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  • 1.
    Aarnio, Mikko
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Appel, Lieuwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Fredriksson, Mats
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska Inst, Dept Neurosci, Stockholm, Sweden.
    Gordh, Torsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Wolf, Olof
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Sörensen, Jens
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Eriksson, Måns
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Linnman, Clas
    Visualization of painful inflammation in patients with pain after traumatic ankle sprain using [(11)C]-D-deprenyl PET/CT.2017In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, p. 418-424Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Positron emission tomography (PET) with the radioligand [(11)C]-D-deprenyl has shown increased signal at location of pain in patients with rheumatoid arthritis and chronic whiplash injury. The binding site of [(11)C]-D-deprenyl in peripheral tissues is suggested to be mitochondrial monoamine oxidase in cells engaged in post-traumatic inflammation and tissue repair processes. The association between [(11)C]-D-deprenyl uptake and the transition from acute to chronic pain remain unknown. Further imaging studies of musculoskeletal pain at the molecular level would benefit from establishing a clinical model in a common and well-defined injury in otherwise healthy and drug-naïve subjects. The aim of this study was to investigate if [(11)C]-D-deprenyl uptake would be acutely elevated in unilateral ankle sprain and if tracer uptake would be reduced as a function of healing, and correlated with pain localizations and pain experience.

    METHODS: Eight otherwise healthy patients with unilateral ankle sprain were recruited at the emergency department. All underwent [(11)C]-D-deprenyl PET/CT in the acute phase, at one month and 6-14 months after injury.

    RESULTS: Acute [(11)C]-D-deprenyl uptake at the injury site was a factor of 10.7 (range 2.9-37.3) higher than the intact ankle. During healing, [(11)C]-D-deprenyl uptake decreased, but did not normalize until after 11 months. Patients experiencing persistent pain had prolonged [(11)C]-D-deprenyl uptake in painful locations.

    CONCLUSIONS AND IMPLICATIONS: The data provide further support that [(11)C]-D-deprenyl PET can visualize, quantify and follow processes in peripheral tissue that may relate to soft tissue injuries, inflammation and associated nociceptive signaling. Such an objective correlate would represent a progress in pain research, as well as in clinical pain diagnostics and management.

  • 2.
    Alim, Md. Abdul
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Department of Molecular Medicine and Surgery, Karolinska Institutet.
    Ackermann, Paul W
    Eliasson, Pernilla
    Blomgran, Parmis
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Pejler, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Increased mast cell degranulation and co-localization of mast cells with the NMDA receptor-1 during healing after Achilles tendon rupture2017In: Cell and Tissue Research, ISSN 0302-766X, E-ISSN 1432-0878, Vol. 370, no 3, p. 451-460Article in journal (Refereed)
    Abstract [en]

    The role of inflammation and the mechanism of tendon healing after rupture has historically been a matter of controversy. The purpose of the present study is to investigate the role of mast cells and their relation to the NMDA receptor-1 (a glutamate receptor) during healing after Achilles tendon rupture. Eight female Sprague Dawley rats had their right Achilles tendon transected. Three weeks after rupture, histological quantification of mast cell numbers and their state of degranulation was assessed by histochemistry. Co-localization of mast cell tryptase (a mast cell marker) and NMDA receptor-1 was determined by immunofluorescence. The intact left Achilles tendon was used as control. An increased number of mast cells and a higher proportion of degranulated mast cells were found in the healing Achilles tendon compared to the intact. In addition, increased co-localization of mast cell tryptase and NMDA receptor-1 was seen in the areas of myotendinous junction, mid-tendon proper and bone tendon junction of the healing versus the intact tendon. These findings introduce a possible role for mast cells in the healing phase after Achilles tendon rupture.

  • 3.
    Borjesson, Susanne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Fjällskog, Marie-Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrin Oncology.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Arving, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Nurses’ experiences of taxane-induced pain in people treated for breast cancerIn: Article in journal (Other academic)
  • 4.
    Börjesson, Susanne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Fjällskog, Marie-Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrin Oncology.
    Rissanen, Ritva
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Arving, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Colored body images reveal the perceived intensity anddistribution of pain in women with breast cancer treated with adjuvant taxanes:: a prospective multi-method study of pain experience2018In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, p. 581-591Article, review/survey (Refereed)
    Abstract [en]

    Background and aims:

    Breast cancer is the most prevalent adult cancer worldwide. A broader use of screening for early detection and adjuvant systemic therapy with chemotherapy has resulted in improved survival rates. Taxane-containing chemotherapy is one of the cornerstones of the treatment. However, taxane-containing chemotherapy may result in acute chemotherapy-induced nociceptive and neuropathic pain. Since this pain may be an additional burden for the patient both during and after taxane chemotherapy, it is important to rapidly discover and treat it. There is yet no gold standard for assessing taxane-induced pain. In the clinic, applying multiple methods for collecting information on pain may better describe the patients’ pain experiences. The aim was to document the pain during and after taxane through the contribution of different methods for collecting information on taxane-induced pain. Fifty-three women scheduled for adjuvant sequential chemotherapy at doses of ≥75 mg/m2 of docetaxel and epirubicin were enrolled in the study.

