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  • 1.
    Boersma, Katja
    et al.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Linton, Steven J.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Overmeer, Thomas
    Janson, Markus
    Vlaeyen, Johan
    de Jong, Jeroen
    Lowering fear-avoidance and enhancing function through exposure in vivo: a multiple baseline study across six patients with back pain2004In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 108, no 1-2, p. 8-16Article in journal (Refereed)
    Abstract [en]

    This study investigated the effects of an exposure in vivo treatment for chronic pain patients with high levels of fear and avoidance. The fear-avoidance model offers an enticing explanation of why some back pain patients develop persistent disability, stressing the role of catastrophic interpretations; largely fueled by beliefs and expectations that activity will cause injury and will worsen the pain problem. Recently, an exposure in vivo treatment was developed that aims to enhance function by directly addressing these fears and expectations. The purpose of this study was to describe the short-term, consequent effect of an exposure in vivo treatment. The study employed a multiple baseline design with six patients who were selected based on their high levels of fear and avoidance. The results demonstrated clear decreases in rated fear and avoidance beliefs while function increased substantially. These improvements were observed even though rated pain intensity actually decreased somewhat. Thus, the results replicate and extend the findings of previous studies to a new setting, with other therapists and a new research design. These results, together with the initial studies, provide a basis for pursuing and further developing the exposure technique and to test it in group designs with larger samples.

  • 2.
    Boersma, Katja
    et al.
    Örebro University, School of Law, Psychology and Social Work. Center for Health and Medical Psychology.
    Södermark, Martin
    Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden.
    Hesser, Hugo
    Department of Behavioural Sciences and Learning, Division of Psychology, Linköping University, Linköping, Sweden.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Gerdle, Björn
    Department of Medical and Health Sciences, Pain and Rehabilitation Centre, Linköping University, Linköping, Sweden.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work. Center for Health and Medical Psychology.
    Efficacy of a transdiagnostic emotion-focused exposure treatment for chronic pain patients with comorbid anxiety and depression: a randomized controlled trial2019In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, no 8, p. 1708-1718Article in journal (Refereed)
    Abstract [en]

    The comorbidity between chronic pain and emotional problems has proven difficult to address with current treatment options. This study addresses the efficacy of a transdiagnostic emotion-focused exposure treatment ("hybrid") for chronic pain patients with comorbid emotional problems. Adults (n = 115) with chronic musculoskeletal pain and functional and emotional problems were included in a 2-centre, parallel randomized controlled, open-label trial comparing this treatment to an active control condition receiving a guided Internet-delivered pain management treatment based on CBT principles (iCBT). The hybrid treatment (n = 58, 10-16 sessions) integrates exposure in vivo for chronic pain based on the fear-avoidance model with an emotion-regulation approach informed by procedures in Dialectical Behavior Therapy. The iCBT (n = 57; 8 treatment modules) addresses topics such as pain education, coping strategies, relaxation, problem solving, stress, and sleep management using standard CBT techniques. Patient-reported outcomes were assessed before and after treatment as well as at a 9-month primary end point. Across conditions, 78% participants completed post-treatment and 81% follow-up assessment. Intent-to-treat analyses showed that the hybrid had a significantly better post-treatment outcome on pain catastrophizing (d = 0.39) and pain interference (d = 0.63) and significantly better follow-up outcomes on depression (d = 0.43) and pain interference (d = 0.51). There were no differences on anxiety and pain intensity. Observed proportions of clinically significant improvement favoured the hybrid on all but one comparison, but no statistically significant differences were observed. We conclude that the hybrid emotion-focused treatment may be considered an acceptable, credible, and efficacious treatment option for chronic pain patients with comorbid emotional problems.

