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  • 1. Aili, K
    et al.
    Nyman, T
    Svartengren, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Hillert, L
    Sleep as a predictive factor for the onset and resolution of multi-site pain: A 5-year prospective study2015Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 19, nr 3, s. 341-349Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Disturbed sleep and pain often co-exist and the relationship between the two conditions is complex and likely reciprocal. This 5-year prospective study examines whether disturbed sleep can predict the onset of multi-site pain, and whether non-disturbed sleep can predict the resolution of multi-site pain.

    METHODS: The cohort (n = 1599) was stratified by the number of self-reported pain sites: no pain, pain from 1-2 sites and multi-site pain (≥3 pain sites). Sleep was categorized by self-reported sleep disturbance: sleep A (best sleep), sleep B and sleep C (worst sleep). In the no-pain and pain-from-1-2 sites strata, the association between sleep (A, B and C) and multi-site pain 5 years later was analysed. Further, the prognostic value of sleep for the resolution of multi-site pain at follow-up was calculated for the stratum with multi-site pain at baseline. In the analyses, gender, age, body mass index, smoking, physical activity and work-related exposures were treated as potential confounders.

    RESULTS: For individuals with no pain at baseline, a significantly higher odds ratio for multi-site pain 5 years later was seen for the tertile reporting worst sleep [odds ratio (OR) 4.55; 95% confidence interval (CI) 1.28-16.12]. Non-disturbed (or less disturbed) sleep had a significant effect when predicting the resolution of multi-site pain (to no pain) (OR 3.96; 95% CI 1.69-9.31).

    CONCLUSION: In conclusion, sleep could be relevant for predicting both the onset and the resolution of multi-site pain. It seems to be a significant factor to include in research on multi-site pain and when conducting or evaluating intervention programmes for pain.

  • 2.
    Amandusson, Åsa
    et al.
    Division of Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University.
    Blomqvist, Anders
    Estrogen receptor-α expression in nociceptive-responsive neurons in the medullary dorsal horn of the female rat2010Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, nr 3, s. 245-248Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Estrogens exert a substantial influence on the transmission of nociceptive stimuli and the susceptibility to pain disorders as made evident by studies in both animals and human subjects. The estrogen receptor (ER) seems to be of crucial importance to the cellular mechanisms underlying such an influence. However, it has not been clarified whether nociceptive neurons activated by pain express ERs. In this study, a noxious injection of formalin was given into the lower lip of female rats, thereby activating nociceptive neurons in the trigeminal subnucleus caudalis as demonstrated by immunohistochemical labeling of Fos. Using a dual-label immunohistochemistry protocol ERalpha-containing cells were visualized in the same sections. In the superficial layers of the medullary dorsal horn, 12% of ERalpha-labeled cells, mainly located in lamina II, also expressed noxious-induced Fos. These findings show that nociceptive-responsive neurons in the medullary dorsal horn express ERalpha, thus providing a possible morphological basis for the hypothesis that estrogens directly regulate pain transmission at this level.

  • 3.
    André, Malin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Löfvander, Monica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    A study of primary care physicians rating their immigrant patients' pain intensity2013Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 17, nr 1, s. 132-139Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Few studies focus on how physicians evaluate pain in foreign-born patients with varying cultural backgrounds. This study aimed to compare pain ratings [visual analogue scale (VAS) 0-100] done by Swedish primary care physicians and their patients, and to analyse which factors predicted physicians' higher ratings of pain in patients aged 18-45 years with long-standing disabling back pain.

    METHODS:

    The two physicians jointly carried out the somatic and psychiatric diagnostic evaluations and alternated as consulting doctor or observer. One-third of the consultations were interpreted. Towards the end of the consultations, the patients rated their pain intensity 'right now' (patients' VAS). After the patient had left, the two physicians independently rated how much pain they thought the patient had, without looking at the patient's VAS score. The mean of the two doctors' VAS values (physicians' VAS) for each patient was used in the logistic regression calculations of odds ratios (OR) in main effect models for physicians' VAS above median (md) with patient's sex, education, origin, depression, psychosocial stress and pain sites as explanatory variables.

    RESULTS:

    Physicians' VAS values were significantly lower (md 15) than patients' VAS (md 66; women md 73, men md 52). The ratings showed no significant association with whether the physician was acting as consultant or observer. The higher physician VAS was only predicted by findings of multiple pain sites.

    CONCLUSIONS:

    Physicians appear to overlook psychological and emotional aspects when rating the pain of patients from other cultural backgrounds. This finding highlights a potential problem in multicultural care settings.

  • 4.
    Brattberg, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Connective tissue massage in the treatment of fibromyalgia1999Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 3, nr 3, s. 235-244Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to investigate the effect of connective tissue massage in the treatment of individuals with fibromyalgia. The results of this random study of 48 individuals diagnosed with fibromyalgia (23 in the treatment group and 25 in the reference group) show that a series of 15 treatments with connective tissue massage conveys a pain relieving effect of 37%, reduces depression and the use of analgesics, and positively effects quality of life. The treatment effects appeared gradually during the 10-week treatment period. Three months after the treatment period about 30% of the pain relieving effect was gone, and 6 months after the treatment period pain was back to about 90% of the basic value. As long as there is a lack of effective medical treatment for individuals with fibromyalgia, they ought to be offered treatments with connective tissue massage. However, further studies are needed in the mechanisms behind the treatment effects.

  • 5.
    Brattberg, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Do pain problems in young school children persist into early adulthood?: A 13-year follow-up2004Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 8, nr 3, s. 187-199Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Design. In a longitudinal study, 335 children ages 8, 11 and 14, first studied in 1989 were followed-up on two occasions in 1991 and 2002. The subjects filled in questionnaires on pain, the first two times in school, the last as a postal survey.

    Purposes. To determine if headache and back pain during the school years were transitory or if they grew into pain problems in adulthood; to determine predictors of pain.

    Results. In the 2002 study, 59% of the women and 39% of the men reported pain at 21, 24 and 27 years. A total of 68 (52 women, 16 men) or 20% of the subjects reported pain symptoms in all three studies. The cumulative incidence rate for the presence of pain in the cohort studied was 31% for 1989–2002 and 43% for 1991–2002. Four of the 10 individuals with pain also reported signs of stress. Three predictors were found: reported back pain in 8–14-year-olds (p<0.0001); reported headaches once a week or more in the same age group (p<0.0001); and a positive response in the ages 10–16 to the question: “Do you often feel nervous?” (OR=2.1, 95% CI 1.3–3.4). When adjusted for age, sex and all psychosocial risk determinants studied in multiple logistic regression, a positive answer to this question was a significant predictor of pain in young adulthood. A positive response by the 10–16-year-olds to “Do you find it difficult to describe your feelings?” was a predictor of pathological anxiety in early adulthood, but stress perceived in childhood/adolescence did not predict future pain or stress.

    Conclusions. Since pain reports in childhood and early adolescence seem to be associated with the report of pain in early adulthood, more attention should be given to the way ill-health is managed in adolescence in this vulnerable group.

