Shin buprenorphine shine makomar ciwo mai tsanani?
A darajar fuska, matsalar ciwon opioid da ciwo na kullum suna fuskantar tsayayya. Kodayake CDC ta nuna cewa "shaidar da ake yi na tsawon lokaci don maganin ciwon daji na rashin jin dadin rayuwa yana da iyakancewa, tare da rashin shaida don sanin amfanin dindindin ba bisa ka'ida ba," gaskiyar ta tabbata cewa opioids ne babban magunguna don magance ciwo na kullum.
Kodayake masu kula da kulawa na farko sun iya yin bayani game da kwayoyin cutar don ciwo mai tsanani, suna da jinkirin yin haka don tsoron haƙuri kan kari ko kuma dogara. Mafi yawan likitoci na farko sun sami damar samar da marasa lafiya marasa lafiya na tsawon lokaci har ma da sauri kuma suna juya wadannan marasa lafiya zuwa likitoci.
Duk da rashin jin daɗin magance shi, ciwo mai tsanani yana ƙara karuwa. A shekara ta 2010, kashi 31 cikin dari na jama'ar Amirka na fama da ciwo mai tsanani, wanda aka bayyana azabar da ta wuce fiye da uku zuwa watanni shida. Saboda mafiya yawan mutanen da ke fama da ciwon daji na yau da kullum ga likitoci na farko, zai zama babban nasara idan muna da wata matsala mai kyau ga maye gurbin opioids-wasu maganin da waɗannan likitoci za su iya jin dadi. Wani magani da ake kira buprenorphine zai iya taimakawa wata rana don daidaita wannan lissafin.
Menene Buprenorphine?
Buprenorphine na daga cikin kwayoyi da ake kira opioid masu tsaurin kai tsaye-masu tsayayya.
Bugu da ƙari, wani magani wanda ya hada da buprenorphine da naloxone (Suboxone), buprenorphine ana amfani dashi ne a matsayin tsarin maye gurbin opioid don magance magungunan opioid (dogara ga heroin ko maganin narkewar kwayoyi). Wadannan kwayoyi sunyi aiki ta hanyar hana bayyanar cututtuka lokacin da mutumin da ke dogara da opioids ya dakatar da daukar hoton.
Buprenorphine wani abu ne mai tsinkaye na opium na opium alkaloid dabaine wanda aka samo a cikin poppy ( Papaver somniferum ). A hakika ya dauki shekarun da suka wuce don masu bincike sun hada da magungunan miyagun ƙwayoyi, kuma da yawa sun yi ƙoƙarin yin ƙoƙari kafin kamfanin kamfanonin Ingila ya ƙaddamar da shi a shekarar 1966. A shekara ta 1978, an gabatar da kwayar halitta ta buprenorphine, daga bisani kuma wani abu mai zurfi (wanda ake amfani da shi a ƙarƙashin harshen) a shekarar 1982. A shekara ta 1985, an gabatar da buprenorphine a Amurka a matsayin likitanci na opioid.
Yadda Yake aiki
Buprenorphine yana da ƙayyadaddun tsari na aikin da zai sa ya zama mai ban sha'awa ba kawai don magance matsayi na opioid amma mai yiwuwa ciwo mai tsanani ba.
Na farko, buprenorphine yana da dangantaka mai mahimmanci ga mai karɓar μ-opioid, wanda ke da alhakin taimako na jin zafi. Bugu da ƙari, buprenorphine yana da raguwa mai raguwa daga mai karɓan μ-opioid, ma'ana yana tsayawa da tsayi ga mai karɓa, kuma yana da tasiri mai tsawo.
Na biyu, kodayake buprenorphine yana son mai karɓa na μ-opioid kadan kadan, yana aiki ne kawai a matsayin mai rikon kwakwalwa mai tsauri na μ-opioid, wanda ke nufin cewa yayinda buprenorphine ta hana karba daga opioid, ayyukanta ba su da tsarya fiye da kayan ado.
