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Lemming, Dag
Publications (10 of 13) Show all publications
Lemming, D., Börsbo, B., Sjörs, A., Lind, E.-B., Arendt-Nielsen, L., Graven-Nielsen, T. & Gerdle, B. (2017). Cuff Pressure Pain Detection Is Associated with Both Sex and Physical Activity Level in Nonathletic Healthy Subjects. Pain medicine (Malden, Mass.), 18(8), 1573-1581
Open this publication in new window or tab >>Cuff Pressure Pain Detection Is Associated with Both Sex and Physical Activity Level in Nonathletic Healthy Subjects
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2017 (English)In: Pain medicine (Malden, Mass.), ISSN 1526-2375, E-ISSN 1526-4637, Vol. 18, no 8, p. 1573-1581Article in journal (Refereed) Published
Abstract [en]

Purpose. The aim of this study was to evaluate pressure pain sensitivity on leg and arm in 98 healthy persons (50 women) using cuff algometry. Furthermore, associations with sex and physical activity level were investigated.

Method. Normal physical activity level was defined as Godin Leisure-Time Exercise Questionnaire (GLTEQ) score ≤ 45 and high activity level as GLTEQ > 45. A pneumatic double-chamber cuff was placed around the arm or leg where a single chamber was inflated. The cuff inflation rate (1 kPa/s) was constant, and pain intensity was registered continuously on a 10 cm electronic visual analogue scale (VAS). The pain detection threshold (PDT) was defined as when the pressure was perceived as painful, and pain tolerance (PTT) was when the subject terminated the cuff inflation. For PTT, the corresponding VAS score was recorded (VAS-PTT). The protocol was repeated with two chambers inflated.

Result. Only single cuff results are given. For women compared with men, the PDT was lower when assessed in the arm (P = 0.002), PTTs were lower in the arm and leg (P < 0.001), and the VAS-PTT was higher in the arm and leg (P < 0.033). Highly active participants compared with less active had higher PDT (P = 0.027) in the leg. Women showed facilitated spatial summation (P < 0.014) in the arm and leg and a steeper VAS slope (i.e., the slope of the VAS pressure curve between PDT and PPT) in the arm and leg (P < 0.003).

Conclusion. This study indicates that reduced pressure pain sensitivity is associated both with male sex and physical activity level.

Place, publisher, year, edition, pages
Oxford: Oxford University Press, 2017
Keywords
Experimental Pain, Pain Assessment, Cuff Pressure Sensitivity, Physical Activity, Sex, Gender
National Category
Physiotherapy Sport and Fitness Sciences Occupational Health and Environmental Health
Identifiers
urn:nbn:se:liu:diva-140496 (URN)10.1093/pm/pnw309 (DOI)000409845200018 ()
Note

Funding agencies: Swedish Research Council [K2011-69X-21874-01-6]; FORTE The Swedish Research Council for Health, Working life and Welfare [2010-0913]

Available from: 2017-09-05 Created: 2017-09-05 Last updated: 2018-04-16Bibliographically approved
Lemming, D. (2016). Multimodal Rehabilitation Programs (MMRP) for patients with longstanding complex pain conditions – The need for quality control with follow-up studies of patient outcomes. Scandinavian Journal of Pain, 10, 104-105
Open this publication in new window or tab >>Multimodal Rehabilitation Programs (MMRP) for patients with longstanding complex pain conditions – The need for quality control with follow-up studies of patient outcomes
2016 (English)In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 10, p. 104-105Article in journal, Editorial material (Refereed) Published
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-122919 (URN)10.1016/j.sjpain.2015.11.001 (DOI)
Note

Refers to article: Andrea Hållstam, Monika Löfgren, Christer Svensén, Britt-Marie Stålnacke Patients with chronic pain: One-year follow-up of a multimodal rehabilitation programme at a pain clinicScandinavian Journal of Pain, Volume 10, January 2016, Pages 36-42. DOI: 10.1016/j.sjpain.2015.08.008

Available from: 2015-11-30 Created: 2015-11-30 Last updated: 2018-01-10Bibliographically approved
Lemming, D., Börsbo, B., Sjörs, A., Lind, E.-B., Arendt-Nielsen, L., Graven-Nielsen, T. & Gerdle, B. (2015). Single-point but not tonic cuff pressure pain sensitivity is associated with level of physical fitness: a study of non-athletic healthy subjects. PLoS ONE, 10(5), Article ID e0125432.
Open this publication in new window or tab >>Single-point but not tonic cuff pressure pain sensitivity is associated with level of physical fitness: a study of non-athletic healthy subjects
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2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0125432Article in journal (Refereed) Published
Abstract [en]

