2022-
2023
Pijnmanagement
GABRIËLLE VAN EEKERT
,Inhoudsopgave
Les 1: Neurofysiologie van chronische pijn - M.Meeus ..................................................................................... 4
Les 2: Assessment Chronic Pain- L. Dams........................................................................................................ 20
- Woon- of leefsituatie ............................................................................................................................ 34
- Sociale omgeving; ................................................................................................................................. 34
- Werk; .................................................................................................................................................... 34
- Relatie met de partner: sociale steun aangewezen? ............................................................................. 34
- En eerdere/andere behandelingen: attitudes en overtuigingen eerdere zorgverleners? ....................... 34
Les 3: Neuropathic pain - L. Dams................................................................................................................... 37
Pathofysiologie van neuropathische pijn.......................................................................................................... 37
Assessment of neuropathic pain....................................................................................................................... 44
Assessment of neuropathic pain: clinical examination..................................................................................... 46
Assessment of neuropathic pain: diagnostic tests ........................................................................................... 49
Assessment of neuropathic pain: questionnaires ............................................................................................. 50
Assessment of the neurological system ............................................................................................................ 53
Treatment of neuropathic pain ........................................................................................................................ 54
Neuropathic pain syndromes............................................................................................................................ 59
Les 4: Biopsychosociale benadering van chronische pijn: communicatie – A. Heyrman .................................. 70
PSCEBSM, pijnmechanisme in de praktijk … ..................................................................................................... 72
Somatisch symptoomstoornis .......................................................................................................................... 74
Communicatievaardigheden ............................................................................................................................ 77
Verdiepende gespreksvaardigheden ................................................................................................................ 79
Reflectief luisteren ...................................................................................................................................... 79
Les 5: Theoretisch kader behandeling nociplastische pijn - M. Meeus ............................................................ 81
Stress & sleep management: ............................................................................................................................ 96
Medische benadering – E. Brzezinska ............................................................................................................. 97
Nociceptieve pijn: ............................................................................................................................................. 98
Neuropathische pijn ....................................................................................................................................... 104
Invasieve technieken: ..................................................................................................................................... 109
Facetinfiltraties............................................................................................................................................... 109
Epidurale infiltraties ....................................................................................................................................... 110
Zenuwinfiltraties ............................................................................................................................................. 111
Stroombehandelingen: Radiofrequente facetbehandeling ............................................................................ 112
Neurostimulatie .............................................................................................................................................. 113
Invasieve behandelingen praktisch ................................................................................................................ 114
, Multidisciplinair traject: ................................................................................................................................. 117
Act to move (ATM) revalidatie programma: .................................................................................................. 117
TENS: transcutane elektrische neurostimulatie .............................................................................................. 118
The athlete’s pain – K. Kuppens ................................................................................................................... 122
Casuïstiek artrose & pijn – S. Vervullens ...................................................................................................... 134
Artrosepijn: enkel gewrichtspijn? ................................................................................................................... 134
Klinische classificatie van pijn bij artrose ....................................................................................................... 139
Behandeling van pijn bij artrose ..................................................................................................................... 142
Casus Julia .................................................................................................................................................. 146
Voorbeeld van therapeut die percepties over oefeningen met patiënt bespreekt voordat ‘bedreigende’
oefening wordt uitgevoerd ........................................................................................................................ 151
Voorbeeld van therapeut die percepties over oefeningen met patiënt bespreekt na uitvoering ‘bedreigde’
oefening ..................................................................................................................................................... 152
Samengevat .................................................................................................................................................... 153
Pijnmanagement bij kinderen – E. Rheel ...................................................................................................... 154
Pediatrische sub-populaties ........................................................................................................................... 154
Prevalentie en distributie................................................................................................................................ 154
Biologische basis............................................................................................................................................. 155
Sociale en psychosociale basis ........................................................................................................................ 158
Cognitieve processen die bijdragen tot chronische pijn – fear avoidance model ........................................... 159
Casus Molly..................................................................................................................................................... 160
Lange-termijn effecten van pijn bij kinderen .................................................................................................. 161
Pain assessment ............................................................................................................................................. 161
Behandelimplicaties kind met chronische pijn................................................................................................ 163
Kinesitherapie ................................................................................................................................................. 163
Pain science education (PSE) for children ....................................................................................................... 164
Casus .............................................................................................................................................................. 166
Motivational interviewing (MI) in de kinesitherapie .................................................................................... 167
Inleiding .......................................................................................................................................................... 167
Waarom motiverende gespreksvoering? ....................................................................................................... 167
Ambivalentie .................................................................................................................................................. 168
Communicatievaardigheden .......................................................................................................................... 168
Open vragen .............................................................................................................................................. 168
Reflectief luisteren .................................................................................................................................... 168
Bevestigen ................................................................................................................................................. 169
Samenvatten.............................................................................................................................................. 170
Toestemming en timing ............................................................................................................................. 170
Info en advies ............................................................................................................................................ 170
