Bekam Nyeri Punggung Bawah Hanik Badriyah [PDF]

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Bekam untuk Nyeri Punggung Bawah Dr. dr. Hanik B. Hidayati, SpS (K)



Departemen Neurologi FK UNAIR – RSUD Dr. Soetomo Surabaya



Registrasi: https://bit.ly/bekamnyeri



Nyeri & Bekam Sunnah Meet the Experts: Dokter, Doktor dan Ulama



Dr. dr. Hanik B. Hidayati, SpS (K)



Dr. dr. Imam Subadi SpKFR (K)



Ustadz dr. Zaidul Akbar



KH. Kathur Suhardi, S.Pd.I, MA



Dr. Wahyudi Widada, S.Kep, M.Ked



Narahubung: Hamid Arif (085731467000), Kang Tri (081357009108), Widodo (085731311001) No. Rekening: BNI Syariah 7314670005 atau BSM 7314670005 atas nama Abdul Hamid Arif



Ahad, 8 Rabi‟ul Awal 1442 H / Minggu, 25 Oktober 2020, 06.30 – 11.10 WIB, live on



Daftar Isi 01



Pendahuluan



02



Nyeri Punggung Bawah



03



04 05



Terapi Nyeri Punggung Bawah



Bekam sebagai Terapi Alternatif Nyeri Punggung Bawah



Kesimpulan



Pendahuluan



Pendahuluan Alasan terbanyak ke dokter



Pandemik, 80% of lifetime prevalence 1 15-20% populasi pada titik waktu kapan saja 1/4 dewasa: min 1 hari di 3 bln terakhir (Amerika)2



“High costs” Gangguan finansial, sosioekonomik, fisik, ke hilangan pekerjaan & produktivitas, $100M (2006)



Kecacatan usia muda



Nyeri Punggung Bawah



 Fungsi harian & kualitas hidup Gangguan mood, depresi, emosional, kerja



Tekanan fisik & psikis Kelelahan kronik, depresi, kegelisahan, cemas, stres, cemas



Schreiber 2015; Tesfaye 2015; Saeed et al. 2014; Cohen SP et al, 2014; Yalcin I et al, 2014; Kessler TL, 2016; Casanova-García C et al, 2016; Schreiber AK et al, 2015; Obermann 2015; Navya et al. 2017; Lindsay TJ, 2010



Nyeri Punggung Bawah Tempat Tersering pada Kasus Nyeri Kronik Non Kanker



Nyeri Punggung Bawah



“An unpleasant sensory and emotional experien ce associated with, or r esembling that associat ed with, actual or poten tial tis- sue damage”



Definisi Nyeri



Nyeri •



Fungsi vital - mengenali intensitas stimulus yg berpotensi membahayakan - melindungi tubuh thd kerusakan yang lebih luas



Biasanya: singkat



Peran protektif (+)



• Nyeri patologis Kerusakan saraf Kronik (bulan/ tahun) Tantangan berat



Kronik



Fungsi protektif (-)



Definisi



Nyeri Punggung Bawah “Nyeri yang dirasakan di antara sudut iga terbawah dan lipat bokong bawah, yaitu di daerah lumbal atau lumbosakral, dengan atau tanpa disertai penjalaran ke ekstrimitas” 1: (Teixeira and Machado, 2006); 2: (Bhattacharyya et al., 2008); 3: (José A. López-Escámez, 2008); 4: (Fife and von Brevern, 2015); 5: (M urdin, Seemungal and Bronstein, 2016); 6: (Imai et al., 2017)



Epidemiologi Nyeri Peunggung Bawah



Low Back Pain • Affects all ages • Prevalence increase with age until 60–65 y.o • Peaks at 55-64 y.o • >80% of adults: at some point in life • More disability than Cancer + heart disease + stroke + AIDS



50% Equally affected



50% 1Jain N, et al, 2013; Qaseem A, et al 2017; Dageanis S, et al 2012., Allegri M, et al 2016;5:



Joint capsules Ligaments Tendons



Spine: strong design Muscles Nerve



Vertebrae



Protect the spinal cord & spinal nerve roots.



Highly flexible Ligament: • Anterior longitudinal ligament (ALL) • Posterior longitudinal ligament (PLL) • Ligamentum flavum (LF)



The complex anatomy



Mobility in many different planes.



