Patofisiologi neuralgia pascaherpetika (tinjauan biologi molekuler)

https://doi.org/10.22146/bns.v19i2.69201

Aditya Putra Priyahita(1*), Sekar Satiti(2), Yudiyanta Yudiyanta(3)

(1) KSM Saraf, RSU Wiradadi Husada, Banyumas, Jawa Tengah
(2) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(3) Departemen Neurologi Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author

Abstract


Post-herpetic neuralgia (PHN) is a neuropathic pain syndrome with the character of persistent pain in months to years after the healing of the rash of herpes zoster infection (HZ). PHN is one of the persistent chronic pain problems that can have a severe intensity which greatly disrupts the function and quality of the physical, psychological, and social aspects of the patient and ultimately decreases the quality of life.

PHN has very high symptom variability. This indicates that there are many mechanisms that occur in the pathogenesis of PHN. Based on the variation of the symptoms it causes, there are three main mechanisms that explain the occurrence of PHN: peripheral sensitization, central sensitization, and differentiation.

Peripheral and central sensitization is said to be the main mechanism for the clinical symptoms of hyperalgesia and allodynia experienced by the majority of patients with PHN. While the clinical symptoms of hypesthesia or anesthesia, with or without allodinia based on deafferentiation mechanisms are only found in a small proportion of PHN sufferers. A deeper understanding of the mechanism of the occurrence of PHN is needed as a consideration for therapeutic options to improve the quality of life of patients with PHN.

The purpose of writing this literature review is to review the literature on the molecular pathophysiology of the occurrence of PHN.

 

ABSTRAK

 

Neuralgia pascaherpetika (NPH) adalah sindrom nyeri neuropatik dengan karakter berupa nyeri yang menetap dalam hitungan bulan sampai tahun setelah penyembuhan ruam infeksi herpes zoster (HZ). NPH merupakan salah satu masalah nyeri kronis persisten yang dapat memiliki intensitas berat sehingga sangat mengganggu fungsi dan kualitas fisik, psikologis serta aspek sosial pasien dan akhirnya menurunkan kualitas hidupnya.

NPH memiliki variabilitas gejala yang sangat tinggi. Hal tersebut mengindikasikan adanya banyak mekanisme yang terjadi pada proses patogenesis NPH. Secara garis besar, berdasarkan variasi gejala yang ditimbulkannya, terdapat tiga mekanisme utama yang menjelaskan terjadinya NPH, yaitu: sensitisasi perifer, sensitisasi sentral, dan deafferensiasi.

Sensitisasi perifer dan sentral disebutkan menjadi dasar mekanime utama pada gejala klinis hiperalgesia dan alodinia yang dialami mayoritas pasien dengan NPH. Sementara gejala klinis berupa hipestesia atau anestesia, dengan atau tanpa alodinia yang didasari mekanisme deafferensiasi hanya didapatkan pada sebagian kecil penderita NPH. Pemahaman yang lebih mendalam mengenai mekanisme terjadinya NPH sangat diperlukan sebagai pertimbangan pilihan terapi untuk memperbaiki kualitas hidup pasien dengan NPH.

Tujuan penulisan tinjauan pustaka ini adalah untuk mengkaji literatur tentang patofisiologi molekuler terjadinya NPH.

Keywords


pathophysiology; neuropathy; post-herpetic neuralgia

Full Text:

