"Nyeri Sentral Pasca Stroke: Strategi Rehabilitasi Berbasis Bukti untuk Penatalaksanaan Nyeri Neuropatik"
DOI:
https://doi.org/10.33096/egfkfz70Kata Kunci:
Latihan, Nyeri, Stimulasi Magnetik TranskranialAbstrak
Latar Belakang:
Nyeri Sentral Pascastroke (Central Post-Stroke Pain/CPSP) merupakan kondisi klinis yang sering dijumpai namun kompleks, dialami oleh 8-10% penyintas stroke dengan dampak signifikan terhadap kualitas hidup dan pemulihan fungsional. Meskipun prevalensinya cukup tinggi, tatalaksana yang efektif masih menjadi tantangan karena sifatnya yang multifaktorial.
Isi:
Tinjauan ini menganalisis strategi rehabilitasi untuk CPSP dengan penekanan pada pendekatan farmakologis dan non-farmakologis. Terapi latihan fisik—meliputi latihan kekuatan, aerobik, dan fleksibilitas—memegang peran krusial dalam mengurangi nyeri, meningkatkan plastisitas neural, serta memperbaiki outcome fungsional. Modalitas fisik seperti stimulasi magnetik transkranial berulang (repetitive Transcranial Magnetic Stimulation/rTMS) dan akupunktur, ditambah pendekatan psikologis berupa Terapi Kognitif-Perilaku (Cognitive Behavioral Therapy/CBT) dan Terapi Penerimaan dan Komitmen (Acceptance and Commitment Therapy/ACT), secara komprehensif menangani aspek emosional dan kognitif CPSP.
Kesimpulan:
Pendekatan multidisiplin yang berpusat pada pasien dengan mengintegrasikan terapi latihan, modalitas fisik, dan dukungan psikososial merupakan kunci optimalisasi penatalaksanaan CPSP. Penelitian lebih lanjut diperlukan untuk memurnikan dan membakukan protokol rehabilitasi guna mencapai remisi nyeri jangka panjang serta peningkatan outcome pemulihan penyintas stroke.
Referensi
Klit, H., Finnerup, N. B. & Jensen, T. S. Central post-stroke pain: clinical characteristics, pathophysiology, and management. The Lancet Neurology vol. 8 857–868 Preprint at https://doi.org/10.1016/S1474-4422(09)70176-0 (2009).
2. Yam, M. et al. General Pathways of Pain Sensation and the Major Neurotransmitters Involved in Pain Regulation. Int J Mol Sci 19, 2164 (2018).
3. Khalid, S. & Tubbs, R. S. Neuroanatomy and Neuropsychology of Pain. Cureus 9, e1754 (2017).
4. McEntire, D. M. et al. Pain transduction: a pharmacologic perspective. Expert Rev Clin Pharmacol 9, 1069–1080 (2016).
5. Vadivelu, N., Whitney, C. J. & Sinatra, R. S. Pain Pathways and Acute Pain Processing. in Acute Pain Management 3–20 (Cambridge University Press, 2009). doi:10.1017/CBO9780511576706.003.
6. Cambier, J. [Dejerine-Roussy syndrome]. Rev Neurol (Paris) 138, 979–88 (1982).
7. Head, H. & Holmes, G. Sensory Disturbances From Cerebral Lesion. Brain 34, 102–254 (1911).
8. Treede, R.-D. et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 70, 1630–5 (2008).
9. Kim, J. S. Central post-stroke pain or paresthesia in lenticulo-capsular hemorrhages. Neurology 61, 679–682 (2003).
10. Widerström-Noga, E., Loeser, J. D., Jensen, T. S. & Finnerup, N. B. AAPT Diagnostic Criteria for Central Neuropathic Pain. J Pain 18, 1417–1426 (2017).
11. Westerlind, E., Singh, R., Persson, H. C. & Sunnerhagen, K. S. Experienced pain after stroke: a cross-sectional 5-year follow-up study. BMC Neurol 20, 4 (2020).
