Pain management
Uitgangsvraag
Key question
What is the optimal management of pain in patients with spinal metastases, independent of causal treatments?
Aanbeveling
Recommendations
- See the guideline “diagnostiek en behandeling van pijn bij patiënten met kanker (NVA, 2023)” for (invasive) pain management in vertebral metastases, such as nerve blocks.
- Consider specific invasive pain management, such as vertebroplasty or kyphoplasty, in patients with mechanical pain resistant to standard analgesics due to collapse of the vertebral body/endplate only, see Appendix Indication protocol for vertebroplasty or balloon kyphoplasty.
- Do not routinely prescribe dexamethasone, but only in cases of spinal cord, radicular and/or cauda equina compression, and possibly in case of pain flare after radiotherapy.
Overwegingen
Considerations
Balance between desired and undesired effects
There is no clear evidence dexamethasone decreases pain caused by spinal metastases. However, dexamethasone does have the capability to cause important side effects including skin disorders, infections, insomnia, dyspepsia, osteoporosis, glucose control disturbances and psychiatric disorders. Dexamethasone therefore should be reserved for patients with spinal/radicular compression, when it might decrease edema and inflammation due to the compression (Sorensen, 1994), or in case of pain flare after radiotherapy, in which case it might diminish periosteal edema caused by radiotherapy (Chow, 2007; van der Linden, 2020).
As stated earlier in module Surgery patients experiencing pain due to a mechanically unstable vertebra do not benefit from radiotherapy alone. In recent years, vertebroplasty (VP) or balloon kyphoplasty (BK) have been shown to effectively and durably reduce pain in these patients (Sorensen, 2019; Berenson, 2011). This results in an improved quality of life and fewer patients using pain medications (Berenson, 2011). Cement leakage, mostly asymptomatic, is the most reported complication after vertebroplasty and kyphoplasty (Taylor, 2007).
Treatment Criteria for Vertebroplasty and Balloon Kyphoplasty
Following the growing evidence supporting the effectiveness of VP and BK, consensus has been reached regarding which patients qualify for these procedures (Standpunt van het Zorginstituut). Below is a summary of the criteria; please see the appendix or the for the full requirements:
- Symptomatic vertebral metastases with (potentially) unstable vertebrae, for which a multidisciplinary team (MDO in Dutch) has determined that percutaneous vertebroplasty (VP) or balloon kyphoplasty (BK) provides adequate stabilization and pain relief (without the need for additional reinforcement of the posterior elements at that level), or where future instability due to disease progression can be prevented and pain relief achieved through cement augmentation of the vertebral body.
- Symptomatic vertebral metastases eligible for VP or BK must be lytic or mixed (lytic and sclerotic) in nature and technically suitable for percutaneous VP or BK.
- Other treatments, including radiotherapy, analgesics, and systemic therapy, should have already been administered, or there must be well-founded reasons for their omission.
- Even in patients with a life expectancy of less than three months, VP or BK may be considered appropriate during a multidisciplinary meeting (MDO) if it can significantly reduce pain and improve quality of life in the final stages.
- VP or BK may only be performed by qualified interventional radiologists or spine surgeons.
Values and Preferences of Patients (and, if applicable, Their Relatives/Caregivers)
The working group believes that adequate pain management in patients with spinal metastases improves the quality of life of patients which is a major part of best palliative care. Furthermore, it can improve the mobility of patients which can result in less complications due to immobilization (e.g. deep venous thrombosis).
Cost Considerations
Vertebroplasty and balloon kyphoplasty have been shown to be a likely cost-effective treatment in certain patients (NICE, 2023; Health Quality Ontario, 2016), compared to best supportive care. The economic model reported in terms of cost per QALY adjusted life year.
Due to a number of weaknesses in these reports such as missing costs associated with best supportive care, which are likely biased against vertebroplasty and kyphoplasty, the cost benefits are probably even greater than reported.
Equity (Health Equity/Equitable)
The intervention does not lead to an increase or decrease in health equity. Dexamethasone is covered by health insurance. Vertebroplasty and kyphoplasty have recently been reimbursed under the basic health insurance
Acceptability
Ethical Acceptability
Analgetics with a possible sedative effect could be refused by patients with certain cultural background of (religious) philosophy
Sustainability
The use of interventional devices and packaging materials in vertebroplasty and kyphoplasty is expected to have a greater impact on sustainability compared to treatment with medication. However, the working group believes this impact will be minimal due to the low frequency of these procedures.