Klasifikasi Nyeri ANATOMI Kepala, leher, bahu, siku, pergelangan tangan, lutut, punggung bawah, dsb



PENYEBAB Fraktur, dislokasi, kram, sprain, tumor, dll



DURASI Akut, kronik (> 3 bulan ) 1



MEKANISME Nosiseptif, neuropatik, mixed



INTENSITAS



KONTEKS KLINIS



Ringan, sedang, berat



Post pembedahan, penuaan (degeneratif), keganasan



1 Mehta



et al. 2016; Smith et al. 2013; Ji et al. 2014,



Klasifikasi Nyeri Punggung Bawah (NPB) NPB



1. 2.



Akute



Subakut



Kronik



4 minggu



4 - 12 minggu



> 12 minggu



Qaseem A, Wilt TJ, Mclean RM, Forciea MA, Audience T. Noninvasive Treatments for Acute , Subacute , and Chronic Low Back Pain : A Clinical Practi ce Guideline From the American College of. 2017;(May 2016). Allegri M, Montella S, Salici F, Valente A, Marchesini M, Compagnone C, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000 Research [Internet]. 2016;5:1530. Available from: https://f1000research.com/articles/5-1530/v2



Mekanisme Nyeri Punggung Bawah



Nyeri Campuran Nyeri Nosiseptif Kerusakan jaringan, proses penyakit atau pun fungsi abnormal dari otot / organ dalam Mixed Pain (Nyeri Campuran) - Nyeri Nosiseptif - Nyeri Neuropatik



Nyeri Neuropatik - Gejala positif - Gejala negatif



Nyeri Nosiseptif



Nyeri Neuropatik



Gambaran Klinis Nyeri Neuropatik Allodinia 1, hyperalgesia



Terbakar/ Panas Air mendidih 4 • • •



Rasa geli Kesemutan



2



Tertusuk 5 Tajam



Tidak nyaman, tidak menyenangkan 3 Alat skrining: verbal descriptors of pain (++), pemeriksaan fisik Pemilihan alat: berdasar pada kemudahan menggunakan



Tersetrum listrik



Kebas Mati rasa Kurang terasa Tidak terasa



1: (Tiwari et al. 2014; Jarahi et al. 2014; Vallejo et al. 2010; Wang et al. 2015; Yalcin et al. 2014; Calvo et al. 2012; 2: Mihai et al. 2014; Jaggi & Singh 2011; Nickel et al. 2012; Tiwari et al. 2014; Calvo et al. 2012; Jaggi et al. 2011b; Jarahi et al. 2014; Vallejo et al. 2010; 3: Smith et al. 2013; Ji et al. 2014; 4: Costigan et al. 2010‟ 5:



Neuropathic Component of Chronic LBP Up to 37% of patients with chronic low back pain may have a neuropathic component to their pain Freynhagen R et al. Curr Med Res Opin 2006; 22(10):1911-20.



Symptoms



Muscle spasms Weakness throughout the lower extremities Radiating burning pain, numbness, tingling



Risk Factors Nyeri Punggung Bawah



Age Gender education Marital status



Sociodemographic Degenerative



Genetic



Income level Worker’s compensation Personal injury Disability insurance



Socioeconomic



Occupational



General health



Work satisfaction Autonomy Supervisor empathy Monotonous/ repetitive tasks Prolonged heavy activities (lifting, carrying & manual handling)



Tobacco use Body weight Physical activity levels Systemic, physical/ psychological comorbidities



1. Dageanis S, Haldeman S. Evidence-Based Management of Low Back Pain. Dageanis S, Haldeman S, editors. Elsevier Mosby; 2012.



Pathophysiology of Low Back Pain Central sensitization/ dysfunctional pain May develop over time in some px with chronic LBP Chronic LBP commonly have simult aneous multiple pain gener ators. This is called “mixed Nociceptive pain pain.” Most patients with acute non-specific LBP (85%)



Neuropathic pain Radiculopathy (7%)



1. Allegri M, Montella S, Salici F, Valente A, Marchesini M, Compagnone C, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Re search [Internet]. 2016;5:1530. Available from: https://f1000research.com/articles/5-1530/v2 2. Manusov EG. Prim Care 2012; 39(3):471-9; Neblett R et al. Pain 2013; 14(5):438-45; 3. Vellucci R. Clin Drug Investig 2012; 32(Suppl 1):3-10; Woolf CJ, Salter MW. Science 2000; 288(5472):1765-9.



