Fantom aʼzo: Versiyalar orasidagi farq

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„Phantom limb“ sahifasi tarjima qilib yaratildi
(Farq yoʻq)

19-Noyabr 2022, 06:14 dagi koʻrinishi

Fantom a'zo - kesilgan yoki yo'qotilgan, ammo haligacha sezgisi saqlanib qolgandek tuyuladigan qo'l yoki oyoq a'zosi. Amputatsiyani boshdan kechirgan odamlarning taxminan 80-100 foizida kesilgan oyoq-qo'llarini hali ham his qilib turgandek tuyg'u kuzatiladi. Biroq, ulardan juda kam foizdagi odamlar kesilgan a'zolarda hayoliy og'riqni boshdan kechiradi. Bu hislar amputatsiyalanganlarda nisbatan tez-tez uchraydi va odatda davolanishsiz ikki-uch yil ichida yo'qoladi. Tadqiqotlar fantom a'zo og'rig'ining (PLP) asosiy mexanizmlarini va samarali davolash usullarini o'rganishda davom etmoqda[1].

Belgilar va simptomlar

Ko'pchilik (80% dan 100% gacha) amputatsiya qilingan bemorlar fantom a'zo hissini boshdan kechiradi, ularning ba'zilarida bu his og'riqqa aloqador bo'lmaydi[2]. Amputatsiya qilingan odam fantom a'zo hali ham tananing bir qismi ekanligini juda kuchli his qilishi mumkin[3].

Odamlar ba'zida aslida yo'q bo'lgan qo'llari bilan imo-ishora qilayotgandek his qilishadi, qo'llari/oyoqlari qichishayotgandek bo'ladi yoki hatto narsalarni olishga harakat qilishadi. Ular qo'llari yoki oyoqlarini butunlay yo'q deb emas, balki kaltalashib qolgan deb o'ylashadi. Ba'zida og'riq stress, tahlika va ob-havo o'zgarishi sababli kuchayishi mumkin[4]. Ekstremal ob-havo sharoitlari, ayniqsa muzlashdan past haroratlar sezuvchanlikning oshishiga olib kelishi mumkin. Fantom a'zo og'rig'i odatda vaqti-vaqti bilan bo'ladi, lekin ba'zi hollarda doimiy ham bo'lishi mumkin. Hurujlar chastotasi va intensivligi odatda vaqt o'tishi bilan kamayadi[4].

Fantom a'zolardagi repressiv xotiralar amputatsiyadan keyingi hislarning sababi bo'lishi mumkin. Xususan, bir nechta bemorlar kesilgan qo'llarining kaftida tirnoqlar botib turgandek og'riqni his qilishayotganini aytishgan. Yo'qotilgan oyoq-qo'l tufayli motorika kuchayib ketadi, shuning uchun bemorda motorik ma'lumotlar ko'payishi oqibatida og'riq hissi sezilayotgandek bo'lishi mumkin. Bemorda qo'lni musht qilib siqish bo'yicha avvalgi motorika buyruqlari va musht ichida tirnoqlarini kaftiga botirish haqidagi sensorli ma'lumotlarning repressiv xotiralari mavjud bo'lib, bu xotiralar miyadagi oldingi neyron aloqalar tufayli saqlanib qoladi[5].

Fantom a'zo sindromi

"Fantom a'zo" atamasi 1871-yilda shifokor Silas Weir Mitchell tomonidan kiritilgan[6]. Ko'p yillar davomida fantom a'zo paydo bo'lishining asosiy gipotezasi amputatsiya joyida periferik asab tiziminida yuzaga kelganligi edi (neyroma). 1980-yillarning oxiriga kelib, Ronald Melzack bu gipoteza xato ekanligini e'tirof etdi, chunki oyoq-qo'llarisiz tug'ilgan ko'plab odamlarda ham fantom a'zo hissi yuzaga kelgan[7]. Melzackning so'zlariga ko'ra, tanadagi bu hissiyot o'zaro bog'langan nerv tuzilmalarining keng tarmog'i tomonidan yaratilgan bo'lib, u buni "neyromatritsa" deb atagan[7].

National Institutes of Health da (Milliy Sog'liqni saqlash instituti, NIH) Pons va uning hamkasblari (1991) makaka maymunlarida birlamchi somatosensor korteks hissiy ma'lumotlar yo'qolganidan keyin sezilarli darajada qayta tashkil etilishini ko'rsatdi.[8].

Bu natijalar haqida eshitgan Vilayanur S. Ramachandran odamlarda fantom a'zo hissiyotlari inson miyasining somatosensor korteksida qayta tashkil etilishi bilan bog'liq bo'lishi mumkinligini taxmin qildi. Ramachandran va uning hamkasblari ushbu farazni yuzning turli qismlarini silash yetishmayotgan a'zoning turli qismlariga teginish hissi paydo bo'lishiga olib kelishini ko'rsatib berdilar. Keyinchalik amputatsiyalanganlarning miyasini skanerlash Pons maymunlarda kuzatgan kortikal qayta tashkil etilishini yana bir bor isbotladi[9].

