I-Arthritis ne-Fibromyalgia Iziguli Kungenzeka Zibhalwe Ngaphansi Kokucindezeleka
Ungase umangale uma udokotela wakho ekhuthaza ukucindezeleka ngokucindezeleka okungapheli. Ingabe lokhu ngoba ukholelwa ukuthi ucindezelekile? Noma ingabe i-anti-depressants ingasiza ebuhlungu ngisho nabantu abangenazo izimpawu zokucindezeleka? Ake sibheke ukuthi ucwaningo lusitshelani ngendima yamaqembu ahlukene e-antidepressants ekwelapheni ubuhlungu obungapheli.
Isixhumanisi Phakathi Kokucindezeleka Nokucindezeleka Okungapheli
Kuyinto evamile kubantu abanezifo ezibuhlungu ezingapheli nemibandela, njenge- arthritis ye-rheumatoid , lupus , fibromyalgia , nobuhlungu be-neuropathic ukubhekana nokucindezeleka. Abantu abanezinkinga zomzimba ezingapheli banezinga eliphezulu lokuphila lokucindezeleka okukhulu. Ngamanye amazwi, ubuhlungu nokucindezeleka ngokuvamile kuvame ukuhamba (ukuhamba ngakwesokunene.) Ngakolunye uhlangothi lwe-equation, inani elikhulu labantu abatholakale benesifo sokucindezeleka nabo banokuhlupheka okungapheli. Isixhumanisi phakathi kokucindezeleka nokubuhlungu okungapheli kusebenza kuzo zombili izinkomba.
Lokho kusho ukuthi akuvamile ukuthi abantu abanezimo ezibuhlungu ezingapheli kumele banikezwe izidakamizwa zokucindezeleka ngisho noma bengenayo izimpawu zokucindezeleka.
Ama-anti-depressants for Pain Chronicle Without Co-Existing Depression
Nakuba izidakamizwa zokucindezeleka zihloselwe ukuphakamisa isimo sengqondo seziguli ezicindezelekile ngokomzimba ngokuthinta ama-neurotransmitters ebuchosheni, ama-anti-depressants angase anqunywe njengendlela yokwelapha eyinhloko yokwelashwa okungapheli, ukukhathazeka kokukhathazeka, noma ukuphazamiseka kokulala.
Uma zisetshenziselwa ubuhlungu obungapheli injongo yabo ivame kakhulu ngokuthi "ama- analgesics adjuvant ." Lokhu kusho ukuthi bahlelwe kanye neminye imithi yobuhlungu kunokuba basebenzise yedwa njengokwelashwa ubuhlungu. (Funda kabanzi ngemithi emihlanu ephezulu yokuphatha ubuhlungu obungapheli .)
Indlela ecacile lapho izidakamizwa ezisebenza ngayo ukuphatha ubuhlungu ngokuvamile aziwa, nakuba kubonakala sengathi indlela abasiza ngayo ubuhlungu obungapheli kungenzeka ukuthi azihambisani nezinqubo ezinciphisa ukucindezeleka.
Ngokuvamile kucatshangwa ukuthi izidakamizwa zokulwa nokucindezeleka zinethonya kwi-serotonin ye-neurotransmitters ne- norepinephrine , ikakhulukazi lapho behla endleleni yobuhlungu bomgogodla. Ama-antidepressants angase asebenze ngokusebenzisa i-histamine receptors noma iziteshi ze-sodium.
Amakilasi we-Anti-depressants
Kunezigaba eziningana ezihlukene zokulwa nokucindezeleka okuye kwavivinywa kubantu abanezinhlungu ezingapheliyo nokuthi indlela eyodwa yokusebenza kancani yokucindezeleka ingase ihluke kanjani kwesinye. Izidakamizwa eziye zafundwa zihlanganisa:
- I-Tricyclic antidepressants
- I-serotonin reuptake inhibitors ekhethiwe (SSRIs)
- I-Serotonin ne-norepinephrine reuptake inhibitors (i-SNRIs)
- I-Norepinephrine ne-dopamine reuptake inhibitors (NDRIs)
- Ama-inhibitors e-reuptake ehlanganisiwe nama-block blockers
- I-Monoamine oxidase inhibitors (i-MAO inhibitors)
Ake sibheke ngasinye salezi zigaba ngokuhlukana.
I-Tricyclic Antidepressants
Ama-anti-depressants e-Tricyclic ayebhekwa njengokwelashwa okujwayelekile kokucindezeleka ngaphambi kwe-SSRIs. Nakuba lezi zidakamizwa zisetshenziselwa ukucindezeleka kancane kancane, ziyindlela ejwayelekile kakhulu yokucindezeleka okusetshenziselwa ubuhlungu obungapheli. Kubonakala sengathi iphumelela kakhulu ekulawuleni ubuhlungu be-back neuropathic kodwa asetshenziswe kuzo zonke izinhlobo zobuhlungu.
