1. Dr. A. Husni Tanra

3. There are certain barriers :
1.
2.
3.
Patient barrier
Doctor Barrier
Government Barrier

4. 1. PATIENT BARRIERS
Some patients are reluctant to report their pain
 Some due to the culture & religion
 Mostly due to the socio-economic status


5. 2.DOCTORS / HEALTH PROVIDER BARRIERS



No pain specialist doctors in Indonesia
In medical college, very little time is spent to teach
about pain & pain syndromes
Shortage in number of Specialist Doctors of :
SPECIALIST DOCTOR
Anesthesiologists
Neurologists
Neurosurgeons
Orthopedics
Rehabilitation Medicine
Rheumatologists
NUMBER
650 doctors
715 doctors
103 doctors
306 doctors
272 doctors
56 doctors

6. 3.GOVERMENT BARRIER S
 There are 53 medical schools in Indonesia
• 22 government medical schools
• 31 private medical schools
 Only 15 medical schools has post graduate
for specialist doctors
 Immediate release opioids are only available
in 3 top referral hospitals. (now MS contin is
available in big city)
 Pain management is still not the priority.
 Pain management is still considered not
economically beneficial for the government,
because it might need a big budget.

7.  Total
Government Hospitals
 163 units*
 Total
private Hospitals
 960 units*
 Total
Primary Health Care
 5614 unit*
 Total
General Physicians
 50.000 doctors
1

doctor for 5000 people
*Biro Pusat Statistik (2006)

8. Pain Management
In Indonesia
Acute Pain
Postop Pain
Shortage in
Anesthesiologist
(650 doctors)
APS (Acute Pain Service)
only in some teaching hosp.
3hospitas
Chronic /
Neurophatic Pain
Shortage in Neurologist
No Pain Specialist
Only Few Pain Clinics
Only 3 pain clinic
Cancer &
AIDS Pain
Shortage in
Palliative Doctors
Only 5 hospitals
Have Palliative care

9. In many parts of Indonesia :
Many people may die of pain
Many more people dying in pain
Even many more people living in pain
This is our task to help them.

11. 






Was established in 1993, after the 1st Pain
Meeting at Makassar in February 1993
Professor Karjadi was elected as the 1st
Chairman
Dr. A. Husni as the Vice Chairman
Dr. Idrus Paturussi as the Secretary
Dr. Assadul as the Treasurer
However, not many activities concerning pain and
pain management were done.
Indonesia was not yet registered as IASP
member.

12. 1.
2.
3.
4.
5.
Pain relief should be considered as a basic
human right
Pain should be the fifth vital signs in all
hospitals
Pain should be included in medical curriculum,
as early as possible
Development of pain specialists doctor as a
new discipline
Promoting the establishment of Acute Pain
Service, multi disciplinary pain clinic, and
Palliative care.

13. 




Was conducted at Makassar in April 2002
Dr. Husni was elected as the Chairman
Annual Scientific Meeting since 2002.
Global Day Against Pain was held in Surabaya
2004
Promoting establishment of IPS branches in big
cities (Yogyakarta, Jakarta, Surabaya, Makassar, Bandung, Medan,
Solo, Padang, and Denpasar)

Two books were published :
1. Guidelines on Acute Pain Management by IASP (translated to
Indonesia)
2. Guidelines on Neuropathic Pain Management

Promoting the establishment of pain clinic

14.  2nd
National Congress was conducted in
2005 at Surabaya
 Dr. Idrus Paturussi (Orthopedic Surgeon)
was elected as Chairman.
 3rd National Congress was conducted in
2009 at Bali
 Dr. Lukas Meliala (Neurologist) was
elected as Chairman.

15. 


The main idea of establishment of ASEA-PS is not
only to build closer relationships among ASEAN
doctors, but also to bring together pain specialists
from developed countries and ASEAN doctors,
including Indonesian doctors.
In other words, ASEA-PS was established to
improve and to share the knowledge about pain
management in ASEAN countries.
To help each other, and work together to promote
pain management.

25.  Joint
Meeting with NeuPSIG (Neuropathic
Pain Special Interest Group)

29. Indonesian
Society of Anesthesiology
for Pain Management
1st Meeting at Makassar, South
Sulawesi in 2011
2nd Meeting at Makassar, South
Sulawesi in 2012

37.  Dr.
Soetomo General Hospital in
Surabaya, the capital city of East
Java, was the pioneer in pain service in
Indonesia, focusing to the palliative pain
care.
 Pain
service in Surabaya was initiated in
1991.

38.  In
Makassar, the capital city of South Sulawesi,
Acute Pain Service for post-operative patients
was initiated in 2005, using mainly epidural
analgesia as the modality.
 Now, in 2013, only some leading hospitals in big
cities in Indonesia (Jakarta, Bandung, Bali), both
government and private, have pain services.

