uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Publications (10 of 22) Show all publications
Hysing, E.-B., Smith, L., Thulin, M., Karlsten, R., Bothelius, K. & Gordh, T. (2019). Detection of systemic inflammation in severely impaired chronic pain patients and effects of a multimodal pain rehabilitation program. Scandinavian Journal of Pain, 19(2), 235-244
Open this publication in new window or tab >>Detection of systemic inflammation in severely impaired chronic pain patients and effects of a multimodal pain rehabilitation program
Show others...
2019 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, no 2, p. 235-244Article in journal (Refereed) Published
Abstract [en]

Background and aims: Recent research indicates a previously unknown low-grade systemic or neurogenic inflammation in groups of chronic pain (CP) patients. Low-grade inflammation may have an important role in symptoms that have previously not been well depicted: widespread pain, tiredness and cognitive dysfunctions frequently seen in severely impaired CP patients. This study aimed to investigate the plasma inflammatory profile in a group of very complex CP patients at baseline and at a 1-year follow-up after participation in a cognitive behavior therapy (CBT)-based multimodal pain rehabilitation program (PRP).

Methods: Blood samples were collected from 52 well-characterized CP patients. Age- and sex-matched healthy blood donors served as controls. The samples were analyzed with a multiple Proximal Extension Analysis allowing a simultaneous analysis of 92 inflammation-related proteins consisting mainly of cytokines, chemokines and growth-factors. At follow-up, 1-year after participation in the RPR samples from 28 patients were analyzed. The results were confirmed by a multi-array technology that allows quantitative estimation.

Results: Clear signs of increased inflammatory activity were detected in the CP patients. Accepting a false discovery rate (FDR) of 5%, there were significant differences in 43/92 inflammatory biomarkers compared with the controls. In three biomarkers (CXCL5, SIRT2, AXIN1) the expression levels were elevated more than eight times. One year after the PRP, with the patients serving as their own controls, a significant decrease in overall inflammatory activity was found.

Conclusions: Our results indicate that the most impaired CP patients suffer from low-grade chronic systemic inflammation not described earlier with this level of detail. The results may have implications for a better understanding of the cluster of co-morbid symptoms described as the "sickness-syndrome" and the wide-spread pain seen in this group of patients. The decrease in inflammatory biomarkers noted at the follow-up after participation in the PRP may reflect the positive effects obtained on somatic and psycho-social mechanisms involved in the inflammatory process by a rehabilitation program. Besides the PRP, no major changes in medication or lifestyle factors were implemented during the same period. To our knowledge, this is the first study reporting that a PRP may induce inflammatory-reducing effects. Further studies are needed to verify the objective findings in CP patients and address the question of causality that remains to be solved.

Place, publisher, year, edition, pages
WALTER DE GRUYTER GMBH, 2019
Keywords
inflammatory biomarkers, severely impaired pain patients, central inflammation, systemic inflammation, pain rehabilitation program
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-382511 (URN)10.1515/sjpain-2018-0340 (DOI)000463370000003 ()30893060 (PubMedID)
Funder
VinnovaSwedish Research Council, P29797-1
Available from: 2019-04-30 Created: 2019-04-30 Last updated: 2019-04-30Bibliographically approved
Butler, S., Eek, D., Ring, L., Gordon, A. & Karlsten, R. (2019). The utility/futility of medications for neuropathic pain: an observational study. Scandinavian Journal of Pain, 19(2), 327-335
Open this publication in new window or tab >>The utility/futility of medications for neuropathic pain: an observational study
Show others...
2019 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, no 2, p. 327-335Article in journal (Refereed) Published
Abstract [en]

Background and aims

The RELIEF (Real Life) study by AstraZeneca was designed as an observational study to validate a series of Patient Reported Outcome (PRO) questionnaires in a mixed population of subjects with neuropathic pain (NP) coming from diabetes, neurology and primary care clinics. This article is an analysis of a subset of the information to include the medications used and the effects of pharmacological treatment over 6 months. The RELIEF study was performed during 2010–2013.

