Académique Documents
Professionnel Documents
Culture Documents
focus on
Department Of Neurology
dr. Hasan Sadikin Hospital Padjadjaran University
Definition of PAIN
0 10
Complete No
pain relief pain relief
0 10
McQuay, 1998.
Note: Lines must be exactly 100 mm long
FACES SCALES
THE DERMATOMES
Bagaimana Gejala Nyeri Neuropatik ?
Red Flags
HAS/Neuro/2005 (Agency for Health Care Policy and Research, Bigos 1994)
Low Back pain
Seriuos pathology: neoplasm
infection
fracture
cauda equina syndrome
Ischialgia, radicular syndrome
Nonspecific LBP
Syndromes of Epiconus, Conus
Syndrome of lumbal-radiculopathy and Cauda Equina
Low Back Pain
Diagnostic triage
History taking and physical examination to
exclude red flags
Neurological examination (including
Lassegue test)
Consider psychosocial factors if there is no
improvement
X-rays, MRI ??
Red Flags of LBP
Cancer
Infection
Vertebral fractur
Cauda equina syndrome or
Severe neurological deficit
Acute subacute chronic
Yellow Flags
Recognition of psychosocial factors
as predictors of chronicity and
obstacles to recovery
Risk Factors of LBP
Physical : 35 55 y
past history of LBP
Occupational : vibration
bending, twisting
heavy lifting
low job satisfaction
Psychosocial : attitudes
cognition
fear-avoidance beliefs
depression
anxiety
distress and related emotion
Management of
acute LBP
Diagnostic classification, D/ triage
Reassurance
Early and progressive activation
Analgetics ?: acetaminophen
NSAID
consider muscle relaxants
Recognition yellow flags
HAS/P3D
Management of Chronic LBP
Behavioral therapy
Education
Intensive exercise therapy
Multidisciplinary
HEADACHE
HAS/P3D
HEADACHE
DEFINITION :
ORBITA OCCIPUT
HAS/P3D
The International Classification of Headache Disorders
ICHD 2 ( IHS 2004 )
Cranial Neuralgias, central & primary facial pain & other headaches
Cranial neuralgias & central causes of facial pain
Others headache, cranial neuralgias & central or primary facial pain
The International Classification of Headache Disorders
ICHD 2 ( IHS 2004 )
Cranial Neuralgias, central & primary facial pain & other headaches
Cranial neuralgias & central causes of facial pain
Others headache, cranial neuralgias & central or primary facial pain
PAIN SENSITIVE CRANIAL STRUCTURES
Skin,subcutan., muscle
Extracranial arteries
Skull periosteum
Eye,ear, nasal cavities,
sinuses
Intracran.venous sinuses,
large vein, pericavernous
structures
Basis dura, meningeal
arteries, prox.ant/middle
cerebral A, IC int.carotis A
Superf.temporal A
Cranial nerves:II.III,V,IX,X,C1-3
THE ROLE OF NEUROTRANSMITTER :
SEROTONIN (5 HT)
THE ENDOGENOUS PAIN CONTROL MECHANISM -> OPIOID
GABA
MECHANISMS OF CRANIAL PAIN :
MENINGEAL IRRITATION
INTRACRANIAL MASS LESION
RAISED INTRACRANIAL PRESSURE
LOWERED INTRACRANIAL PRESSURE : LP HEADACHE
HISTORY taking:
ATTACK ONSET
QUALITY
SEVERITY
LOCATION
MODE OF ONSET
TIME, INTENSITY, CURVE, DURATION
CONDITION WHICH EXACERBATE / RELIEVE THE PAIN
ASSOCIATED FEATURES
SOCIAL HISTORY, FAMILY HISTORY
PAST HEADACHE HISTORY
HEADACHE IMPACT
HAS/NEURO
Faktor pencetus Nyeri Kepala
Stres
Kurang/kebanyakan tidur
Tidak/telat makan
Bau menyengat : parfum,rokok
Lingkungan: cahaya silau/berkedip,gaduh
ketinggian,panas,lembab
ruang berasap
Makanan/minuman
HAS/Neuro/Bdg/04
RED FLAGS of HEADACHE
Secondary Headache Red Flags
SSNOOP
Systemic symtoms (fever, weight loss) or
Secondary risk factors : underlying diseases
(HIV,systemic cancer)
Neurologic symtoms or abnormal signs (confusion,
impaired alertness,or consciousness)
Onset: sudden,abrupt, or split-second (first,worst)
Older: new onset and progressive headache, especially
in middle age>50 (giant cell arteritis)
Previous headache history or headache progression:
pattern change, first headache or different
(change in attack frequency, severity, or clinical pictures)
HAS/P3D
HAS/P3D
CLUSTER HEADACHE
YOUNG ADULT MEN ( M : F = 5 : 1 )
UNILATERAL PAIN
HAS/NEURO
Tension Type Headache
Psychologic factors
Muscle contraction and myofacial tenderness
Vascular factorsn : NO
Humoral factors : 5HT
Central factors : central pain control system
HAS/P3D
PHYSICAL EXAMINATION
NEUROLOGICAL EXAMINATION
Trigeminal neuralgia
HAS/P3D
HEADACHE TREATMENT
PRIMARY SECONDARY
HEADACHE HEADACHE
TREATMENT TREATMENT
Abortive Causal
Preventive Symtomatic : Analgesic
PRIMARY HEADACHE TREATMENT
MIGRAINE
TTH
Abortive :
Abortive :
Simple analg : acetaminophen/
Simple analg : acetaminophen/ ASA/ NSAID
ASA/NSAID
Specific analg : ergot alkaloids
( ergotamine/ DHE )/
triptan
Antiemetics : metoclopramide/
domperidone
Preventive :
Amitriptylin Preventive :
Anticonvulsants /
Adrenoceptor blockers (propranolol)/
Antidepressants/
Ca-channel blockers
Modifikasi perilaku
Latihan
Relaksasi
Biofeedback
Terapi perilaku kognisi
Terapi fisik
TENS (transcutaneus electric
nerves stimulation)
HAS/Neuro/Bdg/04
(PERDOSSI,2001
HAS/Neuro/2004
Antikonvulsants
(I.C.H.E.)