I-Arthritis ne-Fibromyalgia Izigulane zinokuthi zibekwe i-Anti-depressants
Unokumangaliswa ukuba ugqirha wakho uncoma ukuba uxinzeleleke ukukhathazeka okungapheliyo. Ingaba oko kuba ukholelwa ukuba udandathekile? Okanye ngaba abanokudambisa iingxaki kunokuncedisa intlungu nabantu abangenazo iimpawu zokudandatheka? Makhe sijonge oko uphando lusitshela malunga nenxaxheba yeeklasi ezahlukeneyo zokuxhatshazwa kwindlela yokunyanga intlungu.
Ikhonkco phakathi koxinzelelo kunye nobuhlungu obungapheliyo
Akuqhelekanga kubantu abanezifo ezibuhlungu ezingapheliyo kunye neemeko ezinjenge- rheumatoid arthritis , lupus , fibromyalgia , kunye nentlungu ye-neuropathic ukuxinezeleka. Abantu abaneengxaki ezingapheliyo zineengxaki ezidlulileyo zokuphila. Ngamanye amazwi, intlungu kunye nokudandatheka kudla ngokukhawuleza (zihamba ngesandla.) Ngakolunye uhlangothi lwe-equation, inani elikhulu labantu abanokufumanisa ukuxinezeleka nalo bunzima ngenxa yobuhlungu obungapheliyo. Ikhonkco phakathi kokudandatheka kunye nentlungu engapheliyo isebenza kwimiba mibini.
Oko kwathiwa, akuqhelekanga ukuba abantu abaneemeko ezingapheliyo zichazwe ngokuchasene neengxaki zokuxhatshazwayo nangona bengenazo iimpawu zokudandatheka.
Ukuxhatshazwa kweengxaki zokugula okungapheliyo ngaphandle kokuxinezeleka
Nangona i-anti-depressants imiselwe ngokukodwa ukuphakamisa izigulane zezigulane ezixinzelelekileyo ezikliniki ngokuchaphazela i-neurotransmitters engqondweni, iingxaki zokuxhatshazwayo nazo zinokumiselwa njengonyango oluphambili lweentlungu ezingapheliyo, iingxaki zokuxhalabisa okanye ukuphazamiseka kokulala.
Xa zisetyenziselwa ubuhlungu obungapheliyo injongo yabo idla ngokuba "njenge- analgesics adjuvant ." Oku kuthetha ukuba zichazwe kunye nezinye iilwimi zentlungu kunokuba zisetyenziswe yodwa njengonyango lwentlungu. (Funda kabanzi malunga namachiza amahlanu aphezulu asetyenziswa ukulawula intlungu engapheliyo .)
Inkqubo echanekileyo eyenziwa yi-anti-depressant work to manage the pain is largely unknown, nangona kubonakala ukuba indlela abancedayo ngayo intlungu engapheliyo ingahambelani neendlela zokunciphisa uxinzelelo.
Ngokuqhelekileyo kucingelwa ukuba i-anti-depressants inefuthe kwi-neurotransmitters serotonin kunye ne- norepinephrin , ngokukodwa ngokuhla kweentlungu zomnxeba. I-Anti-depressants ingasebenzisa i-histamine receptors okanye i-sodium channels.
Iiklasi ze-Antidepressants
Kukho iindidi ezahlukahlukeneyo zokuxhatshazwa kwabantu abaye bazama abantu abaneentlungu ezingapheliyo kunye nendlela ababenokusebenza ngayo eklasini yokudandathelanisa ingahluke kunomnye. Iziyobisi eziye zafundwa ziquka:
- I-Tricyclic antidepressants
- I-serotonin i-reuptake inhibitors (iSRRIs)
- I-Serotonin kunye ne-norepinephrine reuptake inhibitors (i-SNRIs)
- I-Norepinephrine kunye ne-dopamine reuptake inhibitors (NDRIs)
- I-reuptake inhibitors kunye nama-block block receptors
- I-Monoamine oxidase inhibitors (i-MAO inhibitors)
Makhe sijonge kule nganye iklasi.
I-Tricyclic Antidepressants
I-Tricyclic antidepressants yabonwa njengonyango oluqhelekileyo lokudandatheka phambi kwe-SSRIs. Nangona la mayeza asetyenziswa ngokuncinci ngokunciphisa ubuninzi, luhlobo oluqhelekileyo lwe-antidepressant elisetyenziselwa ubuhlungu obungapheliyo. Ziyabonakala zinempumelelo kakhulu ekulawuleni iintlungu zentlungu kodwa zisebenzisiwe kuzo zonke iintlobo zentlungu.
