| 1. |
- Gerdle, Björn, et al.
(författare)
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The importance of emotional distress, cognitive behavioural factors and pain for life impact at baseline and for outcomes after rehabilitation - a SQRP study of more than 20,000 chronic pain patients
- 2019
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 19:4, s. 693-711
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims Although literature concerning chronic pain patients indicates that cognitive behavioural variables, specifically acceptance and fear of movement/(re)injury, are related to life impact, the relative roles of these factors in relation to pain characteristics (e.g. intensity and spreading) and emotional distress are unclear. Moreover, how these variables affect rehabilitation outcomes in different subgroups is insufficiently understood. This study has two aims: (1) to investigate how pain, cognitive behavioural, and emotional distress variables intercorrelate and whether these variables can regress aspects of life impact and (2) to analyse whether these variables can be used to identify clinically meaningful subgroups at baseline and which subgroups benefit most from multimodal rehabilitation programs (MMRP) immediately after and at 12-month follow-up. Methods Pain aspects, background variables, psychological distress, cognitive behavioural variables, and two life impact variables were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) for chronic pain patients. These data were analysed mainly using advanced multivariate methods. Results The study includes 22,406 chronic pain patients. Many variables, including acceptance variables, showed important contributions to the variation in clinical presentations and in life impacts. Based on the statistically important variables considering the clinical presentation, three clusters/subgroups of patients were identified at baseline; from the worst clinical situation to the relatively good situation. These clusters showed significant differences in outcomes after participating in MMRP; the subgroup with the worst situation at baseline showed the most significant improvements. Conclusions Pain intensity/severity, emotional distress, acceptance, and life impacts were important for the clinical presentation and were used to identify three clusters with marked differences at baseline (i.e. before MMRP). Life impacts showed complex relationships with acceptance, pain intensity/severity, and emotional distress. The most significant improvements after MMRP were seen in the subgroup with the lowest level of functioning before treatment, indicating that patients with complex problems should be offered MMRP. Implications This study emphasizes the need to adopt a biopsychosocial perspective when assessing patients with chronic pain. Patients with chronic pain referred to specialist clinics are not homogenous in their clinical presentation. Instead we identified three distinct subgroups of patients. The outcomes of MMRP appears to be related to the clinical presentation. Thus, patients with the most severe clinical presentation show the most prominent improvements. However, even though this group of patients improve they still after MMRP show a complex situation and there is thus a need for optimizing the content of MMRP for these patients. The subgroup of patients with a relatively good situation with respect to pain, psychological distress, coping and life impact only showed minor improvements after MMRP. Hence, there is a need to develop other complex interventions for them.
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| 2. |
- Gerdle, Björn, et al.
(författare)
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Who benefits from multimodal rehabilitation - an exploration of pain, psychological distress, and life impacts in over 35,000 chronic pain patients identified in the Swedish Quality Registry for Pain Rehabilitation
- 2019
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Ingår i: Journal of Pain Research. - : DOVE Medical Press Ltd.. - 1178-7090. ; 12, s. 891-908
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic pain patients frequently suffer from psychological symptoms. There is no consensus concerning the prevalence of severe anxiety and depressive symptoms and the strength of the associations between pain intensity and psychological distress. Although an important aspect of the clinical picture is understanding how the pain condition impacts life, little is known about the relative importance of pain and psychological symptoms for individual's life impact. The aims of this study were to identify subgroups of pain patients; to analyze if pain, psychological distress, and life impact variables influence subgrouping; and to investigate how patients in the subgroups benefit from treatments.Methods: Background variables, pain aspects (intensity/severity and spreading), psychological distress (depressive and anxiety symptoms), and two life impact variables (pain interference and perceived life control) were obtained from the Swedish Quality Registry for Pain Rehabilitation for chronic pain patients and analyzed mainly using advanced multivariate methods.Results: Based on >35,000 patients, 35%-40% had severe anxiety or depressive symptoms. Severe psychological distress was associated with being born outside Europe (21%-24% vs 6%-8% in the category without psychological distress) and low education level (20.7%-20.8% vs 26%-27% in the category without psychological distress). Dose relationships existed between the two psychological distress variables and pain aspects, but the explained variances were generally low. Pain intensity/severity and the two psychological distress variables were significantly associated (R2=0.40-0.48; P>0.001) with the two life impact variables (pain interference and life control). Two subgroups of patients were identified at baseline (subgroup 1: n=15,901-16,119; subgroup 2: n=20,690-20,981) and the subgroup with the worst situation regarding all variables participated less in an MMRP (51% vs 58%, P<0.001) but showed the largest improvements in outcomes.Conclusion: The results emphasize the need to assess both pain and psychological distress and not take for granted that pain involves high psychological stress in the individual case. Not all patients benefit from MMRP. A better matching between common clinical pictures and the content of MMRPs may help improve results. We only partly found support for treatment resistance in patients with psychological distress burden.
