MANAJEMEN NYERI

Agus Shuarsedana
Pendahuluan
Nyeri adalah anugerah
 Sesungguhnya nyeri adalah anugerah yg besar dari maha pencipta

 “Pain is alarm protection tell us that something wrong in our body”.

 Sulit dibayangkan seandainya tubuh kita tidak dilengkapi dgn “reseptor

nyeri”, sehingga kita tidak pernah menyadari kalau tubuh kita telah
terancam kerusakan.
 Definisi Nyeri (Pain) dari IASP
(International Association for the Study of Pain)

Pain (Nyeri) adalah suatu Nyeri adalah

pengalaman sensorik dan pengalaman sensorik
emosional yang berkaitan yang berkaitan dengan
dengan kerusakan aktivasi nociceptor
jaringan atau diduga ada dan lintasan nyeri
kerusakan jaringan
Nyeri adalah suatu
pengalaman emosional

Kerusakan jaringan
tidak mesti ada
Evaluation of the Patient with Pain

Pain Measurement
Single / multi dimension
Global Evaluation
Monitoring
- Single dimension
Therapeutic strategy multidimension
Pain management - Therapeutic
effect
- Side effect
Ajustmen of the treatment

Relief pain
 JENIS NYERI

Neuropathic Pain Inflammatory Pain

Mixed Pain
Pain initiated or caused by a Pain with Pain caused by injury to
primary lesion or dysfunction neuropathic and body tissues
in the nervous system nociceptive (musculoskeletal,
(either peripheral or components
cutaneous or visceral)2
central nervous system)1

Examples Examples
Peripheral Examples
• Post herpetic neuralgia • Pain due to inflammation
• Trigeminal neuralgia • Low back pain with
radiculopathy
• Limb pain after a fracture
• Diabetic peripheral neuropathy • Joint pain in osteoarthritis
• Postsurgical neuropathy • Cervical
radiculopathy
• Postoperative visceral pain
• Posttraumatic neuropathy
Central • Cancer pain
Common descriptors2
• Posts troke pain • Carpal tunnel
syndrome
• Aching
Common descriptors2 • Sharp
• Burning • Throbbing
• Tingling
• Hypersensitivity to touch or cold

1. International Association for the Study of Pain. IASP Pain Terminology.

2. Raja et al. in Wall PD, Melzack R (Eds). Textbook of pain. 4th Ed. 1999.;11-57
 Neuropathic Pain Muscle/skeletal Pain

Chronic pain (months/years) Acute pain (hours or days)

Caused by injury or disease to Caused by injury or inflammation that

nerves affects both the muscles and joints

Mild to excruciating pain that can last Moderate to severe pain that
indefinitely disappears when the injury heals

Causes extreme sensitivity to touch – Causes sore, achy muscles

simply wearing light clothing is
painful
Sufferers can become depressed or Sufferers can become anxious and
socially withdrawn because they see distressed but optimistic about relief
no relief in sight and may experience from pain
sleep problems
Wall PD. Textbook of Pain. 4th ed; 1999; Jude EB. Clin in Pod Med and Surg.1999;16:81-97;
Price SA. Pathophysiology: Clinical Concepts of Disease Processes. 5th ed; 1997: Goldman L.
Cecil Textbook of Medicine. 21st ed; 2000
Symptoms of Neuropathic Pain
Characterized Differently
Neuropathic Pain Muscle/Skeletal Pain

Price SA. Pathophysiology: Clinical Concepts of Disease Processes. 5th ed; 1997; Galer BS et
al. Diabetes Res Clin Pract. 2000;47:123-128
  Thick, myelinated, fast
conducting neurons
 Mediate the feeling of initial
fast, sharp, highly localized
pain.
 Very thin, unmyelinated,
slow-conducting
 Mediate slow, dull, more
diffuse, often burning pain.

Rabaan
Tekanan
Nerve Fibers

Class Velocity Function

A- Fast Motor
A- Fast Touch,
pressure
A- Intermediate Muscle tone

A- Intermediate Pain,

temperature
B Small Motor
C Small Pain
 Targets of Pain Therapies
Pharmacotherapy
Non-opioid analgesics
Opioid analgesics
Nerve Blocks
Adjuvant analgesics
(neuropathic, musculoskeletal)

Acetaminofen Electrical Stimulation

Transcutaneous electrical nerve
stimulation (TENS)
Percutaneous electrical nerve
stimulation (PENS)

Alternative
methods
(NSAID) Acupuncture
Physical Therapy
Gottschalk et al., 2001
Chiropractics
Pain Assessment
Dengan Metode PQRST
 P = PROVOKING and PALIATION
Penyebab?
Apakah yang memperbaiki atau memperburuk
 Q = QUALITY
Kualitas nyeri
 R = REGION and RADIATION
Lokasi dan Penyebarannya
 S = SEVERITY and SCALE
(Keparahan/Tingkat nyeri)
 T = TIME and TYPE OF ONSET
(Waktu), lamanya serangan, frekuensi
Pain scales

Scientifically validated pain scales:

 Numeric Pain Rating Scale
 Wong-Baker FACES Scale: for children who can talk
 Observation-FLACC Scale: for children who can’t talk

20
Numeric pain rating scale
No pain Mild pain Moderate pain Severe pain Very severe pain Worst possible pain

0 1 2 3 4 5 6 7 8 9 10

 Pain levels from 0-10 can be explained verbally to the patient using a
scale in which 0 is no pain and 10 is the worst possible pain imaginable
 Patients are asked to rate their pain from 0 to 10
 Record the pain level to make treatment decisions, follow-up, and
compare between examinations

Palliative Care for HIV/AIDS and Cancer Patients in Vietnam, Basic Training Curriculum: Harvard Medical School,
Centre for Palliative Care (2007) 21
 Wong-Baker FACES Pain Rating Scale

Penilaian Skala nyeri dari kiri ke kanan

Wajah Pertama : Sangat senang karena ia tidak merasa sakit sama sekali.
Wajah Kedua : Sakit hanya sedikit.
Wajah ketiga : Sedikit lebih sakit.
Wajah Keempat : Jauh lebih sakit.
Wajah Kelima : Jauh lebih sakit banget.
Wajah Keenam : Sangat sakit luar biasa sampai-sampai menangis
Penilaian skala nyeri ini dianjurkan untuk usia 3 tahun ke atas.
Thank You For Your Attention
Form pengkajian ulang nyeri
Form assesment nyeriC:\Users\diklat.user-
PC\Desktop\dr.AB\form Assesmen Nyeri-
revisi.doc
Panduan manajemen
nyeriC:\Users\diklat.user-
PC\Desktop\dr.AB\PANDUAN MANAJEMEN
NYERI-1.doc

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