| 1. |
- Abrahamssom, Peter, et al.
(författare)
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Onlay bone grafting of the mandible after periosteal expansion with an osmotic tissue expander : an experimental study in rabbits
- 2010
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Ingår i: Clinical Oral Implants Research. - : Wiley. - 0905-7161 .- 1600-0501. ; 21:12, s. 1404-1410
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objectives: To evaluate the space-maintaining capacity of a titanium mesh or a bioresorbable mesh after periosteal expansion and to assess bone formation under a titanium mesh or a bioresorbable mesh on the lateral border of the mandible by qualitative and quantitative histological analysis. Material and methods: In 13 rabbits, a self-inflatable soft tissue expander was placed intraorally, bilaterally under the mandibular periosteum via an extra oral approach. After 2 weeks, the expanders were removed and a particulated onlay bone graft was placed and covered by a titanium mesh or a bioresorbable mesh. After 3 months, the animals were sacrificed and specimens were collected for histology. Results: The osmotic soft tissue expander created a subperiosteal pocket and a ridge of new bone had formed at the edges of the expanded periosteum in all sites. After the healing period of 3 months, soft tissue dehiscence was recorded in two of the sites with bioresorbable meshes. The mean bone fill was 65% under the titanium mesh and 85% under the bioresorbable mesh (P<0.05). There was no significant difference between the titanium mesh and the bioresorbable mesh regarding the height of the meshes, mesh area and mineralized bone area. Scanning electron microscopy shows that new bone is growing in direct contact with the resorbable mesh and the titanium mesh. Conclusion: This study confirms that an osmotic soft tissue expander creates a surplus of periosteum and soft tissue and that new bone can be generated under a titanium mesh or bioresorbable mesh.
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| 2. |
- Abrahamsson, Peter, et al.
(författare)
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Periosteal expansion of rabbit mandible with an osmotic self-inflatable expander
- 2009
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Ingår i: Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. - : Informa Healthcare. - 0284-4311 .- 1651-2073. ; 43:3, s. 121-125
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to evaluate a new technique for intraoral expansion of soft tissue with a self-inflatable expander in rabbits. We placed a self-inflatable soft tissue expander bilaterally in eight rabbits under the periosteum of the mandible through an extraoral approach. The expander was left to self-inflate for two weeks, after which the animals were killed and specimens collected for histological examination. The self-inflatable soft tissue expanders expanded the periosteum. There were no dehiscences or infections. Histological observations showed no signs of any inflammatory reaction and there was no evidence of bony resorption. New bone had formed at the edges of the expanded periosteum. In the control area no new bone had formed. The osmotic soft tissue expander model for intraoral soft tissue and periosteal expansion suggests a promising way of creating a surplus of soft tissue that can be used to cover bone grafts.
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| 3. |
- Buhrman, Monica, 1974-, et al.
(författare)
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Guided internet-delivered acceptance and commitment therapy for chronic pain patients: A randomized controlled trial
- 2013
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Ingår i: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 51:6, s. 307-315
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Tidskriftsartikel (refereegranskat)abstract
- Acceptance and commitment therapy (ACT) interventions for persons with chronic pain have recently received empirical support. ACT focuses on reducing the disabling influences of pain through targeting ineffective control strategies and teaches people to stay in contact with unpleasant emotions, sensations, and thoughts. The aim of the present study was to investigate the effect of a guided internet-delivered ACT intervention for persons with chronic pain. A total of 76 patients with chronic pain were included in the study and randomized to either treatment for 7 weeks or to a control group that participated in a moderated online discussion forum. Intent-to-treat analyses showed significant increases regarding activity engagement and pain willingness. Measurements were provided with the primary outcome variable Chronic Pain Acceptance Questionnaire which was in favour of the treatment group. Reductions were found on other measures of pain-related distress, anxiety and depressive symptoms. A six month follow-up showed maintenance of improvements. We conclude that an acceptance based internet-delivered treatment can be effective for persons with chronic pain.
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| 4. |
- Buhrman, Monica, 1974-, et al.
(författare)
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Guided Internet-delivered cognitive behavioural therapy for chronic pain patients who have residual symptoms after rehabilitation treatment: Randomized controlled trial
- 2013
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Ingår i: European Journal of Pain. - : Elsevier. - 1090-3801 .- 1532-2149. ; 17:5, s. 753-765
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Tidskriftsartikel (refereegranskat)abstract
- Background Chronic pain can be treated with cognitive behavioural therapy delivered in multidisciplinary settings. However, relapse is likely, and there is a need for cost-effective secondary interventions for persons with residual problems after rehabilitation. The aim of the present study was to investigate the effects of a guided Internet-delivered cognitive behavioural intervention for patients who had completed multidisciplinary treatment at a pain management unit. Methods A total of 72 persons with residual pain problems were included in the study and were randomized to either treatment for 8 weeks or to a control group who were invited to participate in a moderated online discussion forum. The participants had different chronic pain conditions, and a majority were women (72%). Twenty-two percent of the participants dropped out of the study before the post-treatment assessment. Results Intent-to-treat analyses demonstrated differences on the catastrophizing subscale of the Coping Strategies Questionnaire (Cohens d=0.70), in favour of the treatment group but a small within-group effect. Differences were also found on other measures of pain-related distress, anxiety and depressive symptoms. A 6-month follow-up exhibited maintenance of improvements. Conclusions We conclude that Internet-delivered treatment can be partly effective for persons with residual problems after completed pain rehabilitation.