Feasibility
Vertebroplasty or kyphoplasty should be performed by trained and experienced personnel. The decision regarding the most appropriate pain treatment is to be discussed in an MDO.
Onderbouwing
Background
The majority of patients with spinal cord compression caused by spinal metastases experience pain (Bach, 1990).
In general, pain is frequently underestimated and undertreated (Van den Beuken-Van Everdingen, 2007; Deandra, 2008). Effective pharmacological pain management can reduce the need for more invasive treatments, such as radiation therapy (Fenstermaker, 1999). Adequate pain control is essential for improving both functional capacity and quality of life (Schuster, 2001).
Managing pain in patients with vertebral metastases presents specific challenges, as its etiology differs from that of traumatic pain. Several types of pain may occur simultaneously, although this is not always the case. These include:
- Inflammatory pain caused by the tumor itself.
- Mechanical pain (as per the Spinal Instability Neoplastic Score – SINS), triggered by stress on bones or intervertebral discs, often due to vertebral instability.
- Neuropathic pain.
- Radicular pain, resulting from compression of nerve roots by spinal metastases.
Identifying the dominant pain mechanism is essential for initiating appropriate treatment. For the treatment of cancer-related pain in general, a separate guideline is available (Dutch Guideline on the Diagnosis and Management of Pain in Patients with Cancer).
As stated earlier in module Surgery patients experiencing pain due to mechanical instability of the vertebrae do not benefit from radiotherapy alone and often require additional structural stabilization. In addition to surgical fixation there are several minimally invasive techniques to consider in spinal metastases. These include vertebroplasty, kyphoplasty, vertebral body stenting, radiofrequency ablation, embolization, infiltration, MR guided High Focused Ultrasound (MR HIFU). We will focus only on the first two techniques, as these are extensively investigated for efficacy and widely used in the Netherlands. In vertebroplasty, a special bone cement - typically polymethylmethacrylate (PMMA) - is injected directly into the fractured vertebra to stabilize it, alleviate pain, and restore some structural integrity. Kyphoplasty involves the insertion and inflation of a small balloon within the vertebra to create a cavity, which is then filled with cement to restore vertebral height and stability. In patients experiencing pain caused by mechanical instability of the vertebrae vertebroplasty and kyphoplasty have been shown to provide effective and long-lasting pain relief (Sorensen, 2019; Berenson, 2011).
There is limited evidence supporting the use of dexamethasone for pain management in patients with spinal metastases without spinal cord or nerve root compression (Leppert, 2012; Mensah, 2009; Watanabe, 1991). However, in patients with spinal cord or nerve root compression, dexamethasone has been shown to significantly reduce pain scores (Vecht, 1989; Bartels, 2008). Through inhibition of prostaglandin synthesis leading to inflammation and reduction of vascular permeability resulting in tissue edema, pain relief is obtained by corticosteroids. Corticosteroids are also having antitumor activity in certain pathologies (e.g. lymphoma, myeloma).
Radiotherapy for spinal metastases can provoke a temporary worsening of pain, commonly referred to as a pain flare (Chow, 2005; Loblaw, 2007; Hird, 2009; Chiang, 2013).
While dexamethasone may reduce the severity of pain flares, possibly by mitigating periosteal edema induced by radiotherapy, A no effect was seen on the incidence of radiation-induced pain flares (Chow, 2007; van der Linden, 2020).
Interestingly, a placebo-controlled study reported a significantly lower incidence of pain flares in patients treated with intravenous methylprednisolone (6.6% vs. 20%) (Al-Maksoud, 2014).
Summary of Findings
The results per outcome comparing high dose dexamethasone to no treatment / a low does are shown in Table 3 and Table 4.
