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- Karlsson, Linn, 1974-
(författare)
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Chronic Pain and Exercise : Studies on pain intensity, biochemistry, adherence and attitudes
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic pain is common in western countries and entails considerable consequences for the afflicted individuals as well as for the society. Furthermore, chronic pain is complex including an advanced interplay between biological-, psychological- and social aspects. Treatment of chronic pain attempts to decrease pain intensity and increase physical-, psychological- and social functioning. However, the treatment of chronic pain is still not optimized. Different types of physical activity and exercise (PA&E) are commonly applied as non-pharmacological treatment strategies for chronic pain, but the most efficient type and dose of PA&E are unclear. In addition, adherence to prescribed PA&E is often troublesome, which further complicates the application of PA&E as treatment for chronic pain.The aim of this thesis is to increase the knowledge about PA&E as treatment for chronic pain regarding pain intensity, biochemical substances, adherence and attitudes.The findings of this thesis were that a long-term, home-based PA&E intervention comprising strength exercises as well as stretch exercises decreased pain intensity and increased function in women with chronic neck- and shoulder pain. Using microdialysis technique, differences in pain modulatory biochemical substances were found, before the intervention, in painful trapezius muscle compared to pain-free trapezius muscle. In addition, alterations in pain modulatory substances in painful trapezius muscle after the intervention were found, which possibly could imply peripheral physiological effects of PA&E. Furthermore, psychological factors could be associated to the effects of and adherence to the PA&E intervention. An intention to be physically active were expressed by patients with chronic pain, but a discordance between the intention and PA&E-behaviour were evident, even though the PA&E were experienced as valuable.In conclusion, this thesis strengthens the importance of PA&E as treatment for chronic pain. Especially, this thesis increases the knowledge about; possible peripheral pain inhibitory effects after long-term exercise; how psychological factors might affect the results of PA&E; and also about important behavioural aspects that might affect adherence to prescribed PA&E. This thesis highlights the need of more research on physiological pain inhibitory effects of long-term PA&E in chronic pain. Furthermore, improved methods for ensured adherence to prescribed PA&E are necessary in order to optimize the effect of PA&E as treatment for chronic pain.
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| 5. |
- Andersson, Sara, et al.
(författare)
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Rehabilitering
- 2007
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Ingår i: Nordisk lärobok i audiologi. - Bromma : C. A. Tegnér AB. - 9789163194405 ; , s. 325-389
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Sjukdomstillstånd och skador i organ och vävnader orsakar diverse funktionella avvikelser, som i sin tur ger upphov till symptom, som personen ifråga kan iaktta och lida av. Dessa orsakar funktionsnedsättningar, som påverkar individens möjligheter att fungera och klara sig i sin dagliga miljö hemma, i olika arbetssituationer och i olika sociala sammanhang.
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| 7. |
- Antepohl, Wolfram, 1968-, et al.
(författare)
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Cognitive impairment in patients with chronic whiplash-associated disorder - A matched control study
- 2003
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Ingår i: NeuroRehabilitation (Reading, MA). - 1053-8135 .- 1878-6448. ; 18:4, s. 307-315
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To verify the occurrence of cognitive impairment in patients with chronic whiplash-associated disorder (WAD) and to provide a more detailed description of the impairment's character and context. Methods: Thirty (30) patients with chronic WAD and 30 matched healthy controls completed a cognitive test battery. Four computerised tests were used: a) two different types of cognitive tasks (reaction time vs. working memory) and b) two types of information processing (verbal vs. spatial). Before testing and after every randomised subtest, subjects rated their pain level on a visual analogue scale. Results: A worse overall performance among patients with WAD and, specifically, worse results concerning working memory tasks were found. Post-hoc testing revealed a statistically significant difference concerning the single variable "verbal reaction time". Pain intensity among patients increased significantly during testing. Pain intensity after the subtest for verbal mental reaction time (independent of test sequence) was significantly correlated with results in this subtest, the more pain, the more time was needed. Conclusion: Compared to healthy controls, patients performed worse overall. Concerning verbal reaction time, the impairment was correlated with pain intensity. The findings support the hypothesis that pain might be one important factor leading to cognitive impairment in patients with chronic WAD.
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| 8. |
- Bager, Johan-Emil, et al.
(författare)
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Acute blood pressure levels and long-term outcome in ischemic stroke.
- 2018
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Ingår i: Brain and behavior. - : Wiley. - 2162-3279. ; 8:6
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Tidskriftsartikel (refereegranskat)abstract
- Elevated blood pressure (BP) is common in acute ischemic stroke, but its effect on outcome is not fully understood. We aimed to investigate the association of baseline BP and BP change within the first day after stroke with stroke severity, functional outcome, and mortality.Patients admitted to hospital with acute ischemic stroke (IS) from 15 February 2005 through 31 May 2009 were consecutively included. Acute stroke severity and functional outcome at three and twelve months were investigated using multivariate regression analysis; the association between BP and all-cause mortality at one, three, and twelve was investigated by Cox proportional hazard regression and Kaplan-Meier survival curves.A total of 799 patients (mean age 78.4±8.0, 48% men) were included. Higher decreases in systolic and mean arterial blood pressure (ΔSBP and ΔMAP) were associated with decreased 1-month mortality (ΔSBP: hazard ratio, HR: 0.981; 95% CI: 0.968 - 0.994; p=.005), 3-month mortality (ΔSBP: HR 0.989; 95% CI 0.981 - 0.998; p-value .014), and twelve-month mortality (ΔSBP: HR 0.989; 95% CI 0.982 - 0.996; p-value .003). Stroke severity was associated with ΔMAP (B coefficient -.46, p-value .011). Higher SBP and MAP on admission were associated with better functional outcome at three (SBP: OR 0.987; 95% CI 0.978 - 0.997; p-value .008 - MAP: OR 0.985; 95% CI 0.971 - 1; p-value .046) and twelve (SBP: OR 0.988; 95% CI 0.979 - 0.998; p-value .015 - MAP: OR 0.983; 95% CI 0.968 - 0.997; p-value .02) months.In this elderly population, higher BP on arrival to the emergency room (ER) and decrease in BP after the patients' arrival to the ward were associated with improved functional outcome and reduced mortality, respectively. These results may reflect a regulatory situation in which elevated initial blood pressure indicates adequate response to cerebral tissue ischemia while subsequent blood pressure decrease instead may be a consequence of partial, successful reperfusion.
