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Burell, Gunilla
Publications (10 of 39) Show all publications
Karlsson, B., Burell, G., Kristiansson, P., Björkegren, K., Nyberg, F. & Svärdsudd, K. (2019). Decline of substance P levels after stress management with cognitive behaviour therapy in women with the fibromyalgia syndrome. Scandinavian Journal of Pain, 19(3), 473-482
Open this publication in new window or tab >>Decline of substance P levels after stress management with cognitive behaviour therapy in women with the fibromyalgia syndrome
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2019 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, no 3, p. 473-482Article in journal (Refereed) Published
Abstract [en]

Background and aims: Substance P (CSF-SP) is known to be elevated in females with fibromyalgia syndrome (FMS). The aims of this study were to evaluate the effect of cognitive behaviour therapy (CBT) on plasma SP levels in women with FMS and to find possible clinical behavioural correlates to plasma SP level changes. Methods: Forty-eight women with FMS were randomly allocated into two groups. Group 1 received the CBT treatment intervention over the course of 6 months while group 2 was waitlisted. CBT was given with a protocol developed to diminish stress and pain. After 6 months, group 2 was given the same CBT treatment as well. All were followed up 1 year after the start of CBT treatment. This approach allowed for two analytical designs a randomised controlled trial (RCT) (n=24 vs. n=24) and a before-and-after treatment design (n=48). All women were repeatedly evaluated by the West Haven-Yale Multidimensional Pain Inventory (MPI) and three other psychometric questionnaires and plasma SP was analysed. Results: In the RCT design, the plasma SP level was 8.79 fmol/mL in both groups at the start of the trial, after adjustment for initial differences. At the end of the RCT, the plasma SP level was 5.25 fmol/mL in the CBT intervention group compared to 8.39 fmol/mL in the control group (p=0.02). In the before-and-after design, the plasma SP was reduced by 33% (p <0.01) after CBT, but returned to the pre-treatment level at follow-up 1 year after the start of CBT treatment. Plasma SP was associated with the MPI dimensions experienced "support from spouses or significant others" and "life control". Conclusions: Plasma SP might be a marker of the effect of CBT in FMS associated with better coping strategies and reduced stress rather than a biochemical marker of pain.

Place, publisher, year, edition, pages
Walter de Gruyter, 2019
Keywords
fibromyalgia, substance P, cognitive behaviour therapy, stress, Westhaven-Yale Multidimensional Pain Inventory, Montgomery-Asberg Depression Rating Scale
National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-390922 (URN)10.1515/sjpain-2018-0324 (DOI)000473300500007 ()30796851 (PubMedID)
Funder
Swedish Research Council, 9459Swedish Rheumatism Association, 51/04Swedish Social Insurance Agency, 11124
Available from: 2019-08-15 Created: 2019-08-15 Last updated: 2019-08-15Bibliographically approved
Norlund, F., Wallin, E., Olsson, E., Wallert, J., Burell, G., von Essen, L. & Held, C. (2018). Internet-based Cognitive Behavior Therapy for Symptoms of Depression and Anxiety among Patients with a Recent Myocardial Infarction: The U-CARE Heart Randomized Trial. Journal of Medical Internet Research, 20(3), Article ID e88.
Open this publication in new window or tab >>Internet-based Cognitive Behavior Therapy for Symptoms of Depression and Anxiety among Patients with a Recent Myocardial Infarction: The U-CARE Heart Randomized Trial
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2018 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 3, article id e88Article in journal (Refereed) Published
Abstract [en]

Background: Symptoms of depression and anxiety are common after a myocardial infarction (MI). Internet-based cognitivebehavioral therapy (iCBT) has shown good results in other patient groups.

Objective: The aim of this study was to evaluate the effectiveness of an iCBT treatment to reduce self-reported symptoms ofdepression and anxiety among patients with a recent MI.

Methods: In total, 3928 patients were screened for eligibility in 25 Swedish hospitals. Of these, 239 patients (33.5%, 80/239women, mean age 60 years) with a recent MI and symptoms of depression or anxiety were randomly allocated to a therapist-guided,14-week iCBT treatment (n=117), or treatment as usual (TAU; n=122). The iCBT treatment was designed for post-MI patients.The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS) 14 weeks post baseline, assessedover the internet. Treatment effect was evaluated according to the intention-to-treat principle, with multiple imputations. For themain analysis, a pooled treatment effect was estimated, controlling for age, sex, and baseline HADS.