Exercise is often used for pain rehabilitation but the link between physical activity level and pain sensitivity is still not fully understood. Pressure pain sensitivity to cuff algometry and conditioned pain modulation (CPM) were evaluated in highly active men (n=22), normally active men (n=26), highly active women (n=27) and normally active women (n=23) based on the Godin Leisure-Time Exercise Questionnaire. Cuff pressure pain sensitivity was assessed at the arm and lower leg. The subjects scored the pain intensity on an electronic Visual Analogue Scale (VAS) during ten minutes with 25 kPa constant cuff pressure and two minutes with zero pressure. The maximal VAS score and area under the VAS-curve were extracted. Pressure pain thresholds (PPT) were recorded by manual pressure algometry on the ipsilateral tibialis anterior muscle before, during and after the tonic arm stimulation.

Tonic cuff stimulation of the arm and leg resulted in higher VAS peak scores in women compared with men (p<0.04). In all groups the PPTs were reduced during and after the cuff stimulation compared with baseline (p=0.001). PPT were higher in men compared with women (p=0.03) and higher in highly physical active compared with normal active (p=0.048). 

Besides the well-known gender difference in pressure pain sensitivity this study demonstrates  that a high physical fitness degree in non-athletic subjects is associated with increased pressure pain thresholds but does not affect cuff pressure pain sensitivity in healthy people.

Place, publisher, year, edition, pages
Public Library of Science, 2015
Keywords
Pain assessment, Cuff algometry, Tonic muscle pressure sensitivity, Experimental pain
National Category
Public Health, Global Health, Social Medicine and Epidemiology Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-131422 (URN)10.1371/journal.pone.0125432 (DOI)000353887100112 ()25933412 (PubMedID)
Note

Research data for the above article to be published in Plos One.

Available from: 2014-11-04 Created: 2014-11-04 Last updated: 2017-12-05Bibliographically approved
Lindström, P., Lemming, D., Lantz Lenander, E. & Jönsson, R. (2015). Sverige behöver riktlinjer för oberoende medicinska utredningar [Sweden needs guidelines for independent medical evaluations]. Läkartidningen, 112, Article ID DHRZ.
Open this publication in new window or tab >>Sverige behöver riktlinjer för oberoende medicinska utredningar [Sweden needs guidelines for independent medical evaluations]
2015 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, article id DHRZArticle in journal, News item (Other academic) Published
Abstract [sv]

En oberoende medicinsk utredning kräver ett tydligt etiskt ställningstagande från utövaren, anser Pål Lindström och medförfattare. De föreslår tydliga etiska riktlinjer baserade på internationell standard, anpassade för svenska förhållanden.

Place, publisher, year, edition, pages
Stockholm: Läkartidningen Förlag AB, 2015
National Category
Medical Ethics Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-140532 (URN)
Available from: 2017-09-05 Created: 2017-09-05 Last updated: 2017-09-12Bibliographically approved
Tribukait, A., Eiken, O., Lemming, D. & Levin, B. (2013). Use of an adjustable hand plate in studying the perceived horizontal plane during simulated flight. Aviation, Space and Environmental Medicine, 84(7), 739-745
Open this publication in new window or tab >>Use of an adjustable hand plate in studying the perceived horizontal plane during simulated flight
2013 (English)In: Aviation, Space and Environmental Medicine, ISSN 0095-6562, E-ISSN 1943-4448, Vol. 84, no 7, p. 739-745Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Quantitative data on spatial orientation would be valuable not only in assessing the fidelity of flight simulators, but also in evaluation of spatial orientation training. In this study a manual indicator was used for recording the subjective horizontal plane during simulated flight.

METHODS: In a six-degrees-of-freedom hexapod hydraulic motion platform simulator, simulating an F-16 aircraft, seven fixed-wing student pilots were passively exposed to two flight sequences. The first consisted in a number of coordinated turns with visual contact with the landscape below. The visually presented roll tilt was up to a maximum 670. The second was a takeoff with a cabin pitch up of 100, whereupon external visual references were lost. The subjects continuously indicated, with the left hand on an adjustable plate, what they perceived as horizontal in roll and pitch. There were two test occasions separated by a 3-d course on spatial disorientation.