  • 6.
    Buhrman, Monica
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Fredriksson, Anders
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Edström, G.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Shafiei, D.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Tärnqvist, C.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Ljóttson, B.
    Hursti, Timo
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Gordh, Torsten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Andersson, G.
    Guided Internet-delivered cognitive behavioural therapy for chronic pain patients who have residual symptoms after rehabilitation: Randomized controlled trial2013Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 17, nr 5, s. 753-765Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Chronic pain can be treated with cognitive behavioural therapy delivered in multidisciplinary settings. However, relapse is likely, and there is a need for cost-effective secondary interventions for persons with residual problems after rehabilitation. The aim of the present study was to investigate the effects of a guided Internet-delivered cognitive behavioural intervention for patients who had completed multidisciplinary treatment at a pain management unit. Methods A total of 72 persons with residual pain problems were included in the study and were randomized to either treatment for 8 weeks or to a control group who were invited to participate in a moderated online discussion forum. The participants had different chronic pain conditions, and a majority were women (72%). Twenty-two percent of the participants dropped out of the study before the post-treatment assessment. Results Intent-to-treat analyses demonstrated differences on the catastrophizing subscale of the Coping Strategies Questionnaire (Cohen's d=0.70), in favour of the treatment group but a small within-group effect. Differences were also found on other measures of pain-related distress, anxiety and depressive symptoms. A 6-month follow-up exhibited maintenance of improvements. Conclusions We conclude that Internet-delivered treatment can be partly effective for persons with residual problems after completed pain rehabilitation.

  • 7.
    Falla, D.
    et al.
    Univ Hosp Gottingen, Pain Clin, Ctr Anesthesiol Emergency & Intens Care Med, Gottingen, Germany.;Univ Birmingham, Sch Sport Exercise & Rehabil Sci, Coll Life & Environm Sci, Birmingham, W Midlands, England..
    Peolsson, A.
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, S-58183 Linkoping, Sweden..
    Peterson, G.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, S-58183 Linkoping, Sweden..
    Ludvigsson, M. L.
    Linkoping Univ, Dept Med & Hlth Sci, Div Physiotherapy, S-58183 Linkoping, Sweden.;Cty Council Ostergotland, Rehab Vast, Motala, Sweden..
    Soldini, E.
    Univ Appl Sci & Arts Southern Switzerland SUPSI, Dept Business Econ Hlth & Social Care, Manno, Switzerland..
    Schneebeli, A.
    Univ Appl Sci & Arts Southern Switzerland, Rehabil Res Lab, Dept Business Econ Hlth & Social Care, Manno, Switzerland..
    Barbero, M.
    Univ Appl Sci & Arts Southern Switzerland, Rehabil Res Lab, Dept Business Econ Hlth & Social Care, Manno, Switzerland..
    Perceived pain extent is associated with disability, depression and self-efficacy in individuals with whiplash-associated disorders2016Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, nr 9, s. 1490-1501Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BackgroundCompletion of a pain drawing is a familiar task in those presenting with whiplash-associated disorders (WAD). Some people report pain almost over their entire body. Yet the reasons for larger pain extent have not been fully explored. MethodsA novel method was applied to quantify pain extent from the pain drawings of 205 individuals with chronic WAD. Pain extent was evaluated in relation to sex, age, educational level, insurance status and financial status. Multiple linear regression analysis was used to verify whether pain extent was associated with other health indicators including perceived pain and disability, health-related quality of life, pain catastrophizing, anxiety, depression and self-efficacy. ResultsPain extent was influenced by sex ((2):10.392, p<0.001) with larger pain extent in women compared to men (7.887.66% vs. 5.406.44%). People with unsettled insurance claims ((2): 7.500, p<0.05) and those with a worse financial situation ((2):12.223, p<0.01) also had larger pain extent. Multiple linear regression models revealed that, when accounting for age, sex, education, insurance status, financial status and neck pain intensity, pain extent remained associated with perceived disability (p<0.01), depression (p<0.05) and self-efficacy (p<0.001). ConclusionBy utilizing a novel method for pain extent quantification, this study shows that widespread pain is associated with a number of factors including perceived disability, depression and self-efficacy in individuals with chronic WAD. Widespread pain should alert the clinician to consider more specific psychological screening, particularly for depression and self-efficacy, in patients with WAD. What does this study add?Women with chronic WAD, those with unsettled insurance claims and those with poorer financial status perceive more widespread pain. When controlling for these factors, larger pain areas remain associated with perceived pain and disability, depression and self-efficacy. The pain drawing is useful to support psychological screening in people with chronic WAD.

  • 8.
    Gilpin, Helen
    et al.
    Guy's and St Thomas' NHSFT.
    Stahl, Daniel
    King's College London.
    McCracken, Lance
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    A theoretically guided approach to identifying predictors of treatment outcome in contextual CBT for chronic pain2019Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 23, nr 2, s. 354-366Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Psychological treatments are known to be effective for chronic pain, but little is understood about which patients are most likely to benefit from which ones.

    METHODS:

    The study reported here included 609 people who attended a residential, interdisciplinary, pain management programme based on Acceptance and Commitment Therapy between January 2012 and August 2014. A flexible and theoretically guided approach to model building based on fractional polynomials was used to identify potential predictors of outcome in domains of emotional, physical and social functioning and pain intensity. Variables considered for inclusion were baseline demographic variables along with measures reflecting processes of psychological flexibility, including acceptance, cognitive defusion and committed action.

    RESULTS:

    Employment status, level of distress, decentring (a process like cognitive defusion) and acceptance significantly contributed to the model above and beyond the effects of other baseline variables. The unique effects of these were small but may be clinically relevant.

    CONCLUSIONS:

    Future research should continue to investigate moderators of treatment outcome and to explicitly link these to treatment mechanisms. Taking a flexible, theoretically driven approach to modelling continuous outcomes may be valuable in furthering our understanding of which patients might respond best to which treatments.

    SIGNIFICANCE:

    Further research is needed to better understand who benefits most from psychological treatments for chronic pain. This study suggests that a flexible, multivariate and theoretical approach to identifying predictors of outcome may be valuable in furthering research in this area.

  • 9. Gustavsson, A.
    et al.
    Bjorkman, J.
    Ljungcrantz, C.
    Rhodin, Annika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Rivano-Fischer, M.
    Sjolund, K. -F
    Mannheimer, C.
    Socio-economic burden of patients with a diagnosis related to chronic pain: Register data of 840,000 Swedish patients2012Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 16, nr 2, s. 289-299Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Chronic pain constitutes a substantial socio-economic challenge but little is known about its actual cost.

    Aim: To estimate the direct and indirect costs of patients with a diagnosis related to chronic pain (DRCP), to determine variation in these costs across different diagnosis groups, and to identify what resources constitute the most important components of costs.

    Methods: Patient level data from three administrative registries in Vastra Gotalandsregionen in Sweden including inpatient and outpatient care, prescriptions, long-term sick-leaves, and early retirement were extracted. Patients with a DRCP between January 2004 and November 2009 were selected.

    Results: In total, 840,000 patients with a DRCP were identified. The mean total costs per patient and year were estimated at 6400 EUR but were higher for patients with cancer (10,400 EUR). Patients on analgesic drugs had more than twice as high costs as patients without analgesic drugs, on average. Indirect costs (sick-leaves and early retirement) constituted the largest cost component (59%) followed by outpatient (21%) and inpatient care (14%), whereas analgesic drug prescriptions constituted less than 1 percent of the total.

    Conclusions: The socio-economic burden of patients with a diagnosis related to chronic pain amounts to 32 billion EUR per year, when findings from Vastra Gotalandsregionen are extrapolated to the whole of Sweden. This compares to a fifth of the total Swedish tax burden in 2007 or about a tenth of Swedish GDP. This study does not provide evidence on what costs are caused by chronic pain per se. However, the higher costs of patients on analgesic drugs might indicate that the consequences of pain are of major importance.

