PAIN MANAGEMENT

Dr. Surya Bayu Prajayana, M.Biomed, Sp. OT

 Definition

“Pain is an unpleasant sensory and

emotional experience associated with
actual or potential tissue damage or
described in terms of such damage.”

International Association for the Study of Pain. Pain. 1979;6:249.

 Pain Classification

 Pain may be classified into two varieties:

acute and chronic.

 As a rule, postoperative pain is

considered a form of acute pain,
although it may become chronic if it is not
effectively treated.
 Pain Sensitization
10
Hyperalgesia Normal
8 Pain
Response
Pain Intensity

6 Injury
Hyperalgesia –
heightened sense of pain
4
Allodynia in response to noxious
stimuli
2 Allodynia – pain resulting
from normally painless
stimuli
0
Stimulus Intensity

Adapted from Gottschalk A et al. Am Fam Physician. 2001;63:1980.

 Example of Measurement Tool
for Assessing Pain

Visual Analog Scale (VAS)

No pain Pain as Bad as it could

possibly be

Carr DB, et al. AHCPR Pub. No. 92–0032. 1992.

 Example of Measurement Tool
for Assessing Pain

Carr DB, et al. AHCPR Pub. No. 92–0032. 1992.

Analgesic Options for Acute Pain Management

 Opioid analgesics
 Nonopioid analgesics
 acetaminophen
 tramadol

 anti-inflammatory agents

 Combination analgesic products

 Local anesthetics, nerve, neuraxial blocks
 Opioid Analgesics

 Binding at , , , receptors
 Highly efficacious
 May be used in PCA
 May be combined with anti-inflammatory agents
 Effects may be reversed
 Side effects common

Fishman SM, Borsook D. In: Benzon HT, et al, eds. Essentials of Pain Medicine and Regional Anesthesia; 1999:51–
54.
 Adverse Effects of Opioids

 CNS depression, sedation

 Respiratory depression
  GI motility, nausea, vomiting
 Urinary retention
 Pruritus
 Case 1

Identitas
Nama : Tn WB
Jenis Kelamin : Laki-laki
Umur : 50 Tahun.
No Cm :13025021
Alamat : Denpasar
Status : BPJS
Ruang Rawat : Angsoka
Diagnosis : MM
 ANAMNESIS.
 Pasien mengeluh nyeri seluruh tubuh dan lemah. Sebelumnya telah
menjalani kemoterapi dan radioterapi.

 PEMERIKSAAN FISIK.
 BB: 45 kg; TB: 158 cm; T : 36,5oC.
 SSP : kompos mentis.
 Respirasi : RR: 16 x/mnt, vesikuler kanan kiri, rhonkhi dan
wheezing tidak ada.
 Kardiovaskuler : TD : 110/70 mmHg. HR 88 x/mnt, S1 & S2
reguler, tidak ada murmur.
 Gastrointestinal : Bising usus normal. Distensi tidak ada.
 Urogenital : dalam batas normal
 Musculoskeletal : dalam batas normal
Tanggal 13 Februari 2014
Pasien MRS, renacana perbaikan KU. Hb : 7,8 g/dL. Pro
tranfusi WB 3kolf. VAS 8 / 10. Diberikan Fentanyl patch
25 mcg / jam

Tanggal 14 Februari 2014

Pemberian transfusi darah. VAS 6 / 10

Tanggal 17 Februari 2014

Pasien diperbolehkan pulang. VAS 5 / 10
 Case 2

Identitas
Nama : Ny. NR
Jenis Kelamin : Perempuan
Umur : 55 Tahun.
No Cm :13025021
Alamat : Karangasem
Status : Umum
Diagnosis : Post Hemiarthroplasty Bipolar
 ANAMNESIS.
 Pasien terjatuh dirumah dan mengeluh nyeri panggul kanan. Sudah
dilakukan hemiarthroplasty Bipolar.

 PEMERIKSAAN FISIK.
 BB: 50 kg; TB: 155 cm; T : 36,2oC.
 SSP : kompos mentis.
 Respirasi : RR: 18 x/mnt, vesikuler kanan kiri, rhonkhi dan
wheezing tidak ada.
 Kardiovaskuler : TD : 120/80 mmHg. HR 80 x/mnt, S1 & S2
reguler, tidak ada murmur.
 Gastrointestinal : Bising usus normal. Distensi tidak ada.
 Urogenital : dalam batas normal
 Musculoskeletal : dalam batas normal
Tanggal 8 November 2015
Pasien BPL. VAS 5/10. Diberikan Tramadol -
Acetaminofen

Tanggal 11 November 2015

VAS 3/10