Summary: High dose dexamethasone compared to no treatment or a low does for spinal metastases
Population: Patients with spinal metastases
Intervention: High dose dexamethasone
Comparator: No treatment or low dose dexamethasone
Table 3. Overview of outcome measures when comparing high dose dexamethasone to no treatment (adapted from the NICE guideline)
|
Outcome |
Study results and measurements |
High dose (N) |
Low dose or No treatment (N) |
Relative effect (95% CI) |
Absolute effect |
Certainty of the Evidence* (Quality of evidence) |
Conclusions |
|
Neurological and functional status |
ambulation (preservation or restoration of gait, 3 months) |
22/27
|
19/30 |
RR 1.29 (0.93 to 1.78) |
184 more per 1000 (from 44 fewer to 494 more) |
Moderate
|
The use of high-dose dexamethasone may not significantly impact ambulation of gait (3 months) compared to no treatment in patients with spinal metastases. (Sorensen 1994) |
|
survival with gait function (6 months) |
16/27 |
10/30 |
RR 1.78 (0.98 to 3.22) |
260 more per 1000 (from 7 fewer to 740 more) |
Moderate
|
The use of high-dose dexamethasone may not significantly impact survival with gait (6 months) compared to no treatment in patients with spinal metastases. (Sorensen 1994) |
|
|
survival with gait function (1 year) |
8/27 |
6/30 |
RR 1.48 (0.59 to 3.72) |
96 more per 1000 (from 82 fewer to 544 more) |
Low |
There is a very low certainty regarding high dose of dexamethasone on survival with gait function (1 year) when compared with no treatment in patients with spinal metastases. (Sorensen 1994) |
|
|
Treatment related toxicity |
significant’ side effects |
3/27 |
0/30 |
POR 8.93 (0.89 to 89.77) |
110 more per 1000 (from 20 fewer to 240 more) |
Low |
There is a very low certainty regarding high dose of dexamethasone on significant side effects when compared with no treatment in patients with spinal metastases. (Sorensen 1994) |
|
discontinuation of dexamethasone therapy due to adverse events |
2/27 |
0/30 |
POR 8.58 (0.52 to 141.22) |
110 more per 1000 (from 8 fewer to 689 more) |
Low |
There is a very low certainty regarding high dose of dexamethasone on discontinuation due to adverse events when compared with no treatment in patients with spinal metastases. (Sorensen 1994) |
|
|
CI: confidence interval; POR: Peto odds ratio; RD: risk difference; RR: risk ratio *Quality of evidence based on GRADE is adapted from the NICE guideline. |
|||||||
Table 4. Overview of outcome measures when comparing high dose dexamethasone to low does (adapted from the NICE guideline
|
Outcome |
Study results and measurements |
High dose (N) |
Low dose (N) |
Relative effect (95% CI) |
Absolute effect |
Certainty of the Evidence* (Quality of evidence) |
Conclusions |
|
Neurological and functional status |
change in bladder function (improved or stable) - 3 hours |
21/22 |
15/15 |
RR 0.96 (0.84 to 1.11) |
40 fewer per 1000 (from 160 fewer to 110 more) |
High |
The use of high-dose dexamethasone does not significantly affect change in bladder function within three hours compared to a low dose in patients with spinal metastases. (Vecht 1989) |
|
change in bladder function (improved or stable) - 24 hours |
19/22 |
15/15 |
RR 0.88 (0.72 to 1.06) |
120 fewer per 1000 (from 280 fewer to 60 more) |
Moderate |
The use of high-dose dexamethasone may not significantly impact change in bladder function within 24 hours compared to a low dose in patients with spinal metastases. (Vecht 1989) |
|
|
change in bladder function (improved or stable) - 1 week |
20/22 |
14/15 |
RR 0.97 (0.81 to 1.18) |
28 fewer per 1000 (from 177 fewer to 168 more) |
High |
The use of high-dose dexamethasone does not significantly affect change in bladder function within one week compared to a low dose in patients with spinal metastases. (Vecht 1989) |
|
|
ambulation rate (all patients) - 24 hours |
14/22 |
6/15 |
RR 1.59 (0.79 to 3.19) |
236 more per 1000 (from 84 fewer to 876 more) |
Low |
There is a very low certainty regarding high dose of dexamethasone on ambulation rate within 24 hours when compared to a low dose in patients with spinal metastases. (Vecht 1989) |
|
|
ambulation rate (all patients) - 1 week |
11/20 |
7/13 |
RR 1.02 (0.54 to 1.94) |
11 more per 1000 (from 248 fewer to 506 more) |
Low |
