Kees Besse - Academia.edu (original) (raw)

Papers by Kees Besse

Research paper thumbnail of Pijn bij patiënten met kanker

Nederlands Vlaams Tijdschrift Voor Palliatieve Zorg, 2012

Research paper thumbnail of REVIEW ARTICLE Opioid Rotation in the Management of Chronic Pain: Where Is the Evidence?

Research paper thumbnail of Pijn bij kanker: Anesthesiologische pijnbehandelingstechnieken voor pijn bij kanker

Research paper thumbnail of Anesthesiologische pijnbehandelingstechnieken voor pijn bij kanker

Research paper thumbnail of Dutch Pain Specialists’ Adherence to the Multidisciplinary Guideline on Treating Pain in Patients with Cancer: A Case Vignette Study

Pain Practice, 2016

Many patients with cancer suffer from pain, which is often not optimally treated. In 2008, the ev... more Many patients with cancer suffer from pain, which is often not optimally treated. In 2008, the evidence-based, multidisciplinary Dutch guideline on the diagnosis and treatment of pain in this patient group was published. We assessed knowledge about and adherence to the guideline by pain specialists. A cross-sectional case vignette survey describing a palliative patient with intractable pancreatic cancer and pain was sent to all 350 Dutch anesthesiologists registered as pain specialists at the Netherlands Association of Anesthesiology. Descriptive statistics were conducted. Ninety-three pain specialists completed the questionnaire (27%). The majority appeared to follow the guideline recommendations on pharmacological (99%) and invasive treatment (95%) in the diverse stages of the disease. However, the recommendation to use a one-dimensional pain scale to evaluate the effect of pain treatment and the recommendation to perform a multidimensional pain assessment if the patient in pain is in a deteriorating stage were only followed by a minority of the respondents (23% and 15%, respectively). Regarding most recommendations, Dutch pain specialists know and intend to follow the national multidisciplinary cancer pain guideline. Yet, only a minority of them perform structural pain assessment of the patient with cancer pain. However, as the response rate was low (27%), the results should be interpreted with caution and cannot be generalized to the entire population of pain specialists in the Netherlands. We recommend that, in the guideline update and implementation programs, more attention be given to thorough assessment of the patient with pain and cancer.

Research paper thumbnail of Pain in Patients with Cancer

Pain Practice

Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side e... more Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate application of these interventional techniques provides better pain control, allows the reduction of analgesics and hence improves quality of life. Until recently, the majority of these techniques are considered to be a fourth consecutive step following the World Health Organization's pain treatment ladder. However, in cancer patients, earlier application of interventional pain management techniques can be recommended even before considering the use of strong opioids. Epidural and intrathecal medication administration allow the reduction of the daily oral or transdermal opioid dose, while maintaining or even improving the pain relief and reducing the side effects. Cervical cordot...

Research paper thumbnail of Opioid rotation in the management of chronic pain: where is the evidence?

Pain practice : the official journal of World Institute of Pain

The management of chronic pain remains a challenge because of its complexity and unpredictable re... more The management of chronic pain remains a challenge because of its complexity and unpredictable response to pharmacological treatment. In addition, accurate pain management may be hindered by the prejudice of physicians and patients that strong opioids, classified as step 3 medications in the World Health Organization ladder for cancer pain management, are reserved for the end stage of life. Recent information indicates the potential value of strong opioids in the treatment of chronic nonmalignant pain. There are, up until now, insufficient data to provide indications about which opioid to use to initiate treatment or the dose to be used for any specific pain syndrome. The strong inter-patient variability in opioid receptor response and in the pharmacokinetic and pharmacodynamic behavior of strong opioids justifies an individual selection of the appropriate opioid and stepwise dose titration. Clinical experience shows that switching from one opioid to another may optimize pain contro...