  • 10.
    Gustavsson, Catharina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Denison, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    von Koch, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna.
    Self-management of persistent neck pain: a randomized controlled trial of a multi-component group intervention in primary health care2010Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, nr 6, s. 630.e1-630.e11Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Studies regarding self-management of persistent neck pain are infrequent. Objective: to compare treatment effects of (a) a multi-component pain and stress self-management group intervention (PASS) and (b) individually administered physical therapy (IAPT) for patients with persistent musculoskeletal tension-type neck pain. Methods: Persons seeking physical therapy treatment due to persistent tension-type neck pain at nine primary health care centers in Sweden were randomly assigned to either PASS or IAPT. Before treatment (baseline) and at 10- and 20-weeks the participants completed a self-assessment questionnaire comprising: the Self-Efficacy Scale, the Neck Disability Index, the Coping Strategies Questionnaire, the Hospital Anxiety and Depression Scale, the Fear-Avoidance Beliefs Questionnaire and questions regarding neck pain, analgesics and utilization of health care. Intention-to-treat analyses were performed using repeated measures analysis of variance between baseline, 10-week and 20-week follow-up. Results: One hundred and fifty six participants were included (PASS n=77, IAPT n=79). On average participants receiving PASS attended seven treatment sessions and participants receiving IAPT 11 sessions over the 20-week follow-up period. Repeated measures ANCOVA showed significant time x group interaction effects for ability to control pain (p<0.001), self-efficacy regarding pain-interfering activities (p=0.005), disability due to neck pain (p=0.001) and levels of catastrophic thinking (p<0.001) in favour of PASS. Conclusion: PASS had a better effect than IAPT in the treatment of persistent musculoskeletal tension-type neck pain regarding coping with pain, in terms of patients' self-reported pain control, self-efficacy, disability and catastrophizing, over the 20-week follow-up.

  • 11. Hamunen, Katri
    et al.
    Laitinen-Parkkonen, Pirjo
    Paakkari, Pirkko
    Breivik, Harald
    Gordh, Torsten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Jensen, Niels Henrik
    Kalso, Eija
    What do different databases tell about the use of opioids in seven European countries in 2002?2008Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, nr 6, s. 705-715Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    The objective of this paper was to analyse opioid consumption in a number European countries using different sources of data.

    Methods

    Data were extracted from the United Nations’ International Narcotics Control Board Report (INCB) 2003 and from the registers of the national health authorities in seven countries where data were available for 2002. The amount of opioid used was calculated as daily defined doses per 1000 inhabitants per day (DDD/1000/day). Danish Register of Medicinal Products Statistics was further explored for characteristics of opioid consumption (age, gender, type of opioids consumed) by patients in primary care. Total opioid consumption and consumption of 11 selected opioids (7 strong and 4 weak) were analysed. The amount of opioids consumed by outpatients was also examined.

    Results

    There were considerable differences in the number of opioids reported and significant discrepancies in the amounts of opioids consumed between the national data and the INCB report. The source of data for the national registers on drug consumption varied (pharmacies or wholesale). The INCB data provide information on opioid import and estimated need rather than on medical consumption.

    Conclusions

    Caution is required when interpreting the data on opioid consumption between countries because of differences in the collection and reporting of data. Better recording of opioid consumption is needed for meaningful analysis of opioid consumption and its possible effect on pain management in different countries. Data on opioids consumed for cancer-related pain in comparison with chronic non-malignant pain are needed. A uniform method of collection of data on analgesic consumption should be established for all European countries.

  • 12.
    Haukenes, Inger
    et al.
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Hensing, G.
    Stålnacke, Britt-Marie
    Umeå universitet, Rehabiliteringsmedicin.
    Hammarström, Anne
    Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Does pain severity guide selection to multimodal pain rehabilitation across gender?2015Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 19, nr 6, s. 826-833Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Studies have addressed the effect of multimodal pain rehabilitation (MMR), whereas criteria for selection are sparse. This study examines whether higher scores on musculoskeletal pain measures are associated with selection to MMR, and whether this differs across gender.

    Method A clinical population of 262 male and 589 female patients was recruited consecutively during 3 years, 2007-2010. The patients were referred from primary care to a pain rehabilitation clinic in Northern Sweden for assessment and selection to MMR. Register-based data on self-reported pain were linked to patients' records where outcome (MMR or not) was stated. We modelled odds ratios for selection to MMR by higher scores on validated pain measures (pain severity, interference with daily life, pain sites and localized pain vs. varying pain location). Covariates were age, educational level and multiple pain measures. Anxiety and depression (Hospital, Anxiety and Depression Scale) and working status were used in sensitivity tests.

    Results Higher scores of self-reported pain were not associated with selection to MMR in multivariate models. Among women, higher scores on pain severity, pain sites and varying pain location (localized pain=reference) were negatively associated with selection to MMR. After adjustment for multiple pain measures, the negative odds ratio for varying location persisted (OR=0.59, 95% CI=0.39-0.89).

    Conclusion Higher scores on self-reported pain did not guide selection to MMR and a negative trend was found among women. Studies of referral patterns and decision processes may contribute to a better understanding of the clinical practice that decides selection to MMR.

  • 13.
    Hedén, Lena E.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    von Essen, Louise
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Psykosocial onkologi och stödjande vård.
    Ljungman, Gustaf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Effect of morphine in needle procedures in children with cancer2011Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 15, nr 10, s. 1056-1060Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The aim was to investigate whether children experience less fear, distress, and/or pain when they receive oral morphine vs. placebo before a needle is inserted in a subcutaneously implanted intravenous port when combined with topical anesthesia.

    Method: Fifty children 1-18 years of age who were treated in a pediatric oncology and hematology setting were included consecutively when undergoing routine needle insertion into an intravenous port. All children were subjected to one needle insertion following topical anesthetic (EMLA) application in this randomized, triple-blind, placebo-controlled study comparing orally administered morphine (n = 26) 0.25 mg/kg body weight with placebo (n = 24). The patients' fear, distress, and pain were reported by parents, nurses and the children themselves (if >= 7 years of age) on 0-100 mm Visual Analogue Scales. In addition, observational methods were used to measure distress and procedure pain.

    Results: No differences between the morphine and the placebo group were found with respect to age, weight, height, physical status, sex, weeks from diagnosis, or weeks from latest needle insertion. According to, parents, nurses, and children, oral morphine at a dose of 0.25 mg/kg body weight did not reduce fear, distress or pain compared with placebo.

    Conclusion: We could not reject the null hypothesis that there is no difference between the oral morphine and placebo groups assuming an effect size of 15 mm on VAS. Therefore it seems that oral morphine at 0.25 mg/kg does not give any additional reduction of fear, distress or pain compared with placebo when combined with topical anesthesia in pediatric patients undergoing subcutaneous port needle insertion, and would not be expected to be of any advantage for similar procedures such as venipuncture and venous cannulation when topical anesthesia is used.

  • 14.
    Hedén, Lena
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    von Essen, Louise
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk psykologi i hälso- och sjukvård.
    Ljungman, Gustaf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    The relationship between fear and pain levels during needle procedures in children from the parents’ perspective2016Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, nr 2, s. 223-230Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The primary objective was to determine the levels of and potential relationships between procedure-related fear and pain in children. Secondary objectives were to determine if there are associations between the child’s age and sex, diagnostic group, time since diagnosis, time since last needle insertion, cortisol levels and the parent’s fear level in relation to fear and pain.

