Penatalaksanaan Nyeri

Mekanisme Akupunktur Analgesia

Implikasi Klinis
Kompilasi oleh
Ruben Dharmawan
Untuk FK UNS
2018
 What is Pain?
Definitions:
An unpleasant sensory and emotional
experience associated with actual or potential
tissue damage.
Pain is whatever the experiencing person says it
is.
May not be directly proportional to amount of
tissue injury.
 Pain categories

1. Somatogenic pain is pain with cause (usually known)

localised in the body tissue
a/ nociceptive pain
b/ neuropatic pain

2. Psychogenic pain is pain for which there is no known

physical cause but processing of sensitive information in
CNS is disturbed
 Pain categories
Acute and chronic pain
Acute pain is a protective mechanism that alerts the individual
to a condition or experience that is immediately harmful to the
body
Onset - usually sudden

Chronic pain is persistent or intermittent usually defined as

lasting at least 6 months. The cause is often unknown, often
develops insidiously, very often is associated with a sense of
hopelessness and helplessness. Depression often results.
 Nociceptive vs Neuropathic Pain
Nociceptive
Pain
Caused by activity in neural
pathways in response to
potentially tissue-damaging
stimuli
Mixed Type Neuropathic
Caused by a Pain
combination of both Initiated or caused by
primary injury and primary lesion or
secondary effects dysfunction in the nervous
system

CRPS*

Postoperative Postherpetic
pain Arthritis Trigeminal
neuralgia
neuralgia
Sickle cell Neuropathic
Mechanical crisis low back pain Central post-
low back pain
Distal stroke pain
Sports/exercise polyneuropathy
injuries (eg, diabetic, HIV)
*Complex regional pain syndrome
 Neuroanatomy of pain
The portions of the nervous system responsible for the
sensation and perception of pain may be divided into three
areas:

• 1. afferent pathways

• 2. CNS

• 3. efferent pathways
 Neuroanatomy of pain
The afferent portion is composed of:

a) nociceptors (pain receptors)

b) afferent nerve fibres

c) spinal cord network
 Activation of nocioceptors by tissue-damaging stimuli.

Mechanisms:
• neurogenic inflammation - vasodilation; inflammatory cells;
antidromic (polymodal) nocioceptor release of Substance P
and others from nerve terminals
• endogenous substances - directly activate nocioceptors -
histamine, Subs. P, bradykinin, ACH, serotonin, K+
• prostoglandins - sensitize nocioceptors: produce lower
thresholds for noxious stimuli (also: serotonin, ADP, NE,
interleukin, NGF); role in development of chronic pain
 Physiology of Pain Perception

Injury Brain

• Transduction
• Transmission
• Modulation
• Perception Descending
Pathway
• Interpretation
• Behavior
Dorsal
Peripheral Root
Nerve Ganglion

Ascending
Pathways
C-Fiber

A-beta Fiber Dorsal

Horn
A-delta Fiber
Spinal Cord

9 Adapted with permission from WebMD Scientific American® Medicine.

Nerve Reflex Theory
-Ishikawa and Fujita et al, Japan, 1950s

• Autonomic nervous system

extending thru the internal
organs
• Viscera-mutinous reflex
• Cutanous –Viscera reflex
• Acupuncture utilize these
reflexes for restoring the
homeostasis of the body
and acceralate the healing
process.
Therapeutic Mechanisms of
Acupuncture
 Acupuncture Mechanisms of
Action
• Conduction of
electromagnetic
signals
• Activation of opioids
systems
• Changes in brain
chemistry-release of
neurotransmitters and
neurohormones.
Acupuncture Pathways
 Meridian-Cortex-Viscera Correlation
Hypothesis
• 1. The meridian system is and connected the
nervous system to the cerebral cortex.
• 2. It acts through neurohumoral mechanisms
• 3. Acu-point-Brain-organ model: stimulates
the brain cortex/nervous system, then
controlling the chemical or hormone release
to the disordered organs for treatment.