  • 3.
    Buer, Nina
    et al.
    Neurotec Department, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Department of Health Promotion for Personnel, Örebro University Hospital, Örebro, Sweden .
    Linton, Steven J
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden .
    Fear-avoidance beliefs and catastrophizing: occurrence and risk factor in back pain and ADL in the general population2002In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 99, no 3, p. 485-491Article in journal (Refereed)
    Abstract [en]

    Fear-avoidance beliefs and catastrophizing have been shown to be powerful cognitions in the process of developing chronic pain problems and there is a need for increased knowledge in early stages of pain.

    The objectives of this study were therefore, firstly, to examine the occurrence of fear-avoidance beliefs and catastrophizing in groups with different degrees of non-chronic spinal pain in a general population, and secondly to assess if fear-avoidance beliefs and catastrophizing were related to current ratings of pain and activities of daily living (ADL).

    The study was a part of a population based back pain project and the study sample consisted of 917 men and women, 35-45 years old, either pain-free or with non-chronic spinal pain. The results showed that fear-avoidance beliefs as well as catastrophizing occur in this general population of non-patients. The levels were moderate and in catastrophizing a 'dose-response' pattern was seen, such that more the catastrophizing was, the more was pain. The study showed two relationships, which were between fear-avoidance and ADL as well as between catastrophizing and pain intensity. Logistic regression analyses were performed with 95% confidence intervals and the odds ratio for fear-avoidance beliefs and ADL was 2.5 and for catastrophizing and pain 1.8, both with confidence interval above unity. The results suggest that fear-avoidance beliefs and catastrophizing may play an active part in the transition from acute to chronic pain and clinical implications include screening and early intervention. (C) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.

  • 4.
    Burkill, Sarah
    et al.
    Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Sweden; Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Sweden; Department of Epidemiology and Public Health, University College London, UK.
    Kockum, Ingrid
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Centre for Molecular Medicine, Karolinska University Hospital Solna, Sweden.
    Piehl, Fredrik
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Centre for Molecular Medicine, Karolinska University Hospital Solna, Sweden.
    Strid, Pernilla
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Centre for Molecular Medicine, Karolinska University Hospital Solna, Sweden.
    Hillert, Jan
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
    Alfredsson, Lars
    Institute of Environmental Medicine, Karolinska Institutet, Sweden; Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
    Olsson, Tomas
    Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Centre for Molecular Medicine, Karolinska University Hospital Solna, Sweden.
    Bahmanyar, Shahram
    Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Sweden; Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Sweden.
    The association between multiple sclerosis and pain medications2019In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, no 2, p. 424-432Article in journal (Refereed)
    Abstract [en]

    Patients with multiple sclerosis (MS) are at greater risk of pain than people without the disease; however, the occurrence and characteristics of pain among these patients are incompletely described. We aimed to assess characteristics of pain amongst MS patients using MS patients who were recruited to participate in 3 studies in Sweden (n = 3877) and were matched with individuals without MS (n = 4548) by sex, year of birth, and region of residence. The Prescribed Drugs Register identified prescribed pain medication, overall and restricted to those given 4 or more prescriptions in 1 year to assess chronic pain. Anatomical therapeutic chemical codes classified whether pain was neuropathic, musculoskeletal, or migraine. Cox-proportional hazard models were used to estimate associations. Our findings showed patients with MS were at increased risk of pain treatment, with a hazard ratio (HR) of 2.52 (95% confidence interval 2.38-2.66). The largest magnitude HR was for neuropathic pain (5.73, 5.07-6.47) for which 34.2% (n = 1326) of the MS and 7.15% (n = 325) of the non-MS cohort were prescribed a treatment. The HR for chronic pain treatment was 3.55 (3.27-3.84), indicating an increased effect size relative to any pain treatment. Chronic neuropathic pain showed the largest HR at 7.43 (6.21-8.89). Neuropathic pain was shown to be the primary mechanism leading to increased risk of pain in patients with MS.