Imithi ebizwa ngokuthi i-tricyclic antidepressants ihlanganisa:
- Elavil (amitriptyline)
- I-Ascendin (i-amoxapine)
- I-Anafranil (i-clomipramine)
- I-Pamelor (nortriptyline)
- I-Norpramin (deipramine)
- I-Tofranil (i-imipramine)
- I-Vivactil (i-protriptyline)
- I-Surmontil (i-trimipramine)
- I-Sinequan (doxepin)
Lapho i-tricyclic anti-depressants (ikakhulukazi i-amitriptyline) isetshenziselwa ubuhlungu obungapheli, ngokuvamile ihlinzekwa ngamanani aphansi kakhulu kunalawo asetshenziselwa ukucindezeleka, ngakho-ke ngokuvamile kuholela emiphumeleni emincane. Imiphumela emibi evamile ingabandakanya umbono obonakalayo, inzuzo yesisindo, nokulala.
I-Serotonin Reuptake Inhibitors Ekhethiwe (SSRIs)
I-serotonin reuptake inhibitors (SSRIs) ekhethiwe yizinye zezidakamizwa ezivame ukushiwo ngokucindezeleka nokukhathazeka.
Izidakamizwa kulesi sigaba zihlanganisa:
- I-Prozac (i-fluoxetine)
- I-Lexapro (i-escitalopram)
- I-Luvox (i-fluvoxamine)
- Celexa (citalopram)
- I-Zoloft (sertraline)
- I-Paxil (i-paroxetine)
Njengoba igama liphakamisa, ama-SSR ahlose i-neurotransmitter (ebuchosheni bemikhiqizo ye-serotonin) futhi umgomo ukwandisa amazinga e-serotonin ebuchosheni. I-SSRI imithi ephumelelayo yeziguli eziningi kanye nemiphumela emibi ngokuvamile iyalinganisa futhi ibekezeleleke ngaphezu kwalabo abahambisana ne-tricyclic anti-depressants.
Izifundo ezibheke ukusetshenziswa kwe-SSRIs ngokubuhlungu okungapheli ngaphandle kokucindezeleka zithola ukuthi lezi zidakamizwa zinomthelela othile ezimweni eziningi zobuhlungu obungapheli, kodwa ucwaningo olwengeziwe luyadingeka.
I-Serotonin ne-Norepinephrine Reuptake Inhibitors (i-SNRIs)
I-Serotonin ne-norepinephrine reuptake inhibitors (i-SNRIs) ihlose ama-serotonin amabili we-neurotransmitter ne-norepinephrin futhi abhekwa njengama-inhibitors amabili ngenxa yalesi sizathu.
Kokubili ama-SSRI nama-SNRI angasiza ukuhlukunyezwa nokukhathala okuhambisana nezimo ezibuhlungu ezingapheli noma i-fibromyalgia, kodwa ama-SNRI angase aphumelele kakhulu kune-SSRIs ngokukhululeka kobuhlungu.
Izidakamizwa kulesi sigaba zihlanganisa:
- I-Cymbalta (i-duloxetine)
- I-Effexor (i-venlafaxine)
- I-Pristiq (desvenlafaxine)
- I-Savella (i-milnacipran)
I-Cymbalta yamukelwa yi-FDA yokwelashwa kwe-fibromyalgia ngonyaka ka-2008 kanye nokwelashwa kobuhlungu obuyisifo samasculoskeletal ngo-2010.
Imiphumela emibi ejwayelekile ehambisana ne-SNRIs ihlanganisa ukuhlukunyezwa, ukulahlekelwa ukudla, ukukhathazeka, ikhanda, ukulala nokushona.
I-Norepinephrine ne-Dopamine Reuptake Inhibitors (NDRIs)
I-NDRIs ingenye uhlobo lwe-anti-depressant, ne-bupropion (i-Wellbutrin noma i-Zyban) izidakamizwa eziyinhloko kuleli klasi.
Imiphumela emibi evamile ihlanganisa ukufutheka, isisulu, ukukhanda ikhanda, ukulahlekelwa ukudla, ukungalali, nokunyuka kwengcindezi yegazi.
Ama-Inhibitors e-Reuptake ahlanganisiwe nama-Blockers abamukelayo
Ama-inhibitors ahlanganisiwe nama-block blockers angasetshenziselwa ukucindezeleka, izimo zokulala, noma ubuhlungu obungapheliyo-ilebula bese ufaka:
- I-Desyrel (i-trezodone)
- I-Remeron (i-mirtazapine)
- I-Serzone (nefazodone)
Imiphumela emibi evamile ihlanganisa ukulala, umlomo owomile, isicashu, kanye nesizungu, futhi lezi zidakamizwa akufanele zisetshenziswe ngabantu abanomlando wezinkinga zesibindi.
I-Monoamine Oxidase Inhibitors (i-MAO Inhibitors)
I-MAO Inhibitors yizindala zokudambisa izidakamizwa ezingasetshenziselwa kakhulu ukuphatha ukucindezeleka noma ezinye izimo ngenxa yephrofayili yethonya.
