| 1. |
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
- Bäckryd, Emmanuel, Docent, 1974-
(författare)
-
Att navigera mellan opioidrädsla och opiocentrism i dagens vård : Undvik stereotyp förskrivning med hjälp av grundlig smärtanalys och individualiserad analys av risk och nytta [Navigating between opiophobia and opiocentrism in today's healthcare]
- 2022
-
Ingår i: Läkartidningen. - Stockholm : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 119
-
Tidskriftsartikel (refereegranskat)abstract
- Opioids are an essential category of medicines, and opiophobia should therefore be shunned. However, it is also important to avoid opiocentrism, i.e., the phenomenon of giving an unduly central place to opioids in the practice of pain medicine. To find a way between these two extremes, it is essential to do a thorough pain assessment and a risk analysis. In this paper, the question of how to best prescribe opioids is related to a "Pain Analysis 3×3" framework in which 3 areas, each consisting of 3 points, are discussed: 1) Is the pain acute, chronic, or cancer-related? 2) Is the pain nociceptive, neuropathic, or nociplastic? 3) Have biological, psychological and social/contextual aspects been taken into consideration (the bio-psycho-social model of pain)? Chronic nociplastic pain conditions such as e.g. fibromyalgia, irritable bowel syndrome or "unspecific" back pain are generally unsuitable for treatment with opioids.
|
|
| 5. |
- Bäckryd, Emmanuel, 1974-
(författare)
-
Dags att folkbilda om smärta
- 2016
-
Ingår i: Svenska dagbladet. - Stockholm : Svenska dagbladets AB. - 1101-2412 .- 2001-3868. ; :10 April
-
Tidskriftsartikel (populärvet., debatt m.m.)
|
|
| 6. |
- Bäckryd, Emmanuel, Docent, 1974-
(författare)
-
Doctoral supervision as leadership : a practice-based proposal with special reference to the university hospital setting
- 2022
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Leadership issues seem to be strangely absent from discussions about what good doctoral supervision is. The purpose of this paper is to explore the concept of doctoral supervision as a form of leadership, with special reference to the university hospital setting. From a personal reflective practice point of view, James Kouzes and Barry Posner's The Five Practices of Exemplary Leadership® Model is used as a lens through which Anne Lee’s concepts of doctoral research supervision are viewed. Four out of five of Lee’s concepts seem to be leadership-related, when viewed from the perspective of Kouzes & Posner, namely “enculturation”, “critical thinking”, “emancipation”, and “relationship development”. The fifth concept, “functional”, can instead be viewed to reflect managerial skills. Hence, it seems meaningful to view doctoral supervision as a form of leadership. The present concept paper should be viewed as hypothesis-generating, and future studies should examine the proposed hypothesis in a more in-depth fashion, using appropriate empirical methodologies and not as in the present paper mere practice-based reflections.
|
|
| 7. |
- Bäckryd, Emmanuel, 1974-, et al.
(författare)
-
Dynamiken i förskrivningen av opioider i Sverige 2000–2015 - Markanta omfördelningar inom opioidgruppen, men ingen »epidemi«
- 2017
-
Ingår i: Läkartidningen. - : Läkartidningen Förlag. - 0023-7205 .- 1652-7518. ; 114
-
Tidskriftsartikel (refereegranskat)abstract
- Opioid prescription changes in Sweden 2000-2015 In contrast to the well-established »opioid epidemic« in the US, very little is known about how the prescription of opioids in Sweden has developed during the last decade. Aggregated data from the open Statistical database of the Swedish Board of Health and Welfare were analyzed descriptively. The yearly prevalence of opioid prescription did not change 2006-2015, but there were dramatic shifts in the choice of opioids. During this period, dextropropoxyphene was pulled off the market. Tramadol was used by fewer individuals (-54 % over the decade), but dosages expressed as Defined Daily Dose/patient/year (DDD/pat/y) increased (+41 %). In contrast, oxycodone and morphine were used by more individuals (+465 % and +137 %, respectively), but DDD/pat/y decreased during the period (-56% and -54%). Studies on non-aggregated data from available registries are needed to further elucidate the circumstances and possible consequences of these shifts in opioid prescription patterns.
|
|
| 8. |
- Bäckryd, Emmanuel, 1974-, et al.