Korteksdagi noto'g'ri o'zgarishlar fantom og'rig'iga sabab bo'lishi mumkin, ammo hammasi ham bunga bog'liq emas. Tamar Makin (Oksford) va Marshall Devor (Hebrew University, Quddus) kabi og'riqlar bo'yicha tadqiqotchilarning ta'kidlashicha, fantom a'zo og'rig'i birinchi navbatda periferik asab tizimidagi "keraksiz" ma'lumotlar natijasidir[10],

Fantom a'zodagi og'riqning asosiy neyron mexanizmlari bo'yicha ko'plab tadqiqotlar o'tkazilganiga qaramay, uning sabablari haqida hali ham aniq konsensus mavjud emas. Miya ham, periferik asab tizimi ham bu jarayonda ishtirok etishi mumkin[11].

Aniqroq mexanizmlar va tushuntirishlar bo'yicha tadqiqotlar davom etmoqda[12].

Nerv mexanizmlari

Og'riq, harorat, teginish va bosim ma'lumotlari markaziy asab tizimiga anterolateral tizim (spinotalamik yo'llar, spinoretikulyar yo'llar, spinomezensefalik yo'llar) orqali yetkaziladi, og'riq va harorat ma'lumotlari lateral spinotalamik yo'llar orqali birlamchi sezgi korteksiga uzatiladi. Parietal lobdagi postcentral girusda sensorli ma'lumotlar somatotropik tarzda ifodalanadi va sensorli homunculus hosil bo'ladi[13].

Fantom a'zo sindromida tananing ortiq mavjud bo'lmagan qismidan og'riqni ko'rsatadigan sensorik ma'lumot mavjud bo'ladi. Ushbu hodisa hali ham to'liq tushunilmagan, ammo bu somatosensor korteksning faollashuvidan kelib chiqqan deb taxmin qilinadi.

Davolash

So'nggi yigirma yil ichida davolanishga yondashuvlarning aksariyati simptomlarning izchil yaxshilanishini ko'rsatmadi. Davolash usullari antidepressantlar, orqa miya stimulyatsiyasi, vibratsiya terapiyasi, igna sanchib davolash, gipnoz va biofeedback kabilarni o'z ichiga oladi[14]. Ammo, qaysi davo chorasi boshqalardan ko'ra samaraliroq ekanligi haqida ishonchli dalillar yo'q[15].

V. S. Ramachandran tomonidan ishlab chiqilgan fantom a'zo sindromini davolash uchun qo'llaniladigan ko'zgu qutisi

Ko'pgina davolash usullari u qadar samarali emas[16]. Ketamin yoki morfin operatsiya vaqtida foyda berishi mumkin[17]. Morfin operatsiyadan keyin ham uzoq vaqt davomida foydali bo'lishi mumkin[17]. Gabapentin haqida turlicha dalillar va fikrlar mavjud[17]. Mahalliy anesteziyani ta'minlaydigan perinevral kateterlar jarrohlikdan so'ng fantom a'zo og'rig'ining oldini olish uchun qo'yilganda yaxshi samara bermagan[18].

Jamoatchilikka qiziqish uyg'otgan yondashuvlardan biri ko'zgu qutisidan foydalanishdir. Ko'zgu qutisi inson qo'l yoki oyog'ini xuddi kesilmagandek ko'rishi va fantom a'zosini go'yo "harakatlantira olishini" ko'rib, uni potentsial og'riqli pozitsiyalardan chiqarish imkonini beradi[19].

Ko'zgu terapiyasi V. S. Ramachandran tomonidan 1990-yillarning boshida davo chorasi sifatida kiritilgan bo'lsa-da, 2009-yilgacha u haqida kam tadqiqot olib borilgan va 2016-yilgi taqrizlarga ko'ra, keyingi tadqiqotlarning aksariyati sifatsiz bo'lgan[20]. Ko'zgu terapiyasi (MT) bo'yicha ko'plab hisobotlarning ilmiy sifatini ham tanqid qilgan 2018-yilgi taqriz 2012- va 2017-yillar oralig'ida o'tkazilgan 15 ta sifatli tadqiqotni aniqladi (115 ta nashrdan) va "Ko'zgu terapiyasi fantom a'zo og'rig'ini bartaraf etishda, kunlik og'riq epizodlarining intensivligi va davomiyligini kamaytirishda samara berishi mumkin, bu fantom og'rig'i uchun to'g'ri, oddiy va arzon davo chorasidir" degan xulosaga keldi[21].

