| 1. |
- Bendelin, Nina, et al.
(författare)
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Hurdles and potentials when implementing internet-delivered Acceptance and commitment therapy for chronic pain: a retrospective appraisal using the Quality implementation framework
- 2024
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Internet-delivered psychological interventions can be regarded as evidence-based practices and have been implemented in psychiatric and somatic care at primary and specialist levels. However, challenges as low adherence and poor routinization, have arisen during attempts to implement internet-delivered interventions in chronic pain settings. Internet-delivered Acceptance and Commitment Therapy (IACT) has been found to be helpful for chronic pain patients and might aid in developing pain rehabilitation services. However, the integration of IACT into standard health care has not yet been described from an implementation science perspective. The aim of this hybrid 1 effectiveness-implementation study was to evaluate the process of implementing IACT in a pain rehabilitation setting, to guide future implementation initiatives.Methods: In this retrospective study we described actions taken during an implementation initiative, in which IACT was delivered as part of an interdisciplinary pain rehabilitation program (IPRP) at a specialist level clinic. All documents relevant to the study were reviewed and coded using the Quality Improvement Framework (QIF), focusing on adoption, appropriateness and sustainability.Results: The QIF-analysis of implementation actions resulted in two categories: facilitators and challenges for implementation. Sustainability may be facilitated by sensitivity to the changing needs of a clinical setting and challenged by unfitting capacity building. Appropriateness might be challenged by an insufficient needs assessment and facilitated by aligning routines for communication with the clinics existing infrastructure. Adoption may be facilitated by staff key champions and an ability to adapt to occurring hurdles. Possible influential factors, hypotheses and key process challenges are presented in a logic model to guide future initiatives.Conclusions: Sustainable implementation may depend on both the continuity of facilitating implementation actions and flexibility to the changing needs and interests of patients, caregivers and organization. We conclude that the use of theories, models and frameworks (TMF) as well as a logic model may ease design, planning and evaluation of an implementation process. Lastly, we suggest that IACT may be appropriate for IPRP when given before or after IPRP, focusing on psychiatric comorbidities.
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| 2. |
- Björkstrand, Frida, et al.
(författare)
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Access to psychological treatment for chronic cancer-related Pain in Sweden
- 2024
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Ingår i: Scandinavian Journal of Pain. - 1877-8860. ; 24:1, s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesCancer related pain (CRP) is among the most frequent collateral effects of cancer, with chronic CRP, lasting at least three months, affecting >40% of cancer survivors.Evidence based treatments, including pain-focused Cognitive Behavioral Therapy(CBT) are available, but it appears that cancer patients/survivors are often poorlyinformed about CRP or the potential benefits of CBT for such pain. The present studyexamines current experience of Swedish cancer patients/survivors in relation to CRP.MethodsParticipants (N= 276; 83% female; mean age = 55.5 years, SD=11.9) were recruited to an online survey via cancer websites in Sweden, and provided information about their history of chronic CRP, and whether they received information about or treatment for CRP from a healthcare professional.ResultsParticipants had a history of breast (36%), gynecological (12%), lung (10%), colon(8%) and other forms of cancer (36%). A majority (74%) reported a history of chronicCRP and being prescribed analgesic medications (70%). Less than half (47%)received information from their healthcare provider about the risk of CRP and only 13% with chronic CRP received psychological treatment, and of these only 33% received CBT. Among those receiving psychological treatment for chronic CRP, satisfaction rates were moderate, reported as an average of 6 on a 0-10 scale (SD 2.6).ConclusionsGreater efforts are needed to raise awareness among cancer patients/survivors, andhealthcare providers about the risk of CRP and evidence-based interventions,including CBT, the first-line intervention for chronic pain. These efforts will need to be matched with increases in treatment capacity, particularly pain-focused CBT.
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| 3. |
- Björkstrand, Frida Köhler, et al.
(författare)
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Access to psychological treatment for chronic cancer-related pain in Sweden
- 2024
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Cancer-related pain (CRP) is among the most frequent collateral effects of cancer, with chronic CRP, lasting at least 3 months, affecting >40% of cancer survivors. Evidence-based treatments, including pain-focused cognitive behavioral therapy (CBT), are available, but it appears that cancer patients/survivors are often poorly informed about CRP or the potential benefits of CBT for such pain. This study examined current experience of Swedish cancer patients/survivors in relation to CRP. Methods Participants (N = 276; 83% female; mean age = 55.5 years, SD = 11.9) were recruited to an online survey via cancer websites in Sweden, and they provided information about their history of chronic CRP and whether they received information about or treatment for CRP from a healthcare professional. Results Participants had a history of breast (36%), gynecological (12%), lung (10%), colon (8%), and other forms of cancer (36%). A majority (74%) reported a history of chronic CRP and being prescribed analgesic medications (70%). Less than half (47%) received information from their healthcare provider about the risk of CRP and only 13% with chronic CRP received psychological treatment, and of these, only 33% received CBT. Among those receiving psychological treatment for chronic CRP, satisfaction rates were moderate, reported as an average of 6 on a 0-10 scale (standard deviation 2.6). Conclusions Greater efforts are needed to raise awareness among cancer patients/survivors and healthcare providers about the risk of CRP and evidence-based interventions, including CBT, the first-line intervention for chronic pain. These efforts will need to be matched with increases in treatment capacity, particularly pain-focused CBT.