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| 3. |
- Åkerblom, Sophia, et al.
(författare)
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A network analysis of chronic pain rehabilitation program registry data: Structure, change, and responder analyses
- 2020
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Konferensbidrag (refereegranskat)abstract
- Background: Efforts to identify specific variables most related to outcomes in interdisciplinary pain rehabilitation are challenged by the complexity of chronic pain. Methods to manage this complexity are needed. In this study we apply network analysis to a large sample of people seeking interdisciplinary pain treatment. The purpose of the study was to determine the network structure entailed in the set of variables, examine change, and look at potential predictors of outcome, from a network perspective. Methods: Participants in this research (N = 2,421, age M = 43.8 years, % women = 82.2%) were all those consecutive cases providing pre- and post treatment data in the Swedish Quality Registry for Pain Rehabilitation (SQRP). Variables analyzed include pain intensity, pain interference, extent of pain, depression, anxiety, insomnia, and psychological variables from cognitive behavioral models of chronic pain. Network estimation, plotting, accuracy, and changes were call calculated in R. Results: We found Acceptance, Pain Interference, and Depression to be key, “central,” variables in the network of self-reported clinical variables. Interestingly, there were few changes in the network structure following treatment, particularly with respect to which variables appeared most central. On the other hand, Catastrophizing, Depression, Anxiety, and Pain Interference each became less central. The variables where changes were most strongly related to changes in the remainder of the network as a whole were Life Control, Acceptance, and Anxiety. Finally, no network differences were found between treatment responders and non-responders. Conclusions: Further application of a network approach to pain rehabilitation data is recommended. Future studies may improve upon the current results by selecting variables for analysis in a theoretically guided fashion and approaching the data ideographically, to detect unique individual differences in potential treatment processes.
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| 4. |
- Åkerblom, Sophia, et al.
(författare)
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A network analysis of clinical variables in chronic pain: a study from the Swedish quality registry for pain rehabilitation (SQRP)
- 2021
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Ingår i: Pain Medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 22:7, s. 1591-1602
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Tidskriftsartikel (refereegranskat)abstract
- Background. Efforts to identify specific variables that impact most on outcomes from interdisciplinary pain rehabilitation are challenged by the complexity of chronic pain. Methods to manage this complexity are needed. The purpose of the study was to determine the network structure entailed in a set of self-reported variables, examine change, and look at potential predictors of outcome, from a network perspective. Methods. In this study we apply network analysis to a large sample of people seeking interdisciplinary pain treatment (N = 2,241). Variables analyzed include pain intensity, pain interference, extent of pain, depression, anxiety, insomnia, and psychological variables from cognitive behavioral models of chronic pain. Results. We found that Acceptance, Pain Interference, and Depression were key, “central,” variables in the pretreatment network. Interestingly, there were few changes in the overall network configuration following treatment, specifically with respect to which variables appear most central relative to each other. On the other hand, Catastrophizing, Depression, Anxiety, and Pain Interference each became less central over time. Changes in Life Control, Acceptance, and Anxiety were most strongly related to changes in the remainder of the network as a whole. Finally, no network differences were found between treatment responders and non-responders. Conclusions. This study highlights potential future targets for pain treatment. Further application of a network approach to interdisciplinary pain rehabilitation data is recommended. Going forward, it may be better to next do this in a more comprehensive theoretically guided fashion, and ideographically, to detect unique individual differences in potential treatment processes.
