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Samenvatting Pijnmanagement theorie & praktijk
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Gedetailleerde samenvatting van alle theorie en praktijklessen van pijnmanagement
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By: basvandijck12 • 1 year ago
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Samenvatting Pijnmanagement: theorie & praktijkH1: Neurofysiologie van chronische pijn ................................................................................................ 7
1. PIJN FYSIOLOGIE.......................................................................................................................... 7
1.1. Acute pijn ............................................................................................................................ 7
1.2. Nociceptie ........................................................................................................................... 8
2. CLASSIFICATIE............................................................................................................................ 10
2.1. Nociceptieve pijn............................................................................................................... 10
2.2. Neuropathische pijn .......................................................................................................... 11
2.3. Nociplastische pijn ............................................................................................................ 11
3. NEUROPLASTICITEIT .................................................................................................................. 12
3.1. Definitie ............................................................................................................................. 12
3.2. Manifestatie ...................................................................................................................... 13
3.3. Mechanisme ...................................................................................................................... 13
4. HYPOTHETISCH MODEL CHRONISCHE PIJN .............................................................................. 20
5. VRAGEN ..................................................................................................................................... 21
H2: Onderzoek en behandeling neuropathische pijn ........................................................................... 22
1. PATHOFYSIOLOGIE .................................................................................................................... 22
1.1. Zenuwstelsel ..................................................................................................................... 22
1.2. Werking somatosensorisch systeem................................................................................. 23
1.3. Sensitisatie ........................................................................................................................ 23
2. ASSESSMENT ............................................................................................................................. 27
2.1. Voorgeschiedenis .............................................................................................................. 27
2.2. Klinisch onderzoek ............................................................................................................ 29
2.3. Diagnostische testen ......................................................................................................... 30
2.4. Vragenlijsten ..................................................................................................................... 30
2.5. Neurogene provocatietesten ............................................................................................ 31
3. BEHANDELING ........................................................................................................................... 31
3.1. Farmacologie ..................................................................................................................... 31
3.2. Chirurgie ............................................................................................................................ 32
3.3. Kinesitherapie ................................................................................................................... 32
3.4. Psychologische therapie modaliteiten .............................................................................. 34
4. NEUROPATHISCHE PIJNSYNDROMEN ....................................................................................... 35
4.1. Perife neuropathische pijn ................................................................................................ 35
4.2. Centrale neuropathische pijn............................................................................................ 42
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,H3: Assessment chronische pijn ........................................................................................................... 44
1. INLEIDING .................................................................................................................................. 44
2. MODELLEN ................................................................................................................................ 44
3. PSCEBSM-MODEL ...................................................................................................................... 45
3.1. Somatisch .......................................................................................................................... 45
3.2. Pijntype ............................................................................................................................. 46
3.3. Cognitieve factoren ........................................................................................................... 51
3.4. Emotionele factoren ......................................................................................................... 53
3.5. Gedragsfactoren ............................................................................................................... 56
3.6. Sociale factoren................................................................................................................. 58
3.7. Motivatie ........................................................................................................................... 58
H4: Behandeling nociplastische pijn ..................................................................................................... 60
1. INLEIDING .................................................................................................................................. 60
2. PIJNEDUCATIE ........................................................................................................................... 61
2.1. Educatie neurofysiologie................................................................................................... 62
3. STRESS MANAGEMENT ............................................................................................................. 66
4. ACTIVITEIT & SLAAPMANAGEMENT ......................................................................................... 66
4.1. Slaap .................................................................................................................................. 66
4.2. Activiteiten ........................................................................................................................ 67
5. GRADED ACTIVITY, GRADED EXERCISE...................................................................................... 68
5.1. Flare-ups............................................................................................................................ 69
5.2. Chronische pijn, niet dominant centraal........................................................................... 70
5.3. Dominant centrale sensitisatie ......................................................................................... 71
5.4. Samengevat....................................................................................................................... 72
H5: Medische behandeling chronische pijn .......................................................................................... 73
1. FARMACOLOGISCHE BEHANDELING ......................................................................................... 73
1.1. NSAID’s/ COXIB’s ............................................................................................................... 73
1.2. Paracetamol ...................................................................................................................... 73
1.3. Opioïden ............................................................................................................................ 74
1.4. Anti-depressiva ................................................................................................................. 76