Research paper thumbnail of 23. Pain in Patients with Cancer

Pain Practice, 2011

Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side e... more Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate application of these interventional techniques provides better pain control, allows the reduction of analgesics and hence improves quality of life. Until recently, the majority of these techniques are considered to be a fourth consecutive step following the World Health Organization's pain treatment ladder. However, in cancer patients, earlier application of interventional pain management techniques can be recommended even before considering the use of strong opioids. Epidural and intrathecal medication administration allow the reduction of the daily oral or transdermal opioid dose, while maintaining or even improving the pain relief and reducing the side effects. Cervical cordotomy may be considered for patients suffering with unilateral pain at the level below the dermatome C5. This technique should only be applied in patients with a life expectancy of less than 1 year. Plexus coeliacus block or nervus splanchnicus block are recommended for the management of upper abdominal pain due to cancer. Pelvic pain due to cancer can be managed with plexus hypogastricus block and the saddle or lower end block may be a last resort for patients suffering with perineal pain. Back pain due to vertebral compression fractures with or without pathological tumor invasion may be managed with percutaneous vertebroplasty or kyphoplasty. All these interventional techniques should be a part of multidisciplinary patient program.

Research paper thumbnail of Effect of 1 Night of Total Sleep Deprivation on Cerebrospinal Fluid β-Amyloid 42 in Healthy Middle-Aged Men

JAMA Neurology, 2014

Increasing evidence suggests a relationship between poor sleep and the risk of developing Alzheim... more Increasing evidence suggests a relationship between poor sleep and the risk of developing Alzheimer disease. A previous study found an effect of sleep on β-amyloid (Aβ), which is a key protein in Alzheimer disease pathology. To determine the effect of 1 night of total sleep deprivation on cerebrospinal fluid Aβ42 protein levels in healthy middle-aged men. The Alzheimer, Wakefulness, and Amyloid Kinetics (AWAKE) study at the Radboud Alzheimer Center, a randomized clinical trial that took place between June 1, 2012, and October 1, 2012. Participants were cognitively normal middle-aged men (40-60 years of age) with normal sleep (n = 26) recruited from the local population. Participants were randomized to 1 night with unrestricted sleep (n = 13) or 1 night of total sleep deprivation (24 hours of wakefulness) (n = 13). Sleep was monitored using continuous polysomnographic recording from 3 pm until 10 am. Cerebrospinal fluid samples were collected using an intrathecal catheter at defined times to compare cerebral Aβ42 concentrations between evening and morning. A night of unrestricted sleep led to a 6% decrease in Aβ42 levels of 25.3 pg/mL (95% CI [0.94, 49.6], P = .04), whereas sleep deprivation counteracted this decrease. When accounting for the individual trajectories of Aβ42 over time, a difference of 75.8 pg/mL of Aβ42 was shown between the unrestricted sleep and sleep deprivation group (95% CI [3.4, 148.4], P = .04). The individual trajectories of evening and morning Aβ42 concentrations differed between the unrestricted sleep and sleep deprivation groups (P = .04) in contrast to stable Aβ40, tau, and total protein levels. Sleep deprivation, or prolonged wakefulness, interferes with a physiological morning decrease in Aβ42. We hypothesize that chronic sleep deprivation increases cerebral Aβ42 levels, which elevates the risk of Alzheimer disease. clinicaltrials.gov Identifier: NCT01194713.

Research paper thumbnail of The Impact of a National Guideline on the Management of Cancer Pain on the Practice of Pain Assessment and Registration

Pain Practice, 2014

The Dutch clinical practice guideline on the diagnosis and management of pain in patients with ca... more The Dutch clinical practice guideline on the diagnosis and management of pain in patients with cancer was published in 2008 and intensively promoted to healthcare professionals who see patients with cancer. One of the most important recommendations is the systematic registering of the pain and its intensity. To evaluate in which degree this part of the practice guideline is implemented, we analyzed the medical records of patients attending the outpatient oncological clinic in an academic hospital, a large teaching hospital, and 4 smaller peripheral hospitals. None of the participating hospitals assessed pain by a standardized scale. Reference to pain in the medical record happened more frequently in the academic hospital than in the other hospitals. The frequency of recording pain in the medical record in the academic hospital was much higher in this study than the one previously reported, whereas the findings in the other hospitals were comparable. There may be several reasons for the difference in reporting rate of pain in patients with cancer. Our findings indicate that the clinical practice guideline with regard to pain registration is poorly implemented in oncology outpatient clinics. More efforts should be made to generate the awareness for the need of pain registration.

