| 1. |
- Baad-Hansen, Lene, et al.
(författare)
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Somatosensory sensitivity in patients with persistent idiopathic orofacial pain is associated with pain relief from hypnosis and relaxation
- 2013
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Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 29:6, s. 518-526
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: In a recent study hypnosis has been found to relieve persistent idiopathic orofacial pain. Quantitative sensory testing (QST) is widely used to evaluate somatosensory sensitivity, which has been suggested as a possible predictor of management outcome. The objectives of this study were to examine: (1) possible associations between clinical pain relief and baseline somatosensory sensitivity and (2) the effect of hypnosis management on QST parameters. METHODS: Forty-one patients with persistent idiopathic orofacial pain completed this randomized controlled study in 1 of 2 groups: hypnosis (hypnotic analgesia suggestions) or control (relaxation). QST at 2 intraoral (pain region and contralateral mirror image region) and 3 extraoral (hand and both cheeks) sites was performed at baseline and after the hypnosis/control management, together with pressure pain thresholds and pressure pain tolerance thresholds determined bilaterally at the masseter and temporalis muscles, the temporomandibular joints, and the third finger. RESULTS: Degree of pain relief was negatively correlated with a summary statistic of baseline somatosensory sensitivity (summed z-score), that is, high baseline somatosensory sensitivity was associated with low pain relief (r=-0.372, P=0.020). Hypnosis had no major effect on any QST measure compared with relaxation (P>0.063). CONCLUSIONS: High pain sensitivity at baseline may predict poor pain management outcome. In addition, despite clear clinical pain relief, hypnosis did not significantly or specifically influence somatosensory sensitivity. Future studies should further explore QST measures as possible predictors of different management response in orofacial pain conditions.
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| 2. |
- Chen, Mengying, et al.
(författare)
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A prospective study of pain experience in a neonatal intensive care unit of China
- 2012
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Ingår i: The Clinical Journal of Pain. - Philadelphia, PA, USA : Lippingcott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 28:8, s. 700-704
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To assess pain burden in neonates during their hospitalization in China and thus provide evidence for the necessity of neonatal pain management. Patients and Methods: The Neonatal Facial Coding System was used to evaluate pain in neonates. We prospectively collected data of all painful procedures performed on 108 neonates (term, 62; preterm, 46) recruited from admission to discharge in a neonatal intensive care unit of a university-affiliated hospital in China. Results: We found that during hospitalization each preterm and term neonate was exposed to a median of 100.0 (range, 11 to 544) and 56.5 (range, 12 to 249) painful procedures, respectively. Most of the painful procedures were performed within the first 3 days. Preterm neonates, especially those born at 28 and 29 weeks' gestational age, experienced more pain than those born at 30 weeks' gestation or later (P < 0.001). Among those painful procedures, tracheal aspiration was the most frequently performed on preterm neonates, and intravenous cannulation was the most common for term neonates. Moreover, tracheal intubations and femoral venous puncture were found to be the most painful. Notably, none of the painful procedures was accompanied by analgesia. Conclusions: Neonates, particularly preterm neonates, were exposed to numerous invasive painful procedures without appropriate analgesia in hospitals in China. The potential long-term impacts of poorly treated pain in neonates call for a change in pediatric practice in China and in countries with similar practices.
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| 3. |
- Gerdle, Björn, et al.
(författare)
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Chronic Widespread Pain : Increased Glutamate and Lactate Concentrations in the Trapezius Muscle and Plasma
- 2014
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Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 30:5, s. 409-420
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND:: Chronic widespread pain (CWP), including fibromyalgia syndrome (FM), is associated with prominent negative consequences. CWP has been associated with alterations in the central processing of nociception. Whereas some researchers consider CWP/FM as a central hyperexcitability pain condition, others suggest that the central alterations are maintained by peripheral nociceptive input. Microdialysis can be used in vivo to study muscle alterations in chronic myalgia. AIM:: The aim of the study was to investigate the plasma and interstitial concentrations of metabolites and algesics in the trapezius muscle of women with CWP and in pain-free women (CON).MATERIALS AND METHODS:: Seventeen women with CWP and 24 CON went through a clinical examination and completed a questionnaire; the pressure pain thresholds in the upper and lower extremities were registered. Microdialysis was conducted in the trapezius muscle, and a blood sample was drawn. Muscle blood flow, interstitial muscle concentrations, and plasma concentrations of lactate, pyruvate, glutamate, glucose, and glycerol (not in the plasma) were determined.RESULTS:: CWP patients had significantly increased interstitial muscle (P=0.02 to 0.001) and plasma (P=0.026 to 0.017) concentrations of lactate and glutamate. No significant differences existed in blood flow between CWP and CON. The interstitial concentrations-but not the plasma levels-of glutamate and lactate correlated significantly with aspects of pain such as pressure pain thresholds of the trapezius (R=0.22) and tibialis anterior (R=0.18) and the mean pain intensity (R=0.10) in CWP but not in CON.CONCLUSIONS:: The present study supports the suggestion that aspects of pain and central alterations in CWP/FM are influenced by peripheral tissue alterations.
