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Bäckryd, E. (2018). Gender differences in dispensed analgesics in Sweden during 2006-2015 - an observational, nationwide, whole-population study. International Journal of Women's Health, 10, 55-64
Open this publication in new window or tab >>Gender differences in dispensed analgesics in Sweden during 2006-2015 - an observational, nationwide, whole-population study
2018 (English)In: International Journal of Women's Health, ISSN 1179-1411, E-ISSN 1179-1411, Vol. 10, p. 55-64Article in journal (Refereed) Published
Abstract [en]

A potentially illuminating way of looking at gender differences in health and disease is to study differences in drug utilization. The aim of this study was to describe gender differences in dispensed analgesics (including nonsteroidal anti-inflammatory drugs [NSAIDs]) in Sweden during 2006-2015.

Place, publisher, year, edition, pages
Dove Medical Press, 2018
Keywords
NSAIDs; acetaminophen; drugs; medicines; nonsteroidal anti-inflammatory drugs; opioids; paracetamol; sex; triptans
National Category
Gender Studies Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-152527 (URN)10.2147/IJWH.S142052 (DOI)29403317 (PubMedID)
Available from: 2019-03-05 Created: 2019-03-05 Last updated: 2019-03-05
Kallman, T. F., Ghafouri, B. & Bäckryd, E. (2018). Salivary beta-endorphin and substance P are not biomarkers of neuropathic chronic pain propensity. Heliyon, 4(8), Article ID e00718.
Open this publication in new window or tab >>Salivary beta-endorphin and substance P are not biomarkers of neuropathic chronic pain propensity
2018 (English)In: Heliyon, ISSN 2405-8440, Vol. 4, no 8, article id e00718Article in journal (Refereed) Published
Abstract [en]

Objective

The pathophysiology of chronic pain is complex, with most of our knowledge being derived from preclinical studies. The search for biomarkers mirroring the pathophysiology of chronic pain is ongoing, and there is an increasing interest in saliva as a diagnostic tool. Given what is known about salivary substance Pand salivary gland innervation, we hypothesized that salivary substance P and/or beta-endorphin might reflect the basal activity of these neuropeptides in the central nervous system, thereby perhaps mirroring a general propensity to chronic pain. Based on this overall hypothesis, our aim was to compare salivary levels of these neuropeptides in chronic neuropathic pain patients with healthy controls. An additional aim was to relate salivary levels to plasma levels.

Materials and methods

We compared salivary concentrations of beta-endorphin and substance P in 14 chronic neuropathic pain patients with concentrations in 18 healthy controls using a Luminex technology kit. Salivary-to-plasma quotients were also calculated.

Results

We found no significant difference between the groups' salivary concentrations of substance P and beta-endorphin. No correlation was found between salivary and plasma concentrations of each neuropeptide, which we hypothesize might point to local production of beta-endorphin and/or substance P in the salivary glands. Given high substance P salivary-to-plasma quotients, such a local production seems more likely for substance P than for beta-endorphin.

Conclusions

Propensity to neuropathic chronic pain was not substantiated by our analysis of salivary levels of substance P and/or beta-endorphin. However, we report salivary-to-plasma quotients that give potentially important physiological insight about these neuropeptides.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Neurology, Neuroscience
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-154915 (URN)10.1016/j.heliyon.2018.e00718 (DOI)000443512800046 ()30116793 (PubMedID)2-s2.0-85050880433 (Scopus ID)
Available from: 2019-03-05 Created: 2019-03-05 Last updated: 2019-03-14Bibliographically approved
Olausson, P., Ghafouri, B., Bäckryd, E. & Gerdle, B. (2017). Clear differences in cerebrospinal fluid proteome between women with chronic widespread pain and healthy women - a multivariate explorative cross-sectional study. Journal of Pain Research, 10, 575-590
Open this publication in new window or tab >>Clear differences in cerebrospinal fluid proteome between women with chronic widespread pain and healthy women - a multivariate explorative cross-sectional study
2017 (English)In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 10, p. 575-590Article in journal (Refereed) Published
Abstract [en]