(författare)
-
Evidence of both systemic inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and to plasma
- 2017
-
Ingår i: Journal of Pain Research. - : DOVE MEDICAL PRESS LTD. - 1178-7090. ; 10
-
Tidskriftsartikel (refereegranskat)abstract
- In addition to central hyperexcitability and impaired top-down modulation, chronic inflammation probably plays a role in the pathophysiology of fibromyalgia (FM). Indeed, on the basis of both animal experiments and human studies involving the analysis of cytokines and other inflammation-related proteins in different body fluids, neuroinflammatory mechanisms are considered to be central to the pathophysiology of many chronic pain conditions. However, concerning FM, previous human plasma/serum and/or cerebrospinal fluid (CSF) cytokine studies have looked only at a few predetermined cytokine candidates. Instead of analyzing only a few substances at a time, we used a new multiplex protein panel enabling simultaneous analysis of 92 inflammation-related proteins. Hence, we investigated the CSF and plasma inflammatory profiles of 40 FM patients compared with CSF from healthy controls (n= 10) and plasma from blood donor controls (n= 46). Using multivariate data analysis by projection, we found evidence of both neuroinflammation (as assessed in CSF) and chronic systemic inflammation (as assessed in plasma). Two groups of proteins (one for CSF and one for plasma) highly discriminating between patients and controls are presented. Notably, we found high levels of CSF chemokine CX3CL1 (also known as fractalkine). In addition, previous findings concerning IL-8 in FM were replicated, in both CSF and plasma. This is the first time that such an extensive inflammatory profile has been described for FM patients. Hence, FM seems to be characterized by objective biochemical alterations, and the lingering characterization of its mechanisms as essentially idiopathic or even psychogenic should be seen as definitively outdated.
|
|
| 9. |
|
|
| 10. |
- Bäckryd, Emmanuel, 1974-
(författare)
-
Genombrottssmärta
- 2013
-
Ingår i: BestPractice Smärta. ; , s. 17-19
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
|
|
| 11. |
|
|
| 12. |
- Bäckryd, Emmanuel, 1974-
(författare)
-
Långvarig smärta efter kirurgi, neuropatisk smärta, CRPS
- 2017
-
Ingår i: Information från Läkemedelsverket. - Uppsala, Sweden : Läkemedelsverket. - 1101-7104. ; 3, s. 34-38
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Neuropatisk smärta orsakas definitionsmässigt av en skada eller sjukdom i det somatosensoriska nervsystemet. Långvarig postoperativ smärta (LPOS) är tämligen vanligt, framför allt efter ingrepp som exempelvis amputation, torakotomi, eller mastektomi. I många fall anses LPOS vara av neuropatisk karaktär, och den farmakologiska behandlingen utgår då i stor utsträckning från rekommendationerna för behandling av neuropatisk smärta, med fokus på vissa antidepressiva läkemedel (amitriptylin, duloxetin) och gabapentinoider (gabapentin, pregabalin). Topikal behandling med till exempel lidokainplåster kan vara av stort värde när smärtan utlöses av lätt beröring av huden (allodyni). Överlag bör stor försiktighet råda angående långtidsanvändning av opioider. Vid LPOS efter bukkirurgi bör man speciellt beakta opioidernas negativa effekter på tarmfunktionen, eftersom en ”ond cirkel” kan uppkomma mellan ökade doser opioider och ökad smärta. Komplext regionalt smärtsyndrom (CRPS) kan uppkomma i en extremitet efter trauma av lindrig karaktär och/eller immobilisering (till exempel gipsning). Även om CRPS typ 1 definitionsmässigt inte är ett neuropatiskt smärttillstånd, är de farmakologiska behandlingsprinciperna ändå i stor utsträckning desamma som för neuropatisk smärta. Mer forskning behövs för att på sikt kunna få fram bättre, mer mekanism-baserade behandlingsmetoder.
|
|
| 13. |
- Bäckryd, Emmanuel, Docent, 1974-, et al.
