Curriculum Vitae

PLACE AND DATE OF BIRTH

Jakarta, March 20th 1979

EDUCATION
Neurology, Padjadjaran University, Bandung, 2010
M.D. Faculty of Medicine, Gajah Mada University,
Yogyakarta, 2003

TRAINING
Workshop Alteplase Theraphy, 2014
EEG Certification from Asian Epilepsy Academy
(ASEPA) and Asean Neurological Association
(ASNA), 2013

Dr Marcelia Suryatenggara,
Suryatenggara, SpS
How to choose your analgetics
in chronic non cancer pain?

Pekanbaru, 2nd December 2018

Background
Among the most common reasons for seeking medical attention .
Do not generally change the course of the disease process,
mostly are used for symptomatic relief.
But important, cause:
–Emotional and physical suffering;
–Sleep disturbance;
–Delayed mobilization, promotes thrombosis.
Goals Of Pain Treatment:
»Improve quality of life for the patient;
»Decrease pain and suffering
»Instill hope
Nociceptive pain:
Pharmacologic approach

Chronic kidney disease, advance

age: avoid NSAID and cox-2
inhibitor
Peptic ulcer, glucocorticoid –
avoid NSAID,
Hepatic disease – avoid NSAID,
cox – 2 inhibitor and
acetaminophen – use amitriptilin
or duloxetine first line
Cardiovascular disease or risk –
use lowest effective dose of
NSAID ; in patients who require
treatment, suggest naproxen.
 NSAIDs
Arachidonic Acid

Glucocorticoids
(block mRNA expression)

COX-1 COX-2
(Constitutive) (Cytokine inducible)

x nsNSAIDs x

Purpose-designed COX-2
x
specific inhibitor
GI tract Inflammatory site:
Kidney Macrophages
Platelet Synoviocytes
Endothelial cells

*ns = non-selective

nsNSAIDs: non selective Non Steroid Anti Inflammatory Drugs

Needleman P, and Isakson PC. J Rheumatol Suppl 1997;49:6-7; Flower RJ. Nat Rev Drug Discov 2003;2:179-191
 Neuropatic pain:
Pharmacologic approach
Paracetamol : Change prostaglandin levels in the brain
NSAID : Mainly work by changing prostaglandin levels in
the periphery, thereby reducing inflammation
Codeine : Acts on opioid receptors in the brain and spinal
cord
Tramadol: Acts weakly on opioid receptors, also
increases descending inhibitory signals in the spinal cord
Morphine, pethidine : Act on opioid receptors in the
brain and spinal cord
Tricyclicantidepressants : Increase descending inhibitory
signals in the spinal cord
Anticonvulsants : “Membrane stabilisers”, probably work
by reducing abnormal firing of pain nerves
Local anaesthetics: Temporarily block signalling in pain
nerves in periphery (e.g. infiltration or nerve block) or
spinal cord (e.g. spinal block)
 Opioid:
Only be initiated when:
No other better alternative therapies (ex: risk
factors for NSAID)
Pain is adversely affecting quality of life
Choose the weak opioid (tramadol, codein) with
the lowest effective dose
Combine with non opioid pharmaco therapy
and non pharmacologic therapies
Thank you