  • 5.
    Busch, Hillevi
    et al.
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Bodin, Lennart
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Bergström, Gunnar
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Jensen, Irene B.
    Division of Intervention and Implementation Research, Department of Public Health, Karolinska Institutet, Sweden.
    Patterns of sickness absence a decade after pain-related multidisciplinary rehabilitation2011In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 152, no 8, p. 1727-1733Article in journal (Refereed)
    Abstract [en]

    Multidisciplinary programmes using a vocational approach can enhance work return in chronic pain patients, but little is known about the long-term effects of rehabilitation. The current study examined the patterns of sickness absence 10 years after participation in 3 treatment groups (physiotherapy, cognitive behavioural therapy, and vocational multidisciplinary rehabilitation) in comparison to a control group receiving treatment-as-usual. Cost-effectiveness was also assessed. Two hundred fourteen patients participated in a randomized controlled trial and were followed-up via register data 10 years after the interventions. On average, persons in multidisciplinary rehabilitation had 42.98 fewer days on sickness absence per year compared to those treated-as-usual (95% confidence interval −82.45 to −3.52, P=0.03). The corresponding reduction of sickness absence after physiotherapy and cognitive behavioural therapy was not significantly different from the control group. The effect of rehabilitation seems to be more pronounced for disability pension than for sick leave. The economic analyses showed substantial cost savings for individuals in the multidisciplinary group compared to the control group.

  • 6.
    Gatzounis, Rena
    et al.
    Faculty of Psychology and Educational Sciences, Research Group Health Psychology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.
    Schrooten, Martien G. S.
    Örebro University, School of Law, Psychology and Social Work. Faculty of Psychology and Educational Sciences, Research Group Health Psychology, University of Leuven, Leuven, Belgium.
    Crombez, Geert
    Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
    Vlaeyen, Johan W. S.
    Faculty of Psychology and Educational Sciences, Research Group Health Psychology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.
    Activity interruptions by pain impair activity resumption, but not more than activity interruptions by other stimuli: an experimental investigation2018In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 159, no 2, p. 351-358Article in journal (Refereed)
    Abstract [en]

    Interrupting ongoing activities whilst intending to resume them later is a natural response to pain. Whereas this response facilitates pain management, at the same time it may also disrupt task performance. Previous research has shown that activity interruptions by pain impair subsequent resumption of the activity, but not more than pain-irrelevant interruptions. Ongoing task complexity and pain threat value might influence interruption effects. In this experiment, we adjusted a paradigm from outside the field of pain to investigate how activity interruptions by pain affect task performance. Healthy participants (n=69) were required to answer a series of questions, in a specific sequence, about presented letter-digit combinations. This ongoing task was occasionally interrupted by painful electrocutaneous or non-painful vibrotactile stimulation (between-subjects) followed by a typing task. Upon interruption completion, participants were required to resume the ongoing task at the next step of the question sequence. Results indicate impaired sequence accuracy (less frequent resumption at the correct step of the sequence) but preserved non-sequence accuracy (similarly frequent correct responses to question content) immediately after an interruption. Effects were not larger for interruptions by pain, compared to non-pain. Further, participants in the two conditions reported similar task experience, namely task motivation, perceived difficulty, and confidence to resume the interrupted task. Pain catastrophizing did not influence the results. As in previous studies, activity interruptions by pain were shown to impair the resumption of a task that requires keeping to a step sequence, but not more than interruptions by non-painful stimuli. Potential explanations are discussed.