Introduction: Frequent chronic local pain can develop into chronic widespread pain (CWP). The spread of pain is correlated with pain intensity, anxiety, and depression, conditions that ultimately lead to a poor quality of life. Knowledge is incomplete about CWPs etiology, although it has been suggested that both central hyperexcitability and/or a combination with peripheral factors may be involved. Cerebrospinal fluid (CSF) could act as a mirror for the central nervous system as proteins are signal substances that activate the formation of algesics and control nociceptive processes. To this end, this study investigates the CSF protein expression in women with CWP and in female healthy controls. Materials and methods: This study included 12 female patients with CWP diagnosed according to the American College of Rheumatology criteria with 13 healthy age-and sex-matched pain-free subjects. All subjects went through a clinical examination and answered a health questionnaire that registered sociodemographic and anthropometric data, pain characteristics, psychological status, and quality of life rating. CSF was collected by lumbar puncture from each subject. Two-dimensional gel electrophoresis in combination with mass spectrometry was used to analyze the CSF proteome. This study identifies proteins that significantly discriminate between the two groups using multivariate data analysis (MVDA) (i.e., orthogonal partial least squares discriminant analysis [OPLS-DA]). Results: There were no clinically significant levels of psychological distress and catastrophization presented in subjects with CWP. MVDA revealed a highly significant OPLS-DA model where 48 proteins from CSF explained 91% (R-2) of the variation and with a prediction of 90% (Q(2)). The highest discriminating proteins were metabolic, transport, stress, and inflammatory. Conclusion: The highest discriminating proteins (11 proteins), according to the literature, are involved in apoptotic regulations, anti-inflammatory and anti-oxidative processes, the immune system, and endogenous repair. The results of this explorative study may indicate the presence of neuro-inflammation in the central nervous system of CWP patients. Future studies should be larger and control for confounders and determine which alterations are unspecific/general and which are specific changes.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD, 2017
Keywords
biomarkers; muscle pain; inflammation
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:liu:diva-136368 (URN)10.2147/JPR.S125667 (DOI)000396321300001 ()28331360 (PubMedID)
Note

Funding Agencies|Swedish Research Council [K2015-99x-21874-05-4]; Medical Research Council of Southeast Sweden [FORSS-159031]; Region Ostergotland [LIO-35923, SC-2013-00395-36]; AFA Insurance [140341]

Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2018-04-17
Bäckryd, E., Heilig, M. & Hoffmann, M. (2017). Dynamiken i förskrivningen av opioider i Sverige 2000–2015 - Markanta omfördelningar inom opioidgruppen, men ingen »epidemi«. Läkartidningen, 114
Open this publication in new window or tab >>Dynamiken i förskrivningen av opioider i Sverige 2000–2015 - Markanta omfördelningar inom opioidgruppen, men ingen »epidemi«
2017 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114Article in journal (Refereed) Published
Abstract [en]

Opioid prescription changes in Sweden 2000-2015 In contrast to the well-established »opioid epidemic« in the US, very little is known about how the prescription of opioids in Sweden has developed during the last decade. Aggregated data from the open Statistical database of the Swedish Board of Health and Welfare were analyzed descriptively. The yearly prevalence of opioid prescription did not change 2006-2015, but there were dramatic shifts in the choice of opioids. During this period, dextropropoxyphene was pulled off the market. Tramadol was used by fewer individuals (-54 % over the decade), but dosages expressed as Defined Daily Dose/patient/year (DDD/pat/y) increased (+41 %). In contrast, oxycodone and morphine were used by more individuals (+465 % and +137 %, respectively), but DDD/pat/y decreased during the period (-56% and -54%). Studies on non-aggregated data from available registries are needed to further elucidate the circumstances and possible consequences of these shifts in opioid prescription patterns.

Place, publisher, year, edition, pages
Läkartidningen Förlag, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-146143 (URN)28485763 (PubMedID)
Available from: 2018-03-29 Created: 2018-03-29 Last updated: 2018-04-13
Bäckryd, E., Tanum, L., Lind, A.-L., Larsson, A. & Gordh, T. (2017). Evidence of both systemic inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and to plasma. Journal of Pain Research, 10
Open this publication in new window or tab >>Evidence of both systemic inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and to plasma
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2017 (English)In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 10Article in journal (Refereed) Published
Abstract [en]