(författare)
-
Långvarig smärta – relationen till ångest och depression är komplex [Chronic pain and its relationship with anxiety and depression] : Fyra möjliga samband – en konceptuell översikt
- 2023
-
Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 120
-
Tidskriftsartikel (refereegranskat)abstract
- Depression and anxiety are highly prevalent in chronic pain. Clinicians often interpret depression/anxiety as consequences of chronic pain, but some psychiatrists contend that the consequence hypothesis is overrated and that psychiatric symptoms in pain patients should be understood as part of the psychiatric disease. In this overview, the potential bidirectional nature of the relationship between chronic pain and depression/anxiety is discussed on a conceptual level. Two additional possible ways of understanding the relationship are presented: psychological vulnerability can be a risk factor for the chronification of pain, and an underlying mild chronic pain can be exacerbated when the patient encounters a new psychosocial stressor. In clinical practice, it is important not to get stuck in a fruitless chase for a causal understanding. However, it is of great value for clinicians to reflect upon the complexity and dynamic nature of the relationship between pain and depression/anxiety.
|
|
| 14. |
- Bäckryd, Emmanuel, Docent, 1974-
(författare)
-
Långvariga smärttillstånd får ny klassifikation i ICD-11 Chronic pain as a disease : [Chronic pain as a disease: An overview of pain diagnoses in ICD-11]
- 2023
-
Ingår i: Läkartidningen. - : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 120
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Pain is a symptom that can be associated with dangerous diseases such as cancer. Hence, to avoid delay in diagnosis of an underlying serious condition, it is important to be thorough when assessing pain. However, all pains are not symptoms of an underlying disease. Instead, many chronic pain conditions can be viewed as diseases in their own right. Indeed, sometimes the pain is the disease - such is for instance the case for fibromyalgia, painless fibromyalgia being a contradiction in terms. The new classification of chronic pain conditions according to the eleventh version of International Classification of Diseases (ICD-11) is presented and discussed. It is argued that the classification makes pain medicine visible as an academic discipline; that it may contribute to a legitimization process in which the suffering of pain patients is recognized semantically and taxonomically; and that it opens up new research possibilities in the chronic pain field.
|
|
| 15. |
- Bäckryd, Emmanuel, 1974-
(författare)
-
Lättläst översikt om smärta
- 2015
-
Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518.
-
Recension (populärvet., debatt m.m.)
|
|
| 16. |
- Bäckryd, Emmanuel, Docent, 1974-
(författare)
-
”Man ska ju inte behöva ha ont”
- 2019
-
Ingår i: Läkartidningen. - Stockholm, Sweden : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 116
-
Tidskriftsartikel (populärvet., debatt m.m.)
|
|
| 17. |
- Bäckryd, Emmanuel, 1974-
(författare)
-
Med diagnosen som sköld
- 2014
-
Ingår i: NOD. ; 2
-
Tidskriftsartikel (populärvet., debatt m.m.)
|
|
| 18. |
- Bäckryd, Emmanuel, Docent, 1974-, et al.
(författare)
-
Många fallgropar i opioidstatistik
- 2021
-
Ingår i: Läkartidningen. - Stockholm, Sweden : Läkartidningen förlag AB. - 0023-7205 .- 1652-7518. ; 36/37
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
|
|
| 19. |
|
|
| 20. |
- Bäckryd, Emmanuel, et al.
(författare)
-
Serum levels of endocannabinoids and related lipids in painful vs painless diabetic neuropathy: results from the Pain in Neuropathy Study
- 2024
-
Ingår i: Pain. - : LIPPINCOTT WILLIAMS & WILKINS. - 0304-3959 .- 1872-6623. ; 165:1, s. 225-232
-
Tidskriftsartikel (refereegranskat)abstract
- N-arachidonoylethanolamine (also known as anandamide) and 2-arachidonoylglycerol are activators of the cannabinoid receptors. The endocannabinoid system also includes structurally and functionally related lipid mediators that do not target cannabinoid receptors, such as oleoylethanolamide, palmitoylethanolamide, and stearoylethanolamide. These bioactive lipids are involved in various physiological processes, including regulation of pain. The primary aim of the study was to analyze associations between serum levels of these lipids and pain in participants in the Pain in Neuropathy Study, an observational, cross-sectional, multicentre, research project in which diabetic patients with painless or painful neuropathy underwent deep phenotyping. Our hypothesis was that painful neuropathy would be associated with higher levels of the 5 lipids compared with painless neuropathy. Secondary aims were to analyze other patient-reported outcome measures and clinical data in relationship to lipid levels. The lipid mediators were analyzed in serum samples using liquid chromatography tandem mass spectrometry (LC-MS/MS). Serum levels of anandamide were significantly higher in the painful group, but the effect size was small (Cohen d = 0.31). Using cluster analysis of lipid data, patients were dichotomized into a "high-level" endocannabinoid group and a "low-level" group. In the high-level group, 61% of patients had painful neuropathy, compared with 45% in the low-level group (P = 0.039). This work is of a correlative nature only, and the relevance of these findings to the search for analgesics targeting the endocannabinoid system needs to be determined in future studies.
|
|
| 21. |
|
|
| 22. |
- Bäckryd, Emmanuel, 1974-
(författare)
-
Smärtmetaforernas dolda budskap
- 2015
-
Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518.
