To Örebro University

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: Provoked vestibulodynia (PVD) is a common pain condition, negatively impacting the relationships and sexual lives of sufferers. Women's coping behaviour has been associated with psychosexual outcomes, yet coping patterns in clinical PVD samples are unexplored, and it is not known how women's coping relates to their relational context.

METHOD: Women (N = 128) with PVD answered questionnaires about psychosexual function, pain coping (avoidance and endurance), relational- and pain catastrophizing, sexual goals and perceived partner responses. Cluster analysis was used to explore coping patterns; clusters were validated on measures of pain and psychosexual function and compared on catastrophizing, sexual goals and partner responses using multivariate analyses of variance.

RESULTS: The analysis yielded four clusters: endurance; combined high avoidance and endurance; avoidance; and combined low. The group with high levels of both avoidance and endurance coping displayed the worst psychosexual outcomes and high levels of pain- and relational catastrophizing, approach and avoidance goals and perceived negative partner responses.

CONCLUSION: There are distinct patterns of coping among women with PVD, and these coping patterns are associated with psychosexual outcomes and relational cognitions and goals, and perceived partner responses. Women who alternate between avoidance and endurance are more distressed and report worse psychosexual functioning. This pattern needs to be identified and addressed in the treatment of PVD.

SIGNIFICANCE STATEMENT: This study extends previous findings on vulvar pain coping patterns to a clinical population of women with PVD. It is further the first study to address the relationship between relational variables, such as partner responses and relational catastrophizing and different coping patterns. Thus, the contribution of this study is the contextualizing of coping patterns among women with PVD. The results showed that a combined pattern of avoidance and endurance coping is associated with high distress, poor psychosexual outcomes, and indications of insufficient relational coping, highlighting the need for clinical assessment and intervention to target both women's individual coping patterns and their relational context.

Providing new psychological treatments in clinical settings requires implementation strategies adapted to the organizational context. This study explored how licensed psychologists experienced their context when providing a new transdiagnostic psychological treatment, "the hybrid treatment", to treat comorbid pain and emotional problems in a clinical setting. We aimed to identify which contextual factors the therapists experienced as facilitating or hindering, to gain a better understanding of important considerations when planning a future implementation strategy. Contextual factors were identified using the Consolidated Framework of Implementation Research (CFIR) in data collection and analysis. Data were collected through semi-structured interviews (N = 9). Thematic analysis resulted in the identification of five main influencing factors: Perception of the intervention's adaptability, prioritization of the patient's needs, leadership engagement, structure for collaboration, and therapists' professional engagement. The results highlight the importance of ensuring a clearly stated mandate for the key individuals involved. The findings may guide future implementation of new psychological treatments into regular care, to enhance facilitators and overcome barriers.

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: A recent randomized controlled trial (N=140) was indicative of large and sustained average improvements of internet-based exposure for fibromyalgia, as compared to a waitlist. However, little is known about who benefits the most from this treatment.

Objectives: To test for potential moderating effects of age, educational attainment, the duration of fibromyalgia, baseline overall fibromyalgia severity, pain intensity, fibromyalgia-related avoidance behavior, and symptom preoccupation on the waitlist-controlled effect of 10-weeks of internet-based exposure for fibromyalgia.

Methods: Secondary analysis of a randomized controlled trial (ClinicalTrials.gov NCT02638636). We used linear mixed effects models to determine whether the waitlist-controlled effect of exposure therapy on overall fibromyalgia severity (Fibromyalgia Impact Questionnaire) differed as a function of the potential moderators.

Results: Only pain intensity (0-10) was found to be a significant moderator, where a higher baseline pain intensity predicted a more limited waitlist-controlled effect of internet-based exposure (B=3.48, 95% CI: 0.84 – 6.13). Standardized point estimates of effects were small for the sociodemographic variables, and in the moderate range for some clinical variables that did not reach statistical significance such as behavioral avoidance and time with the fibromyalgia diagnosis.

Conclusions: Results suggest that internet-based exposure treatment was more useful for participants with lower baseline levels of pain, and less so for participants with higher baseline levels of pain. The treatment had relatively similar effects across the other tested moderators.

