{"id":10307,"date":"2021-04-16T18:41:18","date_gmt":"2021-04-16T15:41:18","guid":{"rendered":"http:\/\/blog.ulubat.org\/?p=10307"},"modified":"2021-04-16T18:44:28","modified_gmt":"2021-04-16T15:44:28","slug":"var-olmayan-bir-seyi-nasil-hissedebilirim-phantom-limb-pain","status":"publish","type":"post","link":"https:\/\/blog.ulubat.org\/index.php\/genel\/var-olmayan-bir-seyi-nasil-hissedebilirim-phantom-limb-pain\/","title":{"rendered":"Var Olmayan Bir \u015eeyi Nas\u0131l Hissedebilirim? Phantom Limb Pain"},"content":{"rendered":"\n

Varl\u0131\u011f\u0131 s\u00f6z konusu olmayan bir \u015feyi hissedemeyiz \u00f6yle de\u011fil mi? Yoksa durum tam bir yalan m\u0131? Size bug\u00fcn bir rahats\u0131zl\u0131ktan s\u00f6z edece\u011fim. \u00d6yle ki sand\u0131\u011f\u0131m\u0131zdan \u00e7ok daha fazla insanda g\u00f6r\u00fclen ve maalesef sahip olan ki\u015finin hayat\u0131n\u0131 az\u0131msanmayacak derecede etkileyen bir a\u011fr\u0131, Phantom a\u011fr\u0131s\u0131. \u00d6zellikle alt ekstremitelerdeki amp\u00fctasyonlardan sonra ortaya \u00e7\u0131kar ve amp\u00fcte edilen uzuvda kronik ve yo\u011fun bir a\u011fr\u0131n\u0131n hissedilmesi ile karakterizedir. Bug\u00fcn sizlerle bu rahats\u0131zl\u0131\u011f\u0131 detayl\u0131 bir \u015fekilde ele alaca\u011f\u0131z.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Phantom A\u011fr\u0131s\u0131na K\u0131sa Bir Bak\u0131\u015f<\/h2>\n\n\n\n

Amp\u00fctasyon sonras\u0131 kaybedilen uzvun a\u011fr\u0131mas\u0131 \u015feklinde kar\u015f\u0131m\u0131za \u00e7\u0131kan Phantom Limb Pain, ilk olarak 16. Yy da Frans\u0131z bir askeri cerrah olan Ambroise Pare taraf\u0131ndan literat\u00fcre kazand\u0131r\u0131lm\u0131\u015ft\u0131r. Bu rahats\u0131zl\u0131ktan muzdarip ki\u015filerde amp\u00fctasyondan sonra ilk bir y\u0131l i\u00e7inde olu\u015fan bu a\u011fr\u0131, yayg\u0131n bir bulgu olarak kar\u015f\u0131m\u0131za \u00e7\u0131kar. Hastalar olmayan uzvunda kronik bir a\u011fr\u0131 duyar. Bu durum onlar\u0131n fiziksel ve psikolojik olarak y\u0131pranmas\u0131na, ya\u015fam kalitelerinin azalmas\u0131na, gerekli yard\u0131m almazlarsa da umutsuzluk ve depresyon gibi duygudurum bozukluklar\u0131 ya\u015famalar\u0131na sebep olur.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Phantom A\u011fr\u0131s\u0131 Nas\u0131l Olu\u015fur<\/h2>\n\n\n\n

Sa\u011fl\u0131kl\u0131 Bir \u0130nsanda Duyu \u0130letimi<\/strong><\/h3>\n\n\n\n

