| 1. |
- Hansson, Emma, et al.
(författare)
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Liposuction May Reduce Pain in Dercum's Disease (Adiposis Dolorosa).
- 2011
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Ingår i: Pain Medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 12, s. 942-952
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The aim of this prospective study is to assess the effect of liposuction on the pain experienced by women with Dercum's disease (adiposis dolorosa). Design. Pain was examined preoperatively and at 3 months, and 1, 2, 3, and 5 years after liposuction. The subjective pain sensation was evaluated with a visual analog scale and number of words chosen, and the objective pain sensation with the mechanical pressure pain threshold. Setting. Dercum's disease is characterized by obesity and pronounced pain in the adipose tissue. The pain is chronic and often disabling and resistant to traditional analgesics and other pain treatment. However, five reports have been published on the encouraging effect of liposuction. Patients. Pain was evaluated in 53 patients with Dercum's disease that had been operated on with liposuction. As controls, 58 nonoperated subjects with Dercum's disease and 41 obese abdominoplasty patients were followed for 5 years. Results. Both subjective and objective pain measurements revealed a statistically significant decrease in the pain experienced by the Dercum patients after surgery as compared with preoperatively. However, the pain relief diminished over time. Furthermore, a significant postoperative difference could be seen between the Dercum operated group and the Dercum controls as regards measured pain. The difference decreased over time but still lingered 5 years postoperatively. Conclusion. The results suggest that liposuction might alleviate pain in patients with Dercum's disease. However, it is difficult to determine whether the effect is due to the actual surgery or to other factors.
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| 2. |
- Jakobsson, Ulf
(författare)
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Tobacco Use in Relation to Chronic Pain: Results from a Swedish Population Survey.
- 2008
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Ingår i: Pain Medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; Jun 18, s. 1091-1097
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study the relationship between tobacco use and pain intensity. Design. An age-stratified cross-sectional study was carried out in southern Sweden in 2005. Sample. The population study consists of 384 people, aged 18-102 years, with chronic pain. Measurement. Data collection took place by means of a postal questionnaire. Comparisons of pain intensity were made between smokers and nonsmokers, and between users and nonusers of moist snuff. A multiple linear regression analysis was carried out in order to identify the determinants of pain intensity. Results. Among respondents with chronic pain, smokers experienced a higher pain intensity than nonsmokers, although there was no evidence of such a difference among snuff users. The regression analysis revealed that gender (i.e., women) and smoking significantly increased pain intensity. Conclusions. Pain intensity was highest among daily smokers and those who had quit. Thus, interventions to prevent smoking (to stop smoking and in particular not to start smoking) among people with chronic pain may not only be considered a method to improve health but also to reduce pain.
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| 3. |
- Kvorning, Nina, et al.
(författare)
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Plasma Adrenaline Increases in Anesthetized Patients Given Electro-acupuncture Before Surgery
- 2010
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Ingår i: Pain Medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 11:7, s. 1126-1131
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. In anesthetized patients, electro-acupuncture (EA) has been found to reduce sevoflurane-induced suppression of cranial and spinal motor responses to surgery without influencing the level of anesthesia. The underlying mechanisms are unclear. In the present study, blood samples were analyzed to evaluate if the increased clinical motor responses to surgery in patients subjected to EA under sevoflurane anesthesia are also reflected in higher plasma levels of catecholamines, adrenocorticotrophic hormone (ACTH), or cortisol. Methods. Blood samples were obtained before anesthetic induction, soon after the study or control procedures had been completed under general anesthesia, and after 30 minutes of surgery under steady-state anesthesia with 1.8% of sevoflurane, in 45 healthy female patients, scheduled for sterilization by laparoscopy, randomized for bilateral 2 Hz-burst EA (study group; n = 22) or control (control group; n = 23) procedures. Result. Plasma levels of adrenaline were found to approach the higher preanesthetic level after 30 minutes of surgery in patients given EA stimulation but to remain low in control patients (P < 0.05)-in agreement with the stronger clinical motor responses to skin incision in the EA group. Plasma levels of noradrenaline, ACTH, and cortisol did not change in or differ between the two groups. Conclusion. The clinical facilitation of both cranial and spinal motor responses to surgery in patients given acupuncture under sevoflurane anesthesia is associated with increased plasma levels of adrenaline, possibly reflecting sympathetic activation.
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| 4. |
- Berna, Chantal, et al.
