Kusukela ku-anti-inflammatories kuya kuma-opioid kanye nama-anti-depressants nokunye okuningi, izinhlobo eziningi zemithi zenzelwe ubuhlungu be-back and neck. Iningi linikeza okungenani izinzuzo zokuphatha ubuhlungu, kodwa kungenzeka ukuthi imiphumela emibi kakhulu, ngisho nemiphumela eyingozi, ikhona lapho.
Lesi sihloko siqhathanisa imithi emibili enjalo - i-COX-2 inhibitors nama-opioid.
I-Cox-2 Inhibitors - I-Celebrex, i-Vioxx no-Bextra
I-cox-2 inhibitors yimihlobo ye-non-steroidal anti-inflammatory (NSAID) imithi esetshenziselwa ubuhlungu obukhulu, izinhlobo eziningana ze-arthritis kanye nobuhlungu bokuya esikhathini.
Zihlukile ezidakamizwa ezifana ne-aspirin, i-Aleve, i-Motrin nokunye okufana nokuthi isenzo sabo sibhekiswe ngqo.
Ososayensi nodokotela bayazi ukuthi ubuhlungu bubangelwa izinto ezibizwa ngokuthi i-prostaglandins. I-prostaglandin nayo ikhiqizwa emzimbeni ngama-enzyme amabili ahlobene (ngalinye linemiphumela ehlukile), okungukuthi i-COX-1 ne-COX-2. Ochwepheshe abasensimini bayazi futhi ukuthi i-prostaglandins eqondiswe ngokukhethekile ebuhlungu, ukuvuvukala nokuvuvukala kuvele kuvele kuphela nge-COX-2 enzyme.
Umehluko omkhulu phakathi kwemithi yendabuko engeyona isifo sokuvuvukala (okungukuthi, izinhlobo ezahlukene ze-NSAID) kanye ne-COX-2 inhibitors yukuthi ngenkathi i-NSAID ivimbela izenzo zombili ze-COX-1 ne-COX-2 enzymes, i-COX-2 inhibitors, njengoba igama lisho, cindezela kuphela i-COX-2s.
Inkinga kakhulu inhibitors ye-COX-2 isusiwe emakethe. Lokhu kungenxa yokuthi zitholakale zandisa ingozi yemicimbi ye-cardiovascular (ukuhlaselwa yinhliziyo nokushaya) uma isetshenziswe ngokuhamba kwesikhathi.
I-Vioxx (i-generic name rofecoxib) ne-Bextra (igama elivamile i-valdecoxib) lihoxisiwe emakethe ekuqaleni kwawo-2000. I-Vioxx yenziwe nguMerck, noBextra wenziwa yiPfizer.
Okushiya enye i-COX-2 inhibitor ye-Pfizer, i-Celebrex (igama elivamile elibizwa nge-celecoxib.)
Njengoba kuphela izidakamizwa ze-COX-2 inhibitors ezihlala emakethe yase-US, i-Celebrix ne-celecoxib manje beza "nexwayiso ebhokisini elimnyama," eliyilebuli elenzelwe ukuphuma ngokwanele ukuze likuqaphele iphrofayli yokuphepha engabaza yomuthi .
Odokotela abakhipha i-Celebrex baye bafundiswa yi-FDA ukukunika Umhlahlandlela Wezokwelapha, okufaka imininingwane engozini kanye nesilinganiso.
Uma uzibuza ukuthi yini ongayithatha ngaphandle kwe-Celebrex, ukubuyekezwa kuka-2013 kutholile ukuthi kuzo zonke izinsizakalo ze-NSAID ezingakhethi, cishe i-naproxen (i-Aleve) ibeka ingozi encane yomzimba kubantu. Ababhali bokubuyekeza batusa ukuthi yikuphi okusemthethweni kwe-NSAID, ukuthi wenze njalo kumthamo ophansi kunazo zonke, futhi isikhathi esincane kakhulu esingenzeka.
