Identifikasi dan manajemen pada nyeri sentral pascastroke
DOI:
https://doi.org/10.25170/djm.v22i1.3943Keywords:
nyeri neuropatik, nyeri sentral, nyeri sentral pascastroke, strokeAbstract
Pendahuluan: Nyeri sentral pascastroke (NSPS) merupakan nyeri neuropatik sentral yang timbul setelah terjadinya stroke. Kondisi ini ditemukan pada 1-12% dari penderita stroke dan umumnya terjadi dalam 6 bulan pertama setelah terjadinya stroke. Nyeri yang ditimbulkan pada NSPS dapat mengakibatkan penurunan kualitas hidup, menghambat proses rehabilitasi, serta menimbulkan keterbatasan aktivitas dan interaksi sosial.
Tujuan: Sebagai bahan pembelajaran yang membahas mengenai diagnosis, manifestasi klinis, patofisiologi hingga tatalaksana dari NSPS.
Metode: Penulisan artikel ini menggunakan metode tinjauan naratif sebagai bagian dari studi literatur.
Diskusi: Pasien dengan NSPS datang dengan gejala sensoris yang bervariasi mulai dari sensasi terbakar, tertikam, hingga tersengat listrik. Adanya alodinia, disestesia dan hiperalgesia merupakan manifestasi tersering yang ditemukan pada penderita NSPS. Patofisiologi dari NSPS masih belum diketahui secara pasti, namun dikatakan adanya disinhibisi, sensitisasi sentral dan kerusakan pada jalur spinotalamikus dan talamus turut berperan dalam NSPS. Pendekatan tatalaksana pada NSPS dapat berupa terapi farmakologis maupun non farmakologis. Golongan antikonvulsan seperti gabapentin dan pregabalin, serta antidepresan seperti amitriptilin saat ini masih direkomendasikan sebagai terapi lini pertama. Sedangkan pada kasus NSPS yang refrakter, dapat digunakan terapi non farmakologis seperti deep brain stimulation dan motor cortex stimulation (MCS). Peripheral nerve block dalam beberapa laporan kasus juga memperlihatkan hasil yang menjanjikan, namun hal ini perlu ditelusuri lebih lanjut.
Kata Kunci: nyeri neuropatik, nyeri sentral, nyeri sentral pascastroke, stroke.
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References
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15. Chen JM, Chen QF, Wang ZY, Ni GX. Quantitative and Fiber-Selective Evaluation for Central Poststroke Pain. 2022 [cited 2022 Nov 30]; Available from: https://doi.org/10.1155/2022/1507291
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17. Yeo SS, Jang SH, Lee J. Central post-stroke pain due to injury of the spinothalamic tract in patients with cerebral infarction: a diffusion tensor tractography imaging study. 2017 [cited 2022 Nov 30]; Available from: www.nrronline.org
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19. Li S jun, Zhang Y fen, Ma S hui, Yi Y, Yu H yan, Pei L, et al. The role of NLRP3 inflammasome in stroke and central poststroke pain. Medicine (United States) [Internet]. 2018 Aug 1 [cited 2022 Dec 1];97(33). Available from: https://journals.lww.com/md-journal/Fulltext/2018/08170/The_role_of_NLRP3_inflammasome_in_stroke_and.31.aspx
20. Bo Z, Jian Y, Yan L, Gangfeng G, Xiaojing L, Xiaolan L, et al. Review Article Pharmacotherapies for Central Post-Stroke Pain: A Systematic Review and Network Meta-Analysis. 2022 [cited 2022 Nov 30]; Available from: https://doi.org/10.1155/2022/3511385
21. Hesami O, Gharagozli K, Beladimoghadam N, Assarzadegan F, Mansouri B, Sistanizad M. The Efficacy of Gabapentin in Patients with Central Post-stroke Pain. Shaheed Beheshti University of Medical Sciences and Health Services Iranian Journal of Pharmaceutical Research. 2015;14:95–101.