Boshqa fantom sezgilar

Fantom sezgilar, shuningdek, qo'l-oyoqlardan tashqari boshqa a'zolarni olib tashlangandan keyin ham paydo bo'lishi mumkin, masalan, ko'krak amputatsiyasidan so'ng[22], tishni olib tashlashdan keyin (fantom tish og'rig'i)[23] yoki ko'z amputatsiyasi o'tkazilgach (fantom ko'z sindromi)[24].

Jinsni o'zgartirish operatsiyasidan keyin ba'zi odamlar fantom genital a'zo sezgisi haqida shikoyat qilishgan. Bunday shikoyatlar operatsiyadan keyingi transgender ayollar orasida kamroq tarqalgan, ammo transgender erkaklarda bu ko'proq sodir bo'lgan. Xuddi shunday, mastektomiyadan o'tgan subyektlar fantom ko'krak og'rig'ini boshdan kechirishgan; bu shikoyatlar operatsiyadan keyingi transgender erkaklar orasida ancha kam uchraydi[25].

Havolalar

  1. ↑ Manchikanti, Laxmaiah; Singh, Vijay; Boswell, Mark V. (2007-01-01), Waldman, Steven D.; Bloch, Joseph I. (muh.), „chapter 28 - Phantom Pain Syndromes“, Pain Management, W.B. Saunders: 304–315, doi:10.1016/b978-0-7216-0334-6.50032-7, ISBN 978-0-7216-0334-6, qaraldi: 2019-12-09
  2. ↑ Chahine, Lama; Kanazi, Ghassan (2007). "Phantom limb syndrome: A review". MEJ Anesth 19 (2): 345–55. Archived from the original on 2019-07-21. https://web.archive.org/web/20190721010514/https://pdfs.semanticscholar.org/0f8d/2b80b5c20ed0e21076de4b5ac48327ca05d2.pdf. Qaraldi: July 20, 2019. Fantom aʼzo]]
  3. ↑ Melzack, R. (1992). "Phantom limbs". Scientific American 266 (4): 120–126. doi:10.1038/scientificamerican0492-120. PMID 1566028. 
  4. ↑ 4,0 4,1 Nikolajsen, L.. Wall & Melzack's Textbook of Pain, 5th, Elsevier, 2006 — 961–971 bet. 
  5. ↑ Ramachandran, V. S. (1998-11-29). "Consciousness and body image: lessons from phantom limbs, Capgras syndrome and pain asymbolia". Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences 353 (1377): 1851–1859. doi:10.1098/rstb.1998.0337. ISSN 0962-8436. PMID 9854257. PMC 1692421. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1692421. 
  6. ↑ Woodhouse, Annie (2005). "Phantom limb sensation". Clinical and Experimental Pharmacology and Physiology. 32 (1–2): 132–134. doi:10.1111/j.1440-1681.2005.04142.x. ISSN 0305-1870. PMID 15730449.
  7. ↑ 7,0 7,1 Canadian Psychology, 1989, 30:1
  8. ↑ "Massive cortical reorganization after sensory deafferentation in adult macaques.". Science 252 (5014): 1857–1860. 1991. doi:10.1126/science.1843843. PMID 1843843. https://semanticscholar.org/paper/26644cd01a5d33015e37f9c3d68b2298bd2d52a2. 
  9. ↑ Ramchandran, VS; Hirstein, William (1998). "The perception of phantom limbs". Brain 121 (9): 1603–1630. doi:10.1093/brain/121.9.1603. PMID 9762952. 
  10. ↑ Peripheral nervous system origin of phantom limb pain, Pain, Vol. 155, Issue 7, pages 1384-1391
  11. ↑ Collins, Kassondra L; Russell, Hannah G. (2018). "A review of current theories and treatments for phantom limb pain". J Clin Invest 128 (6): 2168–2176. doi:10.1172/JCI94003. PMID 29856366. PMC 5983333. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5983333. "Currently, the most commonly posited CNS theory is the cortical remapping theory (CRT), in which the brain is believed to respond to limb loss by reorganizing somatosensory maps (16)... While an amputation directly affects the PNS, the CNS is also affected due to changes in sensory and movement signaling. Debate still remains over the cause and maintaining factors of both phantom limbs and the associated pain." 
  12. ↑ Kaur, Amreet; Guan, Yuxi (2018). "Phantom limb pain: A literature review". Chin J Traumatol 21 (6): 366–368. doi:10.1016/j.cjtee.2018.04.006. PMID 30583983. PMC 6354174. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6354174. "It is unsurprising that with an amputation that such an intricate highway of information transport to and from the periphery may have the potential for problematic neurologic developments...Although phantom limb sensation has already been described and proposed by French military surgeon Ambroise Pare 500 years ago, there is still no detailed explanation of its mechanisms." 