-
Tidskriftsartikel (populärvet., debatt m.m.)
|
|
| 23. |
- Bäckryd, Emmanuel, Docent, 1974-
(författare)
-
Stora kunskapsluckor om cannabisbaserade läkemedel
- 2021
-
Ingår i: Läkartidningen. - Stockholm, Sweden : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 43
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
|
|
| 24. |
|
|
| 25. |
- Bäckryd, Emmanuel, 1974-
(författare)
-
The Cerebrospinal Fluid in Severe Pain Conditions : Clinical, Pharmacological and Proteomic Aspects
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The treatment of both cancer pain and non-cancer chronic pain is still suboptimal. The overall aim of this PhD thesis was to conduct translational pain research at the interface between clinical pain medicine and the field of human proteomics, using the practice of intrathecal analgesia at our institution as a starting point. Hence, the cerebrospinal fluid (CSF) is at the centre of the present dissertation, both as a target for infusing analgesics (Papers I and II – clinical and pharmacological aspects) and as an important biofluid for human biomarker studies (Papers III and IV – proteomic aspects). In Paper I, 28 cases of intrathecal analgesia in cancer patients were prospectively followed. Movement-evoked breakthrough pain remained a major clinical problem throughout the study month despite otherwise successful intrathecal analgesia (defined as good control of spontaneous resting pain paralleled by a marked decrease of concomitant systemic opioid doses). This study therefore illustrates the importance of considering not only spontaneous resting pain but also movement-evoked breakthrough pain.In Paper II, an expert-based algorithm for trialing the intrathecal analgesic ziconotide by bolus injections was evaluated in an open-label study of 23 patients with chronic neuropathic pain. We found few responders (13%) according to the strict criteria of the algorithm, but ziconotide bolus injection trialing seems feasible. The predictive power of ziconotide bolus trialing remains unclear, and the pharmacological profile of ziconotide (with very slow tissue penetration due to high hydrophilicity) calls the rationale for ziconotide bolus trialing into question.In Paper III, we found low levels of beta-endorphin in the CSF of chronic neuropathic pain patients (n=15) compared to healthy controls (n=19). We speculate that this might indicate dysfunctional top-down control of nociception. Substance P levels in the CSF did not differ by univariate statistics. In Paper IV, the CSF proteome of 11 patients with chronic neuropathic pain and 11 healthy controls was exploratively studied, combining gel-based proteomics with multivariate data analysis. After eliminating four proteins associated with age, 32 proteins were found to highly discriminate between groups. Among these, the seven proteins having the highest discriminatory power between patients and controls were: one isoform of angiotensinogen, two isoforms of alpha-1-antitrypsin, three isoforms of haptoglobin, and one isoform of pigment epithelium-derived factor.In conclusion, this PhD thesis demonstrates the fruitfulness of studying the CSF, both as a target for infusing analgesics and as a potential mirror of the neurobiological processes involved in pathological pain conditions. The thesis points to the need for more research into the mechanisms of different pain conditions, in order to hopefully achieve the vision of mechanism-based pain diagnoses.
|
|
| 26. |
|
|
| 27. |
|
|
| 28. |
- Bäckryd, Emmanuel, Docent, 1974-
(författare)
-
Viktigt undvika stereotyp inställning
- 2022
-
Ingår i: Läkartidningen. - Stockholm, Sweden : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 119
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
|
|
| 29. |
- Gerdle, Björn, et al.
