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Samenvatting "Pijn" - Anesthesie & pijn $12.07   Add to cart
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Samenvatting "Pijn" - Anesthesie & pijn
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  • Course
  • Anesthesie en pijn
  • Institution
  • Universiteit Antwerpen (UA)

Samenvatting van "Pijn" als onderdeel van het vak 'Anesthesie & Pijn' gegeven door prof. Hans G. in de 2e Bachelor Geneeskunde aan de UA. Samenvatting gebaseerd op slides én lesnotities.

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Document information

  • August 31, 2024
  • 61
  • 2023/2024
  • Summary

Subjects

  • chronische pijn
  • chronisch pijnsyndroom
  • nsaid
  • pijnladder
  • opioiden
  • analgetica
  • fantoompijn
  • tart principe

Written for

  • Universiteit Antwerpen (UA)
  • Geneeskunde
  • Anesthesie en pijn
All documents for this subject (19)

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Inhoudsopgave
Pathofysiologie van acute & chronische pijn..............................................................................................4
Leerdoelen........................................................................................................................................... 4
Normale fysiologie van pijn (4 stappen)............................................................................................... 4
Stimulus................................................................................................................................................5
Nociceptoren........................................................................................................................................ 5
Thermoreceptoren.................................................................................................................... 5
Zenuwvezels: dubbel afferent systeem.................................................................................... 5
Modulatie..............................................................................................................................................6
Primaire perifere sensitisatie.................................................................................................... 7
Secundaire centrale sensitisatie...............................................................................................7
Ascenderende banen........................................................................................................................... 9
Perceptie............................................................................................................................................ 10
Descenderende banen....................................................................................................................... 10
Acute vs. chronische pijn............................................................................................................................11
Leerdoelen..........................................................................................................................................11
Acute vs. chronische pijn.................................................................................................................... 11
Van acute naar chronische pijncondities.................................................................................11
Van chronische pijnklachten naar chronisch pijnsyndroom (CPS)..........................................11
Chronische pijn................................................................................................................................... 11
Chronische pijn (CP) vs. chronische pijnsyndroom (CPS)..................................................... 12
Chronisch pijnsyndroom......................................................................................................... 12
Risicofactoren op chronificatie................................................................................................13
Behandeling............................................................................................................................13
Diabetes vs. alle andere neuropathieën.............................................................................................15
Farmacotherapie van pijn............................................................................................................................16
Leerdoelen......................................................................................................................................... 16
Therapeutische aanpak......................................................................................................................16
Lokale anesthetica..................................................................................................................16
NSAID.....................................................................................................................................17
Mechanism-based treatment..............................................................................................................17
WHO-trapladder / pijnlift......................................................................................................... 17
Trap 1: niet-opioïde analgetica............................................................................................... 18
Trap 2: zwakke opioïden.........................................................................................................19
Trap 3: sterke opioïden...........................................................................................................19
Adjuvantia...............................................................................................................................20
Autonome dysregulatie...........................................................................................................21
Interventionele technieken bij kankerpijn..................................................................................................22
Algemeen beleid bij kankerpijn...........................................................................................................22
Overwegingen bij terminaal zieke oncologische patiënten.....................................................22
1. Medicatie........................................................................................................................................ 22
Spinale medicatiesystemen....................................................................................................23
Medicatiebeleid.......................................................................................................................23
Epiduraal vs. intrathecaal....................................................................................................... 23
Verlengde pijntherapie............................................................................................................24
Gebruikte medicatie................................................................................................................24
1