Na uku, buprenorphine ne mai cike da kwakwalwa mai tsinkayye.
Ƙaddamar da sakamako na masu karɓan ky-opioid a cikin sakamako na euphoric da psychotic na opioids. A wasu kalmomi, buprenorphine ba zai sa ku "high" ba.
Gudanarwa
Kamar yadda aka ambata a baya, an haɗa da naloxone tare da buprenorphine a cikin hanyar Suboxone. Naloxone wani ɗan gajeren lokaci ne, antagonist mai karɓa na opioid. Idan an hade shi a cikin ƙananan asarar da buprenorphine, naloxone zai iya magance cututtukan cututtuka masu illa mai haɗari-ciki har da matsanancin numfashi, suturewa, da hypotension-ba tare da ciwo guragu ba, ko taimako na jin zafi. Bugu da ƙari kuma, kariyar naloxone zuwa buprenorphine yana aiki ne don hana tsangwama.
A cewar NIH:
Buprenorphine ya zo a matsayin littafi mai laushi. Haɗuwa da buprenorphine da naloxone sun zo ne a matsayin littafi mai zurfi (Zubsolv) kuma a matsayin fim mai zurfi (Suboxone) don ɗauka a ƙarƙashin harshe kuma a matsayin fim mai kunna (Bunavail) don amfani tsakanin danko da kunci.
Buprenorphine ma ya zo a cikin wata hanyar fassara, intravenous tsari, kuma, mafi yawan kwanan nan, wani submerual spray. A watan Disamba na shekara ta 2017, an sanar da cewa FDA ta sake nazarin sabon suturar da aka yi don magance mummunan ciwo.
Hanyoyin Gaba
Kodayake ba kusan kamar yadda ke kawo hadari kamar yadda opioids ba, duka buprenorphine da Suboxone na iya samun mummunar tasiri ta ciki kamar wadannan:
- Binciken baya
- Binciken tsoro
- Tabbatarwa
- Difficulty da barci
- Ƙunƙarar murya
- Ciwon kai
- Cutar ciwo
- Maganganun launi
Ƙari mafi tsanani mai illa, irin su wahalar numfashi ko busa bakin ko harshe, buƙatar gaggawa a hankali. Abu mai mahimmanci, hadawa da buprenorphine tare da wasu kwayoyi kamar benzodiazepines na iya zama na mutuwa.
Buprenorphine na Balance
A cikin rahoton da aka tsara a watan Disamba na shekara ta 2017, Aiyer da masu marubuta sun bincika tasiri na buprenorphine don gudanar da ciwo mai tsanani. Masu bincike sun binciki fasalin gwaje-gwaje 25 da aka bazu wanda ya shafi tsarin buprenorphine biyar:
- Intravenous buprenorphine
- Sublingual buprenorphine
- Sublingual buprenorphine / naloxone (Suboxone)
- Buccal buprenorphine
- Transdermal buprenorphine
A ƙarshe, masu binciken sun gano cewa 14 daga 25 karatun nuna cewa buprenorphine a kowace halitta ya tasiri ga kula da ciwo na kullum. Fiye da haka, 10 na 15 binciken ya nuna cewa buprenorphine transdermal yana da tasiri, kuma biyu daga cikin binciken uku sun nuna cewa buprenorphine na buccal yana da tasiri. Ɗaya daga cikin littattafai shida ya nuna cewa ko dai dai dai ko dai wani abu ne mai sauƙi ko kuma mai amfani da ƙwayar cuta yana da tasiri don magance ciwo mai tsanani. Abin mahimmanci, babu wani mummunar tasiri da aka ruwaito a cikin kowane binciken, wanda ya nuna cewa buprenorphine mai lafiya.