(författare)
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Presence of Mental Imagery Associated with Chronic Pelvic Pain : A Pilot Study
- 2011
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Ingår i: Pain medicine (Malden, Mass.). - : OXFORD UNIV PRESS. - 1526-2375 .- 1526-4637. ; 12:7, s. 1086-1093
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To ascertain whether a small sample of patients with chronic pelvic pain experienced any pain-related cognitions in the form of mental images. Patients. Ten women with chronic pelvic pain consecutively referred from a tertiary referral center by the physicians in charge of their treatment. Outcome measures. An interview was used to determine the presence, emotional valence, content, and impact of cognitions about pain in the form of Inventory (BPI), Pain Catastrophizing Scale (PCS), Spontaneous Use of Imagery Scale (SUIS), and Hospital Anxiety and Depression Scale (HADS) were completed. Results. In a population of patients with a prolonged duration of pain and high distress, all patients reported experiencing cognitions about pain in the form of mental images. For each patient, the most significant image was both negative in valence and intrusive. The associated emotional-behavioral pattern could be described within a cognitive behavioral therapy framework. Eight patients also reported coping imagery. Conclusion. Negative pain-related cognitions in the form of intrusive mental imagery were reported by women with chronic pelvic pain. Targeting such imagery has led to interesting treatment innovation in the emotional disorders. Thus, imagery, hitherto neglected in pain phenomenology, could provide a novel target for cognitive behavioral therapy in chronic pain. These exciting yet preliminary results require replication and extension in a broader population of patients with chronic pain.
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| 5. |
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| 6. |
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| 7. |
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| 8. |
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| 9. |
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| 10. |
- Bäckryd, Emmanuel, et al.
(författare)
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Do low levels of Beta-endorphin in the cerebrospinal fluid indicate defective top-down inhibition in patients with chronic neuropathic pain? A cross-sectional, comparative study
- 2014
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Ingår i: Pain medicine (Malden, Mass.). - : Wiley-Blackwell. - 1526-2375 .- 1526-4637. ; 15:1, s. 111-119
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivePain medicine still lacks mechanism-specific biomarkers to guide diagnosis and treatment, and defective top-down modulation is an important factor in the pathophysiology of chronic pain conditions. Using modern analytical tools and advanced multivariate statistical analysis, the aim of this study was to revisit two classical potential biomarkers of pro- and anti-nociception in humans (substance P and beta-endorphin), focusing particularly on the cerebrospinal fluid (CSF).DesignCross-sectional, comparative, observational study.SubjectsPatients with chronic, post-traumatic and/or post-surgical, neuropathic pain refractory to conventional treatment (N = 15) and healthy controls (N = 19) were included.MethodsSamples were taken from CSF and blood, and levels of substance P and beta-endorphin were investigated using a Luminex technology kit.ResultsWe found low levels of beta-endorphin in the CSF of neuropathic pain patients (66 ± 11 pcg/mL) compared with healthy controls (115 ± 14 pcg/mL) (P = 0.017). Substance P levels in the CSF did not differ (20 ± 2 pcg/mL, 26 ± 2, P = 0.08). However, our multivariate data analysis showed that belonging to the patient group was associated with low levels of both substances in the CSF. A higher correlation between the levels of beta-endorphin and substance P in CSF was found in healthy controls than in patients (rs = 0.725, P < 0.001 vs rs = 0.574, P = 0.032).ConclusionsPatients with chronic neuropathic pain due to trauma or surgery had low levels of beta-endorphin in the CSF. We speculate that this could indicate a defective top-down modulation of pain in chronic neuropathic pain. Our results also illustrate the importance of taking a system-wide, multivariate approach when searching for biomarkers.
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| 11. |
- Chakravarthy, Krishnan, et al.