Qaphela ukuthi ezinye izinhlobo ze-NSAIDS, uhlobo oluvimbela kokubili i-COX-1 ne-COX-2 enzymes, lungandisa ingozi yokuhlasela kwenhliziyo noma isifo sohlangothi, futhi. Eqinisweni, ngo-2015, i-FDA iyala ukuthi amagama kuwo wonke amalebula ebhokisi le-NSAID (kuhlanganise ne-Celebrex, i-COX-2 inhibitor esele kuphela) evuselelwe ukubonisa ucwaningo olusha oluthola ukuhlaselwa kwenhliziyo lungenzeka ngisho nangamaviki emva kokuqala lolu hlobo lwezidakamizwa, futhi ukuthi uma usebenzisa isikhathi eside umuthi, ukuphakama kwengozi kungaba ngaphezulu.
Ama-opioids we-Back or neck Pain
I-opioid yilasilasi lemithi yokwelashwa enamandla okuletha ukukhululeka okukhulu kakhulu. Ama-opioids avame ukusetshenziselwa ubuhlungu obunzima, kodwa ngezinye izikhathi odokotela bawabeka njengezokwelapha zokuqala ukuze ubuhlungu obukhulu.
Inkinga iwukuthi, lesi sigaba sokudambisa ubuhlungu singumlutha, okusho ukuthi beza nokukwazi ukulutha.
Ezinye iziguli zakha ukubekezelelana, okungaholela ekuxhasweni ngokomzimba, futhi ekugcineni kube nokulutha okugcwele.
Ezinye izidakamizwa ze-opioid ziyizidakamizwa ezihlanzekile, kuyilapho ezinye zixubene nezinkinga zokunciphisa ubuhlungu ezinjengeTyelnol. Ama-opioids akhiwe njengesikhashana, futhi njengoba esenza isikhathi eside.
Ngisho noma ukusetshenziswa kwama-opioids kwentukuthelo yezintamo nobuhlungu kusakazeke, ubufakazi abudingekile ukusekela lo mkhuba. Ukubuyekezwa eBritish Medical Journal kubika ukuthi ama-opioids manje ayimithi ejwayelekile kakhulu e-United States.
Lokho kusho ukuthi umlobi wokubukeza uthi ama-opioids awabonakali ukusiza abantu babuyele emsebenzini ukuze basebenze noma yikuphi okusheshayo kunezinye izinhlobo zokwelapha ubuhlungu emuva, futhi abakuthuthukisi imiphumela yokunakekelwa okuyisisekelo ubuhlungu obubuhlungu bokubuyela emuva.
Uma ubuhlungu bakho be-back emuva bungapheli, ama-opioid angeke akwenze lutho kuwe. Umbhali wokubuyekeza uthola ubufakazi obuncane bokuthi basebenza ngale njongo.
Kanye nomngcipheko wokulutha umuthi, i-opioids iza neminye imiphumela emibi, okubandakanya ukuqotshwa, ukungasebenzi ngokocansi nokucindezeleka, ukubiza amagama ambalwa kuphela.
I-opioids nayo ijwayele imikhankaso yokumaketha edukisa. Olunye uhlobo lwe-opioid, i-OxyContin, lwafakwa njengengxabano "ephephile" ngabamele abamele inkampani emkhankasweni omkhulu wokumaketha. Kodwa abaphathi abakhulu be-Purdue Pharma, abenzi be-OxyContin, kamuva bavuma enkantolo ukuthi lezo zimangalo ziyiqiniso futhi zidukisa.
I-COX-2 Inhibitors ne-Opioids - Cabanga Ngaphambi Kokuthatha
Uma ucabangela noma unqunywe imithi ebuhlungu, cabanga ngazo zonke izinkinga ezingase zivele ngokuzithatha. Ungabe usengozini yokuhlaselwa yinhliziyo noma isifo sokushaya isisu, noma uhlala nomlutha wemithi (ubuhlungu) evame ukuphuza.
Khumbula, ngokuvamile ukuhambisa umzimba wakho kungasiza ngebuhlungu emuva, ukubuyisela umsebenzi olahlekile nokuthuthukisa izinga lokuphila. Ukuvakashelwa okumbalwa ngomuthi wenyama kungase kube yilokho okudingayo ukubuyisela izinga lakho lokuphila.
