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1.
  • Anderson Åhlfeldt, Douglas, et al. (författare)
  • Healthcare Professionals' Perceptions of and Attitudes towards a Standardized Content Description of Interdisciplinary Rehabilitation Programs for Patients with Chronic Pain-A Qualitative Study
  • 2023
  • Ingår i: International Journal of Environmental Research and Public Health. - : Journal Issues Limited. - 1661-7827 .- 1660-4601. ; 20:9
  • Tidskriftsartikel (refereegranskat)abstract
    • Interdisciplinary pain rehabilitation (IPR) is a recommended treatment for people with chronic pain. An inadequate description of the content of IPR programs makes it difficult to draw conclusions regarding their effects. The purpose of this study was to describe the perceptions and attitudes of healthcare professionals toward a content description of IPR programs for patients with chronic pain. Individual interviews with healthcare professionals (n = 11) working in IPR teams in Sweden were conducted between February and May 2019. Analysis of the interviews resulted in a theme: interdisciplinary pain rehabilitation is a complex intervention, with three categories: limitations in the description of IPR programs; lack of knowledge about IPR and chronic pain; and facilitating and hindering factors for using the content description of IPR programs. Conclusion: Healthcare professionals perceived that IPR programs could be described through a general content description. A general content description could enhance the quality of IPR programs through a better understanding of their content and a comparison of different IPR programs. Healthcare professionals also expressed the importance of a content description being a guide rather than a steering document.
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2.
  • Bondesson, Elisabeth, et al. (författare)
  • Can Baseline Characteristics Predict Successful Outcomes after Individual, Physiotherapist-Led Rehabilitation in Patients with Chronic Musculoskeletal Pain?
  • 2023
  • Ingår i: Pain research & management. - 1203-6765. ; 2023
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: No strong and consistent variables to predict outcome after pain rehabilitation have been reported in patients with chronic musculoskeletal pain. The aim of the present study was to clarify if baseline variables could predict successful outcome after a unique, individualized, physiotherapist-led rehabilitation of nine sessions.METHODS: In 274 individuals with severe chronic musculoskeletal pain, the risk ratio (RR) and 95% confidence intervals (CIs) were estimated for potentially predictive baseline variables on successful outcomes of pain management, overall health, and pain rating.RESULTS: Statistically significant results show that patients rating moderate or severe baseline pain were in both cases 14% less likely to improve pain management compared to patients rating mild baseline pain (RR = 0.86; 95% CI 0.77-0.97, RR = 0.86; 95% CI 0.74-1.00). Patients with the shortest pain duration were 1.61 times more likely to improve overall health (RR = 1.61; 95% CI 1.13-2.29) compared to patients reporting the longest pain duration (>5 years). Patients reporting anxiety/depression or severe pain were in both cases 1.48 times more likely to improve overall health compared to better baseline presentations (RR = 1.48; 95% CI 1.16-1.88, RR = 1.48; 95% CI 1.03-2.15). Patients with regional/generalized pain were 36% less likely to rate pain reduction (RR = 0.64; 95% CI 0.41-1.00) compared to patients rating localized baseline pain. Of 17 potentially predictive baseline variables, four reached statistical significance for at least one of the three outcomes; although none of them for all three outcomes.CONCLUSIONS: Of 17 potentially predictive baseline variables, mild pain ratings, short pain duration, and localized baseline pain were statistically significantly associated with improvements after individual, physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain. This suggests that this type of rehabilitation probably should be offered early in the pain process. Reporting anxiety/depression or severe pain at the baseline did not hinder the improvements of overall health.
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  • Bäckryd, Emmanuel, et al. (författare)
  • Chronic pain patients can be classified into four groups: Clustering-based discriminant analysis of psychometric data from 4665 patients referred to a multidisciplinary pain centre (a SQRP study)
  • 2018
  • Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 13:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To subgroup chronic pain patients using psychometric data and regress the variables most responsible for subgroup discrimination. Design Cross-sectional, registry-based study. Setting and subjects Chronic pain patients assessed at a multidisciplinary pain centre between 2008 and 2015. Methods Data from the Swedish quality registry for pain rehabilitation (SQRP) were retrieved and analysed by principal component analysis, hierarchical clustering analysis, and partial least squares-discriminant analysis. Results Four subgroups were identified. Group 1 was characterized by low "psychological strain", the best relative situation concerning pain characteristics (intensity and spreading), the lowest frequency of fibromyalgia, as well as by a slightly older age. Group 2 was characterized by high "psychological strain" and by the most negative situation with respect to pain characteristics (intensity and spreading). Group 3 was characterized by high "social distress", the longest pain durations, and a statistically higher frequency of females. The frequency of three neuropathic pain conditions was generally lower in this group. Group 4 was characterized by high psychological strain, low "social distress", and high pain intensity. Conclusions The identification of these four clusters of chronic pain patients could be useful for the development of personalized rehabilitation programs. For example, the identification of a subgroup characterized mainly by high perceived "social distress" raises the question of how to best design interventions for such patients. Differentiating between clinically important subgroups and comparing how these subgroups respond to interventions is arguably an important area for further research.
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5.
  • Bäckryd, Emmanuel, et al. (författare)
  • The new chronic pain mg30 category and diagnostic specificity in quality registries : problems and suggested solutions with special reference to Swedish quality registry for pain rehabilitation (SQRP)
  • 2024
  • Ingår i: Frontiers in Pain Research. - : MDPI. - 2673-561X. ; 5
  • Tidskriftsartikel (refereegranskat)abstract
    • The Swedish Quality Registry for Pain rehabilitation (SQRP) is a well-established clinical registry for adult patients with complex chronic pain conditions. SQRP registers patient-reported outcome measures from a majority of specialist chronic pain units/departments in Sweden. Up to four International Classification of Diseases version 10 (ICD-10) diagnoses can be registered in SQRP. The aim of the paper is to describe how we envision the new chronic pain category MG30 in ICD-11 can be used in SQRP. We envision that the first diagnosis in SQRP shall always be a MG30 diagnosis, which will ensure broad implementation of ICD-11 in Swedish pain care. However, at first glance, there seems to be specificity problems with ICD-11 codes that might impair their useability in SQRP or other registries. But ICD-11 offers more than meets the eye. First, the entries at the level of the so-called foundational layer have unique resource identifiers (URI) that can be used to enhance specificity. Second, ICD-11 contains numerous extension codes that can be combined with the MG30 codes – for instance, concerning the anatomical location of pain. Third, to enrich the description of the clinical concept at hand, it is possible to create clusters of stem codes. These three options are briefly discussed. We conclude that the full potential of the MG30 category can be better exploited in registries such as SQRP if foundational codes, extension codes, and/or clustering of stem codes are used to enhance diagnostic specificity.
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6.
  • Dong, Huan-Ji, et al. (författare)
  • Facing obesity in pain rehabilitation clinics: Profiles of physical activity in patients with chronic pain and obesity-A study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)
  • 2020
  • Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 15:9
  • Tidskriftsartikel (refereegranskat)abstract
    • Background The obesity epidemic has influenced pain rehabilitation clinics. To date, little is known about baseline level of physical activity (PA) in patients referred to pain rehabilitation clinics. We aimed to investigate the PA levels of patients referred to pain rehabilitation clinics and to evaluate the effect of excess weight on PA level. Methods and findings Data were obtained from the Swedish Quality Registry for Pain Rehabilitation between 2016 and 2017. These data included PA time (everyday PA and physical exercise per week), Body Mass Index (BMI), sociodemographic factors, chronic pain and psychological aspects (e.g., pain intensity, depressive and anxiety symptoms and insomnia problems). Insufficient PA was defined as less than 150 minutes per week. We performed logistic regressions as well as orthogonal partial least square regression to estimate the effects of excess weight on PA. Over one-fourth of the patients were classified as obese (BMI >= 30 kg/m(2), 871/3110, 25.3%) and nearly one-third of these patients were classified as severely obese (BMI >= 35 kg/m(2), 242/871, 27.8%). Time estimations for physical exercise varied among the BMI groups, but patients in the higher BMI category were more likely to spend less time on everyday PA. Compared to normal weight, mild obesity [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.53-0.81] and severe obesity (OR 0.56, 95% CI 0.42-0.74) were associated with less PA. Mild obese patients had an elevated risk of 65% and severe obese patients had an elevated risk of 96% for insufficient PA. Increased pain intensity was positively related to insufficient PA (OR 1.17, 95% CI 1.06-1.29) among the obese patients. Conclusion Having low PA is very common for patients referred to pain rehabilitation clinics, especially for those with comorbid obesity. As a first step to increase PA, obese patients need to be encouraged to increase the intensity and amount of less painful daily PA.
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7.
  • Dong, Huan-Ji, 1981-, et al. (författare)
  • Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry
  • 2021
  • Ingår i: Journal of Pain Research. - : Dove medical press Ltd. - 1178-7090. ; 14, s. 1863-1873
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: It is known that chronic pain makes it difficult to lose weight, but it is unknown whether obese patients (body mass index ≥30 kg/m2) who experience significant pain relief after interdisciplinary multimodal pain rehabilitation (IMMPR) lose weight.Objective: This study investigated whether obese patients with chronic pain lost weight after completing IMMPR in specialist pain units. The association of pain relief and weight change over time was also examined.Methods: Data from obese patients included in the Swedish Quality Registry for Pain Rehabilitation for specialized pain units were used (N=224), including baseline and 12-month follow-up after IMMPR from 2016 to 2018. Patients reported body weight and height, pain aspects (eg, pain intensity), physical activity behaviours, psychological distress, and health-related quality of life (HRQoL). A reduction of at least 5% of initial weight indicates clinically significant weight loss. Patients were classified into three groups based on the pain relief levels after IMMPR: pain relief of clinical significance (30% or more reduction of pain intensity); pain relief without clinical significance (less than 30% reduction of pain intensity); and no pain relief. Linear mixed regression models were used to examine the weight changes among the groups with different pain relief levels.Results: A significant reduction of pain intensity was found after IMMPR (p < 0.01, effect size Cohen's d = 0.34). A similar proportion of patients in the three groups with different pain relief levels had clinically significant weight loss (20.2%~24.3%, p = 0.47). Significant improvements were reported regarding physical activity behaviour, psychological distress, and HRQoL, but weight change was not associated with changes of pain intensity.Conclusion: About one-fifth of obese patients achieved significant weight reduction after IMMPR. Obese patients need a tailored pain rehabilitation program incorporating a targeted approach for weight management.