(författare)
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Burst Spinal Cord Stimulation : A Systematic Review and Pooled Analysis of Real-World Evidence and Outcomes Data
- 2019
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Ingår i: Pain medicine (Malden, Mass.). - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 20, s. S47-S57
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Forskningsöversikt (refereegranskat)abstract
- ObjectiveThis review provides a comprehensive assessment of the effectiveness of burst spinal cord stimulation (SCS). Ratings of pain intensity (visual analog scale or numeric rating scale) and patient-reported outcomes (PROs) on functional/psychometric domains such as depression (Beck Depression Index), catastrophizing (Pain Catastrophizing Scale), surveillance (Pain Vigilance and Attention Questionnaire), and others are addressed.DesignArticles were identified and selected from the literature according to prospective, replicable methods. Effectiveness data—pain scores and PRO ratings—were weighted by study sample sizes and pooled. The effects of burst SCS were compared against values at baseline and with tonic SCS. For PROs, published population norms were used for comparison.ResultsFifteen articles, with a combined sample size of 427, were included. Follow-up ranged from a few hours to two years. A variety of prospective designs were employed, including crossover studies, single-arm cohorts, and a randomized controlled trial, as well as retrospective case reports. The weighted pooled mean pain rating across articles at baseline was 76.7 (±27.4). With tonic SCS, this was reduced to 49.2 (±12.9), and with burst SCS it was further reduced to 36.7 (±11.6), a 12.5-point difference between tonic and burst values. Psychometric analyses of PROs noted preferential improvement with burst SCS. In addition, 65% of subjects stated a preference for burst SCS.ConclusionsIn pooled analyses that incorporated all available published evidence, the improvement over baseline for burst SCS was shown to have a clinically important incremental benefit over tonic SCS. In addition, burst SCS may support resolution of the emotional or cognitive aspects of pain that are mediated by medial thalamo-cortical pathways. This study highlights the value in considering the entire knowledge base in therapeutic assessments as well as adopting a consistent set of outcome variables within neuromodulation. Burst SCS is a valuable intervention, providing both analgesia and psychometric benefits that warrant further thoughtful applications.
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| 12. |
- Chisari, Claudia, et al.
(författare)
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A Network Analysis of Selected Psychosocial Factors in Vulvodynia and Its Subtypes
- 2021
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Ingår i: Pain medicine. - : Oxford University Press. - 1526-2375 .- 1526-4637. ; 22:12, s. 2863-2875
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Tidskriftsartikel (refereegranskat)abstract
- Objective Psychosocial factors are related to pain and sex-related outcomes in provoked vulvodynia and possibly in mixed and spontaneous vulvodynia. However, a broader behavioral framework, such as the psychological flexibility model, has received limited attention in this context. Recently, additional psychosocial variables have also emerged that appear relevant to vulvodynia, including perceived injustice, body-exposure anxiety during intercourse, and unmitigated sexual communion. The present study applied network analysis to explore relations between psychological flexibility, newly emerging psychosocial variables relevant to vulvodynia, and their associations with vulvodynia outcomes. The study also explored potential differences across vulvodynia subtypes.Design An online cross-sectional study of 349 participants with vulvodynia (112 provoked, 237 spontaneous/mixed) was carried out.Methods Participants completed self-report questionnaires, including questions on pain and sexual outcomes, depression, facets of psychological flexibility, body-exposure anxiety during intercourse, unmitigated sexual communion, and perceived injustice. Networks were computed for the total sample and for provoked and mixed/spontaneous vulvodynia subsamples.Results Perceived injustice, pain acceptance, and depression were “central” factors among the included variables, in all models. Psychological flexibility processes were relevant for all networks. Depression was more central in the network for mixed/spontaneous vulvodynia; body-exposure anxiety during intercourse was most central for the provoked subtype.Conclusions Among the included variables, perceived injustice, pain acceptance, depression, and psychological flexibility appear to be important in vulvodynia. As different factors are significant across subtypes, tailored treatment approaches are suggested.
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| 13. |
- Exposto, Fernando G, et al.
(författare)
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Assessment of Pain Modulatory and Somatosensory Profiles in Chronic Tension-Type Headache Patients
- 2021
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Ingår i: Pain medicine. - : Oxford University Press. - 1526-2375 .- 1526-4637. ; 22:10, s. 2356-2365
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to thoroughly phenotype a group of chronic tension-type headache (CTTH) patients.METHODS: Fifteen CTTH patients diagnosed according to the International Classification of Headache Disorders-3 and 15 healthy controls were included in this study. Furthermore, 70 healthy controls were included to establish normative values. Quantitative sensory testing (QST), including temporal summation of pain (TSP), conditioned pain modulation (CPM), and psychological and sleep variables, was assessed in a single session. TSP and CPM were then combined to build pain modulation profiles (PMP) for each individual.RESULTS: No difference was found between groups for PMP, TSP, and CPM. However, 10 CTTH patients showed a pronociceptive PMP, with 8 related to a deficient CPM and 2 to both a deficient CPM and increased TSP. Increased cold detection thresholds were the most common sensory disturbance found in CTTH patients. Significant differences were seen between groups for pain catastrophizing, depression, and sleep quality although not all patient's scores were above the clinically meaningful cutoffs.CONCLUSIONS: In summary, CTTH patients presented with different PMP. These PMP may be related to increased TSP, deficient CPM, alterations in thermal detection that may be related to autonomic dysregulation, or a combination of all three. Overall, this suggests that due to their heterogeneous pathophysiology, CTTH patients should be managed according to their underlying pathophysiology and not with a one-size-fits-all approach.
