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  • 1. Basnet, A.
    et al.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Honore, P. H.
    Butler, M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Gordh, Torsten E.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Kristensen, K.
    Bjerrum, O. J.
    Donepezil provides positive effects to patients treated with gabapentin for neuropathic pain: an exploratory study2014Inngår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 58, nr 1, s. 61-73Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BackgroundThe first-line medication gabapentin and the acetylcholinesterase inhibitor donepezil represent a new promising combination to improve treatment outcomes for patients with severe neuropathic pain. The drugs have previously shown synergism following co-administration in nerve-injured rats. MethodsThe clinical relevance of adding donepezil to existing gabapentin treatment in patients with post-traumatic neuropathic pain was explored in this open-label study. The study comprised two consecutive periods of minimum 6 weeks: (1) titration of gabapentin to the highest tolerable dose or maximum 2400mg daily, and (2) addition of donepezil 5mg once daily to the fixed gabapentin dose. Efficacy and tolerability were assessed by ratings of pain intensity, questionnaires for pain and health-related quality of life, and reporting of adverse events. Pain scores were also analysed using mixed-effects analysis with the software NONMEM to account for intersubject variability. ResultsEight patients commenced treatment with donepezil, of which two withdrew because of adverse events. Addition of donepezil resulted in clinically relevant reductions of pain (>11 units on a 0-100 scale) and improved mental wellness in three of six patients. The remaining three patients had no obvious supplemental effect. Mixed-effects analysis revealed that pain scores were significantly lower during co-administration (P<0.0001 combination vs. monotherapy). ConclusionDonepezil may provide additional analgesia to neuropathic pain patients with insufficient pain relief from gabapentin as monotherapy. The promising results support controlled clinical trials of the drug combination. The usefulness of mixed-effects analysis in small-scale trials and/or for data with high intersubject variability was also demonstrated.

