Studies

Pijn in het algemeen

Schumacher & Brähler (1999): Numerous national and international epidemiological studies concerning the occurrence and distribution of chronic pain disorders have demonstrated that pain is one of the most frequent health problems affecting society.

Gerbershagen et al (2009): 367 van de 438 (84%) van de in het ziekenhuis opgenomen patienten hadden pijn. De meest voorkomende locatie van de pijn was de rug (27%). Pijn was bij 278 (64%) van de patienten de voornaamste reden voor ziekenhuis opname. Intensiteit van pijn: 27% had matige pijn (NRS 5 en 6) en 33% ernstige pijn (NRS ≥ 7).
The results of this study indicate that in most medical disciplines pain is more than merely a symptom of disease. In many instances pain should be considered a serious comorbidity that can influence the outcome of medical and surgical treatment. Recent research has shown that prevention of the pain chronification process is the most promising strategy for avoiding the development of intractable pain. Acceptance, recognition, and assessment of pain as a risk factor at an early stage are essential factors. A first step might involve routine screening for pain on admission to any hospital facility, and subsequently evaluating the impact of pain on biopsychosocial functions.


Pijn bij longziekten

27% van de COPD patienten heeft ‘some problem’ met pijn en 6% heeft ‘extreme problem’, ingevuld op de EQ-5D. COPD patienten hebben vaak ook andere ziekten als Diabetes Mellitus, Osteoporose, CVA etc (Lee 2016). 54-61% van de patienten met COPD geeft pijn aan (Pantilat 2012, Christensen 2016). Lower stages of COPD were associated with higher worst pain and higher pain interference scores. Higher depression scores were associated with higher average pain and higher pain interference scores. In addition, higher number of pain locations was associated with higher average and higher worst pain severity scores. Findings from this study confirm that pain is a significant problem and highlights the need for specific pain management interventions for patients with COPD. More research is needed about specific pain characteristics and symptoms to gain an increased knowledge about the causes of pain in these patients (Christensen 2016).

Longkanker is de belangrijkste oorzaak van sterven aan kanker wereldwijd. De 5-jaars overleving is slechts 15% (Polanski 2016). 90% van de patienten rapporteert pijn (Iyer 2013).
53% van de patienten met longkanker rapporteren pijn in de borst en arm/schouder en deze pijn verergert na 6 en 12 maanden (Langendijk 2001).


Pijn bij neurologie patiënten

Gerbershagen et al. (2008): 320 van de 400 (80%) opgenomen neurologie patienten hebben pijn. Intensiteit van pijn: 27% had ernstige pijn (NRS ≥7) en 26% matige pijn (NRS 5 en 6). Reden van opname: cerebraal infarct of embolisatie cerebrale arterie (12%), epilepsie (6%), rugklachten (6%) en Parkinson (5%).

Williams et al. (2003): 320 van de 483 (66%) opgenomen neurologie patienten hebben pijn. De meest voorkomende diagnoses: neuropathie of neuromusculaire ziekten (23%) en hoofdpijn (21%).

Wurm et al. (2015): 89% van de 63 neurologische patienten geeft pijn aan tijdens opname.
Conclusion: Pain is an important problem for neurological inpatients. Nocturnal pain, pain induced by mobilisation, and pain therapy for patients with degenerative diseases of the spine without radiculopathy require particular attention.

The prevalence of chronic post-stroke pain ranges from 32-42% at four to six months and 11-21% at twelve to sixteen months after a stroke (Appelros 2006, Jönsson 2006, Kong 2004) .
Stroke patients can suffer pain from a variety of sources. These include central post-stroke
pain, headaches, shoulder pain from subluxation, and muscle contractures. Post-stroke patients may also experience hypertonia and spasticity as well as contractures of the muscles and joints,
these can all cause pain. As well as stroke specific pains, patients may have painful co-morbidities such as diabetic neuropathy, arthritis, and osteoporosis.

The prevalence of pain in Multiple Sclerosis patients ranges from 44% to 82% (27% had severe pain). Moreover, pain is a frequent and disabling problem in clinical practice (Archibald 1994, Ehde 2003, Osterberg 2005, Svendsen 2003).

Headache disorders are among the most common disorders of the nervous system and impose significant suffering, disability, and financial cost on patients. Prevalence rates of active
headache disorders among adults worldwide are 11 % for migraine, 42% for tension-type headache, and 3% for chronic daily headache, and headaches are considered among the top
ten disabling conditions for men and women (Stovner 2007).

A Practice Point commentary discusses the findings and limitations of a cross-sectional survey by Nègre-Pagès et al. that investigated the prevalence of pain in a large number of patients with Parkinson disease (PD). The authors used a validated definition of chronic pain and included an age-matched and sex-matched control group. The study showed that chronic pain is a frequent but underreported symptom in PD, suggesting that awareness of this problem should be increased. This commentary highlights the issues to consider when interpreting these results, including the use of self-reported questionnaires and the classification of PD-associated pain. Overall, the findings indicate that interventions in patients with PD should go beyond the treatment of motor symptoms only and also target nonmotor symptoms; in particular, the treatment of pain needs to be improved (Ludwig 2008).

