| 1. |
- Bartels, Sara Laureen, et al.
(författare)
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Development, evaluation and implementation of a digital behavioural health treatment for chronic pain : study protocol of the multiphase DAHLIA project
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:4
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Chronic pain affects about 20%-40% of the population and is linked to mental health outcomes and impaired daily functioning. Pharmacological interventions are commonly insufficient for producing relief and recovery of functioning. Behavioural health treatment is key to generate lasting benefits across outcome domains. However, most people with chronic pain cannot easily access evidence-based behavioural interventions. The overall aim of the DAHLIA project is to develop, evaluate and implement a widely accessible digital behavioural health treatment to improve well-being in individuals with chronic pain.METHODS AND ANALYSIS: The project follows the four phases of the mHealth Agile Development and Evaluation Lifecycle: (1) development and pre-implementation surveillance using focus groups, stakeholder interviews and a business model; (2) iterative optimisation studies applying single case experimental design (SCED) method in 4-6 iterations with n=10 patients and their healthcare professionals per iteration; (3) a two-armed clinical randomised controlled trial enhanced with SCED (n=180 patients per arm) and (4) interview-based post-market surveillance. Data analyses include multilevel modelling, cost-utility and indicative analyses.In October 2021, inter-sectorial partners are engaged and funding is secured for four years. The treatment content is compiled and the first treatment prototype is in preparation. Clinical sites in three Swedish regions are informed and recruitment for phase 1 will start in autumn 2021. To facilitate long-term impact and accessibility, the treatment will be integrated into a Swedish health platform (www.1177.se), which is used on a national level as a hub for advice, information, guidance and e-services for health and healthcare.ETHICS AND DISSEMINATION: The study plan has been reviewed and approved by Swedish ethical review authorities. Findings will be actively disseminated through peer-reviewed journals, conference presentations, social media and outreach activities for the wider public.TRIAL REGISTRATION NUMBER: NCT05066087.
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| 2. |
- Boersma, Katja, 1973-
(författare)
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Fear and avoidance in the development of a persistent musculoskeletal pain problem : implications for secondary prevention
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation focused on the role of fear and avoidance in the development of a persistent back pain problem. The first aim of this dissertation was to study when and how cognitive, affective and behavioral factors influence one another in the development of persistent pain and disability. The moderating role of pain duration on the relationship between psychological risk factors and dysfunction was studied, as well as the interrelationships between psychological risk factors within individuals. The results suggest that pain duration may moderate the relationship between some of the psychological risk factors and function. In study two, depression and function were interrelated independent of stages of chronicity while the strength of the relationship between fear of movement and function increased across the stages. Further, the results suggest that there may be individual variability in the importance of psychological risk factors and in how these factors are interrelated within individuals. In study one and three profiles of psychological functioning emerged that were characterized by pain-related fear with and without depressed mood, by depressed mood only, and by low pain-related fear and no depressed mood. These profiles were meaningfully related to future disability. The second aim of this dissertation was to test a new treatment that is designed to match patients with high levels of fear and avoidance. The results of study four show that this exposure treatment can produce significant decreases in fear and increases in function. The results of the studies in this dissertation suggest that we need to assign a key role to psychological processes such as pain-related fear, depressed mood, and avoidance in our efforts to understand the development of persistent back pain disability. The results highlight that there may be several roads towards a persistent back pain problem and that the relationship between psychological factors and disability is not static but appears to change as a function of pain duration. This suggests that we need to know more about the process of development of persistent back pain disability and that future research should incorporate the role of time, as well as take into consideration that there may be individual variability in the importance of factors and their interactions. Lastly, the results suggest that secondary prevention of persistent back pain disability could be enhanced by addressing psychological processes at a much earlier time point than is currently practiced and by customizing interventions to the characteristics of the individual patient.
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| 3. |
- Boersma, Katja, 1973-, et al.
(författare)
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Lowering fear-avoidance and enhancing function through exposure in vivo : a multiple baseline study across six patients with back pain
- 2004
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Ingår i: Pain. - : Elsevier. - 0304-3959 .- 1872-6623. ; 108:1-2, s. 8-16
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated the effects of an exposure in vivo treatment for chronic pain patients with high levels of fear and avoidance. The fear-avoidance model offers an enticing explanation of why some back pain patients develop persistent disability, stressing the role of catastrophic interpretations; largely fueled by beliefs and expectations that activity will cause injury and will worsen the pain problem. Recently, an exposure in vivo treatment was developed that aims to enhance function by directly addressing these fears and expectations. The purpose of this study was to describe the short-term, consequent effect of an exposure in vivo treatment. The study employed a multiple baseline design with six patients who were selected based on their high levels of fear and avoidance. The results demonstrated clear decreases in rated fear and avoidance beliefs while function increased substantially. These improvements were observed even though rated pain intensity actually decreased somewhat. Thus, the results replicate and extend the findings of previous studies to a new setting, with other therapists and a new research design. These results, together with the initial studies, provide a basis for pursuing and further developing the exposure technique and to test it in group designs with larger samples.