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  • Dong, Huan-Ji, et al. (författare)
  • Maintenance of quality of life improvement for patients with chronic pain and obesity after interdisciplinary multimodal pain rehabilitation - A study using the Swedish Quality Registry for Pain Rehabilitation
  • 2019
  • Ingår i: European Journal of Pain. - : WILEY. - 1090-3801 .- 1532-2149. ; 23:10, s. 1839-1849
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Throughout the world many people have both obesity and chronic pain, comorbidities that decrease Health-Related Quality of Life (HRQoL). It is uncertain whether patients with comorbid obesity can maintain improved HRQoL after Interdisciplinary Multimodal Pain Rehabilitation (IMMPR). Methods Data from 2016, 2017, and 2018 were obtained from a national pain database for Swedish specialized pain clinics and collected at three time points: Pre-IMMPR; Post- IMMPR; and 12-month follow-up (FU-IMMPR). Participants (N = 872) reported body weight, height, pain aspects, and HRQoL (RAND 36-Item Health Survey). Severe obesity (Body Mass Index, BMI amp;gt;= 35 kg/m(2)) was defined according to WHO classifications. We used linear mixed regression models to examine BMI group differences in HRQoL over time. Results More than 25% of patients (224/872) were obese and nearly 30% (63/224) of these were severely obese. All BMI groups improved significantly in both physical and mental composites of HRQoL after IMMPR (Pre- vs. Post-IMMPR, p amp;lt; .001). The improvements were maintained at a 12-month follow-up (Post- vs. FU-IMMPR, p amp;gt; .05). The severe obesity group had the lowest physical health score and least improvement (pre- vs. FU-IMMPR, Cohens d = o.422, small effect size). Severe obesity had negative impact on physical health (beta = -4.39, p amp;lt; .05) after controlling for sociodemographic factors and pain aspects. Conclusion Improvements in HRQoL after IMMPR were achieved and maintained across all weights, including patients with comorbid obesity. Only severe obesity was negatively associated with physical health aspects of HRQoL. Significance Patients with chronic pain and comorbid obesity achieve sustained Health-Related Quality of Life (HRQoL) improvements from Interdisciplinary Multimodal Pain Rehabilitation (IMMPR). This finding suggests that rehabilitation professionals should consider using IMMPR for patients with comorbid obesity even though their improvement may not reach the same level as for non-obese patients.
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9.
  • Gerdle, Björn, et al. (författare)
  • Acceptance and Fear-Avoidance Mediate Outcomes of Interdisciplinary Pain Rehabilitation Programs at 12-Month Follow-Up : A Clinical Registry-Based Longitudinal Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)
  • 2024
  • Ingår i: Journal of Pain Research. - : DOVE MEDICAL PRESS LTD. - 1178-7090. ; 17, s. 83-105
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies. Aim: This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator. Methods: This study uses Patient-Reported Outcome Measures (PROMs) from specialist units reporting data (2008–2016) to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Adult chronic pain patients (N = 1991) answered the PROMs (background, pain, psychological distress, coping, participation, and health-related quality of life (HRQoL)). Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to explore the aims. Results: Changes in acceptance (β:0.424–0.553; all P<0.001) were the strongest predictor of the three outcomes (changes in life control, interference, and HRQoL) at 12-month follow-up. The next strongest predictor was baseline acceptance (β: 0.177–0.233; all P<0.001) and changes in fear-avoidance (β: −0.152– −0.186; all P<0.001). Baseline pain intensity and psychological distress showed weak positive associations. Their effects on the three outcomes were mediated via acceptance aspects. Sex was not a moderator. Discussion and Conclusion: Acceptance aspects (baseline and changes) were important predictors of IPRP outcomes. Changes in fear-avoidance were also important although to a lesser degree. Some of the effects of pain intensity and psychological distress on outcomes were mediated via acceptance at baseline. Future PLS-SEM analysis of real-world IPRP should include more potential mediators (eg, catastrophizing and more facets of psychological flexibility and fear-avoidance) and the components of IPRP.
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10.
  • Gerdle, Björn, et al. (författare)
  • Catastrophizing and acceptance are mediators between insomnia and pain intensity—an SQRP study of more than 6,400 patients with non-malignant chronic pain conditions
  • 2023
  • Ingår i: Frontiers in Pain Research. - : FRONTIERS MEDIA SA. - 2673-561X. ; 4
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Sleep problems (insomnia) and chronic pain are associated. Chronic pain and insomnia/insufficient sleep quality share similar symptoms and features. Although they have a bidirectional relationship, more research is needed to understand how they interact via mediators and how moderators influence this relationship. Aims: In this large clinical registry-based cohort study (N = 6,497), we investigate important mediators between insomnia and pain intensity in a cross-sectional sample of chronic pain patients using advanced path analysis. In addition, we investigate whether some background variables were moderators of the identified important paths or not and the correlation patterns between insomnia and pain intensity in relation to the mediators. Methods: This study includes a cohort of adult patients with chronic non-cancer pain from the Swedish Quality Registry for Pain Rehabilitation (SQRP) with data on patient-reported outcome measures (PROMs) (2008–2016). The PROMs cover the background, pain aspects, psychological distress, pain-related cognitions, activity/participation, and health-related quality of life variables of the patients. Partial least squares structural equation modeling was used to explore the direct and indirect (via mediators) relationships between insomnia and pain intensity at baseline. Results: In this cohort study, insomnia was prevalent at 62.3%, and both direct and indirect mediating paths were present for the insomnia–pain intensity relationship. All of the mediating effects combined were weaker than the direct effect between insomnia and pain intensity. The mediating effects via catastrophizing and acceptance showed the strongest and equal mediating paths, and mediating effects via fear avoidance were the second strongest. Insomnia showed stronger direct significant correlations with psychological distress, catastrophizing, and acceptance compared with those of pain intensity. Sex, age, education level, spatial extent of pain, or body mass index did not moderate the mediating paths. Discussion and conclusion: This study confirms the existence of significant direct and mediating paths between reported insomnia and pain intensity. Future studies should focus on illuminating how sleep interventions influence pain intensity and other important key factors that contribute to the distress of chronic pain patients.
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12.
  • Gerdle, Björn, et al. (författare)
  • Outcomes of Interdisciplinary Pain Rehabilitation Across Subgroups of the Multidimensional Pain Inventory : A Study From the Swedish Quality Registry for Pain Rehabilitation
  • 2021
  • Ingår i: Pain Practice. - : Wiley. - 1530-7085 .- 1533-2500. ; 21:6, s. 662-679
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction The Multidimensional Pain Inventory (MPI) is frequently used in the assessment of chronic pain. Three subgroups have been derived from MPI: adaptive coper (AC), dysfunctional (DYS), and interpersonally distressed (ID). The primary aim of this study was to examine whether outcome of Interdisciplinary Multimodal Pain Rehabilitation Programs (IMMRPs) differed across the MPI subgroups. Methods Patients with chronic pain (N = 34,513), included in the Swedish Quality Registry for Pain Rehabilitation, were classified into MPI subgroups and a subset that participated in IMMRPs (N = 13,419) was used to examine overall treatment outcomes using a previously established Multivariate Improvement Score (MIS) and 2 retrospective patient-evaluated benefits from treatment. Results The subgroups differed on sociodemographic characteristics, pain duration, and spatial spreading of pain. DYS and ID had the best overall outcomes to MIS. AC had the best outcomes according to the 2 retrospective items. Transition into other subgroups following IMMRP was common and most prominent in DYS and least prominent in AC. Conclusion The validity of the MPI subgroups was partially confirmed. DYS and ID had the most severe clinical presentations at baseline and showed most improvement following IMMRP, but overall severity in DYS and ID at post-treatment was still higher than in the AC group. Future studies should examine how processes captured by MPI interact with neurobiological, medical, sociodemographic, and adaptation/coping factors and how these interactions impact severity of chronic pain and treatment outcome.
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  • Gerdle, Björn, et al. (författare)
  • Pain intensity and psychological distress show different associations with interference and lack of life control : A clinical registry-based cohort study of >40,000 chronic pain patients from SQRP
  • 2023
  • Ingår i: Frontiers in Pain Research. - : Frontiers Media SA. - 2673-561X. ; 4
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Both chronic pain and depressive and/or anxiety symptoms are associated with negative impacts on daily living, including interference and lack of life control. However, little is known about how pain and psychological distress affect these impacts. Aim: The first aim was to assess how pain intensity, psychological distress, and social support interact with interference and lack of life control. A second aim was to investigate whether the strength of these relationships is moderated by the presence or absence of depression and/or anxiety. Subjects and methods: Patient-Reported Outcome Measures (PROMs), which are available in the Swedish Quality Registry for Pain Rehabilitation (SQRP), were retrieved for patients with chronic pain (N = 40,184). A theoretical model with the constructs/latent variables pain intensity, psychological distress, interference, lack of life control, and social support was proposed and analyzed using Partial Least Squares Structural Equation Modelling (PLS-SEM). Indicators for these constructs were identified from the PROMs of the SQRP. Two models of the total cohort, which differed with respect to the causal relationship between pain intensity and psychological distress, were investigated. The moderating effects of anxiety and/or depression were also analyzed. Results: Relatively low correlation and explanatory power (R2= 0.16) were found for the pain intensity-psychological distress relationship. Pain intensity had a stronger effect on interference than on lack of life control. The reverse was found for psychological distress – i.e., psychological distress seemed to have a higher negative influence on function than on interference. The underlying assumption of the causal relationship between pain intensity and psychological distress determined how strong pain intensity and psychological distress influenced interference and lack of life control. Social support showed very similar absolute significant correlations with interference and lack of life control. Interference and lack of life control showed relatively weak associations. The psychological distress level was a moderating factor for several of the paths investigated. Discussion and conclusion: A clinical treatment consequence of the low correlation between pain intensity and psychological distress may be that clinically treating one may not reduce the effect of the other. The relative importance of pain intensity and psychological distress on interference and lack of life control depends on the underlying assumption concerning the pain intensity-psychological distress relationship. Interference and lack of life control showed relatively weak associations, underscoring the need to clinically assess them separately. Social support influenced both impact constructs investigated. The cohort display heterogeneity and thus presence of definite signs of anxiety and/or depression or not was a moderating factor for several of the associations (paths) investigated. The results are important both for the assessments and the design of treatments for patients with chronic pain.
