana kēia ʻatikala i nā ʻike hou loa i ka noiʻi ʻana i ka ʻeha hui a hōʻike i kekahi o nā pahuhopu e kū mai ana i ka wā e hiki mai ana o ka mālama ʻana i ka ʻeha o ka arthritis (i hōʻuluʻulu ʻia ma Fig. 1)
ʻO Cytokines
ʻO nā hana o nā cytokines like ʻole i nā haʻawina neurophysiology hui i hōʻike nui ʻia i kēia manawa. ʻO Interleukin-6 (IL-6), no ka laʻana, he cytokine i hoʻopaʻa maʻamau i ka mea hoʻokipa IL-6 (IL-6R). Hiki i ka IL-6 ke hōʻailona ma ka hoʻopaʻa ʻana me kahi IL-6R (SIL-6R) hiki ke hoʻoheheʻe ʻia e hana i kahi paʻakikī IL-6/sIL-6R. Hoʻopili kēia IL-6 / sIL-6R paʻakikī i kahi subunit glycoprotein transmembrane 130 (gp130), a laila e ʻae ai iā IL-6 e hōʻailona i loko o nā cell i hōʻike ʻole i ka membrane-bound IL-6R [25,26]. ʻO IL-6 a me SIL-6R nā mea pāʻani koʻikoʻi i ka ʻāʻī ʻana o ka ʻōnaehana a me ka arthritis, ʻoiai ua ʻike ʻia ka hoʻoponopono ʻana o nā mea ʻelua i ka serum o nā maʻi RA a me ka wai synovial. [27,29]. I kēia mau lā, ua ʻike ʻo Vazquez et al. ʻo ka hui pū ʻana o IL-6 / sIL-6R i nā kuli ʻiole i hōʻeha ʻia i ka ʻeha, e like me ka mea i hōʻike ʻia e ka piʻi ʻana o ka pane ʻana o nā neurons spinal dorsal horn i ka mechanical stimulation o ke kuli a me nā ʻāpana ʻē aʻe. o ka hope [30]. Ua ʻike pū ʻia ka hyperexcitability o ka spinal neuron i ka wā i hoʻohana ʻia ai ka IL-6 / sIL-6R ma ka ʻāina i ka spinal cord. ʻO ka hoʻohana ʻana i ka spinal o ka gp130 hiki ke hoʻoheheʻe ʻia (ʻo ia ka mea e holoi ai i nā paʻakikī IL-6/sIL-6R, a laila e hōʻemi ana i ka trans-signaling) i kāohi i ka IL-6/sIL-6R-induced central sensitization. Eia nō naʻe, ʻaʻole i hōʻemi ka hoʻohana ʻana o ka gp130 soluble wale nō i nā pane neuronal i hoʻokumu ʻia i ka mumū hui.
ʻO nā kaila transient receptor potential (TRP) he mau ala cation koho ʻole e hana ma ke ʻano he mea hoʻohui i nā kaʻina hana physiological a me pathophysiological. Ma waho aʻe o ka thermosensation, chemosensation, a me mechanosensation, pili nā ala TRP i ka modulation o ka ʻeha a me ka mumū. No ka laʻana, ua hōʻike ʻia nā kaila ion TRP vanilloid-1 (TRPV1) i ke kōkua ʻana i ka ʻeha ʻeha ʻeha ʻoiai ʻaʻole hiki ke hoʻoneʻe ʻia ka hyperalgesia thermal i TRPV1 mono arthritic mice [31]. Pēlā nō, hoʻokomo ʻia nā kahawai TRP ankyrin-1 (TRPA1) i ka hypersensitivity mechano arthritic e like me ka blockade o ka mea hoʻokipa me nā antagonists koho i hoʻemi ʻia i ka ʻeha mechanical i loko o ka Freunds complete adjuvant model inflammation [32,33]. ʻO nā hōʻike hou aʻe e pili ana ʻo TRPV1 i ka neurotransmission o ka ʻeha OA mai nā haʻawina i hoʻokiʻekiʻe ʻia ka ʻōlelo TRPV1 neuronal i ke ʻano sodium monoiodoacetate o OA [34]. Eia kekahi, ʻo ka hoʻokele ʻōnaehana o ka TRPV1 antagonist A-889425 i hōʻemi i ka hana evoked a me ka hana manawaleʻa o ka spinal-wide dynamic range a me nā neurons nociception-specific i ka model monoiodoacetate [35]. Hōʻike kēia mau ʻikepili e hiki ke komo i nā endovanilloids i nā kaʻina hana sensitization waena e pili ana i ka ʻeha OA.
Ua ʻike ʻia i kēia manawa he ʻehā mau polymorphism i loko o ka gene e hoʻopili ana i ka TRPV1, e alakaʻi ana i kahi hoʻololi i ke ʻano o ke kahawai ion a me ka hana impaired. Hoʻololi kekahi polymorphism (rs8065080) i ka naʻau o TRPV1 i ka capsaicin, a ʻo ka poʻe e lawe ana i kēia polymorphism ʻaʻole i maʻalahi i ka hyperalgesia thermal [36]. Ua nānā ʻia kahi noiʻi hou inā ua ʻike nā maʻi OA me ka rs8065080 polymorphism i ka ʻike ʻeha i hoʻololi ʻia ma muli o kēia anomaly genetic. Ua ʻike ka hui noiʻi ʻoi aku ka nui o ka poʻe maʻi me ke kuli asymptomatic OA e lawe i ka gene rs8065080 ma mua o nā maʻi me nā ʻeha ʻeha. [37]. Hōʻike kēia nānā i nā maʻi OA me ka hana maʻamau; Loaʻa i nā ala TRPV1 ka nui o ka pilikia o ka ʻeha hui a hōʻoia hou i ke komo ʻana o TRPV1 i ka ʻike ʻeha OA.
Panina
ʻOiai ke hoʻomau nei ka paʻakikī o ka mālama ʻana i ka ʻeha o ka arthritis, ke hana ʻia nei nā lele nui i ko mākou hoʻomaopopo ʻana i nā kaʻina neurophysiological kuleana no ka hana ʻana o ka ʻeha hui. Ke ʻike mau ʻia nei nā pahuhopu hou, ʻoiai ke wehewehe ʻia a hoʻomaʻemaʻe ʻia nā mīkini ma hope o nā ala i ʻike ʻia. ʻO ka huli ʻana i hoʻokahi mea hoʻokipa kikoʻī a i ʻole kaila ion ʻaʻole paha ʻo ia ka hopena no ka hoʻomaʻamaʻa ʻana i ka ʻeha hui, akā ua hōʻike ʻia kahi ala polypharmacy kahi e hoʻohana ʻia ai nā mea hoʻolaha like ʻole i ka hui ʻana i nā manawa kikoʻī o ka maʻi. ʻO ka wehe ʻana i ke kaapuni hana ma kēlā me kēia pae o ke ala ʻeha e hoʻomaikaʻi ai i ko mākou ʻike i ka hana ʻana o ka ʻeha hui. No ka laʻana, ʻo ka ʻike ʻana i nā mea hoʻoponopono pili o ka ʻeha hui e ʻae iā mākou e hoʻomalu i ka nociception i loko o ka hui a pale paha i nā hopena ʻaoʻao waena o nā lāʻau lapaʻau i lawelawe ʻia.
PAINI FACETOGENIC
FASET SYNDROME & FACETOGENIC PAIN
ʻO ka maʻi hoʻoluʻu He maʻi maʻi e pili ana i nā hono o ka lumbar facet a me ko lākou mau innervations a hoʻopuka i ka ʻeha facetogenic kūloko a me ka radiating.
ʻO ka hoʻololi nui ʻana, hoʻolōʻihi, a i ʻole ka hoʻololi ʻana o ke kuamoʻo (hoʻohana pinepine ʻia) hiki ke hopena i nā loli degenerative i ka cartilage o ka hui. Eia kekahi, hiki ke komo i nā hoʻololi degenerative i nā hale ʻē aʻe, me ka disc intervertebral.
CERVICAL FACET SYNDROME & FACETOGENIC PAIN
ʻEha ʻāʻī axial (kakaʻikahi e ʻā ana ma mua o nā poʻohiwi), ka mea maʻamau i ka unilaterally.
Pain me a / a iʻole ka palena o ke kauʻana a me ke kaʻaʻana
Kaʻoluʻolu ma ka palpation
ʻO ka hoʻonāʻana i kaʻeha facetogenic ma kaʻaoʻao āpau a i loko o nā poʻohiwi a iʻole ma luna o ke kua, a hikiʻole ke hoʻoula i mua a lalo paha i kahi lima aiʻole i loko o nā manamana lima e like paha me ka puʻupuʻu i maloʻo.
LUMBAR FACET SYNDROME & FACETOGENIC PAIN
ʻEha a palupalu paha ma ke kua lalo.
ʻO keʻano o keʻano kuʻuna / kūʻokoʻa ma kaʻaoʻao o ka'ōiwi ma lalo.
ʻEha, ʻoʻoleʻa, a paʻakikī paha me kekahi mau neʻe (e like me ke kū pololei ʻana a i ʻole ke ala ʻana mai kahi noho.
Pain ma luna o ka hyperextension
ʻO ka ʻeha i kuhikuhi ʻia mai nā hui ʻaoʻao lumbar luna hiki ke hoʻonui i ka ʻaoʻao, ka ʻūhā, a me ka ʻūhā hope.
Hiki ke komo i loko o ka ʻūhā, ma hope a i ʻole ma hope o ka ʻeha i kuhikuhi ʻia mai ka ʻaoʻao o lalo.
Hiki ke kuhikuhi ʻia nā hui ʻaoʻao L4-L5 a me L5-S1 i ka ʻeha e hoʻonui ana i ka wāwae ʻaoʻao mamao, a i nā manawa kakaʻikahi, i ka wāwae.
KEKAHI MĀKUA
ʻO ka lāʻau hōʻailona kūpilikiʻi i hōʻikeʻia e like me ka Clinical Diagnoses
12. PainʻAna mai ka Lumbar Facet Hui
Hōʻuluʻulu Manaʻo
ʻOiai ua nīnau ʻia ke ola o kahi facet Syndrome, ua ʻae ʻia i kēia manawa ma ke ʻano he ʻano maʻi. Kaukaʻi ʻia i nā pae diagnostics, nā ami zygapophysial ma waena o 5% a me 15% o nā hihia o ka ʻeha mau, axial low back pain. ʻO ka mea maʻamau, ʻo ka ʻeha facetogenic ka hopena mai ke koʻikoʻi hou a / a i ʻole ka ʻeha haʻahaʻa haʻahaʻa kumulative, e alakaʻi ana i ka mumū a me ka hoʻolōʻihi ʻana o ka capsule hui. ʻO ka hoʻopiʻi pinepine ʻana ʻo ia ka ʻeha haʻahaʻa haʻahaʻa axial me ka ʻeha i ʻike ʻia ma ka ʻaoʻao, ka ʻūhā, a me ka ʻūhā. ʻAʻole he pathognomonic nā ʻike hoʻokolokolo kino no ka maʻi maʻi. ʻO ka hōʻailona ikaika loa no ka ʻeha facetogenic lumbar ʻo ia ka hōʻemi ʻana i ka ʻeha ma hope o nā poloka anesthetic o nā rami mediales (nā lālā medial) o nā rami dorsales e hoʻokomo i nā hui facet. Ma muli o nā hopena maikaʻi ʻole a me nā hopena maikaʻi ʻole, pono e wehewehe pono ʻia nā hopena. I nā poʻe maʻi me ka ʻeha hui zygapophysial i hoʻopaʻa ʻia i ka injection, hiki ke hana ʻia nā hana kaʻina hana i loko o ka pōʻaiapili o ka multidisciplinary, multimodal regimen lapaʻau e pili ana i ka lāʻau lapaʻau, ka hoʻomaʻamaʻa kino, a me ka hoʻomaʻamaʻa maʻamau, a, inā hōʻike ʻia, psychotherapy. I kēia manawa, ʻo ke kūlana gula no ka mālama ʻana i ka ʻeha facetogenic ka radiofrequency lapaʻau (1 B+). ʻO nā hōʻike e kākoʻo ana i nā corticosteroids intra-articular i kaupalena ʻia; no laila, pono e mālama ʻia kēia no ka poʻe i pane ʻole i ka lapaʻau radiofrequency (2 B1).
ʻO ka ʻeha Facetogenic e puka mai ana mai nā hui ʻaoʻao lumbar kahi kumu maʻamau o ka ʻeha hope haʻahaʻa i ka heluna kanaka makua. ʻO Goldthwaite ka mea mua i wehewehe i ka maʻi maʻi i ka makahiki 1911, a ua manaʻo nui ʻia ʻo Ghormley i ka hoʻokumu ʻana i ka huaʻōlelo `facet syndrome' i ka makahiki 1933. ʻO ka ʻeha facetogenic ua wehewehe ʻia ʻo ia ka ʻeha e puka mai ana mai kahi ʻāpana o nā hui facet, me ka fibrous capsule. , membrane synovial, cartilage hyaline, a me ka iwi.35
ʻO ka mea maʻamau, ʻo ia ka hopena o ke koʻikoʻi hou a / a i ʻole ka hōʻeha haʻahaʻa haʻahaʻa. ʻO kēia ke alakaʻi i ka mumū, hiki ke hoʻopiha i ka hui facet i ka wai a pehu, ka hopena o ka hoʻolōʻihi ʻana o ka capsule hui a me ka hanauna ʻeha.27 Ke hoʻololiʻana i ka loiloiʻana i ke kikowaena o ke kīʻaha i hiki ke hōʻino i ke kīpē o ke kolaki ma o ka liʻiliʻi liʻiliʻi, e hopena ai i ka sciatica. Eia hou, uaʻikeʻo Igarashi et al.28 i nā cytokines inflammatory i hoʻokuʻuʻia ma o ka puʻu o ka joint joint ma nā maʻi me ka hoʻohaʻahaʻa zygapophysia hiki i kekahi hapa o ke kuleana no nā hōʻailona neuropathic i kēlā me kēia kanaka i ka'ōpū o ke kuamo. ʻO nā kumu kūpono no ka maʻi zygapophysial paakiki pū kekahi,ʻo ia ka spondylolisthesis / lysis, maʻi maʻi discenerative disc, a me ka makahiki kiʻekiʻe .5
KEKAHI HOʻOLA HULA
ʻO ka laha prevalence o nā pathological loli i nā facet ami ma ka nānā ʻana i ka radiological pili i ka makahiki o nā kumuhana, ka hana radiological i hoʻohana ʻia, a me ka wehewehe ʻana o ka pono ʻole. Hiki keʻike ponoʻia nāʻene o ka pahuhopu ma o kaʻikeʻana o ka lolokau (CT).49
NEINOPATHIC PAIN
Hoʻomaka kaʻeha a hanaʻia paha e ka liona mua a iʻole ke kīpē i loko o ka pūnaewele nalu sumatosensory.
ʻO kaʻeha Neuropathic ʻO ka maʻamau, paʻakikī ke mālama ʻia, a kūʻē pinepine i ka hoʻokele analgesic maʻamau.
Hōʻuluʻulu Manaʻo
ʻO ka ʻeha neuropathic ke kumu o ka ʻeha a i ʻole ka maʻi o ka ʻōnaehana somatosensory, e komo pū ana me nā fibers peripheral (A?, A? a me C fibers) a me nā neurons waena, a pili i ka 7-10% o ka lehulehu. Ua wehewehe ʻia nā kumu he nui o ka ʻeha neuropathic. E piʻi aʻe paha kona maʻi ma muli o ka ʻelemakule o ka honua holoʻokoʻa, hoʻonui i ka maʻi diabetes mellitus, a hoʻomaikaʻi i ke ola ʻana mai ka maʻi kanesa ma hope o ka chemotherapy. ʻOiaʻiʻo, ʻaʻole imbalances ma waena o ka excitatory a me ka inhibitory somatosensory hōʻailona, ka hoʻololi ʻana i nā kaila ion, a me ka loli ʻana i ka hoʻololi ʻana o nā leka ʻeha i loko o ka ʻōnaehana nerve waena ua hoʻopili ʻia i ka ʻeha neuropathic. Eia kekahi, ʻo ke kaumaha o ka ʻeha neuropathic mau e pili ana i ka paʻakikī o nā hōʻailona neuropathic, nā hopena maikaʻi ʻole, a me nā hoʻoholo hoʻoholo paʻakikī. ʻO ka mea nui, ua pilikia ka maikaʻi o ke ola i nā poʻe maʻi me ka ʻeha neuropathic ma muli o ka hoʻonui ʻana i ka lāʻau lapaʻau a me nā kipa ʻana i nā mea mālama olakino a me ka maʻi mai ka ʻeha ponoʻī a me ka maʻi hoʻoulu. ʻOiai nā paʻakikī, ʻo ka holomua i ka hoʻomaopopo ʻana i ka pathophysiology o ka ʻeha neuropathic e hoʻoulu i ka hoʻomohala ʻana i nā kaʻina hana diagnostic hou a me nā hana pilikino, e hōʻike ana i ka pono o kahi ala multidisciplinary i ka mālama ʻana i ka ʻeha neuropathic.
KA PATHOGENESIS OF NEINOPATHIC PAIN
ʻO PERIPHERAL MECHANISMS
Ma hope o ka maʻi aʻalolo peripheral, lilo nā neurons i mea maʻalahi a hoʻomohala i ka excitability abnormal a me ka naʻau kiʻekiʻe i ka hoʻoulu.
Uaʻikeʻia kēia ma ka ... Sensitization Papa!
NO KA MEA KUMU
Ma muli o ka hoʻomau ʻana o ka hana kuʻuna ma ka ʻaoʻao, ua hoʻonui nā neurons i ka hana hope, hoʻonui i nā māla hoʻokipa, a hoʻonui i nā pane i nā manaʻo afferent, me ka hoʻoulu ʻana o ka tactile maʻamau. Uaʻikeʻia kēia ma ... Central Sensitization!
ʻOi aku ka nui o ka ʻeha neuropathic maʻi i nā wahine (8% versus 5.7% i nā kāne) a me nā maʻi ma kahi o 50 mau makahiki (8.9% versus 5.6% i kēlā mau makahiki <49 makahiki), a ʻoi loa ka hopena i ke kua haʻahaʻa a me nā lālā haʻahaʻa. , ʻāʻī a me nā lālā o luna24. ʻO nā radiculopathies ʻeha lumbar a me ka cervical ke kumu pinepine o ka ʻeha neuropathic mau. Ma muli o kēia mauʻikepili, kahi noiʻi o> 12,000 mau maʻi me kaʻeha mau loa me nāʻanoʻeha nociceptive a me nā neuropathic, i hāʻawiʻia i nā meaʻeha ma Germany, ua hōʻikeʻia he 40% o nā maʻi a pau iʻike i kekahi mauʻano o kaʻeha neuropathic (e like me ke ahi wela, ʻeha, a me ke kani); ʻO nā poʻe maʻi me ka ʻeha hope a me ka radiculopathy i hoʻopilikia nui ʻia25.
ʻO ka haʻawina o nā neurophysiology maʻi i kaʻikeʻana i nāʻano o ke kīhaʻiʻano lolo.
Hōʻuluʻulu Manaʻo
I kēia manawa, ua alakaʻi ʻia nā noiʻi neurophysiological clinical e pili ana i ka tension-type headache (TTH) me nā kumu nui ʻelua: (1) e hoʻoholo inā hiki i kekahi mau ʻāpana neurophysiological ke hana ma ke ʻano he hōʻailona o TTH, a (2) e noiʻi i ka physiopathology o TTH. E pili ana i ka helu mua, ʻo nā hopena o kēia manawa he mea hōʻino ʻia no ka mea hiki ke ʻike pinepine ʻia kekahi mau mea ʻino i loaʻa i nā maʻi TTH i nā migraineurs. Ma ka ʻaoʻao ʻē aʻe, ua hana nui ka neurophysiology clinical i ka hoʻopaʻapaʻa e pili ana i ka pathogenesis o TTH. Ua ʻike ʻia nā haʻawina e pili ana i ka exteroceptive suppression o ka ʻoki ʻana i ka ʻiʻo temporalis i ka hana ʻole o ka excitability brainstem a me ka mana suprasegmental. Ua loaʻa kahi hopena like me ka hoʻohana ʻana i nā trigeminocervical reflexes, nona nā mea ʻino i ka TTH i hōʻike i ka hana hoʻemi ʻana o ka brainstem interneurons, e hōʻike ana i nā ʻano hana hoʻomalu ʻeha endogenous. ʻO ka mea e mahalo ai, ʻo ka neural excitability abnormality i loko o TTH me he mea lā he mea maʻamau, ʻaʻole i kaupalena ʻia i nā ʻāpana cranial. Ua ʻike ʻia nā ʻano hana like ʻole DNIC ma nā ʻāpana somatic e nā haʻawina nociceptive flexion reflex. ʻO ka mea pōʻino, ʻo ka hapa nui o nā noiʻi neurophysiological e pili ana i ka TTH ua hoʻopōʻino ʻia e nā hemahema ʻano koʻikoʻi, pono e pale ʻia i ka noiʻi e hiki mai ana e wehewehe maikaʻi i nā mīkini TTH.
E hoʻomaopopo ':
ʻO ka neurophysiology o ke kaumaha o ka maʻi. McDougall JJ1 Linton P.
ʻO kaʻeha mai loko mai o nā hui o ke lumbar. Kleef M1, Vanelderen P, Cohen SP, Lataster A, Van Zundert J, Mekhail N.
ʻO kaʻeha NeuropathicLuana Colloca,1ʻO Lila Ludman,1ʻO Didier Bouhassira,2Ralf Baron,3Anthony H. Dickenson,4ʻO David Yarnitsky,5ʻO Roy Freeman,6Andrea Truini,7Nadine Attal, Nanna B. Finnerup,9ʻO Christopher Eccleston,10,11Eija Kalso,12ʻO David L. Bennett,13ʻO Robert H. Dworkin,14a ʻO Srinivasa N. Raja15
ʻO ka haʻawina o nā neurophysiology maʻi i kaʻikeʻana i nāʻano o ke kīhaʻiʻano lolo. Rossi P1, Vollono C, Valeriani M, Sandrini G.
Hoʻomaopopo nā kauka i kaʻeha mau loa, e like me ka mea e kaumaha ai no 3 a 6 mahina aʻoi aʻe paha. ʻO eha nā hopena o ka olakino o kekahi kanaka a me kēlā lā i kēia lā. Paʻi mai ka maʻi mai nā hua'ōlelo e holo i loko o ka pūnaewele makaʻuʻole. Pīhoihoi e pili ana i kaʻeha. Hoʻokumu i nā hōʻailona koʻikoʻi e pili ana i ka manaʻo o kekahi, noʻonoʻo, a me keʻano o nā mea hana i nā lā a pau, e like me ka hiamoe,ʻai a me ka hanaʻana. ʻO Chiropractor,ʻo Dr. Alex Jimenezʻo ia i nā meaola kūikawā hiki ke kōkua i kaʻike a mālamaʻana i nā kumu kumu o kaʻeha a me kaʻeha mau.
ʻO ka hana mua i ka hoʻoponoponoʻiliʻana i kaʻilima, he hōʻike i nāʻano biopsychosocial.
