Assessment and

Classification of Pain

Yudiyanta
 Pain

Assessment of Disease Assessment of Pain

Diagnosis of Disease Diagnosis of Pain

Management of Disease Management of Pain

 Assessment of Pain

Type of Pain Intensity of Pain Comorbidity, Allergy Generator of Pain

& Side Effect (SAFETY)

Nociceptic Neuropathic Disfunctional

Mixed Pain

Diagnosis

Treatment
 Assessment of Pain

Type of Pain Intensity of Pain Comorbidity, Allergy Generator of Pain

& Side Effect (SAFETY)

Nociceptic Neuropathic Disfunctional

Mixed Pain

Diagnosis

Treatment
Type of Pain

(2) (2) (2)

Jenis Nyeri
 Signs and Symptoms of Neuropathic Pain
Spontaneous & stimulus evoked symptoms
 Neuropathic Pain

1. Possible neurophatic pain : Riwayat perjalanan penyakit pasien

merupakan lesi atau penyakit yang relevan menimbulkan gejala nyeri
dan sesuai dengan distribusi neuroanatomi saraf yang terkena
2. Probable neurophatic pain : mencakup kriteria possible dan salah satu
temuan :
1. Konfirmasi tes diagnostik adanya lesi neuropati
2. Ditemukan gejala sensorik negatif atau sensorik positif sesuai area
neuroanatomi
3. Definite neurophatic pain : kriteria possible dan probable (Haanpaa M., Attal N.,

Backonja M., et al. NeuPSIG guidelines on neuropathic pain assessment. Pain 2011;152:14-27)
1. Burning
2. Pricking
3. Light Touch Allodinia
4. Electricshock like
5. Heat Allodinia
6. Numbness <13 13-18 > 18
7. Mecanical Allodinia
 DYSFUNCTIONAL PAIN
Central Projections
of the Nociceptors

location and intensity

affective component of
the pain experience

Descending feedback
systems

The Inter-
Inter-Relationship Between
Pain, Sleep, and Anxiety /
(Cellular and Molecular Mechanisms of Pain,
Depression Basbaum, Bautista et al, 2009)

Syndrome of PAIN
 Assessment of Pain

Type of Pain Intensity of Pain Comorbidity, Allergy Generator of Pain

& Side Effect (SAFETY)

Nociceptic Neuropathic Disfunctional

Mixed Pain

Diagnosis

Treatment
 Goals
• Level of Sensory Intensity (Acute Pain< Uni-dimensional):
– No Pain : 0
– Mild Pain: 1-3
– Moderate Pain: 4-6
– Severe Pain: 7-10

• Level of Emotional Intensity (Chronic Pain, Multi-dimensional)

* Tools for Acute Pain

4/26/2019
 NRS
Intensitas
Nyeri YES VRS Neonatal Infant Pain Scale (NIPS)
VAS 0 : No Pain
1-3 : Mild
4-5 : Moderate
6-7 : Severe
Pasien Mampu
1-3 yo / Cognitive Disorder)
Komunikasi dg
FLACC (Face, Legs, Activity, Cry and
Baik? Consolability)
(Score: 0-10)

3-8 yo
WB/Faces Pain Scale– Photographic
NO
(Score 0-10/no-Very Severe)

Sedation
Comfort Scale
9-17: Inadequate sedation and Pain Control
17-26 : Adequate Sedation and Pain
Control
26-45: Over Sedation
Photographic/Numeric Pain Scale
 Assessment of Pain

Type of Pain Intensity of Pain Comorbidity, Allergy Generator of Pain

& Side Effect (SAFETY)

Nociceptic Neuropathic Disfunctional

Mixed Pain

Diagnosis

Treatment
 Comorbidity, Contraindication and Side Effect
Gastrointestine
Jantung
Vascular otak
Jaringan
Renal perifer
Comorbidity,
Contraindication,
Side Effect (Allergy) Respiratory

Sleep & Anxiety

Substance Abuse

Contraindication And Side Effect (allergy)

 Assessment of Pain

Type of Pain Intensity of Pain Comorbidity, Allergy Generator of Pain

& Side Effect (SAFETY)

Nociceptic Neuropathic Disfunctional

Mixed Pain

Diagnosis

Treatment
 Assessment of Pain

Type of Pain Intensity of Pain Comorbidity, Allergy Generator of Pain

& Side Effect (SAFETY)

Nociceptic Neuropathic Disfunctional

Mixed Pain

Diagnosis

Treatment
 Treatment

Non Pharmacology Pharmacology Interventional PM

Pure Analgetics NSAIDs Adjuvant Analgetics Opioid

PCT Anti- Anti- Steroids Opioid Atypical

Metampiron Ns NSAIDs Coxib Convulsant Deppresant - Opioid
 SUMMARY

• Type of Pain : Nociceptic, Neuropathic, Dysfunctional, Mixed

• Pain Intensity : Mild, Moderate, Severe
• Cp-morbidity : Renal, C-CV, GI, Respiratory, Sleep, Anxiety, Abuse
• Pain Generator
• Side Effect and Contraindication