Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.4
,
No
.3
, Sep
t
em
b
e
r
20
15, pp
. 225
~231
I
S
SN
: 225
2-8
8
0
6
2
25
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
The Comparison of Gabapentin
and Amitriptilin Effectivity as
Pain Th
erapy in Herniat
e
d Nucleu
s Pulpos
us
Indria
stuti Cahya
n
ing
s
ih
1
, Rina
H
a
nd
ayani
2
, Sety
aning
s
ih
3
1
Department of Pharmacolog
y
and
Clinical
Phar
ma
c
y
, F
a
cult
y
of
M
e
dic
i
ne
and
Heal
th S
c
i
e
nc
es
Universitas Muh
a
mmadiy
a
h
Yogy
ak
arta, Indones
i
a
2
Department of Pharmacolog
y
and
Clin
ical Phar
macy
, Faculty
of
Pharmacy
, Univ
ersitas Gad
j
ah
Mada,
Indonesia
3
Neurolog
y
D
e
p
a
rtment Jogja H
o
spital, Indon
esia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
J
u
l 23, 2015
Rev
i
sed
Au
g
24
, 20
15
Accepted Aug 30, 2015
Herniated nucleus pulposus (HNP) is
one of
peripher
a
l n
e
uro
p
athic pain.
Although concensus guidelines
for the
treatment of n
e
uropathic pain ar
e
based on the results of the RCT
studies,
ther
e ar
e still gaps in the liter
a
tur
e
s.
This
s
t
ud
y
aim
e
d to com
p
are
the eff
ect
iven
es
s
and quali
t
y
of life o
f
gabapen
tin and am
itript
y
l
i
ne for
the tre
a
tm
ent
o
f
pain in
HNP. The
m
e
thod
used a quasi experimental with conse
qutive sampling. Th
is stud
y
included 30
pati
ents in th
e g
a
bapen
tin group
and 26 pat
i
ents
in the
am
itript
y
line group
,
and each group
was evaluated fo
r 1 mont
h. Effectiv
eness
was assessed using
Vis
u
al Analogu
e S
cale (VAS
) ever
y
2 we
ek
s
then anali
zed
b
y
M
a
nn
W
h
itne
y
t
e
st.
T
h
e resul
t
s showed that
th
e use of
gabap
e
ntin
and
am
itripti
li
n
in 4 weeks
s
howed the de
cre
a
s
e
of pain s
c
or
e
m
eas
ured b
y
v
i
s
u
al ana
l
og
scale 3
.
70 ± 0.349 and 3.500
± 0.34 a
lthou
gh there was n
o
statistical
differen
ce (p value = 0.704). To su
m up,
effectiven
ess of gabapentin and
am
itript
y
l
i
ne
in
the t
r
ea
tm
ent
of neuropa
thic
pain did
not ha
ve stat
istic
a
l
differen
c
e.
Keyword:
Am
i
t
rip
tilin
Effectiv
ity
Her
n
i
a
t
e
d nu
cl
eus
p
u
l
p
os
us
Gaba
pe
nt
i
n
Copyright ©
201
5 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
In
dri
a
st
ut
i
C
a
h
y
a
ni
ng
si
h,
Depa
rtem
ent of Pharm
acolo
gy and Clinical Pha
r
m
acy,
Uni
v
ersitas M
uhamm
adiyah Yogyaka
r
ta,
Li
ng
kar
B
a
rat
,
Kasi
ha
n,
Tam
a
nt
i
r
t
o
,
B
a
nt
ul
.
Em
a
il: n
d
r
ee_
c
h
y
@yahoo
.com
, in
d
r
iastu
ti.c@u
m
y.ac.id
1.
INTRODUCTION
There
are
t
w
o ki
n
d
s of
pai
n
nam
e
ly
nosi
s
e
p
t
i
c
an
d ne
ur
o
phat
i
c
[1]
.
Ne
ur
o
phat
i
c
i
s
a
sens
ori
c
a
n
d
e
m
o
tio
n
a
l experien
ce th
at is u
n
p
l
easan
t and
h
a
s si
g
n
i
fi
can
t
in
flu
e
n
ce toward
a p
e
rson’s liv
in
g
qu
ality [2
].
Neuro
p
h
a
tic pain
h
a
s similar ch
aracteristic to
th
e
o
t
h
e
r
cr
oni
cal
pai
n
s w
h
i
c
h
i
n
fl
u
e
nce si
gni
fi
ca
nt
l
y
t
o
wa
r
d
p
s
ycho
log
i
cal,
so
cial fu
n
c
ti
o
n
, and
t
h
e
o
t
h
e
r
h
ealth
asp
ects
co
rrelated
t
o
liv
ing
q
u
a
lity of
th
e p
e
op
le [3
].
Neu
r
op
hat
i
c
p
a
i
n
us
ual
l
y
has not
g
o
od
r
e
sp
onse t
o
wa
r
d
anal
g
e
si
c st
anda
r
d
by
Worl
d Heal
t
h
Or
ga
ni
zat
i
on (
W
H
O
)
,
l
i
k
e n
o
n
-
st
er
oi
d a
n
t
i
-
i
n
fl
am
at
i
on m
e
di
ci
ne (N
S
A
I
D
) a
n
d o
p
i
o
i
d
[
4
]
.
N
S
A
I
D a
n
d
aset
am
i
nofe
n
a
r
e
not
e
ffect
i
v
e
t
o
wa
r
d
neu
r
o
p
h
at
i
c
pai
n
[
1
]
.
Ant
i
d
e
p
ressa
nt
an
d ant
i
e
pi
l
e
pcy
m
e
di
ci
ne bec
o
m
e
t
h
e fi
rst
l
i
n
e
of t
h
e m
e
di
ci
ne t
o
ove
rcom
e
neu
r
op
hat
i
c
pa
i
n
[5]
.
Ant
i
d
e
p
ressa
nt
has bee
n
p
r
o
v
e
n
t
o
b
r
i
ng
be
nefi
t
i
n
d
i
abet
es neu
r
op
hat
i
c
, wi
t
h
t
h
e
best
effect can
be
reache
d
by tri
c
yclic
antidepressant (TC
A
)
[6]. Am
itrip
tilin bec
o
m
e
s one m
a
in choice for
neurophatic pa
in from
the group
of
tricyclic antidepressa
nt
[2
]. Antiepilepcy
m
e
dicine has shown its efficacy
t
o
wa
rd
som
e
t
y
pes
of
ne
ur
o
phat
i
c
pai
n
.