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  • Gerdle, Björn, et al. (författare)
  • Spreading of Pain in Patients with Chronic Pain is Related to Pain Duration and Clinical Presentation and Weakly Associated with Outcomes of Interdisciplinary Pain Rehabilitation : A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)
  • 2021
  • Ingår i: Journal of Pain Research. - : Dove Medical Press LTD. - 1178-7090. ; 14, s. 173-187
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: The extent to which pain is distributed across the body (spreading of pain) differs largely among patients with chronic pain conditions and widespread pain has been linked to poor quality of life and work disability. A longer duration of pain is expected to be associated with more widespread pain, but studies are surprisingly scarce. Whether spreading of pain is associated with clinical presentation and treatment outcome in patients seen in interdisciplinary multimodal pain rehabilitation programs (IMMRPs) is unclear. The association between spreading of pain and (1) pain duration (2) clinical presentation (eg, pain intensity, pain-related cognitions, psychological distress, activity/participation aspects and quality of life) and (3) treatment outcome were examined. Methods: Data from patients included in the Swedish Quality Registry for Pain Rehabilitation were used (n=39,916). A subset of patients that participated in IMMRPs (n=14,666) was used to examine whether spreading of pain at baseline predicted treatment outcome. Spreading of pain was registered using 36 predefined anatomical areas which were summarized and divided into four categories: 1-6 regions with pain (20.6% of patients), 7-12 regions (26.8%), 13-18 regions (22.0%) and 19-36 regions (30.6%). Results: More widespread pain was associated with a longer pain duration and a more severe clinical picture at baseline with the strongest associations emerging in relation to health and pain aspects (pain intensity, pain interference and pain duration). Widespread pain was associated with a poorer overall treatment outcome following IMMRPs at both post-treatment and at a 12-month follow-up, but effect sizes were small. Discussion: Spreading of pain is an indicator of the duration and severity of chronic pain and to a limited extent to outcomes of IMMRP. Longer pain duration in those with more widespread pain supports the concept of early intervention as clinically important and implies a need to develop and improve rehabilitation for patients with chronic widespread pain.
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16.
  • Ghafouri, Bijar, et al. (författare)
  • Swedish Chronic Pain Biobank : protocol for a multicentre registry and biomarker project
  • 2022
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:11
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: About 20% of the adult population have chronic pain, often associated with psychological distress, sick leave and poor health. There are large variations in the clinical picture. A biopsychosocial approach is used in investigation and treatment. The concept of personalised medicine, that is, optimising medication types and dosages for individual patients based on biomarkers and other patient-related factors, has received increasing attention in different diseases but used less in chronic pain. This cooperative project from all Swedish University Hospitals will investigate whether there are changes in inflammation and metabolism patterns in saliva and blood in chronic pain patients and whether the changes correlate with clinical characteristics and rehabilitation outcomes.METHODS AND ANALYSIS: Patients at multidisciplinary pain centres at University Hospitals in Sweden who have chosen to participate in the Swedish Quality Registry for Pain Rehabilitation and healthy sex-matched and age-matched individuals will be included in the study. Saliva and blood samples will be collected in addition to questionnaire data obtained from the register. From the samples, proteins, lipids, metabolites and micro-RNA will be analysed in relation to, for example, diagnosis, pain characteristics, psychological distress, body weight, pharmacological treatment and clinical rehabilitation results using advanced multivariate data analysis and bioinformatics.ETHICS AND DISSEMINATION: The study is approved by the Swedish Ethical Review Authority (Dnr 2021-04929) and will be conducted in accordance with the declaration of Helsinki.The results will be published in open access scientific journals and in popular scientific relevant journals such as those from patient organisations. Data will be also presented in scientific meetings, meeting with healthcare organisations and disseminated in different lecturers at the clinics and universities.
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  • Ghafouri, Nazdar, et al. (författare)
  • Effects of interdisciplinary pain rehabilitation programs on neuropathic and non-neuropathic chronic pain conditions – a registry-based cohort study from Swedish Quality Registry for Pain Rehabilitation (SQRP)
  • 2023
  • Ingår i: BMC Musculoskeletal Disorders. - : BMC. - 1471-2474. ; 24:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and aim: Neuropathic pain arises as a direct consequence of a lesion or disease affecting the somatosensory system. Pharmacological treatments for neuropathic pain often fail despite following guidelines. Interdisciplinary Pain Rehabilitation Programs (IPRP) are an effective intervention for chronic pain conditions. Little research has investigated whether IPRP can benefit patients with chronic neuropathic pain compared to other chronic pain conditions. This study assesses the real-world effects of IPRP on patients with chronic neuropathic pain compared to non-neuropathic patients using Patient-Reported Outcome Measures (PROMs) available in the Swedish Quality Registry for Pain Rehabilitation (SQRP). Methods: A neuropathic group of patients (n = 1,654) were identified in two steps. This group was compared to a non-neuropathic group (n = 14,355) composed of common diagnoses (low back pain, fibromyalgia, whiplash associated disorders, and Ehlers-Danlos Syndrome) in relation to background variables, three overall outcome variables, and mandatory outcome variables (pain intensity, psychological distress symptoms, activity/participation aspects and health-related quality of life variables). Of these patients 43–44% participated in IPRP. Results: At assessment, the neuropathic group reported significantly (with small effect sizes (ES)) more physician visits the previous year, older age, shorter pain durations, and less spatial extent of the pain (moderate ES). Moreover, for the 22 mandatory outcome variables, we found only clinically insignificant differences according to ESs between the groups. For patients participating in IPRP, the neuropathic group displayed equal or in some cases slightly superior results compared to the non-neuropathic group. Discussion and conclusion: After assessing the real-world effects of IPRP, this large study found that neuropathic pain patients can benefit from the IPRP intervention. Both registry studies and RCTs are needed to better understand which patients with neuropathic pain are most suitable for IPRP and to what extent special considerations need to be made for these patients within the framework of IPRP.
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19.
  • Grelz, Henrik, et al. (författare)
  • Prevalence of long-term opioid therapy in a chronic non-cancer pain population attending a university-based tertiary pain clinic in Sweden. A cross-sectional study
  • 2022
  • Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081. ; 54
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Opioid therapy has become a common treatment for chronic pain despite accumulating evidence regarding harm and the lack of data to support efficacy for long-term treatments. The prevalence of opioid treatments in Swedish patients with chronic non-cancer pain is unknown. Hence, the present study aimed to assess a short-term period prevalence of prescribed opioid-use and long-term opioid therapy (LTOT) in a population with complex chronic non-cancer pain.METHOD: The study population consisted of 1613 patients suffering from chronic non-cancer pain and referred to a university-based tertiary pain clinic in Sweden during 2015-2017. Data from a 360-day period prior to consultation were extracted from the Swedish Quality Registry for Pain Rehabilitation (SQRP) and Swedish Prescribed Drug Register (SPDR). Milligram morphine equivalents per day (MME/day) for dispensed opioids were analysed for a 90-day period preceding consultation and long-term opioid therapy (LTOT) was determined for the entire 360-day period.RESULTS: The 90-day prevalence was 38% (CI 36-40,8) and the 360-day prevalence was 22.3% (n=360 with CI 20.4-24.4).CONCLUSION: The prescribing rates of opioids in a Swedish population with complex non-cancer chronic pain were high; two in five patients were dispensed an opioid within a 90-day period prior to consultation.
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20.
  • Gustavsson, A., et al. (författare)
  • Pharmaceutical treatment patterns for patients with a diagnosis related to chronic pain initiating a slow-release strong opioid treatment in Sweden
  • 2012
  • Ingår i: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 1872-6623 .- 0304-3959. ; 153:12, s. 2325-2331
  • Tidskriftsartikel (refereegranskat)abstract
    • Slow-release strong opioids (SRSO) are indicated in patients with severe chronic pain. Side effects, lack of efficacy and risk of dependency limit their use in clinical practice. The aim of this study was to explore prescription patterns of SRSO in Swedish real-world data on patients with a diagnosis related to chronic pain (DRCP). Patient-level data were extracted from the national prescriptions register and a regional register with diagnosis codes. The prescription sequences, switches, co-medications, and strengths over time were analyzed for cancer and noncancer patients. Of 840,000 patients with a DRCP, 16,257 initiated treatment with an SRSO in 2007 to 2008. They were 71 years old on average; 60% were female and 34% had cancer. The most common first prescription was oxycodone (54%) followed by fentanyl (19%), buprenorphine (14%), and morphine (13%). 63% refilled their prescription within 6 months, and 12% switched to another SRSO, most commonly fentanyl. After 3 years, 51% of cancer and 27% of noncancer patients still being in contact with health care remained on any SRSO. Of noncancer patients, 35% had a psychiatric co-medication (SSRI or benzodiazepine). In conclusion, fewer patients remain on SRSO in the long-term in clinical practice than reported in previous clinical trials. Oxycodone is the most common first SRSO prescription and one-third of patients get a prescription indicating psychiatric comorbidity. Our interpretation of these findings are that there is need for better treatment options for these patients, and that more effort is needed to improve treatment guidelines and to ascertain that these guidelines are followed. (c) 2012 International Association for the Study of Pain. Published by Elsevier B. V. All rights reserved.