ʻAʻole hiki ke hoʻohālikelike ponoʻia ka nui o nā maʻi pilikino i loko o kaʻike o ka maʻi.
Hiki ke hoʻohanaʻia ka helu mua e hoʻomaopopo i nā wahi e makemake ana i ka loiloi piha piha.
He nui nā lako hana pilipino i hoʻoikaikaʻia e hiki keʻike i ka hopena o kaʻeha mau.
Ka Papa Hana Ana o nā Haumāna me ke Paʻi Paakā
ʻO ka ʻeha ʻeha ka hopohopo olakino lehulehu e pili ana iā 20-30% o ka heluna kanaka o nā ʻāina Komohana. ʻOiai ua nui nā kuhiʻepekema i kaʻikeʻana i keʻano neurophysiology o kaʻeha, hoʻoholo pololei aʻikeʻana i ka pilikia o ka maʻi maʻi mau loa,ʻaʻole ia he maʻalahi a he maikaʻi. Pehea ka hopena lōʻihi e pili ana i ka hopena o ka hopena a me nā mea i manaʻoʻia i ka wā e hana ai i ka hōʻailona paʻakikī. ʻAʻohe mea pilina ma waena o ka nui a iʻole keʻano o nā maʻi pilikino a me ka ikaika o kaʻeha, akā, ʻikeʻia ka hopena o ka hopena maʻamau e nā hanana biomedical, psychosocial (pēnei i nā manaʻo o nā maʻi, nā mea e manaʻo ai, a me keʻano), a me nāʻano o nā hali (e like me ka helu, nā pane a nā mea nui'ē aʻe). ʻO ka hōʻoiaʻana o kēia mau inoa āpauʻekolu ma o ka loiloi pihaʻana o ka mea me ka maʻi maʻamau e pono ai no nā'ōlelo hoʻoholo a me ka hoʻoikaika i nā hopena maikaʻi loa. Pono e komo i kēia loiloi kahi moʻolelo hoʻomanawanui maikaʻi a me ka loiloi olakino a me kahi ninaninau ninaninau e nānā ai i kahi hana a ka mea maʻi. ʻO ka hoʻomaopopo houʻana i ka paneʻana i nā nīnau i ho'ākākaʻia i ka manawa o ka loiloi mua e alakaʻi i nā hoʻoholo e pili ana i nā hōʻike hou aku, inā he mea paha. ʻO nā mea i hoʻohālikelikeʻia e ka poʻe i hōʻikeʻia e loiloi i ka nui o kaʻeha o ka maʻi, nā mana hana, nā manaʻoʻiʻo a me nā mea e manaʻo ai, a hiki i ke kauka, hiki ke hoʻoponoponoʻia,
ʻO ka maʻi he hōʻailona nui loa. ʻO kaʻeha kaumaha wale nō e manaʻoʻia e pili i ka 30% o ka lāhui kanaka makua o ka USA, ma luna o 100 miliona mau mākua.1
Me ka hopena nui o ka hanaʻana i nā kānaka me kaʻeha mau loa,ʻo ka hoʻomaha no nā mea he nui loa iʻole e hoʻomaʻemaʻeʻia i kaʻeha keʻole. ʻOiai ua nui nā holomua i ka ʻike o ka neurophysiology o ka ʻeha, me ka hoʻomohala ʻana i nā lāʻau analgesic mana a me nā hana lapaʻau ʻē aʻe a me nā hana ʻokiʻoki hou, ma ka awelika ka nui o ka hōʻemi ʻeha e nā kaʻina hana i loaʻa he 30-40% a kū kēia i emi ma mua o ka hapalua o nā mea maʻi i mālama ʻia.
ʻO keʻano o mākou e noʻonoʻo ai i kaʻeha ka hopena o ke ala e hele ai mākou e loiloi i kaʻeha. Hoʻomaka ka papa hana ma ka moʻolelo a me ka noʻonoʻo kino, a me ka nānāʻana, e nā laboratory tests a me nā kaʻina hanaʻike diagnost i ka ho'āʻoʻana e hōʻoia a / a hōʻoia i ka heleʻana o kekahi maʻi pilikino e hōʻike ana i ka hōʻailona / mea paʻi kino.
I ka neleʻana o nāʻano pilikino e pili ana i ke kino, hiki i ka mea mālama ola ke manaʻo e hōʻikeʻia nā hōʻailona e pili ana i nā mea noʻonoʻo a hiki ke noi i kahi loiloi no kaʻikeʻana i nā hopena o ka naʻau e pili ana i ka hōʻike o ka maʻi. Aia he lua i kahi e hōʻikeʻia ai ka hōʻike o nā hōʻailona ma ka ʻokoʻa or nā hanaʻenehana.
ʻOiai he laʻana, nā kumuhana kumuhana no kekahi o keʻano maʻamau a me ka manawa hou (e like me ke kīʻaha) 3 a me ka hoʻolālāʻana (eg hoʻi i kaʻehaʻo ka fibromyalgia (FM)] nā pilikia o ka maʻi iʻikeʻoleʻia,ʻo 4,5 i kaʻaoʻao'ē aʻe, hiki i nā mea likeʻole me nā mea likeʻole e like me nā diskena herniated e ho'ākāka i ka maʻi ināʻo ia .6,7Loaʻa ka hemahema o nā wehewehe kūpono no nā mea maʻi me ka ʻole o ke ʻano o nā lāʻauolaola i hōʻike ʻia i ka ʻehaʻeha a me nā mea ʻehaʻeha me nā ʻano pathology koʻikoʻi.
ʻO ke kaumaha o ke kaumaha eʻoi aʻe ma mua o ka mea hoʻomanawanui wale nō, akā,ʻo kāna mau mea nui'ē aʻe (mau hoa, nā pili, nā mea hana a me nā hoa hana a me nā hoaaloha), e hana ana i nā mea e pono ai. ʻO nā mea hōʻoluʻolu maikaʻi e hiki ke loaʻa ma kaʻike pihaʻana o ke aioiolo olaʻole o kaʻeha me keʻano o ka hoʻonaʻauao o ka maʻi a me ka hōʻikeʻana i keʻano o ka maʻi, e like me keʻano o ka manaʻo (e like me ka manaʻo kaumaha, ka puʻuwai, a me ka huhū), kaʻike a me kaʻike o nā hōʻailona, nā hōʻailona ma o nā mea'ē aʻe'ē aʻe .8,9ʻO kahi hoʻonohonoho nui ma muli o ka nui o nā kumu e hoʻopili i nā kaha a me nā palena hana o nā poʻe me kaʻeha mau loa. No laila,ʻikeʻia kaʻike kūpono piha e pili ana i nā lāʻau biomedical, psychosocial, a me nā kūlana kūkākūkā, no ka mea,ʻo kēlā me kēia mea e hāpai i kaʻeha mau loa a me ka hemahema piliʻole .10,11
ʻIke kūpono o ka mea hoʻokahi me ka maʻi paʻi
Ua'ōleloʻo Turk a me Meichenbaum12ʻekolu mau nīnau pilikino e alakaʻi i ka hoʻonaloleiʻana i nā kānaka e hōʻike nei i kaʻeha:
He aha ka nui o ke maʻi a iʻole kaʻeha (hōʻeha kino)?
He aha ka nui o ka maʻi? ʻO ia, pehea ka lōʻihi o ka hoʻomanawanui, nā kīkino, a hikiʻole ke leʻaleʻa i nā hana maʻamau?
He kūpono paha ka hana a kēlā kanaka e like me ka maʻi a iʻole kaʻeha, a iʻole he hōʻike paha o ka hōʻailona hōʻailona no kekahi o nā kumu noʻonoʻo a pilikanaka paha (e like me ka manaʻo maikaʻi, nā lāʻau hoʻololi i keʻano, ka uku kālā)?
I mea e pane ai i kēia mau nīnau, pono e hōʻiliʻili ʻia ka ʻike mai ka mea hoʻomanawanui e ka mōʻaukala a me ka hoʻokolokolo kino ʻana, e hui pū ʻia me kahi nīnau ninaninau, a ma o nā mea loiloi kaulike. Pono nā mea mālama ola e ʻimi i nā kumu o ka ʻeha ma o ka hoʻokolohua kino ʻana a me nā hoʻokolohua diagnostical me ka loiloi pū ʻana i ke ʻano o ka mea maʻi, nā makaʻu, nā manaʻolana, nā hana, nā waiwai, nā pane a nā mea nui ʻē aʻe, a me ka hopena o ka ʻeha i nā maʻi. ola.11 I ka pōkole, pono ka mea mālama ola e loiloi i ka "kanaka holoʻokoʻa" a ʻaʻole wale ka ʻeha.
ʻO nā pahuhopu o ka moʻaukala a me ka loiloiʻana e hoʻoponopono ai i:
(i) e hoʻoholo i ka pono o ka hoʻokolohua diagnostical hou
(ii) e hoʻoholo inā maopopo kaʻikepili lāʻau i nā hōʻailona o ka maʻi, ka paʻakikī paʻakikī, a me nā palena hana
(iii) e hana i kahi hōʻailona lāʻau
(iv) ke noʻonoʻo i ka loaʻa o ka lāʻau kūpono
(v) e hoʻokumu i nā manaʻo o ka mālamaʻana
(vi) e hoʻoholo i kahi kūpono no ka mālamaʻana i ka maʻi ināʻaʻole hiki ke ho'ōla.
ʻO nā helu helu nui o nā maʻi e hōʻike ana i kaʻeha mau loa e hōʻikeʻole i nā maʻi pilikino e hoʻohana i nā leka uila, nāʻikeʻikepili axial calculation, aiʻole nā electromyography (hiki i nā papahana he nui nā haʻawina hoʻolālā kino, ka leka uila a me ka hana leka hana no ka hoʻoholoʻana i ke kumu kino o ka maʻi),ʻo 17 ke hoʻomaopopo aʻikeʻole paha.
Ma kēia mau hopena,ʻo ka hoʻomanaʻoʻana o ka mea maʻi a me ka noʻonoʻo kinoʻana i ke kumu o ka hōʻailona lapaʻau, hiki ke mālama i nā hualoaʻa mai kaʻikeʻikeʻikeʻana i ka hōʻoiaʻana, a hiki ke hoʻohanaʻia e alakaʻi i ke kuhikuhi o nā loiloi hou.
Eia kekahi,ʻo nā maʻi me nā pilikia o kaʻeha mau loa eʻai pinepine i nā lāʻau lapaʻau.18 He mea nui e kūkākūkā i nā lāʻau o ke kanaka maʻi i ka manawa o ka naneele,ʻoiai ua nui nā lāʻauʻona e pili ana i nā hopena o ka hopena e hiki ai ke hoʻoweliweli a hoʻopiʻi paha i ka manaʻo kaumaha .19 ʻAʻole pono i nā mea mālama ola keʻike i nā lāʻau i hoʻohanaʻia no kaʻeha mau loa, akā, me nā hopena hope o kēia mau lāʻau e hiki ai i ka luhi, nā pilikia moe, a me nā loli o ka naʻau e pale i kaʻikeʻole i ke kaumaha.
Hoʻohanaʻia ka hoʻohanaʻana i nā papa hana i nā lā a pau e like me ka hilinaʻiʻana i ka manawa kūpono ma mua o ka hoʻomanaʻoʻana. Hiki ke noiʻia nā maʻi e hoʻomau i nā palani maʻamau o kaʻeha nui me nāʻike i hoʻopaʻaʻia i kekahi manawa i kēlā me kēia lā (e like me kaʻai a me ka hola moe) no nā lā he mau lā a he mau wiki a me nā hōʻehaʻeha hiki ke hoʻonuiʻia ma mua o ka manawa.
ʻO kekahi pilikia i hoʻomaopopo ʻia me ka hoʻohana ʻana o nā diary pepa-a me ka penikala ʻaʻole hiki i nā mea maʻi ke ukali i ke kuhikuhi e hāʻawi i nā helu i nā wā kikoʻī. Ma kahi o, hiki i nā mea maʻi ke hoʻopau i nā diary i mua (ʻe hoʻopihapiha i mua`) a i ʻole ma mua iki o ka ʻike ʻana i kahi kauka (ill hoʻopiha i hope), 24 e hoʻohaʻahaʻa ana i ka pono putative o nā diaries. Ua ʻae ʻia nā diaries uila i kekahi mau noiʻi noiʻi e hōʻalo i kēia mau pilikia.
Ua hōʻikeʻia ka noiʻi i ka nui o ka nānāʻana i ka maikaʻi o ka ola o ke ola (HRQOL) i nā mea maʻi maʻamau me ka hoʻonui i ka hana.31,32 He nui nā papahana HRQOL i hāpai i ka naʻau. -36)], 33 mau mea laulā o ka hana maʻamau (e like me ka'ōlelo Pelekane Hui Pūʻino (PDI)], 34 a me nā mea maʻamau maʻamau [e like me ka Index Ontario MacMaster Osteoarthritis Index (WOMAC); 35 Roland-Morris Back Pain'AnauʻIke Palekana (RDQ) 36 e helu i ka hana a me ke ola o ke ola.
Hoʻopumuʻia nāʻano kaukumu kūikawā e loiloi i ka hopena o kahiʻano kūikawā (e like me kaʻeha a me ke koʻikoʻi o nā kānaka me ka osteoarthritis), akāʻo nā mea maʻamau e hiki ai ke hoʻohālikelike i nā hana hana kino e pili ana me kahi maʻi i hāʻawiʻia a me kāna hanaʻana me nāʻano likeʻole. ʻAʻole hiki keʻikeʻia nā hopena kūikawā o kahi maʻi i ka hoʻohanaʻiaʻana o kahi ana'āinana; no laila, hiki i ka hōʻailona maʻamau paha ke hōʻike i ka holomua o ka maʻi ma muli o ka maʻi. Hiki paha ke hoʻohanaʻia nā hana nui o ka hanaʻana i ka hoʻohālikelikeʻana i nā poʻe maʻi me kahi o nā maʻi kaumaha. ʻO ka hui pūʻiaʻana o nāʻano maʻi a me nā mea maʻamau e kōkua i ka hoʻokōʻana i nā pahuhopuʻelua.
ʻO ka hikiʻana o ke kaumaha o ka naʻau i nā kānaka me kaʻeha mau loa e hōʻalo i ka hopena i ka nānāʻana i nā hōʻailona e like me ka luhi, ka pae hoʻolālā i hoʻemiʻia, hoʻemi libido, hoʻololi hoʻololi, pilikia o ka moe, waiwai waiwai a me nā nalowale, ka hopena o kaʻeha, ke kaumaha o ka naʻau, a me nā lāʻau lapaʻau e pili ana i ka pahūʻana.
Ua hoʻomohala pono ʻia nā mea hana no nā mea maʻi ʻeha e loiloi i ka noʻonoʻo psychological, ka hopena o ka ʻeha i nā ola o nā mea maʻi, ka manaʻo o ka kaohi, nā hana kūleʻa, a me nā ʻano e pili ana i ka maʻi, ʻeha, a me nā mea lawelawe olakino. 17
Eia kekahi laʻana,ʻo ke Anonymous Beck Depression (BDI) 39 a me ka Profile o nā Mood States (POMS) 40 he mea noʻonoʻo no ka heluʻana i nā hiʻohiʻona o keʻano kaumaha, ke kaumaha o ka naʻau, a me ka haunaele o ka naʻau, a ua'ōleloʻia e hoʻohanaʻia i nā hoʻokolohuaʻokoʻa Palekana lōʻihi; 41 akā, pono e unuhi 'ia nā helu he nui a me nā pae hoʻohālike no nā pae o ka pilikia ka pilikia e pono e hoʻololiʻia e pale i nā positena hewa.42
E hōʻike i nā mea hana pāʻani
ʻO nā meaolaolaʻehā nāʻano pilikino e hiki ke hoʻohanaʻia e hōʻike i ke olakino a maʻi paha. Ke nānā nei kēia mau pepa i nā mea pilikino o ke kaumaha haʻahaʻa (LBP) i nā kānaka. ʻO ka LBP ke kumu kumu nui o ke kīnā, i hanaʻia e nā maʻi likeʻole o ke kinipuni, e like me ka hoʻopauʻana o ka disverse intervertebral, ka disc discontinued, ka spinal stenosis, a me keʻano o nā maʻi. ʻO ka nānāʻana o kēia mau haʻawina he mau mea hoʻolaha pāʻokoʻa ia, no ka mea,ʻo ka hoʻolālā ke kōkua i ka pathogenesis o ka hoʻohaʻahaʻa disk a me nā hana hanaʻeha e pili ana. ʻO ka hoʻonuiʻana, ua hōʻikeʻia nā haʻawina e hiki ke anaʻia i mua o nā mea hoʻolaha inflammatory i loko o ke koko. Hiki i kēia mau mea kanu ke lilo i mea hana hou no ke kuhikuhiʻana i ka mālama maʻi. I kēia manawa,ʻaʻohe mea kūponoʻole i ka hoʻihoʻiʻana i nā maʻi i ka hanaʻana i ka maʻi, a,ʻoiai nā hana o nā haunapila e hāʻawi i ka hoʻoponopono āpau a me ka hōʻoluʻolu o kaʻeha, he mea hōʻino a he kumukūʻai. Ke nānā nei ka'ānai i nā noiʻi i hanaʻia no nā lāhui me nā mea hōʻoiaʻiʻo a me nā kumu i hōʻikeʻoleʻia o LBP. Ma muli o ka holomuaʻana o ka moʻomeheu kūʻokoʻa o ka LBP, ua hoʻohālikeʻia kaʻano kino o nā haʻawina e ka lōʻihi o keʻano maʻi / maʻi. Hoʻomanaʻo houʻia nā haʻawina e pili ana i nā loli i nā biomarkers me ka lāʻau. I ka pae hope loa, hiki i nā biomarker diagnostics o LBP a me ka hōʻiliʻiliʻana o ke kuamoʻo ka mea e hiki ai ke mālama i kahi manawa o nā lāʻau lapaʻau maʻamau no nā mea lapaʻau i keʻano o ka LBP.
Nā Biomarkers No ka Pain Neuropathic Chronic a me ka hoʻohana pono ʻana i ka stimulinal cord cord
Ua hoʻolālāʻia kēia nānāʻana i kaʻikeʻana i nā mea i loko o ke kino o ke kanaka a hoʻemiʻia me ka nui o kaʻeha neuropathic. Ua nānā mākou i nāʻano likeʻole, aʻike i ka pilina ma waena o nā maʻi a me nā mea neuropathic o ka pūnaewele immune (kēia pūnaewele pale i ke kino mai nā maʻi a me nā maʻi). ʻO nā mea i loaʻa mai he mea pono loa ia no ka hoʻomaopopoʻana i nāʻano e hōʻemi aiʻole hoʻopauʻia ai ka pilikia, ke lawe pūʻia me kaʻeha neuropathic me ka maʻi. ʻO ke kaʻina hanaʻana o ka'ōpū (SCS) kekahi o nā hōʻailona palekana kūpono no kaʻeha. E hoʻopili kahi haʻawina e pili ana i kā mākou mauʻike mai kēia hōʻike i ka SCS, i mea e maopopo ai i keʻano, a me ka maikaʻi hou aku.
ʻO nā cytokine Pro-inflammatory e like me IL-1?, IL-6, IL-2, IL-33, CCL3, CXCL1, CCR5, a me TNF-?, Ua ʻike ʻia e pāʻani i nā kuleana nui i ka hoʻonui ʻana i nā mokuʻāina ʻeha mau.
Ma hope o ka loiloi ʻana i nā ʻano noiʻi like ʻole e pili ana i nā biomarkers o ka ʻeha, ua ʻike mākou i nā pae serum o nā cytokine pro-inflammatory a me nā chemokines, e like me IL-1?, IL-6, IL-2, IL-33, CCL3, CXCL1, CCR5, a me TNF. -?, ua hoʻonui nui ʻia i ka wā o ka ʻeha mau. Ma nā ʻaoʻao ʻē aʻe, ua loaʻa nā cytokine anti-inflammatory e like me IL-10 a me IL-4 e hōʻike i ke ʻano koʻikoʻi i lalo i ka wā o ka ʻeha mau.
ʻO nā meaolaola no ka pilikia
Ua loaʻa i kahi o ka noiʻi he haneli mau mea kanu no ka pilikia, akā,ʻaʻole i hoʻokumu i kā lākou kūlana ma nā maʻiʻehaʻeha a iʻole i hoʻokumu i nā mea maʻamau i hiki i nā poʻe maʻi a pehea e hoʻohana ai i nā'ikeolaola no ka hoʻonuiʻana i ka hōʻoia, ka maʻi a me kaʻike. ʻO kēia hemahema o ka neʻeʻana i ke kaʻina ma muli o keʻano a me ka nui o ka pōʻino, me keʻano heterogeneity ma loko o nā palapala noiʻi a me nā mea nui o nā biomarkers me ka mana, e like me ka nui o nā mea. Ke nānā nei mākou i nā palapala i hiki mai, kahi e hōʻike ai i nā mea markima e komo ana i nā inflammatory, neurotrophic a me nā hana hana kūmole, a me nā pūnaewele neurotransmitter a me nā neuroendocrine, e hōʻike ana i nā moho kūpaʻa loa. Hiki ke anaʻia kēia mau mea ma o nā moʻo a me nā epigenetic, transcriptomic a proteomic, metabolomic a me nā neuroimaging assessments. Hoʻohanaʻia ka hoʻohanaʻana i nā puke hou a me nā polokalamu noiʻi hoʻonaʻauao maʻamau i kēia manawa no ka hoʻoholoʻana inā, aʻo ia hoʻi, hiki ke hoʻohanaʻia nā biomarkers e wānana i ka paneʻana i ka mālamaʻana, e pale i nā maʻi i nā hōʻailona maʻamau a hoʻoulu i nā hiʻona no nā hana hou. Hoʻomaopopo mākou he nui ka'ōlelo no ka hoʻohaʻahaʻaʻana i ke kaumaha o ke kaumaha ma o ka uluʻana a me ka hoʻonuiʻana i kēia mauʻimi noiʻi.
E hoʻomaopopo ':
Ka nānā ʻana i nā maʻi me ka ʻeha mauʻO EJ Dansiet lāua ʻo DC Turk * t`
Nā mea kanu pālahalaha o ka ukiuki haʻahaʻa a me ka hōʻinoʻiaʻana o ka diseration: he hōʻike.
Khan AN1, Jacobsen HE2, Khan J1, Filippi CG3, Levine M3, Lehman RA Jr2,4, Riew KD2,4, Lenke LG2,4, Chahine NO2,5.
ʻO nā meaolaola no ke kino Neuropathic Pain a me kā lākou mea hoʻohana pono i ka Stinal Cord Stimulation: He Hōʻike
Chibueze D. Nwagwu, 1 Christina Sarris, MD, 3 Yuan-Xiang Tao, Ph.D., MD, 2 a me Antonios Mammis, MD1,2
Nā meaolaola no ka pilikia: nā manaʻo hou, nā hopena a me nā manawa e hiki mai ana. Strawbridge R1, Keiki AH1,2, Cleare AJ1,2.