G
a
bape
nt
i
n
has
been
a
p
p
r
o
v
e
d
by
Fo
o
d
a
n
d
Dr
ug
Adm
i
ni
st
rat
i
on
(FD
A
)
as a
n
ad
di
t
i
onal
t
h
era
p
hy
f
o
r
pa
rt
i
a
l
epi
l
e
pcy
an
d m
a
nagem
e
nt
p
o
st
her
p
et
i
c
ne
u
r
al
gi
a [
7
]
.
Gaba
pe
nt
i
n
i
s
i
n
cl
ude
d
i
n
t
h
e
l
i
s
t
of
m
e
di
cine
pl
av
o
n
pri
c
e (
D
aft
a
r
Pl
a
v
on
Ha
r
g
a
Ob
at
-DP
H
O)
of
heal
t
h
i
n
s
u
ra
n
ce i
n
20
13
fo
r t
h
e di
ag
n
o
se
of p
o
st
he
r
p
h
e
t
i
c
neural
gi
a
(PH
N
)
[8]
.
It
i
s
based o
n
v
a
ri
o
u
s
ev
id
en
ces
and
research
es wh
ich
su
ppo
rt g
a
bap
e
n
tin
as
a t
h
eraph
y
cho
i
ce i
n
PHN. Meanwh
ile, am
itrip
tilin
can
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 4
,
N
o
. 3
,
Sep
t
emb
e
r
201
5
:
2
25
–
23
1
22
6
gene
ral
l
y
be i
n
cl
ude
d i
n
DP
H
O
as one
of t
h
e t
h
erap
hi
es f
o
r som
e
rel
a
t
e
d
di
seases. B
y
consi
d
eri
ng t
h
at
t
h
ere
is n
o
t
eno
ugh
l
iteratu
re
p
r
ov
in
g th
e effectivity o
f
g
a
ba
pent
i
n
as
HN
P t
h
e
r
aphy
,
ga
ba
pent
i
n
as
HN
P t
h
e
r
aphy
has
n
o
t
bee
n
i
n
cl
ude
d i
n
t
h
e
p
l
avo
n
of
heal
t
h
i
n
s
u
ra
nce
DP
HO
.
Phe
r
i
p
henal
ne
ur
o
phat
y
pai
n
i
s
one
of t
h
e ca
uses o
f
ne
u
r
o
p
h
at
y
pai
n
[
2
]
.
Her
n
i
a
t
e
d n
u
cl
eus p
u
l
p
os
us
(H
NP
) o
r
kn
o
w
n
by
sl
i
p
pe
d
ne
ur
on
di
sea
s
e i
s
o
n
e
ki
n
d
of
p
h
eri
p
he
nal
ne
ur
o
phat
y
pai
n
. M
o
st
of t
h
e
researc
h
es nowadays only
focu
s o
n
p
o
st
he
rpet
i
c
neu
r
al
gi
a or
di
a
b
et
i
c
p
e
ri
p
h
eral
neu
r
o
p
at
hy
,
b
u
t
i
n
t
h
i
s
st
udy
t
h
e researc
h
er
focu
ses o
n
p
a
t
i
e
nt
s wi
t
h
neur
o
phat
y
pai
n
ha
vi
n
g
l
e
si
on or
ot
her
di
s
eases as pai
n
f
u
l
cause
i
n
cl
udi
ng
h
e
r
n
i
a
t
e
d n
u
cl
e
u
s
p
u
l
p
os
us.
2.
R
E
SEARC
H M
ETHOD
2.
1.
Ma
terials
Too
l
s and
m
a
t
e
rials n
e
ed
ed fo
r t
h
is stud
y
were inform
ed
co
n
s
en
ts
u
s
ed
t
o
ask
p
a
tien
t
s’ willin
gn
ess
t
o
be t
h
e su
bj
e
c
t
s
of t
h
e st
ud
y
.
B
e
si
des, t
h
e
researc
h
er al
s
o
use
d
q
u
est
i
o
ners t
o
e
x
am
i
n
e dem
ograp
hi
c
dat
a
of
th
e p
a
tien
t
s as well as to
m
e
asu
r
e th
e effectiv
ity b
e
tween g
a
b
a
p
e
n
t
i
n
and
amitrip
tilin
with
Visu
al An
alog
Scale (VAS).
Visual
Anal
og Scale is a measurem
ent sc
ale that
is o
f
t
e
n
u
s
ed to
m
easu
r
e p
a
i
n
in
t
e
n
c
ity in
th
e
cl
i
n
i
cal
t
e
st
[9
]
.
The sc
ore
o
f
VA
S
0-<
4
ca
n b
e
cat
eg
ori
z
ed as l
i
g
ht
pai
n
,
4-<
7
i
s
m
e
di
um
pai
n
, an
d
7-
1
0
i
s
heavy pai
n
[10]. The study us
ed VAS as a scale
m
easur
e
m
en
t for p
a
in
in
t
e
n
c
ity h
e
rn
iated
nu
cleu
s pu
lpo
s
us
p
a
tien
t
s with
t
h
e m
easu
r
em
e
n
t in
terv
al
2
week
s with
m
o
nito
ring
ti
m
e
1
m
o
n
t
h
,
so
th
ere wou
l
d
b
e
availab
l
e
dat
a
f
o
r
pai
n
sc
ore
wi
t
h
V
A
S
scal
e i
n
week
0
,
wee
k
2 a
n
d
w
eek
4.
2.
2.
Rese
arch Pr
ocess
The
resea
r
ch was conducte
d
by
m
easuring t
h
e effe
ctiv
i
t
y
ga
bape
nt
i
n
wi
t
h
t
h
e
do
se
10
0 m
g
2 t
i
m
es a
d
a
y or am
itrip
tilin
1
2
.
5
m
g
o
n
c
e in
a
d
a
y. Effectiv
ity
mo
n
itoring
was
d
o
n
e
ev
ery
one ti
m
e
in
two
weeks
du
ri
n
g
1 m
ont
h t
r
eat
m
e
nt
by
rega
rdi
ng t
h
e s
c
ore
of V
A
S
.
Thi
s
st
u
d
y
was
con
duct
e
d i
n
J
o
g
j
a H
o
s
p
i
t
a
l
.