RESULTS: Responses to changes in simulated roll were, in general, instantaneous. The indicated roll tilt was approximately 30% of the visually presented roll. There was a considerable interindividual variability. However, for the roll response there was a correlation between the two occasions. The amplitude of the response to the pitch up of the cabin was approximately 75%; the response decayed much more slowly than the stimulus.

DISCUSSION: With a manual indicator for recording the subjective horizontal plane, individual characteristics in the response to visual tilt stimuli may be detected, suggesting a potential for evaluation of simulation algorithms or training programs.

Place, publisher, year, edition, pages
Aerospace Medical Association, 2013
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-103732 (URN)10.3357/ASEM.3470.2013 (DOI)000332996200013 ()23855072 (PubMedID)
Available from: 2014-01-24 Created: 2014-01-24 Last updated: 2017-12-06Bibliographically approved
Lemming, D., Graven-Nielsen, T., Sörensen, J., Arendt-Nielsen, L. & Gerdle, B. (2012). Widespread pain hypersensitivity and facilitated temporal summation of deep tissue pain in whiplash associated disorder: an explorative study of women. Journal of Rehabilitation Medicine, 44(8), 648-657
Open this publication in new window or tab >>Widespread pain hypersensitivity and facilitated temporal summation of deep tissue pain in whiplash associated disorder: an explorative study of women
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2012 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 8, p. 648-657Article in journal (Refereed) Published
Abstract [en]

Objective: Widespread deep tissue pain hyperalgesia was evaluated in women with chronic whiplash associated disorder (n=25) and controls (n=10) using computerized cuff pressure algometry and hypertonic saline infusion. Methods: A pneumatic double-chamber cuff was placed around: (i) the arm and (ii) the leg. Cuff inflation rate was constant and the pain intensity was registered continuously on a visual analogue scale (VAS); thresholds of detection and tolerance were extracted. For assessment of spatial summation the protocol was repeated with a single-chamber cuff inflated around the leg. Temporal summation of pain was assessed from the leg with constant cuff pressure stimulation at 2 different pressure intensities for 10 min. Hypertonic saline was infused in the tibialis anterior muscle. Results: Cuff pressure pain thresholds were lower in subjects with whiplash associated disorder compared with controls (pless than0.05). Tonic pressure stimulation evoked higher maximal VAS and larger areas under the VAS curve in subjects with whiplash associated disorder compared with controls (pless than0.05). The pain threshold and tolerance were higher during single cuff than double cuff stimulation. The area under the VAS curve after intramuscular saline infusion was larger in whiplash associated disorder (pless than0.05). Conclusion: The results indicated widespread hyperalgesia in chronic whiplash associated disorder and facilitated temporal summation outside the primary pain area, suggesting involvement of central sensitization.

Place, publisher, year, edition, pages
Foundation for Rehabilitation Information, 2012
Keywords
assessment; cuff algometry; neck; pain; WAD
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79674 (URN)10.2340/16501977-1006 (DOI)000306296400007 ()
Available from: 2012-08-14 Created: 2012-08-13 Last updated: 2017-12-07
Levin, B., Tribukait, A., Lemming, D. & Eiken, O. (2011). Utvärdering av utbildning i spatial desorientering; redovisning av frågeformulär. Linköping: Totalförsvarets forskningsinstitut (FOI)
Open this publication in new window or tab >>Utvärdering av utbildning i spatial desorientering; redovisning av frågeformulär
2011 (Swedish)Report (Other academic)
Abstract [sv]

En kombinerad grundutbildning i spatial desorientering (SD) och flygning med night vision goggles (NVG) ges av företaget AMST Systemtechnik GmbH i dess lokaler i Ranshofen i Österrike.Denna utbildning blev föremål för en ingående utvärdering i samband med att två grupper av svenska flygförare deltog under hösten 2010.Den del av utvärderingen som redovisas i denna rapport är baserad på deltagarnas egna åsikter och bygger på en metod som omfattar såväl öppna frågor som skattningsfrågor och även möjlighet att ange fria kommentarer.Eleverna uppgav att det är viktigt att genomföra både grundläggande och repeterande SD-utbildning.De värdesatte SD-teori generellt sett och efterfrågade ett mer omfattande och djupare teoretiskt paket än vad de hittills har erhållit.Eleverna ansåg också att utbildningen på AMST på ett effektivt sätt ger en ökad förståelse för illusioner, en ökad förmåga att känna igen en illusion och även att komma över en villa om den skulle inträffa.När det gäller night vision (NV) delen uppgav eleverna att utbildningen på ett effektivt sätt ger en ökad förståelse för problematiken runt flygning med night vision goggles (NVG), en ökad förmåga att känna igen NV-relaterade fenomen och en förberedelse för att kunna hantera flygning med NVG.Eleverna framhöll att kursen i större utsträckning borde ha koordinerats med avseende på tid och innehåll med annan redan genomgången utbildning eller sådan som är inplanerad längre fram.I de fall eleverna redan upplevt en del illusioner eller erfarit NV-fenomen etc. uppfattades utbildningen som ett bra komplement och en repetition.Eleverna ansåg att utbildningen på AMST delvis var ineffektiv och man hade förväntat sig både mer teori och tid i simulatorn.Ett stort antal elever i kombination med begränsad tillgång till simulatorutrustning ledde till en ansenlig väntetid mellan passen.Eleverna ansåg också att det finns möjlighet till förbättringar av den SD-utbildning som ges i stort och avgav ett antal olika förslag.