    Methods:

    Prospective pain assessments were done on a visual analog scale (VAS) before and during each cycle of treatment for about 5 months, and using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire’s (EORTC-QLQ-C30) two pain questions at baseline, 3 months, and 12 months. Participants scoring pain on the VAS >30 and undergoing an interview also colored their pain on a body image during treatment and at 12 months.

    Results:

    Surprisingly widespread, intense pain was detected using a multi-method approach. The colored body image showed pain being perceived on 51% of the body surface area during treatment, and on 18% 12 months after inclusion. In general, the pain started and peaked in intensity after the first cycle of taxane. After Cycle 3, most women reported an increase in pain on the VAS. Some women continued to report some pain even during the epirubicin cycles. The VAS scores dropped after the last chemotherapy cycle, but not to the baseline level. At baseline, 3 months and 12 months after inclusion, the women who estimated VAS >30 reported higher levels of pain on the pain questions of the EORTC-QLQ-C30.

    Conclusions:

    This study contributes information on how different pain assessment tools offer different information in the assessment of pain. The colored body image brings another dimension to pain diagnostics, providing additional information on the involved body areas and the pain intensities as experienced by the women. A multi-method approach to assessing pain offers many advantages. The timing of the assessment is important to properly assess pain.

    Implications:

    Pain relief needs to be included in the chemotherapy treatment, with individual assessment and treatment of pain, in the same way as is done in chemotherapy-triggered nausea. There is a time window whereby the risk of pain development is at its highest within 24–48 h after receiving taxane chemotherapy. Proper attention to pain evaluation and treatment should be in focus during this time window.

  • 5.
    Drevin, Jennifer
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Stern, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Annerbäck, Eva-Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Butler, Stephen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Berglund, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala University, National Centre for Knowledge on Men.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Adverse childhood experiences influence development of pain during pregnancy.2015In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 8, p. 840-846Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the association between adverse childhood experiences (ACE) and pain with onset during pregnancy.

    DESIGN: Cross-sectional study.

    SETTING: Eighteen antenatal clinics in southern Mid-Sweden.

    SAMPLE: Of 293 women invited to participate, 232 (79%) women agreed to participate in early pregnancy and were assessed in late pregnancy.

    METHODS: Questionnaires were distributed in early and late pregnancy. The questionnaires sought information on socio-demography, ACE, pain location by pain drawing and pain intensity by visual analogue scales. Distribution of pain was coded in 41 predetermined areas.

    MAIN OUTCOME MEASURES: Pain in third trimester with onset during present pregnancy: intensity, location and number of pain locations.

    RESULTS: In late pregnancy, 62% of the women reported any ACE and 72% reported any pain location with onset during the present pregnancy. Among women reporting any ACE the median pain intensity was higher compared with women without such an experience (p = 0.01). The accumulated ACE displayed a positive association with the number of reported pain locations in late pregnancy (rs  = 0.19, p = 0.02). This association remained significant after adjusting for background factors in multiple regression analysis (p = 0.01). When ACE was dichotomized the prevalence of pain did not differ between women with and without ACE. The subgroup of women reporting physical abuse as a child reported a higher prevalence of sacral and pelvic pain (p = 0.0003 and p = 0.02, respectively).

    CONCLUSIONS: Adverse childhood experiences were associated with higher pain intensities and larger pain distributions in late pregnancy, which are risk factors for transition to chronic pain postpartum.

  • 6. Hysing, Eva-Britt
    et al.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Myofasciell smärta2014In: Smärtbehandling / [ed] Rhodin et al, Studentlitteratur AB, 2014Chapter in book (Other academic)
  • 7.
    Lagali, Neil S.
    et al.
    Linkoping Univ, Inst Clin & Expt Med, Dept Ophthalmol, Linkoping, Sweden..
    Allgeier, Stephan
    Karlsruhe Inst Technol, Inst Appl Comp Sci, Karlsruhe, Germany..
    Guimaraes, Pedro
    Univ Padua, Dept Informat Engn, Padua, Italy..
    Badian, Reza A.
    Univ Coll Southeast Norway, Fac Hlth Sci, Kongsberg, Norway.;Oslo Univ Hosp, Dept Med Biochem, Oslo, Norway.;Univ Bergen, Stavanger Univ Hosp, Fac Med, Stavanger Clin Inst 1,Dept Ophthalmol, Bergen, Norway..
    Ruggeri, Alfredo
    Univ Padua, Dept Informat Engn, Padua, Italy..
    Koehler, Bernd
    Karlsruhe Inst Technol, Inst Appl Comp Sci, Karlsruhe, Germany..
    Utheim, Tor Paaske
    Univ Coll Southeast Norway, Fac Hlth Sci, Kongsberg, Norway.;Oslo Univ Hosp, Dept Med Biochem, Oslo, Norway..
    Peebo, Beatrice
    Linkoping Univ, Inst Clin & Expt Med, Dept Ophthalmol, Linkoping, Sweden..
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Dahlin, Lars B.
    Lund Univ, Skane Univ Hosp, Dept Translat Med Hand Surg, Malmo, Sweden..
    Rolandsson, Olov
    Umea Univ, Dept Publ Hlth & Clin Med, Sect Family Med, Umea, Sweden..
    Reduced Corneal Nerve Fiber Density in Type 2 Diabetes by Wide-Area Mosaic Analysis2017In: Investigative Ophthalmology and Visual Science, ISSN 0146-0404, E-ISSN 1552-5783, Vol. 58, no 14, p. 6318-6327Article in journal (Refereed)
    Abstract [en]