ʻO kaʻeha keʻano o ke kino o ke kino o ke kanaka i ka hōʻeha a maʻi paha, a he mea hoʻomanaʻo pinepine paha he mea hewa. I ka manawa e ola ai ka pilikia, hiki iā mākou ke ho'ōki i ka loaʻaʻana o kēia mau hōʻailona pōʻino, akā, pehea ka hopena i ka manawa e mau ai kaʻeha ma hope o ka halaʻana o ke kumuhana? maʻi eha ua ho'ākāka 'ia me ka lāʻau e like me ke kaumaha mau e mau ana i ka 3 i ka mau makahiki 6 aʻoi aʻe paha. ʻO ka pilikia nui loa kahi pilikia e ola ai me ka hoʻopiliʻana i nā mea a pau mai ka papahana hana a ka mea a me ka mea hiki ke hana a me kā lākou mau pilina pilikino a me nā kūlana koʻikoʻi. Akā, uaʻike aneiʻoe e pili ana paha ka hopena maʻamau i ka hanana a me ka hana o kou lolo? Hiki ke hoʻololi i kēia mau loli o ka lolo e hiki ai i ka hoʻohaʻahaʻa a me ka naʻauʻole.
ʻO ke kaumaha nuiʻaʻole ia e hoʻololi wale i kahi māhele'āina o ka manaʻo, he meaʻoiaʻiʻo, hiki ke hopena i nā loli i nā wahi nui o ka lolo, aʻo ka hapa nui o ia mau mea e komo i nā hana a me nā hana. Uaʻike nāʻano noiʻi noiʻi i nā makahiki he mau hanana i ka hippocampus, me ka hoʻemiʻana i nā meaʻeleʻele mai ka cortex prefrontal dorsolateral, amygdala, pūpū a me ka pono pūpū pono, e kapa i kekahi, e pili ana me kaʻeha mau. Hiki i ka hoʻohaunaeleʻana o kekahi mau hanana o kēia mau āpana a me kā lākou mau hana pili e kōkua i ka hoʻololiʻana o kēia lolo i loko o ka pōʻaiapili, no ka nui o nā poʻe me kaʻeha mau loa. ʻO ke kumu o ka pauku ma hope iho nei, e hōʻike a kūkākūkā paha i nā loli o ka lolo a me ka hana hana e pili ana i kaʻeha mau loa, ma keʻano ināʻaʻole e hōʻinoʻia nā mea a me nā meaʻole.
ʻO nā hoʻololiʻana o nā Brain i ke Kūlana Palekana E Hōʻoia IʻoleʻAʻohe Pōʻino A iʻole Atrophy paha
Hōʻuluʻulu Manaʻo
Pili ka ʻeha ʻeha me ka lolo i ka hoʻoliʻiliʻi mea i nā wahi e like me ka lawe ʻana o ka ʻeha. ʻO nā kaʻina hana morphological e pili ana i kēia mau hoʻololi hoʻololi, e pili ana paha i ka hoʻoponopono hou ʻana i ka hana a me ka plasticity kikowaena i ka lolo, noho maopopo ʻole. ʻO kaʻeha ma ka hip osteoarthritis kekahi o nā syndrome ʻeha mau loa e hiki ke mālama ʻia. Nānā mākou i nā maʻi he 20 me ka ʻeha mau ma muli o ka coxarthrosis unilateral (mean makahiki 63.25-9.46 (SD) mau makahiki, 10 wahine) ma mua o ke kīpiʻi endoprosthetic hui (state pain) a nānā i nā loli o ka lolo a hiki i 1 makahiki ma hope o ke kahakaha ʻana: 6-8 mau pule , 12--18 mau hebedoma a me 10--14 mahina ke kaʻawale loa ka ʻeha. ʻO nā mea maʻi me ka ʻeha mau ma muli o ka coxarthrosis unilateral i ka liʻiliʻi o ka hina hina i ka hoʻohālikelike ʻia i nā kaohi o ka cingulate cort (c), cortex insular a me ka operculum, dorsolateral prefrontal cortex (DLPFC) a me orbitofrontal Cortex. Hana kēia mau wahi ma ke ʻano he mau hoʻohui hoʻohui lehulehu i ka wā o ka ʻike a me ka kali o ka ʻeha. I ka wā i ʻeha ai nā mea maʻi ma hope o ka hoʻōla ʻia ʻana mai ke ʻoki endoprosthetic, ua hoʻonui ʻia kahi mea hina i aneane like nā wahi like. Ua ʻike pū kekahi mākou i kahi piʻi holomua o ka mea hina poʻo lolo i ka premotor cortex a me kahi o ka moto hoʻonui (SMA). Hoʻoholo mākou ʻaʻole nā mea hina i ka ʻeha mau ke kumu, akā ke lua i ka maʻi a ma ka liʻiliʻi i hapa ma muli o nā loli i ka hana kaʻa a me ka hoʻohui kino.
Introduction
ʻO nā hōʻike o ka hana hou a me ke kūkulu hou ʻana i nā mea maʻi ʻeha mau e kākoʻo i ka manaʻo ʻaʻole pono e noʻonoʻo ʻia ka ʻeha mau loa ma ke ʻano he kūlana hana i hoʻololi ʻia, akā ma muli o ka hopena o ka plasticity o ka lolo hana a me ka hanana [1], [2], [3], [4], [5], [6]. I nā makahiki ʻeono i hala iho nei, ua paʻi ʻia ma mua o 20 mau haʻawina e hōʻike ana i ka loli ʻana o ka lolo hanana i 14 syndromes ʻeha mau. ʻO kahi hiʻohiʻona hiʻohiʻona o kēia mau noiʻi āpau ka ʻoiaʻiʻo ʻaʻole i hoʻokaʻawale wale ʻia nā mea hina, akā i kū ʻia i nā wahi lolo i ho'ākāka ʻia a me ka hana maʻamau - ʻo ia hoʻi, ke komo ʻana i ka hana nosiceptive supraspinal. ʻO nā mea i ʻike nui ʻia he ʻokoʻa ia no kēlā me kēia maʻi ʻehaʻeha, akā ua kau ʻia i ka cingulate cortex, ka orbitofrontal cortex, ka insula a me nā dorsal pons [4]. ʻO nā hale hou aʻe ka hui o ka thalamus, dorsolateral prefrontal Cortex, basal ganglia a me ka wahi hippocampal. Kūkākūkā pinepine ʻia kēia mau hopena e like me ke atrophy pūnaewele, e hoʻoikaika ana i ka manaʻo o ka hōʻino a i ʻole ka nalo ʻana o ka hina hina o ka lolo [7], [8], [9]. ʻO ka ʻoiaʻiʻo, ua ʻike nā mea noiʻi i ka hoʻopili ma waena o ka lolo hina mea hoʻemi a me ka lōʻihi o ka ʻeha [6], [10]. Akā pili ka lōʻihi o ka ʻeha i ka makahiki o ka mea maʻi, a me ka makahiki i hilinaʻi ʻia ma ka honua holoʻokoʻa, akā ua hōʻike maikaʻi ʻia ka hāʻule kikoʻī ʻana o ka hina hina [11]. Ma ka ʻaoʻao ʻē aʻe, hiki i kēia mau hoʻololi kūloli ke hoʻemi i ka nui o ka cell, nā wai extracellular, synaptogenesis, angiogenesis a i ʻole ma muli o nā loli o ka nui o ke koko [4], [12], [13]. ʻO kēlā me kēia kumu, no kā mākou wehewehe ʻana i ia ʻano hopena he mea nui e ʻike i kēia mau ʻike morphometric i ka mālamalama o ka waiwai o nā noiʻi morphometric i ka plasticity dependant e pili ana, no ka mea ua hōʻike pinepine ʻia nā loli lolo i nā wahi kikoʻī ma hope o ka noʻonoʻo a me ka hoʻoikaika kino. 14].
ʻAʻole maopopo ʻia ke kumu o ka hapa liʻiliʻi o nā kānaka e hoʻomohala i kahi maʻi ʻeha mau loa, e noʻonoʻo nei he ʻeha ākea ka ʻeha. Kū aʻe ka nīnau inā paha i kekahi mau kānaka kahi ʻokoʻa o ka hanana i ka lawe ʻana i nā ʻōnaehana ʻeha waena e hana ma ke ʻano he diathesis no ka ʻeha mau. Hoʻololi nā mea hina i ka ʻeha phantom ma muli o ka ʻoki ʻana [15] a me ka ʻeha o ke kuamoʻo [3] e hōʻike ana i nā hoʻololi morphological o ka lolo, ma ka liʻiliʻi i kahi ʻāpana, kahi hopena o ka ʻeha mau. Eia nō naʻe, ʻo kaʻeha o ka hip osteoarthritis (OA) kekahi o nā maʻi o ka maʻi mau loa e hiki ke hiki ke mālama ʻia, ʻoiai ʻo 88% o kēia mau mea maʻi he kūʻokoʻa i ka ʻeha ma hope o ke kīʻaha hope. (16). I loko o kahi noiʻi pailaka ua nānā mākou i nā maʻi he ʻumi me ka huina OA ma mua a ma hope koke iho o ke kaha ʻana. Ua ʻike mākou i nā hōʻemi o nā mea hina i ka mua cingulated Cortex (ACC) a me ka insula i ka wā o ka ʻeha mau ma mua o ke kahakaha THR a loaʻa ka hoʻonui ʻia o nā mea hina i nā wahi lolo e pili ana i ka ʻeha manuahi ma hope o ke kahakaha ʻana [17]. Ke nānā nei i kēia hopena, ua hoʻonui mākou i kā mākou noiʻi e noiʻi ana i nā mea maʻi hou aʻe (n? =? 20) ma hope o THR kūleʻa a nānā i nā loli o ka lolo i nā manawa ʻehā, a hoʻokahi makahiki ma hope o ke kaukō ʻana. E kāohi i nā mea hina hina ma muli o ka hoʻomaikaʻi ʻana o ka moto a i ʻole ke kaumaha i lawelawe pū mākou i nā palapala nīnau no ka hoʻomaikaʻi ʻana i ka hana kaʻa a me ke olakino noʻonoʻo.
Nā Pono a me nā Una
'O Volunteers
Ua hōʻike ʻia nā mea maʻi ma aneʻi he lālā o 20 mau maʻi mai 32 mau maʻi i paʻi ʻia i hala iho nei i hoʻohālikelike ʻia i kahi hui mālama olakino kūlike i ka makahiki a me ke kāne a me ke komo ʻana i kahi noiʻi hou aʻe o hoʻokahi makahiki. Ma hope o ke kahakaha ʻana he 17 mau mea maʻi i hāʻule ma muli o ke kaha ʻelua endoprosthetic (n? =? 12), nā maʻi nui (n? =? 2) a me ka haʻalele ʻana o ka ʻae (n? =? 2). Ua haʻalele kēia i kahi hui he iwakālua mau maʻi me ka unilateral kumu mua o ka huina OA (mean makahiki 8--63.25 (SD) makahiki, 9.46 wahine) i ʻimi ʻia ʻehā mau manawa: ma mua o ke kaha ʻana (state pain) a hou 10-6 a me 8-12 mau hebedoma a me 18 10 mau mahina ma hope o ke kaha ʻana o ka endoprosthetic, ke ʻole ka ʻehaʻeha. ʻO nā mea maʻi āpau me ka hip hip mua loa he moʻolelo mōʻaukū ka lōʻihi ma mua o 14 mau mahina, mai ka 12 a i ka 1 mau makahiki (mean 33 mau makahiki) a me ka helu ʻeha ʻeha o 7.35 (mai 65.5 a 40) ma kahi pālākiō analogue visual (VAS) mai 90 (ʻaʻohe ʻeha) i 0 (ʻeha ʻeha maikaʻi ʻole. Ua loiloi mākou i kekahi hanana o nā hanana ʻeha liʻiliʻi, e like me ka niho-, pepeiao a me ka ʻehaʻeha a hiki i nā hebedoma 100 ma mua o ke aʻo ʻana. Ua koho koho ʻole mākou i ka ʻikepili mai ka 4 sex- a me nā makahiki i kū like i nā kaohi olakino (mean makahiki 20--60,95 (SD) mau makahiki, 8,52 wahine) o ka 10 o ka noiʻi pailota i ʻōlelo ʻia ma luna [32]. ʻAʻohe o nā maʻi he 17 a i ʻole ka 20 wahine a me nā makahiki i kūlike i nā mea manawaleʻa olakino i loaʻa i ka mōʻaukala a me ka mōʻaukala kūloko. Ua hāʻawi ʻia ke aʻo ʻana e ka komite Ethics kūloko a ʻae ʻia i ʻike ʻia i kākau ʻia i loaʻa mai i nā mea hoʻopaʻa haʻawina ma mua o ka hoʻokolokolo ʻana.
Kaʻikepili Behavioral
Ua hōʻiliʻili mākou i nā ʻikepili e pili ana i ke kaumaha, somatization, hopohopo, ʻeha a me ke olakino a me ke olakino noʻonoʻo i nā mea maʻi āpau a me nā helu ʻehā a pau e hoʻohana ana i nā nīnau nīnau maʻamau: Beck Depression Inventory (BDI) [18], Brief Symptom Inventory (BSI) [19], Schmerzempfindungs-Skala (SES? =? Pālua ʻoluʻolu ʻole o ka ʻeha) [20] a me ka Health Survey 36-Item Short Form (SF-36) [21] a me ka Nottingham Health Profile (NHP). Ua alakaʻi mākou i nā ana ANOVA a pālua i nā hoʻāʻo t-tiled ʻelua e kālailai i ka ʻikepili luhi lōʻihi e hoʻohana ana iā SPSS 13.0 no Windows (SPSS Inc., Chicago, IL), a hoʻohana i ka hoʻoponopono Greenhouse Geisser inā ua haki ka kuhi no ka sphericity. Ua hoʻonohonoho ʻia ka pae koʻikoʻi ma p <0.05.
VBM -ʻIkeʻIkepili
Loaʻa kiʻi kiʻi. Ua hana ʻia ka nānā ʻana MR kiʻekiʻe-kiʻekiʻe ma kahi ʻōnaehana 3T MRI (Siemens Trio) me kahi wili poʻo poʻo 12-kanal maʻamau. No kēlā me kēia helu o nā manawa ʻehā, scan I (ma waena o 1 lā a me 3 mahina ma mua o ke kahakaha endoprosthetic), scan II (6 a 8 mau pule ma hope o ke kahakaha ʻana), scan III (12 a 18 mau pule ma hope o ke kahakaha ʻana) a scan IV (10-14 mau mahina ma hope o ke kahakaha ʻana), loaʻa kahi T1 kaumaha MRI kūkulu no kēlā me kēia mea maʻi me ka hoʻohana ʻana i ke kaʻina 3D-FLASH (TR 15 ms, TE 4.9 ms, ʻaoʻao flip 25 ", ʻāpana 1 mm, FOV 256-256, nui voxel 1--1-- 1 mm).
Ka HoʻolālāʻImi a me kaʻIke Heluhelu
Hana ʻia ka ʻike mua a me ka hoʻopili ʻana me SPM2 (Wellcome Department of Cognitive Neurology, Ladana, UK) e holo ana ma lalo o Matlab (Mathworks, Sherborn, MA, USA) a me ka mea i loko o kahi morphometry (VBM) -toolbox no ka ʻikepili lonikū, kēlā hoʻokumu ʻia i nā kiʻi 3D MR hoʻolālā hoʻonā kiʻekiʻe loa a ʻae i ka noi ʻana i nā helu helu voxel-wisdom e ʻike i nā ʻokoʻa āpana i ka hina hina o nā mea a i ʻole nā puke [22], [23]. I ka hōʻuluʻulu manaʻo, ʻo ka hana mua ʻana e pili ana i ka normalization spatial, ka mahele hinahina a me ka hoʻoheheʻe spatial 10 mm me kahi hua hua Gaussian. No nā kaʻina hana mua, ua hoʻohana mākou i kahi protocol i hoʻomākaukau ʻia [22], [23] a me kahi scanner- a me kahi anakuhi mea kikoʻī kikoʻī manaʻo [17]. Ua hoʻohana mākou iā SPM2 ma mua o SPM5 a i ʻole SPM8 e hoʻohālikelike i kēia kālailai i kā mākou pailota aʻo [17]. e like me ka mea e ʻae ai i kahi normalization maikaʻi loa a me ka hoʻokaʻawale ʻana o ka ʻikepili lōʻihi. Eia nō naʻe, ma ke ʻano he hōʻano hou o VBM (VBM8) i loaʻa i kēia manawa (dbm.neuro.uni-jena.de/vbm/), ua hoʻohana mākou iā VBM8.
Kaʻike 'ana i ke kaulike
Ua hoʻohana mākou i kahi hoʻāʻo t-hoʻāʻo lua i mea e ʻike ai i nā ʻokoʻa āpau i ka hina hina o ka mea ma waena o nā hui (nā mea maʻi ma ka manawa kiko scan I (ʻeha mau) a me nā kaohi olakino). Ua noi mākou i kahi paepae o ka p <0.001 (uncorrected) ma o ka lolo holoʻokoʻa ma muli o ko mākou ikaika i kahi kuhiakau nui, i hoʻokumu ʻia ma 9 mau noiʻi kūʻokoʻa a me nā cohorts e hōʻike ana i ka emi ʻana o ka mea hina i nā mea maʻi maʻi mau. 7], [8], [9], [15], [24], [25], [26], e hoʻonui ʻia ka mea hina i nā wahi like (no ka hana ʻeha e pili ana) nā wahi e like me kā mākou papa pailaka (27 ). Ua hoʻohālikelike ʻia nā hui no ka makahiki a me ka moekolohe me ka ʻole o nā ʻokoʻa koʻikoʻi ma waena o nā hui. No ka ʻimi inā ua loli nā ʻokoʻa ma waena o nā hui ma hope o hoʻokahi makahiki, ua hoʻohālikelike mākou i nā mea maʻi i ka manawa kiko scan IV (ʻeha manuahi, hoʻokahi makahiki ka ukali) i kā mākou papa mālama olakino.
Ka Hoʻoponopono Longitudinal
E ʻike i nā ʻokoʻa ma waena o nā helu manawa (Scan IIV) ua hoʻohālikelike mākou i ka scanner ma mua o ke kaha ʻana (state pain) a me 6-8 a me 12-18 mau pule a me 10-14 mau mahina ma hope o ke kaha ʻana o ka endoprosthetic (pain pain) e like me ke ana hou ANOVA. Ma muli o ka loli ʻana o ka lolo ma muli o ka ʻeha mau e pono ai i kahi manawa e hoʻi ai ma hope o ka hana a me ka hoʻomaha ʻana o ka ʻeha a ma muli o ka ʻeha hope o ka ʻokiʻoki i hōʻike ʻia e nā mea maʻi, ua hoʻohālikelike mākou i ka loiloi loiloi lōʻihi I a me II me ka scan III a me IV. No ka ʻike ʻana i nā loli ʻaʻole pili pono i ka ʻeha, ua nānā pū mākou no nā loli holomua i nā manawa āpau. Ua hoʻohuli mākou i ka lolo o nā mea maʻi me OA o ka ʻaoʻao hema (n? =? 7) i mea e maʻamau ai no ka ʻaoʻao o ka ʻeha no nā mea ʻelua, ka hoʻohālikelike ʻana o ka hui a me ka loiloi lōʻihi, akā ua nānā mua i ka ʻikepili i hoʻohuli ʻole ʻia. Ua hoʻohana mākou i ka helu BDI ma ke ʻano he covariate i ke kkohu.
Results
Kaʻikepili Behavioral
Ua hōʻike ʻia nā mea maʻi āpau i ka ʻeha mau loa ma mua o ka ʻoki a ʻaʻohe ʻeha (e pili ana i kēia ʻeha mau) ma hope koke o ke kaha ʻana, akā ua hōʻike ʻia kahi ʻeha ma hope o ke kaha ʻana ma ka scan II i ʻokoʻa a ʻeha hoʻi ma muli o ka osteoarthritis. Ka helu olakino noʻonoʻo SF-36 (F (1.925 / 17.322)? =? 0.352, p? =? 0.7) a me ka helu BSI ma ka honua holoʻokoʻa GSI (F (1.706 / 27.302)? =? 3.189, p? =? 0.064 ) ʻaʻole i hōʻike i nā loli i ka holo ʻana o ka manawa a ʻaʻohe pili pū kekahi o ka noʻonoʻo. ʻAʻole hōʻike ʻia kekahi o nā kaohi i kahi ʻehaʻeha a ʻeha mau paha a ʻaʻole i hōʻike ʻia kekahi ʻōuli o ke kaumaha a me ke kīnā ʻole o ke kino / noʻonoʻo.
Ma mua o ke kaha ʻana, hōʻike kekahi mau mea maʻi i nā ʻōuli depressive haʻahaʻa ma nā helu BDI i hoʻemi nui ʻia ma ka scan III (t (17)? =? 2.317, p? =? 0.033) a me IV (t (16)? =? 2.132, p? =? 0.049). Hoʻohui ʻia, hoʻomaikaʻi maikaʻi nā helu SES (ʻoluʻolu ʻole) o nā mea maʻi āpau mai ka scan I (ma mua o ke ʻoki ʻana) e scan II (t (16)? =? 4.676, p <0.001), scan III (t (14)? =? 4.760, p <0.001) a me ka scan IV (t (14)? =? 4.981, p <0.001, 1 makahiki ma hope o ke kaha ʻana) e like me ka hōʻemi ʻana o ka ʻeha me ka ʻeha o ka ʻeha. He maikaʻi ka helu helu ʻeha ma ka scan 1 a me 2, ka helu like i ka lā 3 a me 4 maikaʻi ʻole. Hōʻike wale ka SES i ka maikaʻi o ka ʻeha i ʻike ʻia. No laila maikaʻi ia ma ka lā 1 a me 2 (mean 19.6 ma ka lā 1 a me 13.5 ma ka lā 2) a me ka maikaʻi ʻole (na) ma ka lā 3 & 4. Eia naʻe, ʻaʻole maopopo kekahi o nā mea maʻi i kēia kaʻina hana a hoʻohana i ka SES ma ke ʻano he kaulike ana i ke ola. ʻO kēia ke kumu i nīnau ʻia ai nā mea maʻi āpau i ka lā like pākahi a me ka mea like e pili ana i ka hanana ʻeha.
I ka papa olakino kino olakino olakino (SF-36), i piha me nā ana hōʻuluʻulu manaʻo o kahi Helu olakino kino a me kahi helu olakino noʻonoʻo [29], ua hoʻomaikaʻi maikaʻi nā mea maʻi i ka helu olakino olakino mai ka scan I i scan II (t ( 17)? = ?? 4.266, p? =? 0.001), scan III (t (16)? = ?? 8.584, p <0.001) a me IV (t (12)? = ?? 7.148, p <0.001), akā ʻaʻole ma ka Helu Ola Mental. Ua like nā hopena o ka NHP, i ka subscale ppain (hoʻoliʻiliʻi polarity) ua ʻike mākou i kahi hoʻololi nui mai ka scan I i scan II (t (14)? = ?? 5.674, p <0.001, scan III (t (12 )? = ?? 7.040, p <0.001 a me ka scan IV (t (10)? = ?? 3.258, p? =? 0.009). Ua ʻike pū kekahi mākou i kahi piʻi nui o ka subscale mobility phimum mai ka scan I i scan III (t (12)? = ?? 3.974, p? =? 0.002) a me ka scan IV (t (10)? = ?? 2.511, p? =? 0.031). ʻAʻohe hoʻololi nui ma waena o ka scan I a me ka scan II ( ʻeono pule ma hope o ke kaha ʻana.