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21.
  • Gustavsson, Anders, et al. (författare)
  • Pharmacological Treatment Patterns in Neuropathic Pain-Lessons from Swedish Administrative Registries
  • 2013
  • Ingår i: Pain medicine (Malden, Mass.). - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 14:7, s. 1072-1080
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To explore the treatment patterns of patients with a diagnosis related to chronic pain (DRCP) initiating pharmacological treatment indicated for neuropathic pain (NeuP: tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and anticonvulsants). Design. Retrospective study on administrative registers. Setting. General population in Western Sweden (one sixth of the country). Subjects. All patients with a DRCP (N = 840,000) in years 2004-2009. Outcome Measures. Treatment sequence, continuation, switching, and comedication. Results. In total, 22,997 patients with a first NeuP in 2007 or 2008 were identified, out of which 2% also had epilepsy and 39% had a mood disorder. The remaining 13,749 patients were assumed to be treated for neuropathic pain, out of which 16% had a neuropathy diagnosis, 18% had a mixed pain diagnosis, and the remaining 66% had another DRCP. The most common first prescription was amitriptyline (40%) followed by pregabalin (22%) and gabapentin (19%). More than half had discontinued treatment after 3 months, and 60-70% at 6 months. Seven percent received another NeuP drug within 6 months of the discontinuation of their first NeuP treatment, 11% had another analgesic and 22% had a prescription indicating psychiatric comorbidity (selective serotonin reuptake inhibitors or benzodiazepine). Conclusions. Treatment initiation of currently available drugs indicated for neuropathic pain less frequently lead to long-term treatment in clinical practice compared with clinical trial, and few try more than one drug. We suggest our findings to be indications of a need for better routines in diagnosing patients to ascertain optimal treatment and follow-up.
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22.
  • Hallberg, S., et al. (författare)
  • Burden of disease and management of osteoarthritis and chronic low back pain: healthcare utilization and sick leave in Sweden, Norway, Finland and Denmark (BISCUITS): study design and patient characteristics of a real world data study
  • 2022
  • Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 23:1, s. 126-138
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Osteoarthritis (OA) and chronic low back pain (CLBP) are common musculoskeletal disorders with substantial patient and societal burden. Nordic administrative registers offer a unique opportunity to study the impact of these conditions in the real-world setting. The Burden of Disease and Management of Osteoarthritis and Chronic Low Back Pain: Health Care Utilization and Sick Leave in Sweden, Norway, Finland and Denmark (BISCUITS) study was designed to study disease prevalence and the societal and economic burden in broad OA and CLBP populations. Methods: Patients in Sweden, Norway, Finland and Denmark with diagnoses of OA or CLBP (low back pain record plus >= 2 pain relief prescriptions to indicate chronicity) were identified in specialty care, in primary care (Sweden and Finland) and in a quality-of-care register (Sweden). Matched controls were identified for the specialty care cohort. Longitudinal data were extracted on prevalence, treatment patterns, patient-reported outcomes, social and economic burden. Results: Almost 1.4 million patients with OA and 0.4 million with CLBP were identified in specialty care, corresponding to a prevalence in the Nordic countries of 6.3 and 1.9%, respectively. The prevalence increased to 11-14% for OA and almost 6% for CLBP when adding patients identified in primary care. OA patients had a higher Elixhauser comorbidity index (0.66 vs. 0.46) and were using opioids (44.7 vs. 10.2%) or long-term nonsteroidal anti-inflammatory drug (NSAIDs) (20.9 vs. 4.5%) more than four times as often as compared to controls. The differences were even larger for CLBP patients compared to their controls (comorbidity index 0.89 vs. 0.39, opioid use 77.7 vs. 9.4%, and long-term NSAID use 37.2 vs. 4.8%). Conclusions: The BISCUITS study offers an unprecedented, longitudinal healthcare data source to quantify the real-world burden of more than 1.8 million patients with OA or CLBP across four countries. In subsequent papers we aim to explore among others additional outcomes and subgroups of patients, primarily those patients who may benefit most from better healthcare management.
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23.
  • Harlacher, Uwe, et al. (författare)
  • Using data from Multidimensional Pain Inventory subscales to assess functioning in pain rehabilitation.
  • 2011
  • Ingår i: International Journal of Rehabilitation Research. - 1473-5660. ; 34:1, s. 14-21
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to examine whether Multidimensional Pain Inventory (MPI) subscale score changes can be used for monitoring interdisciplinary cognitive behavioural pain rehabilitation programmes, using the Psychological General Well-Being (PGWB) index as an independent variable of rehabilitation outcome. Data from 434 consecutively referred patients disabled by chronic pain were analysed. The intervention was a 4-week interdisciplinary pain rehabilitation group programme (5 h/day), based on biopsychosocial and cognitive behavioural principles. Mean PGWB total scores improved after rehabilitation (P<0.0001) with clinically relevant effect sizes for patients with 'dysfunctional' and 'interpersonally distressed' MPI profiles. Substantial correlations (r=0.7-0.3; P<0.001) were found between the changes in PGWB total scores and four of the MPI subscale scores. These were combined into a composite variable ['pain severity', 'interference', 'life control' (given reversed scores) and 'affective distress'], and were labelled as the Pain Rehabilitation Index. The subscales, 'support' and 'general activity level', were omitted, as changes were ambiguous with respect to functioning. 'Dysfunctional' and 'interpersonally distressed' profile patients showed a marked improvement in Pain Rehabilitation Index after rehabilitation (effect sizes of 0.77 and 0.43; P<0.0001, respectively). Conversely, the 'adaptive copers' may have deteriorated somewhat (effect size -0.28; P=0.036). We propose that scores from four MPI subscales are integrated and the difference pre-post rehabilitation is used to indicate composite rehabilitation outcomes, making it possible to interpret all included MPI subscales in the same direction. Psychometric evaluation of the index is warranted.Mit der vorliegenden Studie sollte untersucht werden, ob Veränderungen in den Subskalen des Multidimensional Pain Inventory (MPI) zur Effektmessung von interdisziplinären kognitiv-verhaltenstherapeutischen Schmerzmanagement-Programmen verwendet werden können, wobei der PGWB-Index (Psychological General Well-Being) als unabhängige Variable des Reha-Ergebnisses hinzugezogen wird. Analysiert wurden Daten von 434, aufgrund ihrer chronischen Schmerzen als behindert eingestuften, konsekutiv überwiesenen Patienten. Die Intervention erfolgte in Form eines 4-wöchigen interdisziplinären Gruppenprogramms zur Schmerzrehabilitation (5 Std/Tag) auf der Grundlage biopsychosozialer und kognitiv-verhaltenstherapeutischer Prinzipien. Die durchschnittlichen PGWB-Gesamtscores verbesserten sich nach der Rehabilitation (P<0.0001) mit klinisch relevanten Effektgrößen für Patienten mit 'dysfunktionalen' und 'zwischenmenschlich gestörten' MPI-Profilen. Substanzielle Korrelationen (r=0.7-0.3; P<0.001) wurden zwischen den Änderungen bei den PGWB-Gesamtscores und vier der MPI-Subskalaen beobachtet. Sie wurden zu einer zusammengesezten Variable ['Schmerzintensität', 'Interferenz', 'Kontrolle über das eigene Leben' (unter Annahme umgekehrter Scores) und 'affektiver Stress'] unter dem Begriff 'Pain Rehabilitation Index' zusammengefasst. Die Subskalen 'Unterstützung' und 'allgemeine s Aktivitätsniveau' wurden weggelassen, da die Änderungen hinsichtlich der Funktionsfähigkeit in diesen Variablen zweideutig sind. Patienten mit einem 'dysfunktionalen' und 'zwischenmenschlich gestörtem' Profil wiesen nach der Rehabilitation eine signifikante Verbesserung des Pain Rehabilitation Index auf (Effektgröβen von jeweils 0.77 bzw. 0.43; P<0.0001). Demgegenüber haben sich die 'adaptiven Bewältiger' möglicherweise etwas verschlechtert (Effektgröβe -0.28; P=0.036). Wir schlagen vor, die Scores der vier MPI-Subskalen zu integrieren und die Differenz prä-post-Rehabilitation als zusammengesetzes Effektmass zu benutzen in dem Veränderungen in allen einbezogenen MPI-Subskalen in gleicher Richtung interpretierbar sind. Eine psychometrische Evaluation des Indexes ist erforderlich.El objetivo de este estudio fue investigar si las puntuaciones de las subescalas del Inventario Multidimensional del Dolor (IMD) podrían utilizarse en la evaluación de los programas interdisciplinarios de rehabilitación cognitiva-conductuales de pacientes con dolor crónico, para lo cual utilizamos el Índice de Bienestar Psicológico General (IBPG) como variable independiente del resultado de la rehabilitación. Se analizaron los datos correspondientes a 434 pacientes consecutivos aceptados por su discapacidad debida al dolor crónico. La intervención consistió en un programa interdisciplinario de 4 semanas de rehabilitación en grupo para pacientes con dolor crónico (5lh/día), basado en principios biopsicosociales y cognitivos. La media total de las puntuaciones del IBGP mejoró después de la rehabilitación (P<0.0001), y los tamaños del efecto fueron de importancia clínica en pacientes considerados 'disfuncionales' o 'con dificultades interpersonales' según los resultados del IMD. Se hallaron correlaciones importantes (r=0.7-0.3; P<0.001) entre los cambios obtenidos en las puntuaciones totales del IBPG y en cuatro de las puntuaciones de las subescalas del IMD. Estas se combinaron en una variable global ['Severidad del dolor', 'Interferencia del dolor', 'Autocontrol percibido sobre el dolor' (teniendo en cuenta las puntuaciones invertidas) y 'Emocionalidad negativa'] denominada Índice de Rehabilitación del dolor. Las subescalas 'apoyo' y 'grado general de actividad física' se omitieron debido a ambigüedades en los cambios relativos al funcionamiento. Los pacientes considerados 'disfuncionales' o 'con dificultades interpersonales' mostraron una marcada mejoría en el Índice de Rehabilitación del Dolor después de la rehabilitación (tamaño del efecto: 0.77 y 0.43, P<0.0001, respectivamente). Por el contrario, los 'afrontadores adaptativos' mostraron cierto empeoramiento (tamaño del efecto -0.28, P=0.036). Proponemos que se utilicen las puntuaciones de las cuatro subescalas del IMD referidasy las diferencias entre los valores de éstas antes y después de la rehabilitación, para determinar los resultados globales de la rehabilitación. Esto permitiría interpretar de forma uniforme todas las subescalas del IMD utilizadas. Además, recomendamos realizar una evaluación psicométrica del Índice.Cette étude avait pour objet d'examiner si les changements de scores sur la sous-échelle MPI (Multidimensional Pain Inventory) pouvaient être utilisés pour la surveillance des programmes interdisciplinaires de rééducation de la douleur comportementale cognitive en utilisant l'indice PGWB (Psychological General Well-Being) comme variable indépendante des résultats de rééducation. Les données de 434 patients handicapés par la douleur chronique référés consécutivement ont été analysées. L'intervention a adopté la forme d'un programme interdisciplinaire de rééducation de la douleur en groupe sur 4 semaines (5 h/jour), reposant sur des principes comportementaux biopsychosociaux et cognitifs. Les scores moyens PGWB totaux se sont améliorés après la rééducation (P<0.0001) avec des tailles d'effet cliniquement significatives pour les patients présentant des profils MPI de «dysfonctionnement » et de «détresse interpersonnelle». Des corrélations substantielles (r=0.7-0.3; P<0.001) ont été identifiées entre les variations des scores PGWB totaux et quatre des scores sur la sous-échelle MPI. Ces derniers ont été regroupés en une variable composite [«sévérité de la douleur», «interférence», «contrôle de vie» (scores négatifs) et «détresse affective»], pour former un indice de rééducation de la douleur. Les sous-échelles «soutien» et «niveau d'activité général» ont été omis, car les changements étaient ambigus en ce qui concerne le fonctionnement. Les patients présentant un profil «dysfonctionnel» et de «détresse interpersonnelle» ont affiché une amélioration marquée de la douleur sur l'indice de rééducation de la douleur (tailles d'effet de 0.77 et 0.43; P<0.0001, respectivement). Inversement, les patients «maîtrisant» leur adaptation semblent s'être quelque peu détériorés (taille d'effet -0.28; P=0.036). Nous proposons que les scores de quatre sous-échelles MPI soient intégrés et que la différence avant/après rééducation soit utilisée pour indiquer les résultats de rééducation composites, ce qui permettrait d'interpréter toutes les sous-échelles MPI incluses dans le même sens. L'évaluation psychométrique de l'indice est justifiée.