Research paper thumbnail of Adoptation of an evidence-based clinical practice guideline in cancer pain management by medical oncologists: a case vignette study

Supportive Care in Cancer, 2014

Research paper thumbnail of Pain Assessment with Short Message Service and Interactive Voice Response in Outpatients with Cancer and Pain: A Feasibility Study

Research paper thumbnail of Opioïdgeïnduceerde hyperalgesie in de palliatieve zorg

Inzichten in de palliatieve zorg, 2014

ABSTRACT In dit artikel wordt de situatie beschreven waarin ten gevolge van het geven van opioïde... more ABSTRACT In dit artikel wordt de situatie beschreven waarin ten gevolge van het geven van opioïden pijnklachten toe- in plaats van afnemen. Hoewel dit negatieve effect van opioïden al in de negentiende eeuw bekend was, zijn de oorzaken hiervan pas de afgelopen decennia duidelijk geworden. Het toedienen van opioïden kan leiden tot een zodanige verandering in de pijnregistrerende en -regulerende systemen in het perifere en centrale zenuwstelsel dat er geen remming meer optreedt van nociceptieve input, maar dat de patiënt een steeds verder escalerende pijn ervaart. Het preklinisch en klinisch onderzoek aangaande de oorzaken van het optreden van deze ernstige bijwerking van opioïden worden uitgelegd. De verschillende farmacologische mechanismen die mede verantwoordelijk zijn voor het ontstaan van hyperalgesie worden verklaard, te weten de rol van de N-methyl-D-aspartaat receptor en dynorfine. Uitgaande van deze oorzaken van hyperalgesie, worden de vereiste aanpassingen van het analgetisch beleid beschreven, waarin methadon en buprenorfine een voorname rol vervullen.

Research paper thumbnail of Rationale, design, and implementation protocol of the Dutch clinical practice guideline Pain in patients with cancer: a cluster randomised controlled trial with short message service (SMS) and interactive voice response (IVR)

Implementation Science, 2011

Research paper thumbnail of A single night of sleep deprivation increases cerebrospinal fluid beta-amyloid 42 protein in healthy male volunteers

Alzheimer's & Dementia, 2013

Research paper thumbnail of Hourly variability of cerebrospinal fluid biomarkers in Alzheimer patients and healthy elderly controls

Alzheimer's & Dementia, 2010

No abstract is available. To read the body of this article, please view the Full Text online. ...... more No abstract is available. To read the body of this article, please view the Full Text online. ... © 2010 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved. ... Visit SciVerse ScienceDirect to see if you have access via your institution. ... Advertisements on this site ...

Research paper thumbnail of A Case Vignette Study to Assess the Knowledge of Pain Physicians of Neuropathic Cancer Pain: Room for Improvement

Pain physician

In more and more countries, a specific pain education curriculum is provided to instruct pain phy... more In more and more countries, a specific pain education curriculum is provided to instruct pain physicians. However, there is little literature on pain education and in particularly how to evaluate their knowledge. One of the modules interesting to assess is the use of clinical practice guidelines (CPGs) by pain physicians. The aim was to investigate if a case vignette is useful to evaluate pain physicians' knowledge about recommendations contained in CPGs. An email survey was conducted with the support of the Societe Francaise d'Etude et de Traitement de la Douleur to all pain specialists (primary and secondary care) in France. The survey consisted of a case vignette about a patient with pain suffering from an intractable pancreatic cancer with multiple choice questions about diagnosis and treatment of pain. Percentages of participants who treated the patient as suggested in the CPGs were calculated. A total of 214 of those invited to participate (921) answered the questionna...