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| 4. |
- Flink, Ida K., 1980-
(författare)
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Stuck in mind : the role of catastrophizing in pain
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pain catastrophizing emerges in the literature as one of the most important psychological determinants of both pain itself and the negative outcomes commonly associated with it. However, despite decades of research confirming the impact of catastrophizing, there are still areas that remain unexplored or in which the surface has only been scratched. The overall aim of this dissertation was to expand existing knowledge about catastrophizing and to advance the theoretical framework around the concept.The role of catastrophizing was explored in three distinct areas: during pain in childbirth, in exposure treatment for back pain patients, and in a problem solving context. The findings from the three studies confirmed the vital role of catastrophizing in these areas. Firstly, catastrophizing played a critical role in pain in childbirth; women who catastrophized reported labor pain as more intense and the subsequent recovery period as longer than women who did not catastrophize. Secondly, catastrophizing was identified as a moderator of treatment effect in exposure in vivo for back pain patients with pain-related fear; patients who catastrophized were not helped by the exposure. Thirdly, catastrophizing played a role in a problem solving context; although this is in line with contemporary models such as the misdirected problem solving model, the results suggested a somewhat different pathway to this previous model. Taken together, these findings underscore the instrumental role of catastrophizing in diverse areas and imply a need for catastrophzing to be assessed and addressed in clinical contexts. In addition, the findings highlight a need for further development of the theoretical framework around catastrophizing as well as treatment interventions that directly target catastrophizing. Based on these needs, a new model of catastrophizing was proposed – a model of catastrophizing from a process perspective. In this model, the proposed function of catastrophizing is to down-regulate negative affect, as a form of internal avoidance. The model is a complement to existing theoretical models and provides a framework for developing treatment interventions that directly target catastrophizing, for example by problem solving skills training. Successful interventions for people who catastrophize would lead to several gains – for the individual in less suffering and increased ability to handle pain problems, and for society as a whole in reduced costs for health care for these individuals.
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| 5. |
- Flink, Ida, 1980-, et al.
(författare)
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Pain psychology in the 21st century : lessons learned and moving forward
- 2020
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Ingår i: Scandinavian Journal of Pain. - : Elsevier. - 1877-8860 .- 1877-8879. ; 20:2, s. 229-238
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: In the spring of 2019, Professor Steven J. Linton, the founder of the Center for Health and Medical Psychology (CHAMP) at Örebro University, Sweden, formally retired. As a tribute to his scholarly work covering decades of influence and inspiration to the field of pain psychology, the research center organized a topical conference titled "Pain in the 21st century: Where do we come from and where are we going?", which resulted in this state-of the-art synthesis. The aim of this declaration is to highlight lessons learned but not in the least is meant to inspire and guide our continued journey forward, developing pain psychology into the 21st century.Methods: Several collaborators of Professor Linton have summarized and reflected on the current state-of-the-art of pain psychology from the perspective of his input to the field, as well as on developments from the last years of advancements in pain psychology.Results: The topics have been divided into six themed sections covering the fear avoidance model, transdiagnostics, secondary prevention, risk- and protective factors, communication and contextual factors. The sections cover a broad spectrum, from basic experimental studies, integrating emotion and motivational theories into current theoretical models, to applied research on the effect of early interventions as well as sophisticated emotion-focused treatment models for pain patients with concurrent emotional ill-health.Conclusions: There have been major advancements within pain psychology research during the last decades, moving the field towards a more comprehensive picture, taking emotional and motivational aspects into account to understand pain sufferers. Although psychologically informed interventions in general mainly focus on the individual, it has been put forward that pain management is highly influenced by the surrounding environment, including communication with health care providers, and the occupational and social context.Implications: Professor Steven J. Linton has been at the forefront of pain psychology research during the last decades, and inspired by his work this journey will continue into the 21st century, with the ultimate goal of enhancing the understanding and treatment for all people suffering from persistent and disabling pain.
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| 6. |
- Gatzounis, Rena, et al.
(författare)
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A break from pain! : Interruption management in the context of pain
- 2019
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Ingår i: Pain management. - : Future Medicine Ltd.. - 1758-1869 .- 1758-1877. ; 9:1, s. 81-91
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Tidskriftsartikel (refereegranskat)abstract
- Activity interruptions, namely temporary suspensions of an ongoing task with the intention to resume it later, are common in pain. First, pain is a threat signal that urges us to interrupt ongoing activities in order to manage the pain and its cause. Second, activity interruptions are used in chronic pain management. However, activity interruptions by pain may carry costs for activity performance. These costs have recently started to be systematically investigated. We review the evidence on the consequences of activity interruptions by pain for the performance of the interrupted activity. Further, inspired by literature on interruptions from other research fields, we suggest ways to improve interruption management in the field of pain, and provide a future research agenda.
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| 7. |
- Gatzounis, Rena, et al.
