DM neuropathic pain is one of the complications of diabetes mellitus which has a variety of sensations such as burning, very painful cold, and a feeling like electric shock. This pain can become very painful when there is widespread/diffuse damage to the peripheral nerve fibers so that the nerves become dysfunctional. This has an impact on the patient's functional and daily activities, accompanied by a higher incidence of depression and anxiety, thereby reducing the patient's life expectancy.
Mecobalamin is the best form of vitamin B12 for nerves because it has a high concentration in cerebrospinal fluid of 90%, absorbed by nerve cells is higher, with various abilities: nerve regeneration of nerves, protection of nerve cells from glutamate toxicity, and inhibition of the spontaneous electrical flow of nerves. Several studies have shown that mecobalamin is effective for reducing diabetic neuropathy.
The August 2021 study by Purwata TE et al, which was conducted using a randomized, multiple and placebo-controlled method, in 42 patients aged 49-65 years with very painful type 2 DM neuropathic pain, with a pain score of DN4 (Douleur Neuropathique 4) appropriate questionnaire 4 and NPRS (Numeric Pain Rating Scale) worth 6.57. Group 1 (n:21) was given intravenous injection of 500 mcg of mecobalamin 1x/2 days. Group 2 (n:21) was given a placebo. Both groups were given amitriptyline 12.5 mg, 2x/day. This intervention was carried out for 10 days. Follow-up was carried out on days 2, 3, 5, 7, 9, by evaluating the DN4 and NPRS questionnaire scores. Side reports are also noted for their safety. The results of the study are shown below.
The study showed that when compared with placebo, there was a much more significant improvement in the NPRS score in the intervention/mecobalamin group, amounting to 62.6% with a p value of p = 0.001. There were no serious side effects during the intervention.
In this study, it can be concluded that giving intravenous injection of 500 mcg mecobalamin 1x/2 days, in 21 patients with very painful neuropathic type 2 DM, for 10 days, significantly (when compared to the placebo group) significantly reduced the NPRS pain score (Numerical Pain Rating). Scale) of 62.6% at day 10, with a consistent decrease of -1.48 since the start of therapy and no serious side effects during therapy; with a p value of p = 0.001.
Image: Illustration (source:https://www.hopkinsmedicine.org/)
Reference: Purwata TE, Widyadharma IPE, Rudy M, Soejitno A, Gotera W, Suryana K. Intravenous methylcobalamin effectively ameliorated painful diabetic neuropathy: A randomized double-blind placebo controlled trial. Ro J Neurol. August 2021;20(3).