  • 2.
    Breivik, Harald
    et al.
    Univ Oslo, Fac Med, Oslo, Norway.;Oslo Univ Hosp, Dept Pain Management & Res, Pbox 4956 Nydalen, N-0424 Oslo, Norway.;Oslo Univ Hosp, Dept Anaesthesiol, Oslo, Norway..
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp, Pain Ctr, Uppsala, Sweden.
    Qualitative pain research emphasizes that patients need true information and physicians and nurses need more knowledge of complex regional pain syndrome (CRPS)2017Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 15, s. 104-105Artikkel i tidsskrift (Annet vitenskapelig)
  • 3.
    Breivik, Harald
    et al.
    Univ Oslo, Fac Med, Oslo, Norway.;Oslo Univ Hosp, Dept Anaesthesiol, Oslo, Norway.;Oslo Univ Hosp, Dept Pain Management & Res, Box 4956, N-0424 Oslo, Norway..
    Stubhaug, Audun
    Univ Oslo, Fac Med, Oslo, Norway.;Oslo Univ Hosp, Dept Pain Management & Res, Box 4956, N-0424 Oslo, Norway..
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp, Ctr Multidisciplinary Pain, Uppsala, Sweden.
    CNS-mechanisms contribute to chronification of pain2017Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 15, nr 1, s. 137-139Artikkel i tidsskrift (Annet vitenskapelig)
  • 4.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp Uppsala, Ctr Multidisciplinary Pain, Uppsala, Sweden.;St Olavs Hosp, Natl Ctr Complex Disorders, Trondheim, Norway.
    A glimpse into a neglected population: Emerging adults2017Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, s. 230-232Artikkel i tidsskrift (Annet vitenskapelig)
  • 5.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    An investigation into enlarging and reducing the size of mirror reflections of the hand on experimentally induced cold-pressor pain in healthy volunteers2016Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 10, s. 26-27Artikkel i tidsskrift (Annet vitenskapelig)
  • 6.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp, Pain Ctr, Uppsala, Sweden..
    Cortical reorganization of the healthy hand in upper-limb complex regional pain syndrome (CRPS): Is reorganizations of common beliefs about CRPS necessary?2016Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 13, s. 136-137Artikkel i tidsskrift (Fagfellevurdert)
  • 7.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Academic Hospital, Multidisciplinary Pain Center, Uppsala, Sweden.
    Important new insight in pain and pain treatment induced changes in functional connectivity between the Pain Matrix and the Salience, Central Executive, and Sensorimotor networks2017Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 16, s. 64-65Artikkel i tidsskrift (Annet vitenskapelig)
  • 8.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala Univ Hosp, Multidisciplinary Pain Ctr, Ing 79, Uppsala, Sweden.
    Information, back pain, and radiology2019Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, nr 3, s. 427-428Artikkel i tidsskrift (Annet vitenskapelig)
  • 9.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp Uppsala, Ctr Multidisciplinary Pain, Uppsala, Sweden.;St Olavs Hosp, Natl Ctr Complex Disorders, Trondheim, Norway..
    Is there hope for the most complicated chronic pain patients facing back surgery?2016Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 13, s. 130-131Artikkel i tidsskrift (Fagfellevurdert)
  • 10.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Laboratory biomarkers of systemic inflammation - what can they tell us about chronic pain?2020Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 20, nr 1, s. 5-7Artikkel i tidsskrift (Annet vitenskapelig)
  • 11.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp, Pain Ctr, Uppsala, Sweden..
    Patient Reported Outcomes (PROs) are sensitive outcome-variables in patients with chronic pain: Importance of self-efficacy2016Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 13, s. 25-26Artikkel i tidsskrift (Fagfellevurdert)
  • 12.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp Uppsala, Ctr Multidisciplinary Pain, Uppsala, Sweden.;St Olavs Hosp, Natl Ctr Complex Disorders, Trondheim, Norway..
    Relief of phantom limb pain using mirror therapy: A bit more optimism from retrospective analysis of two studies2017Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 15, s. 96-97Artikkel i tidsskrift (Annet vitenskapelig)
  • 13.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp, Ctr Multidisciplinary Pain, Uppsala, Sweden.;St Olavs Hosp, Natl Ctr Complex Disorders, Trondheim, Norway.
    Sleep, widespread pain and restless legs: What is the connection?2017Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, s. 174-175Artikkel i tidsskrift (Annet vitenskapelig)
  • 14.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp, Pain Ctr, Uppsala, Sweden; St Olavs Hosp, Ctr Pain & Complex Disorders, Trondheim, Norway.
    Support for mirror therapy for phantom and stump pain in landmine-injured patients2018Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 18, nr 4, s. 561-562Artikkel i tidsskrift (Annet vitenskapelig)
  • 15.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    The IMMPACT factor or IMMPACT strikes again!2013Inngår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 154, nr 11, s. 2243-2244Artikkel i tidsskrift (Annet vitenskapelig)
  • 16.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp Uppsala, Multidisciplinary Pain Ctr, Uppsala, Sweden.;St Olavs Hosp, Natl Ctr Complex Disorders, Trondheim, Norway..
    The meaning and consequences of amputation and mastectomy from the perspective of pain and suffering - Lessons to be learned and relearned2017Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 14, s. 98-99Artikkel i tidsskrift (Fagfellevurdert)
  • 17.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp, Ctr Multidisciplinary Pain, S-75185 Uppsala, Sweden.
    The triumvirate of co-morbid chronic pain, depression, and cognitive impairment: Attacking this "chicken-and-egg" in novel ways2017Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 15, s. 148-149Artikkel i tidsskrift (Annet vitenskapelig)
  • 18.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp, Ctr Multidisciplinary Pain, Uppsala, Sweden.
    The wit and wisdom of Wilbert (Bill) Fordyce (1923 - 2009)2017Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 16, s. 160-163Artikkel, forskningsoversikt (Fagfellevurdert)
  • 19.
    Butler, Stephen
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Eek, Daniel
    AstraZeneca R&D, Molndal, Sweden.
    Ring, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Klinisk psykologi i hälso- och sjukvård.
    Gordon, Allan
    Wasser Pain Management Ctr, Mount Sinai Hospital, Toronto, Canada.
    Karlsten, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    The utility/futility of medications for neuropathic pain: an observational study2019Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, nr 2, s. 327-335Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and aims