Timing van motiverende gespreksvoering ...................................................................................................... 170
Behoud- versus verandertaal .......................................................................................................................... 171
Omgaan met wrijving ..................................................................................................................................... 172
, Hoe kom ik tot een actieplan? ........................................................................................................................ 172
Doelen ....................................................................................................................................................... 172
Strategie .................................................................................................................................................... 173
Samen een plan opstellen............................................................................................................................... 173
Hindernissen .............................................................................................................................................. 173
Pain Neuroscience Education - L. Dams en S. Vervullens .............................................................................. 174
Rationale PSE.................................................................................................................................................. 174
Target concepts ......................................................................................................................................... 175
Pijneducatie ............................................................................................................................................... 175
PSE in de praktijk ............................................................................................................................................ 176
Informatieverstrekking ................................................................................................................................... 177
Oefening uitleg acuut & chronisch ................................................................................................................. 179
… ..................................................................................................................................................................... 179
Oefening neurofysiologie van de pijn! Maak hierbij gebruik van verschillende metaforen ........................... 179
Afronding ........................................................................................................................................................ 179
ACT kennisclip – A. Heyrman ........................................................................................................................ 180
Biopsychosociale benadering van chronische pijn .......................................................................................... 180
Biopsychosociale kinesitherapeutische pijnanalyse en -behandeling............................................................. 180
Acceptance and Commitment Therapy (ACT) ................................................................................................. 181
Acceptatie (vs experiëntele vermijding) ......................................................................................................... 183
Cognitieve defusie (vs cognitieve fusie) .......................................................................................................... 184
Contact met hier en nu (het geconceptualiseerde verleden en de geconceptualiseerde toekomst ............... 185
Zelf als context (vs zelf als concept) ............................................................................................................... 185
Body awareness interventies .......................................................................................................................... 186
Waarden ......................................................................................................................................................... 187
Toegewijd handelen ....................................................................................................................................... 187
Acceptance and commitment therapy (ACT) – E. Boven en V. Haenen ......................................................... 190
Acceptatie....................................................................................................................................................... 192
Waarden ......................................................................................................................................................... 193
Toegewijde actie............................................................................................................................................. 195
Hier en nu ....................................................................................................................................................... 197
Defusie ............................................................................................................................................................ 197
Zelf als context................................................................................................................................................ 198
2023
Pijnmanagement
GABRIËLLE VAN EEKERT
,Inhoudsopgave
Les 1: Neurofysiologie van chronische pijn - M.Meeus ..................................................................................... 4
Les 2: Assessment Chronic Pain- L. Dams........................................................................................................ 20
- Woon- of leefsituatie ............................................................................................................................ 34
- Sociale omgeving; ................................................................................................................................. 34
- Werk; .................................................................................................................................................... 34
- Relatie met de partner: sociale steun aangewezen? ............................................................................. 34
- En eerdere/andere behandelingen: attitudes en overtuigingen eerdere zorgverleners? ....................... 34
Les 3: Neuropathic pain - L. Dams................................................................................................................... 37
Pathofysiologie van neuropathische pijn.......................................................................................................... 37
Assessment of neuropathic pain....................................................................................................................... 44
Assessment of neuropathic pain: clinical examination..................................................................................... 46
Assessment of neuropathic pain: diagnostic tests ........................................................................................... 49
Assessment of neuropathic pain: questionnaires ............................................................................................. 50
Assessment of the neurological system ............................................................................................................ 53
Treatment of neuropathic pain ........................................................................................................................ 54
Neuropathic pain syndromes............................................................................................................................ 59
Les 4: Biopsychosociale benadering van chronische pijn: communicatie – A. Heyrman .................................. 70
PSCEBSM, pijnmechanisme in de praktijk … ..................................................................................................... 72
Somatisch symptoomstoornis .......................................................................................................................... 74
Communicatievaardigheden ............................................................................................................................ 77
Verdiepende gespreksvaardigheden ................................................................................................................ 79
Reflectief luisteren ...................................................................................................................................... 79
Les 5: Theoretisch kader behandeling nociplastische pijn - M. Meeus ............................................................ 81
Stress & sleep management: ............................................................................................................................ 96
Medische benadering – E. Brzezinska ............................................................................................................. 97
Nociceptieve pijn: ............................................................................................................................................. 98
Neuropathische pijn ....................................................................................................................................... 104
Invasieve technieken: ..................................................................................................................................... 109
Facetinfiltraties............................................................................................................................................... 109
Epidurale infiltraties ....................................................................................................................................... 110
Zenuwinfiltraties ............................................................................................................................................. 111
Stroombehandelingen: Radiofrequente facetbehandeling ............................................................................ 112
Neurostimulatie .............................................................................................................................................. 113
Invasieve behandelingen praktisch ................................................................................................................ 114
, Multidisciplinair traject: ................................................................................................................................. 117
Act to move (ATM) revalidatie programma: .................................................................................................. 117