Research paper thumbnail of Pijn bij patiënten met kanker

Nederlands Vlaams Tijdschrift Voor Palliatieve Zorg, 2012

Research paper thumbnail of REVIEW ARTICLE Opioid Rotation in the Management of Chronic Pain: Where Is the Evidence?

Research paper thumbnail of Pijn bij kanker: Anesthesiologische pijnbehandelingstechnieken voor pijn bij kanker

Research paper thumbnail of Anesthesiologische pijnbehandelingstechnieken voor pijn bij kanker

Research paper thumbnail of Dutch Pain Specialists’ Adherence to the Multidisciplinary Guideline on Treating Pain in Patients with Cancer: A Case Vignette Study

Pain Practice, 2016

Many patients with cancer suffer from pain, which is often not optimally treated. In 2008, the ev... more Many patients with cancer suffer from pain, which is often not optimally treated. In 2008, the evidence-based, multidisciplinary Dutch guideline on the diagnosis and treatment of pain in this patient group was published. We assessed knowledge about and adherence to the guideline by pain specialists. A cross-sectional case vignette survey describing a palliative patient with intractable pancreatic cancer and pain was sent to all 350 Dutch anesthesiologists registered as pain specialists at the Netherlands Association of Anesthesiology. Descriptive statistics were conducted. Ninety-three pain specialists completed the questionnaire (27%). The majority appeared to follow the guideline recommendations on pharmacological (99%) and invasive treatment (95%) in the diverse stages of the disease. However, the recommendation to use a one-dimensional pain scale to evaluate the effect of pain treatment and the recommendation to perform a multidimensional pain assessment if the patient in pain is in a deteriorating stage were only followed by a minority of the respondents (23% and 15%, respectively). Regarding most recommendations, Dutch pain specialists know and intend to follow the national multidisciplinary cancer pain guideline. Yet, only a minority of them perform structural pain assessment of the patient with cancer pain. However, as the response rate was low (27%), the results should be interpreted with caution and cannot be generalized to the entire population of pain specialists in the Netherlands. We recommend that, in the guideline update and implementation programs, more attention be given to thorough assessment of the patient with pain and cancer.

Research paper thumbnail of Pain in Patients with Cancer

Pain Practice

Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side e... more Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate application of these interventional techniques provides better pain control, allows the reduction of analgesics and hence improves quality of life. Until recently, the majority of these techniques are considered to be a fourth consecutive step following the World Health Organization's pain treatment ladder. However, in cancer patients, earlier application of interventional pain management techniques can be recommended even before considering the use of strong opioids. Epidural and intrathecal medication administration allow the reduction of the daily oral or transdermal opioid dose, while maintaining or even improving the pain relief and reducing the side effects. Cervical cordot...

Research paper thumbnail of Opioid rotation in the management of chronic pain: where is the evidence?

Pain practice : the official journal of World Institute of Pain

The management of chronic pain remains a challenge because of its complexity and unpredictable re... more The management of chronic pain remains a challenge because of its complexity and unpredictable response to pharmacological treatment. In addition, accurate pain management may be hindered by the prejudice of physicians and patients that strong opioids, classified as step 3 medications in the World Health Organization ladder for cancer pain management, are reserved for the end stage of life. Recent information indicates the potential value of strong opioids in the treatment of chronic nonmalignant pain. There are, up until now, insufficient data to provide indications about which opioid to use to initiate treatment or the dose to be used for any specific pain syndrome. The strong inter-patient variability in opioid receptor response and in the pharmacokinetic and pharmacodynamic behavior of strong opioids justifies an individual selection of the appropriate opioid and stepwise dose titration. Clinical experience shows that switching from one opioid to another may optimize pain contro...

