from being to becoming ?

Eddy Rahardjo

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 ILYA PRIGOGINE
Free University of Brussels
and
The University of Texas at Austin

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 From Being to Becoming......
Mel Schwartz L.C.S.W. A Shift of Mind
• How we experience our lives is very much informed by how
we see reality operating. The prevailing mindset of most,
still believe in a fixed, static and material universe. From that
vantage, we construct a reality comprised of objects and
see ourselves as things as well, albeit human things. As
such we are beings. Human beings, perhaps somewhat
stuck in our identity of being. This mindscape sees change
as the exception and at times as undesirable; undesired
change is something to be controlled if not warded off, yet
not surprisingly we become mired in failure in our own
attempts to change.
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 Being an anesthesiologist ….

Then …….
becoming interventional pain specialist

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 but how did we look in 1840 ?
• 173 years ago, there was nothing to be
called anesthesia
• There were only no-pain, severe pain,
and died
• “pain free” state did not exist
• Not until TG Morton shed the light

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 William TG Morton
1846, Boston Massachussetts
The first clinical use of ether as anesthetic

Inventor and revealer of anesthetic inhalation

Before whom in all time surgery was agony
By whom pain in surgery was averted and annuled
Since whom science has control of pain
Bigelow
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 cancer
pain
Since whom
science has control neuropathic
of pain pain

labour
pain

trauma
pain

surgical
pain
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 how do we look NOW, 2020 ?

• anesthesiologist becomes a separate and

prominent medical profession
• we manage patients experiencing pain to
be “pain free”
• the magic words: “freedom from pain”
becomes a reality

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 Transfusi

Antibiotika
Kemajuan
Ilmu Bedah

Nutrisi An est esia

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 Nyeri bedah hanya salah satu macam nyeri
Banyak macam nyeri yang lain..

Low Nyeri Nyeri

back pain simpatetik bedah
distrofi

migraine
Nyeri Nyeri
trauma neuropatik Nyeri
postop
Nyeri
khronis
Nyeri
Nyeri
iskemia Nyeri
kanker
phantom

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We started here

Advanced block,
neuro modulasi
Terapi Terapi
farmakologis intervensional
Neuro-ablasi

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 Celiac plexus,
We started here Dorsal cord stimulation

Advanced block,
neuro modulasi
Terapi Terapi
farmakologis intervensional
Neuro-ablasi
Paracetamol SAB
NSAID Epidural Neurolisis
Opioid PNB RF application
etc

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 How do we bring all these
in just a decade of progress?

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 Tugas profesi dokter

• To save lives
–menyelamatkan kehidupan
• To alleviate sufferings
–meringankan penderitaan

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Pain control is the hallmark of
a civilization

KATI

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 who provides pain management?
• Dokter harus melihat bahwa manajemen
nyeri adalah
• “such a great and diverse challenge”
sehingga
• “no single specialist working alone can
do the job well”

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 Trauma
+ Nyeri Anest /APS

MRI Radiologi

Bebat
Cast Ortopedi

RICE
FisioRx KFR

Excercise KFR 6 bln

Sembuh dan
Ballerina ini jatuh dan menderita bisa menari lagi
severe sprain di ankle
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Pain management
adalah satu contoh
Peny Dalam
layanan kesehatan
yang kompleks

Pain Orthopedi
Neurologi Management & Trauma

Kedokteran
Anestesiologi Fisik &
Rehab

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 Terapi nyeri
• Medik farmakologis non-needle
• Medik farmakologis with needle
– non-destructive (blocks etc)
– destructive (neurolysis, etc)
• Medik non farmakologis
– RICE, acupuncture, physioRx, exercise
– Radio Frequency
– Surgery

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Holistic management
means also
Anxiety
dealing with
these additional Immuno Hyper
problems supression tension

PAIN
Increased
Metabolic Arrhythmia
rate

Increased
O2 demand

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• Untuk dapat berhasil dan aman
menyuntikkan phenol guna neurolysis
syaraf pasien dengan nyeri kanker
diperlukan knowledge yang cukup untuk
memahami topografi dan anatomi syaraf
tersebut. Kemudian dibutuhkan
kepiawaian dalam membawa ujung jarum
ke titik neurolysis syaraf tersebut.
• Sebelum dapat dikatakan kompeten
dokter tersebut perlu melakukannya
dibawah supervisi minimal 20 kali.
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 Good doctors keep the ethics…

Do not compromise
If you have to compromise anyway,
never compromise safety

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Florence Nightingale

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 “holistic approach”
• It is not only multi modal treatment
• It is also multi targets treatment
– The pain itself
– The cause of the pain
– The body reaction to pain
• hypertension, cardiac arrhythmia etc
– The psycho-emotional reaction to pain
– The detrimental results of the reaction to pain
• And preparedness for complications of the
treatment
– Convulsion
– Shock and cardiac arrest, etc
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 Honest doctors realize

• To cure sometimes,
• to relieve often,
• to comfort always

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 How to proceed ?

• Make a team, intra and extra profession

• Make a solid team
• We need to share burden
– Create a suitable role for others
• Up-referral
• Down-referral
• Be professional and offer best care
• Don’t raise a price barrier ***
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 Konsultan Manajemen Nyeri
KMN Setara S3, SpAn + 3 tahun

Fellow of Interventional PM
FIPM SpAn + 1 tahun, Pain Clinic

Basic Interventional
SpAn Nerve Blocks incl Anesthesia

Dokter Umum
EPM Basic, Acute Pain Service

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end
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