  • 7.
    Gatzounis, Rena
    et al.
    Research Group Health Psychology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.
    Schrooten, Martien G S
    Örebro University, School of Law, Psychology and Social Work. Research Group Health Psychology, University of Leuven, Leuven, Belgium; Centre for Health and Medical Psychology, Örebro University, Örebro, Sweden.
    Crombez, Geert
    Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
    Vlaeyen, Johan W. S.
    Research Group Health Psychology, University of Leuven, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.
    Interrupted by pain: an anatomy of pain-contingent activity interruptions2014In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 155, no 7, p. 1192-1195Article in journal (Refereed)
  • 8.
    Khatibi, Ali
    et al.
    Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, Katholieke Universiteit, Leuven, Belgium.
    Vachon-Presseau, Etienne
    Departement de Psychologie, Université de Montréal, Montréal, Quebec, Canada; Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, Quebec, Canada.
    Schrooten, Martien
    Örebro University, School of Law, Psychology and Social Work. Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, Katholieke Universiteit, Leuven, Belgium.
    Vlaeyen, Johan
    Research Group on Health Psychology, Faculty of Psychology and Educational Sciences, Katholieke Universiteit, Leuven, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
    Rainville, Pierre
    Departement de Psychologie, Université de Montréal, Montréal, Quebec, Canada; Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montréal, Quebec, Canada; Groupe de Recherche sur le Systeme Nerveux Central (GRSNC), Université de Montréal, Montréal, Quebec, Canada.
    Attention effects on vicarious modulation of nociception and pain2014In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 155, no 10, p. 2033-2039Article in journal (Refereed)
    Abstract [en]

    The observation of others' facial expressions of pain has been shown to facilitate the observer's nociceptive responses and to increase pain perception. We investigated how this vicarious facilitation effect is modulated by directing the observer's attention toward the meaning of pain expression or the facial movements. In separate trials, participants were instructed to assess the "intensity of the pain expression"(meaning) or to "discriminate the facial movements" in the upper vs lower part of the face shown in 1-second dynamic clips displaying mild, moderate, or strong pain expressions or a neutral control. In 50% of the trials, participants received a painful electrical stimulation to the sural nerve immediately after the presentation of the expression. Low-level nociceptive reactivity was measured with the RIII-response, and pain perception was assessed using pain ratings. Pain induced by the electrical stimulation increased after viewing stronger pain expressions in both tasks, but the RIII-response showed this vicarious facilitation effect only in the movement discrimination task at the strongest expression intensity. These findings are consistent with the notion that vicarious processes facilitate self-pain and may prime automatic nociceptive responses. However, this priming effect is influenced by top-down attentional processes. These results provide another case of dissociation between reflexive and perceptual processes, consistent with the involvement of partly separate brain networks in the regulation of cortical and lower-level nociceptive responses. Combined with previous results, these findings suggest that vicarious pain facilitation is an automatic process that may be diminished by top-down attentional processes directed at the meaning of the expression.

  • 9.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Intricacies of good communication in the context of pain: does validation reinforce disclosure?2015In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 156, no 2, p. 199-200Article in journal (Other academic)
  • 10.
    Linton, Steven J.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    McCracken, Lance M.
    Vlaeyen, Johan W.
    Reassurance: help or hinder in the treatment of pain2008In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 134, no 1-2, p. 5-8Article in journal (Refereed)
    Abstract [en]

    Although reassurance is one of the most frequently recommended procedures for pain, this procedure has a surprisingly thin evidence base. While the implicit model for reassurance is compelling, we conclude that reassurance is a complex process involving an interaction of patient experience, thoughts and beliefs, and emotions in a social context as well as an outcome measured in health behavior. There is a need for a sound theory of reassurance which distinguishes between the outcome process (patient) and reassurance methods (HCP perspective) so that reassurance might be utilized for best results.

  • 11.
    Linton, Steven J.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Nicholas, Michael
    Pain Management Research Institute, University of Sydney, Sydney, Australia.
    Shaw, William
    University of Connecticut Health Center, Storrs CT, USA.
    Why wait to address high-risk cases of acute low back pain?: A comparison of stepped, stratified, and matched care2018In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 159, no 12, p. 2437-2441Article in journal (Refereed)
  • 12.
    Quinn, Patrick D.
    et al.
    Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States.
    Rickert, Martin E.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States.
    Franck, Johan
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Sariaslan, Amir
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    DʼOnofrio, Brian M.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Associations of mental health and family background with opioid analgesic therapy: a nationwide Swedish register-based study2019In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 160, no 11, p. 2464-2472Article in journal (Refereed)
    Abstract [en]