Research paper thumbnail of 23. Pain in Patients with Cancer

Pain Practice, 2011

Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side e... more Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate application of these interventional techniques provides better pain control, allows the reduction of analgesics and hence improves quality of life. Until recently, the majority of these techniques are considered to be a fourth consecutive step following the World Health Organization's pain treatment ladder. However, in cancer patients, earlier application of interventional pain management techniques can be recommended even before considering the use of strong opioids. Epidural and intrathecal medication administration allow the reduction of the daily oral or transdermal opioid dose, while maintaining or even improving the pain relief and reducing the side effects. Cervical cordotomy may be considered for patients suffering with unilateral pain at the level below the dermatome C5. This technique should only be applied in patients with a life expectancy of less than 1 year. Plexus coeliacus block or nervus splanchnicus block are recommended for the management of upper abdominal pain due to cancer. Pelvic pain due to cancer can be managed with plexus hypogastricus block and the saddle or lower end block may be a last resort for patients suffering with perineal pain. Back pain due to vertebral compression fractures with or without pathological tumor invasion may be managed with percutaneous vertebroplasty or kyphoplasty. All these interventional techniques should be a part of multidisciplinary patient program.

Research paper thumbnail of Effect of 1 Night of Total Sleep Deprivation on Cerebrospinal Fluid β-Amyloid 42 in Healthy Middle-Aged Men

JAMA Neurology, 2014

Increasing evidence suggests a relationship between poor sleep and the risk of developing Alzheim... more Increasing evidence suggests a relationship between poor sleep and the risk of developing Alzheimer disease. A previous study found an effect of sleep on β-amyloid (Aβ), which is a key protein in Alzheimer disease pathology. To determine the effect of 1 night of total sleep deprivation on cerebrospinal fluid Aβ42 protein levels in healthy middle-aged men. The Alzheimer, Wakefulness, and Amyloid Kinetics (AWAKE) study at the Radboud Alzheimer Center, a randomized clinical trial that took place between June 1, 2012, and October 1, 2012. Participants were cognitively normal middle-aged men (40-60 years of age) with normal sleep (n = 26) recruited from the local population. Participants were randomized to 1 night with unrestricted sleep (n = 13) or 1 night of total sleep deprivation (24 hours of wakefulness) (n = 13). Sleep was monitored using continuous polysomnographic recording from 3 pm until 10 am. Cerebrospinal fluid samples were collected using an intrathecal catheter at defined times to compare cerebral Aβ42 concentrations between evening and morning. A night of unrestricted sleep led to a 6% decrease in Aβ42 levels of 25.3 pg/mL (95% CI [0.94, 49.6], P = .04), whereas sleep deprivation counteracted this decrease. When accounting for the individual trajectories of Aβ42 over time, a difference of 75.8 pg/mL of Aβ42 was shown between the unrestricted sleep and sleep deprivation group (95% CI [3.4, 148.4], P = .04). The individual trajectories of evening and morning Aβ42 concentrations differed between the unrestricted sleep and sleep deprivation groups (P = .04) in contrast to stable Aβ40, tau, and total protein levels. Sleep deprivation, or prolonged wakefulness, interferes with a physiological morning decrease in Aβ42. We hypothesize that chronic sleep deprivation increases cerebral Aβ42 levels, which elevates the risk of Alzheimer disease. clinicaltrials.gov Identifier: NCT01194713.

Research paper thumbnail of The Impact of a National Guideline on the Management of Cancer Pain on the Practice of Pain Assessment and Registration

Pain Practice, 2014

The Dutch clinical practice guideline on the diagnosis and management of pain in patients with ca... more The Dutch clinical practice guideline on the diagnosis and management of pain in patients with cancer was published in 2008 and intensively promoted to healthcare professionals who see patients with cancer. One of the most important recommendations is the systematic registering of the pain and its intensity. To evaluate in which degree this part of the practice guideline is implemented, we analyzed the medical records of patients attending the outpatient oncological clinic in an academic hospital, a large teaching hospital, and 4 smaller peripheral hospitals. None of the participating hospitals assessed pain by a standardized scale. Reference to pain in the medical record happened more frequently in the academic hospital than in the other hospitals. The frequency of recording pain in the medical record in the academic hospital was much higher in this study than the one previously reported, whereas the findings in the other hospitals were comparable. There may be several reasons for the difference in reporting rate of pain in patients with cancer. Our findings indicate that the clinical practice guideline with regard to pain registration is poorly implemented in oncology outpatient clinics. More efforts should be made to generate the awareness for the need of pain registration.

