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1.
  • Andersson, H. Ingemar, 1950-, et al. (författare)
  • Chronic pain in a geographically defined general population : studies of differences in age, gender, social class, and pain localization.
  • 1993
  • Ingår i: The Clinical Journal of Pain. - 0749-8047 .- 1536-5409. ; 9:3, s. 174-182
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To establish basic epidemiological data on chronic pain (duration > 3 months) in a defined population. Relationships between age, gender, and social class were tested. DESIGN: A survey of pain symptoms, including location, intensity, duration, and functional capacity, was conducted by means of a mail questionnaire. SETTING: General populations in two Swedish primary health care districts. Medical care was provided in a state health system. SUBJECTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1,806). The response rate was 90%. OUTCOME MEASURES: Descriptive epidemiologic data in relation to objectives of the study. RESULTS: Without sex differences, 55% (95% confidence interval, 53-58%) of the population had perceived persistent pain for 3 months and 49% for 6 months. Among individuals with chronic pain, 90% localized their pain to the musculoskeletal system to a variable extent. Women experienced more multiple localizations of pain and had pain in the neck, shoulder, arm, and thigh to a greater extent than men. Prevalence of pain increased by age up to 50-59 years for both genders and then slowly decreased. The neck-shoulder area was the most common site of pain (30.2%), followed by the lower back (23.2%). Even in the youngest age groups more than one of four reported chronic pain. Blue-collar workers and employers (including farmers) reported chronic pain to a greater extent than other groups. In 13% of the population, manifest pain problems were associated with reduced functional capacity. CONCLUSION: Chronic pain symptoms are common but unevenly distributed in a general population. The results may influence planning and consultation in primary health care as well as warranting selective prevention activities.
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2.
  • Baad-Hansen, Lene, et al. (författare)
  • Somatosensory sensitivity in patients with persistent idiopathic orofacial pain is associated with pain relief from hypnosis and relaxation
  • 2013
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 29:6, s. 518-526
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: In a recent study hypnosis has been found to relieve persistent idiopathic orofacial pain. Quantitative sensory testing (QST) is widely used to evaluate somatosensory sensitivity, which has been suggested as a possible predictor of management outcome. The objectives of this study were to examine: (1) possible associations between clinical pain relief and baseline somatosensory sensitivity and (2) the effect of hypnosis management on QST parameters. METHODS: Forty-one patients with persistent idiopathic orofacial pain completed this randomized controlled study in 1 of 2 groups: hypnosis (hypnotic analgesia suggestions) or control (relaxation). QST at 2 intraoral (pain region and contralateral mirror image region) and 3 extraoral (hand and both cheeks) sites was performed at baseline and after the hypnosis/control management, together with pressure pain thresholds and pressure pain tolerance thresholds determined bilaterally at the masseter and temporalis muscles, the temporomandibular joints, and the third finger. RESULTS: Degree of pain relief was negatively correlated with a summary statistic of baseline somatosensory sensitivity (summed z-score), that is, high baseline somatosensory sensitivity was associated with low pain relief (r=-0.372, P=0.020). Hypnosis had no major effect on any QST measure compared with relaxation (P>0.063). CONCLUSIONS: High pain sensitivity at baseline may predict poor pain management outcome. In addition, despite clear clinical pain relief, hypnosis did not significantly or specifically influence somatosensory sensitivity. Future studies should further explore QST measures as possible predictors of different management response in orofacial pain conditions.
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3.
  • Biurrun Manresa, Jose A., et al. (författare)
  • Dynamic Changes in Nociception and Pain Perception After Spinal Cord Stimulation in Chronic Neuropathic Pain Patients
  • 2015
  • Ingår i: The Clinical Journal of Pain. - : LIPPINCOTT WILLIAMS and WILKINS. - 0749-8047 .- 1536-5409. ; 31:12, s. 1046-1053
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Patients with an implanted spinal cord stimulation (SCS) system for pain management present an opportunity to study dynamic changes in the pain system in a situation where patients are not stimulated (ie, experiencing severe pain) compared with a situation in which patients have just been stimulated (ie, pain free or greatly reduced pain). The aims of this study were (1) to determine if there are differences in nociceptive withdrawal reflex thresholds (NWR-T) and electrical pain thresholds (EP-T) before and after SCS; and (2) to establish if these differences are related to psychological factors associated with chronic pain. Methods: Seventeen volunteers with chronic neuropathic pain participated in the experiment. Electrical stimuli were applied to assess the NWR-T and the EP-T. In addition, psychological factors (ie, pain characteristics, depression, anxiety, and disability indexes) were also recorded. The NWR-T and EP-T were assessed with the SCS system off (at least 8 h before the experiment), and then reassessed 1 hour after the SCS system was turned on. Results: Ongoing pain intensity ratings decreased (P=0.018), whereas the NWR-T increased (P=0.028) after the SCS was turned on, whereas no significant difference was found for EP-T (P=0.324). Psychological factors were significant predictors for EP-T but not for NWR-T. Discussion: The results of this study suggest that pain relief after SCS is partially mediated by a decrease in the excitability of dorsal horn neurons in the spinal cord.
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4.
  • Boersma, Katja, et al. (författare)
  • Psychological processes underlying the development of a chronic pain problem : a prospective study of the relationship between profiles of psychological variables in the fear-avoidance model and disability
  • 2006
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 22:2, s. 160-166
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Understanding the psychological processes that underlie the development of a chronic pain problem is important to improve prevention and treatment. The aim of this study was to test whether distinct profiles of variables within the fear-avoidance model could be identified and could be related to disability in a meaningful way.Methods: In 81 persons with a musculoskeletal pain problem, cluster analysis was used to identify subgroups with similar patterns on fear and avoidance beliefs, catastrophizing, and depression. The clusters were examined cross-sectionally and prospectively on function, pain, health care usage, and sick leave.Results: Five distinct profiles were found: pain-related fear, pain-related fear + depressed mood, medium pain-related fear, depressed mood, and low risk. These subgroups were clearly related to outcome. In contrast to the clusters medium pain-related fear and low risk, the majority of those classified in the clusters pain-related fear, pain-related fear + depressed mood, and depressed mood reported long-term sick leave during follow-up. The subjects in the clusters with high scores on the depression measure reported the highest percentage of health care usage during follow-up (70% in the pain-related fear + depressed mood group and 42% in the depressed mood group reported >10 health care visits).Conclusions: Distinct profiles of psychological functioning could be extracted and meaningfully related to future disability. These profiles give support to the fear-avoidance model and underscore the need to address the psychological aspects of the pain experience early on.
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5.
  • Boersma, Katja, et al. (författare)
  • Screening to identify patients at risk : profiles of psychological risk factors for early intervention
  • 2005
  • Ingår i: The Clinical Journal of Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0749-8047 .- 1536-5409. ; 21:1, s. 38-43
  • Tidskriftsartikel (refereegranskat)abstract
    • There is a serious need to provide effective early interventions that prevent the development of persistent pain and disability. Identifying patients at risk for this development is an important step. Our aim was to explore whether distinct subgroups of individuals with similar response patterns on a screening questionnaire exist. Moreover, the objective was to then relate these groups to future outcomes, for example, sick leave as an impetus for developing tailored interventions that might better prevent chronic problems. A total of 363 patients seeking primary care for acute or subacute spinal pain completed the Orebro Musculoskeletal Pain Screening Questionnaire and were then followed to determine outcome. Cluster analysis was used to identify subgroups. Validity was tested using 3 methods including the split-half technique. The subgroups were compared prospectively on outcome measures obtained 1 year later. Using pain intensity, fear-avoidance beliefs, function, and mood, we found 4 distinct profiles: Fear-Avoidant, Distressed Fear-Avoidant, Low Risk, and Low Risk-Depressed Mood. These 4 subgroups were also robust in all 3 of the validity procedures. The 4 subgroups were clearly related to outcome. Although the low risk profiles had virtually no one developing long-term sick leave, the Fear-Avoidant profile had 35% and the Distressed Fear-Avoidant profile 62% developing long-term sick leave. Our results suggest that fear-avoidance and distress are important factors in the development of pain-related disability and may serve as a key for early identification. Providing interventions specific to the factors isolated in the profiles should enhance the prevention of persistent pain and disability.
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6.
  • Brattberg, Gunilla, et al. (författare)
  • A longitudinal study of pain : reported pain from middle age to old age.
  • 1997
  • Ingår i: The Clinical Journal of Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0749-8047 .- 1536-5409. ; 13:2, s. 144-149
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE Describe patterns of pain reporting over a span of 24 years. DESIGN Individuals were interviewed on four occasions (1968, 1974, 1981, 1992). PARTICIPANTS Representative sample (n = 321) of the Swedish population aged 53-63 at baseline. MEASURES Self-reported pain in the chest, abdomen, and musculoskeletal system (back or hips, shoulders, hands, elbows, legs, or knees). RESULTS Less than 1% reported chest or abdominal pain on all four occasions. Whereas 21.8% of the sample reported musculoskeletal pain on all four occasions. More than half of the sample reported some kind of pain on three or four occasions. Women reported more severe and more persistent pain compared with men. There were more people who developed pain during the 24-year period than there were who became pain free. An increase in pain was equally common for chest and musculoskeletal pain, but a decrease in pain was much more common for musculoskeletal pain than chest pain. CONCLUSIONS Cross-sectional studies have shown differing age patterns in pain. This longitudinal study demonstrates different patterns for men and women and for different pain localities.
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7.
  • Buhrman, Monica, et al. (författare)
  • Individualized Guided Internet-delivered Cognitive Behaviour Therapy for Chronic Pain Patients with Comorbid Depression and Anxiety : A Randomized Controlled Trial
  • 2015
  • Ingår i: The Clinical Journal of Pain. - : Lippincott, Williams and Wilkins. - 0749-8047 .- 1536-5409. ; 31:6, s. 504-516
  • 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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8.