Every
pat
i
e
nt
was
gi
ven
o
n
e
of t
h
e dr
u
g
s (
g
a
b
a
p
ent
i
n
o
r
am
itri
p
t
y
l
i
n
e) a
nd
gi
ve
n a re
fer
r
a
l
t
o
p
h
y
s
i
o
t
h
erapy
.
Ph
ysio
t
h
er
ap
y
w
a
s
do
n
e
3 times a w
e
ek
fo
r 2 w
e
ek
s fo
l
l
owe
d
by twic
e a
week for t
h
e
next
2 wee
k
s. In
ad
d
ition
t
h
e
p
a
tien
t
s were also
ask
e
d
to use
th
e corset t
h
at
h
a
d b
e
en prov
i
d
ed. Patien
t
s no
t allo
wed to
use th
e
pai
n
m
e
di
cat
i
on
du
ri
n
g
t
h
e st
udy
.
It
ai
m
s
t
o
gi
ve t
h
e st
a
nda
rt
t
h
era
p
y
fo
r
HN
P a
n
d
gi
ve
equal
t
r
eat
m
e
n
t
t
o
al
l
pat
i
e
nt
. T
h
e
d
a
t
a
was
p
r
oce
s
sed a
n
d a
n
al
y
zed
by
usi
n
g
M
a
n
n
Wh
itn
ey t
e
st to
co
m
p
are th
e effectiv
ity
fro
m
gaba
pe
nt
i
n
a
n
d
am
i
t
r
i
p
t
i
l
i
n
. O
n
t
h
e
ot
he
r ha
n
d
,
descri
pt
i
v
e
anal
y
s
i
s
was
u
s
ed t
o
desc
ri
be
soci
o
-
dem
o
g
r
aphi
c
factor, pain characteristic
from
the
patients.
3.
RESULTS
A
N
D
DI
SC
US
S
I
ON
3.
1.
Resp
onde
nts
’
Ch
arac
teristic
C
o
m
p
l
e
t
e
dat
a
t
h
at
c
oul
d
be
anal
y
zed
wer
e
56
res
p
o
nde
nt
s
,
i
n
w
h
i
c
h
30
r
e
sp
on
de
nt
s
we
re
fr
om
t
h
e
g
r
ou
p
tak
i
ng
g
a
b
a
p
e
n
tin
, an
d 26
respond
en
ts
w
e
re fro
m
th
e g
r
o
up tak
i
ng
am
itri
p
tilin
. Respond
en
ts’
descri
pt
i
o
n
ca
n
be see
n
fr
o
m
4 charact
eri
s
t
i
c
s suc
h
as a
g
e,
ge
nde
r,
ed
ucat
i
o
n
ba
ck
gr
ou
n
d
, a
n
d
occ
upat
i
o
n
.
The
dat
a
a
b
o
v
e
can
be e
x
pl
ai
n
e
d i
n
Ta
bl
e 1
.
Tab
l
e
1
sho
w
s th
at th
e r
e
sp
ond
en
ts w
e
r
e
gr
oup
ed
into seve
ral categories
suc
h
a
s
age,
ge
nder,
educat
i
o
n bac
k
g
r
ou
n
d
, an
d occu
pat
i
o
n. B
a
sed o
n
st
at
i
s
ti
cal
anal
y
s
i
s
u
s
i
ng
ch
i squa
re
test g
o
t
th
e resu
lt
respect
i
v
el
y
0
.
5
56;
0
.
9
2
0
;
0.
60
1;
0.
1
6
7
.
It
sho
w
s t
h
at
t
h
ere was
no si
gni
fi
ca
nt
di
ffe
rence i
n
every
ch
aracteritis of th
e research
subj
ect, so
it
cou
l
d b
e
con
c
lud
e
d th
at t
h
e sub
j
ects of th
e
research were
hom
oge
no
us
.
B
a
sed
on
t
h
e
i
n
t
e
r
v
i
e
w,
res
p
on
de
n e
x
p
e
ri
e
n
ced
v
e
ry
di
st
ur
bi
n
g
pai
n
i
n
seve
ral
day
s
bef
o
re
h
a
vi
n
g
co
nsu
ltatio
n
t
o
th
e ho
sp
ital. Mo
st o
f
t
h
e
p
a
tien
t
s said
th
at
th
ey h
a
d
p
a
in
b
e
fo
re
b
ecau
s
e o
f
on
e th
ing
su
ch
as
liftin
g
h
eav
y l
o
ad, falling
d
o
wn,
o
r
activ
ities with
h
i
gh
i
n
ten
c
ity. Here th
ey are
p
a
in ch
aracteristic o
f
t
h
e
pat
i
e
nt
s t
h
at
i
s
sho
w
n i
n
Ta
bl
e 2.
Table 2 shows
that the m
a
in responde
nts’ pain cha
r
act
eri
s
t
i
cs were t
o
bea
t
feel
i
ng t
h
at
c
oul
d
be fel
t
b
y
39
r
e
sp
onden
t
s (69
.
6
4
%)
. Sh
arp
p
a
in
w
a
s f
e
lt
b
y
33
r
e
sp
ond
en
ts (5
8.93
%),
b
u
rn
t f
eel
in
g
cou
l
d b
e
f
e
lt b
y
20 r
e
sp
o
nde
nt
s
(35
.
7
1
%
)
, an
d
cram
p coul
d b
e
fel
t
by
21 res
p
o
n
d
ent
s
(
3
7.
5
0
%)
, w
h
i
l
e
bi
t
i
ng f
eel
i
ng c
oul
d be
fel
t
by
18 resp
on
de
nt
s (3
2.
1
4
%
). H
N
P i
s
o
n
e ki
n
d
o
f
neu
r
ot
r
o
pi
c pai
n
.