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| 5. |
- Buhrman, Monica, et al.
(författare)
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Individualized Guided Internet-delivered Cognitive Behaviour Therapy for Chronic Pain Patients with Comorbid Depression and Anxiety : A Randomized Controlled Trial
- 2015
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Ingår i: The Clinical Journal of Pain. - : Lippincott, Williams and Wilkins. - 0749-8047 .- 1536-5409. ; 31:6, s. 504-516
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Tidskriftsartikel (refereegranskat)abstract
- Depression and anxiety are commonly seen in patients with chronic pain which affects the patient´s daily life functioning. Although considerable attention has been devoted to explain why depression and anxiety are frequent comorbid with chronic pain, little empirical work has been conducted on interventions that target depression and anxiety and chronic pain. The present study was designed to test an individualized cognitive-behavioral treatment delivered through the internet for persons with chronic pain and emotional distress. A total of 52 patients with chronic pain and depression were included and randomized to either treatment for 8 weeks or to a control group that participated in a moderated online discussion forum. Intent-to-treat analyses showed significant decreases regarding depressive symptoms and pain disability in the treatment group. Results on the primary outcomes of depression and anxiety were in favour of the treatment group. Reductions were also found on pain catastrophizing. One year follow-up showed maintenance of improvements. We conclude that an individualized guided internet-delivered treatment based on cognitive behaviour therapy can be effective for persons with chronic pain comorbid emotional distress.
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| 6. |
- Buhrman, Monica, 1974-, et al.
(författare)
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Internet interventions for chronic pain including headache: A systematic review
- 2016
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 4, s. 17-34
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Tidskriftsartikel (refereegranskat)abstract
- Chronic pain is a major health problem and behavioral based treatments have been shown to be effective. However, the availability of these kinds of treatments is scarce and internet-based treatments have been shown to be promising in this area. The objective of the present systematic review is to evaluate internet-based interventions for persons with chronic pain. The specific aims are to do an updated review with a broad inclusion of different chronic pain diagnoses and to assess disability and pain and also measures of catastrophizing, depression and anxiety. A systematic search identified 891 studies and 22 trials were selected as eligible for review. Two of the selected trials included children/youth and five included individuals with chronic headache and/or migraine. The most frequently measured domain reflected in the primary outcomes was interference/disability, followed by catastrophizing. Result across the studies showed a number of beneficial effects. Twelve trials reported significant effects on disability/interference outcomes and pain intensity. Positive effects were also found on psychological variable such as catastrophizing, depression and anxiety. Several studies (n = 12) were assessed to have an unclear level of risk bias. The attrition levels ranged from 4% to 54% where the headache trials had the highest drop-out levels. However, findings suggest that internet-based treatments based on cognitive behavioural therapy (CBT) are efficacious measured with different outcome variables. Results are in line with trials in clinical settings. Meta-analytic statistics were calculated for interference/disability, pain intensity, catastrophizing and mood ratings. Results showed that the effect size for interference/disability was Hedge's g = − 0.39, for pain intensity Hedge's g = − 0.33, for catastrophizing Hedge's g = − 0.49 and for mood variables (depression) Hedge's g = − 0.26.
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| 7. |
- Domeij, Helena, et al.
(författare)
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Experiences of living with fetal alcohol spectrum disorders : a systematic review and synthesis of qualitative data
- 2018
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Ingår i: Developmental Medicine & Child Neurology. - : Wiley. - 0012-1622 .- 1469-8749. ; 60:8, s. 741-
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Forskningsöversikt (refereegranskat)abstract
- Aim: To identify and assess available evidence from qualitative studies exploring experiences of individuals living with fetal alcohol spectrum disorders (FASD) or those living with a child with FASD, as well as experiences of interventions aimed at supporting individuals with FASD and their families.Method: A systematic literature search was conducted in six electronic databases: PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Scopus. Included studies were analysed using manifest content analysis. Methodological limitations and confidence in the evidence were assessed using a modified version of the Critical Appraisal Skills Programme and the Grading of Recommendations, Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Qualitative Research approach respectively.Results: Findings from 18 studies show that individuals with FASD experience a variation of disabilities, ranging from somatic problems, high pain tolerance, destructive behaviour, hyperactivity, and aggressiveness, to social problems with friendship, school attendance, and maintenance of steady employment. Most studies reported parents’ experiences with FASD; parenting was viewed as a lifelong engagement and that the whole family is isolated and burdened because of FASD. People with FASD feel that their difficulties affect their daily life in a limiting way and make them feel different from others.Interpretation: From the perspective of primarily parents, individuals with FASD and their parents face many different difficulties, for which they need societal support.
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| 8. |
- Gasslander, Nils, et al.