Methods

Subjects were recruited from various specialty clinics and one general practice clinic across Canada. The subjects were followed for a total of 2 years with repeated documentation of their status using 10 PROs. A total of 210 of the recruited subjects were entered into the data base and analyzed. Of these, 123 had examination-verified painful diabetic neuropathy (PDN) and 87 had examination-verified post-traumatic neuropathy (PTN). To evaluate the responsiveness of the PROs to change, several time points were included and this study focusses primarily on the first 6 months. Subjects also maintained a diary to document all medications, both for pain and other medical conditions, including all doses, start dates and stop dates, that could be correlated to changes in the PRO parameters.

Results

RELIEF was successful in being able to correlate the validity of the PROs and this data was used for further AstraZeneca Phase 1, 2, and 3 clinical trials of NP. To our surprise, there was very little change in pain and low levels of patient satisfaction with treatment during the trial. Approximately 15% of the subjects reported improvement, 8% worsening of pain, the remainder reported pain unchanged despite the use of multiple medications at multiple doses, alone or in combination with frequent changes of medications and doses over the study. Those taking predominantly NSAIDs (COX-inhibitors) did no worse than those taking the standard recommended medications against NP.

Conclusions

Since this is a real-life study, it reflects the clinical utility of a variety of internationally recommended medications for the treatment of NP. In positive clinical trials of these medications in selected "ideal" subjects, the effects are not overwhelming – 30% are 50% improved on average. This study shows that in the real world the results are not nearly as positive and reflects information from non-published negative clinical trials.

Implications

We still do not have very successful medications for NP. Patients probably differ in many respects from those subjects in clinical trials. This is not to negate the use of recommended medications for NP but an indication that success rates of treatment are likely to be worse than the data coming from those trials published by the pharmaceutical industry.

Keywords
neuropathic pain, real world, drug failure, diabetic neuropathy, posttraumatic neuropathy
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-372254 (URN)10.1515/sjpain-2018-0317 (DOI)000463370000012 ()30407914 (PubMedID)
Funder
AstraZeneca
Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-04-25Bibliographically approved
Radojcic, M. R., Thudium, C. S., Henriksen, K., Tan, K., Karlsten, R., Dudley, A., . . . Guermazi, A. (2017). Biomarker of extracellular matrix remodelling C1M and proinflammatory cytokine interleukin 6 are related to synovitis and pain in end-stage knee osteoarthritis patients. Pain, 158(7), 1254-1263
Open this publication in new window or tab >>Biomarker of extracellular matrix remodelling C1M and proinflammatory cytokine interleukin 6 are related to synovitis and pain in end-stage knee osteoarthritis patients
Show others...
2017 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 158, no 7, p. 1254-1263Article in journal (Refereed) Published
Abstract [en]

