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Pain Management
What is pain?
International Association for The Study of Pain
Definition of pain:
An unpleasant sensory and emotional
Perception
Nociception
Pain
Descending
modulation
Ascending
input
Modulation
Dorsal Horn
Dorsal root
ganglion
Transmission
Transduction
Spinothalamic
tract
Peripheral
nerve
Peripheral
nociceptors
Adapted from Gottschalk A et al. Am Fam Physician. 2001;63:1981, and Kehlet H et al. Anesth Analg. 1993;77:1049.
Trauma
Noxious
stimuli
Descending
modulation
Ascending
input
Activation of the
Peripheral Nervous
System
Pain
Samad TA et al. Nature. 2001;410:471-5.
Dorsal root
ganglion
A
Small
fibers
C
Peripheral sensory
Nerve fibers
Dorsal Horn
Transduction
KERUSAKAN JARINGAN
INFLAMASI
Si-Na+
SENSITISASI
MI
NOS
Pg
AKTIFASI
B
5HT
Adenosin
KORNU DORSALIS
SSA
ECT. DISC.
R-NE
Activation
Pengalaman
Kognitif
Behaviour
Psikologik
Inhibisi
desenden
OTAK
PAIN NO PAIN
External Heat
VR1
Ca
Mechanical
Stimuli
2+
Na+
mDEG ACTION
ACTION POTENTIAL
POTENTIAL
Voltage gated sodium channels
P2X3
ATP
Chemical
Generator potentials
action potentials
Woolf & Mitchel, 2001
Modifikasi Meliala, 2003
NSAID)
Nonopioid analgesics
Route
Maximum
Analgesic
Time to
peak (hr)
duration (hr) recommended
Half-life
(hr)
Analgesic
onset (hr)
-------------Salicylates
Aspirin
Oral
0.5-2
2-3
0.5-1
2-4
Oral
1-2
1.8-2.5
0.5
4-6
Oral
0.5-2
4-6
300
3,600
Propionic acids
Ibuprofen
3,200
Ketoprofen
Naproxen
Acetic Acids
Oral
1,500
2-4
2-4
12-15
4-7
Nonopioid analgesics
Route
Time to
peak (hr)
Half-life
(hr)
Analgesic
onset (hr)
Analgesic
Maximum
(mg)
-----------------------------------------------------------------------------------------------------------------------
Fenamates
(anthranilic acids)
Meclofenamate
Oral
0.5-1
Mefenamic acid
Oral
2-4
0.5-1
4-6
400
2-4
4-6
1,000
30-86
48-72
20
Oxicams
Piroxicam
Oral
3-5
Phenylacetic acids
Diclofenac
Oral
2-3
1.6
200
1.4
0.5
2-4
1,200
P-Aminophenols
Acetaminophen
Oral
0.5-1
Phenacetin
Oral
2,400
Oral
2-3
Rofecoxib
Oral
2-3
0.4
8-12
12-24
400
50
Opioid Analgesics
Dosage (mg)
Onset (hr)
Peak (hr) Duration
(hr) Comment
----------------------------------------------------------------------------------------------------------Morphine
2.5-15 iv
0.125
Rapid onset, peak
0.12-0.5
0.25-1
0.5-1
1
0.5-2
1.5-5
2-4
3-4
4-8
4-7
0.12-0.5
1-3
3-6
COX-1
X
Body Homeostasis
Gastric integrity
Renal function
Platelet function
COX-2
Nonselective
NSAID
X
X
COX-2
selective
Inhibitor
Inflammation
Pain