  • Buhrman, Monica, et al. (författare)
  • Psychological treatment targeting acceptance and compassion in chronic pain patients : a randomized controlled, internet delivered, treatment trial
  • 2023
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 39:12, s. 672-685
  • Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
    • Objectives: Chronic pain is often associated with suffering. Self-criticism is associated with depressive symptoms. The purpose of this study was to explore if fusing acceptance and commitment therapy (ACT) and compassion focused therapy (CFT), could improve psychological wellbeing and disability in chronic pain patients with high levels of self-criticism in comparison to a wait-list control group. Methods: Individuals with chronic pain (n=71) were randomly assigned to an 8-week internet-based intervention focused on acceptance and compassion or a wait-list condition. Primary treatments outcomes were Chronic Pain Acceptance Questionnaire, Self-Compassion Scale, and Pain Disability index. Secondary outcomes were Montgomery Åsberg Depression Rating Scale, Anxiety sensitivity index, Quality of Life Inventor, Multidimensional Pain Inventory and Perseverative Thinking Questionnaire. Results: Missing data at post-intervention was 22.5%. ITT-analyses were conducted using linear mixed-models. Results revealed significantly greater levels of acceptance and self-compassion for the treatment group, which were primary outcomes, with effect sizes ranging from small to large and these results were maintained at six-month follow-up. Rates of clinical significant improvements were also greater for the treatment group in comparison to the wait-list control group on acceptance and compassion. Results in the third primary outcome showed also improvements in disability levels. Significant differences were also found in several of the secondary outcomes, in favour for the treatment group.Discussion: Internet-based ACT with CFT components shows promise as a viable treatment option in the management of chronic pain.
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9.
  • Buhrman, Monica, et al. (författare)
  • Psychological Treatment Targeting Acceptance and Compassion in Patients With Chronic Pain : A Randomized Controlled, Internet-delivered, Treatment Trial
  • 2023
  • Ingår i: The Clinical Journal of Pain. - : Wolters Kluwer Health, Inc.. - 0749-8047 .- 1536-5409. ; 39:12, s. 672-685
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: Chronic pain is often associated with lower function. Self-criticism is associated with depressive symptoms. The purpose of this study was to explore if fusing Acceptance and Commitment Therapy and compassion-focused therapy could improve psychological well-being and disability in individuals with chronic pain with high levels of self-criticism in comparison to a wait-list control group. METHODS: Individuals with chronic pain (n=71) were randomly assigned to an 8-week internet-based intervention focused on acceptance and compassion or a wait-list condition. Primary treatment outcomes were the Chronic Pain Acceptance Questionnaire, Self-Compassion Scale, and Pain Disability Index. Secondary outcomes were the Montgomery Åsberg Depression Rating Scale, Anxiety Sensitivity Index, Quality of Life Inventory, Multidimensional Pain Inventory, and Perseverative Thinking Questionnaire. RESULTS: Missing data at postintervention were 22.5%. Intention-to-treat analyses were conducted using linear mixed models. The results revealed greater levels of acceptance and self-compassion for the treatment group, which were primary outcomes, with effect sizes ranging from small to large, and these results were maintained at 6-month follow-up. The rates of clinically significant improvements were also greater for the treatment group in comparison to the wait-list control group on acceptance and compassion. The treatment group also improved in the third primary outcome, pain disability. Significant differences were found in several of the secondary outcomes, in favor of the treatment group. DISCUSSION: Internet-based Acceptance and Commitment Therapy with compassion-focused therapy components shows promise as a viable treatment option in the management of chronic pain. 
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10.
  • Buhrman, Monica, 1974-, et al. (författare)
  • Psychological Treatment Targeting Acceptance and Compassion in Patients With Chronic Pain
  • 2023
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 39:12, s. 672-685
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Chronic pain is often associated with lower function. Self-criticism is associated with depressive symptoms. The purpose of this study was to explore if fusing Acceptance and Commitment Therapy and compassion-focused therapy could improve psychological well-being and disability in individuals with chronic pain with high levels of self-criticism in comparison to a wait-list control group.Methods: Individuals with chronic pain (n=71) were randomly assigned to an 8-week internet-based intervention focused on acceptance and compassion or a wait-list condition. Primary treatment outcomes were the Chronic Pain Acceptance Questionnaire, Self-Compassion Scale, and Pain Disability Index. Secondary outcomes were the Montgomery angstrom sberg Depression Rating Scale, Anxiety Sensitivity Index, Quality of Life Inventory, Multidimensional Pain Inventory, and Perseverative Thinking Questionnaire.Results:Missing data at postintervention were 22.5%. Intention-to-treat analyses were conducted using linear mixed models. The results revealed greater levels of acceptance and self-compassion for the treatment group, which were primary outcomes, with effect sizes ranging from small to large, and these results were maintained at 6-month follow-up. The rates of clinically significant improvements were also greater for the treatment group in comparison to the wait-list control group on acceptance and compassion. The treatment group also improved in the third primary outcome, pain disability. Significant differences were found in several of the secondary outcomes, in favor of the treatment group.Discussion:Internet-based Acceptance and Commitment Therapy with compassion-focused therapy components shows promise as a viable treatment option in the management of chronic pain.
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11.
  • Chen, Kenneth, et al. (författare)
  • Recommendations for Core Outcome Domain Set for Whiplash Associated Disorders (CATWAD)
  • 2019
  • Ingår i: Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 35:9, s. 727-736
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Inconsistent reporting of outcomes in clinical trials of treatments for Whiplash Associated Disorders (WAD) hinders effective data pooling and conclusions that can be drawn about the effectiveness of tested treatments. The aim of this study was to provide recommendations for core outcome domains that should be included in clinical trials of WAD. Methods: A three-step process was used. 1) A list of potential core outcome domains were identified from the published literature; 2) Researchers, health care providers, patients and insurance personnel participated and rated the importance of each domain via a three round Delphi survey. A priori criteria for consensus were established; 3) Experts comprising researchers, health care providers and a consumer representative participated in a multidisciplinary consensus meeting that made final decisions on the recommended core outcome domains. Results: The literature search identified 63 potential core domains. 223 participants were invited to partake in the Delphi surveys with 41.7% completing Round 1, 45.3% Round 2 and 51.4% Round 3. Eleven core domains met the criteria for inclusion across the entire sample. After the expert consensus meeting, six core domains were recommended: Physical Functioning, Perceived Recovery, Work and Social Functioning, Psychological Functioning, Quality of Life and Pain. Discussion: A 3-step process was used to recommend core outcome domains for clinical trials in WAD. Six core domains were recommended: Physical Functioning, Perceived Recovery, Work and Social Functioning, Psychological Functioning, Quality of Life and Pain. The next step is to determine the outcome measurement instruments for each of these domains.
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12.
  • Chen, Mengying, et al. (författare)
  • A prospective study of pain experience in a neonatal intensive care unit of China
  • 2012
  • Ingår i: The Clinical Journal of Pain. - Philadelphia, PA, USA : Lippingcott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 28:8, s. 700-704
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To assess pain burden in neonates during their hospitalization in China and thus provide evidence for the necessity of neonatal pain management. Patients and Methods: The Neonatal Facial Coding System was used to evaluate pain in neonates. We prospectively collected data of all painful procedures performed on 108 neonates (term, 62; preterm, 46) recruited from admission to discharge in a neonatal intensive care unit of a university-affiliated hospital in China. Results: We found that during hospitalization each preterm and term neonate was exposed to a median of 100.0 (range, 11 to 544) and 56.5 (range, 12 to 249) painful procedures, respectively. Most of the painful procedures were performed within the first 3 days. Preterm neonates, especially those born at 28 and 29 weeks' gestational age, experienced more pain than those born at 30 weeks' gestation or later (P < 0.001). Among those painful procedures, tracheal aspiration was the most frequently performed on preterm neonates, and intravenous cannulation was the most common for term neonates. Moreover, tracheal intubations and femoral venous puncture were found to be the most painful. Notably, none of the painful procedures was accompanied by analgesia. Conclusions: Neonates, particularly preterm neonates, were exposed to numerous invasive painful procedures without appropriate analgesia in hospitals in China. The potential long-term impacts of poorly treated pain in neonates call for a change in pediatric practice in China and in countries with similar practices.
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13.
  • Dawson, Andreas, et al. (författare)
  • Effects of Experimental Tooth Clenching on Pain and Intramuscular Release of 5-HT and Glutamate in Patients With Myofascial TMD
  • 2015
  • Ingår i: The Clinical Journal of Pain. - : Lippincott, Williams andamp; Wilkins. - 0749-8047 .- 1536-5409. ; 31:8, s. 740-749
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: It has been suggested that tooth clenching may be associated with local metabolic changes, and is a risk factor for myofascial temporomandibular disorders (M-TMD). This study investigated the effects of experimental tooth clenching on the levels of 5-HT, glutamate, pyruvate, and lactate, as well as on blood flow and pain intensity, in the masseter muscles of M-TMD patients. Methods: Fifteen patients with M-TMD and 15 pain-free controls participated. Intramuscular microdialysis was performed to collect 5-HT, glutamate, pyruvate, and lactate and to assess blood flow. Two hours after the insertion of a microdialysis catheter, participants performed a 20-minute repetitive tooth clenching task (50% of maximal voluntary contraction). Pain intensity was measured throughout. Results: A significant effect of group (P less than 0.01), but not of time, was observed on 5-HT levels and blood flow. No significant effects of time or group occurred on glutamate, pyruvate, or lactate levels. Time and group had significant main effects on pain intensity (P less than 0.05 and less than 0.001). No significant correlations were identified between: (1) 5-HT, glutamate, and pain intensity; or between (2) pyruvate, lactate, and blood flow. Discussion: This experimental tooth clenching model increased jaw muscle pain levels in M-TMD patients and evoked low levels of jaw muscle pain in controls. M-TMD patients had significantly higher levels of 5-HT than controls and significantly lower blood flow. These 2 factors may facilitate the release of other algesic substances that may cause pain.
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14.