There is a very low certainty regarding high dose of dexamethasone on ambulation rate within one week when compared to a low dose in patients with spinal metastases. (Vecht 1989) |
|
|
ambulation rate (patients ambulant at study entry, 1 month) |
2/6 |
6/9 |
RR 0.5 (0.15 to 1.7) |
333 fewer per 1000 (from 567 fewer to 467 more) |
Low |
There is a very low certainty regarding high dose of dexamethasone on ambulation rate within one month when compared to a low dose in patients with spinal metastases. (Graham 2006) |
|
|
change in ambulation (improved or stable) - 3 hours |
21/21 |
13/14 |
RR 1.09 (0.91 to 1.3) |
84 more per 1000 (from 84 fewer to 279 more) |
Moderate |
The use of high-dose dexamethasone may not significantly impact change in ambulation within three hours compared to a low dose in patients with spinal metastases. (Vecht 1989) |
|
|
change in ambulation (improved or stable) - 24 hours |
20/22 |
13/15 |
RR 1.05 (0.83 to 1.33) |
43 more per 1000 (from 147 fewer to 286 more) |
Moderate |
The use of high-dose dexamethasone may not significantly impact change in ambulation within 24 hours compared to a low dose in patients with spinal metastases. (Vecht 1989) |
|
|
change in ambulation (improved or stable) - 1 week |
14/20 |
11/13 |
RR 0.83 (0.57 to 1.2) |
144 fewer per 1000 (from 364 fewer to 169 more) |
Moderate |
The use of high-dose dexamethasone may not significantly impact change in ambulation within a week compared to a low dose in patients with spinal metastases. (Vecht 1989) |
|
|
Pain |
change in pain score (improved) - 3 hours |
9/17 |
5/12 |
RR 1.27 (0.57 to 2.84) |
113 more per 1000 (from 179 fewer to 767 more) |
Low |
There is a very low certainty regarding high dose of dexamethasone on change in pain score within three hours when compared to a low dose in patients with spinal metastases. (Vecht 1989) |
|
change in pain score (improved) - 24 hours |
10/17 |
10/13 |
RR 0.76 (0.47 to 1.26) |
185 fewer per 1000 (from 408 fewer to 200 more) |
Low |
There is a very low certainty regarding high dose of dexamethasone on change in pain score within 24 hours when compared to a low dose in patients with spinal metastases. (Vecht 1989) |
|
|
change in pain score (improved) - 1 week |
11/14 |
10/11 |
RR 0.86 (0.62 to 1.2) |
127 fewer per 1000 (from 345 fewer to 182 more) |
Moderate |
The use of high-dose dexamethasone may not significantly pain relief within a week compared to a low dose in patients with spinal metastases. (Vecht 1989) |
|
|
Treatment related toxicity |
serious adverse effects - any |
5/9 |
4/11 |
RR 1.53 (0.58 to 4.05) |
193 more per 1000 (from 153 fewer to 1000 more) |
Low |
There is a very low certainty regarding high dose of dexamethasone on any serious adverse effects when compared to a low dose in patients with spinal metastases. (Graham 2006) |
|
serious drug related adverse effects |
1/9 |
0/11 |
POR 9.23 (0.18 to 474.33) |
110 more per 1000 (from 140 fewer to 360 more) |
Low |
There is a very low certainty regarding high dose of dexamethasone on serious drug related adverse effects when compared to a low dose in patients with spinal metastases. (Graham 2006) |
|
|
CI: confidence interval; POR: Peto odds ratio; RD: risk difference; RR: risk ratio *Quality of evidence based on GRADE is adapted from the NICE guideline. |
|||||||
Summary of literature
Description of studies
A total of three studies were included in the analysis of the literature. Important study characteristics and results are summarized in Table 2.
Table 2. Characteristics of included studies
|
Study |
Participants |
Comparison |
Follow-up |
Outcomes |
Comments |
Risk of bias (per outcome measure)* |
|
Graham 2006 |
Inclusion criteria: • MRI evidence of MSCC and at least one of pain, weakness, sensory symptoms or sphincter disturbance symptoms. • Prior histological proof of malignancy. • Age > 16 years • Eastern Co-operative Oncology Group (ECOG) performance status less than 4 before MSCC event. • Minimum power 1 out of 5. • Estimated minimum survival of 2 months. • Written informed consent.
Exclusion criteria: • Prior radiotherapy (defined as being within one vertebral level). • Prior treatment for MSCC. • Multi-level MSCC or other central nervous system disease. • Lymphoma or myeloma histology. • Definite history of peptic ulceration or cardiac failure. • Pregnancy. • Ongoing nonsteroidal medication. • Patients undergoing surgery.