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24.
  • Henrik, Grelz, et al. (författare)
  • Tapering of prescribed opioids in patients with long-term non-malignant pain (TOPIO)-efficacy and effects on pain, pain cognitions, and quality of life : a study protocol for a randomized controlled clinical trial with a 12-month follow-up
  • 2021
  • Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 22
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Opioids are still widely prescribed to long-term pain patients although they are no longer recommended for long-term treatments due to poor evidence for long-term efficacy, risks of serious side effects, and the possibility of inducing opioid hyperalgesia. In a Cochrane study from 2017, the authors identified an urgent need for more randomized controlled trials investigating the efficiency and effects of opioid tapering. The study aimed to assess (1) the efficiency of a structured intervention in causing stable reductions of opioid consumption in a population with long-term non-malignant pain and (2) effects on pain, pain cognitions, physical and mental health, quality of life, and functioning in response to opioid tapering.METHODS: The study is a randomized controlled trial. The sample size was set to a total of 140 individuals after estimation of power and dropout. Participants will be recruited from a population with long-term non-malignant pain who will be randomly allocated to (1) the start of tapering immediately or (2) the control group who return to usual care and will commence tapering of opioids 4 months later. A 12-month follow-up is included. When all follow-ups are closed, data from the Swedish drug register of the National Board of Health and Welfare will be collected and individual mean daily opioid dose in morphine equivalents will be calculated at three time points: baseline, 4 months, and 12 months after the start of the intervention. At the same time points, participants fill out the following questionnaires: Numeric Pain Rating Scale (NPRS), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Chronic Pain Acceptance Questionnaire (CPAQ-8), Hospital Anxiety and Depression Scale (HADS), and RAND-36. At baseline and follow-up, a clinical assessment of opioid use disorder is performed.DISCUSSION: A better understanding of the efficiency and effects of opioid tapering could possibly facilitate attempts to taper opioid treatments, which might prove beneficial for both the individual and society.TRIAL REGISTRATION: ClinicalTrials.gov NCT03485430 . Retrospectively registered on 26 March 2018, first release date. "Tapering of Long-term Opioid Therapy in Chronic Pain Population. RCT with 12 Months Follow up (TOPIO)." First patient in trial 22 March 2018.
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25.
  • Mannerkorpi, Kaisa, 1955, et al. (författare)
  • Experience of physical activity in patients with fibromyalgia and chronic widespread pain
  • 2008
  • Ingår i: Disability and rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 30:3, s. 213-21
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: Patients with fibromyalgia (FM) and chronic widespread pain (CWP) find physical activity troublesome. The purpose was to develop a questionnaire to investigate the experience of physical activity in FM and CWP populations. METHOD: A questionnaire was developed from a qualitative study. After that, a total of 204 patients with FM or CWP completed the questionnaire. A factor analysis was conducted and the internal consistency was investigated. The relationship between the factors and pain, health status (the Fibromyalgia Impact Questionnaire, FIQ), distress (the Hospital Anxiety and Distress scale, HAD) and leisure time physical activity (the Leisure Time Physical Activity Instrument, LTPAI) was investigated. RESULTS: Five factors were identified: Physical Relaxation (PR), Well-being (WB), Activity Beliefs (AB), Activity-related Symptoms (AS) and Activity Habits (AH). Cronbach's alpha ranged from 0.57 to 0.86. The PR showed a correlation (rho 0.28, p < 0.01) with the FIQ Pain. The AS showed a correlation (rho 0.25, p < 0.01) with the FIQ total score, while the AH showed a correlation with the HAD Depression (0.26, p < 0.01) and with strenuous physical activity (LTPAI) (-0.32, p < 0.01). CONCLUSION: A new instrument was developed to study the experience of physical activity in persons with long-lasting pain. Five factors were identified using factor analysis, and three of them showed fair associations with FM symptoms, distress or physical activity.
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26.
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27.
  • Ohlsson, Anders, et al. (författare)
  • Book talks among people with chronic non-cancer pain : Literary meaning making in a shared reading group
  • 2018
  • Ingår i: Working Papers in Medical Humanities. ; 4:1
  • Tidskriftsartikel (refereegranskat)abstract
    • This paper reports findings from a pilot study for the research project SHARP – Shared Reading After Pain Rehabilitation. SHARP explores the feasibility and effect of Shared Reading, a group-based reading intervention, as a way to improve the quality of life for people with chronic non-cancer pain who have undergone a pain rehabilitation programme (5 weeks) at Skåne University Hospital in Sweden. The paper has a methodological focus. Drawing on discursive reception studies (Eriksson Barajas 2015), it aims to explore the usefulness of Judith Langer’s theory of literary meaning making to analyse book talk in a Shared Reading chronic non-cancer pain context. Langer’s key concepts envisionment building and stances (Langer 2011) will be used to trace instances of group members taking others’ perspectives, such as those of literary characters or fellow group members.
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28.
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29.
  • Persson, Elisabeth, et al. (författare)
  • Everyday occupational problems perceived by participants in a pain rehabilitation programme.
  • 2013
  • Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1651-2014 .- 1103-8128. ; 20:4, s. 306-314
  • Tidskriftsartikel (refereegranskat)abstract
    • Abstract Background: Knowledge of the diversity of occupational problems perceived by people with chronic pain is insufficient. Aims: To describe everyday occupational problems among patients with musculoskeletal pain enrolled in a pain rehabilitation programme, and to compare subgroups based on participant characteristics. Methods: The sample consisted of 152 men and women. Occupational performance was assessed with the Canadian Occupational Performance Measure (COPM). Other data were obtained from forms including sociodemographic variables and pain diagnoses. Major findings: The participants reported 706 prioritized everyday occupational problems categorized as self-care (37%), productivity (32%), and leisure (31%). Household management was the largest sub-category. Working, sitting, and cleaning the house were the specific occupational problems reported most frequently. Women reported significantly more occupations related to productivity and men reported more self-care occupations. Principal conclusion: Patients with pain have a wide range of occupational problems that need to be addressed, along with gender-specific needs.
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30.
  • Persson, Elisabeth, et al. (författare)
  • Occupational performance and factors associated with outcomes in patients participating in a musculoskeletal pain rehabilitation programme.
  • 2014
  • Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 46:6, s. 546-552
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To assess outcomes after a pain rehabilitation programme in terms of occupational performance and satisfaction with occupational performance, and to investigate whether socio-demographic factors and pain-related factors were associated with outcomes at follow-up. Methods: A pre- and post-test study of 555 participants with musculoskeletal pain who completed a pain rehabilitation programme. The Canadian Occupational Performance Measure (COPM) was used as the primary outcome measure. Socio-demographic and pain-related factors were collected using background questionnaires, the Disability Rating Index (DRI) and the Multidimensional Pain Inventory (MPI). Data were analysed using multivariate logistic regression analyses. Results: Statistically significant improvements were seen on occupational performance and satisfaction with occupational performance at the 1-year follow-up. Female gender, less severe disability, less life interference and more life control predicted improvements 1 year after the programme. High initial scores on occupational performance and satisfaction with performance predicted reduced possibilities for improvements in these respects. Conclusion: A pain rehabilitation programme can, for a majority of participants, affect occupational performance and satisfaction with performance. Men and those with more severe pain-related consequences may need additional or modified rehabilitation interventions in order to improve their occupational performance and satisfaction with occupational performance.
