| 1. |
- Masferrer, R, et al.
(författare)
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Colored pain drawings: preliminary observations in a neurosurgical practice
- 2003
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Ingår i: European Journal of Pain. - 1090-3801. ; 7:3, s. 213-217
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Tidskriftsartikel (refereegranskat)abstract
- Background: Black and white pain drawings were introduced as a proposed means to identify patients, presenting with low back pain, who demonstrated functional overlay upon neurological testing. The use of color may enhance the usefulness of such pain drawings, but has not been described for adult patients. Aims: To retrospectively explore the use of colored pain drawings in patients with neck, low back, or radicular pain. Methods: Patients with neck, low back, or radicular pain referred to a community-based neurosurgical practice for evaluation during 1 year (n = 359) depicted their pain on anatomical drawings using colored pencils representing different pain characteristics. Patients with abnormal (n = 55) and normal (n = 54) pain drawings were selected for this study. Use of medications, findings on physical examination, radiographic findings, activity levels, Waddell signs, and pending litigation were recorded and compared between patients with normal and abnormal pain drawings, as assessed according to the Ransford penalty point system. Results: Patients whose colored pain drawings were abnormal, demonstrated a greater use of medications, more non-focal clinical findings, Waddell signs, impaired activity levels, involvement in pending litigation, and significantly fewer pathological radiographic findings than patients with normal pain drawings. Conclusions: Our findings agree with previous observations using black and white pain drawings, indicating that colored pain drawings are no less useful than the black and white approach. Further research is necessary to examine the psychometric properties and clinical usefulness of colored pain drawings to predict outcomes and/or determine treatment. (C) 2002 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Science Ltd. All rights reserved.
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| 2. |
- Nilsson, Hans Jörgen, et al.
(författare)
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Long term depression of human nociceptive skin senses induced by thin fibre stimulation.
- 2003
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Ingår i: European Journal of Pain. - 1090-3801. ; 7:3, s. 225-233
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Tidskriftsartikel (refereegranskat)abstract
- We have recently shown that stimulation, through a multi-electrode array, of thin nerve fibres close to the dermo-epidermal junction in the skin, produces powerful inhibition of itch and, to a lesser degree, cutaneous pain in humans. Here, we have studied the induction time and frequency dependency (range 1–10 Hz) of the inhibitory effects of such stimulation on itch, mechanical, and thermal pain, in 20 healthy subjects. Sixteen electrodes applied on the skin were consecutively stimulated using a method termed cutaneous field stimulation (CFS). The results show that different treatment periods with CFS were required for the induction of significant inhibitory effects on different nociceptive qualities: 1st heat pain (1 min), itch (3 min), 2nd heat pain (6 min), pinch evoked pain (8 min). Six to ten minutes stimulation sufficed to induce peak inhibitory effects on all these sensory qualities while longer stimulation (up to 40 min) did not cause significantly stronger inhibition. The effects on itch, 1st and 2nd heat pain lasted over 55 min after termination of CFS. There was no effect on prickle. No significant difference in inhibitory effects of different stimulation frequencies (1, 4 and 10 Hz/electrode) was found. The induction time and effective stimulation frequencies may suggest that the underlying mechanisms are similar to those of long term depression (LTD) previously described in the spinal cord in animal experiments.
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| 3. |
- Alfven, G
(författare)
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Psychosomatic pain
- 1998
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Ingår i: European journal of pain (London, England). - : Wiley. - 1532-2149 .- 1090-3801. ; 2:2, s. 189-190
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Tidskriftsartikel (refereegranskat)
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| 4. |
- Andersson, H. Ingemar
(författare)
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The course of non-malignant chronic pain : a 12-year follow-up of a cohort from the general population
- 2004
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Ingår i: European Journal of Pain. - 1090-3801 .- 1532-2149. ; 8:1, s. 47-53
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Tidskriftsartikel (refereegranskat)abstract
- The high prevalence of chronic pain (duration >3 months) reported from different populations indicates a public health problem. Knowledge of the long-term course of chronic non-malignant pain is incomplete and scarce.This paper describes a follow-up of a cohort recruited from a survey in the general population. The cohort (n=214) consisted initially of individuals with widespread or located (neck-shoulder) pain or without chronic pain. The individuals were initially examined and replied to questionnaires on pain, social factors, lifestyle, medication and health care after two and 12 years. The deaths during the period were obtained from the population register. Complete data exist for 77% of the eligible individuals.After 12 years one-third of the individuals initially without pain reported chronic pain, and among those with initial chronic pain 85% still reported chronic pain. The number of painful areas was the strongest predictor of chronic pain 12 years later (OR 15.8; >3 locations vs. 0) whereas a social factor (having a close friend) decreased the risk (OR 0.44). The onset of chronic pain during the same period was related to the physical workload (work with bent positions; OR 5.31; yes vs. no). Mortality was significantly higher in the group initially reporting widespread pain compared with the other groups. The chronicity of widespread chronic pain supports early and intense intervention among individuals with located pain. The association between chronic widespread pain and increased mortality needs further investigation but may deepen the view of chronic pain as a public health problem.