Other information: Patients had to be randomised within 12 hours of receiving more than 4 mg/24 h of dexamethasone or equivalent steroid.
N=20 (96 mg group n=9; 16 mg group n=11; Patients included in the treatment groups. The study was ended early due to a high rate of ineligibility.)
Age, mean, years (range): 66 (41 – 81). SD not reported.
Sex: female n=20, male n=14. |
High dose dexamethasone 96 mg intravenous daily dexamethasone - days 0 - 2, then tapered to 0 mg by day 15.
Versus
Low dose dexamethasone 16 mg intravenous daily dexamethasone - days 0 - 2, then weaned to 0 mg by day 15. |
12 months. |
Functional status
Treatment related toxicity |
Sources of funding: Trans-Tasman Radiation Oncology Group (TROG); Cancer Council New South Wales.
Study performed in Australia |
Low
Details please see risk of bias assessment in the NICE guideline |
|
Sorensen 1994
|
Inclusion criteria: Patients referred for radiotherapy with compression of the spinal cord or cauda equina by epidural metastasis from a carcinoma. Diagnosis of spinal cord compression confirmed by myelography and, in some cases, by supplementary magnetic resonance imaging, with definition of the cranial and caudal margins of the epidural block.
Exclusion criteria: •Patients with lymphoma. • Previous treatment for epidural metastasis. • Meningeal carcinomatosis. • Infectious disease • Patients with peptic ulcers in whom treatment with high-dose dexamethasone was considered inappropriate. • Patients who underwent surgery. Surgery was considered in patients without previously established diagnosis of cancer, and in a few patients with unstable vertebral lesions. In all other patients, radiotherapy was offered as the department's standard treatment.
N=57 (2 patients excluded after randomisation, both from dexamethasone group due to ineligibility; dexamethasone group n=27; no treatment n=30)
Age, years, median (range): High dose 60 (25-81); no treatment 64 (41-82).
Sex: female n=39, male n=18. |
High dose dexamethasone Intravenous bolus of 96 mg dexamethasone given immediately after myelography or MRI, then maintained on a 96 mg dose of dexamethasone for 3 days (given orally when possible in four divided doses). Treatment was then then tapered over 10 days.
Versus
No treatment No details reported.
|
Every three months for two years or until death. |
Functional status Treatment related toxicity |
Sources of funding: Danish Cancer Research Foundation; Dexamethasone provided by Merck, Sharpe and Dhome, Denmark
Study performed in Denmark |
Low
Details please see risk of bias assessment in the NICE guideline |
|
Vecht 1989
|
Inclusion criteria: •Histologically verified diagnosis of a primary tumour, either a carcinoma or a lymphoreticular malignancy. • Showing complete obstruction for contrast flow on myelography, which was performed on suspicion of metastatic epidural spinal cord compression.
Exclusion criteria: Not reported.
N=37
Age, years, mean (SD): 61 (range 22 -87). SD not reported.
Sex: female n=11; male n=26. |
High dose dexamethasone 100 mg. No further details reported.
Versus
Low dose dexamethasone 10 mg. No further details reported. |
1 week |
Functional status Pain |
Sources of funding: Not reported.
Study performed in Netherlands |
Low
Details please see risk of bias assessment in the NICE guideline |
Search and select
To answer the following question(s), the NICE guideline was consulted, incorporating the PICO framework, the literature search, and the summary of the evidence for this module.
Table 1. PICO
| Patients | Patiënten met wervelmetastasen met neurologische symptomen |
| Intervention | Dexamethasone (oral or intravenous) |
| Control | No dexamethasone; Different regimens (for example different dosage or duration) |
| Outcomes |
Critical: Neurological and functional status including:
Critical: Pain Important: Treatment related toxicity including:
|
| Other selection criteria | Study design: systematic reviews and randomized controlled trials |
A priori, the working group did not define the outcome measures listed above but used the definitions used in the studies.
The NICE guideline defined the following as a minimal clinically (patient) important difference (MID):
- For risk ratios: 0.8 and 1.25.
- For continuous outcomes: MID is calculated by ranking the studies in order of SD in the control arms. The MID is calculated as +/- 0.5 times median SD. For studies that have been pooled using SMD (meta-analysed): +0.5 and -0.5 in the SMD scale are used as MID boundaries.
