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Butler, Stephen
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Publications (10 of 36) Show all publications
Butler, S. (2020). Laboratory biomarkers of systemic inflammation - what can they tell us about chronic pain?. Scandinavian Journal of Pain, 20(1), 5-7
Open this publication in new window or tab >>Laboratory biomarkers of systemic inflammation - what can they tell us about chronic pain?
2020 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 20, no 1, p. 5-7Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
WALTER DE GRUYTER GMBH, 2020
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-403024 (URN)10.1515/sjpain-2019-0148 (DOI)000504845500002 ()31785196 (PubMedID)
Available from: 2020-01-22 Created: 2020-01-22 Last updated: 2020-01-22Bibliographically approved
Wolfe, F., Butler, S. H., Fitzcharles, M., Haeuser, W., Katz, R. L., Mease, P. J., . . . Walitt, B. (2020). Revised chronic widespread pain criteria: development from and integration with fibromyalgia criteria. Scandinavian Journal of Pain, 20(1), 77-86
Open this publication in new window or tab >>Revised chronic widespread pain criteria: development from and integration with fibromyalgia criteria
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2020 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 20, no 1, p. 77-86Article in journal (Refereed) Published
Abstract [en]

Background and aims:

Persons with chronic widespread pain (CWP) have poor medical outcomes and increased mortality. But there are no universally accepted criteria for CWP or of methods to assess it. The most common criteria come from the 1990 American College of Rheumatology (ACR) fibromyalgia (FM) criteria, but that method (WP1990) can identify CWP with as few as three pain sites, and in subjects with wide differences in illness severity. Recently, to correct WP1990 deficiencies, the 2016 fibromyalgia criteria provided a modified CWP definition (WP2016) by dividing the body into five regions of three pain sites each and requiring a minimum of four regions of pain. Although solving the geographic problem of pain distribution, the problem of just how many pain sites (pain diffuseness) are required remained a problem, as WP2016 required as few as four painful sites. To better characterize CWP, we compared four CWP definitions with respect to symmetry, extent of pain sites and association with clinical severity variables.

Methods:

We characterized pain in 40,960 subjects, including pain at 19 individual sites and five pain regions, and calculated the widespread pain index (WPI) and polysymptomatic distress scales (PDS) from epidemiology, primary care and rheumatology databases. We developed and evaluated a new definition for CWP, (WP2019), defined as pain in four or five regions and a pain site score of at least seven of 15 sites. We also tested a definition based on the number of painful sites (WPI >= 7).

Results:

In rheumatology patients, WP1990 and WPI >= 7 classified patients with <4 regions as WSP. CWP was noted in 51.3% by WP1990, 41.7% by WP2016, 37.6% of WPI >= 7 and 33.9% by WP2019. 2016 FM criteria was satisfied in WP1990 (51.1%), WP2016 (63.3%), WPI >= 7 (69.0%) and WP2019 (76.6%). WP2019 positive patients had more severe clinical symptoms compared with WP1990, WP2016 and WPI >= 7, and similar to but less than FM 2016 positive patients. In stepwise fashion, scores for functional disability, visual analog scale fatigue and pain, WPI, polysymptomatic distress score and Patient Health Questionnaire 15 (PHQ-15) worsened from WP1990 through WP2016, WPI >= 7 and WP2019.

Conclusions:

WP2019 combines the high WPI scores of WPI >= 7 and the symmetry of WP2016, and is associated with the most abnormal clinical scores. The WP1990 does not appear to be an effective measure. We suggest that CWP can be better defined by combining 4-region pain and a total pain site score >= 7 (WP2019). This definition provides a simple, unambiguous measure that is suitable for clinical and research use as a standalone diagnosis that is integrated with fibromyalgia definitions.

Implications:

Definitions of CWP in research and clinic care are arbitrary and have varied, and different definitions of CWP identify different sets of patients, making a universal interpretation of CWP uncertain. In addition, CWP is a mandatory component of some fibromyalgia criteria. Our study provides quantitative data on the differences between CWP definitions and their criteria, allowing better understanding of research results and a guide to the use of CWP in clinical care.