  • Demmelmaier, Ingrid, et al. (författare)
  • The associations between pain intensity, psychosocial variables, and pain duration/recurrence in a large sample of persons with nonspecific spinal pain
  • 2008
  • Ingår i: The Clinical Journal of Pain. - 0749-8047 .- 1536-5409. ; 24:7, s. 611-619
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The aims of this study were: (1) to describe and compare pain intensity, disability, cognitive, physical, behavioral, and environmental variables in 4 predefined categories, on the basis of duration and recurrence of nonspecific spinal pain; and (2) to compare disability, cognitive, physical, behavioral, and environmental variables in these 4 predefined categories, after controlling for pain intensity. Methods: Postal questionnaires were sent to a random sample of 5000 persons, aged 20 to 50 years, in Sweden. The response rate was 39%. One thousand and twenty-four participants reporting spinal pain were divided into 4 predefined categories (n=100, 215, 172, and 537) based on duration and recurrence of pain. Multivariate analyses of variance and covariance were performed to investigate differences between the 4 pain duration/recurrence groups. Results: The first analyses revealed that the 4 pain duration/recurrence groups differed in pain intensity, disability, 7 cognitive variables, and perceived social support. After controlling for pain intensity, small but significant group differences were identified in depression, catastrophizing, pain expectations, and perceived social support. Higher levels of catastrophizing and pain expectations and lower levels of perceived social support were seen in groups with longer duration of pain. Discussion: After controlling for pain intensity, categories based on pain duration/recurrence differed in 3 cognitive variables and perceived social support. Pain expectations, catastrophizing and perceived social support were related to longer duration of pain. Between-group differences were small and pain duration/recurrence was not an important explanatory factor.
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15.
  • Fors, Maria, 1987-, et al. (författare)
  • What mediates treatment effects in a pre-surgery physiotherapy treatment in surgical candidates with degenerative lumbar spine disorders? : A mediation and conditional process analysis of the PREPARE randomized controlled trial
  • 2021
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 3, s. 168-176
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Treatment guidelines recommend targeting both physical and psychological factors in interventions for degenerative lumbar spine disorders. Studying treatment mechanisms gives information on key factors explaining outcome improvement which can refine treatments for future research. This study explores treatment mediators in a physiotherapy treatment on disability, pain intensity and health related quality of life (HRQoL) in surgical candidates with degenerative lumbar spine disorders compared to waiting-list controls. An additional aim was to evaluate patients´ expectation as a moderator of treatment outcome.Methods: Data collected from 197 patients in a single blinded randomized controlled trial comparing 9 weeks of multifaceted physiotherapy to waiting-list were used in this conditional process analysis. Analysis was carried out on group differences for change in Oswestry Disability Index (ODI), Pain Visual Analog Scale (VAS) back pain, EuroQol-5D (EQ-5D) and EQ-VAS. The putative moderation role of expectations and mediation role of change in physical variables and psychosocial variables were tested.Results: Change in self-efficacy mediated improvement in all outcomes. Improvement in ODI was also mediated by change in depression, VAS was mediated by change in fear avoidance beliefs and EQ-VAS was mediated by change in activity level and fear avoidance beliefs. Improvements were moderated by patients´ treatment expectations.Discussion: Self-efficacy, fear avoidance beliefs, physical activity level and patients´ treatment expectations were found to be important factors explaining treatment effects. Self-efficacy was the consistent mediator for effects of the pre-surgical physiotherapy on disability, back pain intensity and HRQoL.
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16.
  • Gerdle, Björn, et al. (författare)
  • Chronic Widespread Pain : Increased Glutamate and Lactate Concentrations in the Trapezius Muscle and Plasma
  • 2014
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 30:5, s. 409-420
  • Forskningsöversikt (refereegranskat)abstract
    • BACKGROUND:: Chronic widespread pain (CWP), including fibromyalgia syndrome (FM), is associated with prominent negative consequences. CWP has been associated with alterations in the central processing of nociception. Whereas some researchers consider CWP/FM as a central hyperexcitability pain condition, others suggest that the central alterations are maintained by peripheral nociceptive input. Microdialysis can be used in vivo to study muscle alterations in chronic myalgia. AIM:: The aim of the study was to investigate the plasma and interstitial concentrations of metabolites and algesics in the trapezius muscle of women with CWP and in pain-free women (CON).MATERIALS AND METHODS:: Seventeen women with CWP and 24 CON went through a clinical examination and completed a questionnaire; the pressure pain thresholds in the upper and lower extremities were registered. Microdialysis was conducted in the trapezius muscle, and a blood sample was drawn. Muscle blood flow, interstitial muscle concentrations, and plasma concentrations of lactate, pyruvate, glutamate, glucose, and glycerol (not in the plasma) were determined.RESULTS:: CWP patients had significantly increased interstitial muscle (P=0.02 to 0.001) and plasma (P=0.026 to 0.017) concentrations of lactate and glutamate. No significant differences existed in blood flow between CWP and CON. The interstitial concentrations-but not the plasma levels-of glutamate and lactate correlated significantly with aspects of pain such as pressure pain thresholds of the trapezius (R=0.22) and tibialis anterior (R=0.18) and the mean pain intensity (R=0.10) in CWP but not in CON.CONCLUSIONS:: The present study supports the suggestion that aspects of pain and central alterations in CWP/FM are influenced by peripheral tissue alterations.
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17.
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18.
  • Hedman-Lagerlöf, Maria, et al. (författare)
  • Internet-Delivered Exposure Therapy for Fibromyalgia : A Randomized Controlled Trial
  • 2018
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 34:6, s. 532-542
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Fibromyalgia (FM) is a common and disabling chronic pain disorder, for which existing pharmacological and psychological treatments have yet yielded insufficient effects. Previous literature has shown that exposure therapy may be an effective treatment for chronic pain. This study constitutes the first randomized controlled trial evaluating exposure therapy for FM.Methods: A total of 140 participants with diagnosed FM were randomized to a 10-week Internet-delivered exposure treatment (iExp; n=70) or a waitlist control condition (WLC; n=70). Primary outcome measure were FM symptoms and impact, and secondary outcome measures were fatigue, disability, quality of life, pain-related distress and avoidance behaviors, insomnia, depression, and anxiety.Results: Data retention was high (100% data completion at posttreatment for primary outcome, 96% at 6-month follow-up and 94% at 12-month follow-up). Results showed that participants in the iExp group made large and superior improvements compared with WLC on FM symptoms and impact (B, ?1.93; z, ?10.14; P<0.001, betweengroup Cohen d=0.90), as well as all secondary outcomes (betweengroup Cohen d ranging from 0.44 to 1.38) with sustained results.Conclusions: We conclude that iExp seems to be an efficacious treatment for FM compared with no treatment, and the results also highlight the potential increase of accessibility by using the Internet format to deliver psychological treatments for these patients. Future trials with active control conditions are warranted.
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19.
  • Hollyfield, Shakira, et al. (författare)
  • An Observational Study of Outcomes Associated With Virtual Pain Management Programs Based on Acceptance and Commitment Therapy Implemented During the COVID-19 Pandemic
  • 2023
  • Ingår i: The Clinical Journal of Pain. - : Wolters Kluwer. - 0749-8047 .- 1536-5409. ; 39:10, s. 524-536
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: In response to COVID-19, virtual, group-based interdisciplinary pain management programs (PMPs) were rapidly implemented. This included implementing different intensities and formats of virtual PMPs to address a range of patient needs and complexity. This observational study investigated outcomes associated with virtual high and low-intensity and pre-neuromodulation PMPs based on acceptance and commitment therapy as part of routine care during the pandemic.Methods: Depending on patients’ needs, participants completed a virtual high-intensity or low-intensity PMP, or a virtual PMP in preparation for neuromodulation, from June 2020 to June 2022. Participants completed standardized measures of pain intensity and interference, work and social adjustment, depression, and pain acceptance before and after treatment. Data from 2018 to 2019 for in-person residential (n=561), outpatient (n=123), and pre-neuromodulation (n=207) PMPs were also examined to provide a historical benchmark of performance.Results: The virtual high-intensity PMP (n=294) showed significant improvements in all variables, with small effects. There were significant improvements with small effects for pain interference, depression, and acceptance for the virtual pre-neuromodulation PMP (n=129). No statistically significant improvements were observed for the virtual low-intensity PMP (n=90). The improvements associated with prepandemic in-person PMPs were generally larger relative to the virtual PMPs of comparable intensity delivered during the pandemic.Discussion: These data provide preliminary support for the potential benefits of high, but not low, intensity virtual acceptance and commitment therapy-based PMPs, including in the context of neuromodulation. Research is needed to maximize the impact of virtual PMPs and match patients with the most appropriate delivery format.
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20.
  • Holsti, Liisa, et al. (författare)
  • Behavioral responses to pain are heightened after clustered care in preterm infants born between 30 and 32 weeks gestational age
  • 2006
  • Ingår i: The Clinical Journal of Pain. - Philadelphia : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 22:9, s. 757-764
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To compare biobehavioral pain responses of preterm infants born at differing gestational ages (GAs) when pain was preceded by a rest period or by a series of routine nursing interventions.METHODS: In a randomized, within subjects, cross-over design, facial (Neonatal Facial Coding System), sleep/wake state and heart rate (HR) responses of 43 preterm infants [mean birth weight: 1303 g (range 590 g to 2345 g); mean GA at birth: 30 weeks (range 25 to 32)] were examined across 3 phases of blood collection (Baseline, Lance, and Recovery) under 2 conditions: pain after a 30-minute rest period versus pain after a series of routine nursing interventions (clustered care). Infant behavioral responses were coded from continuous bedside videotapes. HR was analyzed using custom physiologic signal processing software.RESULTS: Infants born at earlier GA (<30 wk) had equally intense facial responses during the Lance phase regardless of condition. However, later born infants (> or =30 wk GA) showed heightened facial responses indicative of sensitized responses during blood collection when it was preceded by clustered care (P=0.05). Moreover, later born infants had significantly lower facial (P=0.05) and HR (P=0.04) reactivity during Recovery when blood collection followed clustered care.DISCUSSION: Earlier born preterm infants showed heightened states of arousal and poor ability to modulate HR during Recovery when an invasive procedure was preceded by routine tactile nursing procedures. Alternatively, later born infants exhibited sensitized responses when clustered care preceded blood collection. Our findings support the importance of cue based individualized approaches to care.
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21.