Results: There was a reduction in HADS scores over time in the total study sample (mean delta=−5.1, P<.001) but no differencebetween the study groups at follow-up (beta=−0.47, 95% CI −1.95 to 1.00, P=.53). Treatment adherence was low. A total of46.2% (54/117) of the iCBT group did not complete the introductory module.

Conclusions: iCBT treatment for an MI population did not result in lower levels of symptoms of depression or anxiety comparedwith TAU. Low treatment adherence might have influenced the result.

Trial Registration: ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 (Archived at Webciteat http://www.webcitation.org/6xWWSEQ22)

National Category
Psychology Cardiac and Cardiovascular Systems
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-336209 (URN)10.2196/jmir.9710 (DOI)000428245500002 ()25873137 (PubMedID)
Funder
Swedish Research Council, dnr 2009-1093Swedish Heart Lung Foundation, dnr E 148/11Forte, Swedish Research Council for Health, Working Life and Welfare, dnr 2014-4947Vårdal Foundation, dnr 2014-0114
Available from: 2017-12-13 Created: 2017-12-13 Last updated: 2018-07-24Bibliographically approved
Olsson, E., Norlund, F., Pingel, R., Burell, G., Gulliksson, M., Larsson, A., . . . Held, C. (2018). The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary disease: results from the SUPRIM-trial. Upsala Journal of Medical Sciences, Supplement, 123(3), 167-173
Open this publication in new window or tab >>The effect of group-based cognitive behavioral therapy on inflammatory biomarkers in patients with coronary disease: results from the SUPRIM-trial
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2018 (English)In: Upsala Journal of Medical Sciences, Supplement, ISSN 0300-9726, Vol. 123, no 3, p. 167-173Article in journal (Refereed) Published
Abstract [en]

Background: The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) is a prospective randomized controlled trial of a group-based cognitive behavioral therapy (CBT) stress management program for coronary heart disease (CHD) patients. The intervention reduced the risk of fatal or non-fatal first recurrent cardiovascular (CV) events. The aim of the present study was to analyze if the positive effects of the CBT program on clinical outcomes could have been mediated by changes in biomarkers for inflammation.

Methods: Altogether 362 patients with CHD were randomly assigned to intervention or usual care. The inflammatory biomarkers (VCAM-1, TNF-R1, TNF-R2, PTX3, and hs-CRP) were serially assessed at five time points every six months from study start until 24 months later, and analyzed with linear mixed models.

Results: Baseline levels of the inflammatory markers were near normal, indicating a stable phase. The group-based CBT stress management program did not significantly affect the levels of inflammatory biomarkers in patients with CHD. Three out of five (VCAM-1, TNF-R2, and PTX3) inflammatory biomarkers showed a slight increase over time in both study groups, and all were positively associated with age.

Conclusion: Group-based CBT stress management did not affect biomarkers for inflammation in patients with CHD. It is therefore unlikely that inflammatory processes including these biomarkers were mediating the effect the CBT program had on the reduction in CV events. The close to normal baseline levels of the biomarkers and the lack of elevated psychological distress symptoms indicate a possible floor effect which may have influenced the results.

Keywords: Biomarkers, CBT, CHD, inflammation, stress management

National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-356841 (URN)10.1080/03009734.2018.1490829 (DOI)000446977000005 ()30086659 (PubMedID)
Funder
Vårdal Foundation, V96-160Vårdal Foundation, V98-403Vårdal Foundation, 2014-0114Swedish Heart Lung Foundation, E010-95Swedish Heart Lung Foundation, E019-96Swedish Heart Lung Foundation, E019-98Swedish Heart Lung Foundation, E010-00Swedish Heart Lung Foundation, E009-01Swedish Heart Lung Foundation, E45-04Swedish Heart Lung Foundation, K-97-21x-12256-01ASwedish Heart Lung Foundation, K98-21X-12256-02BSwedish Heart Lung Foundation, K99-21X-12256-03CSwedish Heart Lung Foundation, 2009-1093Swedish National Board of Health and Welfare, 1471-601:Var95-161Forte, Swedish Research Council for Health, Working Life and Welfare, F0196/99Forte, Swedish Research Council for Health, Working Life and Welfare, 2001-1049Forte, Swedish Research Council for Health, Working Life and Welfare, 2014-4947
Available from: 2018-08-08 Created: 2018-08-08 Last updated: 2018-12-10Bibliographically approved
Wallin, E., Norlund, F., Olsson, E., Burell, G., Held, C. & Carlsson, T. (2018). Treatment Activity, User Satisfaction, and Experienced Usability of Internet-Based Cognitive Behavioral Therapy for Adults With Depression and Anxiety After a Myocardial Infarction: Mixed-Methods Study. Journal of Medical Internet Research, 20(3), Article ID e87.
Open this publication in new window or tab >>Treatment Activity, User Satisfaction, and Experienced Usability of Internet-Based Cognitive Behavioral Therapy for Adults With Depression and Anxiety After a Myocardial Infarction: Mixed-Methods Study
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2018 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 20, no 3, article id e87Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Knowledge about user experiences may lead to insights about how to improve treatment activity in Internet-based cognitive behavioral therapy (iCBT) to reduce symptoms of depression and anxiety among people with a somatic disease. There is a need for studies conducted alongside randomized trials, to explore treatment activity and user experiences related to such interventions, especially among people with older age who are recruited in routine care.