  13. ↑ Kaur, Amreet; Guan, Yuxi (December 2018). "Phantom limb pain: A literature review". Chinese Journal of Traumatology 21 (6): 366–368. doi:10.1016/j.cjtee.2018.04.006. ISSN 1008-1275. PMID 30583983. PMC 6354174. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6354174. 
  14. ↑ Foell, Jens; Bekrater-Bodmann, Robin; Flor, Herta; Cole, Jonathan (December 2011). "Phantom Limb Pain After Lower Limb Trauma: Origins and Treatments". The International Journal of Lower Extremity Wounds 10 (4): 224–235. doi:10.1177/1534734611428730. PMID 22184752. https://semanticscholar.org/paper/1f15898b44062538df7ec25d261b894c11ffb475. 
  15. ↑ Alviar, Maria Jenelyn M.; Hale, Tom; Dungca, Monalisa (2016-10-14). "Pharmacologic interventions for treating phantom limb pain". The Cochrane Database of Systematic Reviews 10 (8): CD006380. doi:10.1002/14651858.CD006380.pub3. ISSN 1469-493X. PMID 27737513. PMC 6472447. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6472447. 
  16. ↑ Flor, H; Nikolajsen, L; Jensn, T (November 2006). "Phantom limb pain: a case of maladaptive CNS plasticity?". Nature Reviews Neuroscience 7 (11): 873–881. doi:10.1038/nrn1991. PMID 17053811. Archived from the original on 2012-07-22. https://web.archive.org/web/20120722014045/http://krieger.jhu.edu/sebin/s/u/Flor_et_al_2006.pdf. Qaraldi: 2012-04-16. Fantom aʼzo]]
  17. ↑ 17,0 17,1 17,2 McCormick, Z; Chang-Chien, G; Marshall, B; Huang, M; Harden, RN (February 2014). "Phantom limb pain: a systematic neuroanatomical-based review of pharmacologic treatment.". Pain Medicine 15 (2): 292–305. doi:10.1111/pme.12283. PMID 24224475. 
  18. ↑ Bosanquet, DC.; Glasbey, JC.; Stimpson, A.; Williams, IM.; Twine, CP. (Jun 2015). "Systematic Review and Meta-analysis of the Efficacy of Perineural Local Anaesthetic Catheters after Major Lower Limb Amputation.". Eur J Vasc Endovasc Surg 50 (2): 241–9. doi:10.1016/j.ejvs.2015.04.030. PMID 26067167. 
  19. ↑ Ramachandran, V. S., Rogers-Ramachandran, D. C., Cobb, S. (1995). "Touching the phantom". Nature 377 (6549): 489–490. doi:10.1038/377489a0. PMID 7566144. 
  20. ↑ Barbin J., Seetha V., Casillas J.M., Paysant J., Pérennou D. (September 2016). "The effects of mirror therapy on pain and motor control of phantom limb in amputees: A systematic review". Annals of Physical and Rehabilitation Medicine 59:4 (4): 270–275. doi:10.1016/j.rehab.2016.04.001. PMID 27256539. "" "The level of evidence is insufficient to recommend MT as a first intention treatment for PLP""" 
  21. ↑ Campo-Prieto, P; Rodríguez-Fuentes, G (November 14, 2018). "Effectiveness of mirror therapy in phantom limb pain: A literature review". Neurologia. doi:10.1016/j.nrl.2018.08.003. PMID 30447854. "It is a valid, simple, and inexpensive treatment for PLP. The methodological quality of most publications in this field is very limited, highlighting the need for additional, high-quality studies to develop clinical protocols that could maximise the benefits of MT for patients with PLP." 
  22. ↑ Ahmed, A.; Bhatnagar, S.; Rana, S. P.; Ahmad, S. M.; Joshi, S.; Mishra, S. (2014). "Prevalence of phantom breast pain and sensation among postmastectomy patients suffering from breast cancer: a prospective study". Pain Pract 14 (2): E17–28. doi:10.1111/papr.12089. PMID 23789788. 
  23. ↑ Marbach, J. J.; Raphael, K. G. (2000). "Phantom tooth pain: a new look at an old dilemma". Pain Med 1 (1): 68–77. doi:10.1046/j.1526-4637.2000.00012.x. PMID 15101965. 
  24. ↑ Sörös, P.; Vo, O.; Husstedt, I.-W.; Evers, S.; Gerding, H. (2003). "Phantom eye syndrome: Its prevalence, phenomenology, and putative mechanisms". Neurology 60 (9): 1542–1543. doi:10.1212/01.wnl.0000059547.68899.f5. PMID 12743251. https://semanticscholar.org/paper/71950c2b1dc9a0ec69fafc7a2cd032615cd29f5c. 
  25. ↑ Phantom Penises In Transsexuals, by V.S. Ramachandran; in Journal of Consciousness Studies Volume 15, Number 1, 2008, pp. 5-16(12); retrieved July 30, 2016 
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