The di
st
i
n
ct
i
v
e
charact
eri
s
t
i
c
fr
om
n
e
uro
t
rop
i
c p
a
in
was sen
s
atio
n
s
lik
e
b
e
ing b
itten
,
g
e
ttin
g electrical sh
o
c
k
,
burn
t
, stiff, an
d
nu
m
b
. Patien
t
s
u
s
ually felt th
e sy
m
t
o
m
s o
f
allo
d
y
n
i
a (p
ain
th
at is cau
sed
b
y
th
e sti
m
u
l
u
s
th
at d
o
e
s no
t cau
se an
y
p
a
in
like
t
ouc
hi
n
g
)
an
d
hy
pe
ral
g
esi
a
(i
ncrease
res
p
on
s t
o
w
a
r
d
st
i
m
ul
us t
h
at
i
s
us
ua
l
l
y
hurt
)
[
2
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Th
e C
o
mpa
r
iso
n
o
f
Ga
bap
entin
an
d Amitrip
tilin
Effectivi
t
y
a
s
Pa
i
n
Th
erap
y
.... (In
dria
stu
ti Ca
h
y
an
ingsih
)
22
7
Table
1.
Dem
ogra
p
hic Cha
r
ac
teristic of t
h
e
Research Subjects
Respondents’ Ch
aracteristic
Gabapentin
A
m
i
t
rip
t
ilin
Respondent
Total
A
m
oun
t
Percen
tage (
%
)
A
m
oun
t
Percen
tage (
%
)
A
m
oun
t
Percen
tage (
%
)
Age
21-
30 y
ear
old
-
-
1
3.
85
1
1.
79
31-
40 y
ear
old
-
-
1
3.
85
1
1.
79
41-
50 y
ear
old
4
13.
33
4
15.
38
8
14.
29
51-
60 y
ear
old
10
33.
33
11
42.
31
21
37.
50
61-
70 y
ear
old
11
36.
67
7
26.
92
18
32.
14
71-
80 y
ear
old
5
16.
67
2
7.
69
7
12.
50
T
o
tal 30
100.
00
26
100.
00
56
100.
00
Gender
M
a
le
10
33.
33
9
34.
62
29
51.
79
Fem
a
le 20
66.
67
17
65.
38
27
48.
21
T
o
tal 30
100.
00
26
100.
00
56
100.
00
E
ducation
Backgr
ound
No School
-
-
1
3.
85
1
1.
79
SD 4
13.
33
6
23.
08
10
17.
86
SM
P 6
20.
00
5
19.
23
11
19.
64
SM
U 9
30.
00
8
30.
77
17
30.
36
Univer
sity 11
36.
67
6
23.
08
17
30.
36
T
o
tal 30
100.
00
26
100.
00
56
100.
00
Occupation Unem
p
l
oy
m
n
t
- -
1 3.
85
1
1.
79
Civil Ser
v
ant
4
13.
33
4
15.
38
8
14.
29
Pr
ivate Sector
1
3.
33
3
11.
54
4
7.
14
E
n
ter
p
r
e
neur 8
26.
67
1
385
9
16.
07
House W
i
fe
7
23.
33
11
42.
31
18
32.
14
L
a
bour
2
6.
67
2
7.
69
4
7.
14
Retir
ed 8
26.
67
4
15.
38
12
21.
43
T
o
tal 30
100.
00
26
100.
00
56
100.
00
Tabl
e
2. T
h
e
C
h
aract
eri
s
t
i
c
of
R
e
sp
on
de
nt
s’
Pai
n
Pain Characte
rist
ics
The Nu
m
b
e
r
of
R
e
spondents
Percen
tage (
%
)
Beating 39
69.
64
Shar
p 33
58.
93
Bur
n
t 20
35.
71
Cr
am
p
21
37.
50
Biting
18
32.
14
Pain
lo
catio
n
felt b
y
th
e p
a
ti
en
ts was also
v
a
ri
o
u
s
; th
ey were in
th
e b
a
ck
bo
n
e
, leg
,
an
d
tigh
.
Pai
n
l
o
cat
i
on o
f
t
h
e
resp
on
de
nt
s i
s
sho
w
ed i
n
Ta
bl
e 3. Tabl
e 3
sho
w
s t
h
at
3
4
resp
o
nde
nt
s (
6
0.
71
%) ex
peri
enced
t
h
e pai
n
i
n
t
h
e bac
k
bo
ne
and
l
e
g.
R
e
sp
on
de
nt
s
wh
o
expe
ri
ence
d t
h
e pai
n
o
n
l
y
i
n
t
h
e
bac
k
w
e
re
1
3
resp
o
nde
nt
s
(2
3.
21
%).
T
h
ere
were
8
res
p
on
dent
s
(
1
4
.
2
9
%
)
w
h
o e
xpe
ri
en
ced t
h
e
pai
n
o
n
l
y
i
n
t
h
e
l
e
g,
and
1
resp
o
nde
nt
(1
.
7
9
%
) e
x
peri
e
n
ced t
h
e
pai
n
i
n
t
h
e bac
k
b
one
and
t
i
g
h
.
Tabl
e
3. R
e
s
p
o
nde
nt
s’
Pai
n
L
o
cat
i
o
n
Pain Location
The Nu
m
b
e
r
of
t
h
e Responden
t
s
Percen
tage (
%
)
Back bone and leg
34
60.
71
Back bone
13
23.
21
L
e
g
8
14.
29
Back bone until tig
h
1
1.79
T
o
tal 56
100.
00
The
pai
n
of
n
o
s
i
s
ept
i
c
ex
peri
enced
by
t
h
e
p
a
t
i
e
nt
s coul
d e
a
si
l
y
expl
ai
n t
h
e pai
n
l
o
cat
i
o
n exact
l
y
,
but
th
e p
a
tien
t
s with
n
e
uro
t
rop
i
c p
a
in
so
m
e
ti
mes g
e
t d
i
fficu
lties to
m
e
n
tio
n
th
e lo
cation o
f
th
e p
a
i
n
ex
actly
because ne
urot
ropic pai
n
is sometimes
wider [1].
HNP
pai
n
with the s
o
urc
e
of the
bac
k
bone
ofte
n s
p
rea
d
s to
the leg
or to t
h
e reproduction orga
n
because
of the e
x
istence of cauda e
q
uine,
a group of ne
uron
c
o
nnecting
an
d prov
id
i
n
g
th
e co
mm
u
n
i
catio
n
with
low ex
trem
ity a
n
d
du
od
en
u
m
con
t
ro
l, ur
eth
e
r
,
an
d sexu
al
f
unctio
n
[1
1]
. I
n
a
n
e
x
t
r
em
e con
d
i
t
i
on,
di
scus
ex
peri
e
n
ci
n
g
her
n
i
a
t
i
on i
s
abl
e
t
o
p
r
e
ss t
h
e e
dge
o
f
t
h
e ne
u
r
o
n
i
n
c
a
ud
a
equi
ne w
h
i
c
h
causes ca
uda
equi
ne sy
n
d
r
o
m
e
causi
ng
bi
l
a
t
e
ral
pai
n
i
n
t
h
e l
e
g,
b
o
t
h
l
e
gs pa
ral
y
ze, an
d
d
i
sab
ility to
hold
th
e
p
ee
[1
2
]
.