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| 4. |
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| 5. |
- Ghafouri, Bijar, et al.
(författare)
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Neck and shoulder pain and inflammatory biomarkers in plasma among forklift truck operators - A case-control study
- 2024
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Ingår i: Scandinavian Journal of Pain. - : WALTER DE GRUYTER GMBH. - 1877-8860 .- 1877-8879. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives - The aim of this study was to investigate a panel of inflammatory biomarkers in plasma from forklift truck operators (FLTOs) and healthy controls, and their relation to neck pain characteristics. Methods - From employees in a warehouse, 26 FLTOs were recruited and 24 healthy age- and sex-matched controls (CONs) were recruited via advertisement. The inclusion criterion for FLTOs was that they should operate reach decker and/or counterbalanced tilting mast forklift trucks. All participants were asked to answer a questionnaire covering demographic data, pain intensity numeric rating scale (NRS), anatomical spread, psychological distress, and health aspects. Pain sensitivity was measured using a pressure algometer. Blood samples were collected and analyzed for inflammatory proteins in plasma using a panel of 71 cytokines and chemokines. Multivariate data analysis including orthogonal partial least square-discriminant analysis (OPLS-DA) was performed to identify significant biomarkers. Results - Thirty percent of FLTOs reported NRS > 3 in the neck. Shoulder pain was common in 26% of the FLTOs. Pain and discomfort that most often prevented completion of activities were in the neck (20%), lower back (32%), and hips (27%). The FLTOs reported significantly (p = 0.04) higher levels of anxiety than the CON group and they had significantly lower pressure pain thresholds in the trapezius muscle on both right (p < 0.001) and left sides (p = 0.003). A significant OPLS-DA model could discriminate FLTOs from CON based on nine inflammatory proteins where the expression levels of four proteins were upregulated and five proteins were downregulated in FLTOs compared to CONs. Twenty-nine proteins correlated multivariately with pain intensity. Conclusions - The profile of self-reported health, pain intensity, sensitivity, and plasma biomarkers can discriminate FLTOs with pain from healthy subjects. A combination of both self-reported and objective biomarker measurements can be useful for better understanding the pathophysiological mechanisms underlying work-related neck and shoulder pain.
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| 6. |
- Gyllensten, Hanna, 1979, et al.
(författare)
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Physical activity with person-centered guidance supported by a digital platform or with telephone follow-up for persons with chronic widespread pain: Health economic considerations along a randomized controlled trial.
- 2024
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Ingår i: Scandinavian Journal of Pain. - 1877-8860 .- 1877-8879. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to investigate the resource use and costs associated with the co-creation of a physical activity plan for persons with chronic widespread pain (CWP) followed by support through a digital platform, compared to telephone follow-up.In this 12-month cost comparison study following up results after a randomized controlled trial, individuals with CWP, aged 20-65 years, were recruited at primary healthcare units in Western Sweden. All participants developed a person-centered health-enhancing physical activity plan together with a physiotherapist. Participants were then randomized to either an intervention group (n = 69) who had a follow-up visit after 2 weeks and was thereafter supported through a digital platform, or an active control group (n = 70) that was followed up through one phone call after a month. Costs to the health system were salary costs for the time recorded by physiotherapists when delivering the interventions.The reported time per person (2.8h during the 12 months) corresponded to costs of SEK 958 (range: 746-1,517) for the initial visits and follow-up (both study groups), and an additional 2.5h (corresponding to a mean SEK 833; range: 636-1,257) for the time spent in the digital platform to support the intervention group.After co-creation of a physical activity plan, it was more costly to support persons through a digital platform, compared to telephone follow-up.
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| 7. |
- Holmqvist, Anna, et al.