In addition to central hyperexcitability and impaired top-down modulation, chronic inflammation probably plays a role in the pathophysiology of fibromyalgia (FM). Indeed, on the basis of both animal experiments and human studies involving the analysis of cytokines and other inflammation-related proteins in different body fluids, neuroinflammatory mechanisms are considered to be central to the pathophysiology of many chronic pain conditions. However, concerning FM, previous human plasma/serum and/or cerebrospinal fluid (CSF) cytokine studies have looked only at a few predetermined cytokine candidates. Instead of analyzing only a few substances at a time, we used a new multiplex protein panel enabling simultaneous analysis of 92 inflammation-related proteins. Hence, we investigated the CSF and plasma inflammatory profiles of 40 FM patients compared with CSF from healthy controls (n= 10) and plasma from blood donor controls (n= 46). Using multivariate data analysis by projection, we found evidence of both neuroinflammation (as assessed in CSF) and chronic systemic inflammation (as assessed in plasma). Two groups of proteins (one for CSF and one for plasma) highly discriminating between patients and controls are presented. Notably, we found high levels of CSF chemokine CX3CL1 (also known as fractalkine). In addition, previous findings concerning IL-8 in FM were replicated, in both CSF and plasma. This is the first time that such an extensive inflammatory profile has been described for FM patients. Hence, FM seems to be characterized by objective biochemical alterations, and the lingering characterization of its mechanisms as essentially idiopathic or even psychogenic should be seen as definitively outdated.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD, 2017
Keywords
cerebrospinal fluid; chemokines; chronic pain; cytokines; fibromyalgia; inflammation
National Category
Neurology
Identifiers
urn:nbn:se:liu:diva-136369 (URN)10.2147/JPR.S128508 (DOI)000396320700001 ()
Note

Funding Agencies|Uppsala Berzelii Technology Centre for Neurodiagnostics; Swedish Governmental Agency for Innovation Systems (Vinnova); Swedish Research Council [P29797-1]

Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2018-04-17
Bäckryd, E. (2017). Långvarig smärta efter kirurgi, neuropatisk smärta, CRPS. Information från Läkemedelsverket, 3, 34-38
Open this publication in new window or tab >>Långvarig smärta efter kirurgi, neuropatisk smärta, CRPS
2017 (Swedish)In: Information från Läkemedelsverket, ISSN 1101-7104, Vol. 3, p. 34-38Article in journal (Other academic) Published
Abstract [sv]

Neuropatisk smärta orsakas definitionsmässigt av en skada eller sjukdom i det somatosensoriska nervsystemet. Långvarig postoperativ smärta (LPOS) är tämligen vanligt, framför allt efter ingrepp som exempelvis amputation, torakotomi, eller mastektomi. I många fall anses LPOS vara av neuropatisk karaktär, och den farmakologiska behandlingen utgår då i stor utsträckning från rekommendationerna för behandling av neuropatisk smärta, med fokus på vissa antidepressiva läkemedel (amitriptylin, duloxetin) och gabapentinoider (gabapentin, pregabalin). Topikal behandling med till exempel lidokainplåster kan vara av stort värde när smärtan utlöses av lätt beröring av huden (allodyni). Överlag bör stor försiktighet råda angående långtidsanvändning av opioider. Vid LPOS efter bukkirurgi bör man speciellt beakta opioidernas negativa effekter på tarmfunktionen, eftersom en ”ond cirkel” kan uppkomma mellan ökade doser opioider och ökad smärta. Komplext regionalt smärtsyndrom (CRPS) kan uppkomma i en extremitet efter trauma av lindrig karaktär och/eller immobilisering (till exempel gipsning). Även om CRPS typ 1 definitionsmässigt inte är ett neuropatiskt smärttillstånd, är de farmakologiska behandlingsprinciperna ändå i stor utsträckning desamma som för neuropatisk smärta. Mer forskning behövs för att på sikt kunna få fram bättre, mer mekanism-baserade behandlingsmetoder.