, Behandeling: refractaire hoofd- en nek-kankerpijn.................................................................25
2. Zenuwonderbreking........................................................................................................................25
Technieken: neurolytische blocks........................................................................................... 25
Onderbreking van perifere zenuwen (PZS)............................................................................ 26
Onderbreking thv het ruggenmerg (CZS)............................................................................... 27
Onderbreking thv het sympathisch zenuwstelsel (SZS)......................................................... 28
Invasieve technieken..........................................................................................................................30
3. Neurochirurgische technieken........................................................................................................30
Fantoompijn..................................................................................................................................................31
Fantoompijn........................................................................................................................................31
Klinische karakteristieken....................................................................................................... 31
Differentiaaldiagnose.............................................................................................................. 31
Functionele MRI..................................................................................................................... 32
Classificaties van fantoompijn................................................................................................ 32
Risicofactoren voor fantoompijn............................................................................................. 32
Behandeling............................................................................................................................33
Preventie................................................................................................................................ 34
Neurotoxische aspecten van opioïden...................................................................................................... 35
Effecten op het centraal zenuwstelsel................................................................................................ 35
Verminderde cognitieve functie.............................................................................................. 35
Delirium.................................................................................................................................. 36
Hallucinaties........................................................................................................................... 36
Directe toxische effecten op neuronen................................................................................... 37
Morfine neurotoxiciteit............................................................................................................ 39
Effecten op het autonoom zenuwstelsel.............................................................................................39
Behandeling van opioïd-neurotoxiciteit.............................................................................................. 39
1. Syndroom herkennen......................................................................................................... 40
2. Opioïden............................................................................................................................. 40
3. Rehydratatie....................................................................................................................... 41
4. Psychofarmaca...................................................................................................................41
5. Andere medicatie................................................................................................................42
6. Andere behandelingsopties................................................................................................ 42
Metabolisatie.......................................................................................................................... 42
Psychotherapeutische aanpak van pijn.....................................................................................................43
Biopsychosociaal model.....................................................................................................................43
Belang van psychosociale gegevens..................................................................................... 43
Behandeling van psychosociale factoren............................................................................... 44
Pijnverwerkingsproces............................................................................................................45
Psychologische interventies................................................................................................... 45
Diagnostiek in chronische pijn................................................................................................................... 47
1. Anamnese...................................................................................................................................... 47
Provoking / palliating factors...................................................................................................47
Quality.................................................................................................................................... 47
Radiculair................................................................................................................................47
Severity...................................................................................................................................47
Time........................................................................................................................................48
Hulpmiddelen..........................................................................................................................48
Rode vlaggen......................................................................................................................... 49
2

, Gele vlaggen.......................................................................................................................... 49
Effect van pijn......................................................................................................................... 50
Tips......................................................................................................................................... 50
2. Klinisch onderzoek......................................................................................................................... 50
TART-principe......................................................................................................................... 50
3. Bijkomende onderzoeken...............................................................................................................50
Bloedname............................................................................................................................. 51
Beeldvorming..........................................................................................................................51
Elektrofysiologisch onderzoek (NCV)..................................................................................... 51
Zebris......................................................................................................................................51
Lower back pain (LBP)....................................................................................................................... 52
Lumbo-sacraal radiculair syndroom (LRS)............................................................................. 52
Facetpijn................................................................................................................................. 53
Sacro-iliacale pijn (SI).............................................................................................................54
Discogene lower back pain.....................................................................................................54
Verschillende soorten pijntypes................................................................................................................. 56
Leerdoelen......................................................................................................................................... 56
Verschillende soorten pijn.................................................................................................................. 56
Nociceptieve pijn................................................................................................................................ 56
Somatische pijn...................................................................................................................... 56
Viscerale pijn.......................................................................................................................... 57
Neuropathische pijn............................................................................................................................58
Subgroepen............................................................................................................................ 59
Symptomen en klinische kenmerken......................................................................................60
Behandeling............................................................................................................................60
Gemengde pijnsyndromen................................................................................................................. 61
Neuroplastische pijn........................................................................................................................... 61

leerdoelen




3

, Pathofysiologie van acute & chronische pijn
Leerdoelen
● uit welke (4) elementen bestaat de normale fysiologie van pijntransductie
● pathofysiologisch proces in de periferie
○ “chemical soup”
○ Triple response of Lewis: wat en wanneer?
● dorsale hoorn (ruggenmerg): functie in de pijngeleiding
○ Welke farmaca werken in ter hoogte van de dorsale hoorn?
● descenderende inhiberende banen: welke farmaca?
● definitie (en verschil) van verschillende sensoriële afwijkingen
○ hyperalgesie (primair en secundair), allodynie, hyperpathie


Normale fysiologie van pijn (4 stappen)
1. transductie: het ontstaan van pijnsignaal door prikkeling van vrije zenuwuiteinden thv perifere
pijnreceptoren (nociceptoren)
● nociceptoren = hoogdrempelige receptoren
○ stimulus moet van hoge intensiteit zijn, voordat nociceptoren geactiveerd worden en
actiepotentialen uitsturen
● nociceptieve stimuli
○ fysische factoren: druk, rek, warmte, koude
○ chemische factoren: ontstekingsmediatoren (bv. prostaglandines, histamine, bradykinine,
serotonine, cytokines) = chemical soup

⇒ proces van pijn is onafhankelijk van het type stimulus dat de pijn veroorzaakt

2. transmissie: de voortgeleiding van de actiepotentiaal via geactiveerde zenuwvezels
● van periferie naar dorsale hoorn
● van dorsale hoorn naar cortex (ascenderende banen)

3. modulatie: veranderingen in de reactie op het pijnsignaal
● snelle aanpassingen van het lichaam om pijnsignaal te onderdrukken/verhogen
○ meestal uitvergroten: verdedigingsmechanisme, waarschuwing
● op elk niveau !

4. perceptie: sensatie van pijn wanneer signaal aankomt ter hoogte van cortex
● integratie en proprioceptie → pijngewaarwording




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