    Methods: The child’s level of pain and fear was reported by parents on 0–100 mm visual analogue scales (VAS). One hundred and fifty-one children were included consecutively when undergoing routine needle insertion into a subcutaneously implanted intravenous port. All children were subjected to one needle insertion following topical anaesthesia (EMLA) application. The effect of the child’s age and sex, diagnostic group, time since diagnosis, time since last needle insertion, cortisol change levels and the parent’s fear level, on fear and pain levels was investigated with multiple regression analysis.

    Results: The needle-related fear level (VAS mean 28 mm) was higher than the needle-related pain level (VAS mean 17 mm) when topical anaesthesia is used according to parents’ reports (n = 151, p < 0.001). With fear as the dependent variable, age and pain were significantly associated and explained 33% of the variance, and with pain as the dependent variable, fear, parents’ fear and change in cortisol level were significantly associated and explained 38% of the variance.

    Conclusions: According to parents, children experienced more fear than pain during needle insertion when topical anaesthesia is used. Therefore, in addition to pain management, an extended focus on fearreducing interventions is suggested for needle procedures.

  • 15.
    Holm, Sara
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Ljungman, Gustaf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Åsenlöf, P
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Linton, S. J.
    Center of Health And Medical Psychology, School of Law, Psychology and Social Work, Örebro University, Sweden.
    Söderlund, A.
    School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Treating youth in pain: Comparing tailored behavioural medicine treatment provided by physical therapists in primary care with physical exercises.2016Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, nr 4, s. 626-638Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To study the efficacy of tailored behavioural medicine treatment within a physical therapy framework.

    METHODS: The study was a randomized controlled study (RCT): tailored behavioural medicine treatment (EXT) delivered by physical therapists (PTs) was compared with exercise-based treatment (CT). Thirty-two adolescents (mean age 14.3 years) with persistent pain participated. Data on pain-related disability and school attendance (primary outcomes), pain intensity, catastrophizing, fear of movement and self-efficacy were collected.

    RESULTS: The pain-related disability measured by the Functional Disability Inventory (FDI) resulted in mean score change of EXT = -18 and CT = -11, respectively. A significant change within both groups was found (EXT p = 0.003, CT p = 0.001), and a large effect size for FDI between the conditions was demonstrated (AUC of 0.77). For school attendance post-treatment, no difference was found between conditions. For secondary outcomes, a significant improvement in pain intensity and pain catastrophizing was found for the EXT and self-efficacy for the CT groups but no statistically significant difference between the two conditions was detected. Caution should be given to the small sample size, as it may affect the interpretation and generalizability of the results.

    CONCLUSION: In this study, differences between tailored behavioural medicine treatment delivered by PTs and exercise-based treatment could not be demonstrated, although the effect size was large. Patients who received either treatment demonstrated significant changes over time in pain-related disability. The low number of participants and suboptimal tailoring of the psychological components may partly explain the failure to demonstrate differences between groups, and future studies are warranted.

  • 16.
    Johansson, Ann-Christin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Gunnarsson, Lars-Gunnar
    Linton, Steven J.
    Bergkvist, Leif
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Stridsberg, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk endokrinologi.
    Nilsson, Olle
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Cornefjord, Michael
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Pain, disability and coping reflected in the diurnal cortisol variability in patients scheduled for lumbar disc surgery2008Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, nr 5, s. 633-640Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Symptoms of lumbar disc herniation can be induced by both mechanical compression of the nerve roots and by biochemical irritants from the disc tissues. Proinflammatory cytokines, as well as stress are potent stimulators of the hypothalamic-pituitary-adrenal axis, reflected in enhanced release of cortisol from the adrenal cortex. Altered cortisol production is also associated to behaviour and coping patterns. The aim of the present study was to explore the relation between pain, physical function, psychosocial factors and quality of life to the diurnal cortisol variability, in patients with lumbar disc herniation.

    METHOD:

    This study had a cross-sectional design. Forty-two patients with lumbar disc herniation, verified by magnetic resonance imaging and a clinical examination by an orthopaedic surgeon, were included in the study. All patients were scheduled for disc surgery. The diurnal cortisol variability was examined before surgery. The patients were dichotomised into two groups based on low or high diurnal cortisol variability. Pain, disability, work related stress, quality of life, coping and fear avoidance beliefs, were estimated by standardised questionnaires.

    RESULTS:

    The low diurnal cortisol variability group was distinguished by a higher median score regarding leg pain at activity and significantly more disability (p<0.05). The patients with a low diurnal cortisol variability had significantly lower coping self-statement scores, but higher pain coping catastrophising scores (p<0.05).

    CONCLUSION:

    Patients with lumbar disc herniation and a low diurnal cortisol variability had lower physical function, perceived lower possibilities of influencing their pain, and were more prone to catastrophise than patients with lumbar disc herniation and a high diurnal cortisol variability.

  • 17.
    Kalliomäki, Maija-L
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Meyerson, Josefine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Gunnarsson, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Gordh, Torsten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Sandblom, Gabriel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Kolorektalkirurgi.
    Long-term pain after inguinal hernia repair in a population-based cohort; risk factors and interference with daily activities2008Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Eur J Pain, ISSN 1090-3801, Vol. 12, nr 2, s. 214-225Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In the Swedish Hernia Register 2834 inguinal hernia repairs in 2583 patients were registered in the county of Uppsala 1998-2004. In May 2005 the 2421 patients still alive were requested by mail to fill in a validated questionnaire concerning postherniorrhaphy pain. The final response rate became 72%. Altogether 519 patients (29%) stated that they had pain in the operated groin to some extent during past week. In 98 patients (6%) the pain interfered with daily activities. Factors associated with an increased risk of residual pain in a multivariate logistic regression analysis were age below median, operation for recurrence, open repair technique, history of preoperative pain, and less than three years from surgery. Factors not associated with occurrence of residual pain were gender, method of anaesthesia during surgery, hernia sac diameter, postoperative complications, hernia type, need for emergency operation, reducibility of the hernia sac and complete dissection of the hernia sac. Factors found to be associated with impairment of function due to pain in a multivariate logistic regression analysis were: age below median, female gender, medial hernia, open repair technique, postoperative complications, need for operation for recurrence, presence of preoperative pain and less than three years from surgery. The possibility of long-term pain as an outcome after hernia operations should be taken into consideration in the decision making prior to operation.

  • 18. Kanstrup, M.
    et al.
    Holmstrom, L.
    Ringström, R.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Wicksell, R. K.
    Insomnia in paediatric chronic pain and its impact on depression and functional disability2014Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 18, nr 8, s. 1094-1102Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Children and adolescents attending health care due to chronic pain commonly presents with insomnia. Previous research suggests that problems with sleep are associated with depression and functional disability. However, more research is needed to clarify the relationship between pain, insomnia and disability. Objective: This study aims to investigate the frequency, severity and importance of insomnia in paediatric patients with chronic pain and to evaluate the mediating role of insomnia in explaining the relationship between pain and depression as well as between pain and functioning. In addition, to ascertain the adequacy of using a Swedish translation of the Insomnia Severity Index (ISI) with youths, analyses included a statistical evaluation of the instrument. Method: Correlational analyses of cross-sectional data from 154 consecutive paediatric patients with chronic pain referred to a tertiary pain clinic. Results: Insomnia explained a significant amount of variance in depression and functional disability when controlling for demographic characteristics and pain. Indirect effects of insomnia were found for both the relationship between pain and depression, and between pain and functional disability. ISI showed satisfactory psychometric properties in this sample, including internal consistency and concurrent criteria validity. Conclusions: Insomnia is highly important in explaining depression and functional disability in paediatric chronic pain and can be adequately assessed using the ISI.