Iziyobisi ezichazwa njenge-tricyclic antidepressants ziquka:
- Elavil (amitriptyline)
- Ascendin (amoxapine)
- I-Anafranil (i-clomipramine)
- Pamelor (nortriptyline)
- I-Norpramin (desipramine)
- ETofranil (imipramine)
- Vivactil (protriptyline)
- Surmontil (trimipramine)
- Sinequan (doxepin)
Xa i-tricyclic antidepressants (ngokukodwa i-amitriptyline) isetyenziselwa ubuhlungu obungapheliyo, ngokuqhelekileyo kunikwa amaxabiso angaphantsi kunezo ezisetyenziselwa ukudakumba, kwaye ngoko ke kukhokelela kwimiphumo embalwa yecala. Iziphumo eziqhelekileyo ezibandakanyekayo zingabandakanya umbono ongenangqondo, ukuzuza ubunzima, nokulala.
I-Serotonin Reuptake Inhibitors (i-SSRIs)
I-serotonin i-reuptake inhibitors (SSRIs) ekhethiweyo yilezi ezinye zezidakamizwa ezixhaswa ngokuqhelekileyo zokudandatheka nokuxhalabisa.
Iziyobisi kule candelo ziquka:
- Prozac (i-fluoxetine)
- Lexapro (escitalopram)
- Luvox (i-fluvoxamine)
- Celexa (citalopram)
- Zoloft (sertraline)
- Paxil (paroxetine)
Njengoko igama libonisa, ii-SSR zijolise kwi-neurotransmitter (i-brain chemicals) i-serotonin kunye nenjongo kukunyusa amanqanaba e-serotonin ebuchosheni. Ii-SSRI ziyeza unyango oluchanekileyo kwizigulane ezininzi kunye neziphumo zempembelelo zivame ukulinganisela kwaye zibekezeleleke ngakumbi kunezo zidibene ne-tricyclic antidepressants.
Izifundo ezijongene nokusetyenziswa kwe-SSRIs ngenxa yentlungu engapheliyo ngaphandle kokudakumba zifumanisa ukuba ezi ziyeza zinefuthe kwiimeko ezininzi ezibuhlungu, kodwa uphando olongezelelweyo lufunekayo.
I-Serotonin kunye ne-Norepinephrine Reuptake Inhibitors (i-SNRIs)
I-Serotonin kunye ne-norepinephrine reuptake inhibitors (i-SNRIs) ijolise i-serotonin ye-neurotransmitter kunye ne-norepinephrine kwaye ibonwa njenge-inhibitors emibili kwesi sizathu.
Zombili ii-SSRI kunye ne-SNRI zinokunceda ukulawula intlungu kunye nokukhathala okuhambisana nezimo ezibuhlungu ezingapheliyo okanye i-fibromyalgia, kodwa i-SNRI inokusebenza ngakumbi kune-SSRIs ngokwempazamo yosizi.
Iziyobisi kule candelo ziquka:
- I-Cymbalta (duloxetine)
- Effexor (venlafaxine)
- Pristiq (desvenlafaxine)
- Savella (milnacipran)
I-Cymbalta yavunywa yi-FDA yonyango lwe-fibromyalgia ngo-2008 kwaye unyango lweentlungu ze-musculoskelet ngo-2010.
Iziphumo eziqhelekileyo ezichaphazelekayo kunye ne-SNRI zibandakanya i-nicea, ukulahleka kwesidlo, ukuxhala, intloko, ukulala, nokudinwa.
I-Norepinephrine kunye neDopamine Reuptake Inhibitors (NDRIs)
I-NDRI enye inhlobo ye-anti-depressant, ne-bupropion (i-Wellbutrin okanye i-Zyban) iziyobisi eziphambili kule klasi.
Iziphumo eziqhelekileyo ziquka ukuxhalaza, isicathulo, intloko, ukulahleka kwesidlo, ukulala, nokunyuka kwengcinezelo yegazi.
I-Reuptake Inhibitors kunye neReceptor Blockers
I-reuptake ye-inhibitors kunye ne-receptor blockers ingasetyenziselwa ukudandatheka, imeko zokulala, okanye ubuhlungu obungapheliyo kwilebuli kwaye zibandakanya:
- Desyrel ( trazodone )
- Remeron (mirtazapine)
- I-Serzone (nefazodone)
Iziphumo eziqhelekileyo ziquka ukulala, umlomo owomileyo, isisongulu, kunye nesisu, kwaye ezi michiza akufanele zisetyenziswe ngabantu abaneengxaki zesibindi.
I-Monoamine Oxidase Inhibitors (i-MAO Inhibitors)
Ii-inhibitors ze-MAO ziyi-antidepressants endala ezingasetshenziswanga ngokubanzi ukuphatha uxinzelelo okanye ezinye iimeko ngenxa yeprofayili yecala.
