DEFINISI NYERI

Pengalaman sensorik dan emosional yang tidak menyenangkan akibat kerusakan jaringan, baik aktual maupun potensial, atau yang digambarkan dalam bentuk kerusakan tersebut

Definisi Nyeri

• Nyeri FisiologikNyeri yang timbul akibat berbagai stimuli yang tidak menimbulkan kerusakan jaringan

• Nyeri Nosiseptif / Nyeri inflamasiNyeri yang timbul akibat berbagai stimuli yang menimbulkan kerusakan jaringan

• Nyeri NeuropatikNyeri yang didahului atau disebabkan oleh lesi atau disfungsi primer pada sistem saraf

• Nyeri Psikogenik/Nyeri FungsionalNyeri di mana faktor psikogenik dominan, tanpa kerusakan jaringan dan sistem saraf sebagai penyebab

Stimulus yg membangkitkan nyeri

• Kulit injury jaringan ok tusukan, sayatan, panas dan dingin• Lambung/usus inflamasi mukosa, spasma otot polos, perlengketan• Otot-otot lurik iskemik• Otot skletal kontraksi terus menerus• Otot jantung iskemik• Sendi inflamasi, saline hipertonik• Arteri distensi, pulsasi berlebihan• Pereganagan arteri dan mening (sakit kepala)

The Process of Pain• The process of pain four phases :1. Transduction2. Transmission3. Perception4. Modulation

1. Transduction • Conversion of chemical information at cellular level electrical inpulses that move

toward the spinal cord• Begins when injured cells release chemicals such as prostaglandin, Substance P,

bradykinin, histamin, and glutamat excite nociceptor in the skin, bone, joints, muscles, and internal organs

2. Transmission• The phase during wich stimuli move from the peripheral nervous system brain• Occurs when peripheral nociceptor form synapses with neurons within the spinal cord

that carry pain inpulses via fast and slow nerve fibers ( A delta and C fiber ).• With the help of substance P, pain impulses move higher level in the brain RAS,

thalamus, cerebral cortex and lim• when pain impulses reach the thalamus two responses occurs

First the thalamus transmits the message to the cortex, where the location and severity of the injury are identified

Second it notifies the nociceptor that the message has been received and that continued transmission is no longer necessary.

3. Perception• occurs when the pain threshold (point at wich sufficient pain transmitting stimuli reach the

brain) is reached.• Pain thresold tend to be the same among healthy people, but each person tolerates the sensation

of pain diffrently• Pain tolerance (amount of pain a person endures) is influence by genetics, behaviors

(culture,gender,age) and other biopsychosocially anxiety level, past pain experiences, and emotional dispotition

4. Modulation• The last phase of pain impulse transmission during wich the brain interacts with the

spinal nerves in a donward fashion to subsequently alter the pain experience.• At this point, the release of pain-inhibiting neurochemicals reduces the painful sensation

( endogenous opioids, GABA).

Klasifikasi Nyeri Neuropatik

I. Berdasarkan intensitas nyeriII. Berdasarkan penyebabIII. Berdasarkan lokasiIV Berdasarkan mekanisme

1. Berdasarkan intensitas nyeri• Pengukuran menggunakan skala nyeri

1. Numeric Pain Intensity Scale (NPIS)1 – 3 Nyeri ringan4 – 6 Nyeri sedang7 – 10 Nyeri berat

2. Visual Analog Scale3. Faces Pain Rating Scale (untuk anak)

III. Berdasarkan lokasi

1. Nyeri neuropatik sentral2. Nyeri neuropatik perifer