12. Kim, J. S. Post-stroke pain. Expert Review of Neurotherapeutics vol. 9 711–721 Preprint at https://doi.org/10.1586/ern.09.19 (2009).
13. Bogousslavsky, J., Regli, F. & Uske, A. Thalamic infarcts. Neurology 38, 837–837 (1988).
14. (Bud) Craig, A. D. A new version of the thalamic disinhibition hypothesis of central pain. Pain Forum 7, 1–14 (1998).
15. Bashir, A. H., Abdullahi, A., Abba, M. A. & Mukhtar, N. B. Central Poststroke Pain: Its Profile among Stroke Survivors in Kano, Nigeria. Behavioural neurology 2017, 9318597 (2017).
16. Kumar, B., Kalita, J., Kumar, G. & Misra, U. K. Central poststroke pain: A review of pathophysiology and treatment. Anesth Analg 108, 1645–1657 (2009).
17. Mohanan, A. T. et al. Stroke-Induced Central Pain: Overview of the Mechanisms, Management, and Emerging Targets of Central Post-Stroke Pain. Pharmaceuticals vol. 16 Preprint at https://doi.org/10.3390/ph16081103 (2023).
18. Zhang, Y.-H. et al. Exercise for Neuropathic Pain: A Systematic Review and Expert Consensus. Front Med (Lausanne) 8, (2021).
19. Kim, Y. et al. Exercise Training Guidelines for Multiple Sclerosis, Stroke, and Parkinson Disease. Am J Phys Med Rehabil 98, 613–621 (2019).
20. Han, P. et al. Clinical Evidence of Exercise Benefits for Stroke. in 131–151 (2017). doi:10.1007/978-981-10-4304-8_9.
21. Vahlberg, B., Lindmark, B., Zetterberg, L., Hellström, K. & Cederholm, T. Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory randomized controlled trial. Disabil Rehabil 39, 1207–1214 (2017).
22. Ma, Y., Luo, J. & Wang, X.-Q. The effect and mechanism of exercise for post-stroke pain. Front Mol Neurosci 15, (2022).
23. Öte Karaca, Ş., Demirsoy, N. & Günendi, Z. Effects of aerobic exercise on pain sensitivity, heart rate recovery, and health-related quality of life in patients with chronic musculoskeletal pain. International Journal of Rehabilitation Research 40, 164–170 (2017).
24. Schmid, A. A., Miller, K. K., Van Puymbroeck, M. & DeBaun-Sprague, E. Yoga leads to multiple physical improvements after stroke, a pilot study. Complement Ther Med 22, 994–1000 (2014).
25. Bastille, J. V & Gill-Body, K. M. A Yoga-Based Exercise Program for People With Chronic Poststroke Hemiparesis. Phys Ther 84, 33–48 (2004).
26. Ramachandran, V. S. & Altschuler, E. L. The use of visual feedback, in particular mirror visual feedback, in restoring brain function. Brain 132, 1693–1710 (2009).
27. Hosomi, K. et al. Daily repetitive transcranial magnetic stimulation of primary motor cortex for neuropathic pain: A randomized, multicenter, double-blind, crossover, sham-controlled trial. Pain 154, 1065–1072 (2013).
28. Bae, S. H., Kim, G. Do & Kim, K. Y. Analgesic effect of transcranial direct current stimulation on central post-stroke pain. Tohoku Journal of Experimental Medicine 234, 189–195 (2014).
29. Katayama, Y., Tsubokawa, T. & Yamamoto, T. Chronic Motor Cortex Stimulation for Central Deafferentation Pain: Experience with Bulbar Pain Secondary to Wallenberg Syndrome. Stereotact Funct Neurosurg 62, 295–299 (1994).
30. Keefe, F. J., Porter, L., Somers, T., Shelby, R. & Wren, A. V. Psychosocial interventions for managing pain in older adults: outcomes and clinical implications. Br J Anaesth 111, 89–94 (2013).
31. Harrison, R. A. & Field, T. S. Post stroke pain: Identification, assessment, and therapy. Cerebrovascular Diseases vol. 39 190–201 Preprint at https://doi.org/10.1159/000375397 (2015).