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| 5. |
- Andersson, H. Ingemar
(författare)
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The course of non-malignant chronic pain : a 12-year follow-up of a cohort from the general population
- 2004
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Ingår i: European Journal of Pain. - : Wiley-Blackwell. - 1090-3801 .- 1532-2149. ; 8:1, s. 47-53
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Tidskriftsartikel (refereegranskat)abstract
- The high prevalence of chronic pain (duration >3 months) reported from different populations indicates a public health problem. Knowledge of the long-term course of chronic non-malignant pain is incomplete and scarce.This paper describes a follow-up of a cohort recruited from a survey in the general population. The cohort (n=214) consisted initially of individuals with widespread or located (neck-shoulder) pain or without chronic pain. The individuals were initially examined and replied to questionnaires on pain, social factors, lifestyle, medication and health care after two and 12 years. The deaths during the period were obtained from the population register. Complete data exist for 77% of the eligible individuals.After 12 years one-third of the individuals initially without pain reported chronic pain, and among those with initial chronic pain 85% still reported chronic pain. The number of painful areas was the strongest predictor of chronic pain 12 years later (OR 15.8; >3 locations vs. 0) whereas a socialfactor (having a close friend) decreased the risk (OR 0.44). The onset of chronic pain during the same period was related to the physical workload (work with bent positions; OR 5.31; yes vs. no). Mortality was significantly higher in the group initially reporting widespread pain compared with the other groups. The chronicity of widespread chronic pain supports early and intense intervention among individuals with located pain. The association between chronic widespread pain and increased mortality needs further investigation but may deepen the view of chronic pain as a public health problem.
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| 6. |
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| 7. |
- Bergström, Gunnar, Professor, et al.
(författare)
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A psychometric evaluation of the Swedish version of the Multidimensional Pain Inventory (MPI‐S): a gender differentiated evaluation
- 1999
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 3:3, s. 261-273
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Tidskriftsartikel (refereegranskat)abstract
- A need to consider possible gender differences in pain research has been recognized by researchers during the last decades. As part of a psychometric evaluation of the Swedish version of the Multidimensional Pain Inventory (MPI-S), we performed gender-differentiated analyses of the internal consistency, validity and sensitivity to change of the MPI-S in a sample of 235 individuals (129 females, 106 males) suffering from long-term non-specific pain from the lower back and/or neck region. The construct validation and sensitivity analyses were performed by using validated self-report measures and direct observational assessment techniques as external constructs. For sections 1 and 2 of the MPI-S, the results support the internal consistency (alpha coefficients ranged from 0.74 to 0.85 for females and 0.62 to 0.89 for males) and construct validity across gender. The General Activity (GA) scale of section 3 of the MPI-S displayed acceptable internal consistency across gender (alpha = 0.79 for females, 0.80 for males) but not a satisfactory construct validity. Furthermore, the results yielded some support for the sensitivity to change of the Pain Severity (PS), Interference (1), Life Control (LC) and Affective Distress (AD) scales (from section 1) across gender. Unfortunately, the GA scale did not display a satisfactory sensitivity either for females or males. Altogether, the results showed a similar pattern across gender, although some divergences were detected, such as the substantially weaker negative correlation between perceived supportive behaviour from significant others and punishing responses for males compared to females. In conclusion, we recommend the use of sections 1 and 2 of the MPI-S as a psychometrically evaluated and comprehensive instrument in the assessment of individuals suffering from chronic non-specific low back pain or neck pain.
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| 8. |
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| 9. |
- Brattberg, Gunilla
(författare)
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Connective tissue massage in the treatment of fibromyalgia
- 1999
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Ingår i: European Journal of Pain. - 1090-3801 .- 1532-2149. ; 3:3, s. 235-244
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate the effect of connective tissue massage in the treatment of individuals with fibromyalgia. The results of this random study of 48 individuals diagnosed with fibromyalgia (23 in the treatment group and 25 in the reference group) show that a series of 15 treatments with connective tissue massage conveys a pain relieving effect of 37%, reduces depression and the use of analgesics, and positively effects quality of life. The treatment effects appeared gradually during the 10-week treatment period. Three months after the treatment period about 30% of the pain relieving effect was gone, and 6 months after the treatment period pain was back to about 90% of the basic value. As long as there is a lack of effective medical treatment for individuals with fibromyalgia, they ought to be offered treatments with connective tissue massage. However, further studies are needed in the mechanisms behind the treatment effects.
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| 10. |
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| 11. |
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| 12. |
- Everts, B, et al.
(författare)
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Morphine use and pharmacokinetics in patients with chest pain due to suspected or definite acute myocardial infarction. The Memo Study
- 1998
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Ingår i: European Journal of Pain. - : Elsevier Ltd. - 1090-3801 .- 1532-2149. ; 2:2, s. 115-125
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Tidskriftsartikel (refereegranskat)abstract
- The characteristics of chest pain due to suspected acute myocardial infarction and morphine use during the first 3 hospital days are described in a population of 2988 consecutive patients admitted to hospital. The duration of pain was usually less than 24h (mean 20.9±0.55h), and only 24.8% of patients experienced chest pain of longer duration. The majority of patients had only one attack of pain, but 34.4% experienced four or more attacks during hospitalization. A mean morphine dose of 6.7±0.2mg was administered over the 3 hospitalization days, but surprisingly 52.4% of all patients required no morphine analgesia at all. Independent predictors of an increased morphine consumption were initial degree of suspicion of acute myocardial infarction, ST changes on admission ECG, male sex, a history of angina pectoris and a history of congestive heart failure. In a separate pharmacokinetic/pharmacodynamic study in 10 patients, plasma concentrations of morphine and its major metabolites, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G), were measured after intravenous administration of morphine. In this patient group, terminal half-life of unchanged morphine ranged from 0.77 to 3.22h. M3G and M6G plasma concentrations increased gradually up to 60–90 min after the intravenous morphine injection. Initial pain intensity by numerical rating scale was 6.6±0.6 (arbitrary units), and after morphine administration, there was a rapid and significant decrease in pain intensity. After 20 min, pain relief was 69±11% and remained at this level during the following 8 h observation period. It is concluded that the need for morphine administration in patients with suspected or definite acute myocardial infarction, differs among subgroups of patients and, in particular, higher doses are needed in those with a strong suspicion of myocardial infarction at arrival. When intravenous morphine is given, it attains full effect 20 min after injection. Furthermore, the active morphine metabolites M3G and M6G appear rapidly in thecirculation, which could influence the analgesic response to morphine treatment.