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31.
  • Persson, Elisabeth, et al. (författare)
  • Positive Effects of a Musculoskeletal Pain Rehabilitation Program Regardless of Pain Duration or Diagnosis
  • 2012
  • Ingår i: PM&R. - : Wiley. - 1934-1482 .- 1934-1563. ; 4:5, s. 355-366
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To investigate how sociodemographic and clinical factors are associated with psychosocial functioning and disability at admission to a musculoskeletal pain rehabilitation program and at 1-year follow-up. Design: A cohort pre-post study. Setting: A University hospital specialized pain rehabilitation unit. Participants: Five hundred nine participants with musculoskeletal pain (neck disorders, 29%; fibromyalgia, 24%; low back pain, 24%; myalgia, 14%; and other pain diagnoses, 8%). Intervention: A 5-week outpatient, group-based, and goal-oriented comprehensive musculoskeletal interdisciplinary pain rehabilitation program based on cognitive behavioral principles. Main Outcome Measures: The Multidimensional Pain Inventory (MPI), the Disability Rating Index (DRI), and forms including sociodemographic factors (gender, age, ethnicity, marital status, educational level, and vocational situation) and clinical factors (pain duration and pain diagnoses). Data were analyzed with multivariate logistic regression. Results: At admission, factors associated with more positive scores on the MPI were being older than 40 years, being at work, being Nordic born, attainment of a higher educational level, and a diagnosis of fibromyalgia (compared with a neck disorder) (. P < .05). Being at work and a diagnosis of fibromyalgia (compared with low back pain) were associated with more positive scores on the DRI (. P < .05). On the basis of cut points for clinically important change on the MPI, participants rated themselves as most improved on the Affective Distress (52%), Life Control (49%), and Pain Severity (43%) subscales, and on the DRI index, the improvement rate was 22%. At the 1-year follow-up, neither sociodemographic nor clinical factors were associated with clinically important improvements of the MPI and the DRI, but younger age was related to deteriorations in pain severity. Conclusions: The lack of an association between sociodemographic and clinical factors and psychosocial functioning and disability at a 1-year follow-up after a musculoskeletal pain rehabilitation program suggests that the program was effective regardless of the participants' initial characteristics, except for age. The changes at the 1-year follow-up indicate that the program influenced the participants' psychosocial functioning more than their perception of disability.
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32.
  • Persson, Elisabeth, et al. (författare)
  • Psychosocial coping profiles after pain rehabilitation: associations with occupational performance and patient characteristics.
  • 2017
  • Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 39:3, s. 251-260
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose The aims of the present study were to assess: (i) changes in coping by use of Multidimensional Pain Inventory profiles from baseline to follow-up, (ii) associations between Adaptive Coper (AC) profiles at follow-up and improvements in occupational performance (by Canadian Occupational Performance Measure COPM) and (iii) ability to predict AC profiles at follow-up by participants' baseline characteristics. Method Data at baseline, discharge and follow-up from 525 participants in a pain rehabilitation program were analyzed with multivariate statistics. Results AC profiles increased and Dysfunctional (DYS) profiles decreased at follow-up. Clinically relevant improvements on COPM were associated with having an AC profile at follow-up. Being Nordic born, having longer education, an AC profile and higher baseline scores on satisfaction with performance predicted an AC profile at follow-up. Conclusions Pain rehabilitation seems to result in sustainable and favourable coping strategies at follow-up, and improved occupational performance is associated with favourable coping at follow-up. Outcomes need to be measured independently of improved coping strategies and improvements of participant's individual goals such as difficulties to perform their most meaningful occupations. Patients at risk for unfavourable coping strategies may need modified interventions. Implications for Rehabilitation More participants reported a beneficial coping, MPI profile, in a long-term perspective after a pain rehabilitation program. Improvements on occupational performance prioritized as meaningful by each of the participants are related to adequate coping strategies at follow-up. The associations between improved occupational performance and beneficial coping profiles need to be better understood. Patients with worse initial occupational performance may need modified pain rehabilitation interventions to improve their coping strategies.
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33.
  • Post Sennehed, Charlotte, et al. (författare)
  • Evaluation of a multimodal pain rehabilitation programme in primary care based on clinical register data: a feasibility study
  • 2020
  • Ingår i: Primary health care research & development. - 1477-1128. ; 21
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: Investigate the feasibility of identifying a well-defined treatment group and a comparable reference group in clinical register data. Background: There is insufficient knowledge on how to avert neck/back pain from turning chronic or to impair work ability. The Swedish Government implemented a national multimodal rehabilitation (MMR) programme in primary care intending to promote work ability, reduce sick leave and increase return to work. Since randomised control trial data for effect is lacking, it is important to evaluate existing observational data from clinical settings. Methods: We identified all unique patients with musculoskeletal pain (MSP) diagnoses undergoing the MMR programme in primary care in the Skåne Health care Register (n = 2140) during 2010–2011. A reference cohort in primary care (n = 56 300) with similar MSP diagnoses, same ages and the same level of sick leave before baseline was identified for the same period. The reference cohort received ordinary care and treatment in primary care. The final study group consisted of 603 eligible MMR patients and 2874 eligible reference patients. Socio-economic and health-related baseline data including sick leave one year before up to two years after baseline were compared between groups. Findings: There were significant socio-economic and health differences at baseline between the MMR and the reference patients, with the MMR group having lower income, higher morbidity and more sick leave days. Sick leave days per year decreased significantly in the MMR group (118–102 days, P < 0.001) and in the reference group (50–42 days, P < 0.001) from one year before baseline to two years after. Conclusions: It was not feasible to identify a comparable reference group based on clinical register data. Despite an ambitious attempt to limit selection bias, significant baseline differences in socio-economic and health were present. In absence of randomised trials, effects of MMR cannot be sufficiently evaluated in primary care.
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34.
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35.
  • Rivano Fischer, Marcelo, et al. (författare)
  • Do quality of life, anxiety, depression and acceptance improve after interdisciplinary pain rehabilitation? A multicentre matched control study of acceptance and commitment therapy-based versus cognitive–behavioural therapy-based programmes
  • 2021
  • Ingår i: Journal of International Medical Research. - : SAGE Publications. - 0300-0605 .- 1473-2300. ; 49:7
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Interdisciplinary pain rehabilitation (IPR) usually employs a cognitive–behavioural therapeutic (CBT) approach. However, there is growing support for chronic pain treatments based on acceptance and commitment therapy (ACT). Most studies of ACT and CBT for chronic pain have evaluated their effects after psychological interventions, not after IPR. We compared the results of an ACT-based IPR programme with two CBT-based IPR programmes. Methods: We used a retrospective multicentre pretest–posttest design with matched patient groups at three centres. Data were collected from the Swedish Quality Registry for Pain Rehabilitation before and after IPR participation. Participants completed the EQ-5D health-related quality of life questionnaire, the Chronic Pain Acceptance Questionnaire, (CPAQ) and the Hospital Anxiety and Depression Scale (HADS). Analyses were performed to compare the effects of the different interventions. Results: Neither EQ-5D nor HADS depression scores were affected by the psychological approach used. The score changes on both CPAQ subscales (activity engagement and pain willingness) indicated significant improvements between admission and discharge at all centres. Conclusions: These findings indicate the effectiveness of using psychological approaches to manage chronic pain. Both CBT and ACT had a beneficial effect on most of the assessed health-related parameters.
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36.
  • Rivano Fischer, Marcelo, et al. (författare)
  • Return to work after interdisciplinary pain rehabilitation : one- and two-year follow-up study based on the Swedish quality registry for pain rehabiliation
  • 2019
  • Ingår i: Journal of Rehabilitation Medicine. - : Foundation of Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 51:4, s. 281-289
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To investigate: (1) changes in sick-leave benefits from 1 year prior to multimodal rehabilitation to 1 and 2 years after rehabilitation; (ii) sex differences in sick leave; and (iii) the impact of policy changes on sick leave.Methods: All patients undergoing multimodal rehabilitation registered in a national pain database for 2007-11 (n = 7,297) were linked to the Swedish Social Insurance Agency database. Sick leave was analysed in 3-month periods: T0: 1 year before rehabilitation; T1: before start; T2: 1 year after; and T3: 2 years after rehabilitation. Four sick-leave benefit categories were constructed: no sick leave, part-time sick leave, full-time sick leave, and full-time permanent sick leave. The individual change in sick-leave category at each time-period was analysed.Results: Sick-leave benefits increased from T0 to T1 (p <0.001) and decreased from T1 to T3 (p < 0.001). Reductions were significant for both men and women from T1 to T3, but men had less sick-leave benefits at T2 and T3. Positive changes in sick-leave benefits at T2 and T3 were found both prior to and after policy changes, with less sick-leave benefits after policy changes at all time-points.Conclusion: Multimodal rehabilitation may positively influence sick-leave benefits for patients with chronic pain, regardless of their sick-leave situation, sex or policy changes.
  •  
37.
  • Rivano Fischer, Marcelo, et al. (författare)
  • Variability in patient characteristics and service provision of interdisciplinary pain rehabilitation : a study using the Swedish national quality registry for pain rehabilitation
  • 2020
  • Ingår i: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 52:11
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To describe the organization, content and dosage of interdisciplinary pain rehabilitation, and the differences in degree of severity of problems of patients admitted to clinical units reporting to a Swedish national quality pain registry, grouped according to unit size and possible affiliation with a university hospital.Methods: Reports from 31 out of 39 clinical units in Sweden, on inclusion processes, organization, content and dosage of interdisciplinary pain rehabilitation, and patient-reported data from a Swedish national quality pain registry at assessment for interdisciplinary pain rehabilitation were analysed.Results: the number of patients treated annually at each unit ranged from 3 to 340. In 17 units, teams comprised 5 professionals. Dosage of interdisciplinary pain rehabilitation ranged from 20-180 h per patient in total. Patients at the university-hospital units scored the highest levels of symptoms and lowest levels of health related quality of life. Units used similar sets of inclusion criteria, and several treatments, such as education, self-training and psychological interventions, were used by most units.Conclusion: When interpreting outcome data from registries, aspects other than rehabilitation out-comes must be considered. The interpretation of outcomes from quality registries would be facilitated if data, in addition to assessments and patient reported outcomes, also includes standardized descriptions of the reporting clinical units.