A cikin shekara ta 2014, Cote da co-marubuta sun wallafa wani nazari na yau da kullum wanda yayi nazari akan inganci na buprenorphine na sublingual don magance ciwo mai tsanani. Kodayake yawancin nazarin da suka bincika sun kasance masu tsinkayewa da rashin inganci, masu bincike sun gano cewa buprenorphine mai zurfi yana da tasiri wajen magance ciwo mai tsanani. Musamman, Cote da co-marubuta sun hada da jerin masu amfani na buprenorphine:
- Ƙãra inganci a cikin neuropathic zafi saboda ta musamman pharmacological profile.
- Amfani dashi a cikin tsofaffi da kuma rashin lalacewa saboda ƙananan sakamako akan rabi-rai da kuma metabolites.
- Kadan jigilar cutar idan aka kwatanta da morphine da fentanyl bisa la'akari da iyakacin shaida daga aiki na asali da kuma aikin asibiti.
- Sakamakon rufi na numfashi na numfashi idan aka yi amfani da shi ba tare da wani ɓangaren magunguna na tsakiya ba, watakila saboda aikin da ke ciki don haifar da analgesia na iya zama ƙasa da na numfashi na numfashi.
- Ƙananan sakamako a kan hypogonadism, kamar yadda aka nuna a cikin farfadowa magani.
- Ƙananan ci gaba na haƙuri, watakila ta hanyar kwakwalwa ta karuwanci ko kuma opioid-receptor-like (ORL-1) agonism.
- Harkokin antihyperalgesic, watakila saboda ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwar ƙwayar cuta ko kuma ORL-1 agonism.
- Hanyoyin cutar antidepressant a cikin marasa lafiya ba su amsa zuwa ga al'ada ba.
Abin sha'awa, anyi zaton cewa saboda kaddarorinsa, buprenorphine zai iya taimakawa mutanen da ke samun maganin da ake yiwa na opioid.
A cikin wata kasida mai taken "Binciken cikakken nazari na hyperalgesia na opioid," Lee da co-marubuta sunyi amfani da hyperlagesia kamar yadda:
Anyi amfani da hyperalgesia-induced hyphengesia (OIH) a matsayin wani mahimmanci wanda ya haifar da yadawa ga kayan aiki. Yanayin yana da alamar amsawa mai ban tsoro wanda wani mai karɓar haƙuri ya samu magani don maganin ciwo zai iya zama mafi mahimmanci ga wasu matsaloli masu zafi. Irin irin ciwo da aka samu zai iya zama daidai da ciwo mai mahimmanci ko kuma zai iya bambanta da asali na asali. OIH ya zama wani abu ne mai ban mamaki, wanda ba zai yiwu ba, kuma mai halayyar mutum wanda zai iya bayyana asarar tasiri mai kyau a wasu marasa lafiya.
Bayan bayanin kula, jin zafi mai zafi shine mummunan ciwo wanda zai haifar da lalacewar jiki. Anyi zaton cewa buprenorphine na da kayan mallakar antinociceptive.
A cikin labarin da aka buga a Anesthesiology a shekarar 2014, Chen da masu marubuta sun rubuta wadannan:
An nuna Buprenorphine don sake juyayin hyperalgesia wanda ya haifar da opioids ta hanyar antinociception 'buprenorphine.' Bugu da ƙari, buprenorphine mashawarcin mai kwakwalwa ne mai kwakwalwa kuma zai iya yin gasa tare da tasiri na dynorphin spinal, mai rikon kwarjin kwan-kwaryar kwastan. Domin dynorphin tazarar ya karu bayan an nuna shi a matsayin opioid kuma yana taimaka wa OIH, wannan sakamako mai tasiri na buprenorphine a kan shafin yanar gizon yanar gizo na kwakwalwa na iya rage sakamako na dynorphin spinal da zai haifar da ragewar OIH.
