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  • 1.
    Boersma, Katja
    et al.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Linton, Steven J.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Psychological processes underlying the development of a chronic pain problem: a prospective study of the relationship between profiles of psychological variables in the fear-avoidance model and disability2006Inngår i: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 22, nr 2, s. 160-166Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Understanding the psychological processes that underlie the development of a chronic pain problem is important to improve prevention and treatment. The aim of this study was to test whether distinct profiles of variables within the fear-avoidance model could be identified and could be related to disability in a meaningful way.

    Methods: In 81 persons with a musculoskeletal pain problem, cluster analysis was used to identify subgroups with similar patterns on fear and avoidance beliefs, catastrophizing, and depression. The clusters were examined cross-sectionally and prospectively on function, pain, health care usage, and sick leave.

    Results: Five distinct profiles were found: pain-related fear, pain-related fear + depressed mood, medium pain-related fear, depressed mood, and low risk. These subgroups were clearly related to outcome. In contrast to the clusters medium pain-related fear and low risk, the majority of those classified in the clusters pain-related fear, pain-related fear + depressed mood, and depressed mood reported long-term sick leave during follow-up. The subjects in the clusters with high scores on the depression measure reported the highest percentage of health care usage during follow-up (70% in the pain-related fear + depressed mood group and 42% in the depressed mood group reported >10 health care visits).

    Conclusions: Distinct profiles of psychological functioning could be extracted and meaningfully related to future disability. These profiles give support to the fear-avoidance model and underscore the need to address the psychological aspects of the pain experience early on.

  • 2.
    Boersma, Katja
    et al.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Linton, Steven J.
    Örebro universitet, Institutionen för beteende-, social- och rättsvetenskap.
    Screening to identify patients at risk: profiles of psychological risk factors for early intervention2005Inngår i: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 21, nr 1, s. 38-43Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    There is a serious need to provide effective early interventions that prevent the development of persistent pain and disability. Identifying patients at risk for this development is an important step. Our aim was to explore whether distinct subgroups of individuals with similar response patterns on a screening questionnaire exist. Moreover, the objective was to then relate these groups to future outcomes, for example, sick leave as an impetus for developing tailored interventions that might better prevent chronic problems. A total of 363 patients seeking primary care for acute or subacute spinal pain completed the Orebro Musculoskeletal Pain Screening Questionnaire and were then followed to determine outcome. Cluster analysis was used to identify subgroups. Validity was tested using 3 methods including the split-half technique. The subgroups were compared prospectively on outcome measures obtained 1 year later. Using pain intensity, fear-avoidance beliefs, function, and mood, we found 4 distinct profiles: Fear-Avoidant, Distressed Fear-Avoidant, Low Risk, and Low Risk-Depressed Mood. These 4 subgroups were also robust in all 3 of the validity procedures. The 4 subgroups were clearly related to outcome. Although the low risk profiles had virtually no one developing long-term sick leave, the Fear-Avoidant profile had 35% and the Distressed Fear-Avoidant profile 62% developing long-term sick leave. Our results suggest that fear-avoidance and distress are important factors in the development of pain-related disability and may serve as a key for early identification. Providing interventions specific to the factors isolated in the profiles should enhance the prevention of persistent pain and disability.

  • 3.
    Hedman-Lagerlöf, Maria
    et al.
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Hedman-Lagerlöf, Erik
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Axelsson, Erland
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Ljótsson, Brjánn
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Engelbrektsson, Johanna
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Hultkranz, Sofia
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Lundbäck, Karolina
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Björkander, Daniel
    Department of Psychology, Stockholms Universitet, Stockholm, Sweden.
    Wicksell, Rikard
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Flink, Ida
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Andersson, Erik
    Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
    Internet-Delivered Exposure Therapy for Fibromyalgia: A Randomized Controlled Trial2018Inngår i: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 34, nr 6, s. 532-542Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Fibromyalgia (FM) is a common and disabling chronic pain disorder, for which existing pharmacological and psychological treatments have yet yielded insufficient effects. Previous literature has shown that exposure therapy may be an effective treatment for chronic pain. This study constitutes the first randomized controlled trial evaluating exposure therapy for FM.

    Methods: A total of 140 participants with diagnosed FM were randomized to a 10-week Internet-delivered exposure treatment (iExp; n=70) or a waitlist control condition (WLC; n=70). Primary outcome measure were FM symptoms and impact, and secondary outcome measures were fatigue, disability, quality of life, pain-related distress and avoidance behaviors, insomnia, depression, and anxiety.