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| 13. |
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| 14. |
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| 15. |
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| 16. |
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| 17. |
- Hasselstrom, J, et al.
(författare)
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Prevalence of pain in general practice
- 2002
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Ingår i: European journal of pain (London, England). - 1090-3801. ; 6:5, s. 375-385
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Tidskriftsartikel (refereegranskat)
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| 18. |
- Kosek, Eva, et al.
(författare)
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Segmental and plurisegmental modulation of pressure pain thresholds during static muscle contractions in healthy individuals.
- 2003
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Ingår i: European Journal of Pain. - 1090-3801 .- 1532-2149. ; 7:3, s. 251-8
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to assess possible segmental (uni- and/or bilateral) and plurisegmental changes in pressure pain thresholds (PPTs) during static muscle contractions. Twenty-four healthy subjects (12 female, 12 male) performed a standardised isometric contraction with the dominant m. quadriceps femoris (MQF) and m. infraspinatus (MI), respectively. PPTs were assessed using pressure algometry at the contracting muscle, at the contralateral (resting) muscle and at a distant resting muscle (MI during contraction of MQF and vice versa). The PPT assessments were performed before, during and 30min. following each contraction. The contractions were held until exhaustion or for a maximum of 10 PPT assessments/muscle. During contraction of MQF PPTs increased compared to baseline at the middle ( p<0.001) and the end (p<0.001) of the contraction period at all assessed sites alike. During contraction of MI PPTs increased compared to baseline at the middle (p<0.001) and the end (p<0.007) of the contraction period at all sites. The increase was more pronounced at the contracting muscle compared to the contralateral (p<0.002; p<0.01) and the distant (p<0.002; p<0.002) site. No statistically significant difference was seen in PPTs between the latter two. Following the contractions PPTs returned to baseline. Submaximal isometric contraction of MQF and MI gave rise to a statistically significant increase in PPTs at the contracting muscle, the resting homologous contralateral muscle and at the distant resting muscle indicating that generalised pain inhibitory mechanisms were activated. Contraction of MI, but not of MQF, gave rise to an additional activation of unilateral segmental antinociceptive effects.
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| 19. |
- Kosek, Eva, et al.
(författare)
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The influence of experimental pain intensity in the local and referred pain area on somatosensory perception in the area of referred pain.
- 2002
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 6:6, s. 413-25
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate the influence of experimental pain intensity in the local and referred pain area on somatosensory perception thresholds in the area of referred pain. Pain was induced by intramuscular electrical stimulation of the left infraspinatus muscle in 12 healthy individuals. The stimulation corresponded to the local pain threshold ("mild local pain"), the referred pain threshold ("mild referred pain"), and a pain intensity corresponding to 2 on a 10-point category scale in the referred pain area ("moderate referred pain"). Quantitative sensory testing was performed to assess perception thresholds in the referred pain area and the homologous contralateral area before and during stimulation. Perception thresholds to light touch (LTTs), pressure pain (PPTs), and to innocuous as well as noxious warmth and cold were assessed. During stimulation the LTTs increased in the referred pain area compared to baseline, uninfluenced by pain intensity. Perception thresholds to innocuous cold and warmth increased bilaterally during the stimulation, without relation to pain intensity. Heat pain thresholds were not affected. Compared to baseline, PPTs increased bilaterally during stimulation corresponding to "mild local pain" and "mild referred pain", respectively, and a further increase was seen during "moderate referred pain". The decreased sensitivity to innocuous cold, warmth, and pressure pain was bilateral, indicating activation of endogenous net inhibitory mechanisms interacting bilaterally. We found no influence of pain intensity on somatosensory thresholds restricted to the referred pain area and light touch was the only affected modality in the referred pain area only.
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| 20. |
- Leffler, Ann-Sofie, et al.
(författare)
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Somatosensory perception in patients suffering from long-term trapezius myalgia at the site overlying the most painful part of the muscle and in an area of pain referral.
- 2003
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Ingår i: European Journal of Pain. - 1090-3801 .- 1532-2149. ; 7:3, s. 267-76
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Tidskriftsartikel (refereegranskat)abstract
- In subgroups of patients with localised musculoskeletal pain spread of pain and signs of altered somatosensory processing at painful sites, both focal and referred areas have been reported. The purpose of the study was to examine somatosensory processing in patients with mainly unilateral long-term (> or =1 year) trapezius myalgia with ongoing pain for the last 3 months in the trapezius muscle in conjunction with ongoing or recurrent referral of pain to the ipsilateral arm. Ten patients with trapezius myalgia and 10 age- and sex-matched healthy controls participated. Pressure pain sensitivity, low threshold mechanoreceptive function and thermal sensitivity, including thermal pain, were assessed at the site overlying the most painful part of the trapezius muscle and in an area of pain referral in the ipsilateral upper arm/forearm as well as in the corresponding contralateral areas. No significant difference in sensibility was found in the most affected trapezius muscle and contralaterally compared to the corresponding areas in controls. In the area of pain referral there was a significantly increased sensitivity to pressure pain compared to the homologous contralateral area (p<0.01) as well as to the corresponding area in controls (p<0.009). Compared to controls a bilaterally decreased sensitivity to light touch was found in patients in the area of referred pain (p<0.01). No differences were found in the outcome of thermal testing. These findings suggest altered central processing of somatosensory input from the area of referred pain in patients with trapezius myalgia.