Neuropathic Component of LBP • Neuropathic component of LBP may be caused by: • Mechanical compression of nerve root (mechanical neuropathic nerve root pain) • Damage to sprouting C-fibers within the degenerated disc (localized ne uropathic pain) • Action of inflammatory mediators released from the degenerated disc (inflammatory neuropathic nerve root pain), even without mechanical c ompression



Freynhagen R, Baron R. Curr Pain Headache Rep 2009; 13(3):185-90.



Looking for the pain generator Joints



Joints



Nerve roots Bones



Intervertebral discs (IVDs)



Muscle Fascial structures Organs within the abdominal cavity Fundamental importance in determining the therapeutic approach 1. Allegri M, Montella S, Salici F, Valente A, Marchesini M, Compagnone C, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Re search [Internet]. 2016;5:1530. Available from: https://f1000research.com/articles/5-1530/v2



Tendon Otot Saraf perifer Ligamen Tulang & kartilago



Risk Factors Nyeri Punggung Bawah



Age Gender education Marital status



Sociodemographic Degenerative



Genetic



Income level Worker’s compensation Personal injury Disability insurance



Socioeconomic



Occupational



General health



Work satisfaction Autonomy Supervisor empathy Monotonous/ repetitive tasks Prolonged heavy activities (lifting, carrying & manual handling)



Tobacco use Body weight Physical activity levels Systemic, physical/ psychological comorbidities



1. Dageanis S, Haldeman S. Evidence-Based Management of Low Back Pain. Dageanis S, Haldeman S, editors. Elsevier Mosby; 2012.



Differential Diagnosis of LBP Intrinsic Spine



Systemic



Referred



• Compression fractu • Malignancy • Gastrointestinal conditions re (e.g., pancreatitis, peptic ulcer • Infection (e.g., disease, cholecystitis) • Lumbar strain/sprai vertebral n discitis/osteomye• Pelvic conditions (e.g., litis) endometriosis, pelvic • Herniated disc inflammatory disease, • Connective tissue • Spinal stenosis prostatitis) disease • Spondylolisthesis • Retroperitoneal conditions • Inflammatory • Spondylolysis (e.g., renal colic, spondyloarthropathy • Spondylosis (degen pyelonephritis) erative disc or facet • Herpes zoster joint It is important to identify and treat the underlying causes of pain whenever possible! Casazza BA. Am Fam Physician 2012; 85(4):343-50.



Chronic LBP • • • • •



Radicular Pain Facet Joint Pain Sacro-iliac Pain Pain Related to Lumbar Stenosis Discogenic Pain



Common Causes of Low Back Pain Mechanical (80-90%) (e.g., disc degeneration, fractured vertebrae, instability, unknown cause [most cases]) Neurogenic (5-15%) (e.g., herniated disc, spinal stenosis, osteophyte damage to nerve root) Non-mechanical spinal conditions (1-2%) (e.g., neoplasm, infections, inflammatory arthritis, Paget’s disease) Referred visceral pain (1-2%) (e.g., gastrointestinal disease, kidney disease, abdominal aortic ane urism) Other (2-4%) (e.g., fibromyalgia, somatoform disorder, “faking” pain ) Cohen S. BMJ 2008; 337:a2718.



Common Causes of Low Back Pain Muscle tension and spasm are among the most common reasons for LBP, for example, in patients with fibromyalgia



In other cases, LBP can be attributed to different pain generators, with spe-cific characteristics, such as radicular, facet joint, sacro-iliac, and discogenic pain, as well as spinal stenosis.



1. Allegri M, Montella S, Salici F, Valente A, Marchesini M, Compagnone C, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Re search [Internet]. 2016;5:1530. Available from: https://f1000research.com/articles/5-1530/v2



Terapi Nyeri Punggung Bawah



Follow-Up of Patients with Acute Low Back Pain Review and assess improvement within 2 weeks No improvement or deterioration



Assess risk of persistent disability



Improvement



Consider referral if there is se vere, refractory radicular pai n/neurological deficit



Low risk



Continue current management



Medium risk



High risk



Refer to physiotherapist



Refer for biopsychosocial assessment



Review within 12 weeks No improvement : consider referral to specialist



Adapted from: Lee J et al. Br J Anaesth 2013; 111(1):112-20.



