INTERVENTIONAL PAIN MANAGEMENT

KETUT NGURAH GUNAPRIYA dr SpAn KIC FIPM FIPP CIPS

MAYAPADA HOSPITAL
ACUTE PAIN IS ALARM
 Definisi Nyeri

 MENURUT IASP 1979 “ PAIN IS DEFINE AS: AN UNPLEASANT

SENSORY AND EMOTIONAL EXPERIENCE ASSOCIATED WITH ACTUAL
Makna dari definisi
OR POTENTIAL TISSUE ini adalah:
adalah
DAMAGE : DESCRIBE IN TERM OF SUCH
OR

DAMAGE . (Hof
Key word AROLD MERSKEY )
pain is unpleasant
unpleasant sensory and emotional
experience (rasa yg tdk menyenangkan sensorik dan emotional
emotional)).
 Associated with actual tissue damage (Acute
(Acute Pain =Nociceptive
pain)
 Due to potential
potential tissue damage (Nociceptive pain = Physiological pain =
withdrawal Reflex)
 Described in term of such damage (digambarkan seperti adanya
kerusakan jaringan .(
.(tapi tidak))  chronic pain .
tapi tidak
 1. Nociceptive Pain
• NYERI NOSISEPTIF ADALAH NYERI
YANG TERJADI AKIBAT ADANYA
SUATU STIMULUS KUAT (MEKANIK,
TERMAL ATAU KIMIAWI) PADA
JARINGAN YANG INTACT (UTUH).
• JADI ADA POTENTIAL TISSUE
DAMAGE YANG MENGHASILKAN
WITHDRAWAL REFLEX.
• BELUM ADA KERUSAKAN
JARINGAN.
• GUNAYA SEBAGAI ALAT
PROTEKSI TUBUH DARI BERBAGAI
KERUSAKAN.
Nociceptive pain
Minimal tissue damage
Sebenarnya pembedahan dimulai dgn nyeri nosiseptif  nyeri akut nyeri i
 sembuh nyeri hilang, kalau sembuh tapi nyerinya menetap  nyeri kronik
 Mekanisme Nyeri Nosiseptif atau Nyeri Akut
Diantara simulus noksius dan persepsi ada 5 proses yg Persepsio
tersendiri yaitu;  Nosisepsi (respons saraf terhadap stimulus noksius) n
1. Transduksi
2. Konduksi Neuron III
3. Modulasi
4. Transmisi
5. Persepsi

Transduction

Mechanical
Conduction
Transmissio
Action potential n
Modulation
Neuron II
Thermal

Neuron I
Transmission
Chemical

Modified by AHT
CHRONIC PAIN IS DESEASE
CHRONIC PAIN
CHRONIC PAIN IS A PAIN THAT PERSISTS
BEYOND NORMAL TISSUE HEALING TIME,
WHICH IS ASSUMED TO BE THREE – SIX
MONTHS.

The International Association for study of pain (IASP)

(IAS

 Pain that continues when it should not.

 • POST-TRAUMATIC PAIN
• POST-OPERATIVE PAIN
• LABOUR PAIN

PAIN MANAGEMENT • NERVE ENTRAPMENT SYNDROME

• CERVICOGENIC HEADACHE
• MSK PAIN
RVENTIONAL PAIN MANAGEMENT • ACUTE LOW BACK PAIN & NECK PAIN WITH
RADICULOPATHY

• COMPLEX REGIONAL PAIN SYNDROME ( RSD)

• HERPETIC & POST-HERPETIC NEURALGIA
• ACUTE PANCREATITIS
• ACUTE MYOCARDIAL INFARCTION
• SIMPATIS BLOCK
1. DISC PROCEDURES: DISCOGRAPHY, OZONE
NUCLEOLYSIS, PERCUT. DISCECTOMY

2. PERCUT. VERTEBROPLASTY
3. SPINAL CORD STIMULATION
4. SPINAL ENDOSCOPY
Every thing I do is to help you
avoid surgery”
 OUR WELL BEING, IS ONLY FREEDOM FROM PAIN” ( DE
MONTAIGNE.1592)
ERDOSSI 2002
25 % HOSPITAL VISIT • PAIN CLINIC RSU KERTHA USADA
PAIN MANAGEMENT
CHRONIC PAIN (POST HERPES NEURALGIA)
ACUTE PAIN (FR CRURIS )
COIN ON THE SAND
AS A SNIPER NOT A BOMBER
LOST IN SPACE
MUSCULOSKELATAL
NERVE ENTRAPMENT
SPINE PROBLEM
CHEPALGIA
CANCER PAIN
MUSCULOSKELETAL
INJECTION
RADIO FREQUENCY ABLATION
NERVE ENTRAPMENT SYNDROME
NERVE NAME
• GREAT OCCIPITAL NERVE • CERVICO GENIC CHEPALGIA
• SUPRASCAPULAR NERVE • SUPRASCAPULAR NERVE ENTRAPMENT
• PUDENDAL NERVE • PUDENDAL NERVE ENTRAPMENT
• ABDOMINAL CUTANEUS NERVE • ABDOMINAL NERVE ENTRAPMENT SYNDROME
• SCIATIC NERVE • PIRIFORMIS SYNDROME

• LATERAL FEMORAL CUTANEUS • MERALGIA PARAESTHICA

• CARPAL TUNNEL SYNDROME
• MEDIAN NERVE
• GUYON CANNAL SYNDROME
• ULNAR NERVE
• ILIOHYPOGASTRIC NERVE ENTRAPMENT
• ILIOHYPOGASTRIC NERVE
• OBTURATOR NERVE ENTERAPMENT
• OBTURATOR NERVE
• TIBIAL NERVE ENTRAPMENT SYNDROME
• TIBIAL NERVE
OCCIPITAL CHEPALGIA
BLOCK GREAT OCCIPITAL

Windt et al, 2008

PIRIFORMIS SYNDROME
SPINE PROBLEM

BACK PAIN

• DISCOGENIC PAIN
• FACET JOINT
• SI JOINT
• HNP
LUMBAL FACET
USG
ATIPICAL FACIAL PAIN
TRIGEMINAL NEURALGIA
LUMBAL FACET
USG
STEVE JOBS 1955
1955--2011
COMMON SYMPATHETIC BLOCKS

• SPHENOPALATINE GANGLION
• STELLATE GANGLION
• THORACIC SYMPATHETIC CHAIN
• CELIAC PLEXUS
• LUMBAR SYMPATHETIC
• SUPERIOR HYPOGASTRIC PLEXUS
• GANGLION OF IMPAR
SUMMARY

• ACUTE PAIN IS A GOOD NEWS

• CHRONIC PAIN IS A DESEASE
• AS A SNIPER,NOT AS A BOMBER
• DON
DON’’T TREAT THE PICTURE