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| 21. |
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| 22. |
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| 23. |
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| 24. |
- Sandberg, Margareta, et al.
(författare)
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Peripheral effects of needle stimulation (acupuncture) on skin and muscle blood flow in fibromyalgia
- 2004
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Ingår i: European Journal of Pain. - 1090-3801. ; 8:2, s. 163-171
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Tidskriftsartikel (refereegranskat)abstract
- Acupuncture has become a widely used treatment modality in various musculoskeletal pain conditions. Acupuncture is also shown to enhance blood flow and recovery in surgical flaps. The mechanisms behind the effect on blood flow were suggested to rely on vasoactive substances, such as calcitonin gene-related peptide, released from nociceptors by the needle stimulation. In a previous study on healthy subjects, one needle stimulation into the anterior tibial muscle was shown to increase both skin and muscle blood flow. The aim of this study was to examine the effect of needle stimulation on local blood flow in the anterior tibial muscle and overlying skin in patients suffering from a widespread chronic pain condition. Fifteen patients with fibromyalgia (FM) participated in the study. Two modes of needling, deep muscle stimulation and subcutaneous needle insertion were performed at the upper anterior aspect of the tibia, i.e., in an area without focal pathology or ongoing pain in these patients. Blood flow changes were assessed non-invasively by photoplethysmography (PPG). The results of the present study were partly similar to those earlier found at a corresponding site in healthy female subjects, i.e., deep muscle stimulation resulted in larger increase in skin blood flow (mean (SE)): 62.4% (13.0) and muscle blood flow: 93.1% (18.6), compared to baseline, than did subcutaneous insertion (mean (SE) skin blood flow increase: 26.4% (6.2); muscle blood flow increase: 46.1% (10.2)). However, in FM patients subcutaneous needle insertion was followed by a significant increase in both skin and muscle blood flow, in contrast to findings in healthy subjects where no significant blood flow increase was found following the subcutaneous needling. The different results of subcutaneous needling between the groups (skin blood flow: p=0.008; muscle blood flow: p=0.027) may be related to a greater sensitivity to pain and other somatosensory input in FM.
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| 25. |
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| 26. |
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| 27. |
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| 28. |
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| 29. |
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| 30. |
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| 31. |
- Brun Sundblad, Gunilla M, et al.
(författare)
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Prevalence and co-occurrence of self-rated pain and perceived health in school-children : Age and gender differences.
- 2007
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 11:2, s. 171-80
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Tidskriftsartikel (refereegranskat)abstract
- In this nationwide study, 1975 students from grades 3, 6, and 9 (ages 9, 12, and 15 at the onset of the year), were recruited from randomly selected schools, which represented different geographical areas throughout Sweden. The main aim of the study was to assess the prevalence of self-reported pain (headache, abdominal, and musculoskeletal pain) and perceived health (problems sleeping and/or if they often felt tired, lonely and sad). A second aim was to study the co-occurrence among different pain and health variables. The students, (n = 1908 distributed by grade 3: 255 girls and 305 boys, grade 6: 347 girls and 352 boys, grade 9: 329 girls and 320 boys) answered retrospectively (three months) a specially designed questionnaire. Fifty percent (50%) of the students reported that they had experienced pain, either as headache, abdominal pain or musculoskeletal pain, within the recall period. Gender differences were especially noticeable for headaches, where twice as many girls (17%, n = 159) than boys (8%, n = 80) reported that they suffered such pain at least once a week or more often. Co-occurrence among the variables was moderate (0.3-0.5). For the total of the seven variables, the perception of pain and health complaints decreased with age for boys from grades 3 to 9, while multiple complaints increased for girls.
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| 32. |
- Aili, Katarina, 1980-, et al.
(författare)
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Sleep as a predictive factor for the onset and resolution of multi-site pain : A 5-year prospective study
- 2015
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Ingår i: European Journal of Pain. - Oxford : Wiley. - 1090-3801 .- 1532-2149. ; 19:3, s. 341-349
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Disturbed sleep and pain often co-exist and the relationship between the two conditions is complex and likely reciprocal. This 5-year prospective study examines whether disturbed sleep can predict the onset of multi-site pain, and whether non-disturbed sleep can predict the resolution of multi-site pain.METHODS: The cohort (n = 1599) was stratified by the number of self-reported pain sites: no pain, pain from 1-2 sites and multi-site pain (≥3 pain sites). Sleep was categorized by self-reported sleep disturbance: sleep A (best sleep), sleep B and sleep C (worst sleep). In the no-pain and pain-from-1-2 sites strata, the association between sleep (A, B and C) and multi-site pain 5 years later was analysed. Further, the prognostic value of sleep for the resolution of multi-site pain at follow-up was calculated for the stratum with multi-site pain at baseline. In the analyses, gender, age, body mass index, smoking, physical activity and work-related exposures were treated as potential confounders.RESULTS: For individuals with no pain at baseline, a significantly higher odds ratio for multi-site pain 5 years later was seen for the tertile reporting worst sleep [odds ratio (OR) 4.55; 95% confidence interval (CI) 1.28-16.12]. Non-disturbed (or less disturbed) sleep had a significant effect when predicting the resolution of multi-site pain (to no pain) (OR 3.96; 95% CI 1.69-9.31).CONCLUSION: In conclusion, sleep could be relevant for predicting both the onset and the resolution of multi-site pain. It seems to be a significant factor to include in research on multi-site pain and when conducting or evaluating intervention programmes for pain.