Keywords
widespread pain, fibromyalgia, criteria
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:uu:diva-402629 (URN)10.1515/sjpain-2019-0054 (DOI)000504845500011 ()31596726 (PubMedID)
Available from: 2020-01-17 Created: 2020-01-17 Last updated: 2020-01-17Bibliographically approved
Butler, S. (2019). Information, back pain, and radiology. Scandinavian Journal of Pain, 19(3), 427-428
Open this publication in new window or tab >>Information, back pain, and radiology
2019 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, no 3, p. 427-428Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Walter de Gruyter, 2019
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-390329 (URN)10.1515/sjpain-2019-2011 (DOI)000473300500001 ()31228862 (PubMedID)
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-08-09Bibliographically 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
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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
Torstensson, T., Butler, S., Lindgren, A., Peterson, M., Nilsson-Wikmar, L., Eriksson, M. & Kristiansson, P. (2018). Anatomical landmarks of the intra-pelvic side-wall as sources of pain in women with and without pregnancy-related chronic pelvic pain after childbirth: a descriptive study. BMC Women's Health, 18, Article ID 54.
Open this publication in new window or tab >>Anatomical landmarks of the intra-pelvic side-wall as sources of pain in women with and without pregnancy-related chronic pelvic pain after childbirth: a descriptive study
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2018 (English)In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 18, article id 54Article in journal (Refereed) Published
Abstract [en]

Background: Chronic pelvic pain (CPP) affects 15-24% of women and can have a devastating impact on quality of life. Laparoscopy is often used in the investigation, although in one third of the examinations there is no visible pathology and the women may be dismissed without further investigation. Also, the contribution of skeletal, muscular, periosteal and ligamentous tissues to CPP remains to be further elucidated. The objective of the present study was to compare pain intensity provoked from anatomical landmarks of the intra-pelvic side-wall in women with pregnancy-related CPP after childbirth and women without such pain. Methods: This is a descriptive study of 36 non-randomly selected parous women with CPP after childbirth and 29 likewise selected parous women after childbirth without CPP. Pain was determined by questionnaire and clinical examination. The primary outcome measure was reported pain intensity provoked on 13 anatomical landmarks of the intra-pelvic side-wall. All women reported their perceived pain intensity for each anatomical landmark on Likert scales and an individual sum score was calculated. Results: Women with chronic pelvic pain were older than women without CPP. At several intra-pelvic landmarks high intensity pain was provoked in women with CPP compared with less intense pain provoked at fewer landmarks in women without low back or pelvic pain (p < 0.0001). The average sum of pain intensity scores was about 4 times higher in women with CPP (1.3) as compared with those without low back or pelvic pain (0.3), p < 0. 0001. This association remained when adjusting for the age difference between the pain groups in linear regression analysis. In addition, reported pain intensity at worst past week was independently associated with sum of pain intensity scores. The maximum individual sum of pain intensity scores among women without CPP was exceeded by that of 85% of the women with CPP. Conclusions: Parous women with CPP after childbirth had a heightened pain intensity over 13 anatomical landmarks during pelvic examination compared with parous women without CPP. These results need to be confirmed in a larger cohort with different types of CPP.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Anatomical landmarks, Intra-pelvic side-wall, Chronic pelvic pain, Pregnancy-related
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-354347 (URN)10.1186/s12905-018-0542-z (DOI)000428659500002 ()29587728 (PubMedID)
Available from: 2018-06-27 Created: 2018-06-27 Last updated: 2018-06-27Bibliographically approved
Glette, M., Landmark, T., Jensen, M. P., Woodhouse, A., Butler, S., Borchgrevink, P. C. & Stiles, T. C. (2018). Catastrophizing, Solicitous Responses From Significant Others, and Function in Individuals With Neuropathic Pain, Osteoarthritis, or Spinal Pain in the General Population. Journal of Pain, 19(9), 983-995
Open this publication in new window or tab >>Catastrophizing, Solicitous Responses From Significant Others, and Function in Individuals With Neuropathic Pain, Osteoarthritis, or Spinal Pain in the General Population
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2018 (English)In: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 19, no 9, p. 983-995Article in journal (Refereed) Published
Abstract [en]