(författare)
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Fatigue and cognitive fatigability in patients with chronic pain
- 2024
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Fatigue is common in patients with chronic pain. Still, there is a lack of studies examining objectively measurable cognitive aspects of fatigue: cognitive fatigability (CF). We aimed to investigate the presence of CF in patients with chronic pain and its relation to self-rated fatigue, attention, pain characteristics, sleep disturbance, depression, and anxiety.Methods: Two hundred patients with chronic pain and a reference group of 36 healthy subjects underwent a comprehensive neuropsychological test battery, including measurement of CF with the Wechsler Adult Intelligence Scale-III Coding subtest, and self-assessment of trait and state fatigue.Results: The patients with chronic pain did not show more CF as compared to the reference group. There was an association between CF and processing speed on a test of sustained and selective attention in the chronic pain group, while self-rated fatigue measures and pain characteristics were not associated with CF. Self-rated fatigue measures were highly correlated with self-rated pain intensity, spreading of pain, depression, anxiety, and sleep disturbance.Conclusions: The findings highlight the distinction between objective and subjective aspects of fatigue in chronic pain, and that the underlying causes of these different aspects of fatigue need to be studied further.
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| 8. |
- Jonsson, Kent, et al.
(författare)
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Hypocapnia in women with fibromyalgia
- 2024
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study was to investigate whether people with fibromyalgia (FM) have dysfunctional breathing by examining acid-base balance and comparing it with healthy controls.Methods: Thirty-six women diagnosed with FM and 36 healthy controls matched for age and gender participated in this cross-sectional study. To evaluate acid-base balance, arterial blood was sampled from the radial artery. Carbon dioxide, oxygen, bicarbonate, base excess, pH and lactate were analysed for between-group differences. Blood gas analyses were performed stepwise on each individual to detect acid-base disturbance, which was categorized as primary respiratory and possible compensation indicating chronicity. A three-step approach was employed to evaluate pH, carbon dioxide and bicarbonate in this order.Results: Women with FM had significantly lower carbon dioxide pressure (p = 0.013) and higher lactate (p = 0.038) compared to healthy controls at the group level. There were no significant differences in oxygen pressure, bicarbonate, pH and base excess. Employing a three-step acid-base analysis, 11 individuals in the FM group had a possible renally compensated mild chronic hyperventilation, compared to only 4 among the healthy controls (p = 0.042).Conclusions: In this study, we could identify a subgroup of individuals with FM who may be characterized as mild chronic hyperventilators. The results might point to a plausible dysfunctional breathing in some women with FM.
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| 9. |
- Linton, Steven J., 1952-, et al.
(författare)
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The "future" pain clinician : Competencies needed to provide psychologically informed care
- 2024
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 24:1
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND & OBJECTIVE: Psychologically informed care has been proposed to improve treatment outcomes for chronic pain and aligns with a person-centered approach. Yet implementation lags behind, and studies suggest that a lack of competency leads to poor results. It is unclear what training clinicians require to deliver this care. We examine how we might improve psychologically informed care guided by the needs of the patient and in congruence with the scientific literature with a particular focus on how competencies might be upgraded and implementation enhanced.METHODS: We selectively review the literature for psychologically informed care for pain. The patient's view on what is needed is contrasted with the competencies necessary to meet these needs and how treatment should be evaluated.RESULTS: Patient needs and corresponding competencies are delineated. A number of multi-professional skills and competencies are required to provide psychologically informed care. Single-subject methodologies can determine whether the care has the desired effect for the individual patient and facilitate effectiveness. We argue that becoming a competent "pain clinician" requires a new approach to education that transcends current professional boundaries.CONCLUSIONS: Providing person-centered care guided by the needs of the patient and in line with the scientific literature shows great potential but requires multiple competencies. We propose that training the pain clinician of the future should focus on psychologically informed care and the competencies required to meet the individual's needs. Single-subject methodology allows for continual evaluation of this care.
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| 10. |
- Ljungvall, Hanna, et al.
(författare)
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Reliability, construct validity, and factorial structure of a Swedish version of the medical outcomes study social support survey (MOS-SSS) in patients with chronic pain
- 2024
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives This study aimed to examine the psychometric properties of a Swedish version of the Medical Outcomes Study Social Support Survey (MOS-SSS).Methods Standard forward-backward translation was used. A cross-sectional survey was conducted among treatment seeking individuals with chronic pain included in a clinical cohort. Internal consistency was measured with Cronbach’s α, test-retest reliability was examined with intraclass correlation, confirmatory factor analyses was used for examining factor structure, and correlations between the MOS-SSS and selected health validity measures were used for testing concurrent validity hypotheses.Results 182 participants were included in the study. Internal consistency measured with Cronbach’s alpha was acceptable for all subscales and for the total support index of the MOS-SSS. Test-retest reliability was moderate – good for the different subscales, and was good for the overall support index. The original four factor model of the MOS-SSS was confirmed, and the concurrent validity hypotheses were also confirmed; however, the associations were weaker than expected.Conclusions The Swedish version of the MOS-SSS was found psychometrically sound and offers a systematic assessment of social support in specialized pain care.
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