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| 33. |
- Alfvén, G, et al.
(författare)
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Children with chronic stress-induced recurrent muscle pain have enhanced startle reaction.
- 2017
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 21:9, s. 1561-1570
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Children with recurrent pain of negative chronic stress origin from different locations have a characteristic pattern of tender points in the temporal, trapezoid, great pectoral and abdominal muscles. We tested the hypothesis that the startle reaction is activated in these children and that some of the startle-activated muscles are related to the tender point pattern and the recurrent pain.METHODS: In children/adolescents, aged 10-17 years, 19 with recurrent psychosomatic pain (PAIN) and 23 controls (CON) we measured and analysed resting activity and acoustic startle response with electromyography (EMG) for the muscles involved in the pattern of tender points and also the lumbar erector spinae.RESULTS: The PAIN group showed higher resting activity and higher acoustic startle response values than the CON group for all six muscles together regarding the mean amplitude in the initial 200 ms, and during the burst of activity, and longer burst duration and shorter burst latency. For PAIN versus CON, all separate muscles showed generally higher values of EMG amplitudes and burst durations, and shorter latencies for the burst onset in all measures; with significance or strong trends for several parameters and muscles.CONCLUSION: For the first time in children with recurrent psychosomatic pain, increased resting activity and potentiated startle response were demonstrated in the muscles involved in the stress tender point pattern.SIGNIFICANCE: This study demonstrates in adolescents how recurrent pain of negative stress origin from the head, stomach, back and chest is related to increased startle reaction and increased muscular tension in these regions. This study contributes to the understanding of the mechanisms underlying the global burden of recurrent pain.
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| 34. |
- Amandusson, Åsa, et al.
(författare)
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Estrogen receptor-α expression in nociceptive-responsive neurons in the medullary dorsal horn of the female rat
- 2010
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Ingår i: European Journal of Pain. - : Elsevier. - 1090-3801 .- 1532-2149. ; 14:3, s. 245-248
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Tidskriftsartikel (refereegranskat)abstract
- Estrogens exert a substantial influence on the transmission of nociceptive stimuli and the susceptibility to pain disorders as made evident by studies in both animals and human subjects. The estrogen receptor (ER) seems to be of crucial importance to the cellular mechanisms underlying such an influence. However, it has not been clarified whether nociceptive neurons activated by pain express ERs. In this study, a noxious injection of formalin was given into the lower lip of female rats, thereby activating nociceptive neurons in the trigeminal subnucleus caudalis as demonstrated by immunohistochemical labeling of Fos. Using a dual-label immunohistochemistry protocol ERalpha-containing cells were visualized in the same sections. In the superficial layers of the medullary dorsal horn, 12% of ERalpha-labeled cells, mainly located in lamina II, also expressed noxious-induced Fos. These findings show that nociceptive-responsive neurons in the medullary dorsal horn express ERalpha, thus providing a possible morphological basis for the hypothesis that estrogens directly regulate pain transmission at this level.
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| 35. |
- Andre, Malin, et al.
(författare)
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A study of primary care physicians rating their immigrant patients pain intensity
- 2013
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Ingår i: European Journal of Pain. - : Elsevier. - 1090-3801 .- 1532-2149. ; 17:1, s. 132-139
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Tidskriftsartikel (refereegranskat)abstract
- Background Few studies focus on how physicians evaluate pain in foreign-born patients with varying cultural backgrounds. This study aimed to compare pain ratings [visual analogue scale (VAS) 0100] done by Swedish primary care physicians and their patients, and to analyse which factors predicted physicians higher ratings of pain in patients aged 1845 years with long-standing disabling back pain. Methods The two physicians jointly carried out the somatic and psychiatric diagnostic evaluations and alternated as consulting doctor or observer. One-third of the consultations were interpreted. Towards the end of the consultations, the patients rated their pain intensity right now (patients VAS). After the patient had left, the two physicians independently rated how much pain they thought the patient had, without looking at the patients VAS score. The mean of the two doctors VAS values (physicians VAS) for each patient was used in the logistic regression calculations of odds ratios (OR) in main effect models for physicians VAS above median (md) with patients sex, education, origin, depression, psychosocial stress and pain sites as explanatory variables. Results Physicians VAS values were significantly lower (md 15) than patients VAS (md 66; women md 73, men md 52). The ratings showed no significant association with whether the physician was acting as consultant or observer. The higher physician VAS was only predicted by findings of multiple pain sites. Conclusions Physicians appear to overlook psychological and emotional aspects when rating the pain of patients from other cultural backgrounds. This finding highlights a potential problem in multicultural care settings.
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| 36. |
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| 37. |
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| 38. |
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| 39. |
- Bergström, Gunnar, et al.
(författare)
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A 7-year follow-up of multidisciplinary rehabilitation among chronic neck and back pain patients : Is sick leave outcome dependent on psychologically derived patient groups?