Improvement : continue supportive management



Management of Acute Low Back Pain Clinical presentation: acute low back pain History and examination Red flags? No



Yes



Consider differential diagnosis



Advise mobilization a nd avoidance of bed rest



Provide appropriate pain relief



Provide education and counsel on self -care



Review and assess improvement within 2 weeks



Adapted from: Lee J et al. Br J Anaesth 2013; 111(1):112-20.



Investigation and mana gement; consider referral



Management of Persistent Low Back Pain* Persistent low back pain Signs and symptoms of nerve root disease or spinal stenosis? No Yes Re-evaluate symptoms and risk factors, review diagnosis and consider referral and/or imaging studies Consider alternative therapy (e.g., interdisciplinary approach incorporating pharmacological and non-pharmacological elements Review response



Consider referral and/or diagnostic MRI No Nerve root compromise or spinal stenosis? Yes Refer for specialist manageme nt



*American College of Physicians and the American Pain Society Adapted from: Chou R et al. Ann Intern Med 2007; 147(7): 478-91.



Multimodal Treatment of Low Back Pain Lifestyle management Sleep hygiene



Physical/ occupational thera py



Stress management



Pharmacotherapy



Interventional management



Education Complementary therapies



Biofeedback



Gatchel RJ et al. Psychol Bull 2007; 133(4):581-624; Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research; National Academies Press; Washington, DC: 2011; Mayo Foundation for Medical Education and Research. Comprehensive Pain Rehabilitation Center Program Guide. Mayo Clinic; Ro chester, MN: 2006.



Nyeri Dipengaruhi Banyak Hal



Harapan Terapi Nyeri Punggung Bawah



Education Px expectations for pain relief



Analgesic effect



Balance



WHO



PENGOBATAN TRADISIONAL



Menjawab ketidakpuasan terhadap perawatan kedokteran modern ini, terutama terkait Penyakit kronik ESO kimiawi Kurangnya akses sejumlah besar orang (80%) di bebe rapa negara untuk mendapatkan perawatan kesehatan primer



MENGEMBANGKAN PENGOBATAN TRADISIONAL



Slogan "Kesehatan untuk semua”  tx tradisional



Bekam Tx tradisional Tx banyak penyakit, slh 1: nyeri Di tangan professional: aman Al-rawi & Fetters 2012; Lee dkk., 2011; Mehta & Dhapte 2015; Reza dkk., 2002; Rozenfeld & Kalichman 2016; Emerich dkk., 2014; Sajid 2016; Kim dkk., 2014; SHI dkk., 2013; Tagil dkk., 2014 ; Malik 2014; Al-kazazz et al. 2014; Cao et al. 2014



Terapi Bekam Nyeri Punggung Bawah



Nama Lain *To restore to the original size



Al Hijamah* 3



Canduk/ kop/ canthuk 7



Al Hijama 1



Baguan 2



Cupping therapy 5 Βεντούζα 8 B_a gu_an li_ao fǎ 4 Cupping method 6



Ventusynge 7 Ventouza 1: Kim et al. 2014; Mehta & Dhapte 2015; 2:  Cavlak M, 2015; 3: Sajid 2016; 4: Mehta & Dhapte 2015; 5: Araştırılması et al. 2013; 6: Shi et al. 2013 ; 7: Samiasih 2013; 8: Chirali 2014



“Cupping is a therapy in which a cup is applied to the skin to cause local congestion throug h negative pressure created b y heat or vacuum” “ Application of suction by creating a vacuum” (WHO) 1



Definisi Bekam



1: Chi LM, 2016



Sejarah Bekam



Intervensi Tertua 1



3000 SM 2 China Tanduk banteng



1550 M



Mesir Ebers papyrus 3 Membuang “zat asing”



400 SM



1800 M



Yunani Eropa & Amerika Kuno Galen nyeri kepala Paracelcus nafsu makan, Ambroise Pare pencernaan, pingsan, abses, narkolepsi,



