당뇨병 족부 신경통 진통 요법 > 닥터 약물 요법

당뇨병 족부 신경통 진통 요법

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당뇨병 족부 신경통 <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /></TD></TR>
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.1 당뇨병의 합병증인 다발성 감각 신경통은 가장 흔한 신경통 중 하나이다
 
.2 통증은 주로 작열 감 이며 찌르는 통증이나 지속적  둔통 도 많다
 
.3 이 같은 당뇨병 성 신경통은 혈당 조절과 중성 지질 조절을 
철저히 하면 매우 도움이 된다.  당과 중성 지질이 신경을 파괴하고 있기 때문이다
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<IMG src="/_dimg/1%20당뇨병%20신경굥%2020140523_050714.png">
[그림] 당과 중성지질(Tryglyceride) 높아지면 허리에서부터 발 끝에 이르는 
긴 신경(Peroenal Nerve)의 전달 속도가 느려지기 시작: 
이 노란 색 신경을 좌골 신경이라고 부른다  

 
 
<IMG src="/_dimg/2%20수소%2020140523_050837.png">
[그림] 신경을 덮고 있는 영양 세포 수초 (Myelin) 가 중성 지질과 당에 의해  파괴
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진통 요법</TD></TR>
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.1 NSAID 나 Acetaminophen 같은 비 마약 성 진통제는
신경통에는 잘 듣지 않으나 일단은 시도는 해 볼 수 있다
 
.2 당뇨병성 신경통은 대상포진 성 신경통 치료 법과 동일한 방법을 사용한다
 
.3 Amitriptyline or Nortriptyline 같은 3환계 항 우울제가 선택 약 이다. 
 
.4 SSRI 계 항우울 제는 시도 해 보았으나  3환계 항 우울제 보다 효과가 적다 
 
.5 Sertonin과 Noradrenalin 재 흡수 억제제인 Duloxetin은
당뇨병성 신경통에 적응증을 허가 받고 있다
 
.6 Carbamazepine, Gabapentin, Phenytoin, Ppregabalin같은
항 경련제는 찌르고 에이는 통증에 사용 될 수 있다 Lamotrigine 과 Topiramate는 검토 중이다 
 
.7 부정맥 약인 Lidopcaine 을 정맥 주 하거나 Mexiletin 을 경구 투여하면 통증의 상당 부분에 효과를 발휘한다. 그러나 Mexi;etine 은 강력한 효과 입증 자료가 없으므로 극단적으로 난치성인 경우와 심장 위험이 없는 자애게 사용 해 볼 수 있다
 
.8 Capsaicin 이나 Lidocaine을 국소에 바르면 효과를 볼 수 잇는 경우도 있다 그러나 Capsaicin은 작열감을 유발 할 수 도 있다
 
.9  Methadone, Oxycodone, Tramadol 같은 마약 성 진통제는 부분적으로 효과가 있으므로 다른 약이 듣지 않을 때 사용해 볼수 있다
 
.10 피하 전기 신경 자극 술(TENS) 도 시도해 볼 수 있다
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근거 </TD></TR>
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