Kaʻikepili helu
Loaʻa mahele o ke kaʻina. Ua hoʻokomo mākou i ka makahiki ma ke ʻano he covariate i ka laulā laina laulā a ʻike ʻole i ka huikau o ka makahiki. Hoʻohālikelike ʻia i ka moekolohe a me nā makahiki i hoʻohālikelike ʻia, ua hōʻike nā mea maʻi me ka hip mua OA (n? =? 20) i ka pre-operative (Scan I) e hoʻoliʻiliʻi i ka mea hina i ka cexulate cingulate cortex (ACC), ka huina insular, operculum, dorsolateral prefrontal Cortex ( DLPFC), ka pou kino ʻākau a me ka cerebellum (Papa 1 a me ke Kii 1). Koe no ka putamen kūpono (x? =? 31, y? = ?? 14, z? = ?? 1; p <0.001, t? =? 3.32) ʻaʻole i loaʻa ka hoʻonui nui ʻana i ka nui o nā mea hina i nā mea maʻi me ka OA i hoʻohālikelike ʻia. i nā kaohi olakino. Ke hoʻohālikelike nei i nā mea maʻi i ka manawa kiko scan IV me nā kaohi i kūlike ʻia, ua loaʻa nā hopena like e like me ka mahele ʻāpana o ka ʻāpana e hoʻohana ana i ka scan I hoʻohālikelike ʻia i nā kaohi.
Kiʻi 1: Nā palapala 'āina parametric e hōʻike ana i nā ʻokoʻa o ke ʻano o ka hina hina i nā maʻi me ka ʻeha mau ma muli o ka hip OA mua i hoʻohālikelike ʻia i nā mana a me ka lōʻihi i hoʻohālikelike ʻia iā lākou iho i ka manawa. Hōʻike ʻia nā hoʻololi nui hina hina i ke kala, hōʻike ʻia ka ʻikepili cross-sectional i ka ʻikepili ʻulaʻula a me ka longitudinal i ka melemele. Axial plane: ʻo ka ʻaoʻao hema o ke kiʻi ka ʻaoʻao hema o ka lolo. kiʻekiʻe: Nā wahi o ka emi nui o ka mea hina ma waena o nā maʻi me ka ʻeha mau ma muli o ka hip OA mua a me nā kumuhana mana ʻole. p<0.001 i hoʻoponopono ʻole ʻia: piʻi ka mea hina i nā maʻi ʻeha ʻole 20 i ke kolu a me ka ʻehā o ka manawa ma hope o ka hoʻololi ʻana i ka hip, ke hoʻohālikelike ʻia me ka scan mua (preoperative) a me ka lua (6-8 mau pule ma hope o ke kaʻina hana). P<0.001 Nā ʻāpana ʻaʻole i hoʻoponopono ʻia: ʻO nā manaʻo hoʻohālikelike a me 90% ka wā hilinaʻi, nā hopena o ka hoihoi, nā ʻāpana kūʻokoʻa. axis-x: nā ʻokoʻa no nā manawa 4, axis-y: kuhi ʻokoʻa ma ?3, 50, 2 no ACC a me ka helu ʻokoʻa ma 36, 39, 3 no ka insula.
Ke hoʻololi nei i ka ʻikepili o nā maʻi me ka ʻūhā hema OA (n? =? 7) a me ka hoʻohālikelike ʻana iā lākou me nā kaohi olakino ʻaʻole i hoʻololi i nā hopena, akā no ka hōʻemi ʻana o ka thalamus (x? =? 10, y? = ?? 20, z? =? 3, p <0.001, t? =? 3.44) a me ka hoʻonui ʻia o ka cerebellum akau (x? =? 25, y? = ?? 37, z? = ?? 50, p <0.001, t? =? 5.12) ʻaʻole i hiki i ka mea nui i ka ʻike pili ʻole o ka poʻe maʻi ke hoʻohālikelike ʻia i nā kaohi.
Ka lōʻihi lōʻihi. I ka loiloi lōʻihi, ua ʻike ʻia kahi hoʻonui nui (p <.001 uncorrected) o ka mea hina e ka hoʻohālikelike ʻana i ka scan mua a me ka lua (ʻeha mau / ʻeha hope) a me ka scan ʻekolu a ʻehā (manuahi ʻole) ma ka ACC, insular cortex, cerebellum a me pars orbitalis i nā mea maʻi me ka OA (Papa 2 a me ke Kii 1). Ua emi ka hina hina ma luna o ka manawa (p <.001 kuhi ʻokoʻa i ka lolo) i ka lua o ka somatosensory cortex, hippocampus, midcingulate cortex, thalamus a me caudate nucleus i nā mea maʻi me OA (Kiʻi 2).
Hōʻike 2: a) Hoʻonui ka nui o ka hina hina o ka lolo ma hope o ka holomua o ka hana. ʻIke axial o ka hoʻoliʻiliʻi koʻikoʻi o ka hina hina i nā mea maʻi me ka ʻeha mau ma muli o ka hip hip mua e hoʻohālikelike ʻia i nā kumuhana kaohi. p <0.001 i hoʻoponopono ʻole ʻia (ʻāpana ʻāpana ʻāpana), b) Hoʻonui ka lōʻihi o ka hina hina i ka manawa ma ka melemele e hoʻohālikelike ana i ka scan I & IIscan III> scan IV) i nā mea maʻi me OA. p <0.001 uncorrected (longitudinal analysis). ʻO ka ʻaoʻao hema o ke kiʻi ka ʻaoʻao hema o ka lolo.
Ke hoʻololi nei i ka ʻikepili o nā mea maʻi me ka ʻūhā hema OA (n? =? 7) ʻaʻole i hoʻololi i nā hopena, akā no ka hoʻoliʻiliʻi o ka hina hina o ka lolo i ka Heschl Gyrus (x? = ?? 41, y? = ?? 21, z? =? 10, p <0.001, t? =? 3.69) a me Precuneus (x? =? 15, y? = ?? 36, z? =? 3, p <0.001, t? =? 4.60) .
Ma ka hoʻohālikelike ʻana i ka scanning mua (presurgery) me ka scans 3 + 4 (posturgery), ua ʻike mākou i ka hoʻonui ʻia o ka mea hina i ka mua o ka Cortex a me ka moto (p <0.001 uncorrected). Hoʻomaopopo mākou he ʻoi aku ka paʻakikī o kēia ʻokoʻa ke loaʻa iā mākou i kēia manawa ka liʻiliʻi o nā scans no kēlā me kēia ʻano (ʻeha vs. non-pain). Ke hoʻohaʻahaʻa mākou i ka paepae hana hou mākou i nā mea i loaʻa iā mākou e hoʻohana ana i ka hoʻohālikelike o 1 + 2 vs. 3 + 4.
Ma ka ʻimi ʻana i nā wahi e hoʻonui i nā wā āpau, ua ʻike mākou i nā loli o ka hina hina o ka lolo i nā wahi kaʻa (ʻĀpana 6) i nā mea maʻi me ka coxarthrosis ma hope o ka huina hope o ka hika (scan Idbm.neuro.uni-jena.de/vbm/) hiki iā mākou ke hoʻohālikelike i kēia ʻike i ka mua a me ka mid-cingulate cortex a me nā insulae mua.
Ua helu mākou i nā nui o ka hopena a me ka hōʻuluʻulu ʻāpana (nā maʻi a me nā kaohi) i loaʻa kahi Cohenss o 1.78751 i ka voxel piko o ka ACC (x? = ?? 12, y? =? 25, z? = ?? 16). Ua helu mākou iā Cohensss no ke aniani longitudinal (hoʻohālikelike scan scan 1 + 2 vs. scan 3 + 4). Ua hopena kēia i kahi Cohenss o 1.1158 i ka ACC (x? = ?? 3, y? =? 50, z? =? 2). E pili ana i ka insula (x? = ?? 33, y? =? 21, z? =? 13) a pili i ka like like, ʻo Cohen s 1.0949. Hoʻohui ʻia, ua helu mākou i ke kumu o nā helu voxel non-zero o ka palapala ʻāina Cohen ma loko o ka ROI (i loko o ka mahele mua o ka cingulate gyrus a me ka subcallosal cortex, i lawe ʻia mai ka Harvard-Oxford Cortical Structural Atlas): 1.251223.
Dr. Alex Jimenez's Insight
Hiki i nā'ōpiopio maʻi ke loaʻa i nā hanana olakino āpau o ka manawa, keʻole i nā hōʻailona keu o ke kino. Eia kekahi lā, he nui nā kānaka eʻike i nā pilikia e hiamoe ana ma muli o ka hopena, akā,ʻo ka mea nui loa,ʻo kaʻeha lōʻihi e hiki ai ke alakaʻi i nā hihia no ke olakino, e like me ka manaʻo kaumaha a me ke kaumaha. ʻO nā hopena i hiki i kaʻeha ke loaʻa i ka lolo, hiki paha ke nānā aku i nā mea koʻikoʻi nui akāʻo nā hōʻike ulu e hōʻike anaʻaʻole hiki ke loli kēia lolo a hiki ke hoʻohuliʻia i ka wā e loaʻa ai ka lāʻau kūpono i nā maʻi o nā maʻi. Wahi a kaʻatikala,ʻo nā meaʻinoʻeleʻele i loaʻa i loko o kaʻeha mau loa e hōʻikeʻole i ka pōʻino o ka lolo, akā, he hopena pinepine ia e kūpono ke mālama ponoʻia kaʻeha. ʻO ka mea pōmaikaʻi, hiki ke kōkua i kahi mau hōʻailona kūpono e kōkua ai i ka hōʻemi i nā hōʻailona hōʻailona a hoʻoulu hou i ka hale a me ka hana o ka lolo.
kūkākūkā
Ke nānā nei i ka hana o ka lolo holoʻokoʻa i ka manawa, hōʻoia mākou a hoʻonui i kā mākou ʻike pilote i paʻi ʻia i hala iho nei [17]. Ua loaʻa iā mākou nā loli i ka mea hina o ka lolo i nā mea maʻi me ka osteoarthritis hip mua i ka mokuʻeha mau loa, kahi e hoʻi i ka hapa ke loaʻa ʻole ka ʻeha o kēia mau mea maʻi, ma hope o ke kīʻaha endoprosthetic hui pū ʻia. ʻO ka hoʻonui hapa ʻana o ka mea hina ma hope o ke kaha ʻana he ʻaneʻane ma nā wahi like i ʻike ʻia ai ka emi ʻana o ka hina hina ma mua o ke kaha ʻana. ʻO ka hoʻopili ʻana i ka ʻikepili o nā mea maʻi me ka ʻūhā hema o OA (a no laila maʻamau no ka ʻaoʻao o ka ʻeha) he mea nui wale ka hopena ma nā hopena akā ua hōʻike pū kekahi i ka hoʻoliʻiliʻi o ka hina hina i ka gyrus a Heschl a me Precuneus i hiki ʻole iā mākou ke wehewehe maʻalahi a, ʻoiai ʻaʻohe kuhiakau o ka priori, e nānā me ke akahele. Eia nō naʻe, ʻo ka ʻokoʻa i ʻike ʻia ma waena o nā mea maʻi a me nā kaohi olakino ma ka scan ʻana ua ʻike mau ʻia wau i ka hoʻopili ʻāpana ʻāpana i ka scan IV. ʻO ka hoʻonui ʻana o ka mea hina i ka manawa o ka manawa he maʻalahi, ʻo ia hoʻi ʻaʻole i lawa ka hoʻokaʻawale ʻana i kahi hopena ma ka ʻāpana ʻāpana o ke keʻa, kahi ʻike i hōʻike ʻia i nā noiʻi e noiʻi ana i ka ʻike pili i ka plasticity [30], [31]. Hoʻomaopopo mākou i ka ʻoiaʻiʻo e hōʻike mākou i kekahi mau ʻāpana o ka lolo-loli ma muli o ka ʻeha mau e hoʻi hou ʻia ʻaʻole ia e kāpae i kekahi mau ʻāpana o kēia mau loli i hiki ʻole ke hoʻihoʻi ʻia.
ʻO ka mea mahalo, uaʻike mākou i ka emiʻana o ka hina hina ma ka ACC i nā maʻi maʻi mau loa ma mua o ka hanaʻana i ka holoʻana i ka 6 mau wiki ma hope o ke kāpili (scan II) a hoʻonui waleʻia i ka'ōʻiliʻili III a me IV, hiki paha i ka paʻi hopeʻana o ke kahakaha, hana. Loaʻa kēia i kaʻike o nā'ōnaehana no ka hoʻolālā paʻakikī i komo i loko o ka NHP, kahi i hōʻikeʻole i ka hoʻololi nui i ka manawa II ma kahi o ka pāʻaniʻana akā ua nui ka piʻiʻana i ka'ōnaehana III a me IV. ʻO kaʻike, ua hōʻikeʻoleʻia ko mākou mau maʻi i kaʻeha i loko o ka'alē ma hope o ke kāpiliʻana, akā, loaʻa kaʻeha i hope o ka paeʻana i nāʻiʻo a me kaʻili iʻikeʻia e ka poʻe maʻi. Eia nō naʻe, i ka manawa i hōʻike pinepine ai nā mea maʻi i ke kaumaha ma ka scan II, hoʻohālike pū mākou i ka'ōkuhi mua (ka hana mua) me ka scans III + IV (ke kauʻana), e hōʻike ana i ka hoʻonuiʻana i ka meaʻeleʻele i mua o ka palekana mua a me ka hoʻokele pua. Hoʻomaopopo mākou he paʻakikī kēia kūkēkēʻana ma muli o ke emi o ka mīkini maʻamau (ʻo ka maʻi a me ka maʻiʻole). Ke hoʻohaʻahaʻa iho nei mākou i ka paepae, haʻi hou mākou i nā mea i loaʻa iā mākou ma ka hoʻohālikeʻana o I + II vs III + IV.
Hōʻike ikaika kā mākou ʻikepili i ka hoʻololi ʻana o nā mea hina i nā maʻi o ka maʻi mau, i ʻike pinepine ʻia ma nā wahi e pili ana i ka hana supraspinal nociceptive [4] ʻaʻole no ka atronal neuronal a me ka hōʻino ʻana o ka lolo. ʻO ka ʻike o kēia mau hoʻololi i ʻike ʻia i ka mokuʻāina ʻeha mau ʻole i hiki ke wehewehe ʻia me kahi wā pōkole o ka nānā ʻana (hoʻokahi makahiki ma hope o ka hana me ke ʻano o ʻehiku mau makahiki o ka ʻeha mau ma mua o ka hana. Ua loli ka lolo Neuroplastic i ulu paha i mau makahiki (no ka hopena o ka hoʻokomo mau ʻana o ka nociceptive) pono i kahi manawa hou aku e huli hope loa. ʻO kahi hiki ke ʻike ʻia ka hoʻonui ʻana o ka hina hina i ka ʻikepili longitudinal akā ʻaʻole ma ka ʻikepili o ka ʻaoʻao (ʻo ia ma waena o nā cohorts i ka manawa o ka manawa IV) ka liʻiliʻi o ka nui o nā mea maʻi (n? =? 20). Pono e kuhikuhi ʻia ka ʻokoʻa ma waena o ka lolo o kekahi mau kānaka he nui a loaʻa i ka ʻikepili longitudinal ka liʻiliʻi o ka ʻokoʻa e like me ka nānā ʻana o nā lolo like i nā manawa he nui. A laila, e ʻike wale ʻia nā loli lahilahi ma ka ʻikepili lonikū [30], [31], [32]. ʻAʻole hiki iā mākou ke kāpae i kēia mau loli ma ka liʻiliʻi i hiki ʻole ke hoʻihoʻi ʻia ʻoiai ʻaʻole paha ia, hāʻawi ʻia nā hopena o ka hoʻolālā pilikino kikoʻī a me ka hoʻoponopono hou ʻana [4], [12], [30], [33], [34]. I mea e pane ai i kēia nīnau, pono nā noiʻi e hiki mai ana e nānā pinepine i nā mea maʻi ma mua o nā manawa lōʻihi, he mau makahiki paha.
Hoʻomaopopo mākou e hiki iā mākou ke hana i nā hopena i kau waleʻia e pili ana i ka ikaika o ka lolo morphology i ka manawa. ʻO ke kumu ke kūkulu mākou i kēia noi ma 2007 a nānāʻia i ka 2008 a me ka 2009,ʻaʻole iʻikeʻia inā e loli ana nā hoʻololi kūlohelohe a no nā kumu o ka pono i koho ai mākou i nā lāpili a me nā papa manawa e like me ia i ho'ākākaʻia maʻaneʻi. Hiki i kekahi ke hoʻopaʻapaʻa i ka loli o ka hina i ka manawa, a mākou e wehewehe ai no ka pūʻulu maʻi, hiki paha i ka hui pūʻulu a me ka hopena. Eia naʻe,ʻo nā hoʻololiʻana no kaʻelemakule, inā he nui, e manaʻoʻia he emi iho ka nui. Hāʻawiʻia ko mākou kuhiakau mua, ma muli o nā noiʻi kūʻokoʻa 9 a me nā kākoʻo e hōʻike ana i ke emiʻana o ka mea hina i nā mea maʻi maʻamau [7], [8], [9], [15], [24], [25], [26] [27], [28], ke kālele nei mākou i nā hoʻonui ākea ma kahi o ka manawa a no laila manaʻoʻiʻoʻaʻole mākou he hopena manawa maʻalahi. No kaʻike,ʻaʻole hiki iā mākou ke hoʻoholo i ka emiʻana o ka hina hina i ka manawa i loaʻa iā mākou i loko o ko mākou maʻi hoʻomanawanui i hiki i ka hopena manawa, no ka mea,ʻaʻole mākou i nānā i kā mākou papa hana i ka manawa hoʻokahi. Hāʻawiʻia nā hopena, he pono e hoʻonuiʻia ka hoʻolālāʻana i nā manawa a me nā wā pōkole, no ka mea, hiki i ka hana ma hope o ka wikiwiki morphometric ka wikiwiki e like me ka 1 wiki [32], [33].
Ma waho aʻe o ka hopena o ka maʻi o ka maʻi ma luna o ka mea hina [17] [34], [6] uaʻike mākou i nā loli i kaʻoihana hana hiki ke kōkua pū paha i nā hoʻololi. Loaʻa iā mākou kahi kaʻa a me nā wahi kikowaena (3 āpau) e hoʻonui i nā wā āpau (Figure 35). Ma muli o ka noʻonoʻo pono paha kēia ma muli o ka hoʻomaikaʻiʻana i kaʻoihana kaʻaʻoi aku i ka manawa aʻo ka mea i hoʻomahaʻoleʻia ai ka poʻe ola i ka nohoʻana i ke ola maʻamau. ʻO keʻano,ʻaʻole mākou i nānā aku i ka hana kaʻa akā i ka hoʻonuiʻana i kaʻike o ka maʻi, hāʻawiʻia i kā mākou noi mua eʻimi ai i ka loli maikaʻi o ka loloʻeleʻele i nā maʻi maʻi mau. No laila,ʻaʻole mākou i hoʻohana i nā mea kiko'ī eʻimi ai i ka hana maʻamau. Eia nō naʻe, ua hoʻoponopono ponoʻia ka hui houʻana o nā huihuʻi me ka maʻi paʻi [36], [37], [38], [39]. Eia kekahi,ʻo ka huakiko kaʻa he mea nui ia ma nāʻano maʻi lapaʻau i nā mea maʻi maʻamau i loaʻa i ka lāʻau me ka hoʻohanaʻana i ka hoʻonākau o ka lolo maʻamau (40), [41], me ka hoʻonāʻano o ka manawa kūʻokoʻa [42], a me ka hoʻonāʻano keʻakeʻa hou [43], [40]. ʻO ka hoʻohālikelike o kēiaʻano hoʻololi (kōkua me ka hanaʻole, a me ka pale waleʻana i nā pūnaewele pili i nā maʻi)ʻaʻole i hoʻonuiʻia i [13]. Ua hōʻikeʻia kahi hōʻike hou nei e hiki i kekahiʻikeʻike maʻamau ke hoʻololi i ka pilina o ka lolo [44]. ʻO ka synaptogenesis, ka hoʻohui houʻana o ka hōʻike a me ka angiogenesis i ka hana pūkō kino e hiki ke hana me nā koi kūikawā o kahi hana kaʻa. Tsao et al. Hōʻike i ka hoʻouka houʻana i loko o ka huakiko kaʻa o nā maʻi me kaʻeha hope haʻahaʻa e hoʻihoʻiʻia ana e like me ka mea i hōʻano houʻia [45] a me Puri et al. uaʻikeʻia ka emiʻana o ka mea'āpana'āpana'āpana'āpana poʻo hina i ka meaʻoluʻolu o ka fibromyalgia (28). ʻAʻole i hanaʻia kā mākou aʻoʻana no ka weheweheʻana i nāʻano likeʻole e hiki ai ke hoʻololi i ka lolo i loko o kaʻeha mau loa akā ua wehe mākou i kā mākouʻikepili e pili ana i ka hina hina e hoʻololi wale i nā hopena o ka hoʻokomoʻoleʻana i nā manaʻo. ʻO kaʻoiaʻiʻo,ʻo kahi noiʻi hou i nā maʻi maʻi neuropathic ka mea i hōʻike ai i nā mea likeʻole ma nāʻaoʻao o ka lolo e pili ana i ka manaʻo noʻonoʻo, ka pilikino, a me kaʻike o ke kaumaha, e'ōlelo ana he mea koʻikoʻi lākou i ka hoʻolālā kiʻi honua o XNUMX.
Hōʻike 3: Nā palapala ʻāina parametric helu e hōʻike ana i ka hoʻonui nui ʻana o ka mea hina hina ma nā wahi kaʻa (ʻĀpana 6) i nā mea maʻi me ka coxarthrosis ma mua o ka hoʻohālikelike ʻia ma hope o THR (ka loiloi lōʻihi, scan I Kuhi hoʻohālikelike ma x? =? 19, y? = ?? 12, z? =? 70.