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| 5. |
- Åkerblom, Sophia, et al.
(författare)
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A validation and generality study of the Committed Action Questionnaire in a Swedish sample with chronic pain.
- 2016
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Ingår i: International Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 1070-5503 .- 1532-7558.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Psychological flexibility is the theoretical model that underpins Acceptance Commitment Therapy (ACT). There is a growing body of evidence indicating that ACT is an effective treatment for chronic pain but one component of the model, committed action, has not been sufficiently researched. The purpose of this study is to validate Swedish-language versions of the full length Committed Action Questionnaire (CAQ; CAQ-18) and the shortened CAQ (CAQ-8), to examine the generality of previous results related to committed action and to further demonstrate the relevance of this construct to the functioning of patients with chronic pain. Method The study includes preliminary analyses of the reliability and validity of the CAQ. Participants were 462 consecutive referrals to the Pain Rehabilitation Unit at Skåne University Hospital. Results The Swedish-language versions of the CAQ (CAQ- 18 and CAQ-8) demonstrated high levels of internal consistency and satisfactory relationships with various indices of patient functioning and theoretically related concepts. Confirmatory factor analyses showed that the Swedish versions of the CAQ yielded similar two-factor models as found in the original validation studies. Hierarchical regression analyses identified the measures as significant contributors to explained variance in patient functioning. Conclusion The development, translation and further validation of the CAQ is an important step forward in evaluating the utility of the psychological flexibility model to the treatment of chronic pain. The CAQ can both assist researchers interested in mediators of chronic pain treatment and further enable research on change processes within the psychological flexibility model.
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| 6. |
- Åkerblom, Sophia, et al.
(författare)
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Acceptance : A factor to consider in persistent pain after neck trauma
- 2019
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 19:4, s. 733-741
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Tidskriftsartikel (refereegranskat)abstract
- Studies on the interaction between acceptance and pain-related processes after neck trauma are to our knowledge sparse and such treatment strategies are rarely incorporated in management and treatment of posttraumatic neck pain. Thus, the aim of the present study is to investigate how acceptance relates to persistent pain in patients after neck trauma, when controlling for the influence of other psychological factors, trauma characteristics and demographic variables. Consecutive patients with persistent pain and disability after neck trauma (n = 565) were assessed by a multi-professional team at a specialized pain rehabilitation clinic. Separate regression analyses were conducted with three outcomes: pain distribution, pain interference, and pain severity. Predictors were age, sex, education, time since trauma, type of trauma, anxiety, depression, and acceptance. Acceptance was the only factor associated with all outcomes, and patients with lower acceptance displayed more widespread pain and greater interference and severity of pain. The results also showed that higher depression was associated with worse pain interference and severity, whilst anxiety only mattered significantly for pain severity and not for pain interference. Female sex was related to more widespread pain and greater pain interference. Overall acceptance stood out as the most important factor for the different outcomes and lower acceptance was associated with more widespread pain distribution and greater pain interference and severity. The findings of this study add to a growing body of literature confirming that the development of chronicity after neck trauma should be understood as a multidimensional process, best described by a biopsychosocial model. The results also suggest that psychological factors and especially acceptance might be important processes with implications for enhanced recovery after neck trauma.
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| 7. |
- Åkerblom, Sophia, et al.