    PURPOSE

    To determine if corneal subbasal nerve plexus (SBP) parameters derived from wide-area depth-corrected mosaic images are associated with type 2 diabetes.

    METHODS

    One hundred sixty-three mosaics were produced from eyes of 82 subjects by laser-scanning in vivo confocal microscopy (IVCM). Subjects were of the same age, without (43 subjects) or with type 2 diabetes (39 subjects). Mosaic corneal nerve fiber length density (mCNFL) and apical whorl corneal nerve fiber length density (wCNFL) were quantified and related to the presence and duration of diabetes (short duration < 10 years and long duration >= 10 years).

    RESULTS

    In mosaics with a mean size of 6 mm(2) in subjects aged 69.1 +/- 1.2 years, mCNFL in type 2 diabetes was reduced relative to nondiabetic subjects (13.1 +/- 4.2 vs. 15.0 +/- 3.2 mm/mm(2), P = 0.018). Also reduced relative to nondiabetic subjects was mCNFL in both short-duration (14.0 +/- 4.0 mm/mm(2), 3.2 +/- 3.9 years since diagnosis) and long-duration diabetes (12.7 +/- 4.2 mm/mm(2), 15.4 +/- 4.2 years since diagnosis; ANOVA P = 0.023). Lower mCNFL was associated with presence of diabetes (P = 0.032) and increased hemoglobin A1c (HbA1c) levels (P = 0.047). By contrast, wCNFL was unaffected by diabetes or HbA1c (P > 0.05). Global SBP patterns revealed marked degeneration of secondary nerve fiber branches outside the whorl region in long-duration diabetes.

    CONCLUSIONS

    Wide-area mosaic images provide reference values for mCNFL and wCNFL and reveal a progressive degeneration of the SBP with increasing duration of type 2 diabetes.

  • 8.
    Lagali, Neil S.
    et al.
    Linkoping Univ, Inst Clin & Expt Med, Dept Ophthalmol, S-58183 Linkoping, Sweden.
    Allgeier, Stephan
    Karlsruhe Inst Technol, Inst Appl Comp Sci, D-76131 Karlsruhe, Germany.
    Guimaraes, Pedro
    Univ Padua, Dept Informat Engn, I-35122 Padua, Italy.
    Badian, Reza A.
    Univ Coll Southeast Norway, Fac Hlth Sci, N-3045 Drammen, Norway;Oslo Univ Hosp, Unit Regenerat Med, Dept Med Biochem, N-0407 Oslo, Norway;Univ Oslo, N-0407 Oslo, Norway.
    Ruggeri, Alfredo
    Univ Padua, Dept Informat Engn, I-35122 Padua, Italy.
    Koehler, Bernd
    Karlsruhe Inst Technol, Inst Appl Comp Sci, D-76131 Karlsruhe, Germany.
    Utheim, Tor Paaske
    Oslo Univ Hosp, Unit Regenerat Med, Dept Med Biochem, N-0407 Oslo, Norway;Univ Oslo, N-0407 Oslo, Norway.
    Peebo, Beatrice
    Linkoping Univ, Inst Clin & Expt Med, Dept Ophthalmol, S-58183 Linkoping, Sweden.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Dahlin, Lars B.
    Lund Univ, Skane Univ Hosp, Dept Translat Med Hand Surg, S-22241 Malmo, Sweden.
    Rolandsson, Olov
    Umea Univ, Sect Family Med, Dept Publ Hlth & Clin Med, S-90187 Umea, Sweden.
    Wide-field corneal subbasal nerve plexus mosaics in age-controlled healthy and type 2 diabetes populations2018In: Scientific Data, E-ISSN 2052-4463, Vol. 5, article id 180075Article in journal (Refereed)
    Abstract [en]

