To Örebro University

Pain and emotions are inherently connected, and this review presents contemporary findings on the pain-emotion connection. We address in what ways pain and emotions are related as well as how the link may be understood and targeted in treatment. Both pain and negative emotions are essential (and ancient) biological and motivational systems which share protective and regulatory functions. There is a marked co-occurrence between chronic pain and mental health conditions. One way to understand the pain-emotion connection, stressed by recent theoretical models, is that pain and emotions share cognitive and behavioral mechanisms that serve to downregulate these unpleasant inner states. Treatments targeting these shared regulatory mechanisms show promising results, but more research is needed on generalization, implementation and dissemination.

Objective: Chronic pain is a prevalent condition in older adults, associated with substantial distress. For many older people, chronic pain interferes with their daily life which is reflected in various life domains. This study aimed to investigate whether interactions among self-reported indicators of biological, psychological, social, and existential life domains differ for older adults with no pain, with non-interfering pain, and with interfering pain.

Method: The study was based on the cross-sectional 65+ and Safe Study data (N = 622; age range 64–106 years; 60.6 % women). Network analysis was used to assess the inter-variable associations for older adults reporting no pain, non-interfering pain, and interfering pain separately. Network visualization and centrality tests were performed. Permutation-based analyses were conducted to investigate the connections among variables in three subgroups.

Results: We identified a structural difference between the networks of older adults with no pain and interfering pain, suggesting differences in connectivity among the life domains. The strength centrality metrics showed the central role of presence of meaning in the networks of older adults with no pain and with non-interfering pain, while for older adults with interfering pain, anxiety appeared to be dominant.

Conclusion: The findings illuminated that anxiety regulation and meaning-enhancement are potentially important intervention targets for older adults with recurrent pain. Overall, the study highlighted the value of a holistic biopsychosocial-existential approach for understanding and managing pain in older adults.

BACKGROUND: Online treatments are increasing in number and are currently available for a wide range of clinical problems. To date little is known about the role of treatment expectations and other placebo-like mechanisms in online settings compared to traditional face-to-face treatment. To address this knowledge gap, we analyzed individual participant data from randomized clinical trials that compared online and face-to-face psychological interventions.

METHODS: MEDLINE (Ovid) and PsycINFO (Ovid) were last searched on 2 February 2021. Randomized clinical trials of therapist guided online v. face-to-face psychological interventions for psychiatric or somatic conditions using a randomized controlled design were included. Titles, abstracts, and full texts of studies were independently screened by multiple observers. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Authors of the matching trials were contacted for individual participant data. Ratings from the Credibility and Expectancy Questionnaire and the primary outcome measure from each trial were used to estimate the association between expectation ratings and treatment outcomes in online v. face-to-face interventions, using a mixed-effects model.

RESULTS: Of 7045 screened studies, 62 full-text articles were retrieved whereof six studies fulfilled the criteria and provided individual participant data (n = 491). Overall, CEQ ratings predicted clinical outcomes (β = 0.27) at end of treatment with no moderating effect of treatment modality (online v. face-to-face).

CONCLUSIONS: Online treatment appears to be equally susceptible to expectancy effects as face-to-face therapy. This furthers our understanding of the importance of placebo-like factors in online treatment and may aid the improvement of healthcare in online settings.

