Pain dan inflamator

Arthritis IL-1 , IL-6, TNF-

Back / neck pain (Herniated disk)
Prostaglandin TNF- a IL-1B
Bursitis/tendonitis Prostaglandin, IL-1
Fibromyalgia Substance P, IL-1 , IL-6
Neuropathic pain Substance P, Prostaglandin,
IL-1, IL-6, TNF-, glutamate
Migraine Serotonin, substance P
Osteoporosis IL-6, TNF-
RSD/CRPS Substance P, IL-1 , IL-6, TNF-,
glutamate
Perilaku nyeri :Terapi kognitif & Restorasi
fungsional
Penderitaan suffering: Antidepresan,
Psikotropika, Relaksasi, Spiritual
nosiseptik: Blok Lokal, Diklofenak, Etodolac,
Dexketoprofen, coxib, Pembedahan,
nyeri : Opioid, Tramadol, Oxcarbazepine,
Gabapentin, Eperisone HCL, Paracetamol,
OAINS, Pregabalin
Prinsip manajemen nyeri
Terapi farmakologik
- Analgesik non opioid & Analgesik opioid
- Analgesik ajuvan & Analgesik topikal
. Terapi invasif non bedah
- Blok saraf, spinal, Neurolitik, Suntikan Botox
Terapi non farmakologik
- Terapi fisik, Terapi spiritual, Terapi enersi
Terapi bedah - Thalamotomi, Rhizotomi
Osteotomi
Analgesik non opioid
ASPIRIN 500 mg / 4-6 jam 4000 mg
CELECOXIB 100-200 mg/2x/hari 400 mg
DICLOFENAC 50-75 mg/8-12 jam 150 mg
IBUPROFEN 400-800 mg/6-8 jam 3200 mg
KETOROLAC 30 60 mg / hari < 65 th : 120 mg> 65
th : 60 mg
MELOXICAM 7,5 mg 15 mg 15 mg
PARACETAMOL 500-1000 mg / 6 jam 4000mg
ULTRACET (Paracetamol 325 mg + Tramadol 37,5
mg) 3x1 tab 4x2 tab
Analgesik opiod
MORFIN 5 mg / 3-6 jam
CODEIN 30 90 mg / 4-6 jam
TRAMADOL 50-100 mg ; max. 400 mg
OXYCODONE CR 10 mg b.i.d

Terapi non farmakologik
Terapi fisik : terapi termal, masase, traksi,
UKG, ultra sound, TENS
Terapi spiritual : Biofeedback, terapi
perilaku kognitif (CBT), terapi relaksasi,
terapi musik
Terapi enersi : Akupungtur, akupresor,
refleksologi, prana, reiki, yoga, shiatsu
Golongan antidepresan
Amitriptilin 10 150 .Imipramin 25 75
.Maproptilin 25 150. Fluoxetin 20 - 40
Paroxetin 20-40 Sertralin 50 Duloxetin 60-
120 Venlafaxin 150

Golongan antikonvulsan
Carbamazepin 100 1000 Pusing, neutropeni
Fenitoin 100 - 300 Ataxia, hipertrofi gusi
Gabapentin 300 - 1500 Somnolen, ataxia
Lamotrigin150 - 500 Diplopia, mengantuk
Oxcarbazepin900 - 1800 Lelah, ngantuk
Topiramat25 - 200 Lelah, anorexia
Valproat150 - 1000 Tremor, mual
Pregabalin150 600 Somnolen, pusing

GUIDELINE NYERI KRONIK
I. Terapi Farmakologik
Analgesik Non Opioid
Analgesik Opioid
Blok Saraf, Neurostimulasi
II. Nyeri Neuropatik
Analgesik Ajuvan
Analgesik Topikal
III. Terapi Non Farmakologik
Rehabilitasi fisik dan Psikoterapi
GUIDELINE TERAPI NYERI NEUROPATIK (EFNS
2006)
1. Nyeri Neuropatik Perifer
Gabapentin/Pregabalin
Antidepresan trisiklik
Opioid, Duloxetin
2. Neuralgia Trigeminal
Karbamazepin
Operasi
3. Nyeri Sentral (Stroke/Spinal cord injury)
Antidepresan trisiklik/Lamotrigin
Gabapentin/ Pregabalin
Rekomendasi IASP 2008
Lini 1 Antidepresan trisiklik, Duloxetin,
Gabapentin, Pregabalin, Lidokain topical
Lini 2 Analgesik opioid, Tramadol
Lini 3 Antikonvulsan (tertentu), Antidepresan
(tertentu), Mexiletine, Antagonis Reseptor
NMDA Kapsaisin topikal