  • 19. Landén Ludvigsson, Maria
    et al.
    Peterson, Gunnel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Dedering, Åsa
    Falla, Deborah
    Peolsson, Anneli
    Factors associated with pain and disability reduction following exercise interventions in chronic whiplash2016Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, nr 2, s. 307-315Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Some studies support the prescription of exercise for people with whiplash-associated disorders (WAD); however, the response is highly variable. Further research is necessary to identify factors which predict response.

    METHODS:

    This is a secondary analysis of a randomized, multicentre controlled clinical trial of 202 volunteers with chronic WAD (grades 2 and 3). They received either neck-specific exercise with, or without a behavioural approach, or prescription of physical activity for 12 weeks. Treatment response, defined as a clinical important reduction in pain or disability, was registered after 3 and 12 months, and factors associated with treatment response were explored using logistic regression.

    RESULTS:

    Participation in the neck-specific exercise group was the only significant factor associated with both neck pain and neck disability reduction both at 3 and 12 months. Patients in this group had up to 5.3 times higher odds of disability reduction and 3.9 times higher odds of pain reduction compared to those in the physical activity group. Different baseline features were identified as predictors of response depending on the time point examined and the outcome measure selected (pain vs. disability).

    CONCLUSION:

    Factors associated with treatment response after exercise interventions differ in the short and long term and differ depending on whether neck pain or disability is considered as the primary outcome. Participation in a neck-specific exercise intervention, in contrast to general physical activity, was the only factor that consistently indicated higher odds of treatment success. These results support the prescription of neck-specific exercise for individuals with chronic WAD.

  • 20.
    Linnman, Clas
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Appel, Lieuwe
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för radiologi, onkologi och strålningsvetenskap, Enheten för nuklearmedicin och PET.
    Söderlund, Anne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Frans, Örjan
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Engler, Henry
    Furmark, Tomas
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Gordh, Torsten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Långström, Bengt
    Fredrikson, Mats
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Chronic whiplash symptoms are related to altered regional cerebral blood flow in the resting state2009Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 13, nr 1, s. 65-70Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The neural pathogenic mechanisms involved in mediating chronic pain and whiplash associated disorders (WAD) after rear impact car collisions are largely unknown. This study's first objective was to compare resting state regional cerebral blood flow (rCBF) by means of positron emission tomography with (15)O labelled water in 21 WAD patients with 18 healthy, pain-free controls. A second objective was to investigate the relations between brain areas with altered rCBF to pain experience, somatic symptoms, posttraumatic stress symptoms and personality traits in the patient group. Patients had heightened resting rCBF bilaterally in the posterior parahippocampal and the posterior cingulate gyri, in the right thalamus and the right medial prefrontal gyrus as well as lowered tempero-occipital blood flow compared with healthy controls. The altered rCBF in the patient group was correlated to neck disability ratings. We thus suggest an involvement of the posterior cingulate, parahippocampal and medial prefrontal gyri in WAD and speculate that alterations in the resting state are linked to an increased self-relevant evaluation of pain and stress.

  • 21.
    McCracken, Lance
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Kings Coll London, Hlth Psychol Sect, Dept Psychol, Inst Psychiat Psychol & Neurosci, London, England; Guys & St Thomas NHSFT, INPUT Pain Management, London, England.
    Patel, Shrina
    Guy's and St Thomas' NHSFT.
    Scott, Whitney
    King's College London.
    The role of psychological flexibility in relation to suicidal thinking in chronic pain2018Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, nr 10, s. 1774-1781Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Suicidal thinking (ST) is common in people with chronic pain. It is relevant as it can be associated with suicidal attempts, and typically reflects significant suffering. While little is known about the psychological processes that contribute to ST, current psychological models, such as the Psychological Flexibility (PF) model, could help guide further investigation. This study investigates relations between ST and components of PF in chronic pain. Methods: Participants were 424 adults attending treatment for chronic pain in the UK. Included in measures administered before treatment were standardized measures of depression, pain, pain-related interference, andmeasures of PF, including acceptance, cognitive defusion, committed action, and self-as-context. An item from the measure of depression wasused to reflect ST. Results: A large proportion of the sample reported ST, 45.7%. ST wasuncorrelated with participant background characteristic, medications taken, or pain intensity. However, it was correlated with the presence of widespread pain, pain-related interference, and depression. Eachcomponent of PF was found to be significantly negatively associated with ST, as predicted. General acceptance correlated with ST at a level equal to that achieved by the depression score. In adjusted multivariate logistic regression general acceptance and committed action remainedsignificantly uniquely associated with it. Conclusion: This preliminary study suggests for the first time that components of PF are associated with part of a pattern of suicidal behaviour in people with chronic pain. They may be relevant for reducing avoidance in general and providing more positive behavioural options. Significance: This study provides evidence that components of psychological flexibility are associated with a reduced frequency of suicidal thinking in people with chronic pain. Treatments targeting psychological flexibility may help mitigate the impact of chronic pain on suicidal thinking.

  • 22. Namer, B.
    et al.
    Schick, M.
    Kleggetveit, I. P.
    Orstavik, K.
    Schmidt, Roland
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Klinisk neurofysiologi.
    Jorum, E.
    Torebjörk, E.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Klinisk neurofysiologi.
    Handwerker, H.
    Schmelz, M.
    Differential sensitization of silent nociceptors to low pH stimulation by prostaglandin E2 in human volunteers2015Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 19, nr 2, s. 159-166Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BackgroundInflammatory mediators activate and sensitize nociceptors. Tissue acidosis with low pH of 5.5 often accompanies inflammation and could enhance inflammatory pain and sensitization. MethodsAction potentials from single mechano-responsive (CM) and mechano-insensitive (CMi) C-nociceptors of cutaneous fascicles of the peroneal nerve in healthy volunteers were recorded by microneurography. Low pH solutions with and without prostaglandin E2 (PGE2) were injected twice (with an interval of approximately 5min) into two spots of the receptive fields of C-fibres. Heat thresholds of the C-fibres were obtained before and after each injection. ResultsInjections of the low pH solutions immediately induced phasic responses in CM nociceptors, whereas CMi fibres responded after a delay of several seconds with a sustained response. More CMi fibres than CM fibres showed ongoing discharge after low pH injection, but the duration and intensity of the responses to the first low pH injection did not differ between them. Upon repetition, duration and intensity of the pH responses increased more than twofold in CMi fibres only. Furthermore, combined application of pH and PGE2 sensitized the response in CMi fibres only. In contrast, heat activation thresholds were sensitized by the combination of low pH and PGE2 in both fibre classes. ConclusionsOur results confirm nociceptor class independent heat sensitization by PGE2 which is probably mediated by transient receptor potential vanilloid 1 phosphorylation. However, prolonged and increased pain responses in humans upon low pH/PGE2 stimulation appear to be primarily dependent on CMi fibres, whereas CM nociceptors appear crucial for phasic responses.