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| 14. |
- Gentili, Charlotte, et al.
(författare)
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ACTsmart : Guided Smartphone-Delivered Acceptance and Commitment Therapy for Chronic Pain — A Pilot Trial
- 2021
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Ingår i: Pain medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 22:2, s. 315-328
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAcceptance and commitment therapy (ACT) is a behavioral health intervention with strong empirical support for chronic pain but, to date, widespread dissemination is limited. Digital solutions improve access to care and can be integrated into patients’ everyday lives.ObjectiveACTsmart, a guided smartphone-delivered ACT intervention, was developed to improve the accessibility of an evidence-based behavioral treatment for chronic pain. In the present study, we evaluated the preliminary efficacy of ACTsmart in adults with chronic pain.MethodsThe study was an open-label pilot trial. The treatment lasted for 8 weeks, and participants completed all outcome measures at pretreatment and posttreatment and at 3-, 6-, and 12-month follow-ups, with weekly assessments of selected measures during treatment. The primary outcome was pain interference. The secondary outcomes were psychological flexibility, values, insomnia, anxiety, depressive symptoms, health-related quality of life, and pain intensity. All outcomes were analyzed using linear mixed-effects models.ResultsThe sample consisted of 34 adults (88% women) with long-standing chronic pain (M=20.4 years, SD=11.7). Compliance to treatment was high, and at the end of treatment, we observed a significant improvement in the primary outcome of pain interference (d = –1.01). All secondary outcomes significantly improved from pretreatment to posttreatment with small to large effect sizes. Improvements were maintained throughout 12 months of follow-up.ConclusionThe results of this pilot study provide preliminary support for ACTsmart as an accessible and effective behavioral health treatment for adults with chronic pain and warrant a randomized controlled trial to further evaluate the efficacy of the intervention.
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| 15. |
- Ghafouri, Nazdar, et al.
(författare)
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Effects of two different specific neck exercise interventions on palmitoylethanolamide and stearoylethanolamide concentrations in the interstitium of the trapezius muscle in women with chronic neck shoulder pain
- 2014
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Ingår i: Pain medicine (Malden, Mass.). - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 15:8, s. 1379-1389
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. Chronic neck/shoulder pain (CNSP) is one of the most common pain conditions. The understanding of mechanisms, including the peripheral balance between nociceptive and antinociceptive processes, is incomplete. N-acylethanolamines (NAEs) are a class of endogenous compounds that regulate inflammation and pain. The aim of this study was to investigate the levels of two NAEs: the peroxisome proliferator-activated receptor type-a ligand palmitoylethanolamide (PEA) and stearoylethanolamide (SEA) in the muscle interstitium of the trapezius muscle in women with CNSP randomized to two different neck specific training programs and in a healthy pain-free control group (CON). Materials and Methods. Fifty-seven women with CNSP were randomized to strength + stretch or stretch alone exercise programs. Twenty-nine subjects underwent microdialysis procedure before and after 4-6 months of exercise. Twenty-four CON subjects underwent microdialysis procedure before and after 4-6 months without any intervention in between. Microdialysate samples were collected from the trapezius muscle and analyzed by mass spectrometry for PEA and SEA levels. Results. PEA and SEA levels were significantly higher in CNSP patients compared with CON. PEA was significantly higher in CNSP than in CON after both training programs. SEA was significantly higher in CNSP than in CON after stretch alone but not after strength + stretch training. A significant positive correlation was found between changes in pain intensity and in SEA levels in the strength + stretch group, but not in the stretch alone group. Conclusion. Our results indicate that exercise interventions differentially affect the levels of the bioactive lipids PEA and SEA in the interstitium of the trapezius muscle in women with CNSP.
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| 16. |
- Grimby-Ekman, Anna, et al.
(författare)
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Different DHEA-S Levels and Response Patterns in Individuals with Chronic Neck Pain, Compared with a Pain Free Group-a Pilot Study.