22. Liampas A, Velidakis N, Georgiou T, Vadalouca A, Varrassi G, Hadjigeorgiou G, et al. Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis. Adv Ther [Internet]. 2020 Jul;37(7):3278–91. Available from: https://doi.org/10.6084/m9.figshare.12287795.
23. Staudt MD, Clark AJ, Gordon AS, Lynch ME, Morley-Forster PK, Nathan H, et al. Long-Term Outcomes in the Management of Central Neuropathic Pain Syndromes: A Prospective Observational Cohort Study. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques [Internet]. 2018 Sep 12 [cited 2022 Nov 30];45(5):545–52. Available from: https://www.cambridge.org/core/product/identifier/S0317167118000550/type/journal_article
24. Scuteri D, Mantovani E, Tamburin S, Sandrini G, Corasaniti MT, Bagetta G, et al. Opioids in Post-stroke Pain: A Systematic Review and Meta-Analysis. Front Pharmacol [Internet]. 2020 Nov 27 [cited 2022 Dec 5];11. Available from: /pmc/articles/PMC7793939/
25. Morishita T, Inoue T. Brain stimulation therapy for central post-stroke pain from a perspective of interhemispheric neural network remodeling. Front Hum Neurosci. 2016 Apr 21;10(APR2016):1–8.
26. Geil D, Thomas C, Zimmer A, Meißner W. Chronified Pain Following Operative Procedures: The Place of Locoregional and Systemic Local Anesthetics. Dtsch Arztebl Int [Internet]. 2019 Apr 12 [cited 2022 Dec 6];116(15):261. Available from: /pmc/articles/PMC6546858/
27. Liu Q, Zhong Q, Tang G, Ye L. Ultrasound-Guided Stellate Ganglion Block for Central Post-Stroke Pain: A Case Report and Review. J Pain Res [Internet]. 2020 Feb 26 [cited 2022 Dec 2];13:461–4. Available from: https://www.dovepress.com/ultrasound-guided-stellate-ganglion-block-for-central-post-stroke-pain-peer-reviewed-fulltext-article-JPR
28. Haroutounian S, Ford AL, Frey K, Nikolajsen L, Finnerup NB, Neiner A, et al. How central is central poststroke pain? The role of afferent input in poststroke neuropathic pain: A prospective, open-label pilot study. Pain [Internet]. 2018 Jul 1 [cited 2022 Dec 7];159(7):1317–24. Available from: https://journals.lww.com/pain/Fulltext/2018/07000/How_central_is_central_poststroke_pain__The_role.15.aspx
29. Tang SC, Lee LJH, Jeng JS, Hsieh ST, Chiang MC, Yeh SJ, et al. Pathophysiology of central poststroke pain motor cortex disinhibition and its clinical and sensory correlates. Stroke. 2019 Oct 1;50(10):2851–7.
30. Corbetta D, Sarasso E, Agosta F, Filippi M, Gatti R. Mirror therapy for an adult with central post-stroke pain: a case report. Arch Physiother. 2018 Dec 1;8(1).
2. Kementrian Kesehatan RI. Hasil Riset Kesehatan Dasar (Riskesdas) 2018. Jakarta: Badan Penelitian dan Pengembangan Kesehatan Kementrian RI. 2019;204.
3. Klit H, Finnerup NB, Jensen TS. Diagnosis, Prevalence, Characteristics, and Treatment of Central Poststroke Pain. In 2015.
