A.M.

TAKDIR MUSBA

DEPARTMENT OF ANESTHESIOLOGY, INTENSIVE THERAPY AND

PAIN MANAGEMENT, FACULTY OF MEDICINE HASANUDDIN UNIVERSITY
INDONESIAN SOCIETY OF ANESTHESIOLOGY FOR PAIN MANAGEMENT ( ISAPM)
INDONESIA PAN SOCIETY
 KNOWING PAIN
 PAIN AND QUALITY OF LIFE
 PAIN MANAGEMENT-BASED QoL
 ROLE OF PAIN SERVICES
 INDONESIA NOW
 In order to treat something we first must
learn to recognize it.
Sir William Osler

Doctors think they deal with pain well

This is a delusionary idea is well documented
Clarke I. M., LANCET, 1993
 An unpleasant sensory and emotional
experience associated with actual or
potential tissue damage, or described in
terms of such damage.

International Association for the Study of Pain (IASP) 2011

International Association for the Study of Pain. IASP Taxonomy. Available at: http://www.iasp-
pain.org/AM/Template.cfm?Section=Pain_Definitions. Accessed: July 15, 2013.
Gatchel, 2004
 TWO WAY OF THINKING TO TREAT PAIN
 Philosophical world view of the physician, OR
 the patient's presenting condition

 Physicians who see pain in mechanistic terms most

likely will look for the anatomic foci of pain and be
confounded if the source of the suffering is unclear
 Physicians who are focused on the patient's
adaptation to life might focus on issues of lifestyle,
stress, and emotional upheaval and assist the patient
to work toward more adaptive behavioral responses
to their pain.
 PHARMACOLOGICAL TREATMENT
 ANATOMICALLY SPECIFIC TREATMENTS
 COGNITIVE AND BEHAVIOUR TREATMENT
 Pharmacotherapy Interventional
Approach
Surgical
Physical Medicine Strategies for Approach
and Rehabilitation Managing Pain and
Associated Disability
Complementary and Psychological
Alternative Medicine Support
Lifestyle Change

bio-psycho-social approach
Schatman M.E., Interdisciplinary Chronic Pain Management.
Bonica’s Pain Management , 4th ed. 2010
 Evaluate Impact of Pain on Functioning

Pain

Central
sensitization/
dysfunctional
pain

Functional
impairment
Nociceptive Neuropathic
pain pain

Anxiety and Sleep

depression disturbances

Nicholson B, Verma S. Pain Med 2004; 5(Suppl 1):S9-27.

 Quality of life (QoL) refers to an individual's
perception of his or her position in life in the
context of the culture and value systems in
which they live and in relation to their goals,
expectations, standards, and concerns.
WHO, 1995
WHOQOL Group. (1995). The World Health
Organization quality of life assessment
(WHOQOL): Position paper from the World
Health Organization. Social Science & Medicine,
41(10)
 WHOQOL-BREF  EQ-5D-5L
 General health  mobility dimension
 Physical  anxiety/depression
 Psychological  self-care dimension
 Social  usual activities
 Environmental dimension
 pain/discomfort
dimension
 Pain affects most domains of QOL, primarily
physical and emotional functioning
 Pain reduction is not always attended by the
expected improvement in QOL
 Pain is not synonymous with poor QOL and
constitutes only one important factor
determining QOL

Niv D, Kreistler S. Pain Practice, Voll 1 Issue 2 2001

 A representative sample of 1056 people aged
17–75 years
 The most self-reported health problems were
observed in the pain/discomfort dimension
39.66%)
 Respondents reported problems related to
pain/discomfort more often

PLoS One. 2018; 13(5). Published online 2018 May 11.

