Antidepresan Pada Nyeri Neuropati Diabetik

Abstract

Diabetic neuropathy is a most common and troublesome complication of diabetes mellitus. Approximately 20 to 40% of patients with diabetes develop some form of neuropathy. Diabetic neuropathy is a family ofprogressive, degenerative disorders affecting the sensory, motor or autonomic peripheral nerves. Autonomic and motor involvement is less common than sensory neuropathy. Risk factors for the development and progression of diabetic neuropathy include poor glycaemic control, increasing age, undiagnosed type 2 diabetes, long duration of diabetes, cardiovascular disease, peripheral vascular disease, smoking, high alcohol intake, low socioeconomic status and renal or cardiac failure.
Control ofpain is one of the most difficult management issues in diabetic neuropathy. The goal oftreatmentfor painful diabetic peripheral neuropathy is to relieve painful symptoms, prevent further tissue damage and improve patient education. Combinations of pharmacological, physical and psychological interventions are likely to attain the optimum level ofpain relieffor most patients. The mainstay therapeutic agents for managing diabetic neuropathic pain are tricyclic antidepressants and anticonvulsants.

Neuropati diabetik merupakan komplikasi yang menyulitkan dan paling sering teijadi pada diabetes melitus. Sekitar 20 - 40 % penderita diabetes mengalami berbagai bentuk neuropati. Neuropati diabetik merupakan suatu kelainan degeneratifprogresifyang mengenai saraf tepi sensorik, motorik maupun otonom. Neuropati otonom dan motorik lebih jarang teijadi dibandingkan neuropati sensori. Faktor risiko timbulnya neuropati diabetik meliputi gula darah tak terkontrol, usia, diabetes tipe 2, lamanya menderita diabetes, merokok, alkohol, status sosial ekonomi yang rendah, serta gagal ginjal atau jantung.
Penanggulangan nyeri adalah suatu problem paling sulit dalam penatalaksanaan neuropati diabetik. Tujuan pengobatan nyeri neuropati diabetik adalah mengurangi gejala yang ada serta mencegah perburukan neuropati dan kerusakan saraf lebih lanjut. Terapi kombinasi secara farmakologik, fisiologik, dan psikologik memberikan hasil terapi yang optimal dalam mengurangi nyeri neuropati diabetik pada kebanyakan pasien. Pilihan utama untuk penanggulangan nyeri neuropatui diabetik adalah antidepresan trisikik dan antikonvulsan.