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| 4. |
- Lilje, Stina, et al.
(författare)
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Costs and Utilities of Manual Therapy and Orthopedic Standard Care for Low-prioritized Orthopedic Outpatients of Working Age A Cost Consequence Analysis
- 2014
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Ingår i: The Clinical Journal of Pain. - : Lippincott Williams. - 0749-8047 .- 1536-5409. ; 30:8, s. 730-736
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Treatment for musculoskeletal disorders in primary care in Sweden is generally initiated with advice and medication. Second-line therapy is physiotherapy and/or injection and radiography; third-line therapy is referral to an orthopedist. Manual therapy is not routine. It is a challenge to identify patients who benefit from treatment by different specialists. The current referral strategy probably contributes to long waiting lists in orthopedic departments, which is costly and implies prolonged suffering for the patients. The aim of this health economic evaluation was to compare costs and outcomes from naprapathic manual therapy (NMT) with orthopedic standard care for common, low-prioritized, nonsurgical musculoskeletal disorders, after second-line treatment. Materials and Methods: Diagnose Related Groups were used to define the costs, and the SF-36 was encoded to evaluate the outcomes in cost per quality adjusted life years gained. Results: Results from a 12 months' follow-up showed significantly larger improvement for the NMT than for orthopedic standard care, significantly lower mean cost per patient; 5427 SEK (*Price level 2009; 1 Euro = 106,213 SEK; 1 US Dollar = 76,457 SEK) (95% confidence interval, 3693-7161) compared to14298 SEK (95% confidence interval, 8322-20,274), and more gains in outcomes in cost per quality adjusted life years per patient (0.066 compared with 0.026). Thus the result is "dominant." Discussion: It is plausible that improved outcomes and reasonable cost savings for low-prioritized nonsurgical outpatients would be attainable if NMT were available as an additional standard care option in orthopedic outpatient clinics.
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| 5. |
- Lilje, Stina, et al.
(författare)
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Naprapathic Manual Therapy or Conventional Orthopedic Care for Outpatients on Orthopedic Waiting Lists? A pragmatic randomized controlled trial.
- 2010
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Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 26:7, s. 602-610
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Traditionally, orthopedic outpatient waiting lists are long, and many referrals are for conditions that do not respond to interventions available at an orthopedic outpatient department. The overall objective of this trial was to investigate whether it is possible to reduce orthopedic waiting lists through integrative medicine. Specific aims were to compare the effects of naprapathic manual therapy to conventional orthopedic care for outpatients with nonurgent musculoskeletal disorders unlikely to benefit from surgery regarding pain, physical function, and perceived recovery. Methods: Seventy-eight patients referred to an orthopedic outpatient department in Sweden were included in this pragmatic randomized controlled trial. The 2 interventions compared were naprapathic manual therapy (index group) and conventional orthopedic care (control group). Pain, physical function, and perceived recovery were measured by questionnaires at baseline and after 12, 24, and 52 weeks. The number of patients being discharged from the waiting lists and the level of agreement concerning management decisions between the naprapath and the orthopedists were also estimated. Results: After 52 weeks, statistically significant differences betweenthe groups were found regarding impairment in pain, increasedphysical function, and regarding perceived recovery, favoring theindex group. Sixty-two percent of the patients in the index group agreed to be discharged from the waiting list. The level of agreement concerning the management decisions was 80%. Discussion: The trial suggests that naprapathic manual therapy may be an alternative to consider for orthopedic outpatients with disorders unlikely to benefit from surgery.
