| 1. |
- Gustavsson, A., et al.
(författare)
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Socio-economic burden of patients with a diagnosis related to chronic pain : Register data of 840,000 Swedish patients
- 2012
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 16:2, s. 289-299
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic pain constitutes a substantial socio-economic challenge but little is known about its actual cost.Aim: To estimate the direct and indirect costs of patients with a diagnosis related to chronic pain (DRCP), to determine variation in these costs across different diagnosis groups, and to identify what resources constitute the most important components of costs.Methods: Patient level data from three administrative registries in Vastra Gotalandsregionen in Sweden including inpatient and outpatient care, prescriptions, long-term sick-leaves, and early retirement were extracted. Patients with a DRCP between January 2004 and November 2009 were selected.Results: In total, 840,000 patients with a DRCP were identified. The mean total costs per patient and year were estimated at 6400 EUR but were higher for patients with cancer (10,400 EUR). Patients on analgesic drugs had more than twice as high costs as patients without analgesic drugs, on average. Indirect costs (sick-leaves and early retirement) constituted the largest cost component (59%) followed by outpatient (21%) and inpatient care (14%), whereas analgesic drug prescriptions constituted less than 1 percent of the total.Conclusions: The socio-economic burden of patients with a diagnosis related to chronic pain amounts to 32 billion EUR per year, when findings from Vastra Gotalandsregionen are extrapolated to the whole of Sweden. This compares to a fifth of the total Swedish tax burden in 2007 or about a tenth of Swedish GDP. This study does not provide evidence on what costs are caused by chronic pain per se. However, the higher costs of patients on analgesic drugs might indicate that the consequences of pain are of major importance.
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| 2. |
- Holmberg, Johan, et al.
(författare)
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Treatment of phobic postural vertigo A controlled study of cognitive-behavioral therapy and self-controlled desensitization.
- 2006
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Ingår i: Journal of Neurology. - : Springer Science and Business Media LLC. - 1432-1459 .- 0340-5354. ; 253:4, s. 500-506
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Tidskriftsartikel (refereegranskat)abstract
- In balance clinic practice, phobic postural vertigo is a term used to define a population with dizziness and avoidance behavior often as a consequence of a vestibular disorder. It has been described as the most common form of dizziness in middle aged patients in dizziness units. Anxiety disorders are common among patients with vestibular disorders. Cognitive-behavioral therapy is an effective treatment for anxiety disorders, and vestibular rehabilitation exercises are effective for vestibular disorders. This study compared the effect of additional cognitive-behavioral therapy for a population with phobic postural vertigo with the effect of self-administered vestibular rehabilitation exercises. 39 patients were recruited from a population referred for otoneurological investigation. Treatment effects were evaluated with the Dizziness Handicap Inventory, Vertigo Symptom Scale, Vertigo Handicap Questionnaire, and Hospital Anxiety and Depression Scale. All patients had a self treatment intervention based on education about the condition and recommendation of self exposure by vestibular rehabilitation exercises. Every second patient included was offered additional cognitive behavioral therapy. Fifteen patients with self treatment and 16 patients with cognitive-behavioral treatment completed the study. There was significantly larger effect in the group who received cognitive behavioral therapy than in the self treatment group in Vertigo Handicap Questionnaire and the Hospital Anxiety and Depression scale and its subscales. Cognitive-behavioral therapy has an additional effect as treatment for a population with phobic postural vertigo. A multidisciplinary approach including medical treatment, cognitive-behavioral therapy and physiotherapy is suggested.
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| 3. |
- 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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| 4. |
- Åkerblom, Sophia, et al.
(författare)
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Treatment outcomes in group-based cognitive behavioural therapy for chronic pain : An examination of PTSD symptoms
- 2020
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 24:4, s. 807-817
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe relevance of post‐traumatic stress disorder (PTSD) symptoms to outcomes of cognitive behavioural therapy (CBT) for chronic pain is unclear. This study examines whether (a) traumatic exposure or the severity of PTSD symptoms at pre‐treatment predicts the outcomes (pain intensity/interference), (b) participation in this treatment is associated with reduced PTSD symptoms and (c) any observed changes in PTSD symptoms are mediated by changes in psychological mechanisms that have been shown to be of importance to PTSD and chronic pain.MethodsParticipants were 159 chronic pain patients who were consecutively admitted for a multidisciplinary, group‐based CBT program at the Pain Rehabilitation Unit at Skåne University Hospital. A self‐report measure of traumatic exposure and PTSD symptoms was administered before and after treatment, and at a 12‐month follow‐up, along with measures of depression, anxiety, pain intensity, pain interference, psychological inflexibility, life control and kinesiophobia.ResultsTraumatic exposure and PTSD symptom severity did not predict pain intensity or interference at 12‐month follow‐up. There were no overall significant changes in PTSD symptom severity at post‐treatment or follow‐up, but 24.6% of the participants showed potential clinically significant change at follow‐up. Psychological inflexibility mediated the changes that occurred in PTSD symptoms during treatment.ConclusionsNeither traumatic exposure nor baseline symptoms of PTSD predicted the treatment outcomes examined here. Despite improvements in both comorbid depression and anxiety, participation in this pain‐focused CBT program was not associated with improvements in comorbid PTSD. To the extent that changes in PTSD symptoms did occur, these were mediated by changes in psychological inflexibility during treatment.SignificancePain‐focused CBT programs yield clinically meaningful improvements in pain and comorbid symptoms of depression and anxiety, but may have little effect on comorbid PTSD. This raises the issue of whether current pain‐focused CBT programs can be modified to improve outcomes for comorbid conditions, perhaps by better targeting of psychological flexibility, and/or whether separate treatment of PTSD may be associated with improved pain outcomes.
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