Little is known about local and systemic biomarkers in relation to synovitis and pain in end-stage osteoarthritis (OA) patients. We investigated the associations between the novel extracellular matrix biomarker, C1M, and local and systemic interleukin 6 (IL-6) with synovitis and pain. Serum C1M, plasma, and synovial fluid IL-6 (p-IL-6, sf-IL-6) were measured in 104 end-stage knee OA patients. Contrast-enhanced magnetic resonance imaging was used to semiquantitatively assess an 11-point synovitis score; painwas assessed by theWesternOntario and McMaster Universities Osteoarthritis Index (WOMAC) and the Neuropathic PainQuestionnaire (NPQ). Linear regression was used to investigate associations between biomarkers and synovitis, and biomarkers and pain while controlling for age, sex, and bodymass index. We also testedwhether associations between biomarkers and painwere confounded by synovitis. We found sf-IL-6 was associated with synovitis in the parapatellar subregion (B 5 0.006; 95% confidence interval [ CI] 0.003-0.010), and no association between p-IL-6 and synovitis. We also observed an association betweenC1Mand synovitis in the periligamentous subregion (B50.013; 95% CI 0.003-0.023). Furthermore, sf-IL-6, but not p-IL-6, was significantly associated with pain, WOMAC(B50.022; 95% CI 0.004-0.040), andNPQ(B50.043; 95% CI 0.005-0.082). Therewas no association betweenC1MandWOMACpain, butwe did find an association between C1M and NPQ (B50.229; 95% CI 0.036-0.422). Lastly, synovitis explained both biomarker-NPQassociations, but not the biomarker-WOMAC association. These results suggest that C1M and IL-6 are associated with synovitis and pain, and synovitis is an important confounding variable when studying biomarkers and neuropathic features in OA patients.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2017
Keywords
C1M, IL-6, MRI, Synovitis, WOMAC, Neuropathic pain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-331254 (URN)10.1097/j.pain.0000000000000908 (DOI)000404972200011 ()28333699 (PubMedID)
Available from: 2017-10-24 Created: 2017-10-24 Last updated: 2017-10-24Bibliographically approved
Radojcic, M. R., Thudium, C. S., Henriksen, K., Tan, K., Karlsten, R., Dudley, A., . . . Guermazi, A. (2017). Bone Marrow Lesions Are Associated With Pain, But Not With Inflammatory Biomarkers In End-Stage Knee Osteoarthritis Patients. Paper presented at World Congress of the Osteoarthritis-Research-Society-International (OARSI) on Osteoarthritis, APR 27-30, 2017, Las Vegas, NV. Osteoarthritis and Cartilage, 25, S374-S374
Open this publication in new window or tab >>Bone Marrow Lesions Are Associated With Pain, But Not With Inflammatory Biomarkers In End-Stage Knee Osteoarthritis Patients
Show others...
2017 (English)In: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 25, p. S374-S374Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2017
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:uu:diva-342144 (URN)000406888100640 ()
Conference
World Congress of the Osteoarthritis-Research-Society-International (OARSI) on Osteoarthritis, APR 27-30, 2017, Las Vegas, NV
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-02-22Bibliographically approved
Crema, M. D., Roemer, F. W., Li, L., Alexander, R. C., Chessell, I. P., Dudley, A. D., . . . Guermazi, A. (2017). Comparison between semiquantitative and quantitative methods for the assessment of knee synovitis in osteoarthritis using non-enhanced and gadolinium-enhanced MRI. Osteoarthritis and Cartilage, 25(2), 267-271
Open this publication in new window or tab >>Comparison between semiquantitative and quantitative methods for the assessment of knee synovitis in osteoarthritis using non-enhanced and gadolinium-enhanced MRI
Show others...
2017 (English)In: Osteoarthritis and Cartilage, ISSN 1063-4584, E-ISSN 1522-9653, Vol. 25, no 2, p. 267-271Article in journal (Refereed) Published
Abstract [en]