    There is evidence of greater opioid prescription to individuals in the United States with mental health conditions. Whether these associations generalize beyond the US prescription environment and to familial mental health and socioeconomic status (SES) has not been examined comprehensively. This study estimated associations of diverse preexisting mental health diagnoses, parental mental health history, and SES in childhood with opioid analgesic prescription patterns nationwide in Sweden. Using register-based data, we identified 5,071,193 (48.4% female) adolescents and adults who were naive to prescription opioid analgesics and followed them from 2007 to 2014. The cumulative incidence of any dispensed opioid analgesic within 3 years was 11.4% (95% CI, 11.3%-11.4%). Individuals with preexisting self-injurious behavior, as well as opioid and other substance use, attention-deficit/hyperactivity, depressive, anxiety, and bipolar disorders had greater opioid therapy initiation rates than did individuals without the respective conditions (hazard ratios from 1.24 [1.20-1.27] for bipolar disorder to 2.12 [2.04-2.21] for opioid use disorder). Among 1,298,083 opioid recipients, the cumulative incidence of long-term opioid therapy (LTOT) was 7.6% (7.6%-7.7%) within 3 years of initiation. All mental health conditions were associated with greater LTOT rates (hazard ratios from 1.66 [1.56-1.77] for bipolar disorder to 3.82 [3.51-4.15] for opioid use disorder) and were similarly associated with concurrent benzodiazepine-opioid therapy. Among 1,482,462 adolescents and young adults, initiation and LTOT rates were greater for those with parental mental health history or lower childhood SES. Efforts to understand and ameliorate potential adverse effects of opioid analgesics must account for these patterns.

  • 13. Roelofs, J.
    et al.
    Sluiter, J. K.
    Frings-Dresen, M. H. W.
    Goossens, M.
    Thibault, P.
    Boersma, Katja
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Vlaeyen, J. W. S.
    Fear of movement and (re)injury in chronic musculoskeletal pain: evidence for an invariant two-factor model of the Tampa Scale for Kinesiophobia across pain diagnoses and Dutch, Swedish, and Canadian samples2007In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 131, no 1-2, p. 181-190Article in journal (Refereed)
    Abstract [en]

    The aims of the current study were twofold. First, the factor structure, reliability (i.e., internal consistency), and validity (i.e., concurrent criterion validity) of the Tampa Scale for Kinesiophobia (TSK), a measure of fear of movement and (re)injury, were investigated in a Dutch sample of patients with work-related upper extremity disorders (study 1). More specifically, examination of the factor structure involved a test of three competitive models: the one-factor model of all 17 TSK items, a one-factor model of the TSK (Woby SR, Roach NK, Urmston M, Watson P. Psychometric properties of the TSK-11: a shortened version of the Tampa Scale for Kinesiophobia. Pain 2005;117:137-44.), and a two-factor model of the TSK-11. Second, invariance of the aforementioned TSK models was examined in patients with chronic musculoskeletal pain conditions (i.e., work-related upper extremity disorders, chronic low back pain, fibromyalgia, osteoarthritis) from The Netherlands, Sweden, and Canada was assessed (study 2). Results from study 1 showed that the two-factor model of the TSK-11 consisting of 'somatic focus' (TSK-SF) and 'activity avoidance' (TSK-AA) had the best fit. The TSK factors showed reasonable internal consistency, and were modestly but significantly related to disability, supporting the concurrent criterion validity of the TSK scales. Results from study 2 showed that the two-factor model of the TSK-11 was invariant across pain diagnoses and Dutch, Swedish, and Canadian samples. Altogether, we consider the TSK-11 and its two subscales a psychometrically sound instrument of fear of movement and (re)injury and recommend to use this measure in future research as well as in clinical settings. © 2007 International Association for the Study of Pain.