    A dense nerve plexus in the clear outer window of the eye, the cornea, can be imaged in vivo to enable non-invasive monitoring of peripheral nerve degeneration in diabetes. However, a limited field of view of corneal nerves, operator-dependent image quality, and subjective image sampling methods have led to difficulty in establishing robust diagnostic measures relating to the progression of diabetes and its complications. Here, we use machine-based algorithms to provide wide-area mosaics of the cornea's subbasal nerve plexus (SBP) also accounting for depth (axial) fluctuation of the plexus. Degradation of the SBP with age has been mitigated as a confounding factor by providing a dataset comprising healthy and type 2 diabetes subjects of the same age. To maximize reuse, the dataset includes bilateral eye data, associated clinical parameters, and machine-generated SBP nerve density values obtained through automatic segmentation and nerve tracing algorithms. The dataset can be used to examine nerve degradation patterns to develop tools to non-invasively monitor diabetes progression while avoiding narrow-field imaging and image selection biases.

  • 9.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Chronic Tennis Elbow: Aspects on Pathogenesis and Treatment in a Soft Tissue Pain Condition2011Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Objectives: To study the treatment practice of chronic tennis elbow (TE) among general practitioners (GPs) and physiotherapists (PTs), the effects of a simple, graded home exercise regime versus expectation, the effects of eccentric versus concentric exercise, and the involvement of the substance P – NK1 receptor system in the peripheral, painful tissue of chronic TE patients by positron emission tomography (PET).

    Materials and methods: A postal survey regarding therapeutic methods used in patients with chronic TE was sent to 129 GPs and 77 PTs, 81 subjects with chronic TE were randomly and blindly assigned to either an exercise group or a wait list group, 120 subjects were randomly assigned to either eccentric or concentric exercise and ten subjects were examined by PET and the NK1 specific radioligand [11C]GR205171.

    Results: High proportions of GPs and PTs used ergonomic counselling and stretching in the treatment of chronic TE. The majority of GPs prescribed passive anti-inflammatory measures such as sick leave and anti-inflammatory medication. Many PTs prescribed dynamic, particularly eccentric, exercise. Graded dynamic exercise according to a simple low-cost protocol, has better effect on pain than a wait-and-see attitude. Adjusted for outcome affecting variables, eccentric graded exercise has quicker effect than concentric graded exercise. During PET scan with the NK1 specific radioligand [11C]GR205171, voxel volume and signal intensity of this volume was significantly higher in the affected than the unaffected arm in subjects with unilateral chronic TE.

    Conclusions: GPs and PTs used many treatments to a similar extent but differed regarding the use of exercise. Chronic TE responds favourably to graded dynamic exercise aimed specifically at the painful tissue. The exercise should stress the eccentric work phase. The substance P – NK1 receptor system seems to play a part in the peripheral, painful tissue of a chronic, soft tissue pain condition such as chronic TE.

    List of papers
    1. Treatment practice in chronic epicondylitis: a survey among general practitioners and physiotherapists in Uppsala County, Sweden
    Open this publication in new window or tab >>Treatment practice in chronic epicondylitis: a survey among general practitioners and physiotherapists in Uppsala County, Sweden
    2005 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 23, no 4, p. 239-41Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To investigate treatment practice among general practitioners (GPs) and physiotherapists (PTs) in chronic epicondylitis of 3 months' duration or more. DESIGN: Postal survey. SETTING AND SUBJECTS: All 129 GPs and all 77 PTs at 35 primary health care centres in Uppsala County, Sweden, received the questionnaire. MAIN OUTCOME MEASURES: Proportion of responders using various treatments (five specified alternatives + open question). RESULTS: The questionnaire was answered by 70% of the GPs and 61% of the PTs. Ergonomic counselling, stretching, and orthotic devices were common, and used to a similar extent by GPs and PTs. Acupuncture was also common, but less so among GPs than PTs. Transcutaneous electric nerve stimulation was used by relatively few GPs and PTs. The open question revealed that dynamic exercise, particularly eccentric, was used by most PTs but only one GP. A majority of GPs prescribed sick leave and anti-inflammatory treatment with an NSAID or cortisone injections. CONCLUSION: A large number of treatment methods in chronic epicondylitis were reported, none of which is properly evidence-based and some of which are even known to be ineffective. There is a need for randomized controlled studies of potentially effective treatments in this condition.

    Keywords
    Anti-Inflammatory Agents; Non-Steroidal/therapeutic use, Chronic Disease, Family Practice, Humans, Physical Therapy (Specialty), Physical Therapy Modalities/utilization, Physician's Practice Patterns, Questionnaires, Referral and Consultation, Research Support; Non-U.S. Gov't, Sweden, Tennis Elbow/drug therapy/rehabilitation/*therapy
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:uu:diva-75207 (URN)10.1080/02813430510031333 (DOI)16272073 (PubMedID)
    Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2017-12-14Bibliographically approved
    2. A randomized controlled trial of exercise versus wait list in chronic tennis elbow (lateral epicondylosis)
    Open this publication in new window or tab >>A randomized controlled trial of exercise versus wait list in chronic tennis elbow (lateral epicondylosis)
    2011 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 116, no 4, p. 269-279Article in journal (Refereed) Published
    Abstract [en]

    Background.

