Beruflich Dokumente
Kultur Dokumente
INTRODUCTION
Prevalence
-66% for type I and 59% for type II
Peripheral Neuropathy
Peripheral neuropathy is therefore loss
of nerve fiber function in the peripheral
nerves (nerves outside of the brain and
spinal cord.)
Normal Nerve
Abnormal Nerve
DEFINITION
1. PAIN
An unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or
described in terms of such damage.
(IASP: International Association for the Study of Pain)
2. NOCICEPTIVE PAIN
Pain caused by stimuli leading to tissue damage
3. NEUROPATHIC PAIN
Pain initiated or caused by a primary lesion or
dysfunction in the nervous system.
CLASSIFICATION OF PAIN
CLINICAL PAIN
PHYSIOLOGIC PAIN
Peripheral
Central
Deep
Neuropathic
Mixed
Pain
Nociceptive
Pain
Examples
Peripheral
Postherpetic neuralgia
Trigeminal neuralgia
Diabetic peripheral
neuropathy
Postsurgical neuropathy
Posttraumatic neuropathy
Central
Poststroke pain
Pain
Examples
Examples
Pain due to
inflammation
Limb pain after a
fracture
Joint pain in
osteoarthritis
Postoperative visceral
pain
NEUROPATHIC PAIN
Distal at territory of
Injured / dysfunctioned nerve
Burning, stabbing, tingling
lancinating
Chronic
Persists after injury healed
No protective function
POSITIVE
Spontaneous
Evoked
Continuous or paroxysmal
Hyperalgesia
Sensation:
Allodynia
stabbing,paresthesia, shooting,
lancinating, electric-shock-like
NEGATIVE
Hypoesthesia, hypoalgesia
IMPACT OF PAIN
PAIN
NOCICEPTIVE
(Acute)
Avoid tissue damage
Mood
Protective function
NEUROPATHIC
(Chronic)
Physical
Psychological triad:
Impairment
Pain
Disability
Sleep
PAIN TRIAD
PAIN
FUNCTIONAL
IMPAIRMENT
MOOD
- Anxiety
- Depression
- OCD
SLEEP
QOL
- Deprivation
- Insomnia
- Poor
10
20
30
40
50
60
70
STAGING
N1-asymptomatic,signs of neuropathy
N2-symptomatic neuropathy
N3-disabling polyneuropathy.
Symptoms
-Numbness or feeling of walking in cotton
-Sharp shooting or stabbing pain
-Dull constant or boring pain.
-Tingling pins & needles
-Hot or cold sensation
-Allodynia
-Cramps
SIGNS:
Significant distal weakness is uncommon
but EDB weakness may be there.
Ankle reflexes are absent .
Sensory loss in a length related
distribution with the toes and feet being
most affected.
Loss or impairment of all sensory
modalities with vibration sense often the
first to go.
As the sensory loss extends proximally
from a sock to stocking distribution the
TREATMENT OF
NEUROPATHIC PAIN
Advanced treatment in
Neuropathic Pain
Traditional
Treating pain
New paradigm
Treating pain
BETTER
QUALITY
OF LIFE
Persisting Pain
Opioid for mild to moderate pain
+/- Non opioid , +/- Adjuvant
Step 2
Persisting Pain
Non opioid +/- Adjuvant
Step 1
PHARMACOLOGIC THERAPY
1. Non-opioid Analgesic
PAIN MEASUREMENT
Visual Analog Scale (VAS)
0
No pain
10
Worst
pain
THANK YOU
TUTORIAL
PEMERIKSAAN REFLEX