4. Sadekur M, Sarkar R, Hasan M, Alam B, Habib M. Relationship of Central Post-Stroke Pain with Location and Type of Lesions in Brain among Thalamic Stroke Patients. Journal of National Institute of Neurosciences Bangladesh [Internet]. 2022;8(1):9–13. Available from: https://doi.org/10.3329/jninb.v8i1.59925
5. Ri S. The Management of Poststroke Thalamic Pain: Update in Clinical Practice. Diagnostics 2022, Vol 12, Page 1439 [Internet]. 2022 Jun 10 [cited 2022 Dec 6];12(6):1439. Available from: https://www.mdpi.com/2075-4418/12/6/1439/htm
6. Mulla SM, Wang L, Khokhar R, Izhar Z, Agarwal A, Couban R, et al. Management of central poststroke pain: Systematic review of randomized controlled trials. Stroke [Internet]. 2015 [cited 2022 Nov 30];46(10):2853–60. Available from: http://systematic-review.net/
7. Betancur DFA, Tarragó M da GL, Torres IL da S, Fregni F, Caumo W. Central Post-Stroke Pain: An Integrative Review of Somatotopic Damage, Clinical Symptoms, and Neurophysiological Measures. Front Neurol [Internet]. 2021 Aug 18 [cited 2022 Dec 1];12:678198. Available from: /pmc/articles/PMC8416310/
8. Chen KY, Li RY. Efficacy and safety of different antidepressants and anticonvulsants in central poststroke pain: A network meta-analysis and systematic review. PLoS One. 2022;17(10):e0276012.
9. Ramger BC, Bader KA, Davies SP, Stewart DA, Ledbetter LS, Simon CB, et al. Effects of non-invasive brain stimulation on clinical pain intensity and experimental pain sensitivity among individuals with central post-stroke pain: A systematic review. Vol. 12, Journal of Pain Research. Dove Medical Press Ltd.; 2019. p. 3319–29.
10. Widyadharma IPE, Tertia C, Wijayanti IAS, Barus JFA. Central post stroke pain: What are the new insights? Romanian Journal of Neurology [Internet]. 2021 Mar 1 [cited 2022 Nov 30];20(1):28–34. Available from: https://doaj.org/article/d676183922eb428db5c1ed305b785bb2
11. Harrison RA, Field TS. Post Stroke Pain: Identification, Assessment, and Therapy. Cerebrovascular Diseases [Internet]. 2015 May 6 [cited 2022 Dec 2];39(3–4):190–201. Available from: https://www.karger.com/Article/FullText/375397
12. Osama A, Abo Hagar A, Elkholy S, Negm M, Abd El-Razek R, Orabi M. Central post-stroke pain: predictors and relationship with magnetic resonance imaging and somatosensory evoked potentials. Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2018 Dec 1;54(1).
13. Xu XM, Luo H, Rong BB, Zheng XM, Wang FT, Zhang SJ, et al. Nonpharmacological therapies for central poststroke pain: A systematic review. Vol. 99, Medicine (United States). Lippincott Williams and Wilkins; 2020. p. E22611.
14. Sciupokas A. Central Post Stroke Pain: The Clinical-Anatomical Correlations from Pain Clinic Stories. Biomed J Sci Tech Res. 2018 Dec 3;11(4).
15. Chen JM, Chen QF, Wang ZY, Ni GX. Quantitative and Fiber-Selective Evaluation for Central Poststroke Pain. 2022 [cited 2022 Nov 30]; Available from: https://doi.org/10.1155/2022/1507291
16. Treister AK, Hatch MN, Cramer SC, Chang EY. Demystifying post-stroke pain: from etiology to treatment. PM R [Internet]. 2017 Jan 1 [cited 2022 Nov 30];9(1):63. Available from: /pmc/articles/PMC5161714/
17. Yeo SS, Jang SH, Lee J. Central post-stroke pain due to injury of the spinothalamic tract in patients with cerebral infarction: a diffusion tensor tractography imaging study. 2017 [cited 2022 Nov 30]; Available from: www.nrronline.org
18. Park JG, Hong BY, Park HY, Yoo YJ, Yoon MJ, Kim JS, et al. Alteration of white matter in patients with central post-stroke pain. J Pers Med [Internet]. 2021 May 1 [cited 2022 Dec 1];11(5):417. Available from: https://www.mdpi.com/2075-4426/11/5/417/htm
19. Li S jun, Zhang Y fen, Ma S hui, Yi Y, Yu H yan, Pei L, et al. The role of NLRP3 inflammasome in stroke and central poststroke pain. Medicine (United States) [Internet]. 2018 Aug 1 [cited 2022 Dec 1];97(33). Available from: https://journals.lww.com/md-journal/Fulltext/2018/08170/The_role_of_NLRP3_inflammasome_in_stroke_and.31.aspx
20. Bo Z, Jian Y, Yan L, Gangfeng G, Xiaojing L, Xiaolan L, et al. Review Article Pharmacotherapies for Central Post-Stroke Pain: A Systematic Review and Network Meta-Analysis. 2022 [cited 2022 Nov 30]; Available from: https://doi.org/10.1155/2022/3511385
21. Hesami O, Gharagozli K, Beladimoghadam N, Assarzadegan F, Mansouri B, Sistanizad M. The Efficacy of Gabapentin in Patients with Central Post-stroke Pain. Shaheed Beheshti University of Medical Sciences and Health Services Iranian Journal of Pharmaceutical Research. 2015;14:95–101.