Objective: To compare different semiquantitative and quantitative methods using both non-enhanced and gadolinium-enhanced MRI techniques for the assessment of synovitis in knee osteoarthritis (OA). Methods: Knees with end-stage clinical OA in patients undergoing total knee replacement surgery were included in this cross-sectional study. MRI was performed on all knees. Standard non-enhanced and gadolinium-enhanced sequences were acquired. Using non-enhanced MRI, we semiquantitatively assessed two features widely used as surrogates for synovitis: effusion-synovitis and Hoffa-synovitis. Using gadolinium-enhanced sequences, we semiquantitatively assessed synovial thickness. We quantitatively evaluated the total synovial volume on the gadolinium-enhanced sequences as well. We assessed the correlations of effusion-synovitis and Hoffa-synovitis with synovial thickness and volume, applying Spearman correlation analysis. The diagnostic performance of both synovitis features on non-enhanced MRI was assessed using synovial thickness on gadolinium-enhanced MRI as the reference. Results: A total of 104 subjects (one knee per subject) were included. Correlations of effusion-synovitis with synovial thickness and volume were r = 0.41 and r = 0.43 (P < .001) r = 0.32 and r = 0.39 (P < .0001). Conclusion: Using synovial thickness assessed on gadolinium-enhanced sequences as the reference, effusion-synovitis showed superior correlations and sensitivity. Effusion-synovitis should be preferred over Hoffa-synovitis as a surrogate marker for synovial thickening, in studies of knee OA for which gadolinium-enhanced sequences are not available.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2017
Keywords
Osteoarthritis, Knee, Synovitis, Magnetic resonance imaging
National Category
Orthopaedics Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:uu:diva-318601 (URN)10.1016/j.joca.2016.09.016 (DOI)000393529500012 ()27697506 (PubMedID)
Available from: 2017-03-31 Created: 2017-03-31 Last updated: 2018-01-13Bibliographically approved
Miclescu, A., Bremer, M., Straatmann, A. & Karlsten, R. (2017). Differences and similarities between persistent neuropathic pain and neuropathy without pain after nerve suture surgery. In: : . Paper presented at 6th Congress on Neuropathic Pain Gothenburg.
Open this publication in new window or tab >>Differences and similarities between persistent neuropathic pain and neuropathy without pain after nerve suture surgery
2017 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-337388 (URN)
Conference
6th Congress on Neuropathic Pain Gothenburg
Funder
Swedish Society of Medicine
Available from: 2017-12-24 Created: 2017-12-24 Last updated: 2017-12-24
Karlsten, R. (2017). Finally a promising analgesic signal in a long-awaited new class of drugs: TRPV1 antagonist mavatrep in patients with osteoarthritis (OA). Scandinavian Journal of Pain, 17, 154-155
Open this publication in new window or tab >>Finally a promising analgesic signal in a long-awaited new class of drugs: TRPV1 antagonist mavatrep in patients with osteoarthritis (OA)
2017 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, p. 154-155Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Walter de Gruyter, 2017
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-349325 (URN)10.1016/j.sjpain.2017.08.015 (DOI)000419851500025 ()28961519 (PubMedID)
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-04-26Bibliographically approved
Hysing, E.-B., Smith, L., Eriksson, M., Karlsten, R., Butler, S. & Gordh, T. (2017). Identifying characteristics of the most severely impaired chronic pain patients treated at a specialized inpatient pain clinic. Scandinavian Journal of Pain, 17(1), 178-185
Open this publication in new window or tab >>Identifying characteristics of the most severely impaired chronic pain patients treated at a specialized inpatient pain clinic
Show others...
2017 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, no 1, p. 178-185Article in journal (Refereed) Published
Abstract [en]

Background and aims: Patients suffering from chronic nonmalignant pain constitute a heterogeneous population in terms of clinical presentation and treatment results. Few data are available about what distinguishes different groups in this huge population of patients with chronic persistent pain (CPP). A subgroup that is poorly studied, consists of the most severely impaired chronic pain patients. At the Uppsala University Hospital Pain Clinic, there is a specialized department accepting the most complex patients for rehabilitation. In the endeavour to improve and evaluate treatment for this subgroup, a better understanding of the complex nature of the illness is essential. This prospective study aimed to describe the characteristics of this subgroup of patients with CPP.

Methods: Seventy-two consecutive patients enrolled in the Uppsala programme were evaluated. We collected data on demographics, type of pain and experienced symptoms other than pain using a checklist of 41 possible symptoms. Psychiatric comorbidity was assessed by a psychiatrist using a structured clinical interview. Quality of life (QoL), pain rating and medication/drug/alcohol usage were measured by validated questionnaires: SF-36, NRS, DUDIT and AUDIT. Concerning physical functioning and sick leave, a comparison was made with data from the Swedish Quality Register Registry for pain rehabilitation (SQRP).

