Curriculum Vitae

PLACE AND DATE OF BIRTH

Medan, May 25th 1968

EDUCATION
Physical Medicine and Rehabilitation, University of Indonesia,
Jakarta, 2009
M.D. Faculty of Medicine, University of Indonesia,
Jakarta, 1994

WORKING EXPERIENCE
Physical Medicine and Rehabilitation Specialist,
Global Awal Bros Hospital, Bekasi, East Jakarta, 2009
Clinic of Medikaloka, Kuningan, South Jakarta, 2005-2009
Clinic of Dr Boyke, Tebet, South Jakarta, 2001 – 2004
Puskesmas Bula, Center Maluku, 1995 - 2000

Dr Erwin A.D. Nanulaitta,

Nanulaitta, SpKFR
MANAJEMEN NYERI DENGAN
MODALITAS TERAPETIK

Dr. Erwin A.D. Nanulaitta, SpKFR

Tinjauan

1. NYERI

2. MODALITAS TERAPETIK

3. MANAJEMEN NYERI
NYERI
• Nyeri menurut International Association for
the Study of Pain (IASP) : merupakan
pengalaman sensorik dan emosional yang
tidak menyenangkan akibat adanya kerusakan
atau ancaman kerusakan pada jaringan.
• Keluhan utama
• Sensasi yang subyektif
NYERI

Can persist
Warning Protection after its no
longer useful

Inhibiting
Enhancing
efforts to
disability
rehabilitate

Prentice WE, Therapeutic Modalities in

Rehabilitation, 3ed.2005
NYERI

PAIN
Persistent : Pain
that defies Referred : pain
intervention that is perceived
Radiating pain :
from conditions to be in an area
Acute : tissue Chronic : lasting irritation of
where that seems to
damage and for more than 6 nerve root can
continuing have little
after injury. months. cause radiating
(persistent) pain relation to the
pain.
is a symptom of existing
a treatable pathology
condition

Prentice WE, Therapeutic Modalities in

Rehabilitation, 3ed.2005
SKALA PENILAIAN NYERI
McGill
Visual Analog Scales Pain Charts
PainQuestionnaire

• Menggunakan • Untuk menilai • Suatu tool yang

angka 1-10 lokasi nyeri dan menggambarkan
• 1 -> TIDAK NYERI sejumlah rasa sakit
• 10 -> NYERI HEBAT komponen • Umumnya
subyektif digunakan untuk
• Biru-> aching pain penderita LBP.
• Kuning-> kebas ata • Bisa memakan
kesemutan waktu 30 menit
• Merah-> panas, dan sering
terbakar membuat pasien
• Hijau-> kram, frustasi
kejang otot
Prentice WE, Therapeutic Modalities in
Rehabilitation, 3ed.2005
PENILAIAN SKALA NYERI

Activity Pain Indicators

Numeric Pain Scales
Profile

• Mengukur aktivitas • Skala nyeri yang

pasien paling sering
• Berisi 64 pertanyaan, digunakan
alat laporan diri. • Skala nyeri 1-10

Prentice WE, Therapeutic Modalities in

Rehabilitation, 3ed.2005
PERSEPSI NYERI
subjective
Sharp (tajam)

Dull (tumpul)

Aching (nyeri)

Throbbing (berdenyut)

Burning (terbakar)

Piercing (menusuk)

Prentice WE, Therapeutic Modalities in

Rehabilitation, 3ed.2005
Sensory Receptors PPERSEPSI NYERI
Pain receptor /
nociceptors / free
nerve endings
noxious stimuli =
extreme mechanical,
Cognitive
thermal, chemical
Influences
energy
Anxiety,to
respond Attention,
noxious
Depression, Past pain
stimuli – to impending
experiences,
or actual tissue
Cultural(e.g
damage Influences
cuts,
burns, sprains, etc)
-> superficial heat,
cold, analgesic balms,
massage
Prentice WE, Therapeutic Modalities in
Prentica, WE. Denegar, CR. ManagingRehabilitation, 3ed.2005
Pain with Therapeutic Modalities.
PAIN
1st orderSTIMULATION
neuron
• Aα, Aβ (large, fast)
• Aδ, C fibers (small, slow)

2nd order neuron

• Wide dynamic range
(Aβ, Aδ, C fibers )
• Nociceptive specific
(Aδ, C fibers ; noxious
stimulation)

1. Spinothalamicus Lateralis
Tract (effect of concious
sensation of pain)
2. Spinoreticularis Tract
(arousal emotional aspects
of pain)
NOSISEPSI
TRANSMISI SINAPTIK

• Zat-zat peptida neuroaktif memfasilitasi atau

menghambat aktivitas sinaptik
◦  Enkephalin
◦  Serotonin
◦  Norepinephrine
◦  β-endorphine
◦  Dynorphin
Prentice WE, Therapeutic Modalities in
Rehabilitation, 3ed.2005
PAIN CONTROL
(Melzack, Wall and Castle)

The Gate Control Theory of Pain

Descending Pain Control

Β-endorphin & Dynorphin

Prentica, WE. Denegar, CR. Managing Pain with Therapeutic Modalities.