> Umthombo:
> Deyo, R., et. al. Ama-opioids wezinhlungu eziphansi emuva. Ukubuyekezwa Kwemitholampilo. Isibuyekezo sobuciko boMbuso. Jan 2015. http://www.bmj.com/content/350/bmj.g6380
> Nissen, S., et. isib. Ukuphepha Kwemisipha Ye-Celecoxib. N Engl J Med. Nov 2016. http://www.jwatch.org/na42802/2016/11/14/cardiovascular-safety-celecoxib
> Pawlosky, N. Ingozi yezinhliziyo Ingabe wonke ama-NSAID afanayo? I-Pharm J. March 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676195/
I-Vioxx ne-Cox-2 Inhibitors
Ama-cox-2 inhibitors afana ne-Vioxx, i-Celebrex no-Bextra yihlobo lwe-NSAID, noma izidakamizwa ezingezona izidakamizwa eziphikisayo. Zakhiwe ngawo-1990 ukubhekana nemiphumela emibi ye-NSAIDS .
Ngenxa yokuthi emkhayeni owodwa wemithi, zonke i-Cox-2 inhibitors ziziphatha kahle ngendlela efanayo. Ngakho-ke, iziguli ezithatha i-Vioxx noma i-Bextra ngeCelebrex zingase zisengozini yokuhlaselwa yinhliziyo.
Nakuba zingekho ama-cox-2 inhibitors, amanye ama-NSAID afaka izingozi ezingase abe yiMotrin, i-Naprosyn, i-Voltaren ne-Mobic.
Ama-opioids
Ama-opioids asetshenziselwa ubuhlungu obukhulu. Ngaphandle kokubuhlungu okungapheliyo, ama-opioid nawo alawulwa uma kwenzeka ebuhlungu bomdlavuza, ubuhlungu bezinzwa nezinye izimo.
I-opioids yizinhlungu ezikhulu kakhulu zokunciphisa ubuhlungu; i-morphine iyisibonelo esaziwa kakhulu se-opioids, nakuba empeleni kunezinhlobo eziningana ezivela ekusebenzeleni okuncane kuya ezinamandla kakhulu. Izibonelo zifaka i-OxyContin, i-codeine, i-Darvon ne-Vicodin.
Ama-opioids anemiphumela emibi eminingi, kufaka phakathi kungenzeka:
- ukucindezeleka kokuphefumula
- ukuqotshwa
- ingozi yokuthembela nokulutha umlutha
Ukulimala okusobala kakhulu kwama-opioid njengemithi yobuhlungu kungenzeka ukuthi kunomlutha nokuthembela. Ukucwaninga kubonisa ukuthi i-OxyContin, ikakhulukazi, "yindlela" yokulutha izidakamizwa kwezinye izidakamizwa ezinzima. Ngesinye isikhathi, iziguli zingenqatshwa imithi ngoba izizathu zabo ezikhuthazayo aziqondakali kahle, futhi zingase zibonwe njenge-morphine (noma amanye ama-opioid).
Umphumela
Lapho ilawulwa ngokufanele , izinzuzo zokuthatha i-opioids ngobuhlungu zinamandla kunezingozi ezihambisanayo. I-opioids iyasebenza kakhulu ekuphuculeni ubuhlungu. Futhi abacwaningi abaningi, izindikimba ezilawulayo kwezokwelapha, nodokotela banomuzwa wokuthi ama-opioids ayadingeka ukucubungula ukwelashwa okungapheli. Kodwa njenganoma yikuphi ukhetho lokunakekelwa kwezempilo, sebenze nodokotela wakho kanye nabanye ochwepheshe bezempilo ukuze uthole okukhethwa kukho okuhle kuwe.
Umthombo:
Imibuzo nezimpendulo.Izinyathelo zokulawula ze-FDA ze-COX-2 ekhethiwe futhi engakhethi izidakamizwa ezingezona ukuvuvukala (i-NSAID). I-FDA. Ngo-Ephreli 7, 2005.
Brasseur, L. Ukubukeza kokwelashwa kwamanje kwe-pharmacologic yobuhlungu. Izidakamizwa. 1997.
Cicero, TJ, Inciardi, JA, Munoz, A. Izindlela zokuhlukunyezwa kwe-Oxycontin namanye ama-analgesics e-opioid e-United States 2002-2004 JPain Okthoba 2005.
Grau, LE, Dasgupta, N., Harvey, AP, Irwin, K., Givens, A., Kinzley, ML, Heimer, R .. Ukusetshenziswa okungavumelekile kwama-opioids: i-OxyContin "isango"? AmJ Addict May-June 2007.