| 1. |
- Eriksson, Lars B., et al.
(författare)
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Intravenous S-ketamine's analgesic efficacy in third molar surgery : A randomized placebo-controlled double-blind clinical trial
- 2023
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Ingår i: British Journal of Pain. - : Sage Publications. - 2049-4637 .- 2049-4645.
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn most cases, a combination of paracetamol and ibuprofen are the optimal treatment for postoperative pain in third molar surgery. If stronger analgesia is required, opioids are traditionally administered. In day-case, surgery; however, opioids should be avoided. Thus, the anaesthetic agent S-ketamine in analgesic doses might be preferred.MethodsThe study was designed as a randomized placebo-controlled double-blind clinical trial. The study enrolled healthy subjects according to the American Society of Anaesthesiologists classification; I or II (ASA), aged 18 to 44 years, with a body weight between 50 and 100 kg. The patients were randomized into three groups where two doses of S-ketamine were compared (high: 0.25 mg/kg or low: 0.125 mg/kg) with placebo (saline).ResultsA primary outcome of the study was that VAS at 4 h postoperatively, showed no significant difference between the placebo and high-dose S-ketamine group or in the low-dose group. We found a significant difference between the groups for the first 24 h, with a lower VAS-score in the high-dose S-ketamine group. The time to when 50% had taken their first rescue medication was 12 min later in the high-dose ketamine group.ConclusionsPre-emptive S-ketamine 0.25 mg/kg gave a global significant reduction of pain by VAS during the first 24 h postoperatively. The time from end of surgery to first rescue medication were longer in the high-dose ketamine group compared to both low-dose ketamine and placebo groups.
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| 2. |
- Gilpin, Helen R, et al.
(författare)
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Examining the association between group context effects and individual outcomes in an interdisciplinary group-based treatment for chronic pain based on acceptance and commitment therapy
- 2022
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Ingår i: British Journal of Pain. - : Sage Publications. - 2049-4637 .- 2049-4645. ; 16:4, s. 420-432
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Tidskriftsartikel (refereegranskat)abstract
- ackground: Although cognitive-behavioural treatments for chronic pain are delivered in groups, there is little research investigating group effects in these treatments.Purpose: The aim of this study was to investigate associations between group composition variables at the start of treatment and individual outcomes following intensive interdisciplinary treatment for pain based on Acceptance and Commitment Therapy.Methods: This was a secondary analysis of routinely collected observational data. Five-hundred and sixteen patients completed a standard set of demographic, pain-related and psychosocial measures at pre- and post-treatment. Intracluster correlations (ICCs) were computed to examine the clustering of outcomes within groups and multilevel models explored the association between group composition variables and individual level outcomes.Results: The ICCs for pain intensity (0.11) and interference (0.09) suggested that multilevel models were warranted for these outcomes, while a multilevel model for post-treatment depression (ICC = 0.04) was not warranted. Group percentage of participants receiving disability benefits and group mean pain intensity at pre-treatment were significantly positively associated with individual level pain intensity at post-treatment, controlling for pre-treatment individual level pain intensity. Group mean pain intensity at pre-treatment was the only group variable that significantly predicted post-treatment pain interference at the individual level. Psychosocial group composition variables were not significantly associated with individual level outcomes.Conclusion: Given the limited predictive utility of group composition variables in the current study, future research should undertake direct assessment of group level therapeutic and countertherapeutic processes to advance understanding of who benefits from group treatments for pain and how. As the variance in outcomes accounted for by group clustering was relatively small and significant within groups variance remained, research is also needed to further understand individual level factors that influence cognitive-behavioural treatment outcomes for pain.
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| 3. |
- Knight, Lucie D, et al.
(författare)
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Assessment and patient selection process for a pain management programme : a case study in specialty care.