Ya bayyana Buprenorphine
Har ila yau, a Amurka, ana amfani da buprenorphine don magance ciwo na kullum. Ana ba da takardar izini don yin maganin ciwo na kullum. Bugu da ƙari kuma, ana iya samun suturar buprenorphine na transdermal don magance ciwo mai tsanani a cikin Amurka.
Duk da haka, babu wani ra'ayin ra'ayi game da ingancin yin amfani da buprenorphine don wannan dalili. A halin yanzu, ƙananan binciken da ke nazarin sakamakon buprenorphine a kan ciwo na yau da kullum yana da matukar damuwa a hanyarsu, kuma suna da wuya a kwatanta juna.
Kafin sanadin maganin buprenorphine don maganin ciwon daji na yau da kullum ya zama abin da ke tabbatar da shaidar, akwai matsaloli daban-daban da za a warware. Alal misali, nazarin na yau da kullum yana amfani da ma'aunin matsala masu yawa idan aka kwatanta da inganci don haka yana ba da cikakken bincike. Sakamakon gwadawa a cikin nazarin binciken buprenorphine yana bukatar a daidaita. Bugu da ƙari kuma, yin amfani da hanyoyin da za a gudanar da gwamnati zai bukaci a bincika don gabatar da ciwo mai tsanani.
Idan takardun maganin buprenorphine don ciwo na kullum ya kasance da zama shaida, tushen likitoci na farko zai zama maƙasudin wannan aiki. A shekara ta 2000, Dokar Dokar Jiyya ta Drug ta Amurka ta ba da doka ga likitocin kulawa na farko don samar da farfadowa na opioid ta amfani da jigilar Lissafin III, IV, da V. A shekara ta 2002, FDA ta amince da maganin rashin lafiya tare da buprenorphine, yana nuna shi a matsayin likita na jima'i na III.
Duk abin da likitan kulawa na farko ya buƙaci ya iya yin rubutun buprenorphine a cikin wani wuri na rashin lafiya shine kammala karatun sa'a takwas. Duk da haka, ƙananan masu kula da kulawa na farko sun cancanci yin rubutun buprenorphine.
Kodayake magunguna masu kula da kulawa da dama na iya damu da wannan shawara, ba zai zama babban matsala ba don tunani cewa likitocin kulawa na farko zasu iya zama ciwo mai tsanani a cikin mai amfani da buprenorphine. Bugu da ƙari ga likitoci na farko masu kula da likitocin da ke da ikon rubuta rubutun buprenorphine, CDC yana da takaddama a madadin likitocin kulawa na farko don magance ciwon daji tare da opioids.
Ainihin, sharuɗɗan CDC sun bada shawara cewa kula da likitoci na farko suyi amfani da su don ciwo mai tsanani amma idan marasa lafiya na marasa lafiya sun isa, kuma su rubuta kayan aiki a mafi yawan kasuwa. A cikin wannan mahallin, buprenorphine zai iya zama da gaske a matsayin wani zaɓi na opioid.
> Sources:
> Aiyer R, et al. Jiyya na Kwayar Matsala Tare da Shirye-shiryen Buprenorphine Dabba: Binciken Tsare na Nazarin Harkokin Gudanarwa. Anesthesia & Analgesia. 2017. [rubutun gaba]
> Chen KY, Chen L, Mao J. Buprenorphine-Naloxone Far a Pain Management. Anesthesiology. 2014; 120 (5): 1262-74.
> Cote J, Montgomery L. Sublingual Buprenorphine a matsayin Analgesic a cikin Tsoro Bala'in: A Review System. Ciwon Magunguna. 2014; 15: 1171-1178.
> Dowell D, Haegerich TM, Chou A. CDC Manufofin don Bayar da Opioids na Balance mai tsanani - Amurka, 2016. MMWR. 2016; 65 (1): 1-49.
> Lee M, et al. Binciken Binciken Harkokin Harkokin Harkokin Aiki na Opioid. Likita mai zafi. 2011; 14 (2): 145-61.