TENS: transcutane elektrische neurostimulatie .............................................................................................. 118
The athlete’s pain – K. Kuppens ................................................................................................................... 122
Casuïstiek artrose & pijn – S. Vervullens ...................................................................................................... 134
Artrosepijn: enkel gewrichtspijn? ................................................................................................................... 134
Klinische classificatie van pijn bij artrose ....................................................................................................... 139
Behandeling van pijn bij artrose ..................................................................................................................... 142
Casus Julia .................................................................................................................................................. 146
Voorbeeld van therapeut die percepties over oefeningen met patiënt bespreekt voordat ‘bedreigende’
oefening wordt uitgevoerd ........................................................................................................................ 151
Voorbeeld van therapeut die percepties over oefeningen met patiënt bespreekt na uitvoering ‘bedreigde’
oefening ..................................................................................................................................................... 152
Samengevat .................................................................................................................................................... 153
Pijnmanagement bij kinderen – E. Rheel ...................................................................................................... 154
Pediatrische sub-populaties ........................................................................................................................... 154
Prevalentie en distributie................................................................................................................................ 154
Biologische basis............................................................................................................................................. 155
Sociale en psychosociale basis ........................................................................................................................ 158
Cognitieve processen die bijdragen tot chronische pijn – fear avoidance model ........................................... 159
Casus Molly..................................................................................................................................................... 160
Lange-termijn effecten van pijn bij kinderen .................................................................................................. 161
Pain assessment ............................................................................................................................................. 161
Behandelimplicaties kind met chronische pijn................................................................................................ 163
Kinesitherapie ................................................................................................................................................. 163
Pain science education (PSE) for children ....................................................................................................... 164
Casus .............................................................................................................................................................. 166
Motivational interviewing (MI) in de kinesitherapie .................................................................................... 167
Inleiding .......................................................................................................................................................... 167
Waarom motiverende gespreksvoering? ....................................................................................................... 167
Ambivalentie .................................................................................................................................................. 168
Communicatievaardigheden .......................................................................................................................... 168
Open vragen .............................................................................................................................................. 168
Reflectief luisteren .................................................................................................................................... 168
Bevestigen ................................................................................................................................................. 169
Samenvatten.............................................................................................................................................. 170
Toestemming en timing ............................................................................................................................. 170
Info en advies ............................................................................................................................................ 170
Timing van motiverende gespreksvoering ...................................................................................................... 170
Behoud- versus verandertaal .......................................................................................................................... 171
Omgaan met wrijving ..................................................................................................................................... 172
, Hoe kom ik tot een actieplan? ........................................................................................................................ 172
Doelen ....................................................................................................................................................... 172
Strategie .................................................................................................................................................... 173
Samen een plan opstellen............................................................................................................................... 173
Hindernissen .............................................................................................................................................. 173
Pain Neuroscience Education - L. Dams en S. Vervullens .............................................................................. 174
Rationale PSE.................................................................................................................................................. 174
Target concepts ......................................................................................................................................... 175
Pijneducatie ............................................................................................................................................... 175
PSE in de praktijk ............................................................................................................................................ 176
Informatieverstrekking ................................................................................................................................... 177
Oefening uitleg acuut & chronisch ................................................................................................................. 179
… ..................................................................................................................................................................... 179
Oefening neurofysiologie van de pijn! Maak hierbij gebruik van verschillende metaforen ........................... 179
Afronding ........................................................................................................................................................ 179
ACT kennisclip – A. Heyrman ........................................................................................................................ 180
Biopsychosociale benadering van chronische pijn .......................................................................................... 180
Biopsychosociale kinesitherapeutische pijnanalyse en -behandeling............................................................. 180
Acceptance and Commitment Therapy (ACT) ................................................................................................. 181
Acceptatie (vs experiëntele vermijding) ......................................................................................................... 183
Cognitieve defusie (vs cognitieve fusie) .......................................................................................................... 184
Contact met hier en nu (het geconceptualiseerde verleden en de geconceptualiseerde toekomst ............... 185
Zelf als context (vs zelf als concept) ............................................................................................................... 185
Body awareness interventies .......................................................................................................................... 186
Waarden ......................................................................................................................................................... 187
Toegewijd handelen ....................................................................................................................................... 187
Acceptance and commitment therapy (ACT) – E. Boven en V. Haenen ......................................................... 190
Acceptatie....................................................................................................................................................... 192
Waarden ......................................................................................................................................................... 193
Toegewijde actie............................................................................................................................................. 195
Hier en nu ....................................................................................................................................................... 197
Defusie ............................................................................................................................................................ 197
Zelf als context................................................................................................................................................ 198