(författare)
-
Signs of ongoing inflammation in female patients with chronic widespread pain A multivariate, explorative, cross-sectional study of blood samples
- 2017
-
Ingår i: Medicine. - : LIPPINCOTT WILLIAMS & WILKINS. - 0025-7974 .- 1536-5964. ; 96:9
-
Tidskriftsartikel (refereegranskat)abstract
- This cross-sectional study investigates the plasma inflammatory profile of chronic widespread pain CWP) patients compared to healthy controls CON). Rather than analyzing a relatively few substances at a time, we used a new multiplex proximity extension assay PEA) panel that enabled the simultaneous analysis of 92 inflammation-related proteins, mainly cytokines and chemokines. Seventeen women with CWP and 21 female CON participated and a venous blood sample was drawn from all subjects. Pain intensity and pain thresholds for pressure, heat, and cold were registered. A PEA panel 92 proteins) was used to analyze the blood samples. Multivariate data analysis by projection was used in the statistical analyses. Eleven proteins significantly differentiated the CON and CWP subjects R-2=0.58, Q(2)=0.37, analysis of variance of cross-validated predictive residuals P=0.006). It was not possible to significantly regress pain thresholds within each group CON or CWP). Positive significant correlations existed between several proteins and pain intensities in CWP, but the model reliability of the regression was poor. CWP was associated with systemic low-grade inflammation. Larger studies are needed to confirm the results and to investigate which alterations are condition-specific and which are common across chronic pain conditions. The presence of inflammation could promote the spreading of pain, a hallmark sign of CWP. As it has been suggested that prevalent comorbidities to pain (e.g., depression and anxiety, poor sleep, and tiredness) also are associated with inflammation, it will be important to determine whether inflammation may be a common mediator.
|
|
| 30. |
|
|
| 31. |
- Ghafouri, Bijar, 1972-, et al.
(författare)
-
An investigation of metabolome in blood in patients with chronic peripheral, posttraumatic/postsurgical neuropathic pain.
- 2022
-
Ingår i: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 12
-
Tidskriftsartikel (refereegranskat)abstract
- Neuropathic pain (NP) is a chronic pain condition resulting from a lesion or disease in the somatosensory nervous system. The aim of this study was to investigate the metabolome in plasma from patients with chronic peripheral, posttraumatic/postsurgical NP compared to healthy controls. Further, we aimed to investigate the correlation between pain intensity and the metabolome in plasma. The metabolic profile in plasma samples from 16 patients with chronic NP and 12 healthy controls was analyzed using a nuclear magnetic resonance spectroscopy method. Information about pain intensity, pain duration, body mass index (BMI), age, sex, and blood pressure were obtained through a questionnaire and clinical examination. Multivariate data analysis was used to identify metabolites significant for group separation and their correlation with pain intensity and duration, BMI, and age. We found 50 out of 326 features in plasma significantly contributing to group discrimination between NP and controls. Several of the metabolites that significantly differed were involved in inflammatory processes, while others were important for central nervous system functioning and neural signaling. There was no correlation between pain intensity and levels of metabolite in NP. These findings indicate that there seems to be peripheral/systemic differences in the metabolic profile between patients with chronic NP and healthy individuals.
|
|
| 32. |
- Hindocha, Nishma, et al.
(författare)
-
Ice versus lidocaine 5% gel for topical anaesthesia of oral mucosa : a randomized cross-over study
- 2019
-
Ingår i: BMC Anesthesiology. - : BioMed Central. - 1471-2253 .- 1471-2253. ; 19:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundTopical anaesthesia is important to optimize pain control during dental injection. Our aim was to describe a new simple method for topical anaesthesia of oral mucosa and to compare the effectiveness of ice and lidocaine 5% gel for topical anaesthesia of oral mucosa.MethodsA total of 40 patients aged 10.7–19.5 years were included. The side and method of application were both randomized. Heart rate was recorded, and discomfort and pain were evaluated with a visual analogue scale (VAS). A paired t-test was used to compare mean values, a chi2 test was used to compare proportions, and a Pearson correlation test was used to examine correlations between variables.ResultsWhen ice was used, buccal injection VAS pain was rated lower (p = 0.044), and VAS discomfort was rated higher (p = 0.001), in comparison to when lidocaine 5% gel was used. There was no significant difference in relative heart rate change between ice and lidocaine 5% gel at either needle stick or injection. Lidocaine 5% gel produced a relative heart rate reduction after palatal injection (0.99 ± 0.06) while buccal injection produced an increased relative heart rate (1.02 ± 0.08) (p = 0.010). Unpleasant taste was more frequently reported when lidocaine 5% gel was used (p = 0.025). An application time of 1 min was sufficient for both ice and lidocaine 5% gel to achieve pain reduction from needle stick in buccal mucosa.ConclusionThe cheap and readily available described method using ice for topical anaesthesia of oral mucosa before dental injection is an effective alternative to lidocaine 5% gel.Trial registrationThe European Union Drug Regulating Authorities Clinical Trials Database EudraCT201300530531. Date of registration: February 10th, 2014.
|
|
| 33. |
- Kallman, Thomas F., et al.