  •  
38.
  •  
39.
  • Rivano, Marcelo, et al. (författare)
  • Return to work: One and two years follow-up after interdisciplinary pain rehabilitation. A study based on the Swedish Quality Registry for Pain Rehabilitation
  • 2019
  • Ingår i: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081. ; 51:4, s. 281-289
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To investigate: (i) changes in sick-leave benefits from 1 year prior to multimodal rehabilitation to 1 and 2 years after rehabilitation; (ii) sex differences in sick leave; and (iii) the impact of policy changes on sick leave. Methods: All patients undergoing multimodal rehabilitation registered in a national pain database for 2007–11 (n?=?7,297) were linked to the Swedish Social Insurance Agency database. Sick leave was analysed in 3-month periods: T0: 1 year before rehabilitation; T1: before start; T2: 1 year after; and T3: 2 years after rehabilitation. Four sick-leave benefit categories were constructed: no sick leave, part-time sick leave, full-time sick leave, and full-time permanent sick leave. The individual change in sick-leave category at each time-period was analysed. Results: Sick-leave benefits increased from T0 to T1 (p?<0.001) and decreased from T1 to T3 (p? Conclusion: Multimodal rehabilitation may positively influence sick-leave benefits for patients with chronic pain, regardless of their sick-leave situation, sex or policy changes.
  •  
40.
  • Tenenbaum, A, et al. (författare)
  • The Quebec classification and a new Swedish classification for whiplash-associated disorders in relation to life satisfaction in patients at high risk of chronic functional impairment and disability
  • 2002
  • Ingår i: Journal of Rehabilitation Medicine. - 1651-2081. ; 34:3, s. 114-118
  • Tidskriftsartikel (refereegranskat)abstract
    • Unlike the Quebec classification system, which is based primarily on pathoanatomy, a new Swedish classification system is based on the site of functional impairment and disability. A prospective study was performed on 85 patients with whiplash-associated disorders grade II according to the Quebec classification. The patients were examined 3-36 months following trauma. A team of professionals with different training performed the diagnostic procedure. An independent assessor classified these patients according to a Swedish classification system. All patients answered questionnaire regarding life satisfaction. Logistic regression demonstrated significant differences in 6 of 10 specific dimensions of life satisfaction between the classification categories C and D (presence of arm symptoms) in a Swedish classification. Patients with whiplash-associated disorders grade If and neuropsychological symptoms seem to have a worse prognosis for spontaneous recovery than those without. A new Swedish classification system seems to be an important complement to the Quebec classification.
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41.
  • Trulsson Schouenborg, Anna, et al. (författare)
  • Physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain : interventions and promising long-term outcomes
  • 2021
  • Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 22:1, s. 910-910
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: There is no consensus on best content, set-up, category of involved healthcare professionals or duration of rehabilitation-programs for patients with chronic musculoskeletal pain, and outcomes show varying results. Individual care regimes for sub-groups of patients have been proposed.AIM: To describe the type of interventions used in a physiotherapist-led, rehabilitation-program for patients with chronic musculoskeletal pain, refractory to preceding treatments. A second aim was to report clinical outcomes at 1-year follow-up after the intervention period.METHODS: All patients referred to physiotherapist within a specialist pain-unit due to being refractory to preceding treatments, and deemed fit to undergo physiotherapy-based, individualized rehabilitation during 2014-2018 were consecutively included and followed-up 1 year after ending the program. The inclusion was based on structured 'clinical reasoning' using the referral, examination and on patient-relevant outcome measures. The individual interventions, recorded according to a manual used when reading the patients' medical records, were described. Primary outcomes were clinical results of perceived pain, disability and overall health at start, discharge and 1 year after discharge.RESULTS: In total, 274 patients (mean age 42 years, 71% women) were included, suffering from chronic, severe, musculoskeletal pain (VAS median 7/10, duration median 2.8 years) and moderate disability. The most frequent interventions were education, sensorimotor training, physical activity-advice and interventions for structures/functions (for example manual techniques, stretching) for a median of nine sessions during five months. Despite refractory to preceding treatments, 45% of the patients rated clinically important improvements on pain, 61% on disability and 50% on overall health at discharge and the figures were similar at 1-year follow-up.CONCLUSIONS: A physiotherapist-led, one-to-one, rehabilitation-program of median nine sessions during five months, combining individualized education, sensorimotor training, physical activity-advice and interventions for structures/functions rendered clinically relevant improvements on pain, disability and overall health in half of the patients at 1-year follow-up. Since the cohort consisted of patients refractory to preceding treatments, we believe that these results warrant further studies to identify the subgroups of patients with chronic musculoskeletal pain that will improve from new, distinctive, resource-effective rehabilitation-programs involving individualized rehabilitation.
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42.
  • Åkerblom, Sophia, et al. (författare)
  • A network analysis of chronic pain rehabilitation program registry data: Structure, change, and responder analyses
  • 2020
  • Konferensbidrag (refereegranskat)abstract
    • Background: Efforts to identify specific variables most related to outcomes in interdisciplinary pain rehabilitation are challenged by the complexity of chronic pain. Methods to manage this complexity are needed. In this study we apply network analysis to a large sample of people seeking interdisciplinary pain treatment. The purpose of the study was to determine the network structure entailed in the set of variables, examine change, and look at potential predictors of outcome, from a network perspective. Methods: Participants in this research (N = 2,421, age M = 43.8 years, % women = 82.2%) were all those consecutive cases providing pre- and post treatment data in the Swedish Quality Registry for Pain Rehabilitation (SQRP). Variables analyzed include pain intensity, pain interference, extent of pain, depression, anxiety, insomnia, and psychological variables from cognitive behavioral models of chronic pain. Network estimation, plotting, accuracy, and changes were call calculated in R. Results: We found Acceptance, Pain Interference, and Depression to be key, “central,” variables in the network of self-reported clinical variables. Interestingly, there were few changes in the network structure following treatment, particularly with respect to which variables appeared most central. On the other hand, Catastrophizing, Depression, Anxiety, and Pain Interference each became less central. The variables where changes were most strongly related to changes in the remainder of the network as a whole were Life Control, Acceptance, and Anxiety. Finally, no network differences were found between treatment responders and non-responders. Conclusions: Further application of a network approach to pain rehabilitation data is recommended. Future studies may improve upon the current results by selecting variables for analysis in a theoretically guided fashion and approaching the data ideographically, to detect unique individual differences in potential treatment processes.
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43.
  • Åkerblom, Sophia, et al. (författare)
  • A network analysis of clinical variables in chronic pain: a study from the Swedish quality registry for pain rehabilitation (SQRP)
  • 2021
  • Ingår i: Pain Medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 22:7, s. 1591-1602
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. Efforts to identify specific variables that impact most on outcomes from interdisciplinary pain rehabilitation are challenged by the complexity of chronic pain. Methods to manage this complexity are needed. The purpose of the study was to determine the network structure entailed in a set of self-reported variables, examine change, and look at potential predictors of outcome, from a network perspective. Methods. In this study we apply network analysis to a large sample of people seeking interdisciplinary pain treatment (N = 2,241). Variables analyzed include pain intensity, pain interference, extent of pain, depression, anxiety, insomnia, and psychological variables from cognitive behavioral models of chronic pain. Results. We found that Acceptance, Pain Interference, and Depression were key, “central,” variables in the pretreatment network. Interestingly, there were few changes in the overall network configuration following treatment, specifically with respect to which variables appear most central relative to each other. On the other hand, Catastrophizing, Depression, Anxiety, and Pain Interference each became less central over time. Changes in Life Control, Acceptance, and Anxiety were most strongly related to changes in the remainder of the network as a whole. Finally, no network differences were found between treatment responders and non-responders. Conclusions. This study highlights potential future targets for pain treatment. Further application of a network approach to interdisciplinary pain rehabilitation data is recommended. Going forward, it may be better to next do this in a more comprehensive theoretically guided fashion, and ideographically, to detect unique individual differences in potential treatment processes.
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44.
  • Åkerblom, Sophia, et al. (författare)
  • A validation and generality study of the Committed Action Questionnaire in a Swedish sample with chronic pain.
  • 2016
  • Ingår i: International Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 1070-5503 .- 1532-7558.
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose Psychological flexibility is the theoretical model that underpins Acceptance Commitment Therapy (ACT). There is a growing body of evidence indicating that ACT is an effective treatment for chronic pain but one component of the model, committed action, has not been sufficiently researched. The purpose of this study is to validate Swedish-language versions of the full length Committed Action Questionnaire (CAQ; CAQ-18) and the shortened CAQ (CAQ-8), to examine the generality of previous results related to committed action and to further demonstrate the relevance of this construct to the functioning of patients with chronic pain. Method The study includes preliminary analyses of the reliability and validity of the CAQ. Participants were 462 consecutive referrals to the Pain Rehabilitation Unit at Skåne University Hospital. Results The Swedish-language versions of the CAQ (CAQ- 18 and CAQ-8) demonstrated high levels of internal consistency and satisfactory relationships with various indices of patient functioning and theoretically related concepts. Confirmatory factor analyses showed that the Swedish versions of the CAQ yielded similar two-factor models as found in the original validation studies. Hierarchical regression analyses identified the measures as significant contributors to explained variance in patient functioning. Conclusion The development, translation and further validation of the CAQ is an important step forward in evaluating the utility of the psychological flexibility model to the treatment of chronic pain. The CAQ can both assist researchers interested in mediators of chronic pain treatment and further enable research on change processes within the psychological flexibility model.
  •  
45.