ʻElua mau papahana kūlana hope loa e pili ana i ka hoʻoponopono pani paniʻana i nā maʻi o ka maʻi osteoarthritis,ʻo ia wale nō ka maʻi o ka maʻi mau loa e hiki ke kōkua i nā mea likeʻole [17], [46] pani manawa a me kēia mauʻikepili i hoʻopiʻiʻia e kahi noi hou loa i nā maʻi maʻi haʻahaʻa haʻahaʻa. 47]. Pono eʻikeʻia kēia mau haʻawina ma ka mālamalama o kekahi mau loiloi lōʻihi e nānā ana i nā mea iʻikeʻoleʻia ma ka hanana e like me ka [30], [31] a me kahi noi hou o nā lolo i nā mea kōkua olakino e hoʻonāukiuki ana i ka hoʻonāukiukiʻana [34] . ʻO ka hua'ōlelo nui o kēia mau haʻawina aʻo ka hoʻokaʻawale nui i ka hanu o ka lolo ma waena o nā maʻi a me nā mana ke kāohi i ka wā e ho'ōlaʻia ai ka maʻi. Eia naʻe, pono e noʻonoʻoʻiaʻaʻole maopopo i ka loliʻana o nā mea maʻi maʻamau no ka hoʻokomoʻole iʻole ka hopena o ka maʻi a me nā meaʻelua. ʻOiaiʻoi aku ka nui o nā loli maʻamau, e like me ka hopena a hoʻonui paha i ka pilina o ka pilina, ke kuʻi, ka hoʻonaʻauao kino a me nā hoʻololi o ke ola e lawa i ka lolo [6], [12], [28], [48]. ʻO ke kaumaha nui loaʻo ia ka mea lapaʻau a me ka hopena o kaʻeha, he mea noi nui ke ho'ākāka i kaʻokoʻa ma waena o nā maʻi a me nā mana. ʻO kekahi poʻe liʻiliʻi o kā mākou mau maʻi meʻOA ua hōʻike i nā hōʻailona hoʻohaʻahaʻa i hoʻololiʻia i ka manawa. ʻAʻole mākou iʻike i ka hoʻololiʻana i nā papa hana me ka papa BDI-akā ua loaʻa ka nīnau i ka nui o nā loli halihali no ka nele o kaʻeha a me ka hoʻoikaika kaʻaʻana i nā hopena a me keʻano o ka hana. Hiki i kēia mau loli hana ke hoʻoikaika i ka emi o ka hina hina i ka maʻi mau loa a me ka ulu hina ma ka pauʻana o kaʻeha.
ʻO kekahi kumu nui'ē aʻe paha e hōʻeha i kā mākou weheweheʻana i nā hualoaʻa,ʻo ia hoʻi,ʻo nā mea maʻi a pau loa me kaʻeha mau loa i loaʻa nā lāʻau e pili ana i kaʻeha, a ua kū lākou i ka wā iʻole ai lākou e hoʻoluhiʻia. Hiki i kekahi ke hoʻopaʻapaʻa e pili ana nā NSAID e like me diclofenac a iʻole ibuprofen i kekahi mau hopena ma nā pūnaewele neural a he pono ia no nā opioids, nā antiepileptics a me nā antidepressants, nā lāʻau i hoʻohana pinepineʻia i loko o ka pain pain cure. ʻO ka hopena o kaʻeha killers a me nā lāʻau'ē aʻe e pili ana i nā'ikepona morphometric e nui paha (48). ʻAʻohe aʻo i kēia manawa i hōʻikeʻia nā hopena o nā lāʻau paʻi ma ka lolo o ka lolo akā uaʻikeʻia kekahi mau pepa i ka hoʻololiʻana i ka hanu o ka maʻi i nā mea maʻi maʻamauʻole i wehewehe waleʻia e ka maʻi hana piliʻole [15],ʻaʻole hoʻi ma [7] maʻi [9] [49]. Eia naʻe, ua nele nāʻike kūpono. Pono e hoʻonui hou ka noiʻi i nā loli o kaʻike i ka pilikino i loko o ka plasticity, hiki ke nui nā hopena o ka hopena no ka mālamaʻana i kaʻeha mau loa.
Uaʻike mākou i ka emiʻana o ka mea hina i ka nānāʻana o longitudinal, hiki paha i nā papahana hou e hoʻohuiʻia me ka hoʻololiʻana i ka hana a me kaʻike i ka maʻi. ʻAʻoleʻike iki nāʻike e pili ana i nā loli lōʻihi i ka lolo hina ma nāʻanoʻeha, no laila ke kumuʻole o kā mākou kuhiakau no ka emiʻana o ka hina hina ma kēia mau wahi ma hope o ka hana. Teutsch et al. Uaʻikeʻia [25] ka piʻiʻana o ka meaʻeleʻele i ka lolo a me ke kāpili i waena o nā limahana olakino iʻike i ka hoʻonāukiuki i ka hana maʻamau i nā lāʻewalu. ʻO ka loaʻa o ka'āpana kala hina e piʻi ma hope o ka hoʻomohala hoʻomohalaʻana i ka hoʻokomo o ka lolo i ka mea maʻamau i ka heluʻana i nā maʻi i ho'ōlaʻia no kaʻeha mau loa. Hōʻike kēia i ka hoʻokomo maikaʻiʻole i nā limahana olakino e alakaʻi i ka hoʻoikaika i nā hoʻololi o ka hoʻokele, e like me ka mea i loaʻa i nā maʻi me kaʻeha mau loa, a ke hoʻololi nei kēia mau loli i nā limahana olakino i ka pauʻole o nā komo komo. No laila, hiki ke hoʻohālikelikeʻia ka emiʻana o ke oho hina ma kēia mau wahi iʻikeʻia i nā maʻi me kaʻOA ma muli o ke kaʻina hana likeʻole: hoʻoikaika i ka hoʻololi i nā loli o ka lolo [50]. Ma keʻano he kaohiʻole,ʻo MR Morphometry ka meaʻoi loa no kaʻimiʻana eʻike i nā substrate morphological o nā maʻi, e hoʻonui ana i ka maopopo o ka pilina ma waena o ka lolo a me ka hana, a me ka nānāʻana i ka hanaʻana. ʻO kekahi o nā pahuhopu nui i ka wā e hiki mai ana,ʻo ia ka hoʻololiʻana i kēia mea hana ikaika no nā hoʻokolohua nui a me nā ho'āʻo maikaʻi o kaʻeha mau.
Ka palena o kēia aʻoʻana
ʻOiai ke hoʻonui ʻia kēia noi o kā mākou noi mua e hoʻonui nei i ka ʻikepili ukali i 12 mau mahina a me ka ʻimi ʻana i nā mea maʻi hou aʻe, ʻo kā mākou kumu ʻike i ka loli o ka lolo morphometric i ka ʻeha mau. Liʻiliʻi ka nui o nā hopena (ʻike ma luna) a hoʻohele hapa ʻia nā hopena e ka hōʻemi hou ʻana o ka nui o ka hina o ka lolo i ka manawa o ka scan 2. Ke hoʻokaʻawale mākou i ka ʻikepili mai ka scan 2 (pololei ma hope o ka hana) nui wale hoʻonui i ka mea hina hina o ka lolo no ka pahū kaʻa a me ke alo o mua e ola i kahi paepae o p <0.001 i hoʻoponopono ʻole ʻia (Papa 3).
Panina
ʻAʻole hiki keʻike i keʻano o ka hoʻololiʻana i kūkuluʻia a mākou iʻikeʻia ai ma muli o ka loliʻana i ka hoʻokomoʻoleʻana, ka hoʻololiʻana i ka hana kaʻa a iʻole ka lāʻau lāʻau a iʻole nā loli o ka noho maikaʻiʻana. Ma ka paleʻana i nā kuhi likeʻole o ka'ōkuhi mua a me ka hope loa me kekahi me ka hōʻike i ka emi o kaʻokoʻa ma mua o ka mea i manaʻoʻia. Ma muli paha o ka hoʻololiʻana o ka lolo ma muli o ka hopena maʻamau a me nā hopena e ulu nei ma kahi lōʻihi loa a hiki i ka manawa e hoʻi hou ai. Akā, eia nā hopena e hōʻike i nā hanana o ka hoʻoponopono houʻana, e hōʻike ana i ka hoʻokomoʻana o ka hanaʻole a me ka hōʻehaʻana i ka maʻi ma kēia mau maʻi e alakaʻi i ka hana maʻalili i nā wahi kai o ka'āina.
mau hoomaikai ana
Mahalo nui mākou i nā mea limahana a pau no ke komoʻana i kēia noi a me kaʻaoʻao Physics and Methods i NeuroImage Nord ma Hamburg. Ua hāʻawiʻia ke aʻoʻana i ka'āpono kūpono e ka Kōmike Ethics a me kaʻae i kākauʻia ma ka hoʻomaopopoʻana mai nā mea noiʻi a pau ma mua o ka hoʻokolokoloʻana.
Kālāʻike kālā
Ua kākoʻoʻia kēia hana ma nā haʻawina mai ka DFG (German Research Foundation) (MA 1862 / 2-3) a me BMBF (The Federal Ministry of Education and Research) (371 57 01 a me NeuroImage Nord). ʻAʻole nā kuleana o ka waihona kālā ma ka hoʻolālā aʻo, ka hōʻiliʻili a me ke kānana hōʻiliʻili, ka hoʻoholo e hoʻolaha, a iʻole hoʻomākaukauʻana paha i ka puke.
ʻO ka ʻōnaehana Endocannabinoid: ʻO ka ʻōnaehana nui āu i lohe ʻole ai
Ināʻaʻoleʻoe i lohe e pili ana i ka pūnaewele endocannabinoid, aiʻole ECS paha,ʻaʻole ponoʻoe e hilahila. Ma hope o ka 1960, hiki i nā meaʻimi noiʻi i lilo i mea makemake i ka hana ola o Cannabis ka mea nui loa o kāna mau hana hana. Ua laweʻia kekahi mau 30 makahiki hou, no ka mea, nā mea noiʻi e aʻo i nā'ōmeʻa holoholona e huli i kahi hōʻailona no kēia mau mea ECS i loko o ka noʻonoʻo o nā koho, kahi mea e wehe ai i ka honua holoʻokoʻa no ka nīnauʻana i nā EC receptors existence a me kā lākou kumuhana physiological.
I kēia manawa,ʻike mākou i ka nui o nā holoholona, mai ka iʻa a me nā manu, nā endocannabinoid, aʻike mākouʻaʻole i hana wale nā kānaka i kā lākou mau cannabino e pili pū ana me kēia pūnaewele, akā, hana pū mākou i nā pūnaewele e pili ana me ka ECS, iʻikeʻia i nāʻano mea kanu a me nā meaʻai likeʻole, ma mua o nāʻano o ka lāʻauʻo Cannabis.
Ma keʻano he kiko o ke kino o ke kanaka,ʻaʻole kahi papahana kūʻokoʻa o ka ECS e like me keʻano o ka'ōpiopio pūnaewele a iʻole ka pūʻulu maʻi. Ma ka hakahaka, ua hoʻonohonoho likeʻia ka ECS i nā huipuni i hoʻokaʻawaleʻia i loko o ke kino e hoʻoukaʻia ana ma o kahi pūhui liʻiliʻi a mākou iʻike ai he endocannabinoids, aiʻole cannabinoids hope. Hōʻikeʻia nā mea hōʻoia hōʻoiaʻo CB1 a me CB2, akā he mau mea'ē aʻe i manaʻoʻia. Hiki i nā lālā PPAR a me TRP ke pale i kekahi mau hana. Penei, e loaʻa iāʻoeʻelua mau endocannabinoids maikaʻi: anadamide a me 2-arachidonoyl glycerol, aiʻole 2-AG.
Eia kekahi,ʻo ke kumu o ka endocannabinoid pūnaha,ʻo ia nā enzymes e hōʻanoho a hōʻoki i nā endocannabinoids. Hoʻopiliʻia nā endocannabinoids i ka synthesized i kahi kahua e pono ai. ʻO nā kumuhana enzymes i loko,ʻo ia ka diacylglycerol lipase a me ka N-acyl-phosphatidylethanolamine-phospholipase D, aʻo ia ka synthesize 2-AG a me anandamide. ʻO nā enzymes hōʻano nuiʻelua he fatty acid amide hydrolase, aiʻole FAAH, ka mea e hakihaʻi i ka anandamide, a me monoacylglycerol lipase, a MAGL paha, e haki ai i ka 2-AG. Hoʻopiʻi a hōʻemi paha ka hoʻoponoponoʻana i kēia mau enzymesʻelua i ka modulation o ka ECS.
He aha ka hana o ka ECS?
ʻO ka ECS ke kumuhana homeostatic mana o ke kino. Hiki hiki ke nānāʻia e like me ke kino o ka pūnaeho adaptogenic i loko, e hana mau e mālama i ke kaulike o nāʻano hana. Hoʻopiʻi ka Endocannabinoid i ka hanaʻo neuromodulators a, no iaʻano, hoʻoponopono lākou i nāʻano o ke kino, mai ka uluʻana i kaʻeha. ʻO kekahi o ia mau hana iʻoi aku ka maikaʻi ma ka ECS penei:
ko mākou hopohopo System
Mai ke kikowaena pūnaewele, a iʻole ka CNS, hiki i ka hoʻokiʻekiʻe nui o nā mea hāpai CB1 ka mea e pāpā i ka hoʻokuʻuʻana i ka glutamate a me GABA. I loko o ka CNS, ua hoʻokumu ka ECS i ka hana a me ka aʻoʻana i ka hoʻomanaʻo, hoʻonui i ka neurogenesis ma ka hippocampus, e hoʻoponopono ai i ka mea nui e hiki ai. Hiki i ka ECS kekahi hapa ma ke ala e hana ai ka lolo i kaʻeha a me ka mumū. Mai ke poʻo o ka'ōpū, ua hoʻoponopono ka ECS i ka hōʻeha a hōʻeha i nā kānalua kūlohelohe. I loko o ka pūnaewele puni honua, i ka mālamaʻana o CB2 mana, ke hana nui nei ka ECS ma kahi pūnaewele puni honua e hoʻoponopono ai i nā hana o ka'ōpū, urinary, a me nā papa hānau.
Paha a me ka Mood
He nui nā hopena o ka ECS ma luna o nā haunaele kaumaha a me nā loina o ka manaʻo, e like me ka hoʻomakaʻana o kēia pane i ke koʻikoʻi koʻikoʻi a me ka hoʻololiʻana i ka manawa no nā manaʻo lōʻihi lōʻihi, e like me ka makaʻu a me ka hopohopo. He mea koʻikoʻi kahi hana endocannabinoid hana maikaʻi e pili ana i keʻano o ka hoʻololiʻana o nā kānaka ma waena o kahi māʻona maikaʻi o ka huhū i ka hoʻohālikelikeʻana i kahi paeʻoiʻoi aʻoiʻole keʻoluʻolu. Hiki i ka ECS ke hana i ka hoʻomanaʻo i ka hoʻomanaʻo a hiki paha i keʻano o ka lolo e hoʻokomo i ka hoʻomanaʻo mai ka pilikia a iʻole kaʻeha. Ma muli o ka ECS hoʻololi i ka hoʻokuʻuʻana o dopamine, noradrenaline, serotonin, a me cortisol, hiki iā ia ke hoʻohuli ākea i ka pane a me nā hana.
Pūnaehana Huahaʻi
Ua hoʻopiliʻia ka'ōpala me nā CB1 a me CB2 e hoʻoponopono ana i kekahi mauʻano nui o ka olakino GI. Ke manaʻo nei pahaʻo ka ECS paha ka "pūnaewele e nalowale nei" ma ka ho'ākākaʻana i ka pilina o ka pūpū e pili ana i ka'ōpū-me ka liʻiliʻi e komo nui ana i kaʻoihana olakino o ka'ōpala pahū. ʻO ke ECS he mea hoʻokele o ka hopena o ke kīpē, ma muli paha o ka hoʻopiliʻana i ka pūnaehana hoʻopiliʻole mai ka lukuʻana i ka lauoho maikaʻi, a ma o ka hoʻololiʻana i ka hōʻailona cytokine. Hoʻoponopono ka ECS i ka pane o ka'elepuni kūlohelohe i loko o ka'ōhumu'ōpala, a he nui nā hopena no ka nui o nā hihia olakino. ʻO Gastric a me GI pūnaewele nui ka mea e hoʻomalu ponoʻia e ka ECS.
ʻAi a me ka Metabolism
ʻO ka ECS,ʻo ia hoʻi nā'āpana CB1, ke pāʻani i ka makemake, ka hanaʻana, a me ka hoʻoponoponoʻana i ke kino. ʻO ka hoʻoweliweliʻana o nā mea loaʻa ka CB1 e hoʻonui i kaʻimi i ka meaʻai, hoʻonui i kaʻike i kaʻala, hoʻoponopono hoʻi i ka palekana ike. ʻO nā holoholona a me nā kānaka i paʻakikū, ua loaʻa iā lākou ka loiloi ECS e hiki ke alakaʻi i kēia pūnaewele i mea hana maikaʻi, kahi e hoʻoikaika ai i ka hoʻouluʻana a me ka hoʻemiʻana i ka hoʻokele. Hoʻonuiʻia ka hoʻolālāʻana i nā anana o ka anandamide a me ka 2-AG i ka nui, kahi i lilo ma ka hapa no ka emiʻana o ka hanaʻana o ka enzyme hōʻinoʻana o FAAH.
ʻO ka pane'eleponaʻole a me ka huhū
ʻO nā pūnaewele a me nā'ōpuni o ka pūnaewele immune ua lako i nā mea loaʻa me nā endologicobinoid. Hoʻomaopopoʻia nā hopena o Cannabinoid i loko o ka momona o koumus, nā kaula, nā pūpū, a me ka momona o ka iwi, a me nā T-a me nā B-lymphocytes, macrophages, nā mast cells, neutrophils, a me nā pūpoki kaulua maoli. Uaʻikeʻia ka ECS ma keʻano he mea hoʻokele kaʻawale o ka palekana a me ka homeostasis. ʻOiaiʻaʻole maopopo nā hana a pau o ka ECS mai ka'ōnaehana kamepiula, ua hoʻonohonoho ka ECS i ka hoʻoponoponoʻana i ka cytokine a me ka hana i ka paleʻana i ka hanaʻino i loko o ka pūnaewele immune. ʻO ka hoʻonaeho he māhele maoli ia o ka pane o ka immune, a he hana kūpono loa ia i nā'ōlelo hōʻino i ke kino, e like me nāʻeha a me nā maʻi; Akā naʻe, ināʻaʻole mālamaʻia, hiki iā ia ke lilo i mea hoʻomanaʻo a kōkua i ka hopena o nā pilikia o ka pilikia, e like me ke kaumaha mau. Ma ka mālamaʻana i ka pane āpau o ke kaʻina, e kōkua ka ECS i ka mālamaʻana i ka pane'elepona iʻoi aku ka palekana ma o ke kino.
Nāʻokoʻa aʻe o ke olakino i hoʻoponoponoʻia e ka ECS:
Nani ka maʻi
Māmā
ʻO ke ola pale
ʻO ka ola olakino a me ka hanuʻana
ʻO ka moe a me ka circadian rhythm
Pehea e kākoʻo maikaʻi ai i kahi ECS olakino kahi nīnau nui a nā mea noiʻi e ho'āʻo nei e pane. E hoʻomanaʻo no kaʻike hou aku i kēia kumuhana i hoʻomaka.
I ka hopena,Ua pili ka ʻeha syncronic me nā loli o ka lolo, me ka hoʻoliʻiliʻi o ka hina mea. Eia naʻe, ua hōʻike ʻia ka ʻatikala ma luna aʻe e hiki i ka ʻeha mau ke hoʻololi i ka hanana holoʻokoʻa a me ka hana o ka lolo. ʻOiai ʻo ka ʻeha mau e alakaʻi i kēia mau mea, i waena o nā pilikia olakino ʻē aʻe, ʻo ka mālama kūpono ʻana i nā ʻōuli paʻa o ka mea hoʻomanawanui hiki ke hoʻohuli i nā loli o ka lolo a hoʻoponopono i nā mea hina. Eia kekahi, ua nui a nui nā noiʻi noiʻi i puka ma hope o ka mea nui o ka ʻōnaehana endocannabinoid a he hana ia i ka kaohi ʻana a me ka mālama ʻana i ka ʻeha mau a me nā pilikia olakino ʻē aʻe. ʻIke ʻia mai ka National Center for Biotechnology Information (NCBI). "Ka palena o kā mākou ʻike i kaupalena ʻia i ka chiropractic a me nā hōʻeha a me nā kūlana spinal. E kūkākūkā i kēia kumuhana, e ʻoluʻolu e nīnau iā Dr. Jimenez a i ʻole e leka uila iā mākou ma915-850-0900 .
Hoʻopūʻia e Dr. Alex Jimenez
Nā Pāhana Hou: Back Pain
Paʻi hope ʻo ia kekahi o nā kumu nui loa o ka hemahema a ua hala nā lā ma ka hana ma ka honua holoʻokoʻa. ʻOiai he meaʻoiaʻiʻo, ua hoʻokauʻia kaʻeha hope ma keʻano he kumu kumuʻelua no ka heleʻana o ke keʻena o ke kauka,ʻoi aku ma mua wale nō nā maʻi āpau kiʻekiʻe. Ma kahi o 80 pakeneka o ka heluna eʻike i kekahiʻano o kaʻeha hope loa ma kahi o hoʻokahi manawa ma ko lākou ola. ʻO ka'ōiwi kahi hanana paʻapū i hanaʻia i ka iwi, nā hono, nā ligaments a me nāʻiʻo, i waena o nā mea'ē aʻe. Ma muli o kēia, nāʻeha a me nā kūlana hōʻeha, e like me nā kīlei'aniani, hiki ke hopena i nā hōʻailona o ke kaumaha hope. ʻO nāʻeha a me nāʻeha a me nā pōpilikia pū kaʻa paha he kumu pinepine ia o kaʻehaʻeha, akā, i kekahi manawa,ʻoi aku kaʻoi loa o nā hana i loaʻa i nā hopenaʻeha. ʻO ka mea pōmaikaʻi, hiki i nā koho hoʻoponopono'ē aʻe, e like me ka mālamaʻana i ka chiropractic, ke kōkua i ka pale i kaʻeha ma o ka hoʻohanaʻana i nā hoʻololiʻana o ka'ōpū a me nā lima lima, me ka hoʻomaikaʻi maikaʻi i nā maʻi.
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41. Antal A, Brepohl N, Poreisz C, Boros K, Csifcsak G, a me al. (2008)�ʻO ka hoʻoulu ʻana o ka transcranial i kēia manawa ma luna o ka somatosensory cortex e hoʻemi ana i ka ʻike ʻeha ʻeha i hoʻokolohua ʻia.. Clin J Pain24: 56–63.�[Hoʻokuʻuʻia]
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43. O�Connell N, Wand B, Marston L, Spencer S, Desouza L (2010)�Nā ʻenehana hoʻoulu ʻana i ka lolo no ka ʻeha mau. He hōʻike o kahi loiloi ʻōnaehana Cochrane a me ka meta-analysis. ʻO Eur J Phys Rehabil Med�47: 309–326.�[Hoʻokuʻuʻia]
44. Tsao H, Galea MP, Hodges PW (2008)�Hoʻopili ʻia ka hoʻonohonoho hou ʻana o ka cortex motor me nā hemahema o ka postural control i ka ʻeha hope haʻahaʻa. Brain�131: 2161–2171.�[Hoʻokuʻuʻia]
45. Puri BK, Agour M, Gunatilake KD, Fernando KA, Gurusinghe AI, et al. (2010)�ʻO ka ho'ēmiʻana i ka haʻaleleʻana i ka'āpana kaʻa kaʻa kaʻa hina i loko o nā wāhine makua i loaʻa i ka fibromyalgia me ka luhi nui a me ka maʻiʻole o ka maʻi: kahi hoʻokele hoʻokele 3-T magnetic resonance imaging voxel-based morphometry study. J Int Med Res�38: 1468–1472.�[Hoʻokuʻuʻia]
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ʻO ka mea maʻamau o ka maʻi:- Loaʻa i nā syndrome ʻeha āpau kahi pilikino. Hiki ke loli ke ʻano pilikino mai kahi kanaka a kahi kanaka a hiki ke ʻokoʻa i hoʻokahi kanaka i nā manawa like ʻole. ʻO ka mālama ʻana i nā syndrome ʻehaʻeha e hoʻomaopopo i kēia pilikino mumū. Lapaʻau ʻia nā syndrome ʻeha me ka lāʻau, ʻokiʻoki a ʻelua paha. ʻO ka pahuhopu e pāpā / kāohi i ka hana o nā mea hoʻolauna uila. A ʻo kahi hopena kūleʻa kahi hopena i ka liʻiliʻi o ka mumū a ʻoia hoʻi ka liʻiliʻi o ka ʻeha.