    Chronic tennis elbow (lateral epicondylosis) is a common disorder. Like other chronic soft tissue pain conditions it is often difficult to treat successfully. The effects of exercise have been discussed but no convincing evidence has been put forward so far, and a simple protocol for exercise is lacking.

    Aims of the study.

    This study is a randomized, controlled, clinical trial of the effect of exercise versus expectation (wait-list) on pain, muscle strength, function, and quality of life in patients with longstanding lateral epicondylosis.

    Methods.

    Eighty-one subjects with tennis elbow lasting for more than three months were randomly allocated to an exercise group (n=40) or a reference group (n=41). The exercise group performed daily exercise, with weekly load increase, for three months. The reference group was wait listed, but otherwise followed in the same way. Outcome measures were pain during maximum voluntary muscle contraction (Cozen´s test) and pain during maximum muscle elongation with a load (modified Empty-can-test), muscle strength measured with a Chatillon MSE 100 hand-held dynamometer, and the Disability of the Arm, Shoulder and Hand (DASH) and the Gothenburg Quality of Life questionnaires.

    Results

    .The exercise group had greater and faster regression of pain, both during muscle contraction and muscle elongation, than the reference group (p=0.0005 and p=0.0016, respectively). There was a non-significant muscle strength difference between the groups, but no differences regarding DASH scores or quality of life measures.

    Conclusions

    .Exercise appears to be superior to expectation in reducing pain in chronic lateral epicondylosis.

    Keywords
    exercise, chronic, pain, tennis elbow, epicondylitis, RCT, epicondylosis, tendinosis, tendinitis
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:uu:diva-159954 (URN)10.3109/03009734.2011.600476 (DOI)000296794100008 ()
    Available from: 2011-10-13 Created: 2011-10-12 Last updated: 2017-12-08Bibliographically approved
    3. A randomized controlled trial of eccentric versus concentric exercise in chornic tennis elbow (lateral epicondylosis)
    Open this publication in new window or tab >>A randomized controlled trial of eccentric versus concentric exercise in chornic tennis elbow (lateral epicondylosis)
    2011 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149Article in journal (Refereed) Submitted
    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.

    Keywords
    eccentric, exercise, concentric, RCT, tennis elbow, epicondylosis, tendinosis, tendinitis, chronic, pain
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-160038 (URN)
    Available from: 2011-10-13 Created: 2011-10-13 Last updated: 2017-12-08Bibliographically approved
    4. PET-scan shows peripherally increased neurokinin 1 receptor availability in chronic tennis elbow: a picture of neurogenic inflammation?
    Open this publication in new window or tab >>PET-scan shows peripherally increased neurokinin 1 receptor availability in chronic tennis elbow: a picture of neurogenic inflammation?
    Show others...
    2011 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623Article in journal (Refereed) Submitted
    Abstract [en]

    In response to pain, neurokinin 1 (NK1) receptor availability in the central nervous system is altered in the dorsal horn of the spinal cord as well as in the brain. But the NK1 receptor and its primary agonist, substance P, also play a crucial role in peripheral tissue in response to pain, as part of neurogenic inflammation. However, little is known about alterations in NK1 receptor availability in peripheral tissue in chronic pain conditions and very few studies have been performed on human beings. We therefore performed positron emission tomography (PET) with the NK1 specific radioligand [11C]GR205171 in ten subjects with chronic tennis elbow. We demonstrated increased NK1 receptor availability in the affected arm as compared with the unaffected arm, measured as differences between the arms in number and volume of pixels > 2.5 SD above reference as well as signal intensity of this volume. We conclude that in addition to alteration of the NK1 receptor in the CNS, there is also activation, or up-regulation of the NK1 receptor in the peripheral, painful tissue in a chronic pain condition. We interpret this increased NK1 receptor availability as part of ongoing neurogenic inflammation and suggest that this is part of the cause of chronic tennis elbow.

    Keywords
    PET, chronic, pain, substance P, neurokinin 1, tennis elbow, epicondylitis, epicondylosis
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-160048 (URN)
    Available from: 2011-10-13 Created: 2011-10-13 Last updated: 2017-12-08Bibliographically approved
  • 10.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Imaging of pain-associated processes in peripheral tissues2014In: Diagnostic Imaging Europe, Vol. 30, no 2, p. 14-16Article in journal (Other academic)
    Abstract [en]

    Despite the significant effect chronic soft tissue pain such as tennis elbowcan have on the sufferer, the basic pathophysiologic mechanisms underlyingsuch pain are only very poorly understood. In addition, there are currently nosatisfactory methods for the precise localization of pain in peripheral tissues.This article describes the basic biochemistry of the Substance P -Neurokinin 1 (NK1) receptor system and summarizes the findings of arecent study using a PET radioligand specific for the NK1 receptor to identifychronic pain.The results show the potential of the approach, which should be confirmedby larger confirmatory studies.