OBJECTIVE:

The aim of the study was to explore treatment activity, user satisfaction, and usability experiences among patients allocated to treatment in the U-CARE Heart study, a randomized clinical trial of an iCBT intervention for treatment of depression and anxiety following a recent myocardial infarction.

METHODS:

This was a mixed methods study where quantitative and qualitative approaches were used. Patients were recruited consecutively from 25 cardiac clinics in Sweden. The study included 117 patients allocated to 14 weeks of an iCBT intervention in the U-CARE Heart study. Quantitative data about treatment activity and therapist communication were collected through logged user patterns, which were analyzed with descriptive statistics. Qualitative data with regard to positive and negative experiences, and suggestions for improvements concerning the intervention, were collected through semistructured interviews with 21 patients in the treatment arm after follow-up. The interviews were analyzed with qualitative manifest content analysis.

RESULTS:

Treatment activity was low with regard to number of completed modules (mean 0.76, SD 0.93, range 0-5) and completed assignments (mean 3.09, SD 4.05, range 0-29). Most of the participants initiated the introduction module (113/117, 96.6%), and about half (63/117, 53.9%) of all participants completed the introductory module, but only 18 (15.4%, 18/117) continued to work with any of the remaining 10 modules, and each of the remaining modules was completed by 7 or less of the participants. On average, patients sent less than 2 internal messages to their therapist during the intervention (mean 1.42, SD 2.56, range 0-16). Interviews revealed different preferences with regard to the internet-based portal, the content of the treatment program, and the therapist communication. Aspects related to the personal situation and required skills included unpleasant emotions evoked by the intervention, lack of time, and technical difficulties.

CONCLUSIONS:

Patients with a recent myocardial infarction and symptoms of depression and anxiety showed low treatment activity in this guided iCBT intervention with regard to completed modules, completed assignments, and internal messages sent to their therapist. The findings call attention to the need for researchers to carefully consider the preferences, personal situation, and technical skills of the end users during the development of these interventions. The study indicates several challenges that need to be addressed to improve treatment activity, user satisfaction, and usability in internet-based interventions in this population.

Keywords
adherence; attrition; cognitive behavioral therapy; computer-assisted therapy; internet; mental health; myocardial infarction
National Category
Psychology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-347341 (URN)10.2196/jmir.9690 (DOI)000428245500001 ()29549067 (PubMedID)
Funder
Swedish Research Council, dnr 2009-1093Swedish Heart Lung FoundationForte, Swedish Research Council for Health, Working Life and Welfare, dnr 2014-4947Vårdal Foundation, dnr 2014-0114
Available from: 2018-03-29 Created: 2018-03-29 Last updated: 2018-07-23Bibliographically approved
Norlund, F., Wallin, E., Olsson, E., Wallert, J., Burell, G. & Held, C. (2018). Web-Based Cognitive Behavior Therapy for Depression and Anxiety among Patients with a recent Myocardial Infarction: The U-CARE Heart Randomized Trial. Paper presented at 67th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), MAR 10-12, 2018, Orlando, FL. Journal of the American College of Cardiology, 71(11), 1884-1884
Open this publication in new window or tab >>Web-Based Cognitive Behavior Therapy for Depression and Anxiety among Patients with a recent Myocardial Infarction: The U-CARE Heart Randomized Trial
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2018 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 71, no 11, p. 1884-1884Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background

Symptoms of depression and anxiety are common after a myocardial infarction (MI). Web-based cognitive behavioral therapy (wCBT) may improve access to effective psychological treatment to reduce these symptoms. The aim of this prospective randomized trial was to evaluate the effectiveness of a wCBT intervention to reduce self-reported symptoms of depression and anxiety among patients with a recent MI.