39.  Acute
Pain Service (APS) for post-operative
patients is organized as a resident-based
service with anesthesiology residents as
service providers, under supervision of
senior anesthesiologist pain consultants.
 In Makassar, Pain Clinic was opened in 2006,
with integrated modalities of pharmacologic
therapy, acupuncture, and interventional
therapy.

41. Male, 70 y.o. Fracture Femur, with
continuous epidural analgesia
Male, 52 y.o. Post laparatomy, with
Patient Controlled Epidural Analgesia
F, 32 yr. Haemorrhoidectomy , 5 days after
SC, with cont epidural analgesia
Anesthesiologist-supervised APS

42. Surgical Procedures
Digestive
Obgyn
Orthopaedic
Urology
n
1356
1308
800
921
%
30.77
29.53
13.40
22.08
Thorax, Oncology,
Plastic Surgery
201
2.48
Total Patients
4586

43. Percentage of Pain Intensity
90.00
80.00
70.00
60.00
50.00
81.39
40.00
30.00
20.00
10.00
15.88
2.73
0.00
0
1-3
4-6
0.00
7 - 10

45. Pain Clinic & Acupuncture

46. Why Acupuncture???
1. It has been used for more than
2000 years for treatment
2. Eastern method
3. Promoting self-healing
4. Almost no side-effect
5. Is used in more than100 countries
6. Is a treasury of KNOWLEDGE

48. Epidural steroid injection
STELLATE GANGLION BLOCK

50.  Pain
used to be just a part of lecture in
Medical Student Curriculum
 Since 2007, Acupuncture and TCM have
been taught as a subject for
undergraduate medical stundents.
 Collaboration with Xiamen
University, China
 Since 2011, pain has become an individual
subject for undergraduate medical
students.

53.  Nurse
Education for Pain Management
 Nurses have important roles in pain
management and pain services, because
nurses have continuous encounters with
the patients
 Nurses are the first persons to hear
patients complaints and the ones who
communicate patients’ complaints to the
doctors.

56. 2nd ISAPM Workshop Pain for Nurse_2012

57.  Short
course of Basic Acupuncture skill for
Pain Management
 Collaboration with Xiamen University, China
 Collaboration with Onomichi Hospital, Japan
 Role of anesthesiology residents in Acute
Pain Service and pain management in Pain
Clinic

59. Doctors from Xiamen University taught acupuncture
for anesthesiology residents in Makassar, 2006

61. MOU Dept. of Anesthesiology Fac. of Medicine Hasanuddin Univ.
and Dept. of Anesthesiology and Pain Clinic Onomichi Hospital
May 2006

64.  Many
specialists are interested to learn more
about pain and pain management
 Anesthesiologists are the ones who daily deal
with pain and pain-relieving drugs, mainly
opioids
 Fellow on Pain Management started on 2012 in
Our Department under collaborate with
Anesthesiology Collegium, Faculty of Medicine
UNHAS and Teaching Hospital ( RSWS and RSP
UNHAS )

65. Pain Management Education Committee in
Anesthesiology Collegium
 Several Meetings for prepare the formal subspecialist education in Pain Management
 MOU agreement between Anesthesiology
Collegium, Faculty of Medicine and Anesthesiology
Department
 MOU agreement between Anesthesiology
collegium, Anesthesiology Department and Teaching
Hospitals
 Fellow has been run on 2012


67. Fellowship training of pain management for
anesthesiologists was opened, and the first lecture was
conducted in January 2012, after the signing of the MOU
between :
• Indonesian Collegium of Anesthesiology and Intensive Therapy
• Department of Anesthesiology, Intensive Therapy and Pain Management of
Hasanuddin University Medical Faculty
• Teaching Hospitals : Wahidin Sudirohusodo General Hospital and Unhas
Hospital

68.  1st
Lecture in January 2012
 Nine
anesthesiologists from all over
Indonesia were accepted as the first
fellows.
 At
2013, 10 anesthesiologists were
accepted as fellows.

71. Hands on manniquine session workshop under c-arm

72. Hands on manniquine session workshop under c-arm

74. 1st IPM Workshop and has been held for 5 times till now

75. 5th IPM Workshop (Basic)

76. IPM Workshop (2nd Advanced)

77. 2nd ISAPM Workshop Pain for Nurse_2012

78. 2nd ISAPM Pain Symposium for Doctor_2012

79. 

Many studies about pain as a topic
have been conducted for Magister
Thesis for Residents and Doctoral
Dissertation
Oral and Poster Presentations in
National and International Meeting of
Anesthesiology and Pain

81. Poster presentation about APS RSWS-FKUH in World Congress of Pain, Milan 2012

82. 
TO CURE IS SOMETIMES

TO TREAT IS OFTEN

TO COMFORT IS ALWAYS
A. Pare (1598)

83. San Diego, 2002