1.5. Anti-epileptica ................................................................................................................... 77
1.6. Lokale anesthetica ............................................................................................................ 77
1.7. Besluit................................................................................................................................ 78
2. INTERVENTIONELE BEHANDELING ............................................................................................ 78
2.1. Lumbale epidurale ............................................................................................................ 79
2.2. Cervicale epidurale............................................................................................................ 80
2
, 2.3. Sacro-iliacale gewrichtsinfiltratie ...................................................................................... 81
2.4. Infiltratie facetgewrichten ................................................................................................ 81
2.5. Radiofrequente denervatie ............................................................................................... 82
2.6. Intrathecale katheter ........................................................................................................ 83
2.7. Spinal cord stimulator ....................................................................................................... 84
2.8. MET en TENS ..................................................................................................................... 84
3. PSYCHOLOGISCHE BEGELEIDING............................................................................................... 85
4. FYSISCHE REVALIDATIE.............................................................................................................. 85
H6: Biopsychosociale achtergrond en benadering van chronische pijn ............................................... 86
1. EVIDENCE BASES PRACTICE....................................................................................................... 86
2. BIOPSYCHOSOCIALE BENADERING VAN CHRONISCHE PIJN ..................................................... 86
2.1. Biopsychosociale benadering............................................................................................ 86
2.2. Informatieverwerking ....................................................................................................... 87
2.3. Common sense model Leventhal ...................................................................................... 88
2.4. Vlaggen.............................................................................................................................. 90
3. DIAGNOSTISCH PROCES ............................................................................................................ 90
3.1. Biopsychosociale pijnanalyse ............................................................................................ 90
3.2. Placebo, nocebo ................................................................................................................ 92
H7: Motiverende gespreksvoering........................................................................................................ 93
1. MOTIVATIE ................................................................................................................................ 93
2. ZELFDETERMINATIETHEORIE .................................................................................................... 93
2.1. Soorten motivatie ............................................................................................................. 94
3. GEEST VAN MOTIVERENDE GESPREKSVOERING ....................................................................... 94
4. VERANDERTAAL ........................................................................................................................ 95
4.1. Verandertaal uitlokken ..................................................................................................... 96
4.2. Verandertaal versterken ................................................................................................... 97
5. WRIJVING .................................................................................................................................. 99
6. PROCESSEN MOTIVERENDE GESPREKSVOERING ...................................................................... 99
7. CHRONISCHE PIJN ................................................................................................................... 100
H8: Chronische pijn bij artrose............................................................................................................ 101
1. ARTROSEPIJN........................................................................................................................... 101
1.1. Inleiding........................................................................................................................... 101
2. KLINISCHE CLASSIFICATIE VAN PIJN BIJ ARTROSE ................................................................... 102
2.1. Neuropathische pijn ........................................................................................................ 102
2.2. Nociplastische pijn .......................................................................................................... 102
3. BEHANDELING VAN PIJN BIJ ARTROSE .................................................................................... 104
3
, 3.1. Graded activity ................................................................................................................ 105
H9: Pijn bij kinderen ............................................................................................................................ 111
1. GESCHIEDENIS PIJN BIJ KINDEREN .......................................................................................... 111
2. PREVALENTIE........................................................................................................................... 112
2.1. Acute pijn ........................................................................................................................ 112
2.2. Chronische pijn................................................................................................................ 112
3. BIOLOGISCHE BASIS ................................................................................................................ 113
3.1. Ontwikkeling hersenen ................................................................................................... 113
3.2. Centrale sensitisatie ........................................................................................................ 115
4. PSYCHOSOCIALE BASIS ............................................................................................................ 115
4.1. Modellen ......................................................................................................................... 115
4.2. Conditionering ................................................................................................................ 116
5. COGNITIEVE PROCESSEN......................................................................................................... 118
5.1. Fear avoidance model ..................................................................................................... 118
6. LANGE TERMIJN EFFECTEN PIJN ............................................................................................. 119
7. PIJN ASSESSMENT ................................................................................................................... 120
7.1. Self report ....................................................................................................................... 120
7.2. Observationeel ................................................................................................................ 121
8. BEHANDELING ......................................................................................................................... 122
8.1. Behandelimplicaties kind met chronische pijn ............................................................... 122
8.2. Kinesitherapie ................................................................................................................. 122
9. CASUS MOLLY.......................................................................................................................... 125
H10: Acceptance and Commitment Therapy ...................................................................................... 126
1. INLEIDING ................................................................................................................................ 126
2. ACCEPTATIE ............................................................................................................................. 127