Methods

In total, 3928 patients were assessed for eligibility in routine care setting at 25 hospitals. Of these, 239 patients (33% women, mean age 60 years) with a recent MI (< 3 months) and symptoms of depression and/or anxiety assessed with Hospital Anxiety and Depression Scale (HADS) were randomly allocated to a therapist-supported 14 week wCBT program (n=117) or standard of care (n=122). The wCBT program was a tailored intervention with 10 different eligible modules, especially designed for MI patients. Treatment was evaluated according to the intention-to-treat principle. The primary outcome was group difference in HADS total score (HADS-T) at follow-up. Multiple imputation was performed. The pooled treatment effect was thereafter estimated in a multiple linear model, controlling for baseline HADS, age and sex.

Results

There was a reduction in HADS-T over time in the total study sample (delta = -5.1; P < .0001). The difference at follow-up between the wCBT group and the control group with regard to HADS-T was non-significant (-0.47, [-1.95, 1.00], P=0.53). Treatment adherence was low. In the treatment group, 54% completed the introductory module and 15% completed additional modules.

Conclusion

This wCBT program did not reduce symptoms of depression and/or anxiety in post-MI patients as compared to standard of care. Low treatment adherence was observed and reasons for this needs to be further explored.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2018
National Category
Cardiac and Cardiovascular Systems Psychiatry
Identifiers
urn:nbn:se:uu:diva-357332 (URN)10.1016/S0735-1097(18)32425-2 (DOI)000429659703534 ()
Conference
67th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), MAR 10-12, 2018, Orlando, FL
Available from: 2018-08-16 Created: 2018-08-16 Last updated: 2018-08-16Bibliographically approved
Norlund, F., Olsson, E. M., Pingel, R., Held, C., Svärdsudd, K., Gulliksson, M. & Burell, G. (2017). Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial. Paper presented at International Society of Behavioral Medicine, Groningen 2014. European Journal of Preventive Cardiology, 24(9), 917-925
Open this publication in new window or tab >>Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial
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2017 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 9, p. 917-925Article in journal (Refereed) Published
Abstract [en]

Background:The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) was a randomized controlledtrial of a group-based cognitive behavioural therapy stress management programme for patients with coronary heartdisease. The project was successful in reducing the risk of fatal or non-fatal first recurrent cardiovascular events. The aimof this study was to analyse the effect of cognitive behavioural therapy on self-rated stress, somatic anxiety, vitalexhaustion and depression and to study the associations of these factors with the reduction in cardiovascular events.

Methods:A total of 362 patients were randomly assigned to intervention or usual care groups. The psychologicaloutcomes were assessed five times during 24 months and analysed using linear mixed models. The mediating roles of theoutcomes were analysed using joint modelling of the longitudinal and time to event data.

Results:The intervention had a positive effect on somatic anxiety (p<0.05), reflecting a beneficial development overtime compared with the controls. Stress, vital exhaustion and depression did not differ between the groups over time.Mediator analysis suggested that somatic anxiety may have mediated the effect of treatment on cardiovascular events.

Conclusions:The intervention had a small positive effect on somatic anxiety, but did not affect stress, vital exhaustionor depression in patients with coronary heart disease. Somatic anxiety was associated with an increased risk of cardio-vascular events and might act as a partial mediator in the treatment effect on cardiovascular events. However, themechanisms between the intervention and the protective cardiovascular outcome remain to be identified.