- 2010
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Ingår i: European Journal of Pain. - : Elsevier. - 1090-3801 .- 1532-2149. ; 14:4, s. 426-433
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Tidskriftsartikel (refereegranskat)abstract
- A valid method for classifying chronic pain patients into more homogenous groups could be useful for treatment planning, that is, which treatment is effective for which patient, and as a marker when evaluating treatment outcome. One instrument that has been used to derive subgroups of patients is the Multidimensional Pain Inventory (MPI). The primary aim of this study was to evaluate a classification method based on the Swedish version of the MPI, the MPI-S, to predict sick leave among chronic neck and back pain patients for a period of 7 years after vocational rehabilitation. As hypothesized, dysfunctional patients (DYS), according to the MPI-S, showed a higher amount of sickness absence and disability pension expressed in days than adaptive copers (AC) during the 7-years follow-up period, even when adjusting for sickness absence prior to rehabilitation (355.8days, 95% confidence interval, 71.7; 639.9). Forty percent of DYS patients and 26.7% of AC patients received disability pension during the follow-up period. However, this difference was not statistically significant. Further analyses showed that the difference between patient groups was most pronounced among patients with more than 60days of sickness absence prior to rehabilitation. Cost-effectiveness calculations indicated that the DYS patients showed an increase in production loss compared to AC patients. The present study yields support for the prognostic value of this subgroup classification method concerning long-term outcome on sick leave following this type of vocational rehabilitation.
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| 40. |
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| 41. |
- Bjurstrom, M. F., et al.
(författare)
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Preoperative sleep quality and adverse pain outcomes after total hip arthroplasty
- 2021
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Ingår i: Eur J Pain. - : Wiley. ; 25:7, s. 1482-1492
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sleep disturbance is thought to aggravate acute postoperative pain. The influence of preoperative sleep problems on pain control in the long-term and development of chronic postsurgical pain is largely unknown. METHODS: This prospective, observational study aimed to examine the links between preoperative sleep disturbance (Pittsburgh Sleep Quality Index, PSQI) and pain severity (Brief Pain Inventory, BPI) 6 months postoperative (primary outcome), objective measures of pain and postoperative pain control variables (secondary outcomes). Patients (n = 52) with disabling osteoarthritis (OA) pain undergoing total hip arthroplasty (THA) were included. Quantitative sensory testing (QST) was performed preoperatively on the day of surgery to evaluate pain objectively. Clinical data, as well as measures of sleep quality and pain, were obtained preoperatively and longitudinally over a 6-month period. RESULTS: Preoperatively, sleep disturbance (i.e., PSQI score >5) occurred in 73.1% (n = 38) of THA patients, and pain severity was high (BPI pain severity 5.4 +/- 1.3). Regression models, adjusting for relevant covariates, showed that preoperative PSQI score predicted pain severity 6 months postoperative (beta = 0.091 (95% CI 0.001-0.181), p = .048, R(2) = 0.35). Poor sleep quality was associated with increased pressure pain sensitivity and impaired endogenous pain inhibitory capacity (R(2) range 0.14-0.33, all p's < 0.04). Moreover, preoperative sleep disturbance predicted increased opioid treatment during the first 24 hr after surgery (unadjusted beta = 0.009 (95% CI 0.002-0.015) mg/kg, p = .007, R(2) = 0.15). CONCLUSIONS: Preoperative sleep disturbance is prevalent in THA patients, is associated with objective measures of pain severity, and independently predicts immediate postoperative opioid treatment and poorer long-term pain control in patients who have undergone THA. SIGNIFICANCE: Poor sleep quality and impaired sleep continuity are associated with heightened pain sensitivity, but previous work has not evaluated whether preoperative sleep problems impact long-term postoperative pain outcomes. Here, we show that sleep difficulties prior to total hip arthroplasty adversely predict postoperative pain control 6 months after surgery. Given sleep difficulties robustly predict pain outcomes, targeting and improving sleep may have salutary effects on postoperative pain reports and management.
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| 42. |
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| 43. |
- Boersma, Katja, professor, 1973-, et al.
(författare)
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Expectancy, fear and pain in the prediction of chronic pain and disability : A prospective analysis
- 2006
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Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 10:6, s. 551-557
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Tidskriftsartikel (refereegranskat)abstract
- Studies with (sub) acute back pain patients show that negative expectancies predict pain and disability at a one-year follow up. Yet, it is not clear how expectations relate to other factors in the development of chronic disability such as pain and fear. This study investigates the relationship between expectations, pain-related fear and pain and studies how these variables are related to the development of chronic pain and disability. Subjects (N = 141) with back and/or neck pain (duration <1 year) were recruited via primary care. They completed measures on pain, expectancy, pain-related fear (pain-related negative affect and fear avoidance beliefs) and function. A one-year follow up was conducted with regard to pain and function. It was found that pain, expectancy, pain-related fear and function were strongly interrelated. In the cross-sectional analyses negative expectancies were best explained by frequent pain and a belief in an underlying and serious medical problem. Prospectively, negative expectancy, negative affect and a belief that activity may result in (re) injury or increased pain, explained unique variance in both pain and function at one-year follow up. In conclusion, expectancy, negative affect and fear avoidance beliefs are interrelated constructs that have predictive value for future pain and disability. Clinically, it can be helpful to inquire about beliefs, expectancy and distress as an indication of risk as well as to guide intervention. However, the strong interrelations between the variables call for precaution in treating them as if they were separate entities existing in reality.