(författare)
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Tailored internet-based cognitive behavioral therapy for individuals with chronic pain and comorbid psychological distress : a randomized controlled trial
- 2022
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Ingår i: Cognitive Behaviour Therapy. - : Taylor & Francis. - 1650-6073 .- 1651-2316. ; 51:5, s. 408-434
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Tidskriftsartikel (refereegranskat)abstract
- Comorbid psychological problems are commonly related to chronic pain but addressing heterogeneous comorbidities in traditional settings is often difficult. Delivering individually tailored treatment using the internet could be a viable alternative. The present study investigates whether a guided, individually tailored and internet-delivered cognitive behavioral therapy (ICBT) could improve mood and reduce disability in individuals suffering from chronic pain and comorbid psychological distress. Participants were recruited from a pain clinic and randomized to either ICBT or waiting list. The participants (n = 187) individually tailored treatments included 6-13 modules targeting different types of psychological distress. Modules were designed to be completed weekly, and feedback was provided by clinicians. Participants completed an average of 5.1 (49.7%) modules, with 22.9% completing all assigned modules. Intention-to-treat analyses showed significantly larger improvements in depression, disability, pain acceptance, catastrophizing, and quality of life in the ICBT-group compared to the control group. Between-group effect sizes were very small or small at post for the primary outcomes depression (d = 0.18) and pain interference (d = 0.22). Other effect sizes ranged from very small to small, with the largest effect being improvements in pain acceptance (d = 0.3). All significant changes were stable at 12-month follow up.
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| 9. |
- Gordh, Monica
(författare)
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Survival of onlay bone grafts. A study in the adult rat.
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to study onlay bone grafting in the adult rat to improve graft incorporation and perservation of graft size. In 167 adult isogeneic lewis rats, the size maintenance and bone formation at the graft-host interface of uni- and bicortical onlays positioned in various environments and treatments were investigated. The findings were assessed after four, 12 and 20 weeks with routine histology and immunohistochemistry, using antibodies against some bone and cartilage matrix proteins and proteoglycans. The immunolabelling aimed to explore the possible occurence and localization of such proteins which are essential to various stages of osteogenesis and bone repair. The main findings were: Bicortical grafts were found to retain volume better than unicortical grafts and the exposed bone-marrow space of the graft was sealed off from the surrounding connective tissue by compact bone, emanating from the cortical margins of the graft. A major improvement in graft incorporation was observed following exposure of the underlying recipient marrow. On the other hand, these grafts were occasionally markedly submerged into the recipient bed, which was believed to be due to the disappearance of its pressure-resistant outer cortical layer. The effects of limited marrow exposure by cortical perforations of the recipient bed resulted in a migration of the recipient bone marrow into the graft as well as decreased graft size diminution. A combination of cortical perforations of a bicortical graft and the host bed entailed increased graft stability and corticalization of the marrow. When the graft was covered by an osteopromotive expanded polytetrafluoroethylene (e-PTFE) membrane, improved graft integration and greater size persistence was observed even after membrane removal. However, full volumetric maintenance of the graft was not accomplished in any of these studies. The combined treatment of the higher concentration (32µg/80µl) tested recombinant human bone morphogenetic protein-2 (rhBMP-2) and membrane lead to a rapid and complete graft integration and pronounced bone formation resulting in maintained or even enhanced graft size. In contrast, the application of high-dose rhBMP-2 without a membrane resulted in loss of graft size, extensive bone resorption and only small amounts of new bone formation. Therefore, when a collagen carrier is used for rhBMP-2 in conjunction with onlay bone grafting, our results indicate the advantage of applying a membrane to obtain graft volume persistence. The immunohistochemical labelling contributed to a more detailed picture of the mechanisms involved in graft incorporation and offered a dynamic indication of the bone repair and remodelling process as compared to routine histology.
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| 10. |
- Kalliomäki, Maija, et al.
(författare)
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Structural and functional differences between neuropathy with and without pain?
- 2011
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Ingår i: Experimental Neurology. - : Elsevier BV. - 0014-4886 .- 1090-2430. ; 231:2, s. 199-206
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to find functional and structural differences in neuropathy between patients with and without chronic pain following nerve injury. We included 30 patients requiring hand surgery after a trauma, with 21 reporting chronic pain for more than one year after the injury, while 9 did not suffer from injury-related chronic pain. We assessed mechanical sensitivity, thermal thresholds, electrically induced pain and axon reflex erythema and cutaneous nerve fiber density in skin biopsies of the injured site and its contralateral control. Epidermal fiber density of the injured site was reduced similarly in both patient groups. Thresholds for cold and heat pain and axon reflex areas were reduced in the injured site, but did not differ between the patient groups. Only warmth thresholds were better preserved in the pain patients (35.2 vs. 38.4 degrees C). Neuronal CGRP staining did not reveal any difference between pain and non-pain patients. Epidermal innervation density correlated best to warmth detection thresholds and deeper dermal innervation density to the area of the axon reflex erythema. No specific pattern of subjective, functional or structural parameters was detected that would separate the neuropathy patients into pain and non-pain patients. Specific staining of additional targets may help to improve our mechanistic understanding of pain development.
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