Op de website van de Nederlandse Vereniging van Neurologie staan veel patiënteninformatie folders. In veel folders wordt gesproken over pijn.



Referenties


Appelros P. Prevalence and predictors of pain and fatigue after stroke: a population-based study. Int J Rehabil Res 2006; 29(4): 329-33.

Archibald CJ, McGrath PJ, Ritvo PG, Fisk JD, Bhan V, Maxner CE, et al. Pain prevalence, severity and impact in a clinic sample of multiple sclerosis patients. Pain 1994;58:89–93.

Christensen VL, Holm AM, Kongerud J, Bentsen SB, Paul SM, Miaskowski C, Rustøen T. Occurrence, characteristics, and predictors of pain in patients with chronic obstructive pulmonary disease. Pain Manag Nurs. 2016;17(2):107-18.

Ehde DM, Gibbons LE, Chwastiak L, Bombardier CH, Sullivan MD, Kraft GH. Chronic pain in a large community sample of persons with multiple sclerosis. Mult Scler 2003;9:605–611.

Gerbershagen K1, Gerbershagen HU, Lindena GU, Lachenmayer L, Lefering R, Schmidt CO, Kohlmann T. Prevalence and impact of pain in neurological inpatients of a German teaching hospital.Clin Neurol Neurosurg 2008;110(7):710-7.

Gerbershagen K1, Gerbershagen HJ, Lutz J, Cooper-Mahkorn D, Wappler F, Limmroth V, Gerbershagen M. Pain prevalence and risk distribution among inpatients in a German teaching hospital. Clin J Pain 2009;25:431–437.

Iyer S, Taylor-Stokes G, Roughley A. Symptom burden and quality of life in advanced non-small cell lung cancer patients in France and Germany. Lung Cancer 2013;81(2):288–293.

Jönsson AC, Lindgren I, Hallström B, Norrving B, and Lindgren A. Prevalence and intensity of pain after stroke: a population based study focusing on patients’ perspectives. J Neurol Neurosurg Psychiatry. 2006; 77(5): 590-5.

Kong KH, Woon VC, and Yang SY. Prevalence of chronic pain and its impact on health-related quality of life in stroke survivors. Arch Phys Med Rehabil 2004; 85(1): 35-40.

Langendijk JA, Aaronson NK, de Jong JM, ten Velde GP, Muller MJ, Lamers RJ, Slotman BJ, Wouters EF. Prospective study on quality of life before and after radical radiotherapy in non-small-cell lung cancer. J Clin Oncol 2001;15:2123-33.

Lee SH, Hwang ED, Lim JE, Moon S, Kang YA, Jung JY, Park MS, Kim SK, Chang J, Kim YS, Kim SY. The Risk Factors and Characteristics of COPD Among Nonsmokers in Korea: An Analysis of KNHANES IV and V. Lung 2016;194:353-361.

Ludwig J, Parkinson disease: do we need to improve treatment strategies that focus on nonmotor complications such as pain? Nat Clin Pract Neurol 2008; 4(9): 478-9.

Osterberg A, Boivie J, Thuomas KA. Central pain in multiple sclerosis—prevalence and clinical characteristics. Eur J Pain 2005; 9:531–542.
Pantilat SZ, O’Riordan DL, Dibble SL, Landefeld CS. Longitudinal assessment of symptom severity among hospitalized elders diagnosed with cancer, heart failure, and chronic obstructive pulmonary disease. J Hosp Med 2012;7:567-72.

Polanski J, Jankowska-Polanska B, Rosinczuk J, Chabowski M, Szymanska-Chabowska A. Quality of life of patients with lung cancer: A review. Onco Targets Ther. 2016;29;9:1023-8.

Schumacher J, Brähler E. The prevalence of pain in the German population: results of population-based studies with the Giessen Subjective Complaints List. Schmerz. 1999;13:375–384.

Stovner LJ, Hagen K, Jensen R,Katsarava Z, Lipton RB, Scher AI, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27:193–210.

Svendsen KB, Jensen TS, Overvad K, Hansen HJ, Koch- Henriksen N, Bach FW. Pain in patients with multiple sclerosis: a population-based study. Arch Neurol 2003;60:1089–1094.

Williams LS, Jones WJ, Shen J, Robinson RL, Weinberger M, Kroenke K. Prevalence and impact of depression and pain in neurology outpatients. J Neurol Neurosurg Psychiatry 2003;74:1587–1589.

Wurm WE, LechnerA, Schmidt R, Szilagvi IS, Maier C, Nestler N, Pichler B, Foussek C, Bornemann-Cimenti H, Sandner-Kiesling A. Optimising pain therapy for neurological inpatients. Fortschr Neurol Psychiatr 2015;83(3):149-156.

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