ʻO ke kelekemaʻana o ka maʻi
Nń Pahuhopu:
ʻO wai nā mea pāʻani nui
He aha nā mea kanu lāʻau?
He aha nā hopena?
Hōʻuluʻulu Uila:
Key Players
No ke aha e ʻeha ai koʻu poʻohiwi? ʻO kahi loiloi o ke kumu Neuroanatomical & Biochemical o ka ʻeha poʻohiwi
KANAWAI
Inā nīnau ka mea maʻi "no ke aha e ʻeha ai koʻu poʻohiwi?" E huli koke ke kamaʻilio i ka ʻepekema ʻepekema a i kekahi manawa ke kuhi hewa ʻole. ʻO ka manawa pinepine, ʻike ka mea lapaʻau i nā palena o ke kumu ʻepekema o kā lākou wehewehe ʻana, e hōʻike ana i ka piha ʻole o ko mākou ʻike i ke ʻano o ka ʻeha o ka poʻohiwi. Lawe kēia loiloi i kahi ʻōnaehana e kōkua i ka pane ʻana i nā nīnau nui e pili ana i ka ʻeha o ka poʻohiwi, me ka manaʻo e hāʻawi i ka ʻike i ka noiʻi e hiki mai ana a me nā ʻano novel no ka mālama ʻana i ka ʻeha o ka poʻohiwi. E ʻimi mākou i nā kuleana o (1) nā peripheral receptor, (2) ka hana ʻeha ākea ākea a i ʻole ka "neociceptia", (3) ka iwi kuamoo, (4) ka lolo, (5) kahi o nā mea loaʻa i ka poʻohiwi a me (6 ) ke neural anatomy o ka poʻohiwi. E noʻonoʻo pū mākou pehea e kōkua ai kēia mau mea i ka loli i ka hōʻike maʻi, ka hōʻailona a me ka mālama ʻana i ka ʻeha o ka poʻohiwi. Kuhi mākou i kēia ala e hāʻawi i kahi nānā o nā ʻāpana o ka ʻōnaehana ʻike ʻeha ākea a me nā hana hana ʻeha waena i ka ʻeha poʻohiwi e launa pū e hana i ka ʻeha maʻi.
INTRODUCTION: HE HISTORI HOLOHOLO KAULIʻO PAʻIA PA'ĀINA ESSENTIAL PALAPALA I NĀ KININI
ʻO ke ʻano o ka ʻeha, ma ke ʻano nui, he kumuhana o nā hoʻopaʻapaʻa i hala i ke kenekulia i hala. I ka kenekulia 17 Descartes 'i manaʻo ʻia e ka manaʻo1 ua pili pono ka ikaika o ka ʻeha i ka nui o ka ʻeha pili a pili ʻia ka ʻeha ma hoʻokahi ala ʻokoʻa. Ua hilinaʻi nui ʻia nā manaʻo mua e pili ana i kēia kālaiʻike Descartian i kapa ʻia ʻo "Dequistian", ke ʻike nei i ka ʻeha ma ke ʻano he hopena o ka hoʻonāukiuki ʻana i kahi mea ʻehaʻeha maʻi maʻi i loaʻa i ka lolo. I ke kenekulia 20 ua hoʻoili ʻia kahi kaua ʻepekema ma waena o ʻelua mau manaʻo kūʻē ʻē aʻe, ʻo ia hoʻi ke kumumanaʻo kikoʻī a me ke kumumanaʻo kumumanaʻo. ʻO ka Descartian "ke kumumanaʻo kikoʻī" i ʻike i ka ʻeha ma ke ʻano he kaʻawale kūikawā o ke komo ʻana o ka sensory me kāna mea pono ponoʻī, ʻoiai ke kumumanaʻo Teltern i manaʻo ʻia ka ʻeha ma muli o ka hoʻonāukiuki nui o nā mea loaʻa ʻole kikoʻī. 2 I ka makahiki 1965, Wall a me Melzack ʻO ke kumumanaʻo o ka ʻeha o ka ʻīpuka i hōʻike ʻia no kahi hiʻohiʻona i hoʻololi ʻia ai ka ʻike ʻeha e nā manaʻo sensory ʻelua a me ka ʻōnaehana waena. ʻO kekahi holomua nui loa i ka ʻatikala ʻeha ma kahi o ka manawa like i ʻike ʻia i ke ʻano kikoʻī o nā hana o nā opioids.3 Ma hope iho, ua hoʻonui nui nā neʻe hou ʻana i ka neuroimaging a me nā lāʻau lapaʻau molekiola i ko mākou ʻike āpau i ka ʻeha.
No laila pehea e pili ai kēia i ka ʻeha o ka poʻohiwi?ʻO kaʻehaʻeha ka hopena maʻamau, a me ka ʻike ikaika i ke ʻano o ka hana ʻia ʻana o ka ʻeha e ke kino e pono ai e ʻike pono a mālama i ka ʻeha o ka mea maʻi. ʻO ka holomua i ko mākou ʻike i ka hana ʻeha e hoʻohiki e wehewehe i ka like ʻole ma waena o nā pathology a me ka ʻike o ka ʻeha, hiki iā lākou ke kōkua iā mākou e wehewehe i ke kumu e pane ʻole ai kekahi mau maʻi i kekahi mau ʻano lapaʻau.
KA BUʻU LĀKĀ PALAPALA O PAIN
Nā mīkini ʻikepili peripheral sensory: ka mīkini ʻenekini a me ka "nociceptor"
Nui a hewahewa nā ʻano like ʻole o nā resepera sensory peripheral i loko o ka ʻōnaehana musculoskeletal kanaka. 5 Hoʻonohonoho ʻia lākou e pili ana i kā lākou func tion (ma ke ʻano o ka mechanoreceptors, thermoreceptors a i ʻole nociceptors) a i ʻole morphology (nā hopena aʻa manuahi a i ʻole nā ʻano ʻelima o nā recepaps encapsulated) .5 Hiki ke hoʻokaʻawale hou ʻia nā ʻano ʻokoʻa o ka receptor ma muli o ka ke kūʻana o kekahi mau kaha kemika. Aia kekahi mau overlaps koʻikoʻi ma waena o nā papa hana like o ka receptor, no ka laʻana
Ka hana ʻeha ʻana o peripheral pain
Hoʻopili ka ʻeha i nā ʻano like ʻole i nā mea ʻimi hoʻopunipuni e hoʻokuʻu ʻia e nā ʻino i hōʻino ʻia e like me bradykinin, histamine, 5-hydroxytr Egyptamine, ATP, nitric oxide a me kekahi mau ion (K + a me H +). ʻO ka hoʻoulu ʻana o ke ala waikawa arachidonic e alakaʻi aku ai i ka hana ʻana o prostaglandins, thromboxanes a me leuko- trienes. ʻO Cytokines, me nā interleukins a me nā tumros necrosis factor?, A me nā neurotrophins, e like me ke kumu ulu o ke aʻalolo (NGF), hoʻokuʻu ʻia a pili pū i ka hana o ka mumū. 15 ʻO kekahi mau mea e like me nā acid amino excitatory (glutamate) a me nā opioids ( endothelin-1) ua hoʻopili ʻia i loko o ka pane o ka mumū koʻikoʻi.16 17 Hiki paha i kekahi o kēia mau ʻākena ke hoʻoulu pololei i nā nociceptors, ʻoiai e lawe ana kekahi i ka hoʻopaʻa ʻana o nā pūnaewele ʻē aʻe a laila e hoʻokuʻu hou i nā mea kōkua maʻalahi.18. o nā neurons nociceptive i kā lākou hoʻokomo maʻamau a / a i ʻole ka hoʻopaʻa ʻana i kahi pane i nā hoʻokomo subthreshold maʻamau i kapa ʻia ʻo "sensitization āpau". - ʻO ke kiʻi 1 hōʻuluʻulu i kekahi o nā ʻano hana i pili.
ʻO ka NGF a me ka receptor transient Loaʻa cation subfamily V lālā 1 (TRPV1) i loaʻa kahi pilina simbiotic i ka wā e pili ana i ka mumū a me ka noʻonoʻo ʻana i ka nociceptor. ʻO nā cytokine i hana ʻia i loko o nā mea āpau i hopena i ka hoʻonui ʻana o ka hana NGF. 19 stimole ʻo NGF i ka hoʻokuʻu ʻia o histamine a me serotonin (5-HT3) e nā cell mast, a me nā sensitizes no neoicic, e hoʻololi paha i nā waiwai o A? nā olonā e like me ka hapa nui i lilo i nociceptive. Aia ka receptor TRPV1 i kahi subpopulation o nā fibre afferent mua a hoʻoulu ʻia e capsaicin, ka wela a me nā protons. Hoʻohui ʻia ka receptor TRPV1 i loko o ke kino o ke olonā afferent, a lawe ʻia i nā kikowaena peripheral a me nā kikowaena waena, kahi e hāʻawi ai i ka ʻike i ka poʻe i loaʻa ʻole i ke aloha. Nā hualoaʻa ka hopena o ka NGF hana peripherally a laila paʻa i ka tyrosine kinase receptor type 1 receptor ma nā kikowaena nociceptor, a laila lawe ʻia ʻo NGF i ke kino pūnaewele kahi e alakaʻi ai i kahi rula o TRPV1 transcription a no laila ua hoʻonui i ka noʻonoʻo nociceptor.19 20 NGF a ʻo nā mea uwao hoʻonāukiuki ʻē aʻe e hoʻomaopopo iā TRPV1 ma o ka lehulehu o nā ala ʻelele ʻelua. Manaʻo ʻia nā mea ʻē aʻe he nui e like me nā cholinergic receptor,? -Aminobutyric acid (GABA) a me nā mea loaʻa somatostatin e pili pū ana i ka ʻike o ka nociceptor peripheral.
Ua hoʻokomo kikoʻī ʻia kahi helu nui o nā mea waena hoʻohauna i ka ʻeha o ka poʻohiwi a me ka maʻi rotator. Pili paha kēia mau loli i ka unuhi a i ʻole ka lohi ʻana o ka transcription dependant. ʻO nā laʻana o ka mea mua he mau loli i ka TRPV21 receptor a i ʻole nā kahawai ion gated voltage i hopena ʻia mai ka phosphorylation o nā protein i hoʻopaʻa ʻia e ka membrane. ʻO nā laʻana o ka hope e pili ana me ka hoʻonui ʻana o NGF i ka hana TRV25 a me ka hoʻoulu ʻia ʻana o ka calcium i nā kumu transcript intracellular.
Nā Molecular Mechanisms Of Nociception
Hoʻomaopopo ka manaʻo o ka ʻeha iā mākou i kahi ʻeha maoli a i ʻole e hōʻeha ʻia ana a hoʻonāukiuki i nā pane pale kūpono. Minamina, ʻoi aku ka nui o ka ʻeha i kona pono ma ke ʻano he ʻōnaehana a laila lilo i wā lōʻihi a hoʻonāwaliwali hoʻi. ʻO kēia hoʻololi i kahi pae mau e pili ana i nā loli i loko o ka iwi kuamoo a me ka lolo, akā aia kekahi modulate kupaianaha kahi e hoʻomaka ai nā leka ʻeha ma ke kiʻekiʻe o ka neuron sensory mua. ʻO nā hana e hoʻoholo ai pehea e ʻike ai kēia mau neo i nā mea hoʻonāukiuki i hana ʻia o kahi mehana, mechanical a kemikala paha i hōʻike i nā ʻōnaehana hōʻailona hou a hoʻokokoke iā mākou i ka hoʻomaopopo ʻana i nā hanana molekole e kōkua ai i ka hoʻololi mai ka ʻeha a ʻeha mau.
ʻO ke Neurochemistry Of Nociceptors
ʻO Glutamate ka pahuhopu nui o nā neurotransmitter i nā mea holoʻokoʻa. Ma kaʻikeʻana o ka neʻeneʻeʻana o C to DRG, hōʻikeʻia nā'ōwiliʻelua o ka fiʻiliʻi C nonmyelinated.
ʻO nā mea kelepa o ka mea kelepa e hana i ka pōʻino
E like me ia i ho'ākākaʻia ma luna nei, hoʻonui ka hōʻeha i ko mākou hopena o kaʻeha ma ka hoʻonuiʻana i kaʻike o nā mea nociceptors i nā kauā a me nā mechanical. ʻO kēia hualoaʻa he hopena, ma ka hapa, mai ka hana a me ka hoʻokuʻuʻana o nā mea keleponaʻenehana mai ke kumu pūnaehana mua a mai nā pūniki neuralʻole (e like me ka fibroblasts, nā mast cells, neutrophils and platelets) i ka environnement36 (Fig 3). Hiki i kekahi mau mea o ke kōpala inflammatory (e like me nā protons, ATP, serotonin, aiʻole lipids) ke hoʻololi i ke kuhi kūpono pololei ma o ke kuhiʻana i nā kaha moana ma ka'āpana nociceptor, akāʻo nā mea'ē aʻe (e like me ka bradykinin a me ka NGF) e hoʻopili i ko lākou hopena ma ka hoʻounaʻana i ka cascades11 hōʻailona lua. Uaʻike nuiʻia ka holomua o kaʻikeʻana i ke kumuhana biochemistry o kēlā me kēia hana.
Nā Extrasellular Protons & Tissue Acidosis
ʻO ka acidosis tissue āpau o keʻano o kaʻeleʻele physiological i nā hōʻeha, a me ka lōʻihi o kaʻeha a me ka pilikiaʻole e pili pono ana me ka nui o acidification37. ʻO ka hoʻohanaʻana i ka waikawa (pH 5) i kaʻili, ua hoʻomauʻia ka hoʻokuʻuʻiaʻana i kahiʻekolu aʻoi aku paha o nā mea hanaʻole polymodal e hoʻokipa ana i ka mākau hoʻolālā 20.
Nā Pūnaewele Mole & Molecular Of Pain
Hōʻuluʻulu Manaʻo
Keʻike a hoʻohālikelike ke kikowaena i nā hanana a me nāʻoihana likeʻole a me keʻano o nā meaʻona. I ka wā nui, kēia mau kumuhana e loaʻa ai kaʻeha nui, a ma ke kauʻana o nā hōʻeha kūpilikiʻi, nāʻaoʻaoʻelua a me nā kikowaena pūnaewele o ke ala o ke kahe e hōʻike ana i ka'ilikala nui, hoʻonui i nā hōʻailona o kaʻeha a me ka hanaʻana i ka haʻikoʻi. Ke hoʻololi ka'ilika i nā palekana palekana, hiki iā ia ke pōmaikaʻi, akā, i ka wā e hoʻololi ai nā loli, hiki ke hopena i ka hopena o ka maʻi. ʻO nā haʻawina pilikino,ʻikepili, a me nā haʻawina pharmacological ke hoʻokiʻekiʻe nei i nā hana molekino e hoʻomanaʻo i kaʻike, coding, a me ka hoʻololiʻana o nā hopena hōʻeha e hoʻopiʻi i kaʻeha.
'Ōlelo Ho'ākāka: Hōʻailona Pōʻino i ka Paʻa Palolo
Hōʻike 5. ʻO ke kōlani'Ākau (Central) Manaʻo
Glutamate / NMDA hoʻokipaʻana i ka hanana.Ma hope o ka hoʻonāukiuki ikaika a i ʻole ʻeha mau, hana ʻia ʻo C a me A? hoʻokuʻu nā nociceptors i nā ʻano like ʻole o nā neurotransmitters e like me ka dlutamate, ka mea P, ka helu helu e pili ana i ka peptide (CGRP), a me ATP, i nā neurons puka ma lamina I o ka pepeiaohao dorsal (ʻulaʻula). Ma muli o ka hopena, hiki i nā mea loaʻa NMDA glutamate hamu maʻamau ke kau ʻia i loko o ka neuron postynaptic i kēia manawa ke hōʻailona, hoʻonui i ka calcium intracellular, a hoʻoulu i kahi ala o nā ala kalina hōʻailona kalina a me nā ʻelele ʻelua e pili pū ana me ka kinase protein (MAPK) i hoʻokumu ʻia me ka mitogen-activated protein kinase C (PKC) , protein kinase A (PKA) a me Src. E hoʻonui kēia cascade o nā hanana i ka pīhoihoi o ka neuron puka a kōkua i ka lawe ʻana o nā leka ʻeha i ka lolo.
ʻO ka hōʻinoʻana.N Ma lalo o nā kūlana maʻamau, hoʻokuʻu mau ka interneurons (polū) i ka GABA a me / a i ʻole glycine (Gly) e hoʻoliʻiliʻi i ka hauʻoli o ka lamina I nā neurons a hoʻohālikelike i ka lawe ʻana o ka ʻeha. Eia nō naʻe, i ke kau ʻana o ka ʻeha, hiki ke lilo i kēia kaohi ʻana, a laila hopena i ka hyperalgesia. Hoʻohui ʻia, hiki i ka disinhibition ke hoʻohana i ka myelinated A non-nociceptive? nā mea i kauoha mua e komo i ka circuitry transmission painry e like me ka mea i ʻike pinepine ʻia nā stimulus ʻino ʻole i kēia manawa he ʻeha. Kū kēia i kahi ʻāpana, ma o ka disinhibition o PKC pīhoihoi? ke hōʻike nei i nā interneurons i loko o lamina II.
Hoʻopauʻia ka Microglial.Hāpai ka ʻehaʻeha pilikino i ka hoʻokuʻu ʻia o ATP a me ka chemokine fractalkine e hoʻoulu ai i nā hunaola microglial. Ma ke kikoʻī, ka hoʻoulu ʻana o purinergic, CX3CR1, a me nā mea loaʻa like me Toll i ka microglia (poni) nā hopena i ka hoʻokuʻu ʻia ʻana o ka mea neurotrophic i loaʻa i ka lolo (BDNF), ma o ka hoʻoulu ʻia ʻana o nā mea loaʻa TrkB i hōʻike ʻia e lamina I nā neurons puka, paipai i ka hoʻonui i ka excitability a me hoʻonui i ka ʻeha i ka pane ʻana i ka hoʻonāukiuki noxious a me nā hala ʻole (ʻo ia hoʻi, hyperalgesia a me allodynia). Hoʻokuʻu pū ka microglia i hoʻoiho ʻia i kahi pūʻulu o cytokines, e like me ka tumrosis tumor factor? (TNF?), Interleukin-1? a me 6 (IL-1 ?, IL-6), a me nā kumu ʻē aʻe e hoʻopili i ka sensitization waena.
ʻO ke KauponaʻOihana Hila
Peripheral sensitization ʻoi aku ka nui o nā hopena mai nā loli e pili ana i ka mumū ma ke ʻano kemika o ke olonā nerve (McMahon et al., 2008). No laila, hui pū ʻia ka hōʻino kino me ka hōʻiliʻili o nā mea endogenous i hoʻokuʻu ʻia mai nā nociceptors i hoʻoneʻe ʻia a i ʻole nā neural non-neural e noho i loko a i ʻole infiltrate i loko o ka wahi i hōʻeha ʻia (e like me nā mast mast, basophil, platelets, macrophages, neutrophil, endothelial cells, keratinocytes, a fibroblasts). Hoʻohui. kapa ʻia kēia mau mea i kapa ʻia ʻo ka «suplam inflammatory», hōʻike i ka nui o nā molela hōʻailona, e like me nā neurotransmitters, peptides (mea P, CGRP, bradykinin), eicosinoids a me nā lipid pili (prostaglandins, thromboxanes, leukotrienes, endocannabinoids), neurotrophins, cytokines , a me nā chemokine, a me nā proteas extracellular a me nā proton. ʻO ka mea kupaianaha, hōʻike nā nociceptors i hoʻokahi a ʻoi paha mau ʻenekini ʻili pūnaewele hiki ke ʻike a pane i kēlā me kēia o kēia agena pro-inflammatory a pro-algesic paha (Kiʻi 4). ʻO ia mau pilina e hoʻonui i ka pīhoihoi o ke olonā nerve, no laila e hoʻonui ai i kona ʻike i ka mahana a i ʻole ka pā.
ʻO ke kumuʻole,ʻo ka hōʻailona maʻamau o ka hōʻemiʻana i kaʻehaʻeha e pili ana i ka hōʻokiʻana i ka hōʻano a me ka hōʻiliʻiliʻana o nā māhele o ke kōpū inflammatory. ʻO kēia ka maikaʻi loa o nā hōʻailona anti-inflammatory steroidal, e like me ka aspirin a me ka ibuprofen, ka mea e ho'ēmi ai i kaʻeha a me ka hyperalgesia e ka hanaʻana i nā cyclooxygenases (Cox-1 a me Cox-2) e komo ana i ka synthesis. ʻO ka lua o kaʻaoʻao,ʻo ia ke kāpae i nā hana a nā meaʻona inflammatory i ka nociceptor. Maʻaneʻi, e hoʻohālikelike mākou i nā hiʻohiʻona e hāʻawi i kaʻike hou i nā'ōnaehana pūnaewele o kaʻike pilikino, a iʻole keʻano o nā kumu hana hōʻailona no ka mālamaʻana i kaʻeha inflammatory.
No ka mea, uaʻike nuiʻia ka NGF no kona kūlana heʻano neurotropic i koiʻia no ke ola a me ka hoʻomohalaʻana i nā neo ma muli o ka embryogenesis, akā ma ke kanaka makua, ua hanaʻia ka NGF ma kahi o nā meaʻeha a me kahi mea nui o ka'ōpūʻona (Ritner et al., 2009). Ma waena o kāna mau polokalamu pūnaewele, hoʻoponopono pololeiʻo NGF i ka peptideric C fiber nociceptors,ʻo ia ka mea e hōʻike ana i ka tygine kinesa NGF nui loa, TrkA, a me ka mea liʻiliʻi neurotrophin receptor, p75 (Chao, 2003, Snider a me McMahon, 1998). Nā NGF e hoʻomaopopo i keʻano o ka hoʻomaʻamaʻaʻana i ka wela a me ka uluʻana o ke kino ma o nā hananaʻokoʻaʻelua. I ka manawa mua, hana ka hulina NGF-TrkA i ke ala o nā ala hōʻailona, e like me ka phospholipase C (PLC), kinase protein kinameʻa (MAPK), a me phosphoinositide 3-kinase (PI3K). Hiki i kēia ka hopenaʻoihana o nā mea hoʻomalu i ke kikowaena nociceptor terminal, ma kahi o TRPV1, hiki i ka loli wikiwiki o kaʻikeʻana o ka wela a me ke kino (Chuang et al., 2001).