  • Hurtig, Ingrid, 1947-, et al. (författare)
  • Quantitative sensory testing in fibromyalgia patients and in healthy subjects : identification of subgroups
  • 2001
  • Ingår i: The Clinical Journal of Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0749-8047 .- 1536-5409. ; 17:4, s. 316-322
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To determine perception and pain thresholds in patients with fibromyalgia syndrome and in healthy controls, and to investigate whether patients with fibromyalgia syndrome can be grouped with respect to thermal hyperalgesia and whether these subgroups differ from healthy controls and in clinical appearance. Design: The authors conducted a quasi-experimental clinical study. Subjects: Twenty-nine women patients with fibromyalgia syndrome and 21 healthy pain-free age-matched women participated in the study. Methods: Quantitative sensory testing using a Thermotest instrument was performed on the dorsum of the left hand. Sleep and pain intensity were rated using visual analog scales. Results: Cold and heat pain but not perception thresholds differed significantly between patients with fibromyalgia syndrome and healthy subjects. Based on thermal pain thresholds, two subgroups could be identified in fibromyalgia syndrome using cluster analysis. Conclusion: Patients with fibromyalgia syndrome were subgrouped by quantitative sensory testing (i.e., thermal pain thresholds). Subgroups show clinical differences in pain intensities, number of tender points, and sleep quality. Cold pain threshold was especially linked to these clinical aspects.
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22.
  • Kemani, Mike K., et al. (författare)
  • Efficacy and Cost-effectiveness of Acceptance and Commitment Therapy and Applied Relaxation for Longstanding Pain : a Randomized Controlled Trial
  • 2015
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 31:11, s. 1004-1016
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Objectives: To date, few studies have compared Acceptance and Commitment Therapy (ACT) for longstanding pain with established treatments. Only 1 study has evaluated the cost-effectiveness of ACT. The aim of the current study was to evaluate the efficacy and cost-effectiveness of ACT and applied relaxation (AR) for adults with unspecific, longstanding pain.Materials and Methods: On the basis of the inclusion criteria 60 consecutive patients received 12 weekly group sessions of ACT or AR. Data were collected pretreatment, midtreatment, and posttreatment, as well as at 3- and 6-month follow-up. Growth curve modeling was used to analyze treatment effects on pain disability, pain intensity, health-related quality of life (physical domain), anxiety, depression, and acceptance.Results: Significant improvements were seen across conditions (pretreatment to follow-up assessment) on all outcome measures. Pain disability decreased significantly in ACT relative to AR from preassessment to postassessment. A corresponding decrease in pain disability was seen in AR between postassessment and 6-month follow-up. Pain acceptance increased only in ACT, and this effect was maintained at 6-month follow-up. Approximately 20% of the participants achieved clinically significant change after treatment. Health economic analyses showed that ACT was more cost-effective than AR at post and 3-month follow-up assessment, but not at 6-month follow-up.Discussion: More studies investigating moderators and mediators of change are needed. The present study is one of few that have evaluated the cost-effectiveness of ACT and AR and compared ACT with an established behavioral intervention, and the results provide additional support for behavioral interventions for longstanding pain.
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23.
  • Landén Ludvigsson, Maria, et al. (författare)
  • The Effect of Neck-specific Exercise With, or Without a Behavioral Approach, on Pain, Disability, and Self-Efficacy in Chronic Whiplash-associated Disorders : A Randomized Clinical Trial
  • 2015
  • Ingår i: The Clinical Journal of Pain. - : Lippincott, Williams andamp; Wilkins. - 0749-8047 .- 1536-5409. ; 31:4, s. 294-303
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The aim of this study was to compare the effect on self-rated pain, disability, and self-efficacy of 3 interventions for the management of chronic whiplash-associated disorders: physiotherapist-led neck-specific exercise (NSE), physiotherapist-led NSE with the addition of a behavioral approach, or Prescription of Physical Activity (PPA). Materials and Methods: A total of 216 volunteers with chronic whiplash-associated disorders participated in this randomized, assessor blinded, clinical trial of 3 exercise interventions. Self-rated pain/pain bothersomeness (Visual Analogue Scale), disability (Neck Disability Index), and self-efficacy (Self-Efficacy Scale) were evaluated at baseline and at 3 and 6 months. Results: The proportion of patients reaching substantial reduction in pain bothersomness (at least 50% reduction) was more evident (P less than 0.01) in the 2 NSE groups (29% to 48%) compared with the PPA group (5%) at 3 months. At 6 months 39% to 44% of the patients in the 2 neck-specific groups and 28% in the PPA group reported substantial pain reduction. Reduction of disability was also larger in the 2 neck-specific exercise groups at both 3 and 6 months (P less than 0.02). Self-efficacy was only improved in the NSE group without a behavioral approach (P = 0.02). However, there were no significant differences in any outcomes between the 2 physiotherapist-led NSE groups. Discussion: NSE resulted in superior outcomes compared with PPA in this study, but the observed benefits of adding a behavioral approach to the implementation of exercise in this study were inconclusive.
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24.
  • Larsson, Britt, et al. (författare)
  • Blood supply and oxidative metabolism in muscle biopsies of female cleaners with and without myalgia
  • 2004
  • Ingår i: The Clinical Journal of Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0749-8047 .- 1536-5409. ; 20:6, s. 440-446
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: Pathomechanisms of work-related myalgia are poorly understood. Myalgia is thought to be caused by excitation of nociceptors present in the muscular tissue but not in the muscle fiber itself. Muscle contraction in combination with hypoxia is known to excite nociceptors. Morphologic analysis can contribute to the knowledge of the excitation of nociceptors. This study thoroughly examines the morphology of the trapezius muscle's capillary supply and signs of disturbed oxidative metabolism to understand their role in work-related myalgia. METHODS: Surgical trapezius muscle biopsies were obtained from 25 female cleaners with long-standing work-related myalgia, 25 female cleaners without trapezius myalgia, and 21 healthy teachers. Enzyme and immunohistochemical stainings were performed to highlight fibers with aberrant intermyofibrillar patterns, indicating a disturbed oxidative metabolism (also known as moth-eaten fibers) and a disturbed capillary supply of different fibers. RESULTS: A significantly lower number of capillaries per fiber area in cleaners suffering from myalgia compared with cleaners without trapezius myalgia was found. Moth-eaten fibers were found in the 3 groups, but these fibers were significantly more prevalent in the groups of cleaners than in the healthy teacher group. CONCLUSION: This work indicates that the capillary supply of trapezius is affected in work-related trapezius myalgia. More studies are needed to understand possible mechanisms that would explain the occurrence of moth-eaten fibers.
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25.
  • Larsson, Britt, et al. (författare)
  • Pain Sensitivity and its Relation to Spreading on the Body, Intensity, Frequency, and Duration of Pain A Cross-Sectional Population-based Study (SwePain)
  • 2017
  • Ingår i: The Clinical Journal of Pain. - : LIPPINCOTT WILLIAMS & WILKINS. - 0749-8047 .- 1536-5409. ; 33:7, s. 579-587
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives:Individuals with chronic pain often report increased pain sensitivity compared with pain-free individuals; hence, it is crucial to determine whether and how different pain characteristics influence or interact with pain sensitivity. An alternative to experimental pain sensitivity testing is the self-reported pain sensitivity questionnaire (PSQ), which captures pain sensitivity in various body areas.This study compares PSQ in individuals with and without pain and clarifies how pain sensitivity relates to spreading of pain on the body, and to intensity, frequency, duration of pain and to age and sex.Materials and Methods:A total of 5905 individuals with pain and 572 individuals without pain from the general population in southeastern Sweden completed and returned a postal questionnaire.Results:The mean PSQ score was 3.9 (95% confidence interval [CI], 3.88-3.98) in individuals with pain and 3.5 (95% CI, 3.38-3.64) in pain-free individuals. Hence, PSQ was the highest among individuals with pain, with a difference of 0.4 (95% CI, 0.30-0.56). There was a considerable variation in the PSQ values (mean=3.5; SD=1.54) among pain-free individuals. Pain sensitivity was positively related to spreading, intensity, and frequency of pain, with a correlation coefficient of 0.3. PSQ was higher in widespread pain, 4.5 (95% CI, 4.27-4.69) in women and 4.3 (95% CI, 3.94-4.71) in men, than in local pain, 3.7 (95% CI, 3.61-3.91) in women and 3.8 (95% CI, 3.66-3.95) in men. The score for women with regional pain was between local and widespread pain at 4.0 (95% CI, 3.95-4.11) and that for men with regional pain was 3.8 (95% CI, 3.69-3.87), which is equal to that of local pain.Discussion:The positive association between pain sensitivity and spreading of pain on the body provides some evidence that the extent of spreading may be related to the degree of pain sensitivity. Before clinical use of PSQ, psychometric development and further research are needed.
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26.
  • Lemming, Dag, et al. (författare)
  • The responses to pharmacological challenges and experimental pain in patients with chronic whiplash-associated pain
  • 2005
  • Ingår i: The Clinical Journal of Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0749-8047 .- 1536-5409. ; 21:5, s. 412-421
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: This study evaluates the analgesic responses to intravenous administration of morphine, lidocaine, and ketamine and their relations to duration of chronic pain after whiplash trauma. In addition, experimental muscle pain sensitivity and its correlation to pain duration and pharmacological responses were assessed. Methods: Thirty-three patients with diagnosed whiplash-associated disorder grade II in the chronic stage, according to the Quebec classification, were included. The pharmacological evaluation was performed in a randomized, double-blind, cross-over design and consisted of a 30-minute period of intravenous administration of morphine (0.3 mg/kg), lidocaine (5 mg/kg), ketamine (0.3 mg/kg), or placebo (isotonic saline). Intensity ratings of habitual pain on a visual analogue scale were taken before, during, and after the infusion. The patients were classified as nonresponders, placebo-responders, or responders (minimum 50% decrease of pain intensity) of the drugs. Pressure pain thresholds and intramuscular and cutaneous electrical stimulation pain thresholds were measured. The pain intensity during experimental muscle pain by intramuscular hypertonic saline was also recorded. Experimental pain assessments were performed on the lower legs outside the habitual painful area. Results: Thirty patients completed the study; 2 were placebo responders and 10 were nonresponders. Of 18 responders, there were 15 morphine responders, 11 lidocaine responders, and 14 ketamine responders. In the patients with whiplash-associated disorder duration less than 2 years, 7 responded to morphine, 5 to lidocaine, and 8 to ketamine. In the patients with pain duration longer than 2 years, 8 responded to morphine, 6 to lidocaine, and 6 to ketamine. Thus, no pattern with respect to pain duration was found. Seventeen patients participated in the experimental pain assessment, and no significant differences in the variables of the intramuscular and cutaneous stimulation and intramuscular-induced pain with respect to response to the pharmacological challenges or whiplash-associated disorder duration existed. Discussion: The pharmacological challenges identified subgroups of patients with chronic whiplash-associated disorder that might be considered before instituting therapeutic interventions or research. However, the pattern of responses to the pharmacological challenges did not show any clear relationships with pain duration or the experimental pain tests.