    Results: Data retention was high (100% data completion at posttreatment for primary outcome, 96% at 6-month follow-up and 94% at 12-month follow-up). Results showed that participants in the iExp group made large and superior improvements compared with WLC on FM symptoms and impact (B, ?1.93; z, ?10.14; P<0.001, betweengroup Cohen d=0.90), as well as all secondary outcomes (betweengroup Cohen d ranging from 0.44 to 1.38) with sustained results.

    Conclusions: We conclude that iExp seems to be an efficacious treatment for FM compared with no treatment, and the results also highlight the potential increase of accessibility by using the Internet format to deliver psychological treatments for these patients. Future trials with active control conditions are warranted.

  • 4. Larsson, Britt
    et al.
    Björk, Jonas
    Kadi, Fawzi
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Lindman, Rolf
    Gerdle, Björn
    Blood supply and oxidative metabolism in muscle biopsies of female cleaners with and without myalgia2004Inngår i: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 20, nr 6, s. 440-446Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: Pathomechanisms of work-related myalgia are poorly understood. Myalgia is thought to be caused by excitation of nociceptors present in the muscular tissue but not in the muscle fiber itself. Muscle contraction in combination with hypoxia is known to excite nociceptors. Morphologic analysis can contribute to the knowledge of the excitation of nociceptors. This study thoroughly examines the morphology of the trapezius muscle's capillary supply and signs of disturbed oxidative metabolism to understand their role in work-related myalgia. METHODS: Surgical trapezius muscle biopsies were obtained from 25 female cleaners with long-standing work-related myalgia, 25 female cleaners without trapezius myalgia, and 21 healthy teachers. Enzyme and immunohistochemical stainings were performed to highlight fibers with aberrant intermyofibrillar patterns, indicating a disturbed oxidative metabolism (also known as moth-eaten fibers) and a disturbed capillary supply of different fibers. RESULTS: A significantly lower number of capillaries per fiber area in cleaners suffering from myalgia compared with cleaners without trapezius myalgia was found. Moth-eaten fibers were found in the 3 groups, but these fibers were significantly more prevalent in the groups of cleaners than in the healthy teacher group. CONCLUSION: This work indicates that the capillary supply of trapezius is affected in work-related trapezius myalgia. More studies are needed to understand possible mechanisms that would explain the occurrence of moth-eaten fibers.

  • 5.
    Peters, Madelon L.
    et al.
    Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.
    Smeets, Elke
    Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.
    Feijge, Marion
    MEMIC, Maastricht University, Maastricht, the Netherlands.
    van Breukelen, Gerard
    Department of Methodology and Statistics, and CAPHRI School for Care and Public Health, Maastricht University, Maastricht, the Netherlands.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Buhrman, Monica
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Linton, Steven J.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Center for Health and Medical Psychology.
    Happy Despite Pain: A Randomized Controlled Trial of an 8-week Internet-delivered Positive Psychology Intervention for Enhancing Well-being in Patients with Chronic Pain2017Inngår i: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 33, nr 11, s. 962-975Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: There is preliminary evidence for the efficacy of positive psychology interventions for pain management. The current study examined the effects of an internet-based positive psychology self-help program for patients with chronic musculoskeletal pain and compared it with an internet-based cognitive behavioural program.

    METHODS: A randomized controlled trial was carried out with three conditions: an internet-delivered positive psychology program, an internet-delivered cognitive behavioural program and waitlist control. A total of 276 patients were randomized to one of the three conditions and post treatment data were obtained from 206 patients. Primary outcomes were happiness, depression and physical impairments at post-treatment and at six months follow-up. Intention-to-treat analyses were carried out using mixed regression analyses.

    RESULTS: Both treatments led to significant increases in happiness and decreases in depression. Physical impairments did not significantly decrease compared to waitlist. Improvements in happiness and depression were maintained until six months follow-up. There were no overall differences in the efficacy of the two active interventions but effects appeared to be moderated by education. Patients with a higher level of education profited more from the positive psychology intervention than from the cognitive behavioural program.

    DISCUSSION: The results suggest that an internet-based positive psychology self-help intervention for the management of chronic pain is clinically useful. Because the self-help exercises as used in the current program do not require therapist involvement, dissemination potential is large. Further studies should examine whether it can best be used as stand-alone or add-on treatment combined with established pain treatment programs.