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- Bendelin, Nina, 1980-
(författare)
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Internet-Delivered Acceptance and Commitment Therapy for Chronic Pain : Feasibility, patients’ experiences and implementation process
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic pain represents a major burden for individuals and society. Internet-delivered psychological interventions are evidence-based treatments that enable patients to access qualified care at a time and place convenient for them. Internet-delivered Acceptance and commitment therapy (IACT) has shown promising treatment effects for chronic pain patients on pain-related outcomes such as disability, pain intensity, and interference, and on psychological outcomes such as catastrophizing, fear-avoidance and acceptance. Interdisciplinary pain rehabilitation programs (IPRP) are multimodal interventions given by synchronized teams of health care professionals from different disciplines. With moderate treatment effects on many outcomes, IPRP is the best evidence treatment for chronic pain to date. IACT may add to IPRP’s effectiveness by providing individual psychological treatment via the internet. However, IACT has not yet been implemented in routine care in a larger scale. In this thesis, the aim was to study if IACT may be acceptable for chronic pain patients and if it is feasible and effective as an addition to IPRP. Three methodological approaches were used: qualitative analysis, implementation science and a controlled trial of effectiveness in a clinical context. Study I showed that an internet-delivered aftercare intervention enabled chronic pain patients to change their perception of their body and pain and their attitude about their future and self. Furthermore, self-motivating goals and acceptance strategies appeared to influence autonomy. The results gave promise to the feasibility of IACT as aftercare following IPRP. Study II showed that chronic pain patients’ experiences of IACT vary, with respect to being in treatment and the consequences of treatment. Specifically, e-therapist feedback and deadlines for homework may have an impact on autonomy and change. Patients’ expectations, motivations, and restraints could explain treatment engagement and experiences. In Study III, IACT added during IPRP enhanced the treatment effects on pain acceptance and affective distress. Furthermore, IACT added as aftercare strengthened the long-term effect of IPRP on psychological flexibility and self-efficacy. However, unsatisfactory completion rates complicated the interpretation of the findings. Study IV showed that implementing IACT in an IPRP setting may be facilitated by contextual alinement and modifications based on patients’ needs. Thorough testing of the application and matching the intervention’s aim with the host’s needs are important not to challenge the process. An implementation framework may ease planning and evaluation of implementation processes. In conclusion, IACT could be feasible as an addition to IPRP. IACT can help chronic pain patients self-manage their pain and improve pain acceptance and self-efficacy. However, chronic pain patients’ varying experiences may need to be considered to improve treatment engagement and help patients benefit from treatment. In addition, implementation of IACT in IPRP settings is likely to depend on both flexibility to changing host needs and continuity of known pivotal components in IACT.
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| 10. |
- Boman, Kurt, et al.
(författare)
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Effects of atenolol or losartan on fibrinolysis and von Willebrand factor in hypertensive patients with left ventricular hypertrophy.
- 2010
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Ingår i: Clinical and applied thrombosis/hemostasis. - : SAGE Publications. - 1076-0296 .- 1938-2723. ; 16:2, s. 146-152
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To compare the effects of the beta-blocker atenolol with the angiotensin receptor blocker (ARB) losartan on plasma tissue-type plasminogen activator (tPA) activity and mass concentration, plasminogen activator inhibitor-1 (PAI-1) activity, tPA/PAI-1 complex, and von Willebrand factor (VWF). DESIGN: A prespecified, explorative substudy in 22 patients with hypertension and left ventricular hypertrophy (LVH) performed within randomized multicenter, double-blind prospective study. RESULTS: After a median of 36 weeks of treatment, there were significant differences between the treatment groups, atenolol versus losartan, in plasma median levels of tPA mass (11.9 vs 7.3 ng/mL, P = .019), PAI-1 activity (20.7 vs 4.8 IU/mL, P = .030), and tPA/PAI-1 complex (7.1 vs 2.5 ng/mL, P = .015). In patients treated with atenolol, median levels of tPA mass (8.9-11.9 ng/mL, P = .021) and VWF (113.5%-134.3%, P = .021) increased significantly, indicating a change toward a more prothrombotic state. No significant changes occurred in the losartan group. CONCLUSION: Losartan treatment was associated with preserved fibrinolytic balance compared to a more prothrombotic fibrinolytic and hemostatic state in the atenolol group. These findings suggest different fibrinolytic and hemostatic responses to treatment in hypertensive patients with LVH.
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