 A goal is something we would like to do in the next month
to 6 months, such as walking, water exercise, visiting
family, doing things with friends, or controlling your
diabetes.
 Goals are generally too big to work on all at once, so start
one step at a time and with smaller goals. For example,
your pain will have limited your physical activity so it is
important to exercise, but doing too much all at once may
make your pain worse temporarily.
 You might start with deciding
 what type of exercise to do
 where to go to exercise
 how much time I will spend exercising when first starting, and
maybe asking a friend or family member to exercise with you.
• PRIMARY CARE CENTRE
• Secondary and tertier CARE CENTRE
• PAIN COMPETENCY of HCP
• AVAILABLE ANALGESIC DRUG • Less collaboration
• NOT A PRIORITY IN PRIMARY CARE • Less support
 255.461.686 Population

2488 Hospital 47.849 Specialist

9754 Public Health Centre 41.026 General Practitioner ( 16.565 in PKM )
( 1 : 30.000 population ) 12.740 Dentist ( 6.537 in PKM )
223.940 Nurse

• ACUTE PAIN  CHRONIC PAIN

• LATE D/ & R/  CHRONIC PAIN SUFFERING
• PAIN PALLIATIVE CARE

Ministry of Health, Indonesia, 2015

KARAKTERISTIK PASIEN RAWAT JALAN
DENGAN KELUHAN NYERI DI PUSKESMAS X
KOTA Y PADA BULAN FEBRUARI 2017

simple random sampling dari 1924 pasien

dengan keluhan nyeri , n=331
Hasbar AM, Musba AMT. 2017. unpublished
 Pain Survey in Outpatient Setting, 2011-2012, INDONESIA
 Interviewing patient using closed ended questionnaires
 14218 patients, 528 MDs
 Contributors specialist: Surgeon, Neurologist, Internal
Medicine, PM&R specialist, Rheumatologists, Orthopedic
Surgeon, Neurosurgeon, Urologist, GP, etc.
 Result

 87% of patients suffered pain

 61% suffer from pain more than 1 week
 currently consuming painkiller ( 61% of pts )
 consuming NSAID/COXIB (63% of pts )
 suffer moderate-severe pain (74% of pts )
Source : UTOPIA Initiative, Pain Survey , 2011-2012
INADEQUATE PAIN TREATMENT IN INDONESIA

74% of Patient suffer moderate-severe pain

but only 17% patient get ladder 2 & 3 painkiller
Source : UTOPIA Initiative, Pain Survey, 2011-2012
 f
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Pergolizzi J. TOWARDS A MULTIDISCIPLINARY TEAM

APPROACH IN CHRONIC PAIN MANAGEMENT
Pergolizzi J. TOWARDS A MULTIDISCIPLINARY TEAM APPROACH
IN CHRONIC PAIN MANAGEMENT
ISAPM, 2017
 Survey by mobile application
 52 responses from some specialist work in
Pain Management, mostly anesthesiologist
 76.92% run pain clinic
 28.85% pain practice with other specialist
 55.7% only with consultation
 Ny. M, 80 tahun, dengan keluhan nyeri pinggang bawah sebelah kiri
dengan immobilisaai beberapa bulan akibat keluhannya dgn diagnosa
facet joint pain sinistra, dilakukan Blok Medial branch L3,4,5 dan
dilanjutkan dengan RF MBB L3,4,5
 Dukungan pengadaan sarana juga kurang optimal dari
managemen rumah sakit
 Masalah pembiayaan pasien / asuransi kesehatan yang sering
tidak mendukung optimalnya penanganan nyeri
 Obat yang dibatasi, Sarana dan prasarana belum lengkap
 Pembiayaan, Edukasi pasien, Pasien datang dgn late
presentation
 Halangan dari teman sejawat spesialis lain yang juga praktek
pain
 Holistik dgn berbagai disiplin ilmu belum optimal

REGULASI PEMERINTAH TENTANG PELAYANAN NYERI………

 Menurut anda, idealnya praktek klinik
penanganan nyeri dalam bentuk seperti apa
yang dapat memberikan hasil optimal ?
Jawaban terbanyak yang dituliskan adalah …..
2 Kata

MULTIDISIPLIN dan KOLABORASI

AHT