Liệu pháp chống đau trong bệnh thần kinh ngoại biên do đái tháo đường

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Tác giả: Nguyễn Đình Toàn

Ngôn ngữ: Vie

Ký hiệu phân loại: 616.8 Diseases of nervous system and mental disorders

Thông tin xuất bản: Nội tiết và Đái tháo đường 2021

Mô tả vật lý: 81-88

Bộ sưu tập: Metadata

ID: 399429

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Đau trong Bệnh lý thần kinh ngoại biên do đái tháo đường xảy ra ở khoảng 25% bệnh nhân đái tháo đường và ảnh hưởng đáng kể đến chất lượng cuộc sống. Nó thường gây ra đau rát, dị cảm và tê kiểu mang găng, mang vớ tiến triển từ bàn chân và bàn tay. Các bác sĩ lâm sàng nên xem xét cẩn thận mục tiêu và tình trạng chức năng của bệnh nhân và các tác dụng phụ có thể xảy ra của thuốc khi lựa chọn phương pháp điều trị đau trong bệnh thần kinh ngoại biên do Đái tháo đường. Pregabalin và Duloxetine là những loại thuốc duy nhất được Cục Quản lý Thực phẩm và Dược phẩm Hoa Kỳ phê duyệt để điều trị chứng đau này. Dựa trên các hướng dẫn thực hành hiện tại, những loại thuốc này cộng với Gabapentin và Amitriptyline, nên được xem xét để điều trị ban đầu. Liệu pháp thứ hai bao gồm các loại thuốc giống Opioid (tramadol và tapentadol), Venlafaxine, Desvenlafaxine và các chất bôi ngoài da (miếng dán Lidocain và kemCapsaicin). Isosorbide dinitrate dạng xịt và kích thích dây thần kinh qua da có thể giúp giảm đau ở một số bệnh nhân và có thể được xem xét tại bất kỳ thời điểm nào trong quá trình điều trị. Opioid và thuốc ức chế tái hấp thu serotonin có chọn lọc là những loại thuốc thứ ba không bắt buộc. Châm cứu, y học cổ truyền Trung Quốc, axit alpha lipoic, acetyl-lcarnitine, dầu hoa anh thảo và trường điện từ thiếu bằng chứng chất lượng cao để hỗ trợ việc sử dụng trong điều trị đau ở bệnh nhân bệnh thần kinh ngoại biên do ĐTĐ, Tóm tắt tiếng anh, Painful diabetic peripheral neuropathy occurs in approximately 25% of patients with diabetes mellitus who are treated in the office setting and significantly affects quality of life. It typically causes burning pain, paresthesias, and numbness in a stocking-glove pattern that progresses proximally from the feet and hands. Clinicians should carefully consider the patient's goals and functional status and potential adverse effects of medication when choosing a treatment for painful diabetic peripheral neuropathy. Pregabalin and duloxetine are the only medications approved by the U.S. Food and Drug Administration for treating this disorder. Based on current practice guidelines, these medications, with gabapentin and amitriptyline, should be considered for the initial treatment. Secondline therapy includes opioid-like medications (tramadol and tapentadol), venlafaxine, desvenlafaxine, and topical agents (lidocaine patches and capsaicin cream). Isosorbide dinitrate spray and transcutaneous electrical nerve stimulation may provide relief in some patients and can be considered at any point during therapy. Opioids and selective serotonin reuptake inhibitors are optional third-line medications. Acupuncture, traditional Chinese medicine, alpha lipoic acid, acetyl-l-carnitine, primrose oil, and electromagnetic field application lack highquality evidence to support their use.

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