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- 17 - van der Linden YM, Westhoff PG, Stellato RK, van Baardwijk A, de Vries K, Ong F, Wiggenraad R, Bakri B, Wester G, de Pree I, van Veelen L, Budiharto T, Schippers M, Reyners AKL, de Graeff A. Dexamethasone for the Prevention of a Pain Flare After Palliative Radiation Therapy for Painful Bone Metastases: The Multicenter Double-Blind Placebo-Controlled 3-Armed Randomized Dutch DEXA Study. Int J Radiat Oncol Biol Phys. 2020 Nov 1;108(3):546-553. doi: 10.1016/j.ijrobp.2020.05.007. Epub 2020 May 22. PMID: 32446951.
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Evidence tables
Risk of Bias tables
Details please see the NICE guideline.
Table of excluded studies
Details please see the NICE guideline.
Beoordelingsdatum en geldigheid
Publicatiedatum : 05-06-2026
Beoordeeld op geldigheid : 05-06-2026
Algemene gegevens
De ontwikkeling/herziening van deze richtlijnmodule werd ondersteund door het Kennisinstituut van de Federatie Medisch Specialisten (www.demedischspecialist.nl/kennisinstituut) en werd gefinancierd door de Stichting Kwaliteitsgelden Medisch Specialisten (SKMS). De financier heeft geen enkele invloed gehad op de inhoud van de richtlijnmodule.
Samenstelling werkgroep
Voor het ontwikkelen van de richtlijnmodule is in 2023 een multidisciplinaire werkgroep ingesteld, bestaande uit vertegenwoordigers van alle relevante specialismen (zie hiervoor de Samenstelling van de werkgroep) die betrokken zijn bij de zorg voor patiënten met wervelmetastasen.
Werkgroep
- dr. W. (Walter) Taal (voorzitter), neuroloog Erasmuc MC, Nederlandse Vereniging voor Neurologie
- drs. L. (Lena) van Iterson, AIOS-neuroloog Elisabeth-TweeSteden Ziekenhuis, Nederlandse Vereniging voor Neurologie
- drs. R.P.B. (Robin) Boltjes, neuroloog Antoni van Leeuwenhoek Ziekenhuis, Nederlandse Vereniging voor Neurologie
- Prof. dr. JJ. (Jorrit-Jan) Verlaan, Orthopedisch chirurg UMC Utrecht, Nederlandse Orthopaedische Vereniging
- dr. J. (Jasper) van Tiel, Orthopedisch chirurg UMC Utrecht, Nederlandse Orthopaedische Vereniging
- dr. V. (Vivian) Bongers, Nucleaire geneeskunde Diakonessenhuis Utretch, Nederlandse Vereniging voor Nucleaire Geneeskunde
- Prof. dr. R. (Ronald) Bartels, Neurochirurg Radboudumc, Nederlandse Vereniging voor Neurochirurgie
- dr. S.O. (Selma) Algra, Radioloog UMC Utrecht, Nederlandse Vereniging voor Radiologie
- drs. M.G.A. (Maaike) Schippers, radiotherapeut Instituut Verbeeten, Nederlandse Vereniging voor Radiotherapie en Oncologie
- dr. J.M. (Joanne) van der Velden, radiotherapeut UMC Utrecht, Nederlandse Vereniging voor Radiotherapie en Oncologie
- dr. M.S. (Marthe) Paats, longarts Erasmus MC, Nederlandse Vereniging voor Artsen voor Longziekten en TBC
- dr. P.F. (Paula) Ypma, Internist hematoloog Haga Ziekenhuis, Nederlandse Internisten Vereniging
- dr. F.Y.F.L. (Filip) de Vos, internist-oncoloog en kaderarts palliatieve zorg UMC Utrecht, Nederlandse Internisten Vereniging
- dr. M. (Marije) Vos- van der Hulst, revalidatiearts Sint Maartenskliniek, Nederlandse Vereniging van Revalidatieartsen (vanaf oktober 2025)
- Mevr. S (Silvie) Dronkers†, patiëntvertegenwoordiger, Stichting Darmkanker (tot oktober 2025)
- dr. T.A.R. (Tebbe) Sluis†, Revalidatiearts Rijndam, Nederlandse Vereniging van Revalidatieartsen (tot mei 2025)
Klankbordgroep
- Mevr. Manon Immerzeel, Verpleegkundig specialist Reinier de Graaf ziekenhuis, Verpleegkundigen en Verzorgenden Nederland