A considerable number of pregnant women experience fear of childbirth (FOC), characterized by worries and fear of the unpredictable. Despite this, the psychological processes in FOC have received notably little attention. The aim of this study was to advance the understanding by exploring the applicability of the Intolerance of Uncertainty (IU) model on FOC. Anonymous data was collected in a sample of pregnant women (N = 357) with varying levels of FOC. Analyses supported the associations between FOC and all proposed psychological processes: IU, negative problem orientation, positive beliefs about worry and avoidance of inner experiences. The exploration of potential mediators of the relation between IU and FOC revealed that, of the three processes from the model, only positive beliefs about worry were a mediator, and more specifically, a partial mediator between IU and FOC. These findings add to the theoretical understanding of FOC, by indicating that the role of IU may be similar to other conditions inflicted by worry and anxiety, which may inform treatment development.

Endometriosis, a chronic gynecological disease affecting approximately 10% of women of reproductive age, has a significant impact on physical and mental health. This cross-sectional study aimed to explore experiences of validating and invalidating communication in three contexts (with healthcare providers, employers, and family/friends), and whether this may predict health-related quality of life (HRQoL) in women with endometriosis. Data was collected through a digital survey distributed to women with self-reported endometriosis in Sweden. The survey included measures of validating and invalidating communication, depressive symptoms, anxiety, and HRQoL. A total of 427 women participated. The results indicated that women experienced varying levels of validating and invalidating communication in different contexts, with close family/friends providing the highest level of validation, and healthcare providers the lowest. Furthermore, a combined construct of high levels of validation and low levels of invalidation from healthcare providers and from close family and friends were significant predictors of HRQoL. These findings highlight the importance of supportive communication and understanding from healthcare providers and close social networks in promoting the well-being of women with endometriosis. Future research should further explore the impact of validating communication within healthcare settings and develop interventions to improve communication and support for women with endometriosis.

CONTEXT: Despite the high prevalence of a myofascial pain component in chronic pelvic pain (CPP) syndromes, awareness and management of this component are lacking among health care providers.

OBJECTIVE: To summarize the current state of the art for the management of myofascial pain in chronic primary pelvic pain syndromes (CPPPS) according to scientific research and input from experts from the European Association of Urology (EAU) guidelines panel on CPP.

EVIDENCE ACQUISITION: A narrative review was undertaken using three sources: (1) information in the EAU guidelines on CPP; (2) information retrieved from the literature on research published in the past 3 yr on myofascial pelvic pain; and (3) expert opinion from panel members.

EVIDENCE SYNTHESIS: Studies confirm a high prevalence of a myofascial pain component in CPPPS. Examination of the pelvic floor muscles should follow published recommendations to standardize findings and disseminate the procedure. Treatment of pelvic floor muscle dysfunction and pain in the context of CPP was found to contribute to CPP control and is feasible via different physiotherapy techniques. A multidisciplinary approach is the most effective.

CONCLUSIONS: Despite its high prevalence, the myofascial component of CPP has been underevaluated and undertreated to date. Myofascial pain must be assessed in all patients with CPPPS. Treatment of the myofascial pain component is relevant for global treatment success. Further studies are imperative to reinforce and better define the role of each physiotherapy technique in CPPPS.

PATIENT SUMMARY: Pain and inflammation of the body's muscle and soft tissues (myofascial pain) frequently occurs in pelvic pain syndromes. Its presence must be evaluated to optimize management for each patient. If diagnosed, myofascial pain should be treated.

BACKGROUND: Adolescents with recurrent pain miss out from school more often than pain-free peers. Research has so far used cross-sectional designs, focusing on non-specific absenteeism in clinical samples. Hence, it is unknown whether estimates of absenteeism are specifically linked to the pain itself or reflects the characteristics of clinical samples. This study aimed to prospectively explore pain-related school absenteeism in a non-clinical sample, its variance and potential risk factors.

METHODS: This prospective study followed a cohort of 1300 Sweden-based adolescents (mean age =16.9; 17.2% immigrants; 62.7% girls) with recurrent pain (headache, abdominal and/or musculoskeletal pain) through self-reports at two assessment points 12 months apart. RESULTS: Overall, 64.2% reported any absenteeism at follow-up and about half of these (26.2%) reported frequent absenteeism. Adolescents who indicated missing school were more often girls, slightly older, and had a higher overall pain burden and stressor levels. Yet, after adjusting for previous absenteeism, independent predictors were age, pain intensity, medication use, and stress associated with school attendance. Further to this, immigrant status predicted frequent absenteeism.

CONCLUSIONS: Many adolescents with pain frequently miss out from school due to pain. Identified risk factors points at pain characteristics and coping, stressors associated with participation and advancing age. Taken together, the burden of pain and its correlates emerge earlier and escalate with increasing age hence, early interventions targeting broader domains are needed.