  • 6.
    Sayed-Noor, Arkan S.
    et al.
    Department of Orthopaedic Surgery, Sundsvall Hospital, Sundsvall, Sweden.
    Englund, Erling
    Department of Research and Development, Sundsvall Hospital, Sundsvall, Sweden .
    Wretenberg, Per
    Department of Orthopaedic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Solna, Stockholm, Sweden.
    Sjödén, Göran O.
    Department of Orthopaedic Surgery, Sundsvall Hospital, Sundsvall, Sweden; Department of Surgical and Perioperative Sciences, Norrland University Hospital, Umeå, Sweden .
    Pressure-pain threshold algometric measurement in patients with greater trochanteric pain after total hip arthroplasty2008Inngår i: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 24, nr 3, s. 232-236Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The evaluation of tenderness associated with greater trochanteric pain (GTP) syndrome is amenable to bias and depends on the examiner's experience. In this study, we tested whether the use of an electronic pressure algometer enhanced the reliability of this evaluation.

    Patients and methods: Pressure-pain threshold (PPT) was measured with an electronic algometer in 18 patients who developed GTP after total hip arthroplasty and in matched controls. Both groups were evaluated with visual analog scale.

    Results: The PPT measurements showed large interindividual variability across patients. The correspondence of the PPT measurements in asymptomatic patients was good. We found good validity for the algometer used. The PPT ratio of 0.8 (affected vs. unaffected side) can be used as a cut-off ratio. The PPT measurements at the greater trochanter (local pain) were significantly lower than at the ilio-tibial band (radiated pain). There was no correlation between PPT measurements and visual analog scales. Despite the acceptable sensitivity and specificity of pressure algometer, because of low positive predictive value and large interindividual variability, pressure algometer has a limited value as a screening test.

    Conclusions: The examination of tenderness associated with GTP is facilitated by the used algometer. It is the intraindividual body-side PPT differences that yield the most sensitive measurement for the assessment of deep pain. A cut-off value of 0.8 can be used for diagnostic purposes. Interindividual differences might be considerable and could mask pathologic diagnostic findings.

  • 7.
    Westman, Anders E.
    et al.
    Örebro universitet, Hälsoakademin.
    Boersma, Katja
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Leppert, Jerzy
    Centre for Clinical Research, Uppsala University, Uppsala, Sweden; Central Hospital, Västerås, Sweden.
    Linton, Steven J.
    Örebro universitet, Akademin för juridik, psykologi och socialt arbete.
    Fear-avoidance beliefs, catastrophizing, and distress: a longitudinal subgroup analysis on patients with musculoskeletal pain2011Inngår i: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 27, nr 7, s. 567-577Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The aim of the present study was to describe fear-avoidance beliefs, catastrophizing, and emotional distress among musculoskeletal pain patients in primary healthcare and to explore the relationship of psychological risk profiles for pain, function, and sick leave from baseline through 1-year and 3-year follow-ups.

    Methods: Ratings from 110 musculoskeletal pain patients were collected and cluster analysis was used to identify subgroups with similar patterns on fear-avoidance beliefs, catastrophizing, and emotional distress. The clusters were examined cross-sectionally and prospectively on sick leave, function, and pain.

    Results: Five distinct profiles were found: “low scores cluster,” “high score cluster,” “fear-avoidance beliefs and catastrophizing cluster,” “distress only cluster,” and “medium catastrophizing cluster.” The “low scores cluster” and “distress only cluster” had the most favorable scores on outcome variables. The analysis of common developmental pathways showed considerable stability over time. Reorganization of clusters in a psychological “high risk cluster” and a “low risk cluster” showed significant differences at 1-year and 3-year follow-ups in functional ability as well as in decreased sick leave. There were no significant differences between the groups on average pain ratings at the 2 measure points.

    Conclusions: Distinct profiles of catastrophizing, fear-avoidance beliefs, and emotional distress were extracted and meaningfully related to future sick leave and dysfunction outcomes. The structures of the profiles were essentially stable and became more accentuated across a 3-year period. The results underscore the need to address psychological aspects as fear-avoidance beliefs, catastrophizing, and emotional distress in the management of patients with musculoskeletal pain and may open the path for a better tailored treatment approach for this patient group.

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