Penatalaksanaan NyeriDr. Pangkuwidjaja PDepartemen AnestesiologiFakultas Kedokteran Unika Atma Jaya

PAINPain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (IASP, 1979)Adopted from Mersky, 1964

Features of Physiological PainPain (A and C fibers) can be differentiated from touch (A fibers)Pain as symptomPain serves a protective functionPain acts as a warning of potential damagePain is transientPain is well localizedPathology recognizedStimulus-response pattern is the same as with other sensory modalities

Pain is just like any enemy. You keep moving around and the enemy can not hit you.

Someway with pain. The quicker you break away from the pain, the quicker you will drive the pain out of your system. You sit too long and you will not able to move

TREAT THE PAIN.AGGRESSIVELY !!!

Clinical PainInflammatory responsePeripheral nerve injuryPeripheral sensitizationCentral sensitizationMetabolic and endocrine changesAffective component

Features of Clinical PainPain can be elicited by A and C as well as A fibersPain as diseasePain is pathologicalassociated with inflammation, neuropathy, etcOccurs in the context of peripheral sensitizationOccurs in the context of central sensitizationPain outlast the stimulusPain spread to non-damaged areasNo biologic usefulness

Types of PainNociceptive

Neuropathic

Idiopathic

Pain AssessmentThe cornerstone of pain managementBoth on rest and with activityUsing a valid measurement tool

Taking the HistoryComprehensive historyHistory of pain problemPast medical historyPsychological and psychosocial historyFamily history

History of the PainPain at onsetPain during the intervalPresent pain

History of Paingeneral medical and oncologic historyextent of diseaseprognosisPPalliativeProvocativeQQualityRRadiationSSeverityTTemporal

AAssociated featureBBehaviorsCCourse of painDDuration

Characteristics of the PainLocation and DistributionQualitySeverity / IntensityDuration and periodicityExacerbating / Relieving factorsResponse to previous analgesic and disease-modifying agentsEffect of pain on activity of daily living

Location and DistributionLocalized painProjected painReferred painReflex sympathetic pain

Quality of painNociceptive painSuperficialSharpWell localizedDeep somatic / visceralDullDiffusePoorly localizableNeuropathic painPins and needlesBurning

Duration and PeriodicityContinuousIntermittent

Physical ExaminationGeneral physical examinationNeurologic examination

Treatment of PainAnalgesic Agents

ParacetamolNSAIDsTramadolOpioids

Local anesthetics