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Monalisa Rizal

Pokok bahasan
Definisi nyeri
Pendahuluan
Stimulus Nyeri
Reseptor nyeri
Tahapan persepsi dan respon nyeri
Pathway nyeri
Analgetik endogen
Jenis nyeri
Definisi
Nyeri adalah perasaan yang tidak
menyenangkan yang sifatnya subjektif
Mrpk mekanisme pertahanan tubuh.
Pendahuluan
Pendahuluan
saraf aferen saraf eferen
Klasifikasi serabut saraf
Pendahuluan
Reseptor Sensorik
Mekanoreseptor : deformasi mekanik & taktil
Termoreseptor : Perubahan suhu
Nosiseptor : Kerusakan jaringan
Elektromagnetik reseptor : Cahaya
Kemoreseptor : Zat kimia: bau,rasa
Pendahuluan
Nociceptor
A delta and C fibers
Somatic and visceral
Skin, muscle, joints and some visceral tissues
for noxious mechanical, chemical, or thermal
stimuli
A delta Serat C

Tipe Cepat Tipe Lambat

Muncul pertama kali saat Muncul belakangan, menetap.


rangsangan

Terlokalisir Lokasi tidak jelas

Tajam Menusuk Sensasi Tumpul

Glutamat Substansi P
Stimulus Nyeri

Chemical stimuli :
Asam laktat,prostaglandin, protons, nerve growth
factor, histamine, bradikinin, Potassium
Pathophysiology of Pain
Nociceptive pain mechanism
Neuropathic pain mechanism
Psychological and idiopathic pain
mechanism
Nociceptive pain mechanism
Activation of the nociceptive
system by tissue injury
Nociceptive system:
involves transduction,
transmission, modulation
and perception
Nociceptive pain pathway
Descartes' pain pathway:
"Particles of heat" (A) activate a
spot of skin (B) attached by a fine
thread (cc) to a valve in the brain
(de) where this activity opens the
valve, allowing the animal spirits
to flow from a cavity (F) into the
muscles causing them to flinch
from the stimulus, turn the head
and eyes toward the affected
body part, and move the hand
and turn the body protectively
Tahapan persepsi dan respon nyeri

Tranduksi :
kerusakan jaringan chemical stimuli
potensial reseptor potensial aksi saraf perifer
Transmisi :
penghantaran ke SSP
Modulasi
Modifikasi - penguatan signal nyeri endorphinergic
pain modulatory pathways (peran endorfin)
Persepsi :
Otak menerjemahkan pesan sebagai nyeri.
Nociceptive pain pathway
Ascending Pain Pathway
SIGMA-ALDRICH
Nociceptive pain pathway
Pathway of Pain
Pathway of Pain
Endorphinergic pain modulatory
pathway
Endorphins ("endogenous morphine") are endogenous
opioid peptides that function as neurotransmitters.
Produced by the pituitary gland and the hypothalamus
exercise, excitement, pain, consumption of spicy food, love
and orgasm, and they resemble the opiates in their
abilities to produce analgesia and a feeling of well-being.
Reseptor mu, delta , kappa
Clinical characteristics of nociceptive
pain
Akut
Persisten
Somatic: artritis
Viseral: cramp
Nyeri dideskripsikan sebagai tajam,
menusuk-nusuk
Neuropathic pain
Akibat trauma langsung atau disfungsi
pada saraf perifer atau pusat.
Keluhan: kesemutan ,seperti terbakar,
allodynia, hiperalgesia, hiperpatia
Very complex processes
Spinal cord injury, neuroma, post
penyembuhan,
Psychological and Idiopathic pain

Persistent pain disturbances in mood


(depression or anxiety), impaired coping
worsen pain and pain-related distress.
Kelainan psikologis nyeri (psychogenic
pain) termasuk diagnosis kelainan
somatoform
Persepsi nyeri
Terjadi sec kompleks
Dipengaruhi :
Deskriminasi sensoris
Motivasi (gender, emosi, cemas)
Cognitive
Hasil koordinasi dr korteks cerebri, fore
brain, midbrain)
Three dimensions of pain

"Pain can be treated not only by trying to cut


down the sensory input by anesthetic block,
surgical intervention and the like, but also by
influencing the motivational-affective and
cognitive factors as well."
Thresholds

In pain science, thresholds are measured by gradually increasing the


intensity of a stimulus such as electric current or heat applied to the body.
The pain perception threshold is the point at which the stimulus begins to
hurt, and the pain tolerance threshold is reached when the subject acts to
stop the pain.