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27.
  • Lenoir, D., et al. (författare)
  • Are Reports of Pain, Disability, Quality of Life, Psychological Factors, and Central Sensitization Related to Outcomes of Quantitative Sensory Testing in Patients Suffering From Chronic Whiplash Associated Disorders?
  • 2022
  • Ingår i: Clinical Journal of Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0749-8047 .- 1536-5409. ; 38:3, s. 159-172
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Chronic whiplash associated disorders (CWAD) are characterized by long-lasting symptoms of neck pain occurring after an acceleration-deceleration injury. Central sensitization (CS) has been suggested as the possible underlying mechanism for these symptoms, and is characterized by changes in the central nervous system. Besides CS, psychological factors are believed to play an important role in the experience of (chronic) pain. Objective: Investigating the relationships between self-reported pain, disability, quality of life, psychological factors, and symptoms of CS; and electrical-based quantitative sensory testing (QST) outcomes in CWAD patients. Secondly, to investigate the differences in QST between CWAD patients and pain-free controls. Methods: Seventy-two individuals with CWAD and 55 pain-free controls underwent electrical stimuli-based QST. Detection and pain thresholds (EPT), temporal summation (TS), and conditioned pain modulation were examined. Spearman correlation and linear mixed models analyses were performed to assess, respectively, the hypothesized associations and group differences in QST. Results: The Pain Catastrophizing magnification subscale correlated with the left wrist EPT (r=-0.332; P=0.004), and the Pain Anxiety Symptom Scale-20 with the left wrist (r=-0.325; P=0.005) and ankle (r=-0.330; P=0.005) EPT. TS at the ankle correlated with the CS inventory (r=0.303; P=0.010), Short Form 36 pain subscale (r=-0.325; P=0.005), and Illness Perception Questionnaire revised consequences subscale (r=0.325; P=0.005). EPTs left (P=0.011) and right wrist (P=0.023) were lower in the CWAD group, but conditioned pain modulation and TS did not differ between groups. Conclusion: QST outcomes relate to psychological constructs, rather than to self-reported pain intensity and distribution. Local hyperalgesia was found in individuals with CWAD, but no differences in endogenous pain facilitation nor inhibition.
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28.
  • Liew, Bernard X. W., et al. (författare)
  • Investigating the Causal Mechanisms of Symptom Recovery in Chronic Whiplash-associated Disorders Using Bayesian Networks
  • 2019
  • Ingår i: The Clinical Journal of Pain. - : LIPPINCOTT WILLIAMS & WILKINS. - 0749-8047 .- 1536-5409. ; 35:8, s. 647-655
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The present study's objective was to understand the causal mechanisms underpinning the recovery of individuals with whiplash-associated disorders (WAD). We applied Bayesian Networks (BN) to answer 2 study aims: (1) to identify the causal mechanism(s) of recovery underpinning neck-specific exercise (NSE), and (2) quantify if the cyclical pathway of the fear-avoidance model (FAM) is supported by the present data.Materials and Methods: We analyzed a prospective cohort data set of 216 individuals with chronic WAD. Fifteen variables were used to build a BN model: treatment group (NSE with or without a behavioral approach, or general physical activity), muscle endurance, range of motion, hand strength, neck proprioception, pain catastrophizing, fear, anxiety, depression, self-efficacy, perceived work ability, disability, pain intensity, sex, and follow-up time.Results: The BN model showed that neck pain reduction rate was greater after NSE compared with physical activity prescription (beta=0.59 points per month [P<0.001]) only in the presence of 2 mediators: global neck muscle endurance and perceived work ability. We also found the following pathway of variables that constituted the FAM: anxiety, followed by depressive symptoms, fear, catastrophizing, self-efficacy, and consequently pain.Conclusions: We uncovered 2 mediators that explained the mechanisms of effect behind NSE, and proposed an alternative FAM pathway. The present study is the first to apply BN modelling to understand the causal mechanisms of recovery in WAD. In doing so, it is anticipated that such analytical methods could increase the precision of treatment of individuals with chronic WAD.
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29.
  • Lilje, Stina, et al. (författare)
  • Costs and Utilities of Manual Therapy and Orthopedic Standard Care for Low-prioritized Orthopedic Outpatients of Working Age A Cost Consequence Analysis
  • 2014
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams. - 0749-8047 .- 1536-5409. ; 30:8, s. 730-736
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Treatment for musculoskeletal disorders in primary care in Sweden is generally initiated with advice and medication. Second-line therapy is physiotherapy and/or injection and radiography; third-line therapy is referral to an orthopedist. Manual therapy is not routine. It is a challenge to identify patients who benefit from treatment by different specialists. The current referral strategy probably contributes to long waiting lists in orthopedic departments, which is costly and implies prolonged suffering for the patients. The aim of this health economic evaluation was to compare costs and outcomes from naprapathic manual therapy (NMT) with orthopedic standard care for common, low-prioritized, nonsurgical musculoskeletal disorders, after second-line treatment. Materials and Methods: Diagnose Related Groups were used to define the costs, and the SF-36 was encoded to evaluate the outcomes in cost per quality adjusted life years gained. Results: Results from a 12 months' follow-up showed significantly larger improvement for the NMT than for orthopedic standard care, significantly lower mean cost per patient; 5427 SEK (*Price level 2009; 1 Euro = 106,213 SEK; 1 US Dollar = 76,457 SEK) (95% confidence interval, 3693-7161) compared to14298 SEK (95% confidence interval, 8322-20,274), and more gains in outcomes in cost per quality adjusted life years per patient (0.066 compared with 0.026). Thus the result is "dominant." Discussion: It is plausible that improved outcomes and reasonable cost savings for low-prioritized nonsurgical outpatients would be attainable if NMT were available as an additional standard care option in orthopedic outpatient clinics.
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30.
  • Lilje, Stina, et al. (författare)
  • Naprapathic Manual Therapy or Conventional Orthopedic Care for Outpatients on Orthopedic Waiting Lists? A pragmatic randomized controlled trial.
  • 2010
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 26:7, s. 602-610
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Traditionally, orthopedic outpatient waiting lists are long, and many referrals are for conditions that do not respond to interventions available at an orthopedic outpatient department. The overall objective of this trial was to investigate whether it is possible to reduce orthopedic waiting lists through integrative medicine. Specific aims were to compare the effects of naprapathic manual therapy to conventional orthopedic care for outpatients with nonurgent musculoskeletal disorders unlikely to benefit from surgery regarding pain, physical function, and perceived recovery. Methods: Seventy-eight patients referred to an orthopedic outpatient department in Sweden were included in this pragmatic randomized controlled trial. The 2 interventions compared were naprapathic manual therapy (index group) and conventional orthopedic care (control group). Pain, physical function, and perceived recovery were measured by questionnaires at baseline and after 12, 24, and 52 weeks. The number of patients being discharged from the waiting lists and the level of agreement concerning management decisions between the naprapath and the orthopedists were also estimated. Results: After 52 weeks, statistically significant differences betweenthe groups were found regarding impairment in pain, increasedphysical function, and regarding perceived recovery, favoring theindex group. Sixty-two percent of the patients in the index group agreed to be discharged from the waiting list. The level of agreement concerning the management decisions was 80%. Discussion: The trial suggests that naprapathic manual therapy may be an alternative to consider for orthopedic outpatients with disorders unlikely to benefit from surgery.
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31.
  • Linton, Steven J, 1952-, et al. (författare)
  • Early identification of patients at risk of developing a persistent back problem : The predictive validity of the Örebro musculoskeletal pain questionnaire
  • 2003
  • Ingår i: The Clinical Journal of Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0749-8047 .- 1536-5409. ; 19:2, s. 80-86
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To test the predictive utility of the Orebro Musculoskeletal Pain Screening Questionnaire in identifying patients at risk for developing persistent back pain problems. Design: Prospective, where participants completed the questionnaire and their cases were followed for 6 months to assess outcome with regard to pain, function, and absenteeism due to sickness. Participants: One hundred seven patients, recruited from seven primary care units. Results: Discriminant analyses showed that the items on the questionnaire were significantly related to future problems. For absenteeism due to sickness, 68% of the patients were correctly classified into one of three groups, whereas an even distribution would have produced 33%. The analyses for function correctly classified 81%, and for pain 71%, into one of two groups, compared with a chance level of 50%. A total score analysis demonstrated that a cutoff score of 90 points had a sensitivity of 89% and a specificity of 65% for absenteeism due to sickness, and a sensitivity of 74% and a specificity of 79% for functional ability. Conclusions: The results underscore that psychological variables are related to outcome 6 months later, and they replicate and extend earlier findings indicating that the Örebro Screening Questionnaire is a clinically reliable and valid instrument. The total score was a relatively good predictor of future absenteeism due to sickness as well as function, but not of pain. The results suggest that the instrument could be of value in isolating patients in need of early interventions and may promote the use of appropriate interventions for patients with psychological risk factors.
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32.
  • Linton, Steven J., 1952-, et al. (författare)
  • Psychological Subgrouping to Assess the Risk for the Development or Maintenance of Chronic Musculoskeletal Pain : Is This the Way Forward?