  • 11.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Träning och fysikaliska metoder2014In: Smärtbehandling / [ed] Rhodin et al, Studentlitteratur AB, 2014Chapter in book (Other academic)
  • 12.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Träning och fysikaliska metoder2014In: Smärtbehandling / [ed] Rhodin et al, Studentlitteratur, 2014Chapter in book (Refereed)
  • 13.
    Peterson, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Breivik, Harald
    Even a “simple” pain condition such as “Tennis Elbow” is not only a somatic experience: Body and mind are inseparable entities2013In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 4, no 3, p. 153-154Article in journal (Refereed)
  • 14.
    Peterson, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Butler, Stephen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svardsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    A randomized controlled trial of eccentric versus concentric exercise in chornic tennis elbow (lateral epicondylosis)2011In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149Article in journal (Refereed)
    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.

  • 15.
    Peterson, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Butler, Stephen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy)2014In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 28, no 9, p. 862-872Article in journal (Refereed)
    Abstract [en]

    Objective:To analyse treatment effects of eccentric vs. concentric graded exercise in chronic tennis elbow.

    Design:Randomized controlled trial.

    Setting:Primary care in Uppsala County, Sweden.

    Subjects:A total of 120 subjects with tennis elbow lasting more than three months were recruited from primary care and by advertisement.

    Intervention:Eccentric (n = 60) or concentric exercise (n = 60), by lowering or lifting a weight, at home daily, for three months with gradually increasing load.

    Main measures:Pain during muscle contraction and muscle elongation, as well as strength, was assessed at baseline and after one, two, three, six, and 12 months. Function and quality of life was assessed at baseline and after three, six and 12 months.

    Results:The eccentric exercise group had faster regression of pain, with an average of 10% higher responder rate at all levels of pain reduction, both during muscle contraction and elongation, (p < 0.0001 and p = 0.006, respectively). Significant differences were found in Cox's analysis from two months onwards (HR 0.78, 95% confidence interval (CI) 0.63-0.96, p < 0.02). This represents an absolute pain reduction of 10% in the eccentric vs. the concentric group and a number-needed-to-treat of 10. The eccentric group also had a greater increase of muscle strength than the concentric (p < 0.02). The differences persisted throughout the follow-up period. There were no significant differences between the groups regarding function or quality of life measures.

    Conclusion:Eccentric graded exercise reduced pain and increased muscle strength in chronic tennis elbow more effectively than concentric graded exercise.

  • 16.
    Peterson, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Butler, Stephen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    A randomized controlled trial of exercise versus wait list in chronic tennis elbow (lateral epicondylosis)2011In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 116, no 4, p. 269-279Article in journal (Refereed)
    Abstract [en]

    Background.

    Chronic tennis elbow (lateral epicondylosis) is a common disorder. Like other chronic soft tissue pain conditions it is often difficult to treat successfully. The effects of exercise have been discussed but no convincing evidence has been put forward so far, and a simple protocol for exercise is lacking.

    Aims of the study.

    This study is a randomized, controlled, clinical trial of the effect of exercise versus expectation (wait-list) on pain, muscle strength, function, and quality of life in patients with longstanding lateral epicondylosis.

    Methods.

    Eighty-one subjects with tennis elbow lasting for more than three months were randomly allocated to an exercise group (n=40) or a reference group (n=41). The exercise group performed daily exercise, with weekly load increase, for three months. The reference group was wait listed, but otherwise followed in the same way. Outcome measures were pain during maximum voluntary muscle contraction (Cozen´s test) and pain during maximum muscle elongation with a load (modified Empty-can-test), muscle strength measured with a Chatillon MSE 100 hand-held dynamometer, and the Disability of the Arm, Shoulder and Hand (DASH) and the Gothenburg Quality of Life questionnaires.

    Results

    .The exercise group had greater and faster regression of pain, both during muscle contraction and muscle elongation, than the reference group (p=0.0005 and p=0.0016, respectively). There was a non-significant muscle strength difference between the groups, but no differences regarding DASH scores or quality of life measures.

    Conclusions

    .Exercise appears to be superior to expectation in reducing pain in chronic lateral epicondylosis.