Place, publisher, year, edition, pages
Uppsala, Sweden: Läkemedelsverket, 2017
National Category
Orthopaedics
Identifiers
urn:nbn:se:liu:diva-149515 (URN)
Available from: 2018-07-04 Created: 2018-07-04 Last updated: 2018-08-08Bibliographically approved
Gerdle, B., Ghafouri, B., Ghafouri, N., Bäckryd, E. & Gordh, T. (2017). Signs of ongoing inflammation in female patients with chronic widespread pain A multivariate, explorative, cross-sectional study of blood samples. Medicine (Baltimore, Md.), 96(9), Article ID e6130.
Open this publication in new window or tab >>Signs of ongoing inflammation in female patients with chronic widespread pain A multivariate, explorative, cross-sectional study of blood samples
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2017 (English)In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, no 9, article id e6130Article in journal (Refereed) Published
Abstract [en]

This cross-sectional study investigates the plasma inflammatory profile of chronic widespread pain CWP) patients compared to healthy controls CON). Rather than analyzing a relatively few substances at a time, we used a new multiplex proximity extension assay PEA) panel that enabled the simultaneous analysis of 92 inflammation-related proteins, mainly cytokines and chemokines. Seventeen women with CWP and 21 female CON participated and a venous blood sample was drawn from all subjects. Pain intensity and pain thresholds for pressure, heat, and cold were registered. A PEA panel 92 proteins) was used to analyze the blood samples. Multivariate data analysis by projection was used in the statistical analyses. Eleven proteins significantly differentiated the CON and CWP subjects R-2=0.58, Q(2)=0.37, analysis of variance of cross-validated predictive residuals P=0.006). It was not possible to significantly regress pain thresholds within each group CON or CWP). Positive significant correlations existed between several proteins and pain intensities in CWP, but the model reliability of the regression was poor. CWP was associated with systemic low-grade inflammation. Larger studies are needed to confirm the results and to investigate which alterations are condition-specific and which are common across chronic pain conditions. The presence of inflammation could promote the spreading of pain, a hallmark sign of CWP. As it has been suggested that prevalent comorbidities to pain (e.g., depression and anxiety, poor sleep, and tiredness) also are associated with inflammation, it will be important to determine whether inflammation may be a common mediator.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2017
Keywords
chemokine; cytokine; fibromyalgia; pain; widespread pain
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-136660 (URN)10.1097/MD.0000000000006130 (DOI)000395795900011 ()28248866 (PubMedID)
Note

Funding Agencies|Uppsala Berzelii Technology Center for Neurodiagnostics; Swedish Governmental Agency for Innovation Systems (VINNOVA); Swedish Research Council [P29797-1, K2015-99x-21874-05-4]; County Council of Ostergotland [LIO-35923, SC-2013-00395-36]; AFA Insurance [140341]

Available from: 2017-04-20 Created: 2017-04-20 Last updated: 2018-04-17
Bäckryd, E. (2016). Dags att folkbilda om smärta. Svenska dagbladet (10 April)
Open this publication in new window or tab >>Dags att folkbilda om smärta
2016 (Swedish)In: Svenska dagbladet, ISSN 1101-2412, no 10 AprilArticle in journal (Other (popular science, discussion, etc.)) Published
Place, publisher, year, edition, pages
Stockholm: Svenska dagbladets AB, 2016
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-149517 (URN)
Note

Svenska Dagbladet Debatt, 10 April

Available from: 2018-07-04 Created: 2018-07-04 Last updated: 2019-01-25Bibliographically approved
Bäckryd, E. (2016). Synliggör den osynliga smärtan. Bonnier Business Media
Open this publication in new window or tab >>Synliggör den osynliga smärtan
2016 (Swedish)Other (Other (popular science, discussion, etc.))
Place, publisher, year, pages
Bonnier Business Media, 2016
Series
Dagens medicin, ISSN 1104-7488 ; 2016-10-21
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-149516 (URN)
Available from: 2018-07-04 Created: 2018-07-04 Last updated: 2018-08-30
Karlsson, L., Gerdle, B., Ghafouri, B., Bäckryd, E., Olausson, P., Ghafouri, N. & Larsson, B. (2015). Intramuscular pain modulatory substances before and after exercise in women with chronic neck pain. European Journal of Pain, 19(8), 1075-1085
Open this publication in new window or tab >>Intramuscular pain modulatory substances before and after exercise in women with chronic neck pain
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2015 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 19, no 8, p. 1075-1085Article in journal (Refereed) Published
Abstract [en]

BackgroundIn peripheral tissue, several substances influence pain and pain modulation. Exercise has been found to decrease pain and improve function for chronic pain conditions, but how and why exercise produces beneficial effects remains unclear. This study investigates whether aspects