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| 6. |
- Nordeman, Lena Margareta, et al.
(författare)
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Prevalence and characteristics of widespread pain in female primary health care patients with chronic low back pain.
- 2012
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Ingår i: The Clinical Journal of Pain. - 0749-8047. ; 28:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To estimate the prevalence of widespread pain (WP) according to the American College of Rheumatology, 1990, in women with chronic low back pain (CLBP) consulting primary health care and to evaluate the differences in body function, activity, participation, environmental factors, health-related quality of life, and other health-related aspects between patients having CLBP with or without WP. Methods: A cross-sectional study of women with CLBP including clinical assessment and questionnaires was conducted. Patients were categorized as having CLBP with or without WP and differences between these groups were evaluated. Results: One hundred thirty patients were assessed. Twenty-eight percent (n=37) had WP. Patients with CLBP+WP showed more impaired physical performance (6-min walk test, handgrip strength), higher numbers of tender points, more severe pain, fatigue, and depression compared with CLBP (P<0.05). The CLBP+WP showed greater activity limitation (P=0.00047). Work disability was 35% (n=13/37) in CLBP+WP compared with 16% (n=15/93) in CLBP (P=0.032). Private social support was negatively impacted in CLBP+WP (P=0.010). The CLBP+WP showed lower health-related quality of life (SF-36) in the physical function, bodily pain, and vitality dimension (P<0.05). More severe clinical stress symptoms and risk for future disability were registered for the CLBP+WP (P<0.001). Discussion: Twenty-eight percent fulfilled the American College of Rheumatology 1990 criteria for WP. When WP was present, patients reported significantly more impaired body functions, more severe activity limitations, and participation restrictions. Environmental factors, health-related quality of life, and other health-related aspects were also negatively impacted. It is suggested that the presence of WP should be evaluated in female patients with CLBP.
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| 7. |
- Nordeman, Lena Margareta, et al.
(författare)
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Prognostic factors for work ability in women with chronic low back pain consulting primary health care: a 2-year prospective longitudinal cohort study
- 2014
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Ingår i: The Clinical Journal of Pain. - 0749-8047. ; 30:5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:To investigate prognostic factors for future work ability in women with chronic low back pain (CLBP) consulting primary health care. METHODS:A 2-year prospective longitudinal cohort study of female patients with CLBP within the primary health care was conducted. Patients were assessed at the first assessment and after 2 years. Prognostic factors for work ability (yes/no) were analyzed by multivariate regression. RESULTS:A total of 130 patients were included at first assessment. After 2 years, 123 patients (95%) were followed up. The 6-minute walk test, depression, and earlier work ability predicted work ability at the 2-year follow-up. A nomogram was constructed to assess the probability of future work ability. DISCUSSION:The 6-minute walk test, work ability, and depression predicted work ability for women with CLBP after 2 years.
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| 8. |
- Olaya-Contreras, Patricia, 1964, et al.
(författare)
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Cross-validation of the Depression, Anxiety, and Positive Outlook Scale (DAPOS) for Clinical Use
- 2011
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Ingår i: The Clinical journal of pain. - 0749-8047 .- 1536-5409. ; 27:4, s. 330-337
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The main objective of this study was to investigate different psychometric properties of the Swedish version of the Depression, Anxiety, and Positive Outlook Scale (DAPOS) in patients with chronic musculoskeletal pain in an orthopedic setting. METHODS: A total of 449 participants took part in the study, including 288 patients with chronic musculoskeletal pain and 161 participants in a reference group. Internal consistency, convergent validity, and measurement invariance of the constructs of DAPOS were investigated across sex and diagnostic groups. The Beck Depression Inventory and the Spielberger Anxiety Inventory were used for measures of convergent validity. Multigroup confirmatory factor analysis was performed to test measurement invariance of the theoretical constructs of DAPOS. RESULTS: Internal consistency was good for all 3 constructs, and correlations concerned with convergent validity were found to be acceptable to good. With regard to cross-validation, the 3 constructs of DAPOS were strictly measurement invariant with respect to sex. Across diagnostic groups, the constructs of anxiety and positive outlook were almost strictly measurement invariant, although there were some restrictions of measurement invariance for the construct of depression. DISCUSSION: To be able to rely on an instrument with as few items as DAPOS, the cross-validation of its constructs for sex and diagnostic groups is a valuable information, particularly when investigated in patients with musculoskeletal pain. Based on these results, we recommend that DAPOS could replace longer and more time-consuming screening tests in clinical settings.