Abstract [en]

A combined introductory training course in spatial disorientation (SD) and flight with night vision goggles (NVG) is provided by AMST Systemtechnik GmbH, on-site in the Ranshofen facility in Austria. This course was subject to an extensive evaluation in conjunction with the participation of two groups of Swedish pilots in the fall of 2010. The part of the evaluation included in this report concerns the students' own opinions and is based on open and rating questions together with additional free comments. The students believed that it is important to perform both basic and recurrent SDtraining. In general, SD-theory was much appreciated and they requested a more comprehensive theoretical education than previously received. The students also stated that the training at AMST in an efficient manner increases ones understanding of illusions, gives an increased ability to recognize an illusion, and to overcome an illusion should it occur. Regarding the night vision (NV) part the students claimed that the training efficiently increases ones understanding of NVrelated problems associated with night vision goggles (NVG), gives an increased ability to recognize NV-related phenomena, and enhances ones preparedness for flight using NVG. The students stressed that the course to a larger extent should have been coordinated with their previous or currently planned SD/NV training both regarding timeframe and content. In cases when a student already on a previous occasion had experienced a given illusion or NV-phenomenon, the present training was considered a valuable addition and a rehearsal. The students regarded the training as partially inefficient and had expected more theory and time spent in the simulator. A large number of students in combination with limited access to simulator equipment led to substantial delay between missions. The students believed that their SD-training could be improved and proposed a number of ideas for development.

Place, publisher, year, edition, pages
Linköping: Totalförsvarets forskningsinstitut (FOI), 2011. p. 36
Series
FOI-R, ISSN 1650-1942 ; 3192
Keywords
Spatial desorientering, simulator, träning, mörkerflygning, illusioner, villor, Spatial disorientation, simulator, training, night vision, NVG, illusions
National Category
Physiology
Identifiers
urn:nbn:se:liu:diva-122581 (URN)FOI-R--3192--SE (ISRN)
Available from: 2012-01-03 Created: 2015-11-10 Last updated: 2018-01-10Bibliographically approved
Gerdle, B., Lemming, D., Kristiansen, J., Larsson, B., Peolsson, M. & Rosendal, L. (2008). Biochemical alterations in the trapezius muscle of patients with chronic whiplash associated disorders (WAD): A microdialysis study. European Journal of Pain, 12(1), 82-93
Open this publication in new window or tab >>Biochemical alterations in the trapezius muscle of patients with chronic whiplash associated disorders (WAD): A microdialysis study
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2008 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, no 1, p. 82-93Article in journal (Refereed) Published
Abstract [en]

The mechanisms behind the development of chronic trapezius myalgia in patients with whiplash associated disorders (WAD) appear to involve both peripheral and central components, but the specific contribution of alterations in muscle is not clear. Female patients with WAD and involvement of trapezius (N = 22) and female controls (N = 20; CON) were studied during an experiment compromised of rest (baseline), 20 min repetitive low-force exercise and 120 min recovery. Their interstitial concentrations of serotonin (5-HT), glutamate, lactate, pyruvate, potassium, interleukin-6 (IL-6), and blood flow were determined in the trapezius muscle using a microdialysis technique. Pressure pain thresholds (PPT) over trapezius and tibialis anterior muscles were also assessed. In WAD, we found signs of generalized hypersensitivity according to PPT. The WAD group had significantly higher interstitial [IL-6] and [5-HT] in the trapezius than the CON. [Pyruvate] was overall significantly lower in WAD, and with lactate it showed another time-pattern throughout the test. In the multivariate regression analysis of pain intensity [5-HT] was the strongest regressor and positively correlated with pain intensity in WAD. In addition, blood flow, [pyruvate], and [potassium] influenced the pain intensity in a complex time dependent way. These findings may indicate that peripheral nociceptive processes are activated in WAD with generalized hypersensitivity for pressure and they are not identical with those reported in chronic work-related trapezius myalgia, which could indicate different pain mechanisms.