Results: The cohort consisted of 61% women and the average age was 45 (range 20-70) years. For this cohort, 74% reported being on sick leave or disability-pension. In the SQRP 59% were on sick leave at the time they entered the rehabilitation programmes [1]. On average, the study-population reported 22 symptoms other than pain, to be at a high rate of severity. Patients treated in conventional pain rehabilitation programmes reported a mean of 10 symptoms in average. Symptoms reported with the highest frequency (>80%), were lethargy, tiredness, headache and difficulties concentrating. Seventysix percent were diagnosed with a psychiatric disorder. Sixty-nine fulfilled the criteria for depression or depression/anxiety disorder despite that most (65%) were treated with psychotropic medication. Alcohol/drug abuse was minimal. Seventy-one percent were on opioids but the doses were moderate (<100 mg) MEq. The pain rating was >= 7 (out of a maximum of 10) for 60% of the patients.

Conclusion: This study describes what makes the subgroup of pain patients most affected by their pain special according to associated factors and comorbidity We found that they were distinguished by a high degree of psychiatric comorbidity, low physical functioning and extreme levels of symptom preoccupation/hypervigilance. Many severe symptoms additional to pain (e.g. depression/anxiety, tiredness, disturbed sleep, lack of concentration, constipation) were reported. The group seems hypervigilant, overwhelmed with a multitude of different symptoms on a high severity level.

Implications: When treating this complex group, the expressions of the illness can act as obstacles to achieve successful treatment outcomes. The study provides evidence based information, for a better understanding of the needs concerning these pain patients. Our result indicates that parallel assessment and treatment of psychiatric comorbidities and sleep disorders combined with traditional rehabilitation, i.e. physical activation and cognitive reorganization are imperative for improved outcomes.

Place, publisher, year, edition, pages
WALTER DE GRUYTER GMBH, 2017
Keywords
Characterization of patients with severe, chronic persistent pain, Subgrouping patients with chronic, persistent pain, Severely impaired patients with chronic, pain, Psychiatric comorbidity, Physical dysfunction, Systemic symptoms other than pain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-341827 (URN)10.1016/j.sjpain.2017.09.008 (DOI)000419851500030 ()29032350 (PubMedID)
Available from: 2018-02-15 Created: 2018-02-15 Last updated: 2018-02-15Bibliographically approved
Hardig, B. M., Lindgren, E., Östlund, O., Herlitz, J., Karlsten, R. & Rubertsson, S. (2017). Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial-A randomised, controlled trial. Resuscitation, 115, 155-162
Open this publication in new window or tab >>Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial-A randomised, controlled trial
Show others...
2017 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 115, p. 155-162Article in journal (Refereed) Published
Abstract [en]

Introduction: The LINC trial evaluated two ALS-CPR algorithms for OHCA patients, consisting of 3 min' mechanical chest compression (LUCAS) cycles with defibrillation attempt through compressions vs. 2 min' manual compressions with compression pause for defibrillation. The PARAMEDIC trial, using 2 min' algorithm found worse outcome for patients with initial VF/VT in the LUCAS group and they received more adrenalin compared to the manual group. We wanted to evaluate if these algorithms had any outcome effect for patients still in VF/VT after the initial defibrillation and how adrenalin timing impacted it. Method: Both groups received manual chest compressions first. Based on non-electronic CPR process documentation, outcome, neurologic status and its relation to CPR duration prior to the first detected return of spontaneous circulation (ROSC), time to defibrillation and adrenalin given were analysed in the subgroup of VF/VT patients. Results: Seven hundred and fifty-seven patients had still VF/VT after initial chest compressions combined with a defibrillation attempt (374 received mechanical CPR) or not (383 received manual CPR). No differences were found for ROSC (mechanical CPR 58.3% vs. manual CPR 58.6%, p = 0.94), or 6-month survival with good neurologic outcome (mechanical CPR 25.1% vs. manual CPR 23.0%, p = 0.50). A significant difference was found regarding the time from start of manual chest compression to the first defibrillation (mechanical CPR: 4 (2-5) min vs manual CPR 3 (2-4) min, P < 0.001). The time from the start of manual chest compressions to ROSC was longer in the mechanical CPR group. Conclusions: No difference in short-or long-term outcomes was found between the 2 algorithms for patients still in VF/VT after the initial defibrillation. The time to the 1st defibrillation and the interval between defibrillations were longer in the mechanical CPR group without impacting the overall outcome. The number of defibrillations required to achieve ROSC or adrenalin doses did not differ between the groups.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2017
Keywords
Cardiac arrest, Mechanical chest compressions, Ventricular fibrillation, Defibrillation, Adrenaline, Outcome
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-327130 (URN)10.1016/j.resuscitation.2017.04.005 (DOI)000402489400037 ()28385642 (PubMedID)
Available from: 2017-08-30 Created: 2017-08-30 Last updated: 2017-08-30Bibliographically approved
Miclescu, A., Butler, S. & Karlsten, R. (2017). The changing face of acute pain services. Scandinavian Journal of Pain, 16, 204-210
Open this publication in new window or tab >>The changing face of acute pain services
2017 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 16, p. 204-210Article in journal (Refereed) Published
Abstract [en]