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

    Methods

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

    Results

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

    Conclusions

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

    Implications

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

    Fulltekst (pdf)
    fulltext
  • 20.
    Butler, Stephen H.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Jonzon, Bror
    Branting-Ekenback, Christina
    Wadell, Cecilia
    Farahmand, Bahman
    Predictors of severe pain in a cohort of 5271 individuals with self-reported neuropathic pain2013Inngår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 154, nr 1, s. 141-146Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The influence of pain descriptors and mechanical hypersensitivity on pain severity in neuropathic pain has not been well researched and is poorly understood. The aim of this study was to determine the relationship between pain severity and other factors describing chronic neuropathic pain in a large cohort of patients with self-reported neuropathic pain potentially recruited as subjects for a Phase IIa study. A questionnaire specific to the study parameters covering demographics and pain characteristics was sent to potential participants. Overall, 9185 questionnaires were returned from potential subjects who self-reported neuropathic pain. Adjusted odds ratios with 95% confidence intervals were used as a measure of association. These were estimated by unconditional logistic regression. Pain descriptors in the questionnaire were: burning, shooting, shocking, and aching. The presence of self-reported allodynia and hyperalgesia was strongly indicative of both moderate and severe pain, with a significant interaction of both factors in moderate and severe pain. Having 3 or 4 pain descriptors was also strongly indicative of both moderate and severe pain. Female gender, age, and history of serious mental disorders were found to be weaker indicators of both moderate and severe pain. Given the large and varied population with many neuropathic pain diagnoses in the study, the findings are not likely to be merely chance, but are likely to reflect important relationships between pain severity and other factors in those who suffer from chronic neuropathic pain.

  • 21.
    Butler, Stephen H.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Norwegian Univ Sci & Technol, Fac Med, Dept Circulat & Med Imaging, Trondheim, Norway..
    Landmark, Tormod
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway..
    Glette, Mari
    Norwegian Univ Sci & Technol, Fac Med, Dept Circulat & Med Imaging, Trondheim, Norway..
    Borchgrevink, Petter
    Norwegian Univ Sci & Technol, Fac Med, Dept Circulat & Med Imaging, Trondheim, Norway.;St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway..
    Woodhouse, Astrid
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.;Norwegian Univ Sci & Technol, Fac Med, Dept Publ Hlth & Gen Practice, Trondheim, Norway..
    How widespread should pain be to be defined as widespread?: Reply2016Inngår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 157, nr 8, s. 1832-1833Artikkel i tidsskrift (Fagfellevurdert)
  • 22.
    Butler, Stephen
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Norwegian Univ Sci & Technol, Fac Med, Dept Circulat & Med Imaging, N-7034 Trondheim, Norway; Univ Uppsala Hosp, Pain Ctr, ING 79,2 TR, S-75185 Uppsala, Sweden.
    Landmark, Tormod
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Glette, Mari
    Norwegian Univ Sci & Technol, Fac Med, Dept Circulat & Med Imaging, N-7034 Trondheim, Norway.
    Borchgrevink, Petter
    Norwegian Univ Sci & Technol, Fac Med, Dept Circulat & Med Imaging, N-7034 Trondheim, Norway; St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Woodhouse, Astrid
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway; Norwegian Univ Sci & Technol, Fac Med, Dept Publ Hlth & Gen Practice, N-7034 Trondheim, Norway.
    Chronic widespread pain - the need for a standard definition2016Inngår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 157, nr 3, s. 541-543Artikkel, forskningsoversikt (Fagfellevurdert)
  • 23.
    Drevin, Jennifer
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Stern, Jenny
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Annerbäck, Eva-Maria
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Peterson, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Tydén, Tanja
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Berglund, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH). Uppsala universitet, Nationellt centrum för kvinnofrid (NCK).
    Larsson, Margareta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Kristiansson, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Adverse childhood experiences influence development of pain during pregnancy.2015Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, nr 8, s. 840-846Artikkel i tidsskrift (Fagfellevurdert)
    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.

    Fulltekst (pdf)
    fulltext
  • 24. Galer, Bradley S.
    et al.
    Jensen, Mark
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Neglect-like signs and symptoms in CRPS2013Inngår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 154, nr 6, s. 961-962Artikkel i tidsskrift (Fagfellevurdert)
  • 25.
    Glette, Mari
    et al.
    Norwegian Univ Sci & Technol, Dept Circulat & Med Imaging, Trondheim, Norway;St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Landmark, Tormod
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway;Norwegian Univ Sci & Technol, Dept Psychol, Trondheim, Norway.
    Jensen, Mark P.
    Univ Washington, Sch Med, Dept Rehabil Med, Seattle, WA 98195 USA.
    Woodhouse, Astrid
    Norwegian Univ Sci & Technol, Dept Circulat & Med Imaging, Trondheim, Norway;St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway;Univ Hosp Uppsala, Pain Ctr, Uppsala, Sweden.
    Borchgrevink, Petter C.
    Norwegian Univ Sci & Technol, Dept Circulat & Med Imaging, Trondheim, Norway;St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Stiles, Tore C.
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway;Norwegian Univ Sci & Technol, Dept Psychol, Trondheim, Norway.
    Catastrophizing, Solicitous Responses From Significant Others, and Function in Individuals With Neuropathic Pain, Osteoarthritis, or Spinal Pain in the General Population2018Inngår i: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 19, nr 9, s. 983-995Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 26.
    Hysing, Eva-Britt
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Smith, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper.
    Eriksson, Måns
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Statistiska institutionen.
    Karlsten, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Gordh, Torsten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Identifying characteristics of the most severely impaired chronic pain patients treated at a specialized inpatient pain clinic2017Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, nr 1, s. 178-185Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