- drs. A. (Anita) Ophof, anesthesioloog Antoni van Leeuwenhoek Ziekenhuis, Nederlandse Vereniging voor Anesthesiologie
Met dank aan
- dr. J.H. (Jurgen) Runge, interventieradioloog, UMC Groningen, Nederlandse Vereniging voor Radiologie
Met ondersteuning van
- dr. J. (Josefien) Buddeke, senior adviseur, Kennisinstituut van de Federatie Medisch Specialisten (vanaf juli 2024)
- dr. L. (Linda) Oostendorp, senior adviseur, Kennisinstituut van de Federatie Medisch Specialisten (tot juli 2024)
- drs. B. (Beatrix) Vogelaar, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- dr. J. (Jing) de Haan-Du, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- drs. D. (Danique) Middelhuis, adviseur, Kennisinstituut van de Federatie Medisch Specialisten
- drs. A. (Alies) Oost, informatiespecialist, Kennisinstituut van de Federatie Medisch Specialisten
Belangenverklaringen
Een overzicht van de belangen van werkgroepleden en het oordeel over het omgaan met eventuele belangen vindt u in onderstaande tabel. De ondertekende belangenverklaringen zijn op te vragen bij het secretariaat van het Kennisinstituut van de Federatie Medisch Specialisten via secretariaat@kennisinstituut.nl.
Gemelde (neven)functies en belangen werkgroep
|
Naam WERKGROEP |
Hoofdfunctie |
Nevenwerkzaamheden |
Persoonlijke Financiele_Belangen |
Persoonlijke Relaties |
Extern Gefinancierd Onderzoek |
Intellectuele Belangen Reputatie |
Overige Belangen |
Datum |
Acties |
|
Jasper van Tiel |
Orthopedisch chirurg UMC Utrecht en Acibadem IMC |
geen |
geen |
geen |
geen |
geen |
geen |
22-11-2023 |
Geen restrictie |
|
Joanne van der Velden |
Radiotherapeut bij het UMC Utrecht, betaald |
Bestuurslid bij het Landelijk Platform Palliatieve Radiotherapie (NVRO), onbetaald |
Geen |
Geen |
Deelname aan 2 extern gefinancierde onderzoeken, zie onder |
Verwerven van erkenning speelt mee aan mijn deelname aan de werkgroep richtlijn Wervelmetastasen |
Geen overige belangen |
28-12-2023 |
Geen restrictie |
|
Jorrit-Jan Verlaan |
Orthopedisch chirurg, UMC Utrecht (0.4 Fte) |
Lid steering committee AO Spine Knowledge Forum Tumor (onbetaald maar met onkosten vergoeding). |
Hoe de richtlijn wordt vormgegeven staat los van mijn persoonlijke financiële belangen. Er zijn ook geen belangen voor SentryX hoe de richtlijn wordt vormgegeven. |
geen |
Ja. |
Ik heb nationale/internationale expertise/reputatie en een leerstoel op het gebied van de behandeling van wervelmetastasen. Een goed uitgevoerde richtlijn kan helpen deze expertise/reputatie meer exposure te geven maar de impact en eventuele belangenverstrengeling zijn mij onduidelijk. |
geen |
22-11-2023 |
Geen restrictie. Geen penvoerder bij module 'Inschatten overleving'. |
|
Filip de Vos |
Internist-oncoloog en kaderarts palliatieve zorg |
geen |
geen |
geen |
ja |
geen |
BMS Advisory Board; Faculty member ESMO CNS tumors; Quality of Care commission Dutch Society of Medical Oncology; |
20-12-2023 |
Geen restrictie. (In de richtlijn worden geen systemische therapien aanbevolen.) |
|
Maaike Schippers |
Radiotherapeut |
geen |
geen |
geen |
geen |
geen |
geen |
3-12-2023 |
Geen restrictie |
|
Marthe Paats |
Longarts Erasmus MC |
geen |
Geen relevant voor huidige richtlijn. |
geen |
industrie gesponsorde studies lopend in het Erasmus MC waarbij ik lokale PI ben. |
geen |
geen |
26-02-2024 |
