Arthritis uye Fibromyalgia Varwere Vanogona Kunyorwa Anodzvinyirira
Iwe unogona kushamiswa kana chiremba wako anokurudzira anodzvinyirira kuti anzwe kurwadziwa kusingaperi. Ndizvo here nokuti anotenda iwe wakaora mwoyo? Kana kuti zvinogona kukonzera zvinodzvinyirira zvinobatsira kurwadziwa kunyange kune vanhu vasina zviratidzo zvekuora mwoyo? Ngatitarisei izvo tsvakurudzo inotitaurira pamusoro pebasa rezvikwata zvakasiyana zvevanorwisa zvinodhaka mukurapa kusuruvara kusingaperi.
The Link Between Depression and Chronic Pain
Hazvishamisi kune vanhu vane zvirwere zvinorwadza zvisingaperi uye zvinetso, zvakadai se rheumatoid arthritis , lupus , fibromyalgia , uye kurwadziwa neuropathic kuti uwane kushushikana. Vanhu vane zvinetso zvisingagumi zvepanyama vane hutano hwakanaka hwehupenyu hukuru hwekuora mwoyo. Mune mamwe mazwi, kurwadziwa uye kuora mwoyo zvinowanzonyangadza (enda noruoko.) Kune rumwe rutivi rwean equation, nhamba yakawanda yevanhu vanoonekwa kuti vane kuora mwoyo vanobatwawo nekurwadziwa kusingaperi. Kubatana pakati pekuora mwoyo uye kurwadziwa kusingaperi kunoshanda kumativi maviri.
Izvozvo zvakati, hazvisi zvisizvo kune vanhu vane marwadzo asingagumi anongorondedzerwa kurwisa vanodzvinyirira kunyange kana vasina zviratidzo zvekuora mwoyo.
Kushungurudzika kweHumambo Husingaperi Pasina Kupo-Kuda Kuora Mwoyo
Kunyange zvazvo zvirwere zvinorwisana nehutachiona zvinonyanya kurongerwa kukwidziridza mafungiro evarwere vanodzvinyirirwa nehutachiona kuburikidza nevanosangana neurotransmitters muuropi, zvirwere zvinodhaka zvinogonawo kurongerwa sechirwere chikuru chekurwadziwa kusingaperi, kushushikana kwepfungwa, kana kushungurudzika kwekurara.
Apo iyo inoshandiswa mukurwadziwa kusingaperi chinangwa chavo kazhinji kacho se "matanho anjuju ". Izvi zvinoreva kuti zvinorayirwa pamwe nemamwe mishonga inorwadza panzvimbo pokushandiswa chete sekutambudzika kunorwadza. (Dzidza zvakawanda pamusoro pemishonga mitanhatu yakashandiswa kugadzirisa kurwadziwa kusingaperi .)
Nzira chaiyo iyo inodzvinyirirwa iyo inoshandiswa kugadzirisa kurwadziwa inonyanya kuzivikanwa, kunyange zvazvo inoratidzika kuti nzira iyo yavanobatsira marwadzo asingagumi angave asingabatanidzi maitiro avanoderedza kuderedza.
Zvinowanzofungidzirwa kuti zvinodhaka zvinokonzerwa neurotransmitters serotonin uye norepinephrine , kunyanya pamwe nekudzika kunorwa kwepamuviri. Anodzvinyirira angashandisewo kuburikidza ne histamine receptors kana sodium.
Makirasi eAnode-depressants
Kune zvikamu zvakasiyana-siyana zvakasiyana-siyana zvezvinorwisana nehutachiwana izvo zvakave zvichiedzwa kune vanhu vane kurwadziwa kusingaperi uye nzira iyo iyo inodzvinyirira yekirasi mabasa inogona kunge yakasiyana kune imwe. Zvinodhaka izvo zvakadzidzwa zvinosanganisira:
- Tricyclic vanodzvinyirira
- Kusarudza serotonin reuptake inhibitors (SSRIs)
- Serotonin uye norepinephrine reuptake inhibitors (SNRIs)
- Norepinephrine uye dopamine reuptake inhibitors (NDRIs)
- Combined reuptake inhibitors uye receptor blockers
- Monoamine oxidase inhibitors (MAO inhibitors)
Ngatitarisei pane imwe neimwe yezvikoro izvi zvakasiyana.
Tricyclic Anodzvinyirira
Tricyclic vanodzvinyirirwa vaifungidzirwa kuti kurapwa kwakakwana kwekuora mwoyo pamberi peSRRIs kwakagadzirwa. Kunyange zvazvo mishonga iyi iko ikozvino inoshandiswa kudarika nguva zhinji nokuda kwekuora mwoyo, iyo ndiyo inowanzoshandiswa nehutachiona hunoshandiswa mukurwadziwa kusingaperi. Zvinoratidzika kuti dzinonyanya kubudirira muhutano hwehutano hwekurwa kwehutano asi hwakashandiswa pamhando dzose dzekutambudzika.
