 |
Complications of diabetes can vary from the retina (Diabetisk retinopathy), kidneys (nephropathy Diabetisk), bowel movements (gastropati Diabetisk), blood vessels (angiopati), up to the edge of nerves (neuropathy Diabetisk).
Diabetisk neuropathy generally appears slower and have a slow progression as well. Symptoms are loss of sensation or feeling that is the dominance in the fingertips.
Diabetisk neuropathy is one of the major complications of diabetes. A study in Australia in 2436 patients with diabetes showed that 13.1% of patients had peripheral neuropathy / nerve damage to the edge (Tapp, et al, 2003).
Symptoms of pain are common complaints in patients with neuropathy Diabetisk Several epidemiological studies indicate that pain is found in 7-13% of cases at neuroapti diabetika early diagnosis.
Prevalence of pain and tingling paraestesia or increases with duration of diabetes mellitus. The pain is often described as burning pain, such as tingling, are paroksismal. Hiperalgesia (severe pain due to mild pain stimuli) and allodinia (pain not due to pain stimuli).
Research in the United States showed that 10-20% of patients when the diagnosis is established diabetes has neuropathy, and the prevalence increased to 50% in patients who have suffered from DM> 25 years (Partanen, et al, 1995). Diabetisk neuropathy prevalence is approximately 30% of all DM patients (De Cherney, 1997, Echeverry and Sherman, 2003).
Of all cases of diabetes, Diabetisk neuropathy as a complication of diabetes is also said to be the main cause of patients undergoing inpatient at the hospital, as well as the main cause of amputations in patients undergoing external trauma.
Every year, the United States there are 80,000 cases of neuropathy due to undergo amputation or 1 amputation Diabetisk every 2 minutes (Vinik, 2002). Painful neuropathy (pain due to nerve damage) suffered by the estimated 1% of the total population and 1 / 3 of them are ND (Bennett, 1997).
Of the total people with diabetes, 7.5% of whom suffer from painful neuropathy (Nash, 1997). Description Diabetisk neuropathy pain characterized by burning (burning), a sense of being stabbed, electrocuted, ripped, tied, numbness, and tingling.
Positive symptoms or negative symptoms
Damage to nerve fibers generally starts from the distal / proximal end to the / base, while the repair process started from the proximal to distal. Therefore, patients usually complain of numbness or pain in the tips of your toes (Vinik, 2002). Compared with the nerve fibers with large diameter, can be seen that initially the lesion is small nerve fibers (De Cherney, 1999).
Neuropathic pain patients with complaints of severe pain (especially in the feet) generally showed a mild neurologic abnormalities of distal sensory disturbance foot reflex while still in the normal range. Patients who suffered nerve damage without pain often show neurologic symptoms such as negative reflex (Scadding, 1999). This means that patients with nerve damage pain lighter than patients without pain.
Does it fit with the dynamics of the process of degeneration, is still in question. Nerve function is as a conductor of impulses. Interference spur impulse conducting functions or activate survival programs or death. Thus understood, when the lesions of patients suffered severe enough so that active neuronal death program.
Neuron death causes the negative symptoms of nervous system disorders with manifestations of sensory numbness, feeling bold, anesthesia, paralysis of motor disorders or disorders of the autonomic impotence.
However, if mild lesions, the degeneration of axons occurs (survival response). This response causes phenotypic changes to prepare the process of regeneration. Regeneration process caused distortion of the signal, such as the emergence of receptors, ion channels new, sprouting of nerve endings with neuroma, all of which can cause pain.
The process was proven on biopsy examination of nerve neuropathy in patients with severe pain, which was the degeneration of afferent nerve fibers with or without myelin with new shoots (sprouting) (Scadding, 1999). New shoots that grow this can bring pain.
What can be done?
The main principle Diabetisk neuropathy pain management is controlling blood sugar levels. Controlling blood sugar levels to prevent progression of neuropathy Diabetisk. Research in 1441 patients with type 1 diabetes showed that controlling blood sugar levels effectively to slow the progression of neuropathy diabetika.
Another common therapy used to treat pain are anti-depressants and anti konvulsan / anti-epileptic drugs. Anti konvulsan have the ability to suppress the abnormal sensitivity of the neurons in the central nervous system on which the resurrection of epilepsy (Chong and Smith, 2000).
Epilepsy and neuropathic pain are both arise because of the abnormal activity of the nervous system. Hipereksitabilitas epilepsy triggered by the central nervous system that can cause spontaneous paroksismal resurrection, and this is equal to the incidence of spontaneous pain paroksismal on neuropathic pain.
Stress and anxiety will make the pain inhibitory system is not working properly. Depression will add to the suffering and pain intensity. Behavior modification and comfort is one form of therapy that should also be done.
Posted by Health