  • 14. Roelofs, Jeffrey
    et al.
    van Breukelen, Gerard
    Sluiter, Judith
    Frings-Dresen, Monique H. W.
    Goossens, Marielle
    Thibault, Pascal
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Vlaeyen, Johan W. S.
    Norming of the Tampa Scale for Kinesiophobia across pain diagnoses and various countries2011In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 152, no 5, p. 1090-1095Article in journal (Refereed)
    Abstract [en]

    The present study aimed to develop norms for the Tampa Scale for Kinesiophobia (TSK), a frequently used measure of fear of movement/(re) injury. Norms were assessed for the TSK total score as well as for scores on the previously proposed TSK activity avoidance and TSK somatic focus scales. Data from Dutch, Canadian, and Swedish pain samples were used (N = 3082). Norms were established using multiple regression to obtain more valid and reliable norms than can be obtained by subgroup analyses based on age or gender. In the Dutch samples (N = 2236), pain diagnosis was predictive of all TSK scales. More specifically, chronic low back pain displayed the highest scores on the TSK scores followed by upper extremity disorder, fibromyalgia, and osteoarthritis. Gender was predictive of TSK somatic focus scores and age of TSK activity avoidance scores, with male patients having somewhat higher scores than female patients and older patients having higher scores compared with younger patients. In the Canadian (N = 510) and Swedish (N = 336) samples, gender was predictive of all TSK scales, with male patients having somewhat higher scores than female patients. These norm data may assist the clinician and researcher in the process of decision making and treatment evaluation.

  • 15.
    Schrooten, Martien G. S.
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Changing pain expectations: the role of social context and communication2017In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 158, no 7, p. 1185-1186Article in journal (Other academic)
  • 16.
    Sündermann, Oliver
    et al.
    Department of Psychology, National University of Singapore, Singapore.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    My body is not working right: a cognitive behavioral model of body image and chronic pain2020In: Pain, ISSN 0304-3959, E-ISSN 1872-6623Article in journal (Refereed)
  • 17. Trost, Zina
    et al.
    Vangronsveld, Karoline
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Quartana, Phillip J.
    Sullivan, Michael J. L.
    Cognitive dimensions of anger in chronic pain2012In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 153, no 3, p. 515-517Article, review/survey (Refereed)
  • 18. Vangronsveld, Karoline
    et al.
    Peters, Madelon
    Goossens, Mariëlle
    Linton, Steven J.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Vlaeyen, Johan
    Applying the fear-avoidance model to the chronic whiplash syndrome2007In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 131, no 3, p. 258-261Article in journal (Refereed)
    Abstract [en]

    This article reviews the literature to ascertain whether the fear-avoidance model, which was developed to expain back pain, might also apply to whiplash.  Although there are large gaps in the data, some evidence suggests that the model is useful and may guide future research.

  • 19. Vlaeyan, J.W.S.
    et al.
    Crombez, G.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    The fear-avoidance model of pain: We are not there yet. Comment on Wideman et al. “A prospective sequential analysis of the fear-avoidance model of pain” [Pain, 2009] and Nicholas “First things first: reduction in catastrophizing before fear of movement” [Pain, 2009]2009In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 146, no 1-2, p. 222-222Article in journal (Refereed)
  • 20. Vlaeyen, Johan W. S.
    et al.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Fear-avoidance model of chronic musculoskeletal pain: 12 years on2012In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 153, no 6, p. 1144-1147Article, review/survey (Refereed)
  • 21.
    Vlaeyen, Johannes
    et al.
    Research Group on Health Psychology, KU Leuvcen, Leuven, Belgium.
    Crombez, Geert
    Ghent University, Gent, Belgium.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    The fear-avoidance model of pain2016In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 157, no 8, p. 1588-1589Article in journal (Refereed)
    Abstract [en]

    This article describes the latest developments in the fear-avoidance model of pain and summarizes the research findings underpinning the model.

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