1: Kim et al. 2014; 2: Rozenfeld & Kalichman 2016; 3: Araştırılması et al. 2013



Abad: 19, akhir 20



Inggris Unisovyet



Sejarah Bekam Ebers Papyrus (1550 SM)



Kop gelas Timur Tengah Mesir Kom Omb o



Yunani



Dokter Muslim melakukan bekam



Hippocrates: WCT > CT Galen Mesir  negara barat (dilakukan dr. bedah terkenal) Alexandrians & Byzantines  timur tengah



Sejarah Bekam



Afrika: WCT dengan tanduk hewan 1



Dokter bedah melakukan bekam 1



Sacrificator dg 13 Set bekam 1878 M lancet 1 Eropa abad 17 1



1 Chirali



2014



Tantara dibekam lengannya saat situasi politik Prancis dg Jerman1820 1



Bekam di Banyak Negara Cina, Yunani, Mesir, India, Jerman, Norwegia, Finlandia, Jerman, Finlandia, dll Asia, Afrika, Eropa, America (North)3 China:



Indonesia



Jiao Fa (角法 horn method) Huo Guan (火罐Fire Cupping)



Vietnam Pengobatan 1: Filipina - Tradisional - Alternatif - Rakyat Inggris - Komplementer Seluruh dunia, ribuan tahun 2



Saudia Arabia Korea Taiwan 12.8% of the participants: use of CT 1 



1: (Al-rawi dan Fetters, 2012; Cao dkk., 2014a; Lee, Kim dan Ernst, 2011; Mehta dan Dhapte, 2015a; Reza, Mahdavi dan Ghazanfari, 2012; 2: Tagil, 2014; 3:  Cavl ak M, 2015



ATLIT & SELEBRITI Victoria Beckham, Justin Bieber, Lady Gaga, Jennifer Aniston, Gwyneth Paltrow, Kim Kardashian West, Lena Dunham



Moeen Ali



Michael Phelps



„boxer”



Alexander Naddour



Will Russell



Natalie Coughlin



„body builder”



Steven Adams



Bekam Di tangan profesional 0 1



Sederhana 1 0 2 0 3



Aman, bisa ditoleransi 2



Mudah digunakan 3 0 3



Untuk banyak penyakit, di antaranya : nyeri 2: Sajid 2016; 3: Al-kazazz et al. 2014, 4: Kim, 2014; El Sayed, SM, 2014 



Efek samping minimal 4



Animal horns cups Bamboo cups : murah, gampang, namun ujung tajam, sulit steril Suction cups Rubber cups Glass cups ✓: mudah (pakai, steril, kontrol), namun mudah pecah Silicone or plastic cups Pottery cups Porcelain cups Electromagnetic cups Portable cupping machine Cup with squeeze rubber top Needle cupping cupping therapy



MACAM & BENTUK KOP (Kim et al. 2011; Mehta & Dhapte 2015; Rozenfeld & Kalichman 2016)



• Tarikan mekanik ✓ • Elektrik



ALAT TEKANAN NEGATIF Tarikan mekanik lebih dipilih untuk menghindari efek terbakar pada kulit (Michalsen et al. 2009)



Cao et al. 2014; El-Domyati & Saleh 2013, (El-Domyati & Saleh 2013; Kim et al. 2014; Michalsen et al. 2009, Michalsen et al. 2009



Adverse Effects WCT  eneralized body ache/ G itching Factitious panniculitis  Iron deficiency anemia 



Burns & blisters from fir e cupping



0 1 0 3 0 5 0 7



0 2 0 4 0 6 0 8



kin laceration S Light scratches (WCT)



Dark circular mark ain/ pressure/ P discomfort at the cupping sites Tingling



Jenis Bekam



1. Flashing fi re cupping



2. Throw fire c upping



3. Fire-retention c upping



4. fire stacking cupping



Jenis Bekam



Moving cupping application



Jenis Bekam Bekam basah



Bekam seluncu r Bekam kombinas Bekam obat i



Bekam air



Bekam gerak Bekam yang dit ahan



Bekam air



Bekam jarum Bekam cepat



Jenis Bekam 1 Bekam



Bekam kering