(författare)
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Further validation of the Chronic Pain Values Inventory in a Swedish chronic pain sample
- 2017
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Ingår i: Journal of Contextual Behavioral Science. - : Elsevier BV. - 2212-1447. ; 6:3, s. 261-267
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Tidskriftsartikel (refereegranskat)abstract
- PurposeValue based action is an important process in the psychological flexibility model and is associated with daily functioning in people with chronic pain, but measures of it are not well-developed. The purpose of the present study was to examine the reliability and validity of a Swedish-language version of the Chronic Pain Values Inventory (CPVI) in a large sample of adults seeking treatment for chronic pain.Material and methodsA Swedish version of the CPVI was created and administered alongside other measures of psychological flexibility and pain-related functioning in a convenience sample of 232 patients admitted for treatment at the Pain Rehabilitation Unit at Skåne University Hospital between February 2014 and December 2015. Internal consistency of the CPVI was assessed as was its relationship to theoretically related facets from the psychological flexibility model. The utility of values-related processes in explaining variance in pain-related functioning was also examined by correlations and hierarchical regression analyses.ResultsOverall, this Swedish-language version of the CPVI was found to have satisfactory reliability and validity. The CPVI subscales yielded high levels of internal consistency. Evidence of construct validity in relation to other measures from the psychological flexibility model was observed as well as evidence of clinical utility in relation to measures of pain-related functioning.DiscussionThis brief self-report measure of values-based action seems to yield valid data in Swedish adults suffering from chronic pain. Values based processes appear important within evidence-based treatments for chronic pain, especially Acceptance and Commitment Therapy (ACT), and the CPVI may help assess these, particularly in predictor studies of pain-related functioning and analyses of therapeutic change processes or mechanisms.
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| 8. |
- Åkerblom, Sophia, et al.
(författare)
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Internet-Based Acceptance and Commitment Therapy for Transdiagnostic Treatment of Comorbid Posttraumatic Stress Disorder and Chronic Pain : A Development Pilot Study
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Ingår i: Psychological Trauma: Theory, Research, Practice, and Policy. - 1942-9681.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Acceptance and commitment therapy (ACT) is a transdiagnostic, behavioral treatment focusing on common processes behind different diagnoses. Internet-based treatment programs can improve access to treatment and easily be integrated into the individual’s life. Method: This single-arm, pre-post-follow-up pilot study examined the acceptability, safety, and effectiveness of internet-based ACT (iACT) for participants with comorbid posttraumatic stress disorder (PTSD) and chronic pain treated at a tertiary pain clinic. All participants (N = 10) received the iACT program over a period of 10 weeks and were assessed pre- and postintervention and at a 3-month follow-up. Results: This study provides preliminary evidence for the acceptability, safety, and effectiveness of iACT for comorbid PTSD and chronic pain. The program showed clinically significant improvement in relation to the primary outcomes PTSD symptom severity and pain interference for this patient group with complex, comorbid symptoms, with sustained effects at the 3-month follow-up. Conclusions: These results add to previous research where face-to-face ACT has been shown to be of benefit to individuals with either chronic pain or PTSD. The findings also suggest that iACT can be delivered to individuals with comorbid PTSD and chronic pain with an effectiveness that is comparable to other cognitive behavioral therapy-based treatments for somatic and psychiatric disorders.