- 2017
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Ingår i: Pain medicine (Malden, Mass.). - : Oxford University Press. - 1526-2375 .- 1526-4637. ; 18:5, s. 846-855
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To test, in this pilot study, whether DHEA-S (Dehydroepiandrosterone, sulfated form) plasma levels are lower among persons with chronic neck pain, compared to control persons, and to investigate the DHEA-S response after a physical exercise.SUBJECTS: Included were 12 persons with chronic neck pain and eight controls without present pain, all 18 and 65 years of age. Exclusion criteria for both groups were articular diseases or tendinosis, fibromyalgia, systemic inflammatory and neuromuscular diseases, pain conditions due to trauma, or severe psychiatric diseases.DESIGN AND METHODS: The participants arm-cycled on an ergometer for 30 minutes. Blood samples were taken before, 60 minutes, and 150 minutes after this standardized physical exercise.RESULTS: The estimated plasma DHEA-S levels at baseline were 2.0 µmol/L (95% confidence interval [CI] 1.00; 4.01) in the pain group and 4.1 µmol/L (95% CI2.0; 8.6) in the control group, adjusted for sex, age, body mass index (BMI), and Shirom-Melamed Burnout Questionnaire (SMBQ), with a ratio of 0.48 (P = 0.094).The total DHEA-S (AUCG) in the pain group were 183 min*µmol/L lower than in the control group (P = 0.068). For the response to the exercise (AUCI), the difference between the pain group and the control group was 148 min*µmol/L (P = 0.011).CONCLUSIONS: In this pilot study, the plasma DHEA-S levels appeared to be lower among the persons with chronic neck pain, compared with the control group. It was indicated that DHEA-S decreased during the physical exercise in the control group, and either increased or was unaffected in the chronic pain group.
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| 17. |
- Gustavsson, Anders, et al.
(författare)
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Pharmacological Treatment Patterns in Neuropathic Pain-Lessons from Swedish Administrative Registries
- 2013
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Ingår i: Pain medicine (Malden, Mass.). - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 14:7, s. 1072-1080
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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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| 18. |
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| 19. |
- Hambraeus, Johan, et al.
(författare)
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Radiofrequency denervation improves health-related quality of life in patients with thoracic zygapophyseal joint pain
- 2017
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Ingår i: Pain medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 19:5, s. 914-919
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe a practical approach for the diagnosis and treatment of thoracic zygapophyseal joint pain and to present preliminary clinical data on the effects of this treatment approach on health-related quality of life.Design: An observational study.Setting: Specialist outpatient pain clinic in northern Sweden.Subjects: Patients with long-term thoracic pain.Methods: We describe a method of radiofrequency denervation of thoracic zygapophyseal joints. We compared health-related quality of life between patients who underwent radiofrequency denervation of thoracic zygapophyseal joints and patients who underwent radiofrequency denervation for lumbar and cervical zygapophyseal joint pain.Results: Treatment according to the Spine Intervention Society Guidelines was performed on the lumbar region in 178 patients and in the cervical region in 55 patients. Another 82 patients were treated in the thoracic region with our proposed technique. A survival plot of improvements in health-related quality of life revealed that all three treatments were effective in 65% or more of patients. The improvement in health-related quality of life was maintained for 12 or more months after treatment in 47% to 51% of patients.Conclusions: Our results suggest that radiofrequency denervation of thoracic zygapophyseal joint pain is as effective as radiofrequency denervation, the standard treatment, for lumbar and cervical zygapophyseal joint pain. If these results can be confirmed by other centers, radiofrequency denervation is likely to become more widely available for the treatment of thoracic zygapophyseal joint pain.
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| 20. |
- Kanzler, Kathryn E, et al.
(författare)
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Mitigating the Effect of Pain Severity on Activity and Disability in Patients with Chronic Pain : The Crucial Context of Acceptance.