  • 17.
    Peterson, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Elmfeldt, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Treatment practice in chronic epicondylitis: a survey among general practitioners and physiotherapists in Uppsala County, Sweden2005In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 23, no 4, p. 239-41Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate treatment practice among general practitioners (GPs) and physiotherapists (PTs) in chronic epicondylitis of 3 months' duration or more. DESIGN: Postal survey. SETTING AND SUBJECTS: All 129 GPs and all 77 PTs at 35 primary health care centres in Uppsala County, Sweden, received the questionnaire. MAIN OUTCOME MEASURES: Proportion of responders using various treatments (five specified alternatives + open question). RESULTS: The questionnaire was answered by 70% of the GPs and 61% of the PTs. Ergonomic counselling, stretching, and orthotic devices were common, and used to a similar extent by GPs and PTs. Acupuncture was also common, but less so among GPs than PTs. Transcutaneous electric nerve stimulation was used by relatively few GPs and PTs. The open question revealed that dynamic exercise, particularly eccentric, was used by most PTs but only one GP. A majority of GPs prescribed sick leave and anti-inflammatory treatment with an NSAID or cortisone injections. CONCLUSION: A large number of treatment methods in chronic epicondylitis were reported, none of which is properly evidence-based and some of which are even known to be ineffective. There is a need for randomized controlled studies of potentially effective treatments in this condition.

  • 18.
    Peterson, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Pingel, Ronnie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Lagali, N.
    Linkoping Univ, Dept Clin & Expt Med, Sect Ophthalmol, Linkoping, Sweden..
    Dahlin, L. B.
    Hand Surg Lund Univ, Dept Translat Med, Malmo, Sweden.;Skane Univ Hosp, Dept Hand Surg, Malmo, Sweden..
    Rolandsson, O.
    Umea Univ, Dept Publ Hlth & Clin Med, Sect Family Med, Umea, Sweden..
    Association between HbA1c and peripheral neuropathy in a 10-year follow-up study of people with normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes2017In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, no 12, p. 1756-1764Article in journal (Refereed)
    Abstract [en]

    Aims: To explore the association between HbA(1c) and sural nerve function in a group of people with normal glucose tolerance, impaired glucose tolerance or Type 2 diabetes.

    Methods: We conducted a 10-year follow-up study in 87 out of an original 119 participants. At study commencement (2004), 64 men and 55 women (mean age 61.1 years) with normal glucose tolerance (n=39), impaired glucose tolerance (n=29), or Type 2 diabetes (n=51) were enrolled. At the 2014 follow-up (men, n=46, women, n=41; mean age 71.1 years), 36, nine and 42 participants in the normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes categories, respectively, were re-tested. Biometric data and blood samples were collected, with an electrophysiological examination performed on both occasions.

    Results: At follow-up, we measured the amplitude of the sural nerve in 74 of the 87 participants. The mean amplitude had decreased from 10.9 V (2004) to 7.0 mu V (2014; P<0.001). A 1% increase in HbA(1c) was associated with a similar to 1% average decrease in the amplitude of the sural nerve, irrespective of group classification. Crude and adjusted estimates ranged from -0.84 (95% CI -1.32, -0.37) to -1.25 (95% CI -2.31, -0.18). Although the mean conduction velocity of those measured at both occasions (n=73) decreased from 47.6 m/s to 45.8 m/s (P=0.009), any association with HbA(1c) level was weak. Results were robust with regard to potential confounders and missing data.

    Conclusions: Our data suggest an association between sural nerve amplitude and HbA(1c) at all levels of HbA(1c). Decreased amplitude was more pronounced than was diminished conduction velocity, supporting the notion that axonal degeneration is an earlier and more prominent effect of hyperglycaemia than demyelination.

  • 19.
    Peterson, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Appel, Lieuwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Section of Nuclear Medicine and PET.
    Engler, Henry
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Section of Nuclear Medicine and PET.
    Aarnio, Mikko
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Gordh, Torsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Langström, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Section of Nuclear Medicine and PET. Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Physical Organic Chemistry.
    Sörensen, Jens
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Section of Nuclear Medicine and PET.
    PET-Scan Shows Peripherally Increased Neurokinin 1 Receptor Availability in Chronic Tennis Elbow: Visualizing Neurogenic Inflammation?2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 10, p. e75859-Article in journal (Refereed)
    Abstract [en]

    In response to pain, neurokinin 1 (NK1) receptor availability is altered in the central nervous system. The NK1 receptor and its primary agonist, substance P, also play a crucial role in peripheral tissue in response to pain, as part of neurogenic inflammation. However, little is known about alterations in NK1 receptor availability in peripheral tissue in chronic pain conditions and very few studies have been performed on human beings. Ten subjects with chronic tennis elbow were therefore examined by positron emission tomography (PET) with the NK1 specific radioligand [C-11]GR205171 before and after treatment with graded exercise. The radioligand signal intensity was higher in the affected arm as compared with the unaffected arm, measured as differences between the arms in volume of voxels and signal intensity of this volume above a reference threshold set as 2.5 SD above mean signal intensity of the unaffected arm before treatment. In the eight subjects examined after treatment, pain ratings decreased in all subjects but signal intensity decreased in five and increased in three. In conclusion, NK1 receptors may be activated, or up-regulated in the peripheral, painful tissue of a chronic pain condition. This up-regulation does, however, have moderate correlation to pain ratings. The increased NK1 receptor availability is interpreted as part of ongoing neurogenic inflammation and may have correlation to the pathogenesis of chronic tennis elbow.