  • 2020
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 36:3, s. 172-177
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Because musculoskeletal pain problems are so prevalent, new methods of evaluating and treating patients are needed to increase effectiveness. Subgrouping is a method wherein patients are classified into defined groups on the basis of psychosocial factors with the expectation of more specific and tailored treatments can be prescribed for them. For those seeking care for a new episode, the risk of developing chronic pain-related disability is assessed, whereas, for those with existing pain, the risk for the maintenance of the chronic pain problem is evaluated.AIM: The purpose of this narrative review is to examine how patients are classified into subgroups with regard to methods of evaluation and to ascertain whether subgrouping actually facilitates treatment.RESULTS: For the development of disability, screening tools, for example, the Örebro Musculoskeletal Pain Screening Questionnaire, accurately stratify patients into groups (eg, high, medium, low risk) that predict future pain-related work disability. In addition, several studies show that treatments that directly key in on risk groups enjoy enhanced outcomes compared with treatment as usual. For the maintenance of chronic musculoskeletal pain problems, there are several instruments that classify patients into specific groups or profiles, for example, on the basis of the avoidance and endurance model or the International Classification of Functioning, Disability and Health (ICF) assessment. Although some evidence shows that these classifications are related to treatment outcome, we found no study that directly tested a system for providing treatment matched to the subgrouping for maintenance.CONCLUSIONS: We conclude that it is possible to reliably subgroup patients with musculoskeletal problems. Likewise, treatments that address the risk factors in the screening procedure may enhance outcomes compared with treatment as usual. More work is needed, however, to better understand the mechanism, so that assessment methods can be improved, and treatment specific to subgroups can be developed and evaluated.
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33.
  • Linton, Steven J., 1952-, et al. (författare)
  • The Effects of Cognitive-Behavioral and Physical Therapy Preventive Interventions on Pain-Related Sick Leave : A Randomized Controlled Trial
  • 2005
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 21:2, s. 109-119
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Recent recommendations suggest that reassuring patients with an acute bout of low back pain and encouraging a return to normal activities may be helpful in preventing the development of chronic disability. There is also a question as to whether psychologic or physical therapy interventions actually add anything to such reassurance and advice in terms of preventing chronicity. This study aimed to ascertain the preventive effects on future sick leave and health-care utilization of adding on a cognitive-behavioral group intervention or a cognitive-behavioral group intervention and preventive physical therapy (focused on activity and exercise) relative to a minimal treatment group (examination, reassurance, and activity advice).Subjects: A total of 185 patients seeking care for nonspecific back or neck pain who were employed and at risk for developing long-term disability volunteered to participate in the study. Of these 185, 158 (85%) completed the pre- and 1-year follow-up assessments.Results: Significant differences were observed on the key outcome variables of future health-care utilization and work absenteeism. For health-care utilization, the cognitive-behavioral intervention group and preventive physical therapy group had significantly fewer healthcare visits than did the Minimal Treatment Group. For work absenteeism, the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group had fewer days during the 12-month follow-up than did the Minimal Treatment Group. The risk for developing long-term sick disability leave was more than five-fold higher in the Minimal Group as compared with the other 2 groups. However, there was no difference between the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group on sick leave.Conclusion: Taken as a whole, this study shows that adding cognitive-behavioral intervention and cognitive-behavioral intervention and preventive physical therapy can enhance the prevention of long-term disability. There was no substantial difference in the results between the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group.
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34.
  •  
35.
  • Michaelson, Peter, et al. (författare)
  • Factors predicting pain reduction in chronic back and neck pain after multimodal treatment.
  • 2004
  • Ingår i: The Clinical Journal of Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0749-8047 .- 1536-5409. ; 20:6, s. 447-454
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To determine whether treatment related pain reduction on the short- and long-term is predicted by different baseline variables, and with different accuracy, in patients with chronic low back pain as compared with those with chronic neck pain. DESIGN AND METHODS: A single blinded prospective cohort study based on patients with chronic musculoskeletal pain in the lower back (N = 167) or the neck (N = 136) who completed a 4-week multimodal rehabilitation program. At admission, each patient was evaluated on 17 potential predictors, including pain characteristics and physical, sociodemographic, and psychosocial-behavioral variables. Changes in self-reported pain intensity in the lower back or the neck between the pretreatment evaluation and those performed immediately after, and 12 months after the rehabilitation program, were assessed. RESULTS: Logistic regression models revealed that change in pain intensity could be predicted with good specificity but with poor sensitivity both for patients with chronic low back pain and chronic neck pain. Significant predictors among the neck pain patients were high endurance, low age, high pain intensity, few other symptoms, low need of being social, to do things with others, and to be helped, along with optimistic attitudes on how the pain will interfere with daily life. Among the low back pain patients, high pain intensity, low levels of pain severity, and high affective distress were important predictors. Variables such as sex, sick leave history, working status, accident, pain duration, and depressive symptoms demonstrated no predictive value. Short- and long-term pain outcome was equally predictable and predicted by almost the same variables. CONCLUSIONS: Patients who reported unchanged or increased pain after multimodal treatment could be predicted with good accuracy, whereas those who reported decreased pain were more difficult to identify. Treatment-related pain alteration in chronic low back pain seems to be predicted by partly different variables than in chronic neck pain.
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36.
  • Olaya-Contreras, Patricia, 1964, et al. (författare)
  • Cross-validation of the Depression, Anxiety, and Positive Outlook Scale (DAPOS) for Clinical Use
  • 2011
  • Ingår i: The Clinical journal of pain. - 0749-8047 .- 1536-5409. ; 27:4, s. 330-337
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The main objective of this study was to investigate different psychometric properties of the Swedish version of the Depression, Anxiety, and Positive Outlook Scale (DAPOS) in patients with chronic musculoskeletal pain in an orthopedic setting. METHODS: A total of 449 participants took part in the study, including 288 patients with chronic musculoskeletal pain and 161 participants in a reference group. Internal consistency, convergent validity, and measurement invariance of the constructs of DAPOS were investigated across sex and diagnostic groups. The Beck Depression Inventory and the Spielberger Anxiety Inventory were used for measures of convergent validity. Multigroup confirmatory factor analysis was performed to test measurement invariance of the theoretical constructs of DAPOS. RESULTS: Internal consistency was good for all 3 constructs, and correlations concerned with convergent validity were found to be acceptable to good. With regard to cross-validation, the 3 constructs of DAPOS were strictly measurement invariant with respect to sex. Across diagnostic groups, the constructs of anxiety and positive outlook were almost strictly measurement invariant, although there were some restrictions of measurement invariance for the construct of depression. DISCUSSION: To be able to rely on an instrument with as few items as DAPOS, the cross-validation of its constructs for sex and diagnostic groups is a valuable information, particularly when investigated in patients with musculoskeletal pain. Based on these results, we recommend that DAPOS could replace longer and more time-consuming screening tests in clinical settings.
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37.
  • Peters, Madelon L., et al. (författare)
  • Happy Despite Pain : A Randomized Controlled Trial of an 8-week Internet-delivered Positive Psychology Intervention for Enhancing Well-being in Patients with Chronic Pain
  • 2017
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 33:11, s. 962-975
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: There is preliminary evidence for the efficacy of positive psychology interventions for pain management. The current study examined the effects of an internet-based positive psychology self-help program for patients with chronic musculoskeletal pain and compared it with an internet-based cognitive behavioural program.METHODS: A randomized controlled trial was carried out with three conditions: an internet-delivered positive psychology program, an internet-delivered cognitive behavioural program and waitlist control. A total of 276 patients were randomized to one of the three conditions and post treatment data were obtained from 206 patients. Primary outcomes were happiness, depression and physical impairments at post-treatment and at six months follow-up. Intention-to-treat analyses were carried out using mixed regression analyses.RESULTS: Both treatments led to significant increases in happiness and decreases in depression. Physical impairments did not significantly decrease compared to waitlist. Improvements in happiness and depression were maintained until six months follow-up. There were no overall differences in the efficacy of the two active interventions but effects appeared to be moderated by education. Patients with a higher level of education profited more from the positive psychology intervention than from the cognitive behavioural program.DISCUSSION: The results suggest that an internet-based positive psychology self-help intervention for the management of chronic pain is clinically useful. Because the self-help exercises as used in the current program do not require therapist involvement, dissemination potential is large. Further studies should examine whether it can best be used as stand-alone or add-on treatment combined with established pain treatment programs.
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38.
  • Pillai, Rajath S, et al. (författare)
  • Assessment of Somatosensory and Psychosocial Function of Patients With Trigeminal Nerve Damage
  • 2020
  • Ingår i: Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 1536-5409 .- 0749-8047. ; 36:5, s. 321-335
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The present study assessed somatosensory changes related to trigeminal nerve damage using extensive evaluation tools and assessed the effect of such damage on the patients' psychosocial status and quality of life compared with healthy participants.METHODS: In 37 patients with intraorally or extraorally presenting trigeminal nerve damage diagnosed as painful or nonpainful posttraumatic trigeminal neuropathy, psychophysical tests like quantitative sensory testing (QST) and qualitative sensory testing and the electrophysiological "nociceptive-specific" blink reflex were performed. The patients and 20 healthy participants completed a set of questionnaires assessing their psychosocial status and quality of life.RESULTS: A loss or gain of somatosensory function was seen in at least 1 QST parameter in >88.9% of the patients. Patients in whom extraoral QST was performed showed an overall loss of somatosensory function, whereas intraoral QST showed a general gain of somatosensory function. Qualitative sensory testing identified a side-to-side difference in the tactile and pinprick stimulation in >77% of the patients. An abnormal "nociceptive-specific" blink reflex response was seen in 42.1% to 71.4% of patients dependent on the trigeminal branch stimulated, though comparisons with healthy reference values showed ambiguous results. Compared with the healthy participants, patients showed higher scores for pain catastrophizing, symptoms of depression and anxiety, limited jaw function, more somatic symptoms, and significantly impaired oral health-related quality of life (all P<0.038).DISCUSSION: The results from the present study showed presence of varied somatosensory abnormalities when assessed using psychophysical and electrophysiological investigations and a significantly impaired psychosocial status.
  •  
39.