Chronic overlapping pain conditions (COPCs) by definition frequently co-occur, perhaps reflecting their shared etiologies. Their overlapping nature presents a methodological challenge, possibly masking associations between COPCs and health outcomes attributable to either general or specific processes. To address this challenge, we used population-based cohort data to evaluate the predictive validity of a bifactor model of nine self-reported COPCs by assessing its association with incident pain-related clinical diagnoses; pain-relevant pharmacotherapy; and other health outcomes. We obtained data from a 2005-2006 study of Swedish adult twins linked with health data from nationwide registers through 2016 (N = 25,418). We then fit a bifactor model comprising a general COPC factor and two independent specific factors measuring pain-related somatic symptoms and neck and shoulder pain. Accounting for age, biological sex, and cancer, the general factor was associated with increased risk of all pain-related outcomes (e.g., COPC diagnosis aOR, 1.71; 95% CI [1.62, 1.81]), most mental health-related outcomes (e.g., depression aOR, 1.72 [1.60, 1.85]), and overdose and mortality (e.g., all-cause mortality aOR, 1.25 [1.09, 1.43]). The somatic symptoms specific factor was associated with pain-relevant pharmacotherapy (e.g., prescribed opioids aOR, 1.25 [1.15, 1.36]), most mental health-related outcomes (e.g., depression aOR, 1.95 [1.70, 2.23]), and overdose (e.g., nonfatal overdose aOR, 1.66 [1.31, 2.10]). The neck and shoulder pain specific factor was weakly and inconsistently associated with the outcomes. Findings provide initial support for the validity and utility of a general-factor model of COPCs as a tool to strengthen understandings of co-occurrence, etiology, and consequences of chronic pain. PERSPECTIVE: This article presents associations between a novel measurement model of chronic overlapping pain conditions (COPCs) and various health outcomes. Findings provide support for measuring pain across multiple domains rather than only measuring pain specific to one physical location in both research and clinical contexts.

Introduction: During adolescence, peers gain a central role and with the availability of technology, socializing can occur around the clock. Very few studies have focused on the role of peers in adolescents’ sleep using social network analyses. These analyses describe peer relationships and social positions in a defined context (e.g., school) based on friendship nominations. Adolescents who receive many nominations can be defined as “popular”, which has been found to have its costs (i.e., shorter sleep duration) but also benefits (i.e., fewer insomnia symptoms). The aim of this study was to partially replicate and expand previous findings in a large Swedish sample of adolescents.

Method: The sample included 1394 adolescents (46% girls, Mage = 15.3, SD = .53, range 14-18) from 16 public schools in middle Sweden. Adolescents reported on their weekly sleep duration, insomnia symptoms, anxiety, depression, alcohol use, demographics, and nominated up to three friends in school. We used R to calculate outgoing nominations and incoming nominations. Linear regressions were used to examine the association between popularity and sleep, controlling for confounding variables (demographics, emotional problems). Finally, we explored sex differences.

Results: Controlling for confounders, popular adolescents reported shorter sleep duration (B=-3.00; 95% CI [-5.77, -0.19]), and popular girls reported more insomnia symptoms (B = 0.36; 95% CI [.04,.68]). There were no significant associations found for boys. 

Discussion: Popularity was linked to shorter sleep duration (up to -27 minutes for the most popular teens). Moreover, girls may pay a price for their popularity by experiencing more insomnia symptoms. Sex differences and potential mechanisms should be further explored.

OBJECTIVES: Inflexibly relying on avoidance of expression may increase and perpetuate pain-related emotional distress in patients with chronic pain. The context-insensitive avoidance (CIA) scale was recently developed to measure the degree to which patients avoid expressing their pain and distress in social situations. This study explored the psychometric properties of the CIA scale in a new sample.

METHODS: This study uses baseline data from a treatment trial for n = 115 patients with chronic pain and co-occurring emotional distress. Reliability and construct and criteria validity were studied using the same instruments as in the original psychometric study and further explored in two new measures. A series of multiple regression analyses were conducted to assess the relationship between the CIA scale and criteria variables compared to the other psychological constructs.

RESULTS: The CIA scale showed good reliability. Significant correlations between high scores on the CIA scale and low scores on self-compassion and activity engagement could be replicated. Significant correlations between high scores on the CIA scale and high scores of pain intensity and pain interference could also be replicated. In the exploring part of this study, validity was extended to general problems with emotion regulation and to satisfaction with life in general and contact with friends but not to satisfaction with family, partner, or sexual life. Avoidance of expression was the only significant predictor of pain intensity.

CONCLUSION: This study could replicate acceptable psychometric properties of a scale measuring CIA of expression. As in the original study, avoidance of expression was associated with increased suffering. Clinically, this instrument may be used to identify patients who may otherwise remain in aggravating silence. Theoretically, it introduces the important concept of context sensitivity to the field of chronic pain. Limitations include uncertainty about causal relationships, and that several important social situations were not examined.