  • 20.
    Peterson, Magnus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Appel, Lieuwe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular Medicine.
    Engler, Henry
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Långström, Bengt
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Biochemistry and Organic Chemistry.
    Sörensen, Jens
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    PET-scan shows peripherally increased neurokinin 1 receptor availability in chronic tennis elbow: a picture of neurogenic inflammation?2011In: Pain, ISSN 0304-3959, E-ISSN 1872-6623Article in journal (Refereed)
    Abstract [en]

    In response to pain, neurokinin 1 (NK1) receptor availability in the central nervous system is altered in the dorsal horn of the spinal cord as well as in the brain. But the NK1 receptor and its primary agonist, substance P, also play a crucial role in peripheral tissue in response to pain, as part of neurogenic inflammation. However, little is known about alterations in NK1 receptor availability in peripheral tissue in chronic pain conditions and very few studies have been performed on human beings. We therefore performed positron emission tomography (PET) with the NK1 specific radioligand [11C]GR205171 in ten subjects with chronic tennis elbow. We demonstrated increased NK1 receptor availability in the affected arm as compared with the unaffected arm, measured as differences between the arms in number and volume of pixels > 2.5 SD above reference as well as signal intensity of this volume. We conclude that in addition to alteration of the NK1 receptor in the CNS, there is also activation, or up-regulation of the NK1 receptor in the peripheral, painful tissue in a chronic pain condition. We interpret this increased NK1 receptor availability as part of ongoing neurogenic inflammation and suggest that this is part of the cause of chronic tennis elbow.

  • 21.
    Torstensson, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Butler, Stephen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Lindgren, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Referred pain patterns provoked on intra-pelvic structures among women with and without chronic pelvic pain: a descriptive study2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 3, article id e0119542Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To describe referred pain patterns provoked from intra-pelvic structures in women with chronic pelvic pain (CPP) persisting after childbirth with the purpose to improve diagnostics and give implications for treatment.

    MATERIALS AND METHODS:

    In this descriptive and comparative study 36 parous women with CPP were recruited from a physiotherapy department waiting list and by advertisements in newspapers. A control group of 29 parous women without CPP was consecutively assessed for eligibility from a midwifery surgery. Inclusion criterion for CPP was: moderate pain in the sacral region persisting at least six months after childbirth confirmed by pelvic pain provocation tests. Exclusion criteria in groups with and without CPP were: persistent back or pelvic pain with onset prior to pregnancy, previous back surgery and positive neurological signs. Pain was provoked by palpation of 13 predetermined intra-pelvic anatomical landmarks. The referred pain distribution was expressed in pain drawings and described in pain maps and calculated referred pain areas.

    RESULTS:

    Pain provoked by palpation of the posterior intra-pelvic landmarks was mostly referred to the sacral region and pain provoked by palpation of the ischial and pubic bones was mostly referred to the groin and pubic regions, with or without pain referred down the ipsilateral leg. The average pain distribution area provoked by palpation of all 13 anatomical landmarks was 30.3 mm² (19.2 to 53.7) in women with CPP as compared to 3.2 mm² (1.0 to 5.1) in women without CPP, p< 0.0001.

    CONCLUSIONS:

    Referred pain patterns provoked from intra-pelvic landmarks in women with CPP are consistent with sclerotomal sensory innervation. Magnification of referred pain patterns indicates allodynia and central sensitization. The results suggest that pain mapping can be used to evaluate and confirm the pain experience among women with CPP and contribute to diagnosis.

  • 22.
    Torstensson, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Sundsvall Hosp, Dept Physiotherapy, S-85186 Sundsvall, Sweden.
    Butler, Stephen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala Univ Hosp, Pain Ctr, S-75185 Uppsala, Sweden.
    Lindgren, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Sundsvall Hosp, Dept Physiotherapy, S-85186 Sundsvall, Sweden.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Stockholm Cty Council, Acad Primary Healthcare Ctr, S-10431 Stockholm, Sweden.
    Nilsson-Wikmar, Lena
    Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, S-14183 Huddinge, Sweden;Stockholm Cty Council, Acad Primary Healthcare Ctr, S-10431 Stockholm, Sweden.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    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 study2018In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 18, article id 54Article in journal (Refereed)
    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.

  • 23.
    Torstensson, Thomas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Butler, Stephen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Lindgren, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Nilsson-Wikmar, Lena
    Karolinska Institutet.
    Eriksson, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Provoked pain intensity on intra-pelvic structures in women with and without chronic pelvic painManuscript (preprint) (Other academic)
1 - 23 of 23
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Output format
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  • asciidoc
  • rtf