  • Powers, Mark B., et al. (författare)
  • Nonpharmacologic Pain Management Among Hospitalized Inpatients : A Randomized Waitlist-Controlled Trial of Standard Virtual Reality (CGI VR) Versus Video Capture VR (360 degrees 3D/Stereoscopic Video Capture VR)
  • 2021
  • Ingår i: The Clinical Journal of Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0749-8047 .- 1536-5409. ; 37:9, s. 678-687
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Nonpharmacologic pain management strategies are needed because of the growing opioid epidemic. While studies have examined the efficacy of virtual reality (VR) for pain reduction, there is little research in adult inpatient settings, and no studies comparing the relative efficacy of standard animated computer-generated imagery (CGI) VR to Video Capture VR (360 degrees 3D/stereoscopic Video Capture VR). Here, we report on a randomized controlled trial of the relative efficacy of standard CGI VR versus Video Capture VR (matched for content) and also compared the overall efficacy of VR to a waitlist control group.Materials and Methods: Participants (N=103 hospitalized inpatients reporting pain) were randomized to 1 of 3 conditions: (1) waitlist control, (2) CGI VR, or (3) Video Capture VR. The VR and waitlist conditions were 10 minutes in length. Outcomes were assessed pretreatment, post-treatment, and after a brief follow-up.Results: Consistent with hypotheses, both VR conditions reduced pain significantly more relative to the waitlist control condition (d=1.60, P<0.001) and pain reductions were largely maintained at the brief follow-up assessment. Both VR conditions reduced pain by ∼50% and led to improvements in mood, anxiety, and relaxation. Contrary to prediction, the Video Capture VR condition was not significantly more effective at reducing pain relative to the CGI VR condition (d=0.25, P=0.216). However, as expected, patients randomized to the Video Capture VR rated their experience as more positive and realistic (d=0.78, P=0.002).Discussion: Video Capture VR was as effective as CGI VR for pain reduction and was rated as more realistic.
  •  
40.
  • Rhodin, Annica, 1949-, et al. (författare)
  • Opioid endocrinopathy : a clinical problem in patients with chronic pain and long-term opioid treatment
  • 2010
  • Ingår i: The Clinical Journal of Pain. - 0749-8047 .- 1536-5409. ; 26:5, s. 374-380
  • Tidskriftsartikel (refereegranskat)abstract
    • Background:The use of strong opioids for treatment of noncancer chronic pain has increased. However, strong evidence for sustained pain relief and improved function is lacking. Controversy prevails, whether hormonal changes are induced by long-term treatment with opioids. The purpose of this study was to investigate the occurrence of endocrine dysfunction in chronic pain patients on long-term opioid treatment.Methods:A study group of 39 chronic pain patients treated with strong oral opioids for more than 1 year was compared with a control group of 20 chronic pain patients without opioid treatment. Basic levels of prolactin and function of the hypothalamic-pituitary-thyroid-, hypothalamic-pituitary-adrenal-axis, and hypothalamic-pituitary-growth-hormone - and hypothalamic-pituitary-gonadal-axis were measured. Quality-of-life and side effects were estimated with EORTC-QLQ-C30.Results:In the opioid-treated group, the patients had signs of pituitary dysfunction affecting all axes. Significant differences were shown in hypofunction of the hypothalamic-pituitary-gonadal -axis, hyperfunction of the hypothalamic-pituitary-adrenal -axis, and higher prolactin levels in the opioid-treated group, compared with the control group. The degree of pain was rated the same in both groups, but the opioid-treated group reported more side effects and lower quality of life.Conclusions:Long-term treatment of chronic pain with strong opioids causes side effects that can be attributed to hormonal abnormalities caused by opioid-induced inhibition of hypothalamic-pituitary function. Hormone substitution can be indicated to treat symptoms. Decreasing the opioid dose or stopping the opioid treatment can reverse endocrine dysfunction. This needs to be recognized by all practitioners treating chronic pain patients with opioids.
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41.
  • Rothman, Mats Georg, et al. (författare)
  • Improved Quality of Life, Working Ability, and Patient Satisfaction After a Pretreatment Multimodal Assessment Method in Patients With Mixed Chronic Muscular Pain A Randomized-controlled Study
  • 2013
  • Ingår i: The Clinical Journal of Pain. - 0749-8047 .- 1536-5409. ; 29:3, s. 195-204
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To investigate whether a pretreatment multimodal (MM) assessment of patients with chronic muscular pain has an impact on treatment outcome. Methods: The present randomized-controlled study evaluated an MM assessment compared with routine multidisciplinary assessment given to a control group. The study population consisted of primary care patients with mixed chronic muscular pain. Variables assessed were: pain intensity, depression, life stress, quality of life (QOL), disability, working ability, and treatment satisfaction. Follow-up was performed at 15 months and 182 patients of 220 (83%) completed the study. Results: Univariate and multivariate logistic regression showed from baseline to 15 months a significant improvement in QOL as measured by Short-Form 36 in the MM group compared with the control group on the domains of physical function (odds ratio 2.40; 95% confidence interval 1.32-4.37), role physical (2.37; 1.10-5.09), and role emotional (2.05; 1.05-3.96). Working ability improved more significantly in the MM group (46% vs. 35%) and impairment was less (1% vs. 15%) compared with the control group (P = 0.016). Satisfaction with the assessment was, on average, higher (P < 0.001) in the MM group than in the control group. Discussion: Patients who underwent an MM assessment before treatment in comparison with patients receiving routine multidisciplinary assessment improved QOL, working ability, and were also significantly more satisfied. This result indicates that MM pretreatment assessment could be advantageous in the selection of patients for suitable rehabilitation treatment in a primary care setting, and also be used to prepare patients for future rehabilitation.
  •  
42.
  • Sagafors, Dagrun, et al. (författare)
  • Single-Fiber Recordings Of Nociceptive Fibers in Patients With HSAN Type V With Congenital Insensitivity To Pain
  • 2016
  • Ingår i: The Clinical Journal of Pain. - 0749-8047 .- 1536-5409. ; 32:7, s. 636-642
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Nerve growth factor (NGF) is a protein important for growth and survival, but also for modulation of sensitivity of nociceptors and sympathetic neurons. The purpose of the present study was to investigate the effects of reduced NGF signaling in patients with hereditary sensory and autonomic neuropathies type V, congenital insensitivity to pain, caused by a mutation of the NGF beta gene, including a characterization of single nociceptive fibers using microneurography (MNG).Materials and Methods: One homozygote and 2 heterozygote patients with this mutation were examined with electromyography/neurography, thermal testing, quantitative sudomotor axon reflex test, and electrically induced axon reflex erythema in addition to MNG.Results: Low quantitative sudomotor axon reflex test measurements of 0.02 (left foot) and 0.03 (right foot) mL/cm(2) and elevated thermal thresholds for warmth and cold detection testing showed clear impairment of small nerve fibers, both sudomotor efferent and somatic afferent fibers, in the patient homozygote for the mutation. MNG from one of the heterozygote patients revealed changes in the small nociceptive fibers in skin, including abnormally low conduction velocity, spontaneous activity in A-delta fibers and C-nociceptors and abnormal or lacking response to heat.Discussion: The findings of grossly intact pain thresholds compared with anamnestic insensitivity of pain in deep somatic tissue such as bone suggest a gradient of impairment dependent on different NGF availability in various tissues. Even though these patients in some aspects report insensitivity to pain, they also report chronic spontaneous pain as their main symptom, strikingly highlighting differential mechanisms of insensitivity to evoked pain versus spontaneous pain.
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43.
  • Sayed-Noor, Arkan S., et al. (författare)
  • Pressure-pain threshold algometric measurement in patients with greater trochanteric pain after total hip arthroplasty
  • 2008
  • Ingår i: The Clinical Journal of Pain. - Philadelphia, USa : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 24:3, s. 232-236
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The evaluation of tenderness associated with greater trochanteric pain (GTP) syndrome is amenable to bias and depends on the examiner's experience. In this study, we tested whether the use of an electronic pressure algometer enhanced the reliability of this evaluation.Patients and methods: Pressure-pain threshold (PPT) was measured with an electronic algometer in 18 patients who developed GTP after total hip arthroplasty and in matched controls. Both groups were evaluated with visual analog scale.Results: The PPT measurements showed large interindividual variability across patients. The correspondence of the PPT measurements in asymptomatic patients was good. We found good validity for the algometer used. The PPT ratio of 0.8 (affected vs. unaffected side) can be used as a cut-off ratio. The PPT measurements at the greater trochanter (local pain) were significantly lower than at the ilio-tibial band (radiated pain). There was no correlation between PPT measurements and visual analog scales. Despite the acceptable sensitivity and specificity of pressure algometer, because of low positive predictive value and large interindividual variability, pressure algometer has a limited value as a screening test.Conclusions: The examination of tenderness associated with GTP is facilitated by the used algometer. It is the intraindividual body-side PPT differences that yield the most sensitive measurement for the assessment of deep pain. A cut-off value of 0.8 can be used for diagnostic purposes. Interindividual differences might be considerable and could mask pathologic diagnostic findings.
  •  
44.
  • Sharma, Sonia, et al. (författare)
  • Graded Chronic Pain Scale : Validation of 1-month Reference Frame.
  • 2022
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 38:2, s. 119-131
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: The 1-month Graded Chronic Pain Scale (GCPS) commonly used in clinical studies has never been validated. This study compares the GCPS 1-month with the 6-months version for reliability and validity.METHODS: The Validation Project included 521 subjects with at least one temporomandibular disorder for cross-sectional data and 74 subjects for test-retest data. Internal reliability, stability, and construct validity were used for testing the 1-month version. Comparisons were made between the two versions for characteristic pain intensity (CPI), interference, and chronic pain grade (CPG).RESULTS: For GCPS 1-month, internal consistency for pain intensity and interference was high (Cronbach's alpha=0.87 and 0.94, respectively), and temporal stability was high for CPI (intraclass correlation coefficient (ICC)=0.91), interference (ICC=0.85), and CPG (weighted kappa=0.88). ICC or kappa between the two versions was 0.78 (CPI), 0.66 (interference), and 0.69 (CPG); high-impact pain, in contrast, was 0.50. Construct validity exhibited higher correlations with predictor variables for 1-month version attributes of CPI, interference, and CPG. Modified Bland-Altman plots indicated that both versions measure CPI well.DISCUSSION: Overall, reliability of the 1-month GCPS is equal to or better than the 6-months version for pain intensity, disability days, pain interference, CPG, and high-impact pain. However, consistency between versions is lower for measures of disability days and interference, and for the derived measures of CPG and high-impact pain; highly skewed distributions and increasing disagreement in reported status over the time periods affect the measures of function. Therefore, we recommend that GCPS-1 month only be used to calculate pain intensity and pain interference.
  •  
45.