Purpose: There is a wide range of individual and work environment factors that influence work ability among workers withpain and stress-related ill-health. The multiple interactions and overlap between these factors are insufficiently understood,and a network approach could mitigate limitations of previous research. This pilot study aimed to explore interactions betweenindividual characteristics and psychosocial work environment and potential links to long-term work ability.

Methods: Prospective data from a prevention project was used. Individuals (N = 147) with pain and/or stress-related ill-health(95% women) at public sector workplaces filled out baseline questionnaires about a collection of individual and work environ-ment factors, which were used for constructing undirected networks. The model was run in three subsamples of workplaces.Finally, a separate model was established with work ability at 6-month follow-up as outcome variable. A shortest pathwayanalysis was calculated to identify mediators of work ability.

Results: Symptom catastrophizing and perceived stress were the most influential factors in all network models. Symptomcatastrophizing and pain-disability risk were found to mediate the relation between perceived stress and long-term workability. Further, demand-control-support factors were interrelated, and patterns of interaction differed between differenttypes of workplaces.

Conclusion: The findings support the importance of individual factors, specifically symptom catastrophizing in an individual’scoping with pain or stress-problems and its influence on long-term work ability. Catastrophizing might play a role in stress-related disorders which should be further investigated. Individual and work environment factors interact and vary acrosscontext, which needs to be taken into consideration to prevent pain and stress-related ill-health at work.

BACKGROUND: Understanding the relationship between chronic pain conditions and suicidal behavior-suicide attempt, other intentional self-harm, and death by suicide-is imperative for suicide prevention efforts. Although chronic pain conditions are associated with suicidal behaviors, these associations might be attributed to unmeasured confounding or mediated via pain comorbidity.

METHODS: We linked a population-based Swedish twin study (N=17,148 twins) with 10 years of longitudinal, nationwide records of suicidal behavior from health and mortality registers through 2016. To investigate whether pain comorbidity versus specific pain conditions were more important for later suicidal behavior, we modeled a general factor of pain and two independent specific pain factors (measuring pain-related somatic symptoms and neck-shoulder pain, respectively) based on 9 self-reported chronic pain conditions. To examine whether the pain-suicidal behavior associations were attributable to familial confounding, we applied a co-twin control model.

RESULTS: Individuals scoring one standard deviation above the mean on the general pain factor had a 51% higher risk of experiencing suicidal behavior (odds ratio (OR), 1.51; 95% confidence interval (CI), 1.34-1.72). The specific factor of somatic pain was also associated with increased risk for suicidal behavior (OR, 1.80; 95% CI, 1.45-2.22]). However, after adjustment for familial confounding, the associations were greatly attenuated and not statistically significant within monozygotic twin pairs (general pain factor OR, 0.89; 95% CI, 0.59-1.33; somatic pain factor OR, 1.02; 95% CI, 0.49-2.11)

CONCLUSION: Clinicians might benefit from measuring not only specific types of pain, but also pain comorbidity; however, treating pain might not necessarily reduce future suicidal behavior, as the associations appeared attributable to familial confounding.

Objective: Psychological constructs related to the fear-avoidance model such as fear of movement, pain catastrophizing, and affective distress have been found to be inter-related among patients with chronic pain. However, relationships of these constructs have mostly been examined using regression-based analyses. This cross-sectional study employs a novel analytical approach, network analysis, to illustrate the complex interplays among these variables as well as pain intensity and pain interference.

Methods: This study utilized the Swedish Quality Registry for Pain Rehabilitation, including data from 10,436 participants (76.0% women; Mage = 45.0 years). Networks were analyzed separately for patients with different pain extents (i.e., numbers of pain locations) as the interplays may differ qualitatively depending on pain extent.

Results: We found that patients with a larger pain extent showed a worse clinical presentation (i.e., more depression and anxiety, increased fear of movement and pain interference), and their network differed from the patients with a smaller number of pain extent in terms of how strongly key variables were interconnected. In all network models, pain interference and catastrophizing showed consistently influential roles.

Conclusion: Our findings highlight the interactive nature of psychological aspects of pain and how interrelated associations differ depending on pain extent. Findings are discussed based on ideas on how both fear and pain become overgeneralized.