Zvinodhaka zvinoshandiswa se tricyclic zvinodzvinyirira zvinosanganisira:
- Elavil (amitriptyline)
- Ascendin (amoxapine)
- Anafranil (clomipramine)
- Pamelor (nortriptyline)
- Norpramin (deipramine)
- Tofranil (imipramine)
- Vivactil (protriptyline)
- Surmontil (trimipramine)
- Sinequan (doxepin)
Apo tricyclic zvinodzvinyirira (kunyanya amitriptyline) zvinoshandiswa mukurwadziwa kusingaperi, dzinowanzopiwa murairo yakaderera zvikuru kune iyo inoshandiswa kuora mwoyo, uye naizvozvo kazhinji inoguma nemigumisiro shoma. Migumisiro yakajairika inogona kusanganisira maonero asina kunaka, kuwedzera kuwanda, uye kurara.
Sarudzo yeSerotonin Reuptake Inhibitors (SSRIs)
Kusarura serotonin reuptake inhibitors (SSRIs) ndevamwe vanonyanya kurongerwa zvinodzvinyirira kuvhiringidzika nekuzvidya mwoyo.
Zvinodhaka munharaunda iyi zvinosanganisira:
- Prozac (fluoxetine)
- Lexapro (escitalopram)
- Luvox (fluvoxamine)
- Celexa (citalopram)
- Zoloft (sertraline)
- Paxil (paroxetine)
Sezvinoratidzwa nezita racho, SSRIs inotarisa neurotransmitter (brain chimiro) serotonin uye chinangwa ndechokuwedzera maitiro e serotonin muuropi. SSRIs inoshanda mishonga yakawanda yevarwere vakawanda uye nemigumisiro inowanzotarisirwa uye inonzwisisika kupfuura iyo inosangana ne tricyclic vanodzvinyirira.
Zvidzidzo zvinotarisa kushandiswa kweSSSRI kune marwadzo asingagumi pasina kuora mwoyo kunowanikwa kuti mishonga iyi inobatsira pane dzakawanda zvirwere zvisingaperi, asi kutsvakurudza kwakawedzerwa kunodiwa.
Serotonin uye Norepinephrine Reuptake Inhibitors (SNRIs)
Serotonin uye norepinephrine reuptake inhibitors (SNRIs) inotanga mapurogiramu maviri eurotransmitter serotonin uye norepinephrine uye inonzi inalitor mbiri dzechikonzero ichi.
Zvose SSRIs uye SNRIs zvinogona kubatsira kutarisa kurwadziwa uye kuneta kunobatanidza nemamiriro ezvinhu ekurwadziwa asingagumi kana fibromyalgia, asi SNRIs inogona kuva yakakosha kupfuura SSRIs maererano nekunzwa kurwadziwa.
Zvinodhaka munharaunda iyi zvinosanganisira:
- Cymbalta (duloxetine)
- Effexor (venlafaxine)
- Pristiq (desvenlafaxine)
- Savella (milnacipran)
Cymbalta yakagamuchirwa neRDA yekurapa fibromyalgia mugore ra2008 uye kurapwa kwemarwadzo emisumbu muna 2010.
Matambudziko anowanzobatanidzwa neSNRIs anosanganisira kuora mwoyo, kurasikirwa nechido, kushushikana, musoro, kusuruvara, uye kuneta.
Norepinephrine uye Dopamine Reuptake Inhibitors (NDRIs)
NDRIs ndedzimwe rudzi rwekudzivirira mwoyo, ne bupropion (Wellbutrin kana Zyban) mishonga inowanikwa mukirasi ino.
Matambudziko anowanzowanzobatanidza kushungurudzika, kuora mwoyo, kuora musoro, kurasikirwa nechido, kusuruvara, uye kuwedzerwa kweropa.
Akabatanidzwa Reuptake Inhibitors uye Receptor Blockers
Kusanganiswa reuptake Inhibitors uye receptor blockers inogona kushandiswa kuora mwoyo, kurara, kana kuora kwenguva refu-uye inosanganisira:
- Desyrel ( trazodone )
- Remeron (mirtazapine)
- Serzone (nefazodone)
Migumisiro yakajairika inosanganisira kukotsira, kuoma muromo, kusuruvara, uye chizuru, uye madhiragi aya haafaniri kushandiswa nevanhu vane nhoroondo yezvinetso zveropa.
