Perbedaan Gabapentin, Amitriptilin dan Kombinasi Gabapentin dengan Amitriptilin dalam Mengurangi Intensitas Nyeri pada Pasien dengan Nyeri Neuropati Diabetika

Abstract

Background : Pain is the most disturbing symptom of diabetic neuropathy. Painful diabetic neuropathy occurs in 16-26% of patients with diabetes mellitus. Variety of medications are still being studied to get the best treatment for painful diabetic neuropathy. Objective : The objective of this study was to assess the difference Gabapentin, Amitriptyline and combination Amitriptyline with Gabapentin in reducing pain intensity in patients with painful diabetic neuropathy. Methods : Randomized, pretest-postest design was used in this experimental study. The subjects was divided by 3 groups, the first used Gabapentin, the second used Amitriptyline, and the third used in combination treatment, which of 12 patients for each group. Pain intensity was measured three times by using the Numerical Rating Scale (NRS), the first was before treatment, then followed in day 7th after treatment and in day 14th after the dose titrated. To determine the mean change in pain intensity before and after treatment in all three groups, Anova test (p<0,05) was used. Results : From 12 samples for each group, either Gabapentin, Amitriptyline, and in combination, produced pain intensity reduction significantly (p = 0.0001) in day 14th after treatment. Gabapentin alone is not more inferior compared with combination treatment (p = 0.666) for reducing pain intensity, but there was significantly difference (p = 0.013) in reduction pain intensity when compared with Amitriptyline alone. Gabapentine alone cause fewer adverse effects (2. 8%) compared to the two other groups. Conclusion : This study suggested that the use of Gabapentin alone be more better than Amitriptyline alone and their combination for the treatment of pain in patients with painful diabetic neuropathy.