Keywords
Lactate, Pyruvate, Serotonin, Glutamate, Muscle pain, Sensitization, Whiplash
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12921 (URN)10.1016/j.ejpain.2007.03.009 (DOI)
Available from: 2008-01-30 Created: 2008-01-30 Last updated: 2017-12-13
Lemming, D. (2008). Experimental Aspects on Chronic Whiplash-Associated Pain. (Doctoral dissertation). Linköping University Electronic Press
Open this publication in new window or tab >>Experimental Aspects on Chronic Whiplash-Associated Pain
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Chronic pain after whiplash trauma (chronic WAD) to the neck is still a common clinical problem in terms of pain management, rehabilitation and insurance claims. In contrast to the increased knowledge concerning mechanisms of chronic pain in general, no clinical guidelines exist concerning assessment, pain control and rehabilitation of patients with chronic WAD.

Aim: The general aim of this thesis was to use experimental techniques to better understand the complex mechanisms underlying chronic pain after whiplash trauma. The specific aims of papers I and II were mainly to use analgesic drugs with different target mechanisms alone or in combinations to assess their effects on pain intensity (VAS). Experimental pain techniques were used in all studies to assess deep tissue sensitivity (electrical, mechanical and chemical stimuli). Paper IV aimed at assessing deep tissue sensitivity to mechanical and chemical stimulation. The aim in paper III was to investigate if biochemical changes in interstitial muscle tissue (trapezius muscle) could be detected in WAD patients.

Materials and Methods: The thesis is based on three different groups of patients with chronic WAD. In paper III and IV two different groups of healthy controls also participated. All patients were initially assessed in the pain and rehabilitation centre. In paper I (30 patients) and II (20 patients) two different techniques of drug challenges were used. In paper I: morphine, ketamine and lidocaine were used as single drugs. In paper II: remifentanil, ketamine and placebo were used in combinations and together with experimental pain assessments. Microdialysis technique was used in paper III (22 patients from study IV and 20 controls). In paper IV (25 patients and 10 controls) a new quantitative method, computerized cuff pressure algometry, was used in combination with intramuscular saline. In all papers, experimental pain techniques for deep tissue assessment (except cutaneous electrical stimulation in paper I) were used in different combinations: intramuscular hypertonic saline infusion, intramuscular electrical stimulation and pressure algometry.

Results and Conclusion: There are multiple mechanisms behind chronic whiplash-associated pain, opioid sensitive neurons, NMDA-receptors and even sodium channels might play a part. A significant share of the patients were pharmacological non-responders to analgesic drugs targeting the main afferent mechanisms involved in pain transmission, this implies activation of different pain processing mechanisms (i.e. enhanced facilitation or changes in the cortical and subcortical neuromatrix). Experimental pain assessments and drug challenges together indicate a state of central hyperexcitability. Ongoing peripheral nociception (paper III), central sensitization and dysregulation of pain from higher levels in the nervous system may interact. These findings are likely to be present early after a trauma, however it is not possible to say whether they are trauma-induced or actually represents pre-morbid variations. Clinical trials with early assessments of the somatosensory system (i.e., using experimental pain) and re-evaluations, early intervention (i.e. rehabilitation) and intensified pain management could give further knowledge.

Place, publisher, year, edition, pages
Linköping University Electronic Press, 2008. p. 88
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1035
Keywords
Neck injury, whiplash-associated disorders, chronic pain, central sensitization, pain assessment, drug challenges
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-10693 (URN)978-91-85895-19-9 (ISBN)
Public defence
2008-02-22, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2008-01-30 Created: 2008-01-30 Last updated: 2015-11-19
Lemming, D., Graven-Nielsen, T., Sörensen, J., Arendt-Nielsen, L. & Gerdle, B. (2008). Facilitated temporal summation and generalized hyperalgesia in whiplash associated disorder.
Open this publication in new window or tab >>Facilitated temporal summation and generalized hyperalgesia in whiplash associated disorder
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2008 (English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-12922 (URN)
Available from: 2008-01-30 Created: 2008-01-30
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