- 2019
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Ingår i: British journal of pain. - : SAGE Publications. - 2049-4637 .- 2049-4645. ; 13:2, s. 74-81
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The present study audited the process of assessing and selecting patients for a pain management programme with the aim of reviewing best practice in the light of the latest British Pain Society guidelines for pain management programmes for adults. The guidelines include defined inclusion/exclusion criteria and it was explored how they are used by clinicians providing a pain management service.Method: The records of 200 consecutive patients who attended a multidisciplinary assessment for a central London specialist Pain Management Service from September 2014 to December 2014 were audited. The proportions of patients who were offered a programme, were discharged or referred for a different service were calculated. Clinic letters were reviewed to collect information on assessment outcomes, recommendations and inclusion/exclusion criteria used.Results: About half the patients (53%) seen for assessment were offered treatment within the service, most frequently the intensive residential programme (30.5%, with an additional 11.6% offered case management first), followed by the five session outpatient programme (8.1%) and a minority was offered individual treatment (2.5%); 44.7% of the patients were discharged following the assessment. The three most frequently used reasons for exclusion were: not ready to engage with the pain management approach (35%), complex psychological or other needs needing to be prioritised (29.5%) and the patient declining a programme (19.3%).Conclusion: Reviewing the use of inclusion/exclusion criteria revealed some challenges regarding patient selection. For example, a sizable proportion of patients were still seeking pain reduction and were not open to a self-management approach when this was the recommended treatment for them. Complex patients might need other treatment approaches before they can be considered for a programme. Having a range of pain management options of varying intensities available seems helpful in meeting individual patient need.
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| 4. |
- Montesinos, Francisco, et al.
(författare)
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Communication skills in the context of psychological flexibility : training is associated with changes in responses to chronic pain in physiotherapy students in Spain
- 2021
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Ingår i: BRITISH JOURNAL OF PAIN. - : Sage Publications. - 2049-4637 .- 2049-4645. ; 15:1, s. 54-63
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The aim of this study is to explore the effectiveness of a training programme aimed at managing patients' chronic pain in physiotherapy students in Spain. The programme addressed providing them with efficient skills to manage patients' chronic pain from psychological flexibility (PF) perspective. Methods: The programme integrates communication skills training into PF-based training. It sought to contribute to better recognise the role of psychosocial factors in chronic pain and to better promote adherence to treatment. This is an observational study with a pre- and post-training programme design and a 2-month follow-up. A total of 35 physiotherapy students, divided into three groups, participated in a 10-hour training course. Training focused on three areas: (1) communication skills, (2) therapeutic adherence and (3) managing distress and pain. The three areas were addressed from the PF point of view. Impact of training was measured through standardised questionnaires that assessed attitudes towards chronic pain, an ad hoc questionnaire that assessed responses to difficult communicative situations and a training satisfaction scale. Results: Final analyses showed that attitudes changed significantly after training, biomedical attitude scores decreased and biopsychosocial attitude increased, while pain was considered less disabling, and informed empathic responses in communication situations increased. These changes were maintained at 2-month follow-up. Satisfaction with the training was high. Conclusion: We conclude that a brief training programme based on the PF model may help students develop a more comprehensive approach and improve their skills for managing chronic pain.
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| 5. |
- Rankin, Linda, 1987-, et al.
(författare)
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What influences chronic pain management? : A best-worst scaling experiment with final year medical students and general practitioners
- 2019
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Ingår i: British Journal of Pain. - : SAGE Publications. - 2049-4637 .- 2049-4645. ; 13:4, s. 214-225
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic pain education is an essential determinant for optimal chronic pain management. Given that attitudes and preferences are involved in making treatment decisions, identifying which factors are most influential to final year medical students’ and general practitioners’ (GPs) chronic pain management choices is of importance. This study investigates Swedish and Australian students’ preferences with respect to a chronic pain condition, using a best–worst scaling (BWS) experiment, which is designed to rank alternatives.Methods: BWS, a stated-preference method grounded in random utility theory, was used to explore the importance of factors influencing chronic pain management.Results: All three cohorts considered the patients’ pain description and previous treatment experience as the most important factors in making treatment decisions, whereas their demographics and voices or facial expressions while describing their pain were considered least important. Factors such as social support, patient preferences and treatment adherence were, however, disregarded by all cohorts in favour of pain assessment factors such as pain ratings, description and history. Swedish medical students and GPs show very high correlation in their choices, although the GPs consider their professional experience as more important compared to the students.Conclusion: This study suggests that the relative importance of treatment factors is cemented early and thus underline the critical importance of improving pain curricula during undergraduate medical education.
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| 6. |
- Weik, E, et al.
