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Gepubliceerd in:

2016 | OriginalPaper | Hoofdstuk

5. Behandeling van centrale sensitisatiepijn: bottom-up, top-down behandeling of beide?

Auteur : Jo Nijs

Gepubliceerd in: Centrale sensitisatiepijn in de klinische praktijk

Uitgeverij: Bohn Stafleu van Loghum

Samenvatting

Centrale sensitisatie is vastgesteld bij tal van chronische pijnproblemen, zoals whiplash, temporomandibulaire aandoeningen, chronische lage rugpijn, artrose, fibromyalgie, hoofdpijn, tenniselleboog, schouder impingementsyndroom en pijn na kanker. Ondanks dat we steeds meer begrijpen van het mechanisme van centrale sensitisatiepijn, blijft de behandeling een hele uitdaging.

Dit hoofdstuk biedt de clinicus een ‘state of the art’ overzicht van de behandelmogelijkheden voor centrale sensitisatiepijn. Deze omvatten bottom-up strategieën om eventueel perifere pijnbronnen te behandelen (bijv. myofasciale therapie of het plaatsen van een gewrichtsprothese), maar vooral top-down behandelmethoden, waarmee de hypersensitiviteit van het centraal zenuwstelsel direct of indirect wordt behandeld. De wetenschappelijke bewijsvoering voor geïsoleerde behandeleffecten van interventies, zoals pijneducatie, (cognitief-gedragsmatige) oefentherapie en stressmanagement als ‘desensitiserende’ therapie, groeit gestaag.

Actuele inzichten suggereren dat een gecombineerde top-down en bottom-up behandelstrategie aangewezen is, ook al staat de wetenschappelijke evidentie op dat vlak nog in de kinderschoenen.

vorige hoofdstuk Klinisch redeneren bij pijnpatiënten: van diagnostiek tot behandeling aan de hand van een casus

Voor een discussie met internationale experts over het al dan niet bestaan van myofasciale triggerpunten, zie http://www.paininmotion.be/nieuws-2015-myofascial-trigger-points.html.

Deze lijst is vrij verkrijgbaar via http://www.paininmotion.be/DePijnNeurofysiologie-Test.pdf.

De Christelijke Mutualiteit stelt op haar website een kwalitatief goed slaapwerkboek beschikbaar. Dit is vrij verkrijgbaar via: http://www.cm.be/binaries/Doe-boek-slaap_tcm375-113136.pdf.

Bijvoorbeeld de stressbundel in het handboek van Kos D, Nijs J, Meeus M, Salhi B. Chronische vermoeidheid: een praktische handleiding voor de revalidatie van kanker, MS, fibromyalgie en CVS. Leuven/Den Haag: Acco uitgeverij; 2013:223–40.

Nieuwe vormen van elektrotherapie maken gebruik van stroomvormen die men op non-invasieve wijze toepast op het brein. De bekendste methoden zijn: repetitieve transcraniële magnetische stimulatie en transcraniële direct current hersenstimulatie. De eerste methode maakt gebruik van een magnetisch veld om hersenactiviteit te moduleren, terwijl de direct current methode gebruikmaakt van een anode en kathode. Beide methoden worden al langer toegepast in de behandeling van depressie, en kennen ook als diagnosticum in de neurologie en neurochirurgie hun waarde. Met betrekking tot pijnbehandeling duiden meta-analyses op kleine kortetermijneffecten, vooral bij de toepassing van repetitieve transcraniële magnetische stimulatie.

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Titel: Behandeling van centrale sensitisatiepijn: bottom-up, top-down behandeling of beide?
Auteur: Jo Nijs
Uitgeverij: Bohn Stafleu van Loghum
Boek: Centrale sensitisatiepijn in de klinische praktijk
Print ISBN: 978-90-368-0924-5

Elektronisch ISBN: 978-90-368-0925-2

Copyright: 2016
DOI: https://doi.org/10.1007/978-90-368-0925-2_5

Bohn Stafleu van Loghum

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