(författare)
-
Salivary beta-endorphin and substance P are not biomarkers of neuropathic chronic pain propensity
- 2018
-
Ingår i: Heliyon. - : Elsevier. - 2405-8440. ; 4:8
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThe pathophysiology of chronic pain is complex, with most of our knowledge being derived from preclinical studies. The search for biomarkers mirroring the pathophysiology of chronic pain is ongoing, and there is an increasing interest in saliva as a diagnostic tool. Given what is known about salivary substance Pand salivary gland innervation, we hypothesized that salivary substance P and/or beta-endorphin might reflect the basal activity of these neuropeptides in the central nervous system, thereby perhaps mirroring a general propensity to chronic pain. Based on this overall hypothesis, our aim was to compare salivary levels of these neuropeptides in chronic neuropathic pain patients with healthy controls. An additional aim was to relate salivary levels to plasma levels.Materials and methodsWe compared salivary concentrations of beta-endorphin and substance P in 14 chronic neuropathic pain patients with concentrations in 18 healthy controls using a Luminex technology kit. Salivary-to-plasma quotients were also calculated.ResultsWe found no significant difference between the groups' salivary concentrations of substance P and beta-endorphin. No correlation was found between salivary and plasma concentrations of each neuropeptide, which we hypothesize might point to local production of beta-endorphin and/or substance P in the salivary glands. Given high substance P salivary-to-plasma quotients, such a local production seems more likely for substance P than for beta-endorphin.ConclusionsPropensity to neuropathic chronic pain was not substantiated by our analysis of salivary levels of substance P and/or beta-endorphin. However, we report salivary-to-plasma quotients that give potentially important physiological insight about these neuropeptides.
|
|
| 34. |
-
Långvarig smärta: smärtmedicin vol. 2
- 2021. - 1
-
Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- Boken ger läsaren en solid kunskapsbas om smärtmedicinens komplexa natur, från såväl ett vetenskapligt som ett mänskligt perspektiv.Långvarig smärta – smärtmedicin (vol. 2) är ett nytt gediget verk med ett omfattande referensmaterial baserat på den senaste evidensen och klinisk praxis och kan läsas som fördjupningslitteratur eller uppslagsverk. Boken kan användas på utbildningar för läkare, sjuksköterskor och fysioterapeuter samt övriga professioner som i sitt yrke möter människor med smärta.DEL I ger en smärtmedicinsk grund med bland annat fysiologi samt psykologiska, humanistiska och åldersmässiga aspekter av smärta. DEL II behandlar den långvariga smärtans patofysiologi och behandlingsmetoder samt farmakologi. DEL III beskriver olika smärttillstånd såsom muskuloskeletala, neuropatiska, ischemiska och viscerala tillstånd samt ett kapitel om långvarig smärta hos barn.Långvarig smärta (vol. 2) kompletteras av Akut och cancerrelaterad smärta (vol. 1). Böckerna bygger på den välrenommerade boken Smärta och smärtbehandling och har extensivt utökats i omfång och djup tack vare den senaste forskningen inom området. Tillsammans utgör de båda volymerna den i särklass mest heltäckande läroboken om smärta på svenska.
|
|
| 35. |
- Mattsson, Anna, et al.