3.
2.
T
h
e An
al
i
s
ys
of
Vi
su
al
An
al
og
Sc
al
e (
V
AS
)
In
itial
m
easu
r
emen
t to
th
e sco
r
e
o
f
p
a
in
in
t
e
n
c
ity u
s
in
g
VAS can
b
e
d
one wh
en
th
e
p
a
tien
t
s fu
lfill
incom
i
ng incl
usion criteria t
o
recei
ve the
medicine an
d
conducting int
e
rvie
w. T
h
e
patients were a
s
ke
d to
assess th
eir p
a
in
in
ten
c
ity with
VAS scale. Th
e resu
lt o
f
th
e research
sh
ows th
at th
e
in
itial
measu
r
emen
t
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 4
,
N
o
. 3
,
Sep
t
emb
e
r
201
5
:
2
25
–
23
1
22
8
(wee
k 0
)
pat
i
e
nt
s i
n
t
h
e gr
o
u
p
of
ga
bape
nt
i
n
9
3
% ha
d hea
v
y
pai
n
an
d 7
%
m
e
di
um
pai
n
, w
h
i
l
e
i
n
t
h
e gr
o
up
o
f
am
i
t
r
i
p
t
i
l
i
n
8
0
.
7%
ha
d
hea
v
y
pai
n
a
n
d
19
.3% m
e
di
um
pai
n
.
T
h
e re
su
l
t
of t
h
e re
sea
r
ch
was
si
m
i
l
a
r t
o
a
researc
h
c
o
n
d
u
ct
ed
by
O
h
t
o
ri
et
. al
. (
2
01
3
)
m
e
nt
i
oni
ng
t
h
at
t
h
e
pat
i
e
nt
s wi
t
h
her
n
i
a
t
e
d
nucl
e
us
pul
pos
u
s
di
ag
no
se
usual
l
y
had
pai
n
i
n
t
e
nci
t
y
m
easure
d
wi
t
h
VA
S sc
al
e aro
u
n
d
5
-
9
[1
3]
.
The pat
i
e
nt
s g
i
ven ga
bape
nt
i
n
t
h
e
r
a
phy
i
n
t
h
i
s
re
sea
r
ch
were 3
0
.
R
e
gi
m
e
nt
of
t
h
e d
o
se base
d on
gui
del
i
n
e N
I
C
E
(2
0
1
0
)
m
e
nti
ons t
h
at
f
o
r t
h
e t
h
erap
hy
o
f
neu
r
op
hat
y
pai
n
, t
h
e
do
se o
f
gaba
pe
nt
i
n
ad
v
i
ced i
s
10
0
-
3
0
0
m
g
be
fo
re sl
ee
pi
n
g
o
r
10
0-
3
0
0
m
g
i
n
a
day
[
2
]
.
H
o
weve
r,
t
h
e
d
o
s
e
use
d
i
n
t
h
i
s
r
e
search
was
10
0 m
g
2
x
in
a d
a
y.
I
t
w
a
s don
e b
ecau
s
e in
th
e pr
evio
u
s
stud
y w
ith
th
e do
se of
30
0
m
g
in
a d
a
y,
m
o
st o
f
th
e patien
t
s
com
p
lained of
its side effect that m
a
de
th
em feeling
weak
an
d d
i
sturb
e
d, so
th
ey
were not ab
le to
t
o
lerat
e
th
at
co
nd
itio
n.
Th
e
p
a
tien
t
s w
h
o
g
o
t
am
itr
ip
tilin
th
eraphy w
e
re 26
.
Amitrip
til
in
d
o
se g
i
v
e
n
w
a
s
12
.5
m
g
in
th
e
ev
en
i
n
g. Th
e
reg
i
m
e
n
t
o
f
th
is d
o
s
e is b
a
sed
o
n
N
I
CE
(2010
) m
e
n
tio
n
i
ng
th
at th
e d
o
se of amitrip
tilin
fo
r th
e
t
h
era
phy
of
ne
ur
o
p
at
hi
c pai
n
was 10
-
7
5
m
g
once
a day
[
2
]
.
Based
o
n
th
e
no
rm
alit
y test, it
go
t th
e i
n
formatio
n
that th
e
data fro
m
th
e v
a
lu
e of
v
i
su
al
an
alog
scale
(VAS)
was com
p
le
tely d
i
strib
u
t
ed
with
p valu
e>
0
.
0
5
bo
t
h
for
g
a
b
a
p
e
n
tin
g
r
ou
p an
d for am
itrip
til
in
group
.
It
in
d
i
cates th
at it
can
b
e
an
alyzed
b
y
u
s
i
n
g
p
a
ired
sam
p
le t test. Th
e resu
lt of
th
is test is presen
ted
i
n
Tab
l
e
4
.
Tabl
e
4. T
h
e
C
o
m
p
ari
s
on
o
f
S
c
ore
Dec
r
ease
of
V
A
S i
n
Gab
a
pent
i
n
an
d
A
m
i
t
r
i
p
t
i
l
i
n
G
r
o
u
p
V
A
S
Me
as
u
r
em
en
t
Treat
m
ent Group
N
Mean Score of
Declining VAS
p value
Week 0 to
week 2
gabapentin
30
1.
967±0.
2
1
1
0.
340
a
m
itriptilin
26
1.
731±0.
2
1
9
Week 0 to
week 4
gabapentin
30
3.
700±0.
3
4
9
0.
704
a
m
itriptilin
26
3.
500±0.
3
4
3
B
a
sed o
n
Ta
bl
e 4 can
be
kn
o
w
n t
h
at
t
h
e res
u
l
t
of
V
A
S sc
o
r
e dec
r
ease i
n
week
2 a
nd
we
ek 4
di
d
n
o
t
h
a
v
e
sign
ificant d
i
fferen
t
o
f
t
h
e effectiv
ity of g
a
b
a
p
e
n
tin
gro
u
p
and
am
i
t
rip
tilin
g
r
o
u
p
.