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

  • 27.
    Miclescu, Adriana
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Karlsten, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    The changing face of acute pain services2017Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 16, s. 204-210Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and Aims

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

    Method

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

    Results

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

    Conclusions

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

  • 28.
    Miclescu, Adriana
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Karlsten, Rolf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    The changing face of the acute pain2016Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    Aims: To distinguishthe risk factors associated with uncontrolled and problematic pain by prospectively assessing the current acute pain service (APS) activity in an academic hospital and theeffects of this activity on both surgical and medical pain intensity.

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

    Results: Patients (n=730) (mean age 56±4, female 58%, men 42%) were distributed by service to medical (41%) and surgical (58%). Of these, 48% of patients reported a pain score of moderate to severe pain and 27% reported severe pain on the first assessment. On the last examination before discharge, they reported 25–30% less pain (P=0.002). The median NRS (numerical rating scores) decreased significantly from 9.6 (95% confidence interval, 3.4–5.3) to 6.3 (1.0–2.0) for the severe pain (p<0.0001), from 3.8 (3.1–3.8) to 2.4 (2.2–2.4) for the mild pain. Respiratory depression related to pain treatment was reported in 1.6% patients. The APS treated cognitive deficits related to pain treatment, in 30% of the patients, recognized and treated opioid overdose in 14%. The patients who required more than 5 visits by the APS(280 patients representing 38% of all the patients) demonstrated an increased prevalence of psychiatric diseases (from 10% in group 1 to 42% in group 5), opioid dependency (13% in group 1 to 100% in group 5) and chronic painresulted from both nociceptive (gradually increasing from 38% in group 1 to 85% in group 5) and neuropathic pain (from 13 % in group 1 increasing to 35% in group 5). The diagnoses encountered in the patients with frequent visits by the APS team were cancer related pain (17%), endometriosis (9%), reoperation(12%), burn injury(5%).

    Conclusions: Beside the benefits of APS in reducing of pain intensity, and in treating analgesia side effects, this study demonstrates the uncertain role of APS in the treatment of acute pain. The focus of APS has been shifted from the traditional treatment of acute surgical pain to the clinical challenges of treating hospitalized patients who suffered adverse effects from pain treatment and have a high of comorbidities aspsychiatric diseases, opioid dependency and non-surgical chronic pain.

  • 29.
    Miclescu, Adriana
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Nordquist, Lena
    Uppsala universitet.
    Hysing, Eva-Britt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Basu, Samar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Oxidativ stress och inflammation.
    Lind, Anne-Li
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Gordh, Torsten
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Anestesiologi och intensivvård.
    Targeting oxidative injury and citokines activity in the treatment with anti-TNF alpha antibodies against CRPS 12013Inngår i: Pain Practice, ISSN 1530-7085, E-ISSN 1533-2500, Vol. 13, nr 8, s. 641-648Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cytokines and oxygen free radicals have been implicated in the potential pathogenic development of complex regional pain syndrome (CRPS). We aimed to analyze the relationship between clinical status, circulating levels of cytokines, and markers of oxidative damage during the treatment with anti-TNFα antibodies. The patient chosen for treatment had not had improvement through a number of conventional therapies and fulfilled the current diagnostic criteria for CRPS-1. We investigated the clinical variables before and after systemic administration of 1.4 mg/kg anti-TNFα antibody (infliximab), repeated after 1 month in a dose of 3 mg/kg. Blood samples were collected before and after anti-TNFα antibodies administration, and plasma was analyzed for 8-isoprostane-prostaglandin F2α (8-iso-PGF2α, a marker of oxidative injury) and cytokines (TNF-α, IL-4, IL-6, IL-7, IL-8, IL-10, IL-17A). Plasma concentrations of 8-iso-PGF2α were measured with radioimmunoassay (RIA), and the kinetics of cytokines were detected in plasma by antibody-based proximity ligation (PLA). Pathologically high levels of 8-iso-PGF2α were found in the patient. Immediately after each administration of infliximab, the levels of 8-iso-PGF2α decreased. Although the patient showed an improvement of the cutaneous dystrophic symptoms and diminished pain associated with these lesions, the levels of circulating TNFα increased after the administration of anti-TNFα antibodies. In a patient with CRPS-1 treated with anti-TNFα antibodies, we report increased levels of circulating TNFα and a temporary mitigation of oxidative stress as measured by plasma F2-isoprostane. This case report provides evidence 2 supporting the indication of monitoring the oxidative stress biomarkers during treatment with anti-TNFα antibodies in CRPS 1.