- I-Nardil (phenelzine)
- I-Parnate (tranylcypromine)
- I-Marplan (isocarboxazid)
- I-Emsam (selegilint)
Kunemikhawulo eminingi yokudla kubantu abasebenzisa lezi zidakamizwa kanye nemiphumela emibi ebalulekile kakhulu evamile.
Ucwaningo Lokusetshenziswa Kwezinkinga Zokuvimbela Ukucindezeleka Okungapheli
Ucwaningo luye lwathola inzuzo ekusetshenzisweni kwezidakamizwa zokucindezeleka ekulawuleni ubuhlungu obungapheli kubantu abadala, ikakhulukazi i-amitriptyline. Ngeshwa, kunolwazi oluncane kakhulu olutholakala ekusetshenzisweni kwezidakamizwa zokucindezeleka ngenxa yobuhlungu obuhlobene non-umdlavuza ezinganeni noma ezincane.
Izidakamizwa ezivunyelwe ukuhlukunyezwa okungapheli ngokusetshenziswa kwe-Off-Label
Uma ukhuluma mayelana nokusetshenziswa kwezidakamizwa zokucindezeleka ngenxa yobuhlungu obungapheli kubalulekile ukuhlukanisa izidakamizwa ezivunyelwe kulolu hlelo ngokuhambisana nalabo asetshenzisiwe ngaphandle kwelebuli. Uma isidakamizwa i-FDA ivunyelwe ukusetshenziswa okuhlukile kusho ukuthi i-FDA ibuyekeze izifundo futhi ithole ukuthi izidakamizwa zingasebenza futhi ziphephile. Ukusetshenziswa kwelebuli ngaphandle , noma kunjalo, kubhekisela kwizidakamizwa ezise-FDA ezivunyelwe isimo esisodwa (isibonelo lapha, ukucindezeleka) kodwa singasetshenziswa esinye isizathu (isibonelo, ubuhlungu obungapheliyo).
Ukuxwayiswa Ngokusetshenziswa Kwezinkinga Zokucindezeleka
Ukusetshenziswa kwama-anti-depressants akusikho izixwayiso. I-FDA ithi abantu abadala kanye ikakhulukazi izingane kufanele zihlonishwe ngenxa yokucindezeleka okwedlulele noma imicabango yokuzibulala noma ukuziphatha phakathi nezinyanga ezimbalwa zokuqala ukwelashwa noma ukulandela ushintsho emithini yemithi. Abantu kufanele baxhumane nodokotela wabo ngokushesha uma izimpawu zokucindezeleka ziba zimbi noma uma ukucabanga noma ukuziphatha okuzibulala kuyanda. Kubalulekile futhi kulabo abathintekayo ukujwayela izici eziyingozi kanye nezixwayiso zokuzibulala.
Ngaphansi kokusetshenziswa kwezidakamizwa zokuhlukunyezwa okungapheli
Ama-anti-depressants angasiza abantu abhekana nokuhlupheka okungapheli ngendlela engaphezu kweyodwa. Abantu abaningi abaphila ne-fibromyalgia noma ezinye izimo ezibuhlungu ezingapheli nazo zibhekene nokucindezeleka. Noma kunjalo ezinye izidakamizwa zokucindezeleka zingase zinikeze ukukhululeka ebuhlungu obungapheli ngezindlela ezahlukene. Emakilasini ahlukene e-anti-depressants, ama-tricyclic anti-depressants, ikakhulukazi amitriptyline, aye ahlolisiswa kakhulu, ikakhulukazi ekwelapheni ubuhlungu be-neuropathic.
Ukubhekana nobuhlungu obungapheli kunzima, futhi kuthinta zonke izici zokuphila kwakho. Inhlanganisela yemithi ehlukene (njengokungeza ene-anti-depressant) ingase ibe inzuzo kakhulu, kepha ukungelashwa kwemithi nokuphathwa kokucindezeleka kubaluleke kakhulu.
> Imithombo:
> Chou, R., Devo, R., Friedly, J. et al. Izindlela zokwelapha ezenzakalelayo ze-Pharmacologic for Pain Low Back: Ukubuyekezwa Okuhlelekile Kwe-American College of Physicians Umhlahlandlela Wokuzivocavoca. Ama-Annal of Medicine yangaphakathi . 2017. 166 (7): 480-492.
> Cooper, T., Heathcote, L., Clinch, J. et al. Ama-Antidepressants for Pain Non-Cancer Pain In Children and Adolescents. I-Cochrane Database yezibuyekezo ezihleliwe . 2017. 8: CD012535.
> I-Dosenovic, S., i-Kadic, i-A., i-Miljanovic, i-M. et al. Ukungenelela kobuhlungu be-Neuropathic: Sibutsetelo Sokuhlola Okuhlelekile. I-Anesthesia ne-Analgesia . 2017. 125 (2): 643-652.
> Patetsos, E., no-E. Horjales-Araujo. Ukwelashwa Okungapheli Nge-SSRIs: Yini Esaziyo? . Uhlu Lokucwaninga Nokuphathwa . 2016. 2016: 2020915.