Differences in pain perception and tolerance thresholds are associated with,


among other factors, ethnicity, genetics, and sex. People of Mediterranean
origin report as painful some radiant heat intensities that northern
Europeans describe as nonpainful, and Italian women tolerate less intense
electric shock than Jewish or Native American women. Some individuals in
all cultures have significantly higher than normal pain perception and
tolerance thresholds. For instance, patients who experience painless heart
attacks have higher pain thresholds for electric shock, muscle cramp and
heat.[60] Women have lower pain perception and tolerance thresholds than
men, and this sex difference appears to apply to all ages, including newborn
infants.
Jenis Nyeri berdasar lokasi
Nyeri Kutaneus :
Sifat :Tajam, langsung dan terlokalisasi
Lokasi : epidermis, dermis dan subkutan
ex : nyeri tusuk
Nyeri Somatic :
Sifat : difuse sensasi dan berdenyut
Lokasi : muskuloskeletal
Ex: keseleo
Nyeri viseral :
Sifatnya : difuse dan susah dilokalisasi
Lokasi : pada organ dalam rongga tubuh
Ex : appendisitis
Nyeri Alih :
Nyeri yang dirasakan di salah satu bagian tubuh yang berasal
jaringan lain.
Mekanisme ; Adanya sinaps antara sumber nyeri dgn saraf kulit
tertentu pada masa embrional
ex : nyeri jantung
Nyeri Alih
Jenis nyeri berdasar durasi
Nyeri Akut :
Durasi : < 6 bulan
Sebab : kerusakan jaringan
Nyeri Kronik :
Durasi : > 6 bulan
Sebab : bisa diketahui atau tidak.
Dapat menimbulkan gejala susah tidur,
iritabilitas depresi, perubahan kepribadian
Assessment

Pain scales and Pain ladder:

A person's self report is the most reliable measure of pain, with


health care professionals tending to underestimate severity.[62] A
definition of pain widely employed in nursing, emphasizing its
subjective nature and the importance of believing patient reports,
was introduced by Margo McCaffery in 1968: "Pain is whatever
the experiencing person says it is, existing whenever he says it
does".[63] To assess intensity, the patient may be asked to locate
their pain on a scale of 0 to 10, with 0 being no pain at all, and 10
the worst pain they have ever felt. Quality can be established by
having the patient complete the McGill Pain Questionnaire
indicating which words best describe their pain.[5]
The McGill Pain Questionnaire, also known as McGill pain
index, is a scale of rating pain developed at McGill University by
Melzack and Torgerson in 1971.

To use the questionnaire, circle the words that describe your


pain but do not circle more than one word in a group. Then
when you have that done, go back and circle the three words in
groups 1-10 that most convey your pain response. Pick the two
words in groups 11-15 that do the same thing. Then pick one
word in group 16. Finally, pick 1 word in groups 17-20. At the
end you should have seven words that you can take to your
doctor that will help describe both the quality of your pain and
the intensity of it.
Group Words
1 Flickering, Pulsing, Quivering, Throbbing, Beating, Pounding
2 Jumping, Flashing, Shooting
3 Pricking, Boring, Drilling, Stabbing
4 Sharp, Cutting, Lacerating
5 Pinching, Pressing, Gnawing, Cramping, Crushing
6 Tugging, Pulling, Wrenching
7 Hot, Burning, Scalding, Searing
8 Tingling, Itchy, Smarting, Stinging
9 Dull, Sore, Hurting, Aching, Heavy
10 Tender, Taut (tight), Rasping, Splitting
11 Tiring, Exhausting
12 Sickening, Suffocating
13 Fearful, Frightful, Terrifying
14 Punishing, Grueling, Cruel, Vicious, Killing
15 Wretched, Blinding
16 Annoying, Troublesome, Miserable, Intense, Unbearable
17 Spreading, Radiating, Penetrating, Piercing
18 Tight, Numb, Squeezing, Drawing, Tearing
19 Cool, Cold, Freezing
20 Nagging, Nauseating, Agonizing, Dreadful, Torturing
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