Keywords
Stress management, cognitive behavioural therapy, coronary heart disease, depression, anxiety, vital exhaustion
National Category
Psychology Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-315597 (URN)10.1177/2047487317693131 (DOI)000401147700004 ()28195501 (PubMedID)
Conference
International Society of Behavioral Medicine, Groningen 2014
Funder
Vårdal FoundationForte, Swedish Research Council for Health, Working Life and WelfareSwedish National Board of Health and WelfareSwedish Research Council
Available from: 2017-02-16 Created: 2017-02-16 Last updated: 2017-12-20Bibliographically approved
Burell, G. (2016). Behavior As The Key Component In Psychological Interventions For CHD Patients. International Journal of Behavioral Medicine, 23, S208-S208
Open this publication in new window or tab >>Behavior As The Key Component In Psychological Interventions For CHD Patients
2016 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, p. S208-S208Article in journal (Refereed) Published
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-313851 (URN)000388943400655 ()
Available from: 2017-01-26 Created: 2017-01-25 Last updated: 2017-11-29Bibliographically approved
Jennings, G., Tully, P., Burell, G. & Albus, C. (2016). Biopsychosocial Aspects In The Prevention Of Cardiovascular Diseases. International Journal of Behavioral Medicine, 23, S208-S208
Open this publication in new window or tab >>Biopsychosocial Aspects In The Prevention Of Cardiovascular Diseases
2016 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, p. S208-S208Article in journal, Meeting abstract (Refereed) Published
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-313853 (URN)000388943400652 ()
Available from: 2017-01-26 Created: 2017-01-25 Last updated: 2017-11-29Bibliographically approved
Norlund, F., Olsson, E., Wallin, E., Burell, G. & Held, C. (2016). The Development and Feasablity of an Internet-Based Cognitive Behavioral Intervention to reduce Depression and/or Anxiety after a Myocardial Infarction - The U-CARE Heart study. In: : . Paper presented at The 74th Annual Meeting of American Psychosomatic Society (pp. A103-A103). , 78(3)
Open this publication in new window or tab >>The Development and Feasablity of an Internet-Based Cognitive Behavioral Intervention to reduce Depression and/or Anxiety after a Myocardial Infarction - The U-CARE Heart study
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2016 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-284137 (URN)10.1097/PSY.0000000000000343 (DOI)000373949800331 ()
Conference
The 74th Annual Meeting of American Psychosomatic Society
Available from: 2016-04-15 Created: 2016-04-15 Last updated: 2017-03-14Bibliographically approved
Karlsson, B., Burell, G., Anderberg, U. M. & Kurt, S. (2015). Cognitive behaviour therapy in women with fibromyalgia: A randomized cllinical trial. Scandinavian Journal of Pain, 9, 11-21
Open this publication in new window or tab >>Cognitive behaviour therapy in women with fibromyalgia: A randomized cllinical trial
2015 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 9, p. 11-21Article in journal (Refereed) Published
Abstract [en]

Background and aims

Stress has been pointed out as an important influential factor in the development and maintaining of the fibromyalgia syndrome (FMS). Since stress may worsen the pain experience, the development of individual strategies for coping with stress is essential to reduce the impact of FMS on daily life. The aim of the study was to investigate whether a group based stress management cognitive behaviour therapy (CBT) programme could influence self-reported stress, wellbeing and life control, as well as self-reported pain behaviour in female FMS patients.

Methods

48 female FMS patient were randomized into a cognitive behaviour therapy treatment group (n = 24) and a waitlist control group (n = 24). When the 6 months waitlist period was over the control group received the same CBT programme. This allowed two analytical approaches, one based on the randomized controlled trial design and one based on a before-and-after design to improve the statistical power of the study. Four psychometric instruments were used: The West Haven-Yale Multidimensional Pain Inventory (three parts, MPI-1 to MPI-3), the Maastricht Questionnaire, the Everyday Life Stress, and the Montgomery-Åsberg Depression rating scale – self-reported. Primary outcome was the MPI-1 dimension ‘life control’, secondary outcomes were the MPI-1 dimensions ‘interference’, ‘affective distress’ and ‘support from spouses or significant others’, the various MPI-2 dimensions, the ‘general activity level’ in the MPI-3 dimension, and ‘vital exhaustion’, ‘stress behaviour’, and ‘depression’. The only tertiary outcome was the MPI-1 dimension ‘pain severity’.

Results

In the RCT design the West Haven-Yale Multidimensional Pain Inventory dimensions ‘life control’, ‘interference from pain’, ‘affective distress’, ‘support from spouses or significant others’, and ‘distracting responses’ and ratings for depression improved in the treatment group as compared with the control group. In the before-and after design these improvements were maintained and enhanced during 1-year follow-up, and so was the ‘vital exhaustion’ and ‘stress behaviour’. ‘Pain severity’ was rated higher after the intervention.

Conclusions

Cognitive behaviour therapy improved the life control in a female population with FMS. Coping behaviour in response to chronic pain was improved at the same time and in spite of higher subjective ratings of pain. Positive effects were seen on depression, vital exhaustion and stress behaviour. The effects of therapy were maintained and enhanced during the follow up period. It appears that women with FMS after the CBT treatment, according to this protocol obtained tools leading to better acceptance of their disorder.

National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-292588 (URN)10.1016/j.sjpain.2015.04.027 (DOI)
Available from: 2016-05-04 Created: 2016-05-04 Last updated: 2018-01-10Bibliographically approved
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