Background and Aims

Acute Pain Services have been implemented initially to treat inadequate postoperative pain. This study was undertaken to prospectively review the current challenges of the APS team in an academic hospital assessing the effects of its activity on both surgical and medical pain intensity. It also define the characteristics of the patients and the risk factors influencing the multiple visits from the APS team.

Method

This prospective cohort study was conducted at Uppsala University Hospital (a Swedish tertiary and quaternary care hospital) during one year. All the patients referred to the APS team were enrolled. A standardized data collection template of demographic data, medical history, pain diagnosis, associated diseases, duration of treatment, number of visits by the APS team and type of treatment was employed. The primary outcomes were pain scores before, after treatment and the number of follow-ups. The patients were visited by APS at regular intervals and divided by the number of visits by APS team into several groups: group 1 (one visit and up to 2 follow ups); group 2 (3 to 4 follow-ups); group 3 (5 to 9 follow-ups); group 4 (10 to 19 follow-ups); group 5 (>20 followups). The difference between groups were analyzed with ordinal logistic regression analyses.

Results

Patients (n = 730) (mean age 56 ± 4, female 58%, men 42%) were distributed by service to medical (41%) and surgical (58%). Of these, 48% of patients reported a pain score of moderate to severe pain and 27% reported severe pain on the first assessment. On the last examination before discharge, they reported 25–30% less pain (P = 0.002). The median NRS (numerical rating scores) decreased significantly from 9.6 (95% confidence interval, 8.7–9.9) to 6.3 (6.1–7.4) for the severe pain (P < 0.0001), from 3.8 (3.2–4.3) to 2.4 (1.8–2.9) for the moderate pain. The odds ratio for frequent follow-ups of the patients between 18 and 85 years (n = 609) was 2.33 (95% CI: 1.35–4.02) if the patient had a history of chronic neuropathic pain, 1.80(1.25–2.60) in case the patient had a history of chronic nociceptive pain, 2.06(1.30–3.26) if he had mental diseases, and 3.35(2.21–5.08) if he had opioid dependency at the time of consultation from APS. Strong predictors of frequent visits included female gender (P = 0.04).

Conclusions

Beside the benefits of APS in reducing pain intensity, this study demonstrates that the focus of APS has been shifted from the traditional treatment of acute surgical pain to the clinical challenges of treating hospitalized patients with a high comorbidity of psychiatric diseases, opioid dependency and chronic pain.

Place, publisher, year, edition, pages
Walter de Gruyter, 2017
Keywords
Acute pain services, Predictors of uncontrolled pain, Complications of pain treatment
National Category
Medical and Health Sciences
Research subject
Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-337383 (URN)10.1016/j.sjpain.2017.04.072 (DOI)000419850300037 ()28850403 (PubMedID)
Available from: 2017-12-24 Created: 2017-12-24 Last updated: 2018-03-08Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3923-4093

Search in DiVA

Show all publications