- 2018
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Ingår i: Pain medicine (Malden, Mass.). - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The purpose of this study was to examine the effect of pain severity on activity levels and physical disability in the context of high pain acceptance. We hypothesized that pain acceptance moderates the effect of pain severity on general activity and physical disability, such that at higher levels of acceptance, the deleterious effect of pain is mitigated.Methods: Two hundred seven patients with chronic pain were recruited from three clinics in a large southwestern military treatment facility. Participants completed an anonymous self-report battery of standardized measures, including the Chronic Pain Acceptance Questionnaire, modified Oswestry Disability Index, and Pain Severity and General Activity subscales of the West Haven-Yale Multidimensional Pain Inventory.Results: Chronic pain acceptance was found to significantly moderate relations between pain severity and general activity (b = 0.0061, t(198) = 2.75, P = 0.007, 95% confidence interval [CI] = 0.002 to 0.011) and pain severity and disability (b = 0.036, t(193) = -2.564, P = 0.011, 95% CI = -0.063 to -0.008). In the context of higher acceptance, the negative effect of pain on activity and disability appeared reduced. Conversely, in the context of low acceptance, the effect of pain on disability appeared accentuated at all levels of pain severity.Conclusions: Higher acceptance mitigated both activity level and disability in a military-affiliated clinical sample of patients with chronic pain. Results further establish the role of acceptance in relation to functioning in a unique sample of people with chronic pain. These findings have implications for understanding and enhancing functioning in chronic pain populations.
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| 21. |
- Kioskli, Kitty, et al.
(författare)
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Online Acceptance and Commitment Therapy for People with Painful Diabetic Neuropathy in the United Kingdom : A Single-Arm Feasibility Trial
- 2020
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Ingår i: Pain medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 21:11, s. 2777-2788
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study aimed to assess the feasibility of online Acceptance and Commitment Therapy for painful diabetic neuropathy in the United Kingdom and to determine if a larger randomized controlled trial testing treatment efficacy is justified.METHODS: Participants with painful diabetic neuropathy were recruited online and from hospital services. This was a single-arm study in which all participants received online Acceptance and Commitment Therapy. Participants completed questionnaires at baseline and three months post-treatment. Primary feasibility outcomes were recruitment, retention, and treatment completion rates. Secondary outcomes were pre- to post-treatment effects on pain outcomes and psychological flexibility.RESULTS: Of 225 potentially eligible participants, 30 took part in this study. Regarding primary feasibility outcomes, the treatment completion and follow-up questionnaire completion rates were 40% and 100%, respectively. Generally, at baseline those who completed the treatment, compared with those who did not, had better daily functioning and higher psychological flexibility. With respect to secondary outcomes, results from the completers group showed clinically meaningful effects at post-treatment for 100% of participants for pain intensity and pain distress, 66.7% for depressive symptoms, 58.3% for functional impairment, 41.7% for cognitive fusion, 66.7% for committed action, 58.3% for self-as-context, and 41.7% for pain acceptance.CONCLUSIONS: This preliminary trial suggests feasibility of recruitment and follow-up questionnaire completion rates, supporting planning for a larger randomized controlled trial. However, treatment completion rates did not achieve the prespecified feasibility target. Changes to the treatment content and delivery may enhance the feasibility of online Acceptance and Commitment Therapy for people with painful diabetic neuropathy on a larger scale.
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| 22. |
- Kioskli, Kitty, et al.
(författare)
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Psychosocial Factors in Painful Diabetic Neuropathy : A Systematic Review of Treatment Trials and Survey Studies
- 2019
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Ingår i: Pain medicine (Malden, Mass.). - : Oxford University Press. - 1526-2375 .- 1526-4637. ; 20:9, s. 1756-1773
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Diabetes mellitus is associated with a number of complications that can adversely impact patients' quality of life. A common and often painful complication is painful diabetic neuropathy. The aims of this study were to systematically review and summarize evidence from studies of psychological treatments and psychosocial factors related to painful diabetic neuropathy and assess the methodological quality of these studies.METHODS: Electronic databases, related reviews, and associated reference lists were searched. Summaries of participants' data relating to the efficacy of psychological treatments and/or to associations between psychosocial factors and outcomes in painful diabetic neuropathy were extracted from the included studies. The methodological quality of included studies was assessed using two standardized quality assessment tools.RESULTS: From 2,921 potentially relevant titles identified, 27 studies were included in this systematic review. The evidence suggests that depression, anxiety, sleep, and quality of life are the most studied variables in relation to pain outcomes in painful diabetic neuropathy and are consistently associated with pain intensity. The magnitude of the associations ranged from small to large.CONCLUSIONS: Research into psychosocial factors in painful diabetic neuropathy is unexpectedly limited. The available evidence is inconsistent and leaves a number of questions unanswered, particularly with respect to causal associations between variables. The evidence reviewed indicates that depression, anxiety, low quality of life, and poor sleep are associated with pain in painful diabetic neuropathy. The disproportionate lack of research into psychological treatments for painful diabetic neuropathy represents a significant opportunity for future research.