(författare)
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Conditioning induced placebo-like and nocebo-like effects of thermal discomfort in adults but not in youth
- 2023
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Ingår i: British journal of pain. - : SAGE Publications. - 2049-4637 .- 2049-4645. ; 17:4, s. 342-351
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Tidskriftsartikel (refereegranskat)abstract
- Conditioning can be used to modulate the perception of pain, in the form of placebo and nocebo effects. Previous studies show inconsistent results as to whether adolescents show similar, weaker, or non-significant conditioned placebo and nocebo effects compared to effects found in adults. There are suggestions that such differences (if any) may dependent on the cues used in the thermal conditioning paradigms. Therefore, in this current study, we utilized novel, neutral 3D-shaped visual cues to implicitly induce conditioned placebo-like and nocebo-like effects in adolescents and adults. Methods During the conditioning paradigm, distinct cues (Fribbles) were paired with low and high temperatures in 24 adults and 20 adolescents (mean age = 25.5 years). In the testing phase, these conditioned cues as well as a neutral (unconditioned) cue were presented with moderate temperatures. Results Thermal discomfort of moderate temperatures was lower when presented with the conditioned low heat cue (placebo-like effect) and higher when thermal stimuli were presented with the high heat cue (nocebo-like effect) compared to the neutral cue. The effects were driven by adults, as neither the placebo-like nor the nocebo-like effect was significant in adolescents. The difference between adolescents and adults was not explained by differences in temperature or discomfort levels, as adults and adolescents had comparable calibrated temperatures and levels of discomfort during heat stimuli. Conclusion Our findings suggest that thermal perception in adolescents is less influenced by conditioning to an engaging novel visual cue, compared to adults. Our work may have implications for better understanding the scope and limitations of conditioning as a key mechanism of placebo and nocebo effects in youth.
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| 7. |
- Weik, E, et al.
(författare)
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Placebo and nocebo effects in youth: subjective thermal discomfort can be modulated by a conditioning paradigm utilizing mental states of low and high self-efficacy
- 2022
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Ingår i: British journal of pain. - : SAGE Publications. - 2049-4637 .- 2049-4645. ; 16:1, s. 60-70
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Tidskriftsartikel (refereegranskat)abstract
- Conditioning is a key mechanism of placebo and nocebo effects in adults, but little is known about these effects in youth. This study investigated whether personalized verbal cues evoking a sense of high or low self-efficacy can induce conditioned placebo and nocebo effects on subjective discomfort of noxious heat in youth. Methods: In a structured interview, 26 adolescents (13–18 years) described personal situations in which they experienced a sense of high, low or neutral self-efficacy. Participants were then asked to recall these memories during a conditioning paradigm, in which a high thermal stimulus applied to the forearm was repeatedly paired with a low self-efficacy cue and a low thermal stimulus with a high self-efficacy cue. In a testing phase, high, low and neutral self-efficacy cues were paired with the same moderate temperature. We hypothesized that conditioned high and low self-efficacy cues would induce conditioned placebo and nocebo responses to moderate temperatures. Results: Moderate temperatures were rated as more uncomfortable when paired with the conditioned low compared with the neutral self-efficacy cue (nocebo effect). While in the whole-group analysis, there was no significant difference between ratings of moderate thermal stimuli paired with high compared with neutral self-efficacy cues (placebo effect), a sub-group of participants with a greater range of emotional valence between high and neutral self-efficacy cues revealed a significant placebo effect. The strength of the nocebo effect was associated with higher anxiety and lower hope. Conclusion: Conditioned associations using internal self-efficacy states can change subjective discomfort of thermal sensations.
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| 8. |
- Yu, Lin, et al.
