S.A.E. Postma

Neurodegenerative Properties of Chronic Pain: Cognitive Decline in Patients with Chronic Pancreatitis

Chronic pain has been associated with impaired cognitive function. We examined cognitive performance in patients with severe chronic pancreatitis pain. We explored the following factors for their contribution to observed cognitive deficits: pain duration, comorbidity (depression, sleep disturbance), use of opioids, and premorbid alcohol abuse. The cognitive profiles of 16 patients with severe pain due to chronic pancreatitis were determined using an extensive neuropsychological test battery. Data from three cognitive domains (psychomotor performance, memory, executive functions) were compared to data from healthy controls matched for age, gender and education. Multivariate multilevel analysis of the data showed decreased test scores in patients with chronic pancreatitis pain in different cognitive domains. Psychomotor performance and executive functions showed the most prominent decline. Interestingly, pain duration appeared to be the strongest predictor for observed cognitive decline. Depressive symptoms, sleep disturbance, opioid use and history of alcohol abuse provided additional explanations for the observed cognitive decline in some of the tests, but to a lesser extent than pain duration. The negative effect of pain duration on cognitive performance is compatible with the theory of neurodegenerative properties of chronic pain. Therefore, early and effective therapeutic interventions might reduce or prevent decline in cognitive performance, thereby improving outcomes and quality of life in these patients.

Ggz-vragenlijsten staan persoonsgerichte zorg in de weg

SamenvattingLucassen P, Postma S, Olde Hartman TC. Ggz-vragenlijsten staan persoonsgerichte zorg in de weg. Huisarts Wet 2017;60(3):112-4. Vragenlijsten worden in de eerstelijns geestelijke gezondheidszorg (ggz) steeds vaker gebruikt, maar hun nut is betwistbaar. De keus om een vragenlijst te gebruiken bij een patiënt met psychische klachten hangt af van de manier van werken van de huisarts (ziektegericht of persoonsgericht), van de meerwaarde bij screening, diagnostiek of uitkomstmeting, en van de mening van de patiënt. Bij een persoonsgerichte benadering passen geen vragenlijsten, omdat het dan gaat over het verhaal van de patiënt en niet over symptomen. Vragenlijsten passen in principe wel bij een ziektegerichte benadering, maar leveren ook dan onvoldoende op in de eerstelijnssetting. Patiënten staan deels welwillend tegenover vragenlijsten, maar zijn ook bang voor stigmatisering en medicalisering.De enige vragenlijst die wel geschikt is voor de diagnostiek van psychische problemen in de eerste lijn is de Vierdimensionale Klachtenlijst (4DKL), omdat deze lijst kan helpen bij de schifting tussen ongedifferentieerde stress en specifiekere psychische problemen.

Persoonsgerichte aandacht bij multimorbiditeit: Nieuw onderzoek

SamenvattingPersoonsgericht werken bij patiënten met multimorbiditeit is ontzettend belangrijk, dat weet elke huisarts, maar is ook vaak erg moeilijk. Het in kaart brengen en monitoren van het functioneren en participeren van patiënten kan hierbij helpen. Op basis van de International Classification of Functioning, Disability and Health (ICF) is een nieuw instrument ontwikkeld, de Primary Care Functioning Scale (PCFS),dat momenteel onderzocht wordt.

Feeling blue, sad, or depressed: how to manage these patients

Many patients present to primary care complaining of feeling blue, sad, or depressed. GPs generally work from a biomedical standpoint using the concept of depression, with medicalisation being the logical result. We believe that GPs are able to adopt a more person-focused approach in which they prioritise the psychosocial above the biological. Here we provide two examples of how GPs could start with this approach in a consultation with a patient who is feeling blue, sad, or depressed. An important element of the proposed approach is only applying a psychiatric diagnosis in selected patients with a high prior chance of serious psychiatric disorder. The high prescription rates for antidepressants1 suggest that GPs work from a biomedical point of view and start questioning the patient about the symptoms of depression listed in the guidelines. GPs commonly report having ‘no other option’ …

269 HABITUATION EFFECTS ON SOMATOSENSORY EVENT-RELATED POTENTIALS (SEPS) ELICITED BY PAINFUL ELECTRICAL STIMULI

Background and Aims: Pain perception is typically measured by questionnaires and behavioural responses. Somatosensory Evoked Potentials (SEPs), however, provide a direct measure of stimulus processing in the brain. We studied how stimulus repetition influences the SEPs. Methods: A multi-channel EEG was recorded (band pass 0.1−100Hz, sample frequency 1000Hz) from 11 volunteers. Electrical stimuli were applied to the middle phalange of the left ring finger. Each trial consisted of 30 stimuli (1 s duration); inter-stimulus interval of 4 seconds. Three trials were recorded, corresponding with subjective intensity levels 5 (pain detection), 7 (moderate pain) and 9 (pain tolerance). Electric stimuli thus ranged from 1 to 25 mA. Mean amplitudes were extracted from single EEG epochs at Cz: N1: 115–125 ms, P2: 185–195 ms, N2: 195–205 ms and P3: 250–270 ms. Results and Discussion: The N1 component of the SEP decreased between the first and second stimulus. The P3 wave decreased slower; over 4 to 5 stimuli. For the amplitude of the N1 no differences were observed between the three VAS scores. For those of the P3, the amplitudes of the VAS 5 were lower than those of the two higher VAS scores. The amplitude of the N1 reaching an asymptotic level after the second stimulus in the trains, is consistent with those of many earlier studies [ref: J. Kekoni]. The slow habituation of the P3 component contrasts the sensitization in subjective VAS scores found in a parallel experiment. It will be interesting to study whether this SEP habituation differs between chronic pain patients and healthy volunteers.