2.1. Vermijding ....................................................................................................................... 127
2.2. Acceptatie ....................................................................................................................... 127
3. COGNITIEVE DEFUSIE .............................................................................................................. 128
3.1. Fusie ................................................................................................................................ 128
3.2. Defusie ............................................................................................................................ 128
4. CONTACT MET HIER EN NU ..................................................................................................... 128
4.1. Geconceptualiseerde verleden & toekomst ................................................................... 128
4.2. Contact met hier en nu ................................................................................................... 129
5. ZELF ALS CONTEXT .................................................................................................................. 129
5.1. Zelf als concept ............................................................................................................... 129
5.2. Zelf als context ................................................................................................................ 129
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, 6. WAARDEN ............................................................................................................................... 130
7. TOEGEWIJD HANDELEN .......................................................................................................... 130
7.1. Onwerkbare actie............................................................................................................ 130
7.2. Toegewijde actie ............................................................................................................. 130
H11: Pijn bij atleten............................................................................................................................. 131
1. INTRODUCTIE .......................................................................................................................... 131
1.1. Invloed van pijn ............................................................................................................... 131
1.2. Risicofactoren ................................................................................................................. 131
1.3. Return to play.................................................................................................................. 133
1.4. Casus zwemmer .............................................................................................................. 134
2. KNOW PAIN ............................................................................................................................. 136
3. MOTORISCHE PIJN INTERACTIES ............................................................................................. 136
4. ASSESSMENT & MANAGEMENT VAN ATLETEN MET PIJN ...................................................... 137
4.1. Acute pijn ........................................................................................................................ 137
4.2. Link tussen anamnese, KNO & pijntype .......................................................................... 138
4.3. Behandeling .................................................................................................................... 140
H1: Motiverende gespreksvoering...................................................................................................... 141
1. DEFINITIE ................................................................................................................................. 141
2. OARS(TI) .................................................................................................................................. 141
2.1. Open vragen .................................................................................................................... 142
2.2. Affirmatie ........................................................................................................................ 142
2.3. Reflectief luisteren .......................................................................................................... 142
2.4. Samenvatten ................................................................................................................... 143
2.5. Toestemming/timing....................................................................................................... 143
2.6. Info & advies ................................................................................................................... 143
3. BEHOUDTAAL VS. VERANDERTAAL ......................................................................................... 144
4. WEERSTAND ............................................................................................................................ 144
H2: Pain Neuroscience Education ....................................................................................................... 145
1. RATIONALE PNE ...................................................................................................................... 145
2. DEMO ...................................................................................................................................... 146
3. OPBOUW EDUCATIE & VISUELE ONDERSTEUNING ................................................................ 147
3.1. Wat is pijn?...................................................................................................................... 147
3.2. Ontstaan van pijn ............................................................................................................ 148
3.3. Chronische pijn................................................................................................................ 149
3.4. Waarom bij u? ................................................................................................................. 150
4. GESPREKSVAARDIGHEDEN ...................................................................................................... 150
5
, 4.1. Hoe PNE?......................................................................................................................... 151
5. PRAKTISCHE TOEPASSING ....................................................................................................... 153
5.1. Casus ............................................................................................................................... 153
6. REFLECTIE ................................................................................................................................ 155
H3: Acceptance and Commitment Therapy ........................................................................................ 156
1. INLEIDING ................................................................................................................................ 156
2. RUIMTE MAKEN ...................................................................................................................... 156
2.1. Inleiding........................................................................................................................... 157
3. ACCEPTATIE ............................................................................................................................. 157
4. WAARDEN BEPALEN................................................................................................................ 159
4.1. Oefeningen waarden bepalen......................................................................................... 159
5. TOEGEWIJDE ACTIE ................................................................................................................. 161
5.1. Oefeningen toegewijd handelen..................................................................................... 161
5.2. Volgende sessies ............................................................................................................. 162
6. HIER EN NU ............................................................................................................................. 162
7. COGNITIEVE DEFUSIE .............................................................................................................. 162
7.1. Oefeningen defusie ......................................................................................................... 163
8. ZELF ALS CONTEXT .................................................................................................................. 164
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