(författare)
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Activity interruptions by pain impair activity resumption, but not more than activity interruptions by other stimuli : an experimental investigation
- 2018
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Ingår i: Pain. - : Lippincott Williams & Wilkins. - 0304-3959 .- 1872-6623. ; 159:2, s. 351-358
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Tidskriftsartikel (refereegranskat)abstract
- Interrupting ongoing activities whilst intending to resume them later is a natural response to pain. Whereas this response facilitates pain management, at the same time it may also disrupt task performance. Previous research has shown that activity interruptions by pain impair subsequent resumption of the activity, but not more than pain-irrelevant interruptions. Ongoing task complexity and pain threat value might influence interruption effects. In this experiment, we adjusted a paradigm from outside the field of pain to investigate how activity interruptions by pain affect task performance. Healthy participants (n=69) were required to answer a series of questions, in a specific sequence, about presented letter-digit combinations. This ongoing task was occasionally interrupted by painful electrocutaneous or non-painful vibrotactile stimulation (between-subjects) followed by a typing task. Upon interruption completion, participants were required to resume the ongoing task at the next step of the question sequence. Results indicate impaired sequence accuracy (less frequent resumption at the correct step of the sequence) but preserved non-sequence accuracy (similarly frequent correct responses to question content) immediately after an interruption. Effects were not larger for interruptions by pain, compared to non-pain. Further, participants in the two conditions reported similar task experience, namely task motivation, perceived difficulty, and confidence to resume the interrupted task. Pain catastrophizing did not influence the results. As in previous studies, activity interruptions by pain were shown to impair the resumption of a task that requires keeping to a step sequence, but not more than interruptions by non-painful stimuli. Potential explanations are discussed.
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| 8. |
- Gatzounis, Rena, et al.
(författare)
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Effects of activity interruptions by pain on pattern of activity performance : An experimental investigation
- 2018
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 18, s. 109-119
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Suspending an ongoing activity with the intention to resume it again later is a natural response to pain. This response facilitates coping with the pain, but it may also have negative consequences for the resumption and performance of the activity. For example, people with pain problems are often forced to take a break from doing their household chores because of their pain. They might delay resuming their chore, eventually needing longer time to finish it. We investigated how activity interruptions by pain influence the pattern of subsequent activity performance. We expected that when an activity is interrupted by pain (compared to non-pain), people spend longer time away from the activity, need longer time to complete it, and are less motivated to perform it.Methods: Sixty healthy volunteers performed an ongoing task that required them to make joystick movements in different directions according to a specific rule. Occasionally, participants received either a painful electrocutaneous stimulus or a non-painful and non-aversive auditory stimulus (between-subjects) as an interruption cue. The interruption cue was followed by the temporary suspension of the ongoing task and the initiation of a different activity (interruption task). The latter required the categorization of cards and had a maximum duration, but participants could also stop it earlier by pressing a button. We measured time away from the (interrupted) ongoing task, total time to complete the ongoing task (including the interruptions) and self-reported motivation to perform both the ongoing as well as the interruption task.Results: Groups did not differ in the time away from the ongoing task, total time to complete the ongoing task, or self-reported motivation to perform the two tasks.Conclusions: Activity interruptions by pain did not impair the pattern of activity performance more than activity interruptions by non-pain. Potential explanations and suggestions for future research are discussed.
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| 9. |
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| 10. |
- Gatzounis, Rena, et al.
(författare)
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Taking a break in response to pain : An experimental investigation of the effects of interruptions by pain on subsequent activity resumption
- 2017
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Ingår i: Scandinavian Journal of Pain. - : Elsevier. - 1877-8860 .- 1877-8879. ; 16, s. 52-60
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Interrupting ongoing activities with the intention to resume them again later is a natural response to pain. However, such interruptions might have negative consequences for the subsequent resumption and performance of the interrupted activity. Activity interruptions by pain may be more impairing than interruptions by non-painful stimuli, and also be subjectively experienced as such. These effects might be more pronounced in people high in pain catastrophizing. These hypotheses were investigated in two experiments.METHODS: In Experiment 1, healthy volunteers (n=24) performed an ongoing task requiring a sequence of joystick movements. Occasionally, they received either a painful electrocutaneous or a non-painful vibrotactile stimulus, followed by suspension of the ongoing task and temporary engagement in a different task (interruption task). After performing the interruption task for 30s, participants resumed the ongoing task. As the ongoing task of Experiment 1 was rather simple, Experiment 2 (n=30) included a modified, somewhat more complex version of the task, in order to examine the effects of activity interruptions by pain.RESULTS: Participants made more errors and were slower to initiate movements (Experiment 1 & 2) and to complete movements (Experiment 2) when they resumed the ongoing task after an interruption, indicating that interruptions impaired subsequent performance. However, these impairments were not larger when the interruption was prompted by painful than by non-painful stimulation. Pain catastrophizing did not influence the results.CONCLUSIONS: Results indicate that activity interruptions by pain have negative consequences for the performance of an activity upon its resumption, but not more so than interruptions by non-painful stimuli. Potential explanations and avenues for future research are discussed.IMPLICATIONS: Interrupting ongoing activities is a common response to pain. In two experiments using a novel paradigm we showed that activity interruptions by pain impair subsequent activity resumption and performance. However, this effect seems to not be specific to pain.
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