Bu hastal\u0131\u011f\u0131n nas\u0131l olu\u015ftu\u011funu anlayabilmek i\u00e7in sa\u011fl\u0131kl\u0131 bir insanda duyu iletiminin nas\u0131l oldu\u011funa k\u0131saca de\u011finelim. A\u011fr\u0131, dokunma ve \u0131s\u0131 gibi duyular\u0131 i\u00e7inde bar\u0131nd\u0131ran eksteroseptiv duyular; v\u00fccudun \u00e7e\u015fitli yerlerinden ald\u0131klar\u0131 bilgileri anterolateral ve lateral spino-talamik traktus yoluyla talamusa, ard\u0131ndan post-rolandik kortekse ula\u015ft\u0131r\u0131r. Post-rolandik korteks di\u011fer bir ad\u0131yla primer duyu korteksi, b\u00fcnyesinde duyu homunculusunu bar\u0131nd\u0131r\u0131r. V\u00fccudumuzda elimiz, aya\u011f\u0131m\u0131z, dilimiz ve bacaklar\u0131m\u0131z gibi yap\u0131lar\u0131m\u0131z\u0131n beynimizdeki n\u00f6rolojik ba\u011flant\u0131lar\u0131na g\u00f6re haritaland\u0131rmas\u0131na da homunculus denmektedir. K\u0131saca toparlamak gerekirse \u00e7e\u015fitli y\u00fczeysel duyular\u0131m\u0131z, uzun ve karma\u015f\u0131k bir yol ile beynimize ula\u015f\u0131r ve burada sinapslar yaparak ilgili olduklar\u0131 b\u00f6lgede sonlan\u0131r. E\u011fer travma enfeksiyon gibi sebeplerden dolay\u0131 bu yolda bir hasarlanma meydana gelirse de sistem d\u00fczg\u00fcn bir \u015fekilde i\u015fleyemeyece\u011finden ki\u015fi asl\u0131nda olmayan bir uzvun a\u011fr\u0131s\u0131n\u0131 hissetmeye ba\u015flar.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Phantom A\u011fr\u0131s\u0131 Olu\u015fma Sebepleri<\/strong><\/h3>\n\n\n\n

A\u011fr\u0131 duyumuzun normal iletimini \u00f6\u011frencimize g\u00f6re art\u0131k Phantom a\u011fr\u0131s\u0131n\u0131n ne gibi sebeplerle olu\u015ftu\u011funu detayl\u0131 inceleyebiliriz. Bu incelemeyi ba\u015fl\u0131ca iki ba\u015fl\u0131k alt\u0131nda toplayaca\u011f\u0131z: Fiziksel ve kimyasal nedenler.\u00a0<\/p>\n\n\n\n

A\u011fr\u0131n\u0131n Fiziksel Boyutu<\/strong><\/h4>\n\n\n\n

Rahats\u0131zl\u0131\u011f\u0131n fiziksel boyutunda kar\u015f\u0131m\u0131za kortikal reorganizasyon \u00e7\u0131kar. Yeti\u015fkin maymunlar \u00fczerinde yap\u0131lan bir deneyde amp\u00fctasyon sonras\u0131 somatosensoriyel kortekste -genel bir tabirle duyu korteksinde- az\u0131msanmayacak derecede plastisite saptanm\u0131\u015f. Farkl\u0131 a\u011fr\u0131 t\u00fcrleri \u00fczerinde de yap\u0131lan \u00e7al\u0131\u015fmalar sonucunda bu yeniden organizasyonun a\u011fr\u0131n\u0131n b\u00fcy\u00fckl\u00fc\u011f\u00fc ile orant\u0131l\u0131 oldu\u011fu sonucuna ula\u015f\u0131lm\u0131\u015f. K\u0131sacas\u0131 travma sonucu primer duyu korteksinde ne kadar yeniden yap\u0131lanma ve de\u011fi\u015fim oluyorsa Phantom a\u011fr\u0131s\u0131 o kadar yo\u011fun hissedilmektedir.<\/p>\n\n\n\n