(författare)
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Measuring 'self' : preliminary validation of a short form of the Self Experiences Questionnaire in people with chronic pain
- 2021
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Ingår i: BRITISH JOURNAL OF PAIN. - : Sage Publications. - 2049-4637 .- 2049-4645. ; 15:4, s. 474-485
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Tidskriftsartikel (refereegranskat)abstract
- Background: People with chronic pain often struggle with their sense of self and this can adversely impact their functioning and well-being. Acceptance and Commitment Therapy particularly includes a process related to this struggle with self. A measure for this process, the Self Experiences Questionnaire (SEQ), was previously developed in people with chronic pain.Purpose: The aim of the current study was to validate a shorter version of the SEQ in people with chronic pain to reduce respondent burden and facilitate further research.Methods: Data from 477 participants attending an interdisciplinary pain management programme were included. Participants completed measures of treatment processes (self-as-context, pain acceptance, cognitive fusion and committed action) and outcomes (pain, pain interference, work and social adjustment and depression) at baseline and post-treatment. Confirmatory factor analysis was used for item reduction. Correlations between scores from the shorter SEQ and other process and outcome variables were calculated to examine validity. Change scores of the shorter SEQ and their correlations with changes in outcome variables were examined for responsiveness.Results: An eight-item SEQ (SEQ-8) scale including two factors, namely Self-as-Distinction and Selfas-Observer, emerged, demonstrating good reliability (Cronbach's alpha =.87-.90) and validity (vertical bar r vertical bar =.14-.52). Scores from SEQ-8 significantly improved after the treatment (d=.15-21), and these improvements correlated with improvements in most outcomes.Conclusions: The SEQ-8 appears to be a reliable and valid measure of self. This shorter format may facilitate intensive longitudinal investigation into sense of self and functioning and well-being.
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| 9. |
- Yu, Lin, et al.
(författare)
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Preliminary investigation of the associations between psychological flexibility, symptoms and daily functioning in people with chronic abdominal pain
- 2021
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Ingår i: BRITISH JOURNAL OF PAIN. - : Sage Publications. - 2049-4637 .- 2049-4645. ; 15:2, s. 175-186
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Acceptance and commitment therapy (ACT), based in the psychological flexibility model, may benefit people with chronic abdominal pain. The current study preliminarily investigates associations between psychological flexibility processes and daily general, social and emotional functioning in chronic abdominal pain.Methods: An online survey comprising measures of psychological flexibility processes and daily functioning was distributed through social media.Subjects: In total, 89 participants with chronic abdominal pain were included in the analyses.Results: All investigated psychological flexibility processes significantly correlated with pain interference, work and social adjustment, and depression, in the expected directions (vertical bar r vertical bar = .35-.68). Only pain acceptance significantly correlated with gastrointestinal (GI) symptoms, r = -.25. After adjusting for pain in the analyses, pain acceptance remained significantly associated with all outcomes, vertical bar beta vertical bar = .28-.56, but depression. After adjusting for pain and pain acceptance, only cognitive fusion remained significantly associated with anxiety, beta = -.27, and depression, beta = .43. When contrasting GI-specific anxiety with psychological flexibility processes, pain acceptance was uniquely associated with pain-related interference and work and social adjustment, and cognitive fusion and committed action were uniquely associated with depression.Conclusions: Psychological flexibility processes were positively associated with daily functioning in people with chronic abdominal pain. ACT may provide benefit for these people. Further studies with experimental designs are needed to examine the utility of ACT for people with abdominal pain.
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| 10. |
- Vanaelst, B, et al.
(författare)
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Prevalence of negative life events and chronic adversities in European pre- and primary-school children: results from the IDEFICS study.
- 2012
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Ingår i: Archives of Public Health. - : Springer Science and Business Media LLC. - 0778-7367 .- 2049-3258. ; 70:22, s. 1-26
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Tidskriftsartikel (refereegranskat)abstract
- Abstract ABSTRACT: BACKGROUND: Children are not always recognized as being susceptible to stress, although childhood stressors may originate from multiple events in their everyday surroundings with negative effects on children's health. METHODS: As there is a lack of large-scale, European prevalence data on childhood adversities, this study presents the prevalence of (1) negative life events and (2) familial and social adversities in 4637 European pre- and primary-school children (4--11 years old), using a parentally-reported questionnaire embedded in the IDEFICS project ('Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS'). RESULTS: The following findings were observed: (1) Certain adversities occur only rarely, while others are very regular (i.e. parental divorce); (2) A large percentage of children is shielded from stressors, while a small group of children is exposed to multiple, accumulating adversities; (3) The prevalence of childhood adversity is influenced by geographical location (e.g. north versus south), age group and sex; (4) Childhood adversities are associated and co-occur, resulting in potential cumulative childhood stress. CONCLUSIONS: This study demonstrated the importance of not only studying traumatic events but also of focusing on the early familial and social environment in childhood stress research and indicated the importance of recording or monitoring childhood adversities.
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