  • 23.
    Peterson, Magnus
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Eriksson, Margaretha
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Svardsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    A randomized controlled trial of eccentric versus concentric exercise in chornic tennis elbow (lateral epicondylosis)2011Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Chronic tennis elbow was used in this paper as a model for chronic soft tissue pain, which is a common problem, often difficult to treat. Exercise has been shown to have positive effects in chronic pain, but whether eccentric or concentric exercise should be used is controversial. The aim of this study was to test the effects of eccentric versus concentric exercise on pain, strength, function and quality of life in chronic tennis elbow. One hundred and twenty subjects with tennis elbow lasting for more than three months were randomly allocated to eccentric exercise (n=60) or to concentric exercise (n=60), performed at home daily for three months with increasing load. The subjects were seen at baseline and after one, two, three, six, and twelve months of follow up, where the outcome measures pain during maximum voluntary muscle contraction (Cozen’s test), pain during maximum muscle elongation (modified Empty can test), and muscle strength were measured. Function was measured with the Disability of the Arm, Shoulder and Hand questionnaire (DASH) and quality of life with the Gothenburg Quality of Life questionnaire at baseline and after three, six, and twelve months. The eccentric exercise group had faster regression of pain, both during muscle contraction and elongation, as well as greater increase of muscle strength than the concentric group (p<0.0001, p=0.006, and p<0.02, respectively). The differences persisted throughout the follow-up period. There were no significant differences between the groups regarding DASH scores or quality of life measures.

  • 24.
    Scott, Whitney
    et al.
    Kings Coll London, Inst Psychiat Psychol & Neurosci, Hlth Psychol Sect, London, England; Guys & St Thomas NHS Fdn Trust, INPUT Pain Management, London, England.
    Chilcot, Joseph
    Kings Coll London, Inst Psychiat Psychol & Neurosci, Hlth Psychol Sect, London, England.
    Guildford, Beth
    Guys & St Thomas NHS Fdn Trust, INPUT Pain Management, London, England.
    Daly-Eichenhardt, Aisling
    Guys & St Thomas NHS Fdn Trust, INPUT Pain Management, London, England.
    McCracken, Lance
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi. Kings Coll London, Inst Psychiat Psychol & Neurosci, Hlth Psychol Sect, London, England; Guys & St Thomas NHS Fdn Trust, INPUT Pain Management, London, England.
    Feasibility randomized‐controlled trial of online Acceptance and Commitment Therapy for patients with complex chronic pain in the United Kingdom2018Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, nr 8, s. 1473-1484Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Acceptance and Commitment Therapy (ACT) has growing support for chronic pain. However, more accessible treatment delivery is needed. This study evaluated the feasibility of online ACT for patients with complex chronic pain in the United Kingdom to determine whether a larger trial is justified.

    Methods: Participants with chronic pain and clinically meaningful disability and distress were randomly assigned to ACT online plus specialty medical pain management, or specialty medical management alone. Participants completed questionnaires at baseline, and 3‐ and 9‐month post‐randomization. Primary feasibility outcomes included recruitment, retention and treatment completion rates. Secondary outcomes were between‐groups effects on treatment outcomes and psychological flexibility.

    Results: Of 139 potential participants, 63 were eligible and randomized (45% recruitment rate). Retention rates were 76–78% for follow‐up assessments. Sixty‐one per cent of ACT online participants completed treatment. ACT online was less often completed by employed (44%) compared to unemployed (80%) participants. Fifty‐six per cent of ACT online participants rated themselves as ‘much improved’ or better on a global impression of change rating, compared to only 20 per cent of control participants. Three‐month effects favouring ACT online were small for functioning, medication and healthcare use, committed action and decentring, medium for mood, and large for acceptance. Small‐to‐medium effects were maintained for functioning, healthcare use and committed action at 9 months.

    Conclusions: Online ACT for patients with chronic pain in the United Kingdom appears feasible to study in a larger efficacy trial. Some adjustments to treatment and trial procedures are warranted, particularly to enhance engagement among employed participants.

    Significance: This study supports the feasibility of online Acceptance and Commitment Therapy for chronic pain in the United Kingdom and a larger efficacy trial. Refinements to treatment delivery, particularly to better engage employed patients, may improve treatment completion and outcomes.

  • 25.
    Sjögren, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaci.
    Halldin, M. M.
    Karolinska Inst, AlzeCure Fdn, Sci Pk, Huddinge, Sweden.
    Stålberg, O.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för läkemedelskemi, Avdelningen för analytisk farmaceutisk kemi.
    Sundgren-Andersson, A. K.
    AstraZeneca R&D, Global Med Dev, Gaithersburg, MD 20878 USA.
    Preclinical characterization of three transient receptor potential vanilloid receptor 1 antagonists for early use in human intradermal microdose analgesic studies2018Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, nr 5, s. 889-903Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    The transient receptor potential vanilloid receptor 1 (TRPV1) is a nonselective cation channel involved in the mediation of peripheral pain to the central nervous system. As such, the TRPV1 is an accessible molecular target that lends itself well to the understanding of nociceptive signalling. This study encompasses preclinical investigations of three molecules with the prospect to establish them as suitable analgesic model compounds in human intradermal pain relief studies.

    Methods

    The inhibitory effectiveness was evaluated by means of invitro assays, TRPV1 expressing Chinese hamster ovary cells (CHO-K1) and rat dorsal root ganglion cultures in fluorescent imaging plate reader and whole cell patch clamp systems, as well as invivo by capsaicin-evoked pain-related behavioural response studies in rat. Secondary pharmacology, pharmacokinetics and preclinical safety were also assessed.

    Results

    In vitro, all three compounds were effective at inhibiting capsaicin-activated TRPV1. The concentration producing 50% inhibition (IC50) determined was in the range of 3-32nmol/L and 10-501nmol/L using CHO-K1 and dorsal root ganglion cultures, respectively. In vivo, all compounds showed dose-dependent reduction in capsaicin-evoked pain-related behavioural responses in rat. None of the three compounds displayed any significant activity on any of the secondary targets tested. The compounds were also shown to be safe from a toxicological, drug metabolism and pharmacokinetic perspective, for usage in microgram doses in the human skin.

    Conclusion

    The investigated model compounds displayed ideal compound characteristics as pharmacological and translational tools to address efficacy on the human native TRPV1 target in human skin insitu.

    Significance

    This work details the pharmaceutical work-up of three TRPV1-active investigational compounds, to obtain regulatory approval, for subsequent use in humans. This fast and cost-effective preclinical development path may impact research beyond the pain management area, as it allows human target engagement information gathering early in drug development.