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| 23. |
- Kirketeig, Terje, et al.
(författare)
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Burst Spinal Cord Stimulation : A Clinical Review
- 2019
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Ingår i: Pain medicine (Malden, Mass.). - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 20, s. S31-S40
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Forskningsöversikt (refereegranskat)abstract
- ObjectiveClinical review on outcomes using burst spinal cord stimulation (SCS) in the treatment of chronic, intractable pain.DesignNarrative clinical literature review conducted utilizing a priori search terms including key words for burst spinal cord stimulation. Synthesis and reporting of data from publications including an overview of comparative SCS outcomes.ResultsBurst SCS demonstrated greater pain relief over tonic stimulation in multiple studies, which included blinded, sham-controlled, randomized trials. Additionally, burst stimulation impacts multiple dimensions of pain, including somatic pain as well as emotional and psychological elements. Patient preference is weighted toward burst over tonic due to increased pain relief, a lack of paresthesias, and impression of change in condition.ConclusionBurst SCS has been shown to be both statistically and clinically superior to tonic stimulation and may provide additional benefits through different mechanisms of action. Further high-quality controlled studies are warranted to not only elucidate the basic mechanisms of burst SCS but also address how this unique stimulation signature/pattern may more adequately handle the multiple affective dimensions of pain in varying patient populations.
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| 24. |
- Lahousse, A., et al.
(författare)
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The Mediating Effect of Perceived Injustice and Pain Catastrophizing in the Relationship of Pain on Fatigue and Sleep in Breast Cancer Survivors: A Cross-Sectional Study
- 2022
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Ingår i: Pain Medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 23:7, s. 1299-1310
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Tidskriftsartikel (refereegranskat)abstract
- Objective Multidimensional aspects of pain have raised awareness about cognitive appraisals, such as perceived injustice (PI) and pain catastrophizing (PC). It has been demonstrated that they play an important role in patients' pain experience. However, the mediating effect of these appraisals has not been investigated in breast cancer survivors (BCS), nor have they been related to fatigue and sleep. Methods Cross-sectional data from 128 BCS were analysed by structural path analysis with the aim to examine the mediating effect of PI and PC in the relationship of pain on fatigue and sleep. Results The indirect mediating effects of PI on fatigue (CSI*PI = 0.21; P < .01 and VAS*PI = 1.19; P < .01) and sleep (CSI*PI = 0.31; P < .01 and VAS*PI = 1.74; P < .01) were found significant for both pain measures (Central Sensitization Inventory [CSI] and Visual Analogue Scale [VAS]). PC, on the other hand, only mediated the relationship between pain measured by VAS and fatigue (VAS*PC = 0.80; P = .03). Positive associations were found, indicating that higher pain levels are positively correlated with PI and PC, which go hand in hand with higher levels of fatigue and sleep problems. Conclusions PI is an important mediator in the relationship of pain on fatigue and sleep, while PC is a mediator on fatigue after cancer treatment. These findings highlight that both appraisals are understudied and open new perspectives regarding treatment strategies in BCS.
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- Lang, Victoria Ashley, 1994, et al.
(författare)
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Mathematical and Computational Models for Pain: A Systematic Review
- 2021
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Ingår i: Pain Medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 22:12, s. 2806-2817
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Tidskriftsartikel (refereegranskat)abstract
- Objective. There is no single prevailing theory of pain that explains its origin, qualities, and alleviation. Although many studies have investigated various molecular targets for pain management, few have attempted to examine the etiology or working mechanisms of pain through mathematical or computational model development. In this systematic review, we identified and classified mathematical and computational models for characterizing pain. Methods. The databases queried were Science Direct and PubMed, yielding 560 articles published prior to January 1st, 2020. After screening for inclusion of mathematical or computational models of pain, 31 articles were deemed relevant. Results. Most of the reviewed articles utilized classification algorithms to categorize pain and no-pain conditions. We found the literature heavily focused on the application of existing models or machine learning algorithms to identify the presence or absence of pain, rather than to explore features of pain that may be used for diagnostics and treatment. Conclusions. Although understudied, the development of mathematical models may augment the current understanding of pain by providing directions for testable hypotheses of its underlying mechanisms. Additional focus is needed on developing models that seek to understand the underlying mechanisms of pain, as this could potentially lead to major breakthroughs in its treatment.
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