It
can
b
e
sho
w
n
fro
m
p val
u
e w
h
i
c
h was
m
o
re
t
h
a
n
0.
05
.
Th
e resu
lt of t
h
e research
is
si
m
ilar to
a resear
ch c
o
nd
uct
e
d by
M
o
rel
l
o
dk
k
(1
9
9
9
)
s
h
o
w
i
n
g t
h
at
t
h
ere was no
s
i
gni
fi
ca
nt
di
f
f
e
r
ence bet
w
ee
n
gaba
pe
nt
i
n
and
am
itrip
ti
lin
g
r
ou
p
i
n
its effectiv
ity fo
r
pain
fu
l
with
d
i
ab
etes
mell
itu
s (PDN) [6
].
A re
search done
by Dallocchio dkk
(2
000
)
sh
ow
ed
h
i
gh
er
pain
d
e
cr
ease
th
an
th
e p
a
tien
t
s with
g
a
b
a
p
e
n
tin
treatm
e
n
t
, bu
t it wa
s not
di
ffe
re
nt
st
at
i
s
t
i
call
y
[1
4]
. An
ot
he
r re
search
co
ndu
cted
b
y
V
e
g
a
(
201
0)
ex
p
l
ains th
e com
p
ariso
n
of amitrip
til
in
effectiv
ity
an
d
p
r
eg
ab
alin
effecti
v
ity in
th
e
t
h
era
phy
o
f
pa
i
n
f
u
l
di
abet
i
c
neu
r
opat
h
y
[1
5
]
. Prega
b
al
i
n
is an
an
ticon
vu
l
s
an
t wh
ich
also
b
e
co
m
e
s o
n
e
o
f
th
e
fi
rst
l
i
n
e t
h
era
phi
es f
o
r ne
ur
op
hat
i
c
pai
n
w
h
i
c
h
has act
i
o
n m
echani
s
m
li
ke ga
bape
nt
i
n
[2]
.
The
res
u
l
t
of t
h
e
researc
h
s
h
ows
that the
r
e
was
no signif
icant
diffe
re
nce in decreasing the
pain.
The res
u
l
t
of t
h
i
s
resear
ch al
so sh
o
w
s t
h
at
bot
h ga
ba
pent
i
n
g
r
o
u
p
an
d a
m
i
t
r
i
p
t
i
l
i
n
gr
o
up s
h
ow
pai
n
decrease i
f
it was com
p
are
d
before a
n
d
after th
e th
eraph
y
. Statistical
ly
it shows si
gni
ficant differe
n
ce
with
p
v
a
lu
e
0
.
00
0 (p
<0.05). Th
is resu
lt in
d
i
cat
es th
at am
itr
i
p
tilin
and
g
a
bap
e
n
tin are effectiv
e as p
a
i
n
k
iller
t
h
era
phy
i
n
her
n
i
a
t
e
d
nucl
e
us
pul
po
sus
.
T
h
e
resul
t
of
t
h
e a
n
al
y
s
i
s
i
s
prese
n
t
e
d i
n
Tabl
e
5.
Tabl
e 5.
C
o
m
p
ari
s
o
n
Anal
y
s
i
s
R
e
sul
t
of V
A
S
Sc
ore
by
Gi
v
i
ng Ga
bape
nt
i
n
an
d Am
i
r
i
p
t
i
lin
Infor
m
ation
Gabapentin
A
m
i
t
rip
t
ilin
M
ean ±
SE week
0
8.
733± 0,
26
2
8.
346± 0.
33
7
M
ean ±
SE week
4
5.
033± 0,
36
0
4.
846± 0.
40
6
p value
0.
000
0.
000
Th
is resu
lt is
si
m
ilar to
so
me research
es relate
d
to
both
g
a
b
a
p
e
n
tin
effectiv
ity an
d a
m
itrip
ti
lin
eefctiv
ity to
neu
r
op
h
a
tic
p
a
in
su
ch as Back
onj
a et.
al
.
(
1
9
9
8
)
co
n
duct
i
ng a
resea
r
c
h
t
o
t
h
e
pat
i
e
nt
s wi
t
h
Pain
fu
l
Neurop
ath
y
i
n
Patien
t
s
with
Diab
etes Mellitu
s d
i
ag
no
se [1
6
]
.
VAS
v
a
lu
e from
th
e p
a
tien
t
s g
e
tting
gaba
pe
nt
i
n
t
h
e
r
ap
hy
ha
d
decr
ease fr
om
6.4
becom
i
ng
3.
8
aft
e
r
8 we
ks,
c
o
m
p
ared t
o
pl
a
cebo
g
r
o
u
p
f
r
o
m
6.
5
becom
i
ng 5.
1 wi
t
h
p val
u
e<
0
.
0
0
1
.
3.
3.
Side Effect
Si
de e
ffect
be
com
e
s one
of
t
h
e pa
ram
e
t
e
rs w
h
i
c
h
nee
d
t
o
be c
o
n
s
i
d
ere
d
i
n
ch
o
o
si
n
g
a pa
rt
i
c
ul
ar
thera
phy.
Side
effect does
not alwa
ys appear in every patient, but it s
h
ould
bec
o
m
e
an alert so t
h
at the
p
a
tien
t
s can
an
ticip
ate it. Th
e ex
iste
n
ce of its efefctiv
ity
evidence
of the m
e
dicine
for the the
r
a
phy
of
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Th
e C
o
mpa
r
iso
n
o
f
Ga
bap
entin
an
d Amitrip
tilin
Effectivi
t
y
a
s
Pa
i
n
Th
erap
y
.... (In
dria
stu
ti Ca
h
y
an
ingsih
)
22
9
n
e
uro
p
h
a
tic p
a
in
is sig
n
i
ficantly n
eed
ed
to
health
staffs to
d
e
term
in
e th
e m
o
st effectiv
e med
i
cin
e
in
red
u
c
i
ng
pai
n
a
n
d
havi
n
g
m
i
nim
a
l
adverse e
ffect
.
I
d
e
a
l
l
y
, t
h
e evi
d
e
n
ce
of
ch
o
o
si
n
g
m
e
di
ci
ne i
n
a pa
rt
i
c
ul
ar al
g
o
ri
t
h
m
is base
d
on its
direct c
o
m
p
arison one
m
e
dicine
with
the
ot
hers,
both its e
f
ficacy and its
side e
ffect
[17].