That certain psychological factors are negatively associated with function in patients with chronic pain is well established. However, few studies have evaluated these factors in individuals with chronic pain from the general population. The aims of this study were to: 1) evaluate the unique associations between catastrophizing and perceived solicitous responses and psychological function, physical function, and insomnia severity in individuals with neuropathic pain, osteoarthritis, or spinal pain in the general population; and 2) determine if diagnosis moderates the associations found. Five hundred fifty-one individuals from the general population underwent examinations with a physician and physiotherapist, and a total of 334 individuals were diagnosed with either neuropathic pain (n = 34), osteoarthritis (n = 78), or spinal pain (n = 222). Results showed that catastrophizing was significantly associated with reduced psychological and physical function, explaining 24% and 2% of the variance respectively, whereas catastrophizing as well as perceived solicitous responding were significantly and uniquely associated with insomnia severity, explaining 8% of the variance. Perceived solicitous responding was significantly negatively associated with insomnia severity. Moderator analyses indicated that: 1) the association between catastrophizing and psychological function was greater among individuals with spinal pain and neuropathic pain than those with osteoarthritis, and 2) the association between catastrophizing and insomnia was greater among individuals with spinal pain and osteoarthritis than those with neuropathic pain. No statistically significant interactions including perceived solicitous responses were found. The findings support earlier findings of an association between catastrophizing and function among individuals with chronic pain in the general population, and suggest that diagnosis may serve a moderating role in some of these associations. Perspective: When examining persons with pain in the general population, catastrophizing is associated with several aspects of function, and diagnosis serves as a moderator for these associations. The replication of these associations in the general population support their reliability and generalizability.

Keywords
Catastrophizing, solicitous responses, osteoarthritis, spinal pain, neuropathic pain
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-365665 (URN)10.1016/j.jpain.2018.03.010 (DOI)000444365800004 ()29605692 (PubMedID)
Available from: 2018-11-14 Created: 2018-11-14 Last updated: 2018-11-14Bibliographically approved
Butler, S. (2018). Support for mirror therapy for phantom and stump pain in landmine-injured patients. Scandinavian Journal of Pain, 18(4), 561-562
Open this publication in new window or tab >>Support for mirror therapy for phantom and stump pain in landmine-injured patients
2018 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 18, no 4, p. 561-562Article in journal, Editorial material (Other academic) Published
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-373537 (URN)10.1515/sjpain-2018-0115 (DOI)000451213600001 ()30169329 (PubMedID)
Available from: 2019-01-21 Created: 2019-01-21 Last updated: 2019-01-21Bibliographically approved
Butler, S. (2017). A glimpse into a neglected population: Emerging adults. Scandinavian Journal of Pain, 17, 230-232
Open this publication in new window or tab >>A glimpse into a neglected population: Emerging adults
2017 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, p. 230-232Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Walter de Gruyter, 2017
National Category
Neurology Health Sciences
Identifiers
urn:nbn:se:uu:diva-349327 (URN)10.1016/j.sjpain.2017.08.005 (DOI)000419851500042 ()28916418 (PubMedID)
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-04-26Bibliographically approved
Breivik, H., Stubhaug, A. & Butler, S. (2017). CNS-mechanisms contribute to chronification of pain. Scandinavian Journal of Pain, 15(1), 137-139
Open this publication in new window or tab >>CNS-mechanisms contribute to chronification of pain
2017 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 15, no 1, p. 137-139Article in journal, Editorial material (Other academic) Published
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-345648 (URN)10.1016/j.sjpain.2017.03.002 (DOI)000405971800029 ()28850337 (PubMedID)
Available from: 2018-03-12 Created: 2018-03-12 Last updated: 2018-03-12Bibliographically 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
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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
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