Week 8
Lecture 8.6: The physical domain (tt stof CAT 2)
Physically
- How do I deal with pain?
- What treatment do I want?
- Who helps me with my physical complaints?
Social
- Who can support me with my financial problems?
- Can I still live at home?
- How do I maintain my contacts?
Psychological
- How do I deal with my sadness?
- How do I deal with my anxiety and gloom?
- Who can I contact?
Meaning
- Who am I (still)?
- What’s happening to me?
- Who inspires me?
Psychological distress
An unpleasant experience of an emotional, psychological, social, or spiritual nature that
interferes with the ability to cope (e.g. cancer treatment). It extends along a continuum, from
common normal feelings of vulnerability, sadness, and fears, to problems that are disabling,
such as true depression, anxiety, panic, and feeling isolated or in a spiritual crisis.
A range of symptoms and experiences of a person’s internal life that are commonly held to
be troubling, confusing, or out of the ordinary.
Distress
People might describe distress as feeling: sad, fearful,
angry, helpless, hopeless, out of control, unsure of their
faith, purpose, or meaning in life, concerned about illness,
concerned about home or social role, depressed, anxious
or panicked
When is distress more serious?
When it has an impact on functioning, on all parts of life.
Signs and symptoms of more serious distress
- Feeling overwhelmed to the point of panic
- Being overcome by a sense of dread
- Feeling so sad that you can’t go through treatment
- Being unusually irritable or angry
- Feeling unable to cope with pain, tiredness, and nausea
- Poor concentration, “fuzzy thinking”, and sudden memory problems
- Thinking about death all the time
- Having trouble sleeping
- Having trouble eating for a few weeks
- Questioning faith and beliefs that gave you comfort
- Feeling worthless, useless, and like a burden to others
,Depression and anxiety
- Distinction between symptom and disorder
- Screening vs diagnosis
Grief
- Grief consist of all physical, emotional, cognitive, spiritual and behavioural reactions that
occur after the loss of a person with whom one had a meaningful relation.
- Grief is normal, not a disease, so strange to talk of symptoms of grief
Grief is a process with tasks of grief
- Acknowledging/accepting the reality of the loss. Confrontation with reality helps:
being there when person dies, saying farewell to deceased person, talking about it
- Experiencing the pain of the loss. There is no way around it and can express itself in
physical pain or complaints, crying, or aggression
- Adjusting to life without the deceased person; e.g. finding a new daily routine, finding
replacement for certain tasks the deceased person had, gradually going from idealising
the deceased person
- Catching up on daily life
Complicated grief
Very severe problems/ very long duration
- Chronic grief; ‘symptoms’ do not get less over time
- Denied grief; lengthy denial of emotions
- Somatised grief; no clear grief but many physical complaints
- Delayed grief; e.g. due to first caring for others or due to traumatizing circumstances
around death
Psychological distress among health care professionals
“Om hoogwaardige palliatieve zorg te geven, dienen zorgverleners zich bewust te zijn van de
emotionele impact die het geven van palliatieve zorg op henzelf kan hebben. Zij dienen te
reflecteren op hun eigen handelen en oog te hebben voor hun persoonlijke balans. Zij
dragen daarin de zorg voor zichzelf en voor hun collega’s. (kwaliteitskader palliatieve zorg)
What is psychological care?
- Psychological care is concerned with the psychological well-being of the patient and
their family and the provision of general emotional care and support
- Psychological care is concerned with enabling the individual to express thoughts, feelings
and concerns relating to illness, assessing individual needs and resources for coping,
and ensuring that appropriate psychological support is available.
Interventions in psychological care
A range of informal and planned interventions, e.g.
- Communication skills to elicit concerns and to provide supportive care
- Counselling to facilitate reflection upon the illness experience
Psychological care and support should be available at all times. Good psychological care is
everybody’s right and the responsibility of all caregivers
Examples of psychological interventions
- Cognitive techniques in conversations:
• Normalization; ‘that is (a normal) part of’
, • Positive acknowledgement; ‘strong of you, that you do that’
• Adjusting norms and values; ‘maybe you used to be good in sports, but now your
good in another area’
- Cognitive behavioural therapy, e.g. by gradually actively looking for the painful situations
- Experience based psychotherapy, following the experiences of person and reflecting on
them
- Family therapy
Who provides psychological care?
All health-care professionals need to:
- Be able to recognize psychological distress
- Be willing to explicitly assess patients’ psychological concerns
- Basic skills in offering psychological support can fall within the remit of many health-care
professionals
- Assess when to call in help of a more specialized
• Seriousness of problems; ‘normal’ reaction to situation or disorder
• Coping capacity of patient /family
• Limitations of own skills / knowledge
• Time
Who to refer to?
Psychologist/ social worker/ spiritual counsellor? Choice based on:
- In which domain are the most concerns?
- Therapy needed: psychologist
- Patient’s preference
- Availability
, Week 9
Lecture 9.1 + 9.2: Physiology of pain
Definition of pain
‘Pain is an unpleasant sensory and emotional experience associated with or, resembling that
associated with, actual or potential tissue damage”
- Het is emotioneel, het is een ervaring, kan gepaard gaan met
weefselbeschadiging
- NRS = pijnscore (0-10)
- 0 is geen pijn en 10 de ergste pijn die je je maar kan voorstellen
- Deze getallen zeggen eigenlijk niet echt iets, het is heel
subjectief
- Scoringsmaterialen zijn alleen maar gemaakt om iets te zeggen
over of behandelingen hebben geholpen of niet
- Belangrijk om te vragen of iemand uberhoupt pijn heeft en of je
er iets mee moet doen, hoeft niet altijd
Defenition of pain
“Pain, is when a patient tells you he/she’s in pain. PERIOD”
• Acute pain
o “(…) happens suddenly, starts out sharp or intense, and serves as a warning
sign of disease or threat to the body. It is caused by injury, surgery, illness,
trauma, or painful medical procedures and generally last from a few minutes less
than 6 months. Acute pain usually disappears whenever the underlying cause is
treated or healed.”
➔ Je hebt een problem, je hebt een oorzaak, je behandelt die oorzaak en dan is de pijn
weg
• Chronic pain
o “Chronic primary pain is chronic pain in one or more anatomical regions that
persists or recurs for more than 3 months, and that is characterized by significant
emotional distress (anxiety anger/frustration or depressed mood) or functional
disability (interference in daily life activities and reduced participation in social
roles). Chronic primary pain is multifactional: biological, psychological and social
factors contribute to the pain syndrome. The diagnosis is appropriate
independently of identified biological or psychological contributors.”
➔ Hierbij is het veel minder duidelijk waar de pijn vandaan komt
➔ Het is multifactorieel, het is dus heel moeilijk te zeggen van: hier komt het door
Defenition of pain
- Nociceptive pain
- Neuropathic pain
- Nociplastic pain
- Psychological pain
Nociceptive pain
“Pain that arises from actual or threatened damage to non-neural tissue and is due to the
activation of nociceptors”
- Er is echt iets mechanisch aan de hand
- De nociceptoren geven pijn door → die zitten een mechanische prikkel om in een
elektrische prikkel die in de hersenen als pijn wordt waargenomen