22. Liampas A, Velidakis N, Georgiou T, Vadalouca A, Varrassi G, Hadjigeorgiou G, et al. Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis. Adv Ther [Internet]. 2020 Jul;37(7):3278–91. Available from: https://doi.org/10.6084/m9.figshare.12287795.
23. Staudt MD, Clark AJ, Gordon AS, Lynch ME, Morley-Forster PK, Nathan H, et al. Long-Term Outcomes in the Management of Central Neuropathic Pain Syndromes: A Prospective Observational Cohort Study. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques [Internet]. 2018 Sep 12 [cited 2022 Nov 30];45(5):545–52. Available from: https://www.cambridge.org/core/product/identifier/S0317167118000550/type/journal_article
24. Scuteri D, Mantovani E, Tamburin S, Sandrini G, Corasaniti MT, Bagetta G, et al. Opioids in Post-stroke Pain: A Systematic Review and Meta-Analysis. Front Pharmacol [Internet]. 2020 Nov 27 [cited 2022 Dec 5];11. Available from: /pmc/articles/PMC7793939/
25. Morishita T, Inoue T. Brain stimulation therapy for central post-stroke pain from a perspective of interhemispheric neural network remodeling. Front Hum Neurosci. 2016 Apr 21;10(APR2016):1–8.
26. Geil D, Thomas C, Zimmer A, Meißner W. Chronified Pain Following Operative Procedures: The Place of Locoregional and Systemic Local Anesthetics. Dtsch Arztebl Int [Internet]. 2019 Apr 12 [cited 2022 Dec 6];116(15):261. Available from: /pmc/articles/PMC6546858/
27. Liu Q, Zhong Q, Tang G, Ye L. Ultrasound-Guided Stellate Ganglion Block for Central Post-Stroke Pain: A Case Report and Review. J Pain Res [Internet]. 2020 Feb 26 [cited 2022 Dec 2];13:461–4. Available from: https://www.dovepress.com/ultrasound-guided-stellate-ganglion-block-for-central-post-stroke-pain-peer-reviewed-fulltext-article-JPR
28. Haroutounian S, Ford AL, Frey K, Nikolajsen L, Finnerup NB, Neiner A, et al. How central is central poststroke pain? The role of afferent input in poststroke neuropathic pain: A prospective, open-label pilot study. Pain [Internet]. 2018 Jul 1 [cited 2022 Dec 7];159(7):1317–24. Available from: https://journals.lww.com/pain/Fulltext/2018/07000/How_central_is_central_poststroke_pain__The_role.15.aspx
29. Tang SC, Lee LJH, Jeng JS, Hsieh ST, Chiang MC, Yeh SJ, et al. Pathophysiology of central poststroke pain motor cortex disinhibition and its clinical and sensory correlates. Stroke. 2019 Oct 1;50(10):2851–7.
30. Corbetta D, Sarasso E, Agosta F, Filippi M, Gatti R. Mirror therapy for an adult with central post-stroke pain: a case report. Arch Physiother. 2018 Dec 1;8(1).
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2023-07-04
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Felicia, Jaya M. Identifikasi dan manajemen pada nyeri sentral pascastroke. DJM [Internet]. 2023 Jul. 4 [cited 2024 Nov. 24];22(1):69-75. Available from: https://ejournal.atmajaya.ac.id/index.php/damianus/article/view/3943
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