Research paper thumbnail of Adoptation of an evidence-based clinical practice guideline in cancer pain management by medical oncologists: a case vignette study

Supportive Care in Cancer, 2014

Research paper thumbnail of Pain Assessment with Short Message Service and Interactive Voice Response in Outpatients with Cancer and Pain: A Feasibility Study

Research paper thumbnail of Opioïdgeïnduceerde hyperalgesie in de palliatieve zorg

Inzichten in de palliatieve zorg, 2014

ABSTRACT In dit artikel wordt de situatie beschreven waarin ten gevolge van het geven van opioïde... more ABSTRACT In dit artikel wordt de situatie beschreven waarin ten gevolge van het geven van opioïden pijnklachten toe- in plaats van afnemen. Hoewel dit negatieve effect van opioïden al in de negentiende eeuw bekend was, zijn de oorzaken hiervan pas de afgelopen decennia duidelijk geworden. Het toedienen van opioïden kan leiden tot een zodanige verandering in de pijnregistrerende en -regulerende systemen in het perifere en centrale zenuwstelsel dat er geen remming meer optreedt van nociceptieve input, maar dat de patiënt een steeds verder escalerende pijn ervaart. Het preklinisch en klinisch onderzoek aangaande de oorzaken van het optreden van deze ernstige bijwerking van opioïden worden uitgelegd. De verschillende farmacologische mechanismen die mede verantwoordelijk zijn voor het ontstaan van hyperalgesie worden verklaard, te weten de rol van de N-methyl-D-aspartaat receptor en dynorfine. Uitgaande van deze oorzaken van hyperalgesie, worden de vereiste aanpassingen van het analgetisch beleid beschreven, waarin methadon en buprenorfine een voorname rol vervullen.

Research paper thumbnail of Rationale, design, and implementation protocol of the Dutch clinical practice guideline Pain in patients with cancer: a cluster randomised controlled trial with short message service (SMS) and interactive voice response (IVR)

Implementation Science, 2011

Research paper thumbnail of A single night of sleep deprivation increases cerebrospinal fluid beta-amyloid 42 protein in healthy male volunteers

Alzheimer's & Dementia, 2013

Research paper thumbnail of Hourly variability of cerebrospinal fluid biomarkers in Alzheimer patients and healthy elderly controls

Alzheimer's & Dementia, 2010

No abstract is available. To read the body of this article, please view the Full Text online. ...... more No abstract is available. To read the body of this article, please view the Full Text online. ... © 2010 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved. ... Visit SciVerse ScienceDirect to see if you have access via your institution. ... Advertisements on this site ...

Research paper thumbnail of A Case Vignette Study to Assess the Knowledge of Pain Physicians of Neuropathic Cancer Pain: Room for Improvement

Pain physician

In more and more countries, a specific pain education curriculum is provided to instruct pain phy... more In more and more countries, a specific pain education curriculum is provided to instruct pain physicians. However, there is little literature on pain education and in particularly how to evaluate their knowledge. One of the modules interesting to assess is the use of clinical practice guidelines (CPGs) by pain physicians. The aim was to investigate if a case vignette is useful to evaluate pain physicians' knowledge about recommendations contained in CPGs. An email survey was conducted with the support of the Societe Francaise d'Etude et de Traitement de la Douleur to all pain specialists (primary and secondary care) in France. The survey consisted of a case vignette about a patient with pain suffering from an intractable pancreatic cancer with multiple choice questions about diagnosis and treatment of pain. Percentages of participants who treated the patient as suggested in the CPGs were calculated. A total of 214 of those invited to participate (921) answered the questionna...