Monoamine Oxidase Inhibitors (MAO Inhibitors)
MAO Inhibitors ndiyo yakakura yekurapa iyo isingashandisi zvakanyanya kurapa kuora mwoyo kana zvimwe mamiriro ezvinhu zvichienderana nehuwandu hwemagetsi.
- Nardil (phenelzine)
- Parnate (tranylcypromine)
- Marplan (isocarboxazid)
- Emsam (selegilint)
Kune zvakawanda zvinorambidzwa zvekudya kune vanhu vanoshandisa madhiragi aya uye zvakakosha migumisiro yakawanda inowanzoitika.
Studies on the Use of Antidepressants for Chronic Pain
Ongororo dzekutsvakurudza dzakawana kubatsirwa kubva kushandiswa kwevanhu vanorwara nehutachiona muhutano hwehurombo husingaperi kuvanhu vakuru, kunyanya amitriptyline. Zvinosuruvarisa, pane zvishoma zvinyorwa zvinowanika mukushandiswa kwevanhu vanorwara nehutachiona nokuda kwehupombwe husina hutano hwekenza kune vana kana vari kuyaruka.
Zvinodhaka Zvinogamuchirwa Nezvokurwara Zvisingagumi Nekushanda-Kushandisa Itaiti
Kana uchitaura nezvekushandiswa kwevanhu vanorwara nehutachiona nekurwadziwa kusingaperi kunokosha kusiyanisa zvinodhaka zvinogamuchirwa nekuda kwekushandiswa uku zvichienderana neaya anoshandiswa kure-mavara. Kana chirongwa cheDPA chichibvumirwa kushandiswa zvakasiyana zvinoreva kuti FDA yakadzokorora zvidzidzo uye yakawana kuti mishonga inogona kunge inoshanda uye yakachengeteka iyo inoshandiswa. Off-label use , zvisinei, inoreva madhiragi ayo ari FDA anobvumirwa nemamiriro maviri (somuenzaniso pano, kuora mwoyo) asi inogona kushandiswa kune chimwe chikonzero (somuenzaniso, kurwadziwa kusingaperi.)
Manyevero Nezvokushandisa Antidipressants
Kushandiswa kwevanhu vanorwara nehutachiona hakusi kunyeverwa. I-FDA inotaura kuti vanhu vakuru uye kunyanya vana vanofanira kuonekwa nekuda kwekuwedzera kuora mwoyo kana kuzviuraya pfungwa kana mufambiro mukati memwedzi shomanana yekurapa kana kutevera kuchinja kwemishonga inoshandiswa. Vanhu vanofanira kuonana nokukurumidza nachiremba kana kuora mwoyo kunowedzera kuipa kana kuti kuzviuraya pfungwa kana mufambiro kuwedzera. Zvinonyanya kukosha kune avo vanotora anti-depressant kuti vazive nezvengozi dzezvinhu uye zviratidzo zvekuzviuraya.
Pasi Pasi paKushandiswa kweAndidepressants for Chronic Pain
Kuora mwoyo kunogona kubatsira kuvanhu vanorwara nekurwadziwa kusingagumi nenzira dzinopfuura imwe. Vanhu vazhinji vanogara ne fibromyalgia kana zvimwe zvirwere zvinorwadza zvinosanganawo nekuora mwoyo. Asi vamwe vanodzvinyirira vanogona kupa rusununguko kubva mukurwadziwa kusingaperi nenzira dzakasiyana. Pakati pemapoka akasiyana-siyana evanhu vanodzvinyirira, tricyclic vanodzvinyirira, kunyanya amitriptyline, vakaongororwa zvakanyanya, kunyanya pakurapa marwadzo europathic.
Kutsungirira kurwadziwa kusingagumi kwakaoma, uye kunobata zvinhu zvose zvehupenyu hwako. Kubatanidzwa kwemishonga yakasiyana-siyana (yakadai sekuwedzera mune anodzvinyirira) inogona kuva inobatsira zvikuru, asi isiri-mushonga mishonga uye kushandiswa kwepfungwa kunokosha zvakaenzana.
> Sources:
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> Cooper, T., Heathcote, L., Clinch, J. et al. Anodzvinyirira Maitiro Asingaperi-Asina Kanzera Muvana uye Vana Vachiri Kuyaruka. Cochrane Database yekuongorora kwakarongeka . 2017. 8: CD012535.
> Dosenovic, S., Jelicic Kadic, A., Miljanovic, M. et al. Zvinopindirana Neuropathic Pain: Anokurudzira Kuongorora Kwakagadzikana. Anesthesia uye Analgesia . 2017. 125 (2): 643-652.
> Patetsos, E., uye E. Horjales-Araujo. Kurapa Upenyu Husingaperi ne SSRIs: Chii Chatinoziva? . Pain Research and Management . 2016. 2016: 2020915.