  • 26.
    Sjögren, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaci.
    Kullenberg, T.
    Swedish Orphan Biovitrum, Solna, Sweden.
    Jonzon, B.
    Med Prod Agcy, Uppsala, Sweden.
    Segerdahl, M.
    Lundbeck AS, Valby, Denmark;Karolinska Inst, Stockholm, Sweden.
    Stålberg, O.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för läkemedelskemi.
    Halldin, M. M.
    AlzeCure Fdn, Karolinska Inst, Sci Pk, Huddinge, Sweden.
    Sundgren-Andersson, A. K.
    AstraZeneca GMD, Gaithersburg, MD USA.
    Clinical testing of three novel transient receptor potential cation channel subfamily V member 1 antagonists in a pharmacodynamic intradermal capsaicin model2018Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 22, nr 7, s. 1214-1228Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background  The transient receptor potential cation channel subfamily V 1 (TRPV1) is involved in nociception and has thus been of interest for drug developers, as a target for novel analgesics. However, several oral TRPV1 antagonists have failed in development, and novel approaches to target TRPV1 with innovative chemistry are needed. Method This work describes an intradermal microdosing approach in humans for pharmacodynamic deductions and pharmacological profiling of compounds. First, a human capsaicin model was developed, to generate pharmacodynamic translational data (Study Part A, n=24). Then, three small molecule TRPV1 antagonists (AZ11760788, AZ12048189 and AZ12099548) were investigated in healthy volunteers (Study Part B, n=36), applying the established model. Pain and flare were assessed by Visual Analogue Score and laser Doppler, respectively. Results The developed model proved useful for pharmacologic deductions; all compounds caused a dose-dependent inhibition of capsaicin-induced pain and flare responses, with a rank order potency of AZ11760788>AZ12048189 >> AZ12099548. In addition, the dose-response data showed that the minimal antagonist concentrations needed to inhibit TRPV1 was 6-7 times the equilibrium dissociation constant for each compound. Conclusion With careful design of a pharmacodynamic translational human pain model, it was possible to rank order TRPV1 efficacy among three investigational TRPV1 antagonists, and to estimate human efficacious concentrations. SignificanceThis fast and cost-effective translational approach allows for generation of human target engagement information early in drug development. This could be of value for other development programmes where pharmacological targets are expressed in peripheral sensory nerves.

  • 27.
    Sjögren, Erik
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaci.
    Stahle, Lars
    Karolinska Univ, CLINTEC, Hosp Huddinge, Karolinska Inst, Solna, Sweden.
    Quiding, Hans
    3diva, Vaxjo, Sweden.
    Jonzon, Bror
    Med Prod Agcy, Uppsala, Sweden.
    Halldin, Magnus M.
    Karolinska Inst, AlzeCure Fdn, Sci Pk, Huddinge, Sweden.
    Sundgren, Anna K.
    AstraZeneca, Gaithersburg, MD USA.
    The effect of intradermal microdosing of a transient receptor potential cation channel subfamily V member 1 antagonist on heat evoked pain and thermal thresholds in normal and ultraviolet-C exposed skin in healthy volunteers2019Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 23, nr 10, s. 1767-1779Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Three TRPV1 (Transient Receptor Potential Vanilloid Receptor 1) antagonists were developed for testing in situ in human skin (Sjogren et al., 2016; Sjogren et al., 2018; Sjogren et al., 2018). The first human study using these compounds and capsaicin, was performed to determine the required local antagonist concentrations needed for target engagement (Proof of Mechanism, PoM) (Sjogren et al., 2018). In this paper, the aim was to address a TRPV1 antagonist's ability to inhibit a more complex pain signal and to define translational endpoints that could be used in further drug development, when progressing orally bioavailable TRPV1 antagonists as novel analgesic medications. Method This was a single centre, placebo-controlled, clinical proof of principle (PoP) study in 25 healthy volunteers. The subjects were exposed to UV irradiation, causing a local tissue inflammation. Three different doses of AZ12048189 were administered to assess pain perception through quantitative sensory testing (QST) and erythema using Laser Doppler scanning. Results AZ12048189 increased the warmth detection threshold (WDT) and the heat pain threshold (HPT) and decreased the intensity of supra threshold heat pain (STHP). AZ12048189 did not, however, have any significant effects as assessed using mechanical stimulation or Laser Doppler. Conclusions This study validated translational tools to confirm target engagement for TRPV1 antagonists; WDT, HPT and STHP have utility in this respect, after oral administration of a TRPV1 antagonist. This study also proved that TRPV1 antagonists can inhibit a more complex, non-capsaicin dependent thermally induced pain signal.

  • 28. Timmers, Inge
    et al.
    Simons, Laura E
    Hernandez, Jessica M
    McCracken, Lance M
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Wallace, Dustin P
    Parent psychological flexibility in the context of pediatric pain: Brief assessment and associations with parent behaviour and child functioning.2019Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 23, nr 7, s. 1340-1350Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The parent's role in the context of pediatric chronic pain is essential. There is growing evidence that parent psychological flexibility positively impacts child functioning. To assess parents' abilities to respond with psychological flexibility to their child's pain, the Parent Psychological Flexibility Questionnaire (PPFQ) was developed. Here, we aim to validate the 10-item version of the questionnaire in an English-speaking population and to evaluate associations with parent behaviour, child pain acceptance and functioning.

    METHODS: Five hundred and seventy-eight parent-child dyads presenting at a pediatric pain clinic were included (92% mothers, average child age 15.2 ± 1.6 years). The PPFQ was completed by the parent. Parent and child also completed other standardized questionnaires. In addition to confirmatory factor analysis and assessments of reliability and validity of the PPFQ-10, a mediation analysis was performed to examine the direct and indirect effects of parent psychological flexibility on child functioning.

    RESULTS: Confirmatory factor analysis supported the three-factor model with subscales for Values-Based Action, Pain Willingness and Emotional Acceptance, and the PPFQ-10 demonstrated strong psychometric properties. After controlling for child pain, parent psychological flexibility indirectly affected child functioning through its association with both parent behaviour (i.e., protectiveness) and child pain acceptance.

    CONCLUSIONS: Our findings provide further support for use of the PPFQ-10 and the importance of assessing and addressing parent psychological flexibility in the context of child chronic pain. Our data show that parent psychological flexibility has an important adaptive role and can impact child functioning through two different routes, both of which can be actively targeted in treatment.

    SIGNIFICANCE: Our findings demonstrate that the PPFQ-10 is an efficient measure of parent psychological flexibility, demonstrating strong psychometric properties. Furthermore, our analyses showed that parent psychological flexibility indirectly affects child functioning through associations with both adaptive parent behaviour and child functioning. Taken together, this study furthers the understanding of how parent psychological flexibility operates and affects children with chronic pain, and may inform and optimize treatments aimed at improving functioning by addressing child and parent coping.

  • 29.
    Westman, Axel
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Linton, S. J.
    Öhrvik, John
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Wahlén, Petra
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Leppert, Jerzy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Do psychosocial factors predict disability and health at a 3-year follow-up for patients with non-acute musculoskeletal pain?: A validation of the Örebro Musculoskeletal Pain Screening Questionnaire2008Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, nr 5, s. 641-649Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: Early identification and intervention with those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering associated with long-term work absenteeism. The Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) has been used and validated in several studies for participants with mainly acute pain problems. The aim of this study was to validate the OMPSQ for patients with non-acute pain problems (e.g. 1-6 months sick leave) and compare to other relevant questionnaires. Method: One hundred and fifty-eight patients with musculoskeletal pain and disability recruited to a multidisciplinary rehabilitation project completed a battery of questionnaires at baseline and at 3-year follow-up visits. The main analysis involved the relationship between risk levels in the questionnaire and sick leave and perceived health after 3 years. Results: The OMSPQ predicted future sick leave and health and was found to have six factors. The function and pain factors were the best predictors of sick leave after 3 years, while the distress factor was the best predictor of perceived mental health and return to work-expectancy was borderline significant. Perceived physical health at 3 years was best predicted by the function and pain factors with the fear-avoidance factor being marginally significant. Conclusion: The results demonstrate that psychosocial factors as measured by OMPSQ are related to work disability and perceived health even 3 years after treatment for patients with non-acute pain problems. The OMSPQ was a good predictor of outcome.