- Nardil (phenelzine)
- Parnate (tranylcypromine)
- Marplan (isocarboxazid)
- Emsam (selegilint)
Kukho izithintelo ezininzi zokutya kubantu abasebenzisa la mayeza kunye nemiphumo ebalulekileyo engundoqo.
Izifundo ekuSebenzisweni kweeNtsholongwane eziPhezulu
Uphando luye lwafumana inzuzo ekusebenziseni izidandathelwana ekulawuleni ubuhlungu obungapheliyo kubantu abadala, ngakumbi i-amitriptyline. Ngelishwa, kukho ulwazi oluncinci oluninzi olutholakalayo ekusebenziseni izidandlululo zokuxhatshazwa kweengxaki ezingekho komhlaza kubantwana okanye abaselula.
Izidakamizwa ezivunyelwe ukuPhepha okungapheliyo nokuSebenzisa kweTayibhile
Xa uthetha malunga nokusetyenziswa kweengcinezelo zentsholongwane engapheliyo kubalulekile ukuhlukanisa iziyobisi ezivunyiwe kulolu hlobo ngokubhekiselele kwizinto ezisetyenzisiweyo. Xa isicatshulwa i-FDA evunyelwe ukusetyenziswa okuthethi kuthetha ukuba i-FDA ihlaziye uphando kwaye ifumene ukuba iziyobisi zingasebenza kwaye zikhuselekileyo. Ukusetyenziswa kokubhaliweyo , nangona kunjalo, kubhekisela kwiziyobisi ezivunyelwe i-FDA kwimeko enye (umzekelo apha, ukudandatheka) kodwa isetyenziselwa esinye isizathu (umzekelo, intlungu engapheliyo.)
Izilumkiso malunga nokusetyenziswa kwee-Antidepressants
Ukusetyenziswa kwezidandlululo kunokungaxelwanga. I-FDA ithi abantu abadala kwaye ngokukodwa abantwana kufuneka baqwalaselwe ngenxa yokudakumba okukhulu okanye iingcinga zokuzibulala okanye ukuziphatha kwiinyanga ezimbalwa zokuqala zonyango okanye emva kokutshintsha kwimiyeza yeyeza. Abantu kufuneka baqhagamshelane nangoko ugqirha ukuba iimpawu zokudandatheka zibuhlungu okanye ukuba iimeko zokuzibulala okanye ukuziphatha zikhula. Kwakhona kubalulekile kulabo abathintekayo ukuba baqhelane neziganeko zobungozi kunye nemiqondiso yokuzibulala.
Ngaphantsi kwe-Use of Antidepressants for Pain Pain
Ukuxhatshazwa kweengxaki kunokunceda abantu bajamelana nobuhlungu obungapheliyo ngendlela engaphezulu kweyodwa. Abantu abaninzi abahlala ne-fibromyalgia okanye ezinye iimeko ezibuhlungu ezingapheliyo nazo zixinzelelo. Nangona kunjalo ezinye iingxaki zokuxhatshazwayo zingabangela ukukhululeka kwintlungu engapheliyo ngeendlela ezahlukeneyo. Kwimihlathi eyahlukeneyo ye-antidepressants, i-tricyclic antidepressants, ngokukodwa i-amitriptyline, ihloliswe ngokukodwa, ngakumbi kunyango lweentlungu zesifo se-neuropathic.
Ukujamelana nobuhlungu obungapheliyo kunzima, kwaye kuthintela zonke iinkalo zobomi bakho. Ukuhlanganiswa kwamachiza ahlukeneyo (njengokungeza kwi-anti-depressant) inokuba luncedo kakhulu, kodwa ingekho unyango lweyeza kunye nokuphathwa koxinzelelo kubalulekile.
> Imithombo:
> Chou, R., Devo, R., Friedly, J. et al. I-Pharmacologic Therapies ye-Down Back Pain: Uhlolo oluhlelekile kwiKholeji yaseMerika ye-Physicians Guideline Practice. Amanqaku angamayeza angaphakathi . 2017. 166 (7): 480-492.
> Cooper, T., Heathcote, L., Clinch, J. et al. Ukuxhatshazwa kweengxaki ezingapheliyo kwiNtsholongwane kaGawulayo ebantwaneni kunye nabantwana abasebekhulile. I-Cochrane Database yeeNkqubo eziPhezulu . 2017. 8: CD012535.
> I-Dosenovic, S., i-Jelicic Kadic, A., iMiljanovic, uM et al. Amanyathelo okufumana ubuhlungu be-Neuropathic: Ingqwalaselo yeeNkqubo eziPhezulu. IAnesthesia kunye ne-Analgesia . 2017. 125 (2): 643-652.
> Patetsos, E., no E. Horjales-Araujo. UkuPhatha Ubunzima Bokuhlala Ngama-SSRI: Yintoni Esaziyo? . Uphando loPhando noLawulo . 2016. 2016: 2020915.