    Fulltekst (pdf)
    fulltext
  • 30.
    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.

  • 31.
    Peterson, Magnus
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    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 preventivmedicin.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy)2014Inngår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 28, nr 9, s. 862-872Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 32.
    Peterson, Magnus
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    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 preventivmedicin.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    A randomized controlled trial of exercise versus wait list in chronic tennis elbow (lateral epicondylosis)2011Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 116, nr 4, s. 269-279Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 33.
    Torstensson, Thomas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Lindgren, Anne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Peterson, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Eriksson, Margaretha
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Kristiansson, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Referred pain patterns provoked on intra-pelvic structures among women with and without chronic pelvic pain: a descriptive study2015Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 3, artikkel-id e0119542Artikkel i tidsskrift (Fagfellevurdert)
    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.

    Fulltekst (pdf)
    fulltext
  • 34.
    Torstensson, Thomas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Sundsvall Hosp, Dept Physiotherapy, S-85186 Sundsvall, Sweden.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Uppsala Univ Hosp, Pain Ctr, S-75185 Uppsala, Sweden.
    Lindgren, Anne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Sundsvall Hosp, Dept Physiotherapy, S-85186 Sundsvall, Sweden.
    Peterson, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. 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 universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Kristiansson, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    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 study2018Inngår i: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 18, artikkel-id 54Artikkel i tidsskrift (Fagfellevurdert)
    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.

    Fulltekst (pdf)
    fulltext
  • 35.
    Torstensson, Thomas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Lindgren, Anne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Peterson, Magnus
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Nilsson-Wikmar, Lena
    Karolinska Institutet.
    Eriksson, Margaretha
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Kristiansson, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Provoked pain intensity on intra-pelvic structures in women with and without chronic pelvic painManuskript (preprint) (Annet vitenskapelig)
  • 36.
    Wolfe, Frederick
    et al.
    Natl Data Bank Rheumat Dis, Wichita, KS 67214 USA;Univ Kansas, Sch Med, 1035 N Emporia,Ste 288, Wichita, KS 67214 USA.
    Butler, Stephen H
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp Uppsala, Pain Ctr, Uppsala, Sweden;St Olavs Hosp, Ctr Pain & Complex Disorders, Trondheim, Norway.
    Fitzcharles, MaryAnn
    McGill Univ, Hlth Ctr, Montreal, PQ, Canada.
    Haeuser, Winfried
    Klinikum Saarbrucken, Dept Internal Med 1, Saarbrucken, Germany;Tech Univ Munich, Dept Psychosomat Med & Psychotherapy, Munich, Germany.
    Katz, Robert L.
    Rush Med Coll, Chicago, IL 60612 USA.
    Mease, Philip J.
    Univ Washington, Swedish Med Ctr, Seattle, WA 98195 USA.
    Rasker, Johannes J.
    Univ Twente, Fac Behav Management & Social Sci, Enschede, Netherlands.
    Russell, Anthony S.
    Univ Alberta, Dept Med, Edmonton, AB, Canada.
    Russell, I. Jon
    Fibromyalgia Res & Consulting, San Antonio, TX USA.
    Walitt, Brian
    NINR, NIH, Bethesda, MD 20892 USA.
    Revised chronic widespread pain criteria: development from and integration with fibromyalgia criteria2020Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 20, nr 1, s. 77-86Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and aims:

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

    Methods:

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

    Results:

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

    Conclusions:

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

    Implications:

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

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