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| 9. |
- Rhodin, Annica, 1949-, et al.
(författare)
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Opioid endocrinopathy : a clinical problem in patients with chronic pain and long-term opioid treatment
- 2010
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Ingår i: The Clinical Journal of Pain. - 0749-8047 .- 1536-5409. ; 26:5, s. 374-380
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Tidskriftsartikel (refereegranskat)abstract
- Background:The use of strong opioids for treatment of noncancer chronic pain has increased. However, strong evidence for sustained pain relief and improved function is lacking. Controversy prevails, whether hormonal changes are induced by long-term treatment with opioids. The purpose of this study was to investigate the occurrence of endocrine dysfunction in chronic pain patients on long-term opioid treatment.Methods:A study group of 39 chronic pain patients treated with strong oral opioids for more than 1 year was compared with a control group of 20 chronic pain patients without opioid treatment. Basic levels of prolactin and function of the hypothalamic-pituitary-thyroid-, hypothalamic-pituitary-adrenal-axis, and hypothalamic-pituitary-growth-hormone - and hypothalamic-pituitary-gonadal-axis were measured. Quality-of-life and side effects were estimated with EORTC-QLQ-C30.Results:In the opioid-treated group, the patients had signs of pituitary dysfunction affecting all axes. Significant differences were shown in hypofunction of the hypothalamic-pituitary-gonadal -axis, hyperfunction of the hypothalamic-pituitary-adrenal -axis, and higher prolactin levels in the opioid-treated group, compared with the control group. The degree of pain was rated the same in both groups, but the opioid-treated group reported more side effects and lower quality of life.Conclusions:Long-term treatment of chronic pain with strong opioids causes side effects that can be attributed to hormonal abnormalities caused by opioid-induced inhibition of hypothalamic-pituitary function. Hormone substitution can be indicated to treat symptoms. Decreasing the opioid dose or stopping the opioid treatment can reverse endocrine dysfunction. This needs to be recognized by all practitioners treating chronic pain patients with opioids.
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| 10. |
- Rothman, Mats Georg, et al.
(författare)
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Improved Quality of Life, Working Ability, and Patient Satisfaction After a Pretreatment Multimodal Assessment Method in Patients With Mixed Chronic Muscular Pain A Randomized-controlled Study
- 2013
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Ingår i: The Clinical Journal of Pain. - 0749-8047 .- 1536-5409. ; 29:3, s. 195-204
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate whether a pretreatment multimodal (MM) assessment of patients with chronic muscular pain has an impact on treatment outcome. Methods: The present randomized-controlled study evaluated an MM assessment compared with routine multidisciplinary assessment given to a control group. The study population consisted of primary care patients with mixed chronic muscular pain. Variables assessed were: pain intensity, depression, life stress, quality of life (QOL), disability, working ability, and treatment satisfaction. Follow-up was performed at 15 months and 182 patients of 220 (83%) completed the study. Results: Univariate and multivariate logistic regression showed from baseline to 15 months a significant improvement in QOL as measured by Short-Form 36 in the MM group compared with the control group on the domains of physical function (odds ratio 2.40; 95% confidence interval 1.32-4.37), role physical (2.37; 1.10-5.09), and role emotional (2.05; 1.05-3.96). Working ability improved more significantly in the MM group (46% vs. 35%) and impairment was less (1% vs. 15%) compared with the control group (P = 0.016). Satisfaction with the assessment was, on average, higher (P < 0.001) in the MM group than in the control group. Discussion: Patients who underwent an MM assessment before treatment in comparison with patients receiving routine multidisciplinary assessment improved QOL, working ability, and were also significantly more satisfied. This result indicates that MM pretreatment assessment could be advantageous in the selection of patients for suitable rehabilitation treatment in a primary care setting, and also be used to prepare patients for future rehabilitation.
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