BIMBINGAN

FUNGSIONAL
Fisiologi Nyeri
Kulit

Tulang

Otot
Nyeri Aksial

Reseptor Nyeri Deep somatic Pembuluh Darah

Nyeri
Saraf Radikular

Facet joint

Viseral
Selaput Otak
Tipe Nyeri Berdasarkan Penyebarannya

1.Axial : Menyebar disekitar sumber nyeri

• Contoh : facet joint; sacro- iliac joint
2.Radikular: Menjalar jauh dari tempat asal
• Contoh : HNP, penekanan radik dorsalis, CTS
Radicular Pain
• Cause: compression or irritation of a spinal nerve root.
• Etiology: HNP, foraminal stenosis, spinal stenosis
• MRI: find disc herniation, foraminal stenosis, canal stenosis
• EMG
• Characteristic:
• Radiating shooting or burning pain, numbness, tingling,
• Per dermatomal
Radicular Pain
• 1. Pro-inflammatory cytokines are released at the site of lesion:
An inflammatory cascade is initiated by the release of inflammatory mediators or
Cytokines, such as TNF-α (Tumor Necrosis Factor-alpha)
• 2. Ectopic or abnormal neuronal firing at the DRG driven by neurotrophins
Once TNF-α reaches the DRG, the production of the neurotrophic
factor NGF (nerve growth factor) in the surrounding inflamed tissue is
stimulated. NGF triggers the production of another neurotrophic
factor: BDNF (brain-derived neurotrophic factor)
• 3. Ectopic firing at the Dorsal Horn and central pain sensitization
Both NGF and BDNF are also important factors in the development of central
sensitization. In other words, they interfere with neuronal excitability and
transmission in the dorsal horn; maintaining abnormal pain signaling. Ectopic firing
also indices microglia activation
Axial Pain
• Etiology: muscle, ligament, degenerative changes in the spine's facet
joints and discs.
• MRI: fascet joint, muscle and ligament
• Characteristic:
• Localized
• dull, aching pain
• worsen with movement or certain positions.
SI Joint Pain
• Etiology: trauma, arthritis, sacroillitis
• Characteristic:
• deep, aching discomfort lower back or buttocks
• Can be radiating to groin and legs