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| 9. |
- Åkerblom, Sophia
(författare)
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Predictors and mediators of outcome in CBT for chronic pain : The roles of psychological flexibility and PTSD
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic pain is a commonly occurring and debilitating condition, and among the costliest health problems for both the individual and society at large. Cognitive behavioral therapy (CBT) is the most widely-disseminated psychological treatment for chronic pain. Even though it is recommended and evidence-based, it yields quite modest improvements in pain-related functioning and accompanying symptoms of emotional distress. It is now generally acknowledged that further efforts are needed to improve the efficacy of CBT for chronic pain. Specifically, pain researchers have called for studies to identify mechanisms that underlie changes in treatment outcomes (mediators) and characteristics of the individual that predict improvements in these mechanisms and treatment overall (predictors and moderators). To address this call, the primary aim of this research program was to study whether changes in psychological flexibility mediated outcomes in a multi-disciplinary, group-based CBT program delivered at a regional specialist unit for pain rehabilitation. The secondary aim was to identify possible predictors of outcome by focusing on facets of psychological flexibility as well as the understudied influence of posttraumatic stress disorder (PTSD). This aim also included investigation of the relationships between PTSD, pain presentation, and psychological flexibility. With these two aims, we hoped to shed further light on the validity of the psychological flexibility model as an integrating, overarching model that can help define relevant treatment processes for adults presenting with chronic pain and psychiatric problems. Study I investigated whether pain-related acceptance, from the psychological flexibility model, and other variables posited as potential mediators in standard CBT mediated changes in pain-related outcomes measured at post-treatment and 12-month follow-up from the CBT program. The results highlighted the mediating role of pain-related acceptance across different indices of outcome.Study II evaluated the psychometric properties of the Swedish-language versions of the full length and shortened version of the Committed Action Questionnaire, as well as the generalizability of previous results related to committed action. The results supported the validity and reliability of the Swedish-language versions of the measure, the generalizability of earlier findings, and the relevance of committed action to health and functioning in individuals with chronic pain.Study III focused on the prevalence of traumatic experiences, trauma types, and PTSD in patients referred for treatment of chronic pain, and the relationship between PTSD and pain-related functioning prior to treatment. High rates of traumatic exposure and PTSD were found for chronic pain patients. The presence of PTSD in these patients was associated with worse clinical characteristics and an increased need for treatment.Study IV examined whether various processes from the psychological flexibility model mediated the relationship between PTSD and chronic pain. Results indicated that the relationship was mediated by pain-related acceptance, committed action, and cognitive fusion, where pain-related acceptance constituted the most influential mediator from the psychological flexibility model. Study V analysed whether indices of emotional distress (including PTSD) and different facets of psychological flexibility predicted pain-related outcomes at 12-month follow-up from the CBT program. Furthermore, it examined whether changes in processes from the psychological flexibility model mediated changes in pain-related outcomes. The only significant predictors of outcomes turned out to be psychological inflexibility and committed action. All available facets of psychological flexibility had mediating effects on treatment outcomes.Based on the results from these studies, theoretical integration within the CBT field may be facilitated by a process-focused approach including the psychological flexibility model. This model seems to be transdiagnostically and trans-situationally applicable in several ways. Its processes span problem areas with diverse backgrounds from the somatic field and chronic pain to the psychiatric field and PTSD, and appear useful not only to treatments specifically built around targeting psychological flexibility but also more broadly in CBT treatments.
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| 10. |
- Åkerblom, Sophia, et al.
(författare)
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Predictors and mediators of outcome in cognitive behavioral therapy for chronic pain: The contributions of psychological flexibility
- 2020
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Ingår i: Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 0160-7715 .- 1573-3521.
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Tidskriftsartikel (refereegranskat)abstract
- There is now a consensus in the literature that future improvements in outcomes obtained from cognitive behavioral therapy (CBT) for chronic pain will requireresearch to identify patient and treatment variables that help explain outcomes. The frst aim of this study was to assess whether pre-treatment scores on measures of psychological (in)fexibility, acceptance, committed action, cognitive(de)fusion, and values-based action predict outcomes in a multidisciplinary, multicomponent, group-based CBT program for adults with chronic pain. The second aim was to assess whether change scores on these same measures mediate outcomes in the treatment program. Participants were 232 people attending treatment for chronic pain. Of the psychological fexibility measures, only pre-treatment scores on the psychological infexibility scale predicted outcomes; higher scores on this measure were associated with worseoutcomes. However, change scores on each of the psychological fexibility measures separately mediated outcomes. The efcacy of CBT for chronic pain may be improved with a greater focus on methods that increase psychologicalfexibility.
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