  • 30.
    Wicksell, Rikard K.
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Melin, Lennart
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Olsson, Gunnar L.
    Karolinska universitetssjukhuset.
    Exposure and acceptance in the rehabilitation of adolescents with idiopathic chronic pain - a pilot study2007Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 11, nr 3, s. 267-274Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    For chronic pain of unclear origin (idiopathic), pharmacological therapy is often insufficient. Psychological treatment strategies have been developed and evaluated for adults with chronic pain. However, few such studies are seen with youths, and to date there is limited empirical evidence regarding the effectiveness of psychological treatment for generalized musculoskeletal pain syndromes in adolescents. Acceptance and commitment therapy (ACT) is a development of cognitive behaviour therapy emphasizing exposure and acceptance. In this pilot study, 14 adolescents referred to the pain treatment service due to chronic debilitating pain were treated using an ACT-based approach. It was hypothesized that avoidance of pain and related stimuli was central to the disability seen among these patients, and that exposure and acceptance strategies could increase functioning and decrease pain. In contrast to emphasizing reductions in pain and distress, the treatment objective was to improve functioning by increasing the patient's ability to act in line with personal values in the presence of negative thoughts, emotions or bodily sensations. Following treatment, and retained at 3- and 6-month follow-up, improvements in functional ability, school attendance, catastrophizing and pain (i.e., intensity and interference) were seen. The outcome of this pilot study indicates that exposure and acceptance can been useful in the rehabilitation of adolescents with chronic debilitating pain. Randomized controlled studies are needed to empirically evaluate the effectiveness of this approach.

  • 31.
    Wicksell, Rikard K.
    et al.
    Karolinska universitetssjukhuset.
    Olsson, Gunnar L.
    Karolinska universitetssjukhuset.
    Melin, Lennart
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    The Chronic Pain Acceptance Questionnaire (CPAQ)-further validation including a confirmatory factor analysis and a comparison with the Tampa Scale of Kinesiophobia2009Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 13, nr 7, s. 760-768Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Acceptance of pain and distress has lately appeared as an important factor in determining peoples' ability to restore functioning in the presence of chronic pain. Although treatments based on cognitive behaviour therapy are beginning to incorporate acceptance strategies, there is still a lack of reliable and valid instruments to assess relevant processes in such interventions. The Chronic Pain Acceptance Questionnaire (CPAQ) was originally constructed as part of the development of an acceptance oriented treatment approach for pain patients. A revised 20-item version of the instrument with two subscales has shown adequate reliability and validity. In the present study, a Swedish translation of CPAQ was evaluated with 611 participants reporting chronic pain and symptoms of whiplash associated disorders. This study sought to further assess the psychometric properties of the instrument and to investigate its relation to another important measure of pain adjustment, the Tampa Scale of Kinesiophobia. Due to low intercorrelations with other items, item 16 was excluded. Exploratory and confirmatory factor analyses supported the previously suggested two-factor solution. Furthermore, the internal consistencies were good for the subscales (activities engagement and pain willingness) as well as the total scale. Hierarchical regression analyses illustrated strong relations with criteria variables (e.g. disability and life satisfaction). In general, the activities engagement subscale contributed more than pain willingness to the prediction of criteria variables. Furthermore, results illustrated that CPAQ explained more variance than the Tampa Scale of Kinesiophobia in pain intensity, disability, life satisfaction, and depression.

  • 32.
    Wicksell, Rikard
    et al.
    Karolinska universitetssjukhuset.
    Renöfält, Jonas
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Olsson, Gunnar L.
    Karolinska universitetssjukhuset.
    Bond, Frank W.
    Melin, Lennart
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Avoidance and cognitive fusion – Central components in pain related disability?: Development and preliminary validation of the Psychological Inflexibility in Pain Scale (PIPS)2008Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, nr 4, s. 491-500Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Acceptance of pain and other associated negative private experiences has received increasing attention in recent years. This approach is in stark contrast to the traditional approach of reducing or controlling symptoms of pain. The empirical support for treatments emphasizing exposure and acceptance, such as Acceptance and Commitment Therapy, is growing. However, to date, few instruments exist to assess the core processes in these types of treatments. This study describes the development and preliminary validation of the Psychological Inflexibility in Pain Scale. Principal components analysis (PCA) suggests a 2-factor solution with a total of 16 items measuring avoidance of pain and cognitive fusion with pain. Results also indicate adequate reliability and validity for the scale. Implications of these findings for clinical assessment, as well as for research on pain related disability, are discussed along with suggestions for further research in this area.

  • 33. Yu, Lin
    et al.
    Scott, Whitney
    McCracken, Lance M
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Change in Fatigue in Acceptance and Commitment Therapy-Based Treatment for Chronic Pain and Its Association with Enhanced Psychological Flexibility.2019Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Fatigue is commonly reported by people with chronic pain. The purpose of the current study was to examine Acceptance and Commitment Therapy (ACT), based on the Psychological Flexibility (PF) model, for fatigue in chronic pain. This study included 354 adults attending an interdisciplinary ACT-oriented treatment for chronic pain. T-tests and analyses of clinically meaningful change were used to investigate participant improvements in fatigue interference after the treatment. Pearson's correlations and hierarchical regressions were conducted to investigate associations between improvement in fatigue interference and improvements in PF processes. Finally, mixed effects models were used to explore associations between baseline fatigue interference and changes in treatment outcome measures. Participants improved in fatigue interference (d=.37), pain, some PF processes, and daily functioning (d=.18-1.08). 39.7% of participants demonstrated clinically meaningfully improvements in fatigue interference. Changes in fatigue interference was associated with changes in pain, PF processes and daily functioning, |r|= .20-.46. Change in fatigue interference was associated with change in pain acceptance independent of change in pain, β=-.36, p<.001. However, baseline fatigue interference did not predict any treatment outcome. Overall, people with fatigue appeared to benefit from the ACT-oriented interdisciplinary treatment for chronic pain, and relatively higher levels of fatigue did not appear to impede this benefit. ACT-based treatments may benefit people with chronic pain and fatigue. Future studies including experimental designs, and studies investigating other PF processes, are needed to better understand the utility of ACT for co-morbid fatigue and pain.

  • 34.
    Åsenlöf, Pernilla
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Denison, Eva
    Lindberg, Per
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Long-term follow-up of tailored behavioural treatment and exercise based physical therapy in persistent musculoskeletal pain: A randomized controlled trial in primary care2009Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 13, nr 10, s. 1080-1088Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study examined long-term effects of a tailored behavioural   treatment protocol (TBT), as compared with an exercise based physical   therapy protocol (EBT). One-hundred and twenty-two patients who, due to   persistent musculoskeletal pain, consulted physical therapists in   primary care were originally randomized to either of the two   conditions. Follow-up assessments two-year post-treatment were   completed by 65 participants. According to per-protocol analyses,   short-term effects were maintained in both groups for the primary   outcome, pain-related disability. The TBT-group reported lower   disability levels compared with the EBT-group. Intention-to-treat   analyses (ITT) conveyed similar results. Secondary outcomes of pain   intensity, pain control, and functional self-efficacy were maintained   over the 2-year post-treatment, but previous group differences were   levelled out according to the most conservative method of ITT. Fear of   movement/(re)injury increased in the EBT-group, and EBT participants   reported higher fear of movement/(re)injury two years post-treatment   compared to TBT.   The study supports tailoring of treatments in concordance with   patients' needs and preferences of activity goals and functional   behavioural analyses including predictors of pain-related disability,   for successful immediate outcomes and their maintenance in the long   run. Exercise-based treatments resulted in somewhat smaller immediate   treatment effects but had similar maintenance of effects over the   2-year follow-up period.

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