Me ka nānā ʻole i kā lākou papahana pro-nociceptive, ke keʻakeʻa ʻana me ka neurotrophin a i ʻole ka hōʻailona cytokine i lilo i kumumanaʻo nui no ka kaohi ʻana i nā maʻi ʻōpala a i ʻole ka ʻeha hopena. ʻO ke ala nui e pili ana i ka pale ʻana iā NGF a i ʻole TNF-? hana me kahi antibody hoʻoliʻiliʻi. I ka hihia o TNF-?, He hopena maikaʻi loa kēia i ka mālama ʻana i nā maʻi autoimmune he nui, e like me ka rheumatoid arthritis, a hiki i ka hoʻoliʻiliʻi nui ʻana i ka luku ʻia ʻana o nā mea ʻelua a me ka hyperalgesia e hele pū ana (Atzeni et al., 2005). Ma muli o ka hana nui o NGF ma luna o ka makua nokiceptor e hana i ka hoʻonohonoho ʻana o ka mumū, ʻo ka maikaʻi o kēia ala e hoʻoliʻiliʻi ka hyperalgesia me ka ʻole o ka hopena. ʻike ʻeha mau. ʻOiaʻiʻo, aia nā anti-NGF i kēia manawa i nā hoʻokolohua hoʻokolohua no ka mālama ʻana i nā syndromes ʻeha hōʻeha (Hefti et al., 2006).
Glutamate / NMDA Hoʻonāʻana i kaʻikeʻana
Hoʻomakaʻia kaʻeha nui ma ka hoʻokuʻuʻiaʻana o ka glutamate mai nā piko o nā nociceptors, e hoʻonui i nā kaha o ka post-synaptic (EPSC) ma ka papaʻelua i nā neurons. Hoʻoholo mua kēia ma o ka hoʻokomoʻana i ka AMPA postsynaptic a me nā subtypes kainate o nā mea loaʻa ka'āpana kamepiula. ʻO ka hōʻuluʻuluʻana o nā pūnaewele EPSC i lalo o ka paepae ma muli o ke neuron postsynaptic e hopena i ka hanaʻana i ka hana a me ka laweʻana i ka leka uila i nā koina kiʻekiʻe kiʻekiʻe.
ʻO nā haʻawina'ē aʻe e hōʻike ana i nā hoʻololiʻana o ka neuron hana,ʻo ia iho, e hoʻohui i ka kaʻina hana. Eia kekahi laʻana,ʻo ke kino o ke kino o ke kino e hoʻoponopono i ka K + - Cl-trans-conveyor KCC2, he mea nui no ka hoʻomauʻana i nā K + a me nā mea kelihi ma o ka membrane plallma (Coull et al., 2003). Ke hoʻolālāʻia neiʻo KCC2, i ho'ākākaʻia ma lamina I nā neu ua loaʻa, e hopena i kahi hoʻololi i ke Kēkelēkelē, e like me ka hoʻonāʻana o nā GABA-A hōkeo i ka hoʻopalehuʻana, ma mua aʻe o ka hyperpolarize i nā neu. ʻO kēia ka mea e hoʻonui i ka mana kūpono a me ka hoʻonui i ka paʻi. ʻO keʻano,ʻo ka hana kāpili pharmacological a iʻole i ka RNA-mediated downregulation o KCC2 i loko o ka'īlio e hoʻokomo i ka mechanic mechanic.
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No ke aha e hōʻehaʻia ai koʻu poʻohiwi? ʻO keʻano no ka neuroanatomical a me ka biochemic kumu o kaʻeha o ka wāwae
ʻO Benjamin John Floyd Dean, Stephen Edward Gwilym, Andrew Jonathan Carr
Nā Pūnaewele a me nā Molecular Means o Pain
Allan I. Basbaum1, Diana M. Bautista2, Gre? Gory Scherrer1, a me David Julius3
1Department o Anatomy, Ke Kulanui o Kaleponi, San Francisco 94158
2Department o ka Molecular a me ka Cell Biology, Ke Kulanui o Kaleponi, Malena HI 94720 3Department o Physiology, Kulanui o Kaleponi, San Francisco 94158
ʻO ka hana i ka hanaʻole o ka nociception
David Julius * & Allan I. Basbaum`
*Ke Keʻena o Cellular and Molecular Pharmacology, a me �Departments of Anatomy and Physiology and WM Keck Foundation Center for Integrative Neuroscience, University of California San Francisco, San Francisco, Kaleponi 94143, USA (e-mail: julius@socrates.ucsf.edu)
ʻO ka uila neurogenic, aiʻole NI, ke kaʻina hana physicism kahi e hoʻokuʻu pololeiʻia ai ka poʻe hoʻolaha mai nā aʻa mai ke kino e hoʻomaka i kahi paneʻeha. ʻO kēia ka hopena o nā kūmole o kaʻona e like me, erythema, ka hoʻonuiʻana, ka piʻiʻana o ka mahana, ke aloha, a me kaʻeha. ʻO nā hua'ōlelo C-fibers maikaʻi loaʻole i hoʻokuʻuʻia, e pane ana i ka hoʻoikaikaʻana o ka mechanical a me nā mea hana kelepona,ʻo ia ke kumu o ka hoʻokuʻuʻiaʻana o kēia mau meaʻimi pāhili.
I ka hoʻouluʻuʻana,ʻo kēia mau alanana i loko o nāʻokiʻoki liʻiliʻi e hoʻokuʻu i nā neuropeptides ikaika, aiʻole ka P a me ka calcitonin gene pili peptide (CGRP), i ka wikiwiki i loko o ka microenvironment, e hoʻomaka ana i kahi o nā pane inflammatory. Aia kekahi mahele nui i ka hoʻokuʻu i ke kalakino,ʻo ia ka pane mua a me ka hoʻopaʻi hou i hanaʻia e ka pūnaewele mīkini i ka wā e komo ai ka paila i loko o ke kino, akāʻo ka hoʻolālā neurogenic ke komo i kahi pilina pololei ma waena o ka pūnaewele makaʻuʻole a me nā pane paneʻole. ʻOiaiʻo ka mumū neurogenic a me ka hoʻouluʻana i ke olakino e hiki ke noho ma kēia manawa,ʻaʻole loa lākou e komo i ka maʻi. ʻO ke kumu o ka mea i lalo iho nei, e kūkākūkā i keʻano o ka hoʻolālā neurogenic a me ke kuleana o ka pūnaewele puni honua i ka pale kaua a me ka immunopathology.
ʻO Neurogenic Inflammation � ʻO ke kuleana o ka Pūnaehana Nervous Peripheral i ka pale ʻana a me ka Immunopathology.
Hōʻuluʻulu Manaʻo
ʻO ka'ōlohelohe āpau a me nā papa hana kūponoʻole ka manaʻoʻia e like me keʻano o nā hana kū kaʻawale. Akā, eia kēia laina, me ka piʻi nui aʻe o nāʻike hou i ka hoʻolālā neurogenic. Loaʻa i nā neurons nociceptor ka nui o nā ala likeʻole eʻikeʻia ai ka moleula no ka hopena e like me nā kele uila a me ka paneʻana i ka pilikia, ua pili pololei ke kikowaena'ōpili pū me ka pūnaewele immune, ke hanaʻana i kahi hana pale i hoʻohuiʻia. ʻO ka'eneke o ka hōʻailona hōʻailona o nā mea kani a me nā autonomi i loko o nā mea lolo a me ka wikiwiki o ka transduction neural e hiki ai ke hoʻololi wikiwikiʻana i nā neurogenic o ka'āpana. Keʻikeʻia nei nāʻano'elepelepe o ka laulima i kahi hana koʻikoʻi i nā maʻi kūponoʻole i nā maʻi a me nā maʻi maʻi. No laila,ʻo kaʻikeʻana i ka pilina paʻa o nā neuronipuni e pili ana i nā pūnaewele kūlohelohe paha e hiki ke hoʻoholo i nā alapiʻi maikaʻi e hoʻonui i ka pale kaua a hoʻopau i ka'ākuʻopopole.
Introduction
ʻElua kaukani makahiki i hala aku nei, ua wehewehe ʻo Celsus i ka mumū e pili ana i nā hōʻailona koʻikoʻi ʻehā - Dolor (ʻeha), Calor (wela), Rubor (ʻulaʻula), a me Tumor (pehu ʻana), kahi ʻike e hōʻike ana ua ʻike ʻia ka hoʻōla ʻana o ka ʻōnaehana nerve ma ke ʻano he mea hoʻohui ia. ʻāʻā. Eia naʻe, ua manaʻo nui ʻia ka ʻeha mai ia manawa, he hōʻailona wale nō, ʻaʻole ia he mea komo i ka hanauna o ka mumū. Ma kēia hiʻohiʻona, hōʻike mākou he hana pololei a koʻikoʻi ka ʻōnaehana nerve peripheral i ka modulating innate a adaptive immunity, i mea e loaʻa ai i nā ʻōnaehana pale a me nā nūnū kahi hana pale i hoʻohui pū ʻia i ka pale a me ka pane ʻana i ka hōʻeha kino, kahi paʻakikī. hiki ke alakaʻi i ka pathology i nā maʻi maʻi a me nā maʻi autoimmune.
ʻO ke ola ʻana o nā mea ola e hilinaʻi nui ʻia i ka hiki ke kau i kahi pale e kūʻē i ka pōʻino mai ka pōʻino a me ka maʻi. ʻO ka pale ʻana o ka mea hoʻokipa e pili ana i nā ʻano pale ʻelua e wehe i ka pilina me kahi pōʻino (noxious) kaiapuni (kahi hana neural), a me ka neutralization ikaika o nā pathogens (he hana immune). ʻO ka mea maʻamau, ʻo ke kuleana o ka ʻōnaehana pale i ka hakakā ʻana i nā mea maʻi a me ka hoʻoponopono ʻana i ka ʻeha o ka ʻiʻo, ua manaʻo ʻia he ʻokoʻa loa ia mai ka ʻōnaehana nerve, kahi e hoʻohuli ai i nā hōʻailona pōʻino o ke kaiapuni a me loko i loko o ka hana uila e hana i nā manaʻo a me nā reflexes (Fig. 1). Manaʻo mākou he ʻāpana maoli kēia mau ʻōnaehana ʻelua o kahi mīkini pale i hui pū ʻia. Hoʻonohonoho pono ʻia ka ʻōnaehana somatosensory e ʻike i ka pōʻino. ʻO ka mea mua, ʻo nā ʻiʻo āpau i ʻike nui ʻia i ke kaiapuni o waho, e like me ka epithelial surfaces o ka ʻili, ka māmā, ka mimi a me ka digestive tract, ua hoʻopili nui ʻia e nā nociceptors, nā paepae kiʻekiʻe e hoʻoulu ai i ka ʻeha. ʻO ka lua, ʻoi aku ka wikiwiki o ka hoʻololi ʻana i nā hoʻoulu ʻana o waho, ʻoi aku ka wikiwiki o nā kauoha o ka nui ma mua o ka hoʻoulu ʻia ʻana o ka ʻōnaehana immune innate, a no laila ʻo ia ka "pane mua" i ka pale kaua.
Hōʻike 1: Noxious stimuli, microbial a me nā ala ʻike e hoʻāla ai i ka hoʻōla ʻana o ka ʻōnaehana nerve peripheral. Loaʻa i nā neurons sensory kekahi mau ala e ʻike ai i ka hele ʻana o nā mea hoʻoulu ʻino/ʻino. 1) ʻIke nā mea hōʻailona hōʻailona pōʻino, e like me nā kaha TRP, nā ala P2X, a me nā mea hōʻailona molecular pili i ka pōʻino (DAMP) i nā hōʻailona exogenous mai ke kaiapuni (e laʻa me ka wela, ka acidity, nā kinikona) a i ʻole nā hōʻailona pōʻino hopena i hoʻokuʻu ʻia i ka wā o ka ʻeha trauma/tissue (eg ATP, ʻakika uric, hydroxynonenals). 2) Hoʻomaopopo nā mea hoʻokipa ʻike kumu (PRR) e like me Toll-like receptors (TLRs) a me Nod-like receptors (NLRs) e ʻike i nā kumulāʻau molekula pili i ka Pathogen (PAMPs) i hoʻokahe ʻia e nā maʻi bacteria a i ʻole nā maʻi maʻi i ka wā maʻi. 3) Hoʻomaopopo ka cytokine receptors i nā mea i huna ʻia e nā cell immune (eg IL-1beta, TNF-alpha, NGF), ka mea e hoʻāla ai i nā kinases palapala a me nā hana hōʻailona ʻē aʻe e hoʻonui ai i ka excitability membrane.
Ma waho aʻe o nā mea hoʻokomo orthodromic i ka spinal cord a me ka lolo mai ka ʻaoʻao, hiki ke hoʻouna ʻia nā mana hana i nā neurons nociceptor i ka antidromically ma nā lālā lālā i lalo i ka periphery, ka axon reflex. ʻO kēia me nā depolarizations kūloko i hoʻomau ʻia e alakaʻi i ka hoʻokuʻu wikiwiki a kūloko o nā neural mediators mai nā axons peripheral a me nā hopena (Fig. 2) 1. Hōʻike nā hoʻokolohua kahiko a Goltz (ma 1874) a me Bayliss (i ka makahiki 1901) i hōʻike ʻia nā aʻa hope hoʻoulu uila. hoʻoulu i ka vasodilation o ka ʻili, ka mea i alakaʻi i ka manaʻo o ka `neurogenic inflammation', kūʻokoʻa i ka mea i hana ʻia e ka ʻōnaehana immune (Fig. 3).
Hōʻike 2: Nā mea neuronal i hoʻokuʻuʻia mai nā neoronic nociceptor e hoʻopiʻi pono i ka leukocyte chemotaxis, hemodynamics vascular a me ka pane o nā mea āpau. Ke hoʻoikaikaʻia nā hōʻailona palekana i nā aʻa o ke kino, e hanaʻia nā hoʻololi axon antidromic e hoʻoulu ai i ka hoʻokuʻuʻana o nā neuropeptides ma nā hopenaʻaoʻao o nā neuron. ʻO kēia mau mea i loaʻa i kekahi mau meaʻehaʻeleʻele he nui nā hana pāʻona: 1) Keʻolika a me ka hoʻouluʻana o nā neutrophils, macrophages a me nā lymphocytes i kahi pūpū o kaʻeha, a me ka degranulation o nā pūnaewele mast. 2) Ke kuhikuhiʻana i nā pūnaewele endothelial vascular e hoʻonui i ke kaheʻana o ke koko, ka līkī a me ka edema. Mālama kēia i ka loiloi hou o nā leukocytes inflammatory. 3) Ke kuhiʻana o nā pūnaewele dendritic e hoʻohuli i ka hoʻokaʻawale pūnaewele kōkua ma hope o T i ka Th2 a iʻole ka Th17 subtypes.
Hōʻike 3: Ke kaʻina manawa o ka piʻiʻana i kaʻike o nāʻano neurogenic o ka hoʻolinoʻana mai Celsus a hiki i kēia lā.
Hoʻopili ʻia ka ʻeha neurogenic e ka hoʻokuʻu ʻia ʻana o ka neuropeptides calcitonin gene related peptide (CGRP) a me ka mea P (SP) mai nā nociceptors, e hana pololei ana i ka endothelial vascular a me nā ʻiʻo ʻiʻo maʻemaʻe 2-5. Hoʻopuka ka CGRP i nā hopena vasodilation 2, 3, aʻo SP hoʻonui i ka capillary permeability e alakaʻi ana i ka extravasation plasma a me ka edema 4, 5, e hāʻawi ana i ka rubor, calor a me ke koko o Celsus. Eia naʻe, hoʻokuʻu nā nociceptors i nā neuropeptides hou aʻe (ʻikepili pūnaewele: www.neuropeptides.nl/), me Adrenomedullin, Neurokinins A a me B, Vasoactive intestinal peptide (VIP), neuropeptide (NPY), a me ka gastrin releasing peptide (GRP), a me nā mea hoʻolaha molekala ʻē aʻe e like me ka glutamate, nitric oxide (NO) a me nā cytokines e like me eotaxin 6.
I kēia manawa, mahalo mākou i ka hoʻokuʻu ʻia ʻana o nā mea hoʻolaha mai nā neurons sensory ma ka ʻaoʻao ʻaʻole e hana wale i ka vasculature, akā e huki pololei a hoʻōla i nā cell immune innate (mast cell, dendritic cell), a me adaptive immune cell (T lymphocytes) 7-12. Ma ka hoʻonohonoho koʻikoʻi o ka pōʻino o ka ʻiʻo, manaʻo mākou he pale ka neurogenic, hoʻomaʻamaʻa i ka ho'ōla ʻana i ka ʻeha physiological a me ka pale pale ʻana i nā pathogens ma o ka hoʻoulu ʻana a me ka hoʻoulu ʻana i nā cell immune. Eia nō naʻe, ʻo ia mau kamaʻilio neuro-immune ke pāʻani nei i nā kuleana nui i ka pathophysiology o nā maʻi maʻi a me nā maʻi autoimmune ma o ka hoʻonui ʻana i nā pane kūlohelohe a i ʻole maladaptive. I nā ʻano holoholona o ka rheumatoid arthritis no ka laʻana, ua hōʻike ʻo Levine a me nā hoa hana i ka denervation o ka hui e alakaʻi i kahi attenuation koʻikoʻi i ka mumū, e hilinaʻi ana i ka hōʻike neural o ka waiwai P 13, 14. psoriasis, nā neurons sensory mua ke kuleana nui i ka hoʻomaka ʻana a me ka hoʻonui ʻana i ka hoʻāla ʻana o ka immunity innate a adaptive 15-17.
Ke manaʻo nei mākou,ʻaʻole e hoʻolālā wale ke kikowaena o ke kikowaena i ka hana i ka pale kaua (kaʻike o nā hopena hopena a me ka hoʻomakaʻana o ka hana palekana), akā, he hana kūikawā hoʻi me ka pūnaewele ola honua ma ka hoʻololiʻana i nā pane a me ka hakakāʻana i nā meaʻino nā hopena, kahi hana e hiki ke hoʻololiʻia e kōkua i ka maʻi.
Nā Papahana Hoʻokolohua'Āiwi i ke Keʻena'Olepaʻi a me nā Immune Systems
Hoʻopiliʻia nā neo'aehe lolo eʻike i ka hopena i ke kino ma muli o ko lākouʻike i nā hana maʻamau a me nā mea hanaʻino (Fig 1). ʻO nā mea kelepona hiki keʻikeʻia (TRP) uaʻikeʻia ka mea iʻike nuiʻia i nā mea i loaʻa i ka mea iʻikeʻoleʻia. Hoʻomakaʻia ka TRPV1 e nā mahana wela, ka haʻahaʻa pH a me ke kapikomo, ka mea wīwī vallinoid o nā pelekikena 18. Hoʻomalohuaʻo TRPA1 i kaʻike o nā mea hana kūikawā, me nā mea e like me ka hawewe hau a me nā neʻomiocyanates ahupuaʻa 19, akāʻoi aku ka nui, ke hanaʻia hoʻi ma ka hopena o nā mea e like me nā hōʻailona kalapili me 4-hydroxynonenal a prostaglandins 20, 21.
ʻO ka mea e mahalo ai, hoʻokaʻawale nā neo aʻikeʻole i nāʻano likeʻole a me nā alaʻi ka hopena o ka'āhemo lohe honua e like me nā pūnaewele immune i loko, e hiki ai iā lākou keʻike i nā maʻi pathogens (Fig 1). Ma ka pūnaewele hoʻopili, uaʻikeʻia nā pathogens microbial e nā mea hōʻailona hōʻailona ukali i kākauʻia (PRRs), e hōʻoia ana i ka mālamaʻana i nā'ōmumu molepika e pili ana i ka pathogen (PAMPs). ʻO nā PRRs mua eʻikeʻia he mau lālā o kaʻohana e like me ka loli likeʻole (TLR), e hoʻopaʻaʻia i ka levē, nā hapa me nā pūnaewele me nā RNA 22. Ma hope o ka hoʻolālāʻana PRR, hoʻohuliʻia nā ala ala hōʻailona ma luna o kēlā mea e hoʻoulu ai i ka hana cytokine a me ka hoʻonāʻana o ka pākuʻi kūpono. Hiki i nā TLR, ke hana 'ia nā pūnaewele maʻemaʻe i loko o ka pōʻino o kaʻupena e nā hopena o ka hopena iʻikeʻia, iʻikeʻia hoʻi he mau mamalili mole e pili ana i kaʻino (DAMPs) a iʻole nā kīʻaha 23, 24. ʻO nā hōʻailona pilikia kēia e komo pū me HMGB1,'eleka uric, a me nā māmā uila ka mea i hoʻopukaʻia e nā pūpū make i ka manawa o ka necrosis, me ka hoʻonāʻana i nā pūnana liʻiliʻi i ka manawa o ka paneʻoleʻana o ka maʻiʻeha.
ʻO nā PRR me nā TLR 3, 4, 7, a me 9 e hōʻikeʻia e nā neurons nociceptor, a me ka hoʻouluʻana e nā TLR ligands e alakaʻi i ka hoʻokomoʻana i nā au i loko a me ka noʻonoʻo o nā nociceptors i nā mea hoʻouluʻeha 25-27. Eia kekahi, ʻo ka hoʻoulu ʻana o nā neurons sensory e ka TLR7 ligand imiquimod e alakaʻi i ka hoʻāla ʻana i kahi ala ʻike kikoʻī kikoʻī 25. Hōʻike kēia mau hopena i ka ʻeha a me ka ʻeha pili i ka maʻi ma muli o ka hoʻōla pololei ʻana o nā neurons e nā kumu pathogen-derived. ho'āla i nā pūnaewele immune ma o ka hoʻokuʻu ʻana o nā molekele hōʻailona neuronal.
ʻO kahi DAMP / alarmin nui i hoʻokuʻu ʻia i ka wā o ka hōʻeha kelepona ʻo ATP, i ʻike ʻia e nā purinergic receptors ma nā neurons nociceptor a me nā cell immune 28-30. Hoʻokumu ʻia nā mea hoʻokipa Purinergic i ʻelua ʻohana: P2X receptors, ligand-gated cation channels, a me P2Y receptors, G-protein coupled receptors. I loko o nā neurons nociceptor, ʻike ʻia ka ATP ma o P2X3, e alakaʻi ana i ka wikiwiki densensitizing cation au a me ka ʻeha 28, 30 (Fig. 1), aʻo nā mea loaʻa P2Y e hāʻawi i ka nociceptor activation ma o ka sensitization o TRP a me nā kahawai sodium-gated. Ma macrophages, ATP hoʻopaʻa i P2X7 receptors alakai i hyperpolarization, a downstream ho'ā 'ana o ka inflammasome, he molecular paʻakikī nui i ka hanauna o IL-1beta a me IL-18 29. No laila, ATP mea he potent hōʻailona pōʻino e ho'ā i nā neurons peripheral a me ka innate. ka pale ʻana i ka wā ʻeha, a ke hōʻike nei kekahi mau hōʻike e hōʻike ana nā neurons i nā ʻāpana o ka mīkini molekala inflammasome 31.