  • Skillgate, Eva, et al. (författare)
  • Naprapathic manual therapy or evidence-based care for back and neck pain : a randomized, controlled trial
  • 2007
  • Ingår i: The Clinical Journal of Pain. - 0749-8047 .- 1536-5409. ; 23:5, s. 431-439
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To compare naprapathic manual therapy with evidence-based care for back or neck pain regarding pain, disability, and perceived recovery. Naprapathy that is common in the Nordic countries and in some states in the United States is characterized by manual manipulations with a focus on soft and connective tissues, aiming to decrease pain and disability in the musculoskeletal system. Methods: Four hundred and nine patients with pain and disability in the back or neck lasting for at least 2 weeks, recruited at 2 large public companies in Sweden in 2005, were included in this randomized controlled trial. The 2 interventions were naprapathy, including spinal manipulation/mobilization, massage, and stretching (Index Group) and support and advice to stay active and how to cope with pain, according to the best scientific evidence available, provided by a physician (Control Group). Pain, disability, and perceived recovery were measured by questionnaires at baseline and after 3, 7, and 12 weeks. Results: At 7-week and 12-week follow-ups, statistically significant differences between the groups were found in all outcomes favoring the Index Group. At 12-week follow-up, a higher proportion in the naprapathy group had improved regarding pain [risk difference (RD) = 27%, 95% confidence interval (Cl): 17-37], disability (RD = 18%, 95% Cl: 7-28), and perceived recovery (RD = 44%, 95% Cl: 35-53). Separate analysis of neck pain and back pain patients showed similar results. Discussion: This trial suggests that combined manual therapy, like naprapathy, might be an alternative to consider for back and neck pain patients.
  •  
46.
  • Söderberg, Karin, et al. (författare)
  • Psychophysically determined thresholds for thermal perception and pain perception in healthy women across the menstrual cycle
  • 2006
  • Ingår i: The Clinical Journal of Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0749-8047 .- 1536-5409. ; 22:7, s. 610-616
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Several studies have indicated changes in sensation and/or pain sensitivity among women across the menstrual cycle, but the pattern of the changes varies considerably. One reason for the reported discrepancies could reside in lack of biochemical definition of menstrual cycle phase. The aim was to quantify temperature and temperature pain thresholds at biochemically defined stages of the menstrual cycle. Methods: Nineteen healthy women were included in the study. Temperature and temperature pain thresholds were evaluated by quantitative sensory testing, performed at 3 occasions during the menstrual cycle (early follicular phase, late follicular phase, and mid-luteal phase). At each test session, serum concentrations of estradiol and progesterone were assessed. Results: Thermal cold perception threshold at the mammilla was significantly lower in the late follicular and mid-luteal phases, compared with the early follicular phase (P < 0.05, respectively). For the remaining test sites, no cycle related differences in thermal perception or thermal thresholds could be documented. Conclusions: The present study has indicated no major changes in thermal pain thresholds related to phase of the menstrual cycle for the tested locations, although thermal cold perception threshold at the mammilla was a significantly lower in the late follicular and mid-luteal phases, compared with the early follicular phase. The findings of the present study further underlines the need for strict criteria for menstrual cycle phase when studying pain sensitivity in relation to hormonal events in women.
  •  
47.
  • Södermark, Martin, et al. (författare)
  • What Works? Processes of Change in a Transdiagnostic Exposure Treatment for Patients with Chronic Pain and Emotional Problems
  • 2020
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 36:9, s. 648-657
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: We recently developed a transdiagnostic exposure treatment ("the hybrid treatment") for chronic pain patients with concurrent emotional difficulties. This paper investigates the hypothesized treatment processes, specifically: a) if changes on pain-related dysregulation (catastrophizing, fear-avoidance and non-acceptance of pain) and general emotion dysregulation (difficulties to regulate a broad spectrum of emotional responses) mediate effects on outcomes; and b) if mediation is more pronounced for patients who score higher on these processes pre-treatment.METHODS: Structural equation modeling for longitudinal data using the full intention-to-treat sample was used to test whether proposed variables mediated the effect of the hybrid treatment (n=58) compared to a guided internet delivered pain management treatment based on cognitive-behavioral principles (iCBT; n=57) on pain interference and depressive symptoms at 9-months follow up. To make full use of the multiple process-measures collected in the trial, we modeled mediators as two continuous latent variables: pain-related dysregulation and general emotion dysregulation.RESULTS: Reduced pain-related dysregulation mediated the effects of treatment on both outcomes, whereas reduced general emotion dysregulation mediated the effects on depressive symptoms only. In the hybrid treatment, the mediated effect was more pronounced for participants who scored higher on pain-related dysregulation pre-treatment relative to those who scored lower.DISCUSSION: Our findings provide initial support for the transdiagnostic theoretical underpinnings of the hybrid treatment model. Using a hybrid treatment approach that centers on teaching patients emotion regulation skills before commencing broad exposure, successfully influenced both pain-related dysregulation and general emotion dysregulation, which in turn was associated with better treatment outcomes. It appears central to address these processes in pain patients with comorbid emotional problems, especially among patients scoring high on measures regarding catastrophizing, fear-avoidance and non-acceptance of pain.
  •  
48.
  • Thorsell Cederberg, Jenny, et al. (författare)
  • Child and Parent Risk and Resilience Factors as Predictors of Long-term Recovery in Youth Undergoing Spinal Fusion Surgery
  • 2024
  • Ingår i: The Clinical Journal of Pain. - : Wolters Kluwer. - 0749-8047 .- 1536-5409. ; 40:5, s. 278-287
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Undertreated pediatric postsurgical pain negatively affects health-related quality of life (HRQOL) and functioning and may lead to chronic postsurgical pain (CPSP). Predictors of recovery have been identified but more research is needed, particularly regarding resilience, social factors, and long-term effects. The aim of the present study was to investigate child and parent risk and resilience factors as predictors of long-term postsurgical recovery for adolescents.Methods: Participants were patients with Adolescent Idiopathic Scoliosis (AIS), 12 to 18 years old, undergoing spinal fusion, and their parents. Recruitment occurred at the orthopedic units at 4 hospitals in Belgium. Data were collected before surgery (T0), at 3 (T1) and 6 weeks (T2), 6 months (T3), and 1 year (T4) post surgery. Multiple regression models were used to evaluate the predictive effect of pain intensity, pain catastrophizing, psychological flexibility, and pain acceptance on long-term functioning, HRQOL, and pain.Results: The sample comprised 100 adolescents and 61 parents. Pain at T0, T1, and T3 and adolescent pain catastrophizing (T0) predicted health-related quality of life, functioning, and pain at T4 (while pain at T2 predicted HRQOL and pain). Parent pain catastrophizing predicted pain at T4. Adolescent and parental psychological flexibility predicted HRQOL, and parent psychological flexibility also predicted pain at T4. Adolescent acceptance at T1 predicted pain, and acceptance at T2 predicted HRQOL, at T4.Discussion: The study identified pain and adolescent pain catastrophizing as risk factors, and adolescent and parental psychological flexibility and adolescent pain acceptance as resilience factors, for long-term recovery in youths undergoing spinal fusion. Postsurgical pain management targeting these factors may therefore promote recovery for these adolescents.
  •  
49.
  • Thorsell, Jenny, et al. (författare)
  • A Comparative Study of 2 Manual-based Self-Help Interventions, Acceptance and Commitment Therapy and Applied Relaxation, for Persons With Chronic Pain
  • 2011
  • Ingår i: The Clinical Journal of Pain. - 0749-8047 .- 1536-5409. ; 27:8, s. 716-723
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The aim of this study was to compare 2 self-help-based interventions; a coping-oriented approach, applied relaxation (AR) and an acceptance-oriented approach, acceptance and commitment therapy (ACT), for persons with chronic pain. Method: This study is a randomized control trial (N = 90) with a mixed between-within participants design with repeated measures. Interventions in both conditions comprised an initial face-to-face session, a 7-week manual-based self-help intervention including weekly therapist telephone support and a concluding face-to-face session. Outcome measures included satisfaction with life, depression, anxiety, acceptance of chronic pain, level of function, and pain intensity. Effects were measured at preintervention and postintervention and at 6 and 12 months after the end of intervention. Results: The results show that the ACT condition increased their level of acceptance significantly compared with the AR condition. There was also a marginally significant interaction effect regarding satisfaction with life in which the ACT condition had improved in comparison to the AR condition. Further, the ACT condition reported a higher level of function and decreased pain intensity compared with the AR condition. Both conditions improved significantly regarding depression and anxiety. Conclusions: A manual-based self-help intervention with weekly therapist support in an ACT format adds value to the treatment repertoire for persons suffering with chronic pain.
  •  
50.
  • Tseli, Elena, et al. (författare)
  • Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients With Chronic Musculoskeletal Pain : A Systematic Review and Meta-Analysis
  • 2019
  • Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 35:2, s. 148-173
  • Forskningsöversikt (refereegranskat)abstract
    • OBJECTIVES: This systematic review aimed to identify and evaluate prognostic factors for long-term (≥6 mo) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation (MDR).MATERIALS AND METHODS: Electronic searches conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL revealed 25 original research reports, published 1983-2016, (n=9436). Potential prognostic factors relating to initial pain and physical and psychological functioning were synthesized qualitatively and quantitatively in random effects meta-analyses. The level of evidence (LoE) was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE).RESULTS: Pain-related factors (intensity and chronicity) were not associated with function/disability at long-term follow-up, odds ratio (OR)=0.84; 95% confidence interval (CI), 0.65-1.07 and OR=0.97; 95% CI, 0.93-1.00, respectively (moderate LoE). A better function at follow-up was predicted by Physical factors; higher levels of initial self-reported functioning, OR=1.07; 95% CI, 1.02-1.13 (low LoE), and Psychological factors; low initial levels of emotional distress, OR=0.77; 95% CI, 0.65-0.92, low levels of cognitive and behavioral risk factors, OR=0.85; 95% CI, 0.77-0.93 and high levels of protective cognitive and behavioral factors, OR=1.49; 95% CI, 1.17-1.90 (moderate LoE).DISCUSSION: While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR, poor pretreatment physical and psychological functioning influenced the prognosis negatively. Thus, treatment should further target and optimize these modifiable factors and an increased focus on positive, psychological protective factors may perhaps provide an opening for yet untapped clinical gains.
  •  
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