Geen restrictie. In de richtlijn worden geen systemische therapien aanbevolen. |
|
Robin Boltjes |
Neuroloog in Antoni van Leeuwenhoek/NKI |
geen |
geen |
nee |
geen |
geen |
nee |
22-11-2023 |
Geen restrictie |
|
Ronald Bartels |
Neurochirurg |
Medisch Adviseur |
geen |
nee |
geen |
net |
geen |
03-04-2024 |
Restrictie ten aanzien van besluitvorming betreffende 'Inschatten overleving'. Vanuit expertise wel meegediscussierd over inhoud van de module, niet betrokken bij het formuleren van de aanbevelingen. |
|
Tebbe Sluis |
revalidatiearts |
geen |
geen |
geen |
geen |
geen |
geen |
11-12-2023 |
Geen restrictie |
|
Vivian Bongers |
MSB Domstad, medisch specialist |
Uitgeverij Prelum, Redacteur tijdschrift IMAGO |
Geen |
Geen |
Geen |
Geen |
Geen |
23-11-2023 |
Geen restrictie |
|
Ypma |
internist hematoloog Hagaziekenhuis den Haag |
geen |
geen |
geen |
Alphabet trial |
geen |
nvt |
04-05-2024 |
Geen restrictie |
|
Van Iterson |
AIOS neurologie |
geen |
geen |
geen |
geen |
geen |
geen |
25-04-2024 |
Geen restrictie |
|
Selma Algra |
Radioloog,St Jansdal Ziekenhuis |
geen |
geen |
geen |
geen |
geen |
geen |
03-09-2024 |
Geen resctrictie |
|
Silvie Dronkers |
Stichting Darmkanker |
geen |
geen |
geen |
geen |
geen |
geen |
06-02-2025 |
Geen restrictie |
|
Walter Taal (voorzitter) |
Neuroloog, Erasmus MC, Rotterdam |
Geen |
Geen |
Geen |
Ja. Alleen op het gebied van neurofibromatose type 1 |
Geen |
Geen |
07-06-2023 |
Geen restrictie |
|
Marije Vos-van der Hulst |
Revalidatie arts, Sint Maartenskliniek Nijmegen |
Voorzitter werkgroep revalidatie artsen dwarslaesie (Nederlands Vlaams dwarslaesie genootschap= werkgroep van de vereniging revalidatieartsen nederland (VRA)) |
geen |
geen |
geen |
geen |
geen |
13-10-2025 |
Geen restrictie |
|
Naam KLANKBORDGROEP |
Hoofdfunctie |
Nevenwerkzaamheden |
Persoonlijke Financiele_Belangen |
Persoonlijke Relaties |
Extern Gefinancierd Onderzoek |
Intellectuele Belangen Reputatie |
Overige Belangen |
Datum |
Acties |
|
Manon Immerzeel |
Deelnemer clusterstuurgroep |
Geen |
Geen |
Geen |
Geen |
Voorzitter in het bestuur van V&VN pijnverpleegkundigen |
Neen |
22-03-2022 |
Geen restrictie |
|
Anita Ophof |
Antoni van Leeuwenhoek Ziekenhuis |
Geen |
Geen |
Geen |
Geen |
Geen |
Geen |
01-05-2025 |
Geen restrictie |
Inbreng patiëntenperspectief
Kwalitatieve raming van mogelijke financiële gevolgen in het kader van de Wkkgz
Bij de richtlijnmodule voerde de werkgroep conform de Wet kwaliteit, klachten en geschillen zorg (Wkkgz) een kwalitatieve raming uit om te beoordelen of de aanbevelingen mogelijk leiden tot substantiële financiële gevolgen. Bij het uitvoeren van deze beoordeling is de richtlijnmodule op verschillende domeinen getoetst (zie het stroomschema bij Werkwijze).
De kwalitatieve raming is toegevoegd aan het einde van elke herziene module.
| Module | Uitkomst raming | Toelichting |
| Pain management | Geen substantiële financiële gevolgen | Hoewel uit de toetsing volgt dat de aanbevelingen breed toepasbaar zijn (5.000-40.000 patiënten), volgt ook uit de toetsing dat het geen nieuwe manier van zorgverlening of andere organisatie van zorgverlening betreft. Er worden daarom geen substantiële financiële gevolgen verwacht. |
Werkwijze
Voor meer details over de gebruikte richtlijnmethodologie verwijzen wij u naar de Werkwijze. Relevante informatie voor de ontwikkeling/herziening van deze richtlijnmodule is hieronder weergegeven.