To Örebro University

BACKGROUND: Persistent pain, one of the most common reasons for suffering and health care seeking, often co-occurs with emotional problems such as depression and anxiety. Within the Center for Health and Medical Psychology at Örebro University, Sweden, we have developed a new treatment aimed at addressing co-occurring persistent pain and emotional problems: hybrid emotion-focused exposure treatment. The overarching idea behind the treatment is that patients who struggle with comorbid pain and emotional problems need to develop skills in dealing with emotions as well as pain. With better skills in tolerating and soothing difficult emotions, patients will be more able to approach previously avoided stimuli and situations, such as movements, activities and social interaction.

OBJECTIVES: This review aims to delineate the development of the hybrid emotion-focused exposure treatment. It begins by outlining the theoretical background, then proceeds to describe the techniques, discuss the evidence and conclude with an illustrative case example.

RESULTS: Thus far, the treatment has been tested in a single-case study and a randomized controlled trial with promising outcomes. Overall, the hybrid treatment seems to have a good effect on patients' depressive symptoms and pain interference. The treatment is currently being implemented, and the implementation process evaluated, in primary and specialist care across Sweden.

CONCLUSIONS: The hybrid emotion-focused exposure treatment seems to be a well-suited treatment for people with a high burden of persistent pain and emotional difficulties. There is good reason to implement the treatment in clinical practice and continue evaluating treatment effects across different contexts.

BACKGROUND: Chronic pain affects 20%-30% of the population worldwide, leading to significant distress, disability and financial burden. Pain management strategies focusing on pain reduction have shown limited effects on functioning; however, behavioural treatments aimed at enhancing resilience have demonstrated strong empirical support. Digital solutions offer new opportunities for delivering evidence-based treatments, but evaluation at the individual level is needed. The aim of this study is to examine individual-level treatment effects of a digital behavioural treatment for chronic pain in a heterogeneous sample.

METHODS: A study with a single-case experimental design (SCED) was conducted with participants (N = 11) experiencing chronic pain (> 3 months) recruited through healthcare. Participants were randomised at baseline (5-10-day A-phase) and completed a 6-module digital treatment based on learning theory and well-established theories applied to chronic pain (6-8-week B-phase), with weekly therapist contact. Digital diaries, prompted twice daily, tracked psychological flexibility and acceptance, pain-related functioning, pain intensity and well-being. Data were analysed using visual analysis and effect size calculations.

RESULTS: N = 11 enrolled and data from n = 10 were analysed (n = 1 refused digital diary, n = 2 partial completers, n = 8 full completers). Pain profiles varied (e.g., chronic migraine, fibromyalgia, lower back pain, etc.). Several participants benefited from the treatment, though results varied across individuals and across outcomes.

CONCLUSION: The digital behavioural treatment showed promise in addressing diverse pain profiles and associated functioning. The variability in responses highlights the benefit of using SCED to explore individual-level effects, thus offering a methodological proof-of-concept. Findings support further development, including tailoring to match individual needs.

SIGNIFICANCE STATEMENT: This proof-of-concept study provides support for the utility of digital behavioural interventions and individual-level evaluation of treatment effects, highlighting the potential of personalised pain treatments. The findings contribute to the growing body of support for digital solutions as effective and accessible approaches to improve functioning and resilience for people with diverse pain experiences.

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.

INTRODUCTION: Provoked vestibulodynia (PVD) is a prevalent persistent pain disorder, localized to the vulva, not only affecting the sexual health of women suffering from it but also of their partners. Partner's behavioral response to the pain has implications for the affected woman's pain and sexual function, as well as the relational dynamics of the couple.

OBJECTIVES: The main aim of this study was to explore facilitative, solicitous, and negative male partner responses to women with PVD and their links to demographic and psychosexual characteristics. Further, we investigated the discrepancies in psychosexual health between currently sexually active and inactive participants, as well as levels of anxiety and depressive symptoms within our sample of male partners (N = 127).

Methods: Cross-sectional associations were examined using bivariate correlations. Differences in psychosexual health between the two sub-samples were examined using Mann-Whitney U test.

RESULTS: Our results showed that facilitative partner responses were significantly associated with higher relationship and sexual satisfaction, as well as with lower sexual distress and more approach goals. Negative partner responses were significantly associated with higher sexual distress, as well as with lower relationship and sexual satisfaction. Negative partner responses were the only responses significantly associated with the men's anxiety and depression, which suggests that mental health plays a role in partners' management of vulvodynia. In our sample, 10.2% scored above cut-off for clinical levels of depressive symptoms and 8.7% for anxiety, similar to a Swedish community sample.

Conclusion: Partner responses were associated with psychosexual health. In our sample, male partners of women with PVD did not have more anxiety or depression than other men of the same age in the general population.

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: Recent research shows that chronic pain affects 27% of the adult population. For many, pain significantly impairs quality of life and everyday functioning. Behavioral interventions have shown utility, but access remains limited. Digital health solutions can increase reach, but there is a need for user-friendly, feasible, and evidence-based digital interventions.

OBJECTIVE: This study aimed to clarify how a digital behavioral intervention for people with chronic pain can be developed through a user-centered approach to address the needs and preferences of the target population.

METHODS: This study used a multimethod approach involving end users, namely, patients with chronic pain and therapists, to develop prototypes for a digital behavioral intervention across 3 phases. In the preparation phase (phase 0), fictional patient personas (n=3) were created to represent the diversity of the target population while emphasizing transdiagnostic features across people with chronic pain. In the design phase (phase 1), qualitative data from focus groups with patients (n=5; aged 37-51 years; 4/5, 80% women; 2/5, 40% diagnosed with Ehlers-Danlos syndrome; 3/5, 60% either undiagnosed or uncertain about their diagnosis) and therapists (n=12 licensed psychologists; aged 29-64 years; 9/12, 75% women) were collected to explore end-user preferences for the intervention design and content. In the testing phase (phase 2), the initial full prototype of the digital intervention was piloted with patients (n=11; aged 36-58 years; 9/11, 82% women; with diverse diagnoses, including migraine, arthritis, fibromyalgia, complex regional pain syndrome, hypermobile Ehlers-Danlos syndrome, herniated disc, chronic fatigue syndrome, and 1/11, 9% cases of undiagnosed pain) and therapists (n=3 licensed psychologists; aged 36-58 y; 3/3, 100% women). The Consolidated Framework for Implementation Research was used to structure analyses of end-user feedback.

RESULTS: On the basis of end-user input, a 6-week digital behavioral intervention for chronic pain was created. Focus groups highlighted the importance of accessibility and adaptability of the digital intervention, emphasizing the need for tailored content, flexibility (eg, contact with the therapist via asynchronous messaging, telephone, or video calls), and user-friendly design (eg, easy navigation between modules, short microsessions, and visualizations). Average weekly ratings (scale from 1=not at all to 7=very much) by patients during pilot-testing indicated that the intervention was helpful (mean range 4.27-5.45, SD range 1.20-2.20), enjoyable (mean range 3.81-4.81, SD range 1.12-2.08), and understandable (mean range 4.45-6, SD range 1.30-1.86), suggesting initial acceptability and usability of the intervention.

CONCLUSIONS: The results illustrated the utility of the patient personas when preparing, of the focus groups when designing, and of the end-user feedback when testing this new digital intervention for people with chronic pain. The findings indicated that the intervention is promising while also providing relevant end-user suggestions (eg, video content, text-to-speech function, and add-on modules) to guide further improvements.

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.