ʻO kaʻaoʻao māmā o nā hōʻailona pilikia ma nā mea hanaʻole i ke kaʻina o nā TRP o ke kelepili kamepiula. ʻO TRPV2, kahi hui like o TRPV1 i hoʻonāʻia e ka wela wela, ua hōʻikeʻia ma nā kūlana kiʻekiʻe ma nā pūnaewele immune maʻamau o 32. ʻO ka hoʻopau āpau o TRPV2 ua alakaʻiʻia i nā pōʻino i ka macgohage phagocytosis a me kaʻaeʻana o nā maʻi maʻamau 32. Hiki i nā pūnaewele mimiki ke hōʻike i nā kaha TRPV, kahi hiki iā lākou ke pale pololei i ko lākou hōʻino 33. Hoʻomaka ia e hoʻoholo inā hōʻailona nā hopena pilikia i nā pūnaewele immune i keʻano like me nā nociceptors.
ʻO kahi ala nui o ka kamaʻilio ma waena o nā cell immune a me nā neurons nociceptor ma o cytokines. Ma ka ho'ā 'ana o nā cytokine receptors, ho'āla 'ia nā ala transduction hōʻailona i nā neurons sensory e alakaʻi ana i ka phosphorylation downstream o nā protein membrane me ka TRP a me nā ala uila-gate (Fig. 1). ʻO ka hopena o ka sensitization o nā nociceptors, ʻo ia ka mea hiki ke hoʻāla i nā nociceptors maʻamau maʻamau a me nā mea hoʻoulu wela. ʻO Interleukin 1 beta a me TNF-alpha ʻelua mau cytokine koʻikoʻi i hoʻokuʻu ʻia e nā cell immune innate i ka wā o ka mumū. ʻIke pololei ʻia ʻo IL-1beta a me TNF-alpha e nā nociceptors e hōʻike ana i nā mea loaʻa cognate, hoʻoulu i ka hoʻoulu ʻana o nā p38 map kinases e alakaʻi ana i ka hoʻonui ʻana o ka membrane excitability 34-36. ʻO ka Nerve Growth Factor (NGF) a me ka prostaglandin E(2) he mau mea hoʻomake nui hoʻi i hoʻokuʻu ʻia mai nā cell immune e hana pololei i nā neuron sensory peripheral e hoʻoulu ai i ka sensitization. ʻO kahi hopena koʻikoʻi o ka nociceptor sensitization e nā mea immune ka hoʻonui nui ʻana o nā neuropeptides ma nā ʻaoʻao peripheral e hoʻāla hou ai i nā cell immune, a laila e hoʻoulu ai i kahi loop feedback maikaʻi e hoʻokele a hoʻomaʻamaʻa i ka mumū.
Ka'Āina Pūnaewele Nalu o ka Innate a me ka Adaptive Immunity
I ka wā mua o ka mumū, hōʻailona nā neurons sensory i nā ʻiʻo noho mast cell a me nā cell dendritic, ʻo ia nā cell immune innate i mea nui i ka hoʻomaka ʻana i ka pane immune (Fig. 2). Ua hōʻike nā haʻawina Anatomical i ka hoʻopili pololei ʻana o nā terminals me nā mast cell, a me nā cell dendritic, a me nā neuropeptides i hoʻokuʻu ʻia mai nā nociceptors hiki ke hoʻoulu i ka degranulation a i ʻole ka hana cytokine i loko o kēia mau cell 7, 9, 37. He kuleana koʻikoʻi kēia pilina i ke ala ea maʻi. ʻeha a me dermatitis 10–12.
I ka wā o ka hopena hopena o ka mumū, pono nā cell immune e ʻimi i ko lākou ala i kahi kikoʻī o ka ʻeha. Nui nā mea hoʻolaha i hoʻokuʻu ʻia mai nā neurons sensory, nā neuropeptides, chemokines, a me ka glutamate, he chemotactic no nā neutrophils, eosinophils, macrophages, a me T-cells, a hoʻonui i ka endothelial adhesion e hoʻomaʻamaʻa i ka home cell immune 6, 38-41 (Fig. 2). Eia kekahi, ke hōʻike nei kekahi mau hōʻike e hiki i nā neurons ke komo pololei i ka hopena hopena, no ka mea, loaʻa i nā neuropeptides nā hana antimicrobial pololei 42.
Hiki i nā molekele hōʻailona i loaʻa mai i ka neuronally ke kuhikuhi i ke ʻano o ka mumū, ma o ka hāʻawi ʻana i ka ʻokoʻa a i ʻole ka kikoʻī o nā ʻano ʻano like ʻole o nā keena T immune adaptive. Hoʻopili ʻia kahi antigen a hana ʻia e nā cell immune innate, a laila neʻe i ka puʻu lymph kokoke loa a hōʻike i ka peptide antigenic i nā cell T nave. Ma muli o ke ʻano o ka antigen, nā molekala costimulatory ma ka ʻōpū immune innate, a me nā hui pū ʻana o nā cytokines kikoʻī, ʻo nā cell T nave i nā subtypes kikoʻī e lawelawe maikaʻi i ka hoʻoikaika ʻana e hoʻomaʻemaʻe i ka hoʻoulu ʻana i ka pathogenic. Hiki ke hoʻokaʻawale ʻia nā pūnaewele CD4 T, a i ʻole T helper (Th), i ʻehā mau pūʻulu kumu, Th1, Th2, Th17, a me T regulatory cell (Treg). Hoʻokomo nui nā pūnaewele Th1 i ka hoʻoponopono ʻana i nā pane kūlohelohe i nā microorganism intracellular a me nā maʻi autoimmune kikoʻī; He mea koʻikoʻi ka Th2 no ka palekana e kū'ē i nā pathogens extracellular, e like me nā helminths, a he kuleana no nā maʻi maʻi maʻi; He kuleana koʻikoʻi nā pūnaewele Th17 i ka pale ʻana i nā pilikia microbial, e like me ka extracellular bacteria a me nā haʻi; Hoʻopili ʻia nā cell Treg i ka mālama ʻana i ka hoʻomanawanui a me ka hoʻoponopono ʻana i nā pane kūlohelohe. ʻO kēia kaʻina T cell maturation e ʻike nui ʻia e ka sensory neuronal mediators. ʻO nā neuropeptides, e like me CGRP a me VIP, hiki ke hoʻokaʻawale i nā cell dendritic i kahi Th2-type immunity a hoʻemi i ka Th1-type immunity ma o ka hoʻolaha ʻana i ka hana ʻana o kekahi mau cytokines a ke kāohi nei i nā poʻe ʻē aʻe, a me ka hōʻemi a hoʻonui ʻana paha i ka neʻe ʻana o nā cell dendritic i nā wahi lymph nodes 8 , 10, 43. Hoʻokomo nui nā neurons sensory i ka maʻi maʻi (ʻoi aku ka nui o Th2 i alakaʻi ʻia) i ka mumū 17. Ma waho aʻe o ka hoʻoponopono ʻana i nā cell Th1 a me Th2, hiki i nā neuropeptides ʻē aʻe, e like me SP a me Hemokinin-1, ke alakaʻi i ka pane inflammatory e pili ana iā Th17 a i ʻole Treg. 44, 45, ʻo ia hoʻi, hiki i nā neurons ke komo pū i ka hoʻoponopono ʻana i ka hoʻonā inflammatory. I loko o nā immunopathologies e like me ka colitis a me psoriasis, hiki ke hoʻopaʻa ʻia ka pale ʻana o nā mea hoʻoponopono neuronal e like me ka mea P i ka nui o ka cell T a me ka pōʻino mediated immune 15-17, ʻoiai ʻo ke kūʻē ʻana i hoʻokahi mea hoʻopāpā e loaʻa iā ia iho ka hopena i ka ʻeha neurogenic.
Me kaʻikeʻana o ka hōʻailonaʻana i nā molekoki i hoʻokuʻuʻia mai nā kikooho pūnaewele e hoʻoponopono i nā kīʻaha liʻiliʻi wale nō, akā,ʻo ka chemotaxis, homing, maturation, a me ka hoʻonāʻana o nā pūnaewele kūlohelohe, ua maopopo e pili pono nā pilina neuro-immune ma mua o ka manaʻo mua (Fig 2). Eia kekahi, he mea hiki keʻikeʻiaʻaʻole he mau meaʻokoʻa no ke kaiauluʻokoʻa akā he hui pū kekahi o ka hōʻailona o nā molekoki i hoʻokuʻuʻia mai nā nociceptors e hoʻoikaika i nāʻano likeʻole a me nāʻano o nā pane āpau.
ʻO ka Autonic Reflex Control of Immunity
He kuleana no ka cholinergic autonomic nervous system �reflex� circuit i ka hooponopono ana i na pane immune peripheral 46. ʻO ka vagus ke aʻalolo parasympathetic nui e hoʻohui ana i ka ʻōpū o ka lolo me nā ʻāpana visceral. ʻO ka hana a Kevin Tracey a me nā mea ʻē aʻe e kuhikuhi ana i nā pane anti-inflammatory ākea nui i ka haʻalulu septic a me ka endotoxemia, i hoʻoulu ʻia e kahi hana aʻalolo vagal e alakaʻi ana i ka hoʻopau ʻana i nā macrophages peripheral 47-49. Hoʻoulu ka vagus i nā neurons adrenergic celiac ganglion innervating i ka spleen, e alakaʻi ana i ka hoʻokuʻu ʻana o ka acetylcholine i lalo, kahi e hoʻopaʻa ai i ka alpha-7 nicotinic receptors ma nā macrophages i ka spleen a me ka ʻōpū o ka ʻōpū. Hoʻoulu kēia i ka hoʻāla ʻana o ke ala hōʻailona JAK2/STAT3 SOCS3, kahi e hoʻopau ikaika ai i ka TNF-alpha transcription 47. Ke kamaʻilio pololei nei ka adrenergic celiac ganglion me kahi ʻāpana o ka acetylcholine e hana ana i nā cell T hoʻomanaʻo, nāna e hoʻopau i nā macrophages inflammatory 48.
ʻO nā pūnaewele Killer T (iNKT) ka hui pūnaewele he mea kūikawā nui o nā pūnaewele T e hoʻomaopopo ana i nā lipid microbial i loko o ka pōpili o CD1d ma kahi o ka'āpana peptide antigens. ʻO nā pūnaewele NKT kekahi heluna leo lymphocyte nui i komo i ka hakakāʻana i nā maʻi pathogens a me ka hoʻoponopono o ka hoʻoponopono pūnaewele. Noho nā pūnaewele NKT a mahele pinepineʻia ma waena o ka palahalaha a me ka pilikino o ka'ōpū a me ke ake. Hoʻokumu pololei nā aʻalolo beta-nūnoa i loko o ka'ōiwi e hoʻololi i ka hana maʻamau o NKT 50. I loko o keʻano o ka hoʻohālike o ka mīkini (MCAO), no ka mea, uaʻikeʻia ka hanuʻana o ka hanana NKT cell, kahi i hoʻohuliʻia e ka hōʻailona aloha a iʻole nā antagonists beta-adrenergic. Eia kekahi,ʻo kēia hana kuʻuna o nā nerarenergic neʻaliʻi ma nā pūnaewele NKT e alakaʻi i ka hoʻonui i ka maʻi pūnaewele a me kaʻehaʻeha. No laila,ʻo nā hōʻailonaʻoihana mai nā neurones autonomic hiki ke kūkākūkā i ka hopena hopena.
Dr. Alex Jimenez's Insight
ʻO ka hoʻolālā neurogenic kahi hōʻailona o ka'elepuni i hanaʻia e ka'ōpena pūpū. Manaʻoʻia he mea koʻikoʻi ia i ka pilikino o nāʻano olakino likeʻole,ʻo ia hoʻi, migraine, psoriasis, hānō, fibromyalgia, eczema, rosacea, dystonia a me kaʻike nui o nā kino. ʻOiai ua hoʻonui nuiʻia ka hoʻolālā neurogenic e pili ana i ka'ōpoki o ke kaiapuniʻaoʻao,ʻo ka manaʻo o ka hūʻana o neurogenic i loko o ka pūʻali'ōpihi pūpū, e mau hou ana ka noiʻiʻana. Ma muli o kekahi mau noiʻi noiʻi, akā naʻe, ua manaʻoʻia ka pauʻole magnesium i ke kumu nui o ka welaʻana i ka neurogenic. Ke hōʻike nei kēiaʻatikala i kahiʻikepili o nā hana o ke ahi neurogenic i loko o ka pūnaewele'ōpiopio, hiki iā ia ke kōkua i nāʻoihana olakino eʻike i keʻano maikaʻi loa no ka mālamaʻana i nā hanana olakino e pili ana i kēia pūnaewele.
hopena a
He aha nā kuleana kiko'ī o ka somatosensory a me ka autonomic nervous system i ka hoʻoponopono ʻana i ka mumū a me ka ʻōnaehana pale (Fig. 4)? ʻO ka hoʻoulu ʻana o nā nociceptors e alakaʻi i nā axon reflexes kūloko, kahi e hoʻoulu ai a hoʻōla i nā cell immune a no laila, ʻo ia ka pro-inflammatory a me ka spatially confined. ʻO ka ʻokoʻa, alakaʻi ka hoʻoulu ʻana autonomic i kahi immunosuppression systemic ma o ka hoʻopili ʻana i nā loko o nā cell immune i loko o ke ake a me ka spleen. Hoʻomaopopo maikaʻi ʻole ʻia nā hana hōʻailona afferent ma ka ʻaoʻao e alakaʻi ana i ka hoʻomaka ʻana o ka immunosuppressive vagal cholinergic reflex circuit. Eia nō naʻe, ʻo 80-90% o nā fiber vagal he mau mea ʻike afferent sensory mua, a no laila, ʻo nā hōʻailona mai ka viscera, he nui i alakaʻi ʻia e nā cell immune, hiki ke alakaʻi i ka hoʻāla ʻana o nā interneurons i loko o ka lolo a ma o lākou i kahi puka i loko o nā fiber vagal efferent 46.
Hōʻike 4: Hoʻololi nā pūnaewele Sensory a me nā pūnaewele holoʻokoʻa i nā pane āpau a me nā pūnaewele. Hoʻopuka i nāʻano epithelial i loko o ka papa hana (eg peʻa a me ka'ōpū) i nā hopena o ke kīnā, ka hoʻolālāʻana i nā mast mast and cell dendritic. I ka maʻi o ka mīkini maʻi, ka dermatitis a me ka'ōhuma o ka rumatika,ʻo nā neurons nociceptor ke kuleana i ka puhiʻana i ke ahi. ʻO ka hoʻokaʻawaleʻana,ʻo nā ala kaʻawale i loko o ka mālamaʻana i nāʻano o ke kinowai (eg splin and liver) e hoʻoponopono i nā hopena o ka hopena ma ke kāohiʻana i ka pilina a me ka NKT pūnaewele. I loko o ke kīpī a me ka endotoxemiaʻehiku, e hoʻokani kēia mau neurons i kahi hana kuʻuna.
ʻO keʻano,ʻo ka manawa a me keʻano o ka līlū, i ka wā o ka maʻi, nā hopena o ka maʻi, a me nā maʻi pilikinoʻole, ua ho'ākākaʻia e nāʻano o nā pūnaewele kūlohelohe. He mea nui ia eʻike i nāʻano likeʻole o nā pūnaewele i kāohiʻia e hoʻopiliʻia e nā hōʻailonaʻike a me nā mana. ʻImiʻia i kaʻike o nā mea i hiki i nā mea ke kūkākūkā ke hoʻokuʻuʻia mai nā nūhou a me nā neo autonomic a me ka hōʻikeʻana o nā leka uila no kēia mau mea ma o nā pūnaewele i hoʻopiliʻoleʻia e hiki ke kōkua i ka hoʻoponoponoʻana i kēia nīnau.
I ka wā o ka evolution, ua hoʻomohala ʻia nā ala molekika ʻike pōʻino like ʻole no ka ʻokoʻa kūlohelohe a me ka nociception ʻoiai he ʻokoʻa loa nā ʻano o nā cell. ʻOiai ke aʻo ʻokoʻa ʻia nā PRRs a me nā kaila ion ligand-gated noxious e nā immunologists a me nā neurobiologists, ʻo ka laina ma waena o kēia mau kahua ʻelua ke piʻi aʻe nei ka pohō. I ka wā o ka pōʻino o ka ʻiʻo a me ka maʻi pathogenic, ʻo ka hoʻokuʻu ʻana i nā hōʻailona pōʻino e alakaʻi i ka hoʻoulu ʻia ʻana o nā neurons peripheral a me nā cell immune me ke kamaʻilio bidirectional paʻakikī, a me kahi pale hoʻokipa hoʻohui. ʻO ke kūlana anatomical o nā nociceptors ma ke kikowaena me ke kaiapuni, ka wikiwiki o ka neural transduction a me ko lākou hiki ke hoʻokuʻu i nā cocktails potent o nā mediators immune-acting e hiki ai i ka ʻōnaehana nerve peripheral ke hoʻololi ikaika i ka pane kūlohelohe kūlohelohe a hoʻonohonoho i ka palekana adaptive downstream. ʻO ka mea ʻē aʻe, ʻike nui nā nociceptors i nā mediators immune, e hoʻāla a hoʻonaʻauao i nā neurons. ʻO ka neurogenic a me ka immune-mediated inflammation ʻaʻole ia, no laila, he hui kūʻokoʻa akā hana pū ʻia e like me nā mea hoʻolaha mua. Eia nō naʻe, he kuleana koʻikoʻi ka ʻōnaehana neʻe o ke kino i ka pathophysiology, a me ka etiology paha, o ka nui o nā maʻi kūlohelohe e like me ka hānō, psoriasis, a i ʻole colitis no ka mea hiki i kona hiki ke hoʻoikaika i ka ʻōnaehana pale e hiki ke hoʻonui i ka mumū pathological 15-17. Pono e hoʻokomo ʻia ka mālama ʻana no nā maʻi immune, no laila, ka huli ʻana o nā nociceptors a me nā cell immune.
'Ōlelo hōʻeia
Mahalo mākou i ka NIH no ke kākoʻo (2R37NS039518).
I ka hopena,ʻO ka hoʻomaopopo ʻana i ke kuleana o ka ʻāʻī neurogenic i ka wā e pili ana i ka pale ʻana a me ka immunopathology he mea nui ia i ka hoʻoholo ʻana i ke ala lapaʻau kūpono no nā ʻano pilikia olakino. Ma ka nānā ʻana i ka launa pū ʻana o nā neurons peripheral me nā cell immune, hiki i nā limahana mālama ola ke holomua i nā ala lapaʻau e kōkua hou aku i ka hoʻonui ʻana i ka pale ʻana a me ka hoʻopau ʻana i ka immunopathology. ʻO ke kumu o ka ʻatikala ma luna nei e kōkua i ka poʻe maʻi e hoʻomaopopo i ka neurophysiology clinical o neuropathy, ma waena o nā pilikia olakino ʻeha ʻē aʻe. ʻIke ʻia mai ka National Center for Biotechnology Information (NCBI). ʻO ka laulā o kā mākou ʻike i kaupalena ʻia i ka chiropractic a me nā hōʻeha spinal a me nā kūlana. No ke kūkākūkā ʻana i ke kumuhana, e ʻoluʻolu e nīnau iā Kauka Jimenez a i ʻole e kelepona mai iā mākou ma�915-850-0900 .
Hoʻopūʻia e Dr. Alex Jimenez
Nā Pāhana Hou: Back Pain
Paʻi hope ʻo ia kekahi o nā kumu nui loa o ka hemahema a ua hala nā lā ma ka hana ma ka honua holoʻokoʻa. ʻOiai he meaʻoiaʻiʻo, ua hoʻokauʻia kaʻeha hope ma keʻano he kumu kumuʻelua no ka heleʻana o ke keʻena o ke kauka,ʻoi aku ma mua wale nō nā maʻi āpau kiʻekiʻe. Ma kahi o 80 pakeneka o ka heluna eʻike i kekahiʻano o kaʻeha hope loa ma kahi o hoʻokahi manawa ma ko lākou ola. ʻO ka'ōiwi kahi hanana paʻapū i hanaʻia i ka iwi, nā hono, nā ligaments a me nāʻiʻo, i waena o nā mea'ē aʻe. Ma muli o kēia, nāʻeha a me nā kūlana hōʻeha, e like me nā kīlei'aniani, hiki ke hopena i nā hōʻailona o ke kaumaha hope. ʻO nāʻeha a me nāʻeha a me nā pōpilikia pū kaʻa paha he kumu pinepine ia o kaʻehaʻeha, akā, i kekahi manawa,ʻoi aku kaʻoi loa o nā hana i loaʻa i nā hopenaʻeha. ʻO ka mea pōmaikaʻi, hiki i nā koho hoʻoponopono'ē aʻe, e like me ka mālamaʻana i ka chiropractic, ke kōkua i ka pale i kaʻeha ma o ka hoʻohanaʻana i nā hoʻololiʻana o ka'ōpū a me nā lima lima, me ka hoʻomaikaʻi maikaʻi i nā maʻi.
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No ke aha e ʻeha ai koʻu poʻohiwi? ʻO kahi loiloi o ke kumu Neuroanatomical & Biochemical o ka ʻeha poʻohiwi
ʻO ka NGF a me ka receptor transient Loaʻa cation subfamily V lālā 1 (TRPV1) i loaʻa kahi pilina simbiotic i ka wā e pili ana i ka mumū a me ka noʻonoʻo ʻana i ka nociceptor. ʻO nā cytokine i hana ʻia i loko o nā mea āpau i hopena i ka hoʻonui ʻana o ka hana NGF. 19 stimole ʻo NGF i ka hoʻokuʻu ʻia o histamine a me serotonin (5-HT3) e nā cell mast, a me nā sensitizes no neoicic, e hoʻololi paha i nā waiwai o A? nā olonā e like me ka hapa nui i lilo i nociceptive. Aia ka receptor TRPV1 i kahi subpopulation o nā fibre afferent mua a hoʻoulu ʻia e capsaicin, ka wela a me nā protons. Hoʻohui ʻia ka receptor TRPV1 i loko o ke kino o ke olonā afferent, a lawe ʻia i nā kikowaena peripheral a me nā kikowaena waena, kahi e hāʻawi ai i ka ʻike i ka poʻe i loaʻa ʻole i ke aloha. Nā hualoaʻa ka hopena o ka NGF hana peripherally a laila paʻa i ka tyrosine kinase receptor type 1 receptor ma nā kikowaena nociceptor, a laila lawe ʻia ʻo NGF i ke kino pūnaewele kahi e alakaʻi ai i kahi rula o TRPV1 transcription a no laila ua hoʻonui i ka noʻonoʻo nociceptor.19 20 NGF a ʻo nā mea uwao hoʻonāukiuki ʻē aʻe e hoʻomaopopo iā TRPV1 ma o ka lehulehu o nā ala ʻelele ʻelua. Manaʻo ʻia nā mea ʻē aʻe he nui e like me nā cholinergic receptor,? -Aminobutyric acid (GABA) a me nā mea loaʻa somatostatin e pili pū ana i ka ʻike o ka nociceptor peripheral.
ʻO ke Neurochemistry Of Nociceptors
Nā Pūnaewele Mole & Molecular Of Pain
Hōʻike 5. ʻO ke kōlani'Ākau (Central) Manaʻo