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| 44. |
- Bondesson, E., et al.
(författare)
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Comorbidity between pain and mental illness - Evidence of a bidirectional relationship
- 2018
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801. ; 22:7, s. 1304-1311
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pain from various locations in the body and mental illness are common and the comorbidity between the two is well-known although the temporal relationship remains to be determined. Our aim was to follow patients over time to study if pain (here dorsalgia/abdominal pain) or fibromyalgia lead to an increased risk of developing mental illness (here depression/anxiety) and/or the reverse, that is whether patients with mental illness have an increased risk to develop pain or fibromyalgia, compared to the rest of the population. Methods: This prospective cohort study used the Skåne Healthcare Register, covering all care in the region of Skåne, southern Sweden (population ~1.3 million). The cohort included healthcare consultations in primary care, outpatient specialized care and inpatient care between 2007 and 2016 for all patients without prior registered diagnosis of mental illness or pain, aged 18 or older (n = 504,365). Results: The incidence rate ratio (IRR) for developing mental illness after pain was 2.18 (95% CI = 2.14-2.22) compared to without pain. IRR for developing pain after mental illness was 2.02 (95% CI = 1.98-2.06) compared to without mental illness. Corresponding IRR for developing mental illness after fibromyalgia was 4.05 (95% CI = 3.58-4.59) and for developing fibromyalgia after mental illness 5.54 (95% CI = 4.99-6.16). Conclusions: This study shows a bidirectional influence of similar magnitude of pain and mental illness, respectively. In monitoring patients with pain or mental illness, a focus on both conditions is thus important to develop appropriate, targeted interventions and may increase the likelihood of improved outcomes. Significance: We followed a population-based cohort over a period of 10 years, including incident cases of both exposure and outcome and found a bidirectional relationship between pain and mental illness. Clinicians need to pay attention on both conditions, in patients seeking care due to mental illness or pain.
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| 45. |
- Bondesson, E, et al.
(författare)
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Consultation prevalence among children, adolescents and young adults with pain conditions : A description of age- And gender differences
- 2020
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Ingår i: European Journal of Pain. - : Wiley. - 1090-3801 .- 1532-2149. ; 24:3, s. 649-658
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Pain is a common complaint presented in healthcare, but most epidemiological pain research has focused either on single pain conditions or on the adult population. The aim of this study was to investigate the 2017 consultation prevalence of a wide range of pain conditions in the general population of young people.METHODS: We used the Skåne Healthcare Register, covering prospectively collected data on all healthcare delivered (primary and secondary care) to the population in the region of Skåne, southern Sweden (population 2017 n = 1,344,689). For individuals aged 1-24 in 2017 (n = 373,178), we calculated the consultation prevalence, stratified by sex and age, and the standardised morbidity ratio (SMR) to assess overall healthcare consultation.RESULTS: A total of 58,981 (15.8%) individuals consulted at least once for any of the predefined pain conditions. Of these, 13.5% (n = 7,996) consulted four or more times for pain. Abdominal pain, joint pain/myalgia, headache and back/neck pain were the most common complaints. Overall, females had higher consultation prevalence than males: 17.6% versus 14.1% (p < .0001). SMR was 1.82 (95% CI = 1.74-1.87) for females with pain and 1.51 (95% CI = 1.42-1.56) for males with pain. Consultation prevalence increased with age, but this pattern varied between sex and pain condition.CONCLUSIONS: Among individuals under the age of 25, a significant proportion consult for pain already in early ages, and they also have high healthcare consultation rates for conditions other than pain. The even higher consultation rates among young females need additional attention, both in the clinic and in research.
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| 46. |
- Brattberg, Gunilla
(författare)
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Do pain problems in young school children persist into early adulthood? : A 13-year follow-up
- 2004
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Ingår i: European Journal of Pain. - : Elsevier. - 1090-3801 .- 1532-2149. ; 8:3, s. 187-199
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Tidskriftsartikel (refereegranskat)abstract
- Design. In a longitudinal study, 335 children ages 8, 11 and 14, first studied in 1989 were followed-up on two occasions in 1991 and 2002. The subjects filled in questionnaires on pain, the first two times in school, the last as a postal survey. Purposes. To determine if headache and back pain during the school years were transitory or if they grew into pain problems in adulthood; to determine predictors of pain. Results. In the 2002 study, 59% of the women and 39% of the men reported pain at 21, 24 and 27 years. A total of 68 (52 women, 16 men) or 20% of the subjects reported pain symptoms in all three studies. The cumulative incidence rate for the presence of pain in the cohort studied was 31% for 1989–2002 and 43% for 1991–2002. Four of the 10 individuals with pain also reported signs of stress. Three predictors were found: reported back pain in 8–14-year-olds (p<0.0001); reported headaches once a week or more in the same age group (p<0.0001); and a positive response in the ages 10–16 to the question: “Do you often feel nervous?” (OR=2.1, 95% CI 1.3–3.4). When adjusted for age, sex and all psychosocial risk determinants studied in multiple logistic regression, a positive answer to this question was a significant predictor of pain in young adulthood. A positive response by the 10–16-year-olds to “Do you find it difficult to describe your feelings?” was a predictor of pathological anxiety in early adulthood, but stress perceived in childhood/adolescence did not predict future pain or stress. Conclusions. Since pain reports in childhood and early adolescence seem to be associated with the report of pain in early adulthood, more attention should be given to the way ill-health is managed in adolescence in this vulnerable group.
