Dr. Moch.

Bahrudin, SpS
Fakultas Kedokteran
Universitas Muhammadiyah Malang

TOPICS

Pain fisiologi dan patofisiologi

Musculoskeletal pain
The causes of musculoskeletal pain
Sign and symptom
The different types of musculoskeletal pain
Diagnosed
Treated

Pain

PROTECTION

Definitions

Pain is an unpleasant sensory

and emotional experience
associated with actual or potential
tissue damage or described in
terms of such damage.

Physiology of Pain Perception

Injury

Transduction
Transmission
Modulation
Perception
Interpretation
Behavior

Brain

Descending
Pathway

Peripheral
Nerve

Dorsal
Root
Ganglion

Ascending
Pathways
C-Fiber
A-beta Fiber
A-delta Fiber

Dorsal
Horn
Spinal Cord
Adapted with permission from WebMD Scientific American Medicine.

Peripheral Mechanisme
of Pain

Nociceptive vs Neuropathic Pain

MixedType

Nociceptive
Pain
Caused by activity in
neural pathways in
response to potentially
tissue-damaging stimuli

Caused by a
combination of both
primary injury and
secondary effects

Neuropathic
Pain
Initiated or caused by
primary lesion or
dysfunction in the
nervous system
CRPS*

Postoperative
pain

Arthritis

Mechanical
low back pain

Sickle cell
crisis

Sports/exercise
injuries

Postherpetic
neuralgia

Trigeminal
neuralgia

Neuropathic
low back pain

Central poststroke pain

Distal
polyneuropathy
(eg, diabetic, HIV)

What is musculoskeletal pain?

Musculoskeletal pain affects :

the bones, muscles, ligaments, tendons, and

nerves.

It can be acute or chronic (long-lasting).

Musculoskeletal pain can be localized in one
area, or widespread.
Lower back pain >>>
Other common types include tendonitis, myalgia
(muscle pain), and stress fractures.

What are the causes of

musculoskeletal pain?

an injury to the bones, joints, muscles,

tendons, ligaments, or nerves. >>>

Musculoskeletal pain can also be caused by

overuse. Pain from overuse affects 33% of
adults. ( Lower back pain)

Poor posture or prolonged immobilization

What are the symptoms of

musculoskeletal pain?
Clinical manifestation include:
Pain
Paresthesia or hypesthesia
Stiffness
Weaknes
Edema
The limitation of range of motion

What are the different

types of musculoskeletal
Musculoskeletal pain has varying symptoms and causes.
pain?

Bone pain:
This is usually deep, penetrating, or dull. It
most commonly results from injury.

 Muscle pain (myofasial pain) :

This is often less intense than bone pain,

Anita HoldcroftAnita Holdcroft, CORE TOPICS IN PAIN, Cambridge University Press 2005

Anita HoldcroftAnita Holdcroft, CORE TOPICS IN PAIN, Cambridge University Press 2005

 Tendon and ligament pain: Pains in the

tendons or ligaments are often caused by injuries, including
include sprains. This type of musculoskeletal pain often
becomes worse when the affected area is stretched or moved.

Fibromyalgia Syndrome (FMS)

This is a condition that may cause pain in the muscles, tendons, or

ligaments. The pain is usually in multiple locations and can be difficult to
describe. Fibromyalgia is usually accompanied by other symptoms.

Common symptoms in FMS patients are:

Sleep disturbance.
Fatigue.
Morning stiffness.
Anxiety.
Depression.
Co-morbidity with rheumatic and endocrine
disorders.

 Joint pain: Joint injuries and diseases usually produce a stiff,

aching, "arthritic" pain. The pain may range from mild to severe and
worsens when moving the joint. The joints may also swell. Joint
inflammation (arthritis) is a common cause of pain.

 "Tunnel" syndromes: This refers to musculoskeletal disorders that

cause pain due to nerve compression. The disorders include carpal tunnel
syndrome, cubital tunnel syndrome, and tarsal tunnel syndrome. The pain tends
to spread along the path supplied by the nerve and may feel like burning. These
disorders are often caused by overuse.

How is musculoskeletal
pain diagnosed?
Medical

history.
Examination looking for the source of the pain.
These may include:
Blood tests to confirm a diagnosis, such as rheumatoid
arthritis
X-rays to take images of the bones
CT scans to get an even more detailed look at the bones
MRIs to look at soft tissues such as muscles, cartilage,
ligaments, and tendons
Based on the findings from your examination and the
results of these tests,

How is musculoskeletal
pain
treated?
Musculoskeletal pain is best treated by treating its cause.
1. Physical or occupational therapy

Using a splint to immobilize the affected joint and allow healing

Using heat or cold
Reducing workload and increasing rest
Reducing stress through relaxation and biofeedback techniques
Acupuncture or acupressure
Strengthening and conditioning exercises
Stretching exercises
Chiropractic care
Therapeutic massage

CON'T
2. Midications
Injections with anesthetic or anti-inflammatory medications in

or around the painful sites

For patients with fibromyalgia, medications to increase the
body's levels of serotonin and norepinephrine (neurotransmitters
that modulate sleep, pain, and immune system function) are
often prescribed in low doses.
Analgesics such as acetaminophen, NSAIDS, or, if pain is
severe, opioids.

3. Operative

Musculoskeletal pain affects : the bones, muscles,

ligaments, tendons, and nerves.
Clinical manifestation include: Pain, Paresthesia or
hypesthesia,Stiffness,Weaknes,edema,The limitation of
range of motion
Diagnosed : Medical history, Examination looking for the
source of the pain and Laboratory.
Treatments include: Physical or occupational therapy ,
medication and operative