PDF


References

1. Mallick-Searle T, Snodgrass B, Brant JM. Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology. Journal of Multidisciplinary Healthcare. 2016;9:447–454.
2. Gharibo C, Kim C. Neuropathic pain of postherpetic neuralgia. Pain Medical News. 2011;9:84–92.
3. Singh S, Gupta R, Kaur S, Kaur J. Post-herpetic neuralgia: A review of current management strategies. Indian Journal of Pain. 2013;27(1):12-21.
4. Drolet M, Brisson M, Schmader KE. The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study. Canadian Medical Association Journal. 2010; 182(16):1731–1736.
5. Johnson RW, Rice AS. Postherpetic Neuralgia. New England Journal of Medicine. 2014;371(16):1526–1533.
6. Jericho B. Postherpetic neuralgia: a review. Internet Journal of Pain, Symptom Control and Palliative Care. 2010;8(1).
7. Hempenstall K, Nurmikko TJ, Johnson RW, A’Hern RP, Rice ASC. Analgesic therapy in postherpetic neuralgia: A quantitative systematic review. PLoS Med. 2005;2(7): e164.
8. Jeon YH. Herpes zoster and postherpetic neuralgia: practical consideration for prevention and treatment. The Korean Journal of Pain. 2015;28(3):177-184.
9. Johnson RW. Herpes zoster and postherpetic neuralgia. Expert Review Vaccines. 2010; 9(sup3):21–26.
10. Straus SE, Schmader KE, Oxman MN. Varicella and herpes zoster. In: Fitzpatrick TB, Freedberg IM, editors. Fitzpatrick’s Dermatology in General Medicine; 6th ed. New York: McGraw- Hill Book Company; 2003.
11. Hope-Simpson RE. The nature of herpes zoster: A long-term study and a new hypothesis. Proceeding of The Royal Society of Medicine. 2009;58(1):9-20.
12. Hadley GR, Gayle JA, Ripoll J, Jones MR, Argoff CE, Kaye RJ, et al. Post-herpetic neuralgia: a review. Current Pain Headache. 2016;20(3):17.
13. Fashner J, Bell AL. Herpes zoster and postherpetic neuralgia: prevention and management. American Family Physician. 2011;83(12):1432–1437.
14. Gupta R, Smith PF. Post-herpetic neuralgia. Continuing Education in Anesthesia, Critical Care&Pain. 2012;12(4): 181-185.
15. Nagasako EM, Johnson RW, Griffin DR, Dworkin RH. Rash severity in herpes zoster: correlates and relationship to postherpetic neuralgia. Journal of American Academy of Dermatology. 2002;46(6):834–839.
16. Forbes HJ, Thomas SL, Smeeth L, Clayton T, Farmer R, Bhaskaran K, et al. A systematic review and meta-analysis of risk factors for postherpetic neuralgia. Pain. 2016;157(1):30–54.
17. Argoff CE, Katz N, Backonja M. Treatment of postherpetic neuralgia: a review of therapeutic options. Journal Pain Symptom Management. 2004;28(4):396–411.
18. Nagel MA. Post-herpetic neuralgia: New Perspective on pathogenesis and treatment. Pain Medicine News. 2015;S1-S8.
19. Noguchi K. Chapter 20 Central sensitization following nerve injury: molecular mechanisms. In: Handbook of Clinical Neurology. Philadelphia: Elsevier; 2006; 277–291.
20. McMahon SB, Bennett DLH, Bevan S. Inflammatory mediators and modulators of pain. In: Wall and Melzack’s Textbook of Pain; 5th ed. Philadelphia: Elsevier. 2008; 49–72.
21. Schaible HG. Peripheral and central mechanisms of pain generation. In: Stein C, editor. Analgesia. Berlin, Heidelberg: Springer Berlin Heidelberg; 2006.
22. Basbaum AI, Bautista DM, Scherrer G, Julius D. Cellular and molecular mechanisms of pain. Cell. 2009;139(2):267-284.
23. Ritner HL, Machelska H, Stein C. Immune system pain and analgesia. Science of Pain. 2009;407–427.
24. Meyer RA, Ringkamp M, Campbell JN, Raja SN. Peripheral mechanisms of cutaneous nociception. In: McMahon SB, editor. Wall and Melzack’s Textbook of Pain; 5th ed. Philadelphia: Elsevier. 2008.
25. Waldmann R. Proton-gated cation channelsneuronal acid sensors in the central and peripheral nervous system. Advances in Experimental Medicine and Biology. 2001;502:293-304.
26. Hilliges M, Weidner C, Schmelz M, Schmidt R, Ørstavik K, Torebjörk E, et al. ATP responses in human C nociceptors. Pain. 2002;98(1-2):59-68.
27. Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms and treatment. Lancet Neurology. 2010;9(8):807–819.
28. Ahlawat A. Comprehensive review on molecular mechanisms of neuropathic pain. Journal of Innovations in Pharmaceutical and Biological Sciences. 2017;4 (3):87-96.
29. Obata K, Yamanaka H, Dai Y, Tachibana T, Fukuoka T, Tokunaga A, et al. Differential activation of extracellular signal-regulated protein kinase in primary afferent neurons regulates brain- derived neurotrophic factor expression after peripheral inflammation and nerve injury. Journal of Neuroscience. 2003;23(10):4117-4126.
30. Fields HL, Rowbotham M, Baron R. Postherpetic neuralgia: irritable nociceptors and deafferentation. Neurobiology of Disease. 1998;5(4):209–227.
31. Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. The Journal of Clinical Investigation. 2010;120(11):3760-3772.



DOI: https://doi.org/10.22146/bns.v19i2.69201

Article Metrics

Abstract views : 3612 | views : 19167

Refbacks

  • There are currently no refbacks.


Copyright (c) 2021 Berkala NeuroSains

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.