(författare)
-
The treatment lottery of chronic back pain? A case series at a multidisciplinary pain centre
- 2023
-
Ingår i: Scandinavian Journal of Pain. - : WALTER DE GRUYTER GMBH. - 1877-8860 .- 1877-8879. ; 23:2, s. 273-283
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectivesDespite the number of people affected by chronic back pain, and the many available treatment options, even the best modalities provide limited pain reduction on a group level, often without simultaneous improvements in functioning or health-related quality of life. The objective was to provide an overview of the treatment of chronic back pain in clinical practice at a multidisciplinary pain centre, and to study patient and pain characteristics in different treatment groups.Methods104 chronic back pain patients (primary ICD-10-SE-diagnosis M53.0-M54.9 excluding M54.1 and M54.3), referred to the Pain and Rehabilitation Centre, University Hospital, Linkoping in 2015, were studied using data from the Swedish Quality Registry for Pain Rehabilitation, self-reported medication data, and a retrospective medical record review.ResultsThe following treatment groups were identified: rehabilitation (n=21), analgesics (n=33), invasive intervention (n=14), and no treatment (n=35). Significant differences between groups were found with regards to age, sick leave, education level, persisting pain duration, punishing responses by significant other, previous invasive intervention, receiving sub-clinic, physician speciality and referring care level.ConclusionsOverall, patient demographics were associated with treatment strategy to a higher degree than patient-reported outcome measures. Moreover, physician speciality and organisational factors seemed to play a role in treatment choice.
|
|
| 36. |
- Olausson, Patrik, et al.
(författare)
-
Clear differences in cerebrospinal fluid proteome between women with chronic widespread pain and healthy women - a multivariate explorative cross-sectional study
- 2017
-
Ingår i: Journal of Pain Research. - : DOVE MEDICAL PRESS LTD. - 1178-7090. ; 10, s. 575-590
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Frequent chronic local pain can develop into chronic widespread pain (CWP). The spread of pain is correlated with pain intensity, anxiety, and depression, conditions that ultimately lead to a poor quality of life. Knowledge is incomplete about CWPs etiology, although it has been suggested that both central hyperexcitability and/or a combination with peripheral factors may be involved. Cerebrospinal fluid (CSF) could act as a mirror for the central nervous system as proteins are signal substances that activate the formation of algesics and control nociceptive processes. To this end, this study investigates the CSF protein expression in women with CWP and in female healthy controls. Materials and methods: This study included 12 female patients with CWP diagnosed according to the American College of Rheumatology criteria with 13 healthy age-and sex-matched pain-free subjects. All subjects went through a clinical examination and answered a health questionnaire that registered sociodemographic and anthropometric data, pain characteristics, psychological status, and quality of life rating. CSF was collected by lumbar puncture from each subject. Two-dimensional gel electrophoresis in combination with mass spectrometry was used to analyze the CSF proteome. This study identifies proteins that significantly discriminate between the two groups using multivariate data analysis (MVDA) (i.e., orthogonal partial least squares discriminant analysis [OPLS-DA]). Results: There were no clinically significant levels of psychological distress and catastrophization presented in subjects with CWP. MVDA revealed a highly significant OPLS-DA model where 48 proteins from CSF explained 91% (R-2) of the variation and with a prediction of 90% (Q(2)). The highest discriminating proteins were metabolic, transport, stress, and inflammatory. Conclusion: The highest discriminating proteins (11 proteins), according to the literature, are involved in apoptotic regulations, anti-inflammatory and anti-oxidative processes, the immune system, and endogenous repair. The results of this explorative study may indicate the presence of neuro-inflammation in the central nervous system of CWP patients. Future studies should be larger and control for confounders and determine which alterations are unspecific/general and which are specific changes.
|
|
| 37. |
- Stålnacke, Britt-Marie, et al.
(författare)
-
Smärtanalys och diagnossättning vid kroniska smärtor inom specialiserad smärtvård
- 2014
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Vi har som modifiering av SoS diagnosriktlinje föreslagit att smärtdiagnostiken ska använda två system parallellt d.v.s. både ICD10 systemet som det föreslagits av Socialstyrelsen för den specialiserade smärtvården (exklusiveR52.2A-C och F45.4) (Bilaga 1) och en utvidgad smärtmekanistisk klassificering. Vid tillämpningen av det förra används lämpligen den lathund som har utarbetats av diagnosgruppen inom NRS (Bilaga 2). För den senare används kategorierna definierade i detta dokument (dvs. neuropatisk, nociceptiv, generaliserad, psykogen och/eller idiopatisk) tillsammans med ställningstagande till smärtkänslighet.Härigenom skapas mer enhetlig diagnossättning vilket är en förutsättning för kliniska riktlinjer, kliniska jämförelser och intensifierad forskning involverande diagnosaspekter.
|
|
