Nyeri neuropatik

Novi Irawan

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 Pain is an unpleasant sensory and emotional experience
associated with
actual or potential tissue damage or describe in terms of such damage

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Understanding key type of pain

Neuropathic Pain Inflammatory Pain

Mixed Pain
Pain initiated or caused by a Pain with Pain caused by injury to
primary lesion or dysfunction neuropathic and body tissues
in the nervous system nociceptive
(musculoskeletal,
(either peripheral or components
central nervous system)1 cutaneous or visceral)2

Examples Examples Examples

Peripheral
• Postherpetic neuralgia • Low back pain with • Pain due to inflammation
• Trigeminal neuralgia radiculopathy • Limb pain after a fracture
• Diabetic peripheral neuropathy • Cervical • Joint pain in osteoarthritis
• Postsurgical neuropathy radiculopathy • Postoperative visceral pain
• Posttraumatic neuropathy • Cancer pain
Central • Carpal tunnel Common descriptors2
• Poststroke pain syndrome • Aching
Common descriptors2 • Sharp
• Burning • Throbbing
• Tingling
• Hypersensitivity to touch or cold
1. International Association for the Study of Pain. IASP Pain Terminology.
2. Raja et al. in Wall PD, Melzack R (Eds). Textbook of pain. 4th Ed. 1999.;11-57

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Nyeri nosiseptik

Lesi atau
trauma Nyeri
Mediator inflamasi: (hiperalgesia)
jaringan
Bradikinin
Prostagladin
histamin

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Nyeri neuropatik

Lesi atau Nyeri

trauma (parestesia,
Remodelling:
saraf hiperpatia,
Sprouting
allodinia)
Neuroma
Ectopic pacemaker
Ectopic discharge

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 Nyeri Neuropatik
 Nyeri karena adanya lesi primer atau
disfungsi pada sistim saraf.

 Sering kali merupakan kondisi kronik

(postherpetic neuralgia, nyeri pasca
stroke).

 Memberikan respond yang buruk

terhadap analgesik konvensional.

 Nyeri seperti kejutan, tersengat listrik

atau rasa terbakar

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 Akibat umum dari nyeri neuropatik
• Nyeri neuropatik terjadi secara umum di masyarakat dan akan berakibat:
– Mengenai 6.9% orang dengan nyeri kronik 1
– Mengenai hingga 24% pasien diabetes2
– Mengenai hingga 50% orang > 50 tahun yang mengalami herpes zoster2
– 75% dari pasien berusia >70 tahun yang mengalami herpes zoster3
– Terjadi pada kurang lebih 33% pasien kanker4
– Terjadi pada kurang lebih 4.5% orang > 30 menyusul trauma punggung5

1. Zussman J, Young L. Clin Interv Aging 2008;3(2):241-250.

2. Gauthier A et al. Epidemiol Infect 2009;137(1):38-47.
3. Khoromi et al. Pain 2007;130(1-2):66-75.
4. Davis MP, Walsh D. Am J Hosp Palliat Care 2004;21(2):137-142.
5. Meyer-Rosberg K et al. Eur J Pain 2001;5(4):379-389.

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Terapi yang direkomendasikan untuk

nyeri neuropati perifer
Guideline 1st line 2nd line recommendations
recommendations
The European Pregabalin, gabapentin, Tramadol, opioids,
Federation of TCAs, duloxetine, capsaicin§
Neurological Societies venlafaxine ER, lidocaine§
(EFNS)1
The International Pregabalin, gabapentin, Opioid analgesics, tramadol
Association for the TCAs, duloxetine,
Study of Pain (IASP)*2 venlafaxine, lidocaine
(topical)
The Canadian Pain Pregabalin, TCAs, SNRIs, lidocaine (topical)
Society (CPS)*3 gabapentin
*Guidelines did not distinguish between peripheral and central neuropathic pain.
§For focal neuropathy, such as postherpetic neuralgia.

TCAs, tricyclic antidepressants; ER, extended release; SNRIs, serotonin-norepinephrine reuptake inhibitors.
Venlafaxine is not approved for the treatment of neuropathic pain.

1. Attal N et al. Eur J Neurol 2010;17:1113-e88.

Excellence in Execution 2. Dworkin RH et al. Mayo Clin Proc 2010;85(3Suppl):S3-14.
3. Moulin DE et al. Pain Res Manag 2007;12:13-21.
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Terapi yang direkomendasikan untuk

nyeri neuropati sentral
Guideline 1st line 2nd line
recommendations recommendations
The European Pregabalin, Lamotrigine, tramadol,
Federation of gabapentin, TCAs opioids, cannabinoids
Neurological
Societies (EFNS)1
The International Pregabalin, Opioid analgesics,
Association for gabapentin, TCAs, tramadol
the Study of Pain duloxetine,
(IASP)* 2 venlafaxine
*Guidelines did not distinguish between peripheral and central neuropathic pain.
The Canadian Pain Pregabalin, TCAs, SNRIs, lidocaine
TCAs, tricyclic antidepressants; ER, extended release; SNRIs, serotonin-norepinephrine reuptake inhibitors.
Venlafaxine is not approved for the treatment of neuropathic pain.
Society (CPS)*3 gabapentin (topical)

1. Attal N et al. Eur J Neurol 2010;17:1113-e88.

2. Dworkin RH et al. Mayo Clin Proc 2010;85(3Suppl):S3-14.
3. Moulin DE et al. Pain Res Manag 2007;12:13-21.

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