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| 47. |
- Buhrman, Monica, 1974-, et al.
(författare)
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Guided Internet-delivered cognitive behavioural therapy for chronic pain patients who have residual symptoms after rehabilitation treatment: Randomized controlled trial
- 2013
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Ingår i: European Journal of Pain. - : Elsevier. - 1090-3801 .- 1532-2149. ; 17:5, s. 753-765
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Tidskriftsartikel (refereegranskat)abstract
- Background Chronic pain can be treated with cognitive behavioural therapy delivered in multidisciplinary settings. However, relapse is likely, and there is a need for cost-effective secondary interventions for persons with residual problems after rehabilitation. The aim of the present study was to investigate the effects of a guided Internet-delivered cognitive behavioural intervention for patients who had completed multidisciplinary treatment at a pain management unit. Methods A total of 72 persons with residual pain problems were included in the study and were randomized to either treatment for 8 weeks or to a control group who were invited to participate in a moderated online discussion forum. The participants had different chronic pain conditions, and a majority were women (72%). Twenty-two percent of the participants dropped out of the study before the post-treatment assessment. Results Intent-to-treat analyses demonstrated differences on the catastrophizing subscale of the Coping Strategies Questionnaire (Cohens d=0.70), in favour of the treatment group but a small within-group effect. Differences were also found on other measures of pain-related distress, anxiety and depressive symptoms. A 6-month follow-up exhibited maintenance of improvements. Conclusions We conclude that Internet-delivered treatment can be partly effective for persons with residual problems after completed pain rehabilitation.
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| 48. |
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| 49. |
- Bäckryd, Emmanuel
(författare)
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Do the potential benefits outweigh the risks? An update on the use of ziconotide in clinical practice
- 2018
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Ingår i: European Journal of Pain. - : WILEY. - 1090-3801 .- 1532-2149. ; 22:7, s. 1193-1202
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Forskningsöversikt (refereegranskat)abstract
- Ziconotide is a selective and potent blocker of N-type voltage-gated calcium channels. It was approved by the Food and Drug Administration in 2004 and by the European Medicines Agency in 2005 for the treatment of severe chronic pain in patients needing intrathecal analgesia (ITA). The aim of this paper is to provide a practitioner-oriented, educational, narrative, up-to-date review on the use of ziconotide in clinical pain medicine. Of special concern regarding safety is the partial incongruity between dosing statements in the Summary ofProduct Characteristics and novel low-dosage, slow uptitration recommendations. Even though ziconotide has obvious advantages compared to opioids, pain practitioners pondering the use of ziconotide nonetheless have to balance its proved potential analgesic effect against its neurological side effects, with special consideration being given to dosing and neuropsychiatric dangers. Using a seesaw analogy, the paper discusses what factors pain physicians should weigh in when considering ziconotide as ITA drug, the non-opioid advantages of ziconotide being counterbalanced by its potential psychiatric side effects. Ziconotide is an important part of the armamentarium of modern interventional pain medicine. If ITA is deemed necessary, ziconotide is a rational alternative, at least in chronic (neuropathic) non-cancer pain. However, in many European countries, ziconotide treatment is only available in a few (if any) centres. The safety profile of ziconotide is not fundamentally more worrying than that of opioids or cannabinoids; it is just different. This paper provides a concise, up-to-date and clinically-oriented summary of the use of ziconotide in clinical practice, not least concerning safety and dosage issues.
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| 50. |
- Böthun, Alicia, et al.
(författare)
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Clinical signs in the jaw and neck region following whiplash trauma : A 2-year follow-up
- 2023
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Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 27:6, s. 699-709
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pain in the orofacial region is often reported after whiplash trauma. However, prospective studies evaluating clinical signs related to orofacial pain and disability in whiplash populations are rare. The aim of the present study was to evaluate clinical signs related to pain and dysfunction in orofacial and neck regions after whiplash trauma, in a short- and long-term perspective.Methods: In total, 84 cases (48 women) diagnosed with neck distortion after a car accident and 116 controls (68 women) were examined within 1 month, and 49 cases (27 women) and 71 controls (41 women) were re-examined 2 years later. Outcome measures were pain on palpation of jaw and neck muscles and maximal jaw opening. Analysis was performed using mixed-models.Results: Cases and women were at higher risk for pain on palpation of jaw muscles (OR:7.7; p < 0.001 and OR:3.2; p = 0.010 respectively) and neck muscles (OR:12.7; p < 0.001 and OR:2.9; p = 0.020 respectively) but with no significant effect of time. Cases and women also had lower maximal jaw opening (−3.1; p = 0.001 and −3.3; p = 0.001 respectively). There was no significant time effect, but a significant interaction between cases and time (2.2; p = 0.004).Conclusion: Individuals with a whiplash trauma present a higher risk for pain on palpation in jaw and neck muscles both in a short- and long-term perspective, but show normal jaw movements. No time effect suggests that cases do not spontaneously improve nor get worse. Investigating pain on palpation in the jaw and neck muscles after whiplash trauma can identify individuals at risk for developing long-term orofacial pain and dysfunction.Significance: Orofacial pain is often reported after whiplash trauma but most previous studies concerning orofacial pain in whiplash populations have been questionnaire studies. Cases with a previous whiplash trauma and women, in general, had higher risk for pain on palpation in the jaw and neck region. Investigating pain on palpation after a whiplash trauma can help to identify individuals at risk of developing long-lasting pain in the orofacial region.
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