A\u011fr\u0131n\u0131n Kimyasal Boyutu<\/strong><\/h4>\n\n\n\n

\u0130kinci etken olan kimyasal nedenler, molek\u00fcler d\u00fczeyde hiperaljezinin olu\u015fmas\u0131na neden olan glutamat ve N-metil\u00a0d-aspartat konsantrasyonlar\u0131n\u0131n art\u0131\u015f\u0131ndan kaynaklan\u0131r. Geli\u015fen plastisite ile kimyasal de\u011fi\u015fikliklere daha duyarl\u0131 hale gelen sinir sistemimiz bu maddeler ile a\u011fr\u0131 hissine a\u00e7\u0131k hale gelir. Artm\u0131\u015f norepinefrin konsantrasyonu da duyarl\u0131l\u0131k ve dolay\u0131s\u0131yla a\u011fr\u0131 hissinin artmas\u0131na sebep olur.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Sonu\u00e7 Olarak<\/h2>\n\n\n\n

Phantom a\u011fr\u0131s\u0131, y\u00fcksek oranda kronik seyreden tedavisi zahmetli ve maliyetli olan bir rahats\u0131zl\u0131kt\u0131r. \u00c7e\u015fitli ila\u00e7lar ve cerrahi y\u00f6ntemler ile \u00e7\u00f6z\u00fclmeye \u00e7al\u0131\u015f\u0131lsa da uygun tedaviyi alamayan ki\u015filerde bu rahats\u0131zl\u0131k, onlarca y\u0131l devam edebilmektedir. Tedavisinde en yayg\u0131n kullan\u0131lan ila\u00e7lardan bir tanesi trisiklik antidepresanlard\u0131r (TSA).\u00a0 Ayr\u0131ca transkutan\u00f6z sinir sim\u00fclasyonunun da (TENS) Phantom a\u011fr\u0131s\u0131n\u0131 azaltmada yard\u0131mc\u0131 oldu\u011fu g\u00f6sterilmi\u015ftir.<\/p>\n\n\n\n

-Flor, H. et al. (1995) “Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation”,\u00a0Nature<\/em>, 375(6531), pp. 482-484. doi: 10.1038\/375482a0.<\/p>\n\n\n\n

-Kaur, A. and Guan, Y. (2018) “Phantom limb pain: A literature review”,\u00a0Chinese Journal of Traumatology<\/em>, 21(6), pp. 366-368. doi: 10.1016\/j.cjtee.2018.04.006.<\/p>\n\n\n\n

-Aternali, A. and Katz, J. (2019) “Recent advances in understanding and managing phantom limb pain”,\u00a0F1000Research<\/em>, 8, p. 1167. doi: 10.12688\/f1000research.19355.1.<\/p>\n\n\n\n

-Flor, H. (2002) “Phantom-limb pain: characteristics, causes, and treatment”,\u00a0The Lancet Neurology<\/em>, 1(3), pp. 182-189. doi: 10.1016\/s1474-4422(02)00074-1<\/p>\n\n\n\n

-Kuffler, D. (2017) “Coping with Phantom Limb Pain”,\u00a0Molecular Neurobiology<\/em>, 55(1), pp. 70-84. doi: 10.1007\/s12035-017-0718-9.<\/p>\n","protected":false},"excerpt":{"rendered":"

Varl\u0131\u011f\u0131 s\u00f6z konusu olmayan bir \u015feyi hissedemeyiz \u00f6yle de\u011fil mi? Yoksa durum tam bir yalan m\u0131? Size bug\u00fcn bir rahats\u0131zl\u0131ktan<\/p>\n","protected":false},"author":187,"featured_media":10312,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[3,1],"tags":[490,2000,1999,2003,1997,1998,2006,2001,2002,1996,2005,2004,356],"acf":[],"views":1122,"_links":{"self":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/10307"}],"collection":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/users\/187"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/comments?post=10307"}],"version-history":[{"count":6,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/10307\/revisions"}],"predecessor-version":[{"id":10319,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/10307\/revisions\/10319"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media\/10312"}],"wp:attachment":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media?parent=10307"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/categories?post=10307"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/tags?post=10307"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}