In t
h
i
s
researc
h
, m
o
st
of t
h
e
pat
i
e
nt
s di
d n
o
t
expe
ri
ence si
gni
fi
cant
si
de
effect
.
Onl
y
se
veral
peo
p
l
e
g
o
t
its sid
e
effect, b
u
t
it was still
ab
le to
b
e
to
lerated
,
so
t
h
ey were atill
ab
le to
fo
llow th
eth
e
raph
y sessio
n
.
Howe
ver, there were som
e
patients dr
opping out because t
h
ey coul
d not tole
rate the inc
o
m
i
ng side effect. It
hap
p
e
n
ed
f
r
o
m
bot
h ga
ba
p
e
nt
i
n
gr
o
u
p
an
d am
i
t
r
i
p
t
i
l
i
n
gr
o
u
p
.
One
o
f
t
h
e
pat
i
e
nt
s c
o
m
p
l
a
i
n
ed
di
st
ur
bi
n
g
fatig
u
e
after co
n
s
u
m
in
g
am
i
t
rip
tilin
,
b
e
sides th
ere
was
sed
a
tion
effect
th
at
d
i
stu
r
b
e
d
t
h
e
p
a
tien
t
s’ d
a
ily
activ
ities, so
t
h
ey co
u
l
d
no
t co
n
tinu
e
to
p
a
rticip
ate in
th
e research. In
gab
a
p
e
n
tin
gro
u
p
,
th
ere
were
so
m
e
pat
i
e
nt
s com
p
l
a
i
n
i
ng t
o
ha
ve
st
i
ff feel
i
n
g aft
e
r co
ns
um
i
ng gaba
pe
nt
i
n
, s
o
t
h
e pat
i
e
nt
s det
e
rm
i
n
ed t
o
dr
o
p
o
u
t
.
Th
e si
d
e
effect
of th
e m
e
d
i
cin
e
bo
th
i
n
g
a
bapen
tin
g
r
ou
p and
in am
i
t
rip
tili
n
g
r
ou
p is presen
ted
i
n
Tab
l
e
6
.
Tab
l
e
6
.
Sid
e
Effect i
n
th
e Patien
t
s Hav
i
ng
Th
eraph
y
with
Gab
a
p
e
n
tin
and
Am
i
t
rip
tilin
Side Effect
Gabapentin
A
m
i
t
rip
t
ilin
Sedative
9
Dr
y m
outh
1
1
Neusea 3
Headache
1
T
i
r
e
d
1
1
Total
5
12
Based
on
Tab
l
e 6
,
it is kn
own
th
at th
e stage o
f
si
d
e
effect co
m
i
n
g
to
the g
r
ou
p
o
f
am
i
t
rip
tilin
was
sedat
i
o
n
wi
t
h
30
%,
d
r
y
m
out
h,
headac
he,
an
d t
i
r
e
d
ness
res
p
ect
i
v
el
y
3.
3%
fr
om
30
pat
i
e
nt
s.
Whi
l
e 3
1
pat
i
e
nt
s g
o
t
ga
bape
nt
i
n
t
h
e
r
a
phy
3.
2% re
p
o
r
t
e
d
dry
m
out
h
,
3.
2% t
i
r
e
dne
s
s
9.
7% feel
i
ng
nau
s
eat
ed. T
h
i
s
si
de
effect is sim
ila
r to th
e
p
r
ev
i
o
us research
es rel
a
ted
to
t
h
e
u
s
e
o
f
g
a
b
a
p
e
n
tin
an
d am
i
t
rip
tili
n
.
Sid
e
effect of
a
m
itrip
til
in
was m
o
stly rep
o
r
t
e
d
b
y
som
e
researches
suc
h
a
s
a resea
r
ch conducted by
Vega (
2
0
1
0
)
m
e
nt
i
oni
n
g
t
h
at
t
h
e pat
i
e
nt
s wi
t
h
pai
n
ful
di
abet
i
c
neu
r
opat
h
y
got
s
o
m
e
si
de effect
s l
i
k
e
sleep
in
ess 43% fo
r am
i
t
rip
tilin
and
2
0
%
to
th
e patien
t
s
with
p
r
eg
ab
alin
.
A
research
resu
lt
b
y
Kaur, et. al.
(201
1) also
exp
l
ain
s
t
h
at th
e
u
s
e
o
f
am
itrip
t
ilin
sho
w
s
th
e
m
o
st o
f
ten
si
de effect lik
e
d
r
y
m
o
u
t
h (2
8.8%)
with
p
val
u
e<
0,
0
0
1
a
n
d
sl
eepi
n
e
ss 1
8
.
9
%
fr
om
1
1
1
occ
u
re
nc
es, t
h
e
si
de e
f
f
ect
rep
o
rt
e
d
w
a
s 5
8
pat
i
e
nt
s
t
a
ki
ng
p
a
rt to
th
e research
[18
]
. Ad
v
e
rse
effect fro
m
a
m
itrip
tili
n
can
ap
p
e
ar
to
ward
card
i
o
v
a
sc
u
l
ar system lik
e
post
u
ral
hy
p
o
t
e
nsi
o
n, t
a
ki
ka
r
d
i
;
cent
r
al
ne
ur
o
n
sy
st
em
like a
nxi
et
y
,
he
adache
,
e
x
t
r
a
p
i
r
im
i
d
al
sym
p
tom
s
,
in
so
m
n
ia, sed
a
tio
n
and
sk
in
effect lik
e photo
s
en
sitiv
e, al
erg
i
,
u
r
tik
aria,
d
i
g
e
stion
system lik
e co
n
s
tip
atio
n,
i
n
creasi
n
g
wei
ght
a
n
d l
o
w
vi
s
i
on,
m
i
dri
a
si
s [19]
.
A research
con
d
u
c
ted b
y
Ri
n
t
ala et al (2
00
7) co
m
p
ared
th
e u
s
e of am
i
t
ritp
tilin
an
d gab
a
p
e
n
tin
as
p
a
in
t
h
eraph
y
in
sp
i
n
al cord
in
ju
ry, t
h
e
p
a
tien
t
s repo
rt
ed
tth
at th
e sid
e
effect
o
f
u
s
i
n
g
a
m
itrip
til
in
was dry
m
out
h (63
.