Prentice WE, Therapeutic Modalities in
Rehabilitation, 3ed.2005
 The Gate
Control Theory
of Pain

Rubbing
Moist Heat
Massage
Cold
TENS
Ultrasound

Prentica, WE. Denegar,

CR. Managing Pain with Prentice WE, Therapeutic Modalities in
Therapeutic Modalities. Rehabilitation, 3ed.2005
MODALITAS PANAS DAN DINGIN

APPLY TO THE SKIN

HEAT COLD

VASODILATATION VASOCONSTRICTION

SKIN RECEPTORS

GATE CONTROL THEORY

ANALGESIC EFFECT
Prentice WE, Therapeutic Modalities in
Prentica, WE. Denegar, CR. Managing Pain with Therapeutic
Rehabilitation, 3ed.2005 Modalities.
Descending
Pain Control

TENS

Prentica, WE. Denegar,

CR. Managing Pain with Prentice WE, Therapeutic Modalities in
Therapeutic Modalities. Rehabilitation, 3ed.2005
Β-endorphin
& Dynorphin
Release

TENS

Prentica, WE. Denegar,

CR. Managing Pain with
Therapeutic Modalities. Prentice WE, Therapeutic Modalities in
Rehabilitation, 3ed.2005
PENGGUNAAN AGEN FISIK UNTUK MENGHILANGKAN
NYERI
1. Stimulate large-diameter afferent fibers. This can be done
with TENS, massage, and analgesic balms.

2. Terapi dingin dan ultrasound : mengurangi hantaran nyeri

3. Stimulate small-diameter afferent fibers and descending pain

control mechanisms with acupressure, deep massage, or TENS
over acupuncture points or trigger points.

4. Stimulate a release of Beta-endorphine or other endogenous

opioids through prolonged small-diameter fiber stimulation
with TENS Prentice WE, Therapeutic Modalities in
Rehabilitation, 3ed.2005
MANAJEMEN NYERI
Pemilihan Modalitas Terapetik :

1. NYERI AKUT
a. Cold Therapeutical Modalities
b. TENS

2. NYERI SUBAKUT DAN KRONIK

a. Hot Therapeutical Modalities
b. MWD, SWD
c. Laser
d. Ultrasound

Prentica, WE. Denegar, CR. Managing Pain with Therapeutic Modalities.

Prentice WE, Therapeutic Modalities in
Rehabilitation, 3ed.2005
CRYOTHERAPY
INDICATIONS CONTRAINDICATIONS
• Acute pain
• Acute swelling (controlling hemorrhage • Impaired circulation (i.e., Raynaud’s
and edema) phenomenon)
• Peripheral vascular disease
• Myofascial trigger points
• Hypersensitivity to cold
• Muscle guarding • Skin anesthesia
• Muscle spasm • Open wounds or skin conditions
• Acute muscle strain (cold whirlpools and
• Acute ligament sprain • contrast baths)
• Infection
• Acute contusion
• Bursitis, Tenosynovitis, Tendinitis

Prentica, WE. Denegar, CR. Managing Pain with Therapeutic Modalities.

Prentice WE, Therapeutic Modalities in
Rehabilitation, 3ed.2005
THERMOTHERAPY
Indications Contraindications

• Subacute and chronic inflammatory • Acute musculoskeletal conditions

conditions and pain • Impaired circulation
• Peripheral vascular disease
• Decreased ROM
• Skin anesthesia
• Resolution of swelling • Open wounds or skin conditions
• Myofascial trigger points (cold whirlpools
• Muscle spasm • and contrast baths
• Subacute muscle strain
• Subacute ligament sprain
• Subacute contusion

Prentica, WE. Denegar, CR. Managing Pain with Therapeutic Modalities.

Prentice WE, Therapeutic Modalities in
Rehabilitation, 3ed.2005
Ultrasound
INDICATIONS CONTRAINDICATIONS
• Soft tissue healing and repair • Acute conditions
• Scar tissue • Areas of decreased temperature
• Joint contracture sensation
• Chronic inflammation • Areas of decreased circulation
• Increase extensibility of collagen • Vascular insufficiency
• Reduction of muscle spasm • Thrombophlebitis
• Pain modulation • Eyes
• Increase blood flow • Reproductive organs
• Soft tissue repair • Pelvis immediately following menses
• Inflammation associated with myositis • Pregnancy
ossificans • Pacemaker
• Myofascial trigger points • Malignancy
• Epiphyseal areas in young children
• Total joint replacements
• Infection
Prentica, WE. Denegar, CR. Managing Pain with Therapeutic Modalities.
Prentice WE, Therapeutic Modalities in
Rehabilitation, 3ed.2005
 SWD
• INDICATIONS CONTRAINDICATIONS
Acute traumatic musculoskeletal injuries
• Postacute musculoskeletal injuries Acute inflammatory conditions
Areas with ischemia
• Increased blood flow
Areas of reduced sensitivity to temperature
• Vasodilation or pain
• Increased metabolism Joint effusion
• Decreased joint stiffness Synovitis
• Muscle relaxation Eyes
Contact lenses
• Increased pain threshold
Moist wound dressings
• Improved joint range of motion Malignancies
• Increased circulation Infection
• Reduced subacute and chronic pain Pelvic area during menstruation
Testes
Pregnancy
Metal implants
Unshielded cardiac pacemakers
Intrauterine devices
Prentica, WE. Denegar, CR. Managing Pain with Therapeutic
Watches Modalities.
orinjewelry
Prentice WE, Therapeutic Modalities
Rehabilitation, 3ed.2005
Mechanisms of Pain Control
• The theories presented are only models
•
• Pain control is the result of overlapping
mechanisms

Prentice WE, Therapeutic Modalities in

Rehabilitation, 3ed.2005
Summary
• The goal of rehabilitation programs is to
encourage early, pain-free exercise while
promoting optimal healing processes

Prentice WE, Therapeutic Modalities in

Rehabilitation, 3ed.2005