  • Åkerblom, Sophia, et al. (författare)
  • Further validation of the Chronic Pain Values Inventory in a Swedish chronic pain sample
  • 2017
  • Ingår i: Journal of Contextual Behavioral Science. - : Elsevier BV. - 2212-1447. ; 6:3, s. 261-267
  • Tidskriftsartikel (refereegranskat)abstract
    • PurposeValue based action is an important process in the psychological flexibility model and is associated with daily functioning in people with chronic pain, but measures of it are not well-developed. The purpose of the present study was to examine the reliability and validity of a Swedish-language version of the Chronic Pain Values Inventory (CPVI) in a large sample of adults seeking treatment for chronic pain.Material and methodsA Swedish version of the CPVI was created and administered alongside other measures of psychological flexibility and pain-related functioning in a convenience sample of 232 patients admitted for treatment at the Pain Rehabilitation Unit at Skåne University Hospital between February 2014 and December 2015. Internal consistency of the CPVI was assessed as was its relationship to theoretically related facets from the psychological flexibility model. The utility of values-related processes in explaining variance in pain-related functioning was also examined by correlations and hierarchical regression analyses.ResultsOverall, this Swedish-language version of the CPVI was found to have satisfactory reliability and validity. The CPVI subscales yielded high levels of internal consistency. Evidence of construct validity in relation to other measures from the psychological flexibility model was observed as well as evidence of clinical utility in relation to measures of pain-related functioning.DiscussionThis brief self-report measure of values-based action seems to yield valid data in Swedish adults suffering from chronic pain. Values based processes appear important within evidence-based treatments for chronic pain, especially Acceptance and Commitment Therapy (ACT), and the CPVI may help assess these, particularly in predictor studies of pain-related functioning and analyses of therapeutic change processes or mechanisms.
  •  
46.
  • Åkerblom, Sophia, et al. (författare)
  • Predictors and mediators of outcome in cognitive behavioral therapy for chronic pain: The contributions of psychological flexibility
  • 2020
  • Ingår i: Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 0160-7715 .- 1573-3521.
  • Tidskriftsartikel (refereegranskat)abstract
    • There is now a consensus in the literature that future improvements in outcomes obtained from cognitive behavioral therapy (CBT) for chronic pain will requireresearch to identify patient and treatment variables that help explain outcomes. The frst aim of this study was to assess whether pre-treatment scores on measures of psychological (in)fexibility, acceptance, committed action, cognitive(de)fusion, and values-based action predict outcomes in a multidisciplinary, multicomponent, group-based CBT program for adults with chronic pain. The second aim was to assess whether change scores on these same measures mediate outcomes in the treatment program. Participants were 232 people attending treatment for chronic pain. Of the psychological fexibility measures, only pre-treatment scores on the psychological infexibility scale predicted outcomes; higher scores on this measure were associated with worseoutcomes. However, change scores on each of the psychological fexibility measures separately mediated outcomes. The efcacy of CBT for chronic pain may be improved with a greater focus on methods that increase psychologicalfexibility.
  •  
47.
  • Åkerblom, Sophia, et al. (författare)
  • Prolonged exposure for pain and comorbid PTSD : a single-case experimental study of a treatment supplement to multiprofessional pain rehabilitation
  • 2022
  • Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 22:2, s. 305-316
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: It is unclear how to address PTSD in the context of chronic pain management. Here we examine the potential benefits of an addition of prolonged exposure (PE) therapy for PTSD for adults attending multidisciplinary CBT for chronic pain.Methods: Four adults seeking treatment for chronic pain from a specialized pain rehabilitation service were offered PE for PTSD using a replicated, randomized, single-case experimental phase design, prior to commencing a 5-week multidisciplinary CBT program for chronic pain. Pre-, post-, follow-up, and daily measures allowed examination of PTSD and pain outcomes, potential mediators, and the trajectory of these outcomes and potential mediators during the subsequent pain-focused CBT program.Results: Visual inspection of the daily data demonstrated changes in all outcome variables and potential mediators during the PE phase. Changes came at different times and at different rates for the four participants, highlighting the individual nature of putative change mechanisms. Consistent with expectation, PE produced reliable change in the severity of PTSD symptoms and trauma-related beliefs for all four participants, either by the end of the PE phase or the PE follow-up, with these gains maintained by the end of the 5-week pain-focused CBT program. However, few reductions in pain intensity or pain interference were seen either during the PE phase or after.Conclusions: Although "disorder specific" approaches have dominated the conceptualising, study, and treatment of conditions like PTSD and chronic pain, such approaches may not be optimal. It may be better instead to approach cases in an individual and process-focused fashion.
  •  
48.
  • Åkerblom, Sophia, et al. (författare)
  • Prolonged exposure for pain and comorbid PTSD: A single-case experimental study of a treatment supplement to multiprofessional pain rehabilitation
  • 2022
  • Ingår i: Scandinavian Journal of Pain. - 1877-8860. ; 22:2
  • Tidskriftsartikel (refereegranskat)abstract
    • It is unclear how to address PTSD in the context of chronic pain management. Here we examine the potential benefits of an addition of prolonged exposure (PE) therapy for PTSD for adults attending multidisciplinary CBT for chronic pain. Four adults seeking treatment for chronic pain from a specialized pain rehabilitation service were offered PE for PTSD using a replicated, randomized, single-case experimental phase design, prior to commencing a 5-week multidisciplinary CBT program for chronic pain. Pre-, post-, follow-up, and daily measures allowed examination of PTSD and pain outcomes, potential mediators, and the trajectory of these outcomes and potential mediators during the subsequent pain-focused CBT program. Visual inspection of the daily data demonstrated changes in all outcome variables and potential mediators during the PE phase. Changes came at different times and at different rates for the four participants, highlighting the individual nature of putative change mechanisms. Consistent with expectation, PE produced reliable change in the severity of PTSD symptoms and trauma-related beliefs for all four participants, either by the end of the PE phase or the PE follow-up, with these gains maintained by the end of the 5-week pain-focused CBT program. However, few reductions in pain intensity or pain interference were seen either during the PE phase or after. Although "disorder specific"approaches have dominated the conceptualising, study, and treatment of conditions like PTSD and chronic pain, such approaches may not be optimal. It may be better instead to approach cases in an individual and process-focused fashion.
  •  
49.
  • Åkerblom, Sophia, et al. (författare)
  • The impact of PTSD on functioning in patients seeking treatment for chronic pain and validation of the Posttraumatic Diagnostic Scale
  • 2017
  • Ingår i: International Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 1070-5503 .- 1532-7558. ; 24:2, s. 249-259
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To assess the psychometric properties of a Swedish version of the Posttraumatic Diagnostic Scale (PDS); to investigate the prevalence of traumatic experiences, trauma types and posttraumatic stress disorder (PTSD) in a sample of patients seeking treatment for chronic pain; and to examine how indices of pain-related functioning vary with a history of traumatic exposure and PTSD diagnostic status. Methods: Participants were 463 consecutive patients with chronic pain referred for assessment at the Pain Rehabilitation Unit at Skåne University Hospital. Results: The translated version of the PDS demonstrated high levels of internal consistency and a factor structure similar to that reported in previous validation studies using samples identified because of trauma-exposure (not chronic pain), both of which provide preliminary support for the validity of this translated version. Based on their responses to the PDS, most patients (71.8 %) reported one or more traumatic events with 28.9% fulfilling criteria for a current PTSD diagnosis. The patients with PTSD also reported significantly higher levels of pain interference, kinesiophobia, anxiety and depression, as well as significantly lower levels of life control, compared to patients exposed to trauma and not fulfilling criteria for PTSD, and patients with no history of traumatic exposure. Conclusions: Consistent with previous research, a significant proportion of patients seeking treatment for chronic pain reported a history of traumatic exposure and nearly one-third of these met current criteria for PTSD according to a standardized self-report measure. The presence of PTSD was associated with multiple indictors of poorer functioning and greater treatment need and provides further evidence that routine screening of chronic pain patients for PTSD is warranted. Self-report measures like the PDS appear to be valid for use in chronic pain samples and offer a relative low-cost method for screening for PTSD.
  •  
50.
  • Åkerblom, Sophia, et al. (författare)
  • The mediating role of acceptance in multidisciplinary cognitive behavioral therapy for chronic pain
  • 2015
  • Ingår i: Journal of Pain. - : Elsevier BV. - 1526-5900. ; 16:7, s. 606-615
  • Tidskriftsartikel (refereegranskat)abstract
    • Cognitive Behavioral Therapy (CBT) is the most frequently delivered psychological intervention for adults with chronic pain. The treatment yields modest effect sizes and the mechanisms of action remain understudied and unclear. Efforts are needed to identify treatment mediators that could be used to refine CBT and improve outcomes. The primary aim of this study is to investigate whether pain-related acceptance, from the psychological flexibility model, mediates changes in outcome over time in a CBT-based treatment program. This includes comparing how this variable relates to three other variables posited as potential mediators in standard CBT: life-control, affective distress, and social support. Participants attended a five-week outpatient multidisciplinary program with self-report data collected at assessment, post-treatment, and at 12-month follow-up. Multilevel structural equation modeling was used to test for mediation in relation to three outcomes: pain interference, pain intensity, and depression. Results indicate that effect sizes for the treatment were within the ranges reported in the CBT for pain literature. Pain-related acceptance was not related to pain intensity, which is in line with past empirical evidence and the treatment objectives in Acceptance and Commitment Therapy (ACT). Otherwise, pain-related acceptance was the strongest mediator across the different indices of outcome. Accumulating results like these suggest that acceptance of pain may be a general mechanism by which CBT-based treatments achieve improvements in functioning. More specific targeting of pain-related acceptance in treatment may lead to further improvements in outcome. Potential mediators of outcome in a CBT-based treatment for adult chronic pain were investigated using multilevel structural equation modeling. The results highlight the role of pain-related acceptance as an important treatment process even when not explicitly targeted during treatment. These data may help clinicians and researchers better understand processes of change and improve the choice and development of treatment methods.
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