8
%
)
,
sl
eepi
n
ess (
2
7.
1%)
,
an
d co
nst
i
p
at
i
o
n (2
9.
2%)
,
t
i
r
edne
ss (2
0.
5%
) [2
0]
. A sim
i
l
a
r t
h
eory
was
al
so re
p
o
rt
e
d
b
y
t
h
e pat
i
e
nt
s
wh
o
g
o
t
ga
ba
p
e
nt
i
n
th
erap
h
y
with
th
e sa
m
e
occurre
nce stage.
Ad
ve
rse ef
fec
t
fr
om
gabap
e
nt
i
n
ca
n a
p
p
ear s
u
ch a
s
s
e
dat
i
v
e,
d
r
y
m
out
h, hea
d
a
c
he,
p
o
st
u
r
al
h
i
po
ten
s
i
o
n, atax
ia, con
s
tip
at
io
n
,
letarg
i, ed
em
a, p
r
u
r
itis, in
co
m
f
o
r
tab
l
e feelin
g
,
d
i
arhea, n
a
u
s
ea, unclear
v
i
sion
, an
d
t
h
e o
t
h
e
rs [6
]. Acco
rd
ing
to
M
o
rello
, it is also
ex
p
l
ain
e
d
th
at t
h
e u
s
e
of am
i
t
rip
tilin
in
n
e
urop
h
a
ty
p
a
in
t
h
eraph
y
,
th
e sid
e
effect
th
at is m
o
stly
ex
p
e
ri
ence
d
by
t
h
e p
a
t
i
e
nt
s ar
e sedat
i
v
e a
n
d
dry
m
out
h t
h
at
can
b
e
wo
rse fro
m
ti
m
e
to
ti
me. Mean
wh
ile, in th
e u
s
e of g
a
b
a
p
e
n
tin
th
e si
d
e
effect reported
was sed
a
tiv
e and
headac
he.
The
othe
r side effe
cts expe
ri
ence
d by the
patients are postural
h
ypotensi
o
n, weight inc
r
ease,
ataxia
an
d letarg
i altho
ugh
it app
e
ars in
low
prev
alen
ce.
Based
o
n
th
e
discu
ssion
ab
ove, it can
b
e
conclu
d
e
d
th
at t
h
e sid
e
effect
o
f
g
a
b
a
p
e
n
tin
an
d amitrip
tilin
is b
a
sically s
i
milar, b
u
t
in
t
h
is research
sed
a
tiv
e si
d
e
effect
m
o
stly
co
uld
b
e
foun
d
by th
e p
a
tien
t
s
g
e
ttin
g
a
m
itrip
til
in
th
eraph
y
, wh
ile g
a
b
a
p
e
n
tin
d
i
d n
o
t
report
mo
re sid
e
effect
rep
o
rted
b
y
t
h
e resp
ond
en
t
s
. It is
possible
because the e
ffect
of antide
p
ressant
from
the amit
riptilin was bi
gge
r,
so it ha
d m
o
re effect to cal
m
d
o
wn
o
r
sed
a
t
i
v
e
. Th
e sid
e
effect cann
o
t
b
e
sep
a
rated
fro
m
th
e
m
e
d
i
c
i
n
e
an
d
ind
i
v
i
d
u
a
l cond
itio
n o
f
th
e
patients. T
h
e treatm
e
nt can de
crease pai
n
int
e
ncity of th
e
patients, and it is closely
corre
l
ated to the inc
r
ease
o
f
liv
ing
q
u
a
lity, bu
t it d
i
d no
t
d
e
crease its si
d
e
effect
[21
]
.
4.
CO
NCL
USI
O
N
The u
s
e o
f
ga
bape
nt
i
n
a
nd a
m
i
t
r
i
p
t
i
l
i
n
i
n
4
weeks s
h
owe
d
t
h
e dec
r
ease
of p
a
i
n
sc
ore
m
easured
by
vi
sual
a
n
al
o
g
scal
e 3.
7
0
±
0.
34
9 a
n
d
3.
5
0
0
±
0.
3
4
3
w
i
t
h
p
val
u
e>
0.
05
w
h
i
c
h
m
eans t
h
at
i
t
w
a
s n
o
t
si
gni
fi
ca
nt
l
y
di
ffe
rent
, R
e
p
o
r
t
e
d si
de ef
fect
fr
om
t
h
e use o
f
ga
bape
nt
i
n
was 3.
2% fe
el
i
ng
dry
m
out
h,
9.7%
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 4
,
N
o
. 3
,
Sep
t
emb
e
r
201
5
:
2
25
–
23
1
23
0
feelin
g
n
a
u
s
ea
and
3
.
2
%
feel
in
g
tiredn
e
ss; wh
ile for
t
h
e
u
s
e
o
f
am
itrip
t
ilin
was sed
a
ti
v
e
3
0
% , dry
m
o
u
t
h
,
headac
he and
t
i
redness res
p
ec
tively
3.3%.
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I
J
PH
S I
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SN
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225
2-8
8
0
6
Th
e C
o
mpa
r
iso
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Ga
bap
entin
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Effectivi
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23
1
BIOGRAP
HI
ES
OF AUTH
ORS
Indriastuti C
a
h
y
aningsih is a lecturer of pharm
acolog
y
and clinical pha
rmacy
science
at School
of pharmacy
,
Universitas Muhammadiy
a
h Yogy
ak
arta. She was born on
May
26
th
, 1985 in
Yog
y
ak
arta. She got gradu
a
tion, pharmacy
b
y
tr
ai
ning
, and
master of science
at
Gadjah Mad
a
University
, Yogy
ak
arta, Indones
i
a.
Rina Handay
a
n
i
is a one of lectur
er at Gadjah
Mada University
. S
h
e is a doctor. S
h
e has passion
in pharm
aco
log
y
s
c
ien
c
e
.
There
a
r
e s
e
ve
ral
res
e
ar
ch th
at
s
h
e ha
d b
een produ
ced
.
Sety
aningsih
is a neuro
l
ogist
at J
ogja hospital. She was bor
n on July
1
th
,
1958 in Metr
o
Lampung, Sumater
a
. She got
graduation on 1999 at
Gadjah
Mada University
, Yog
y
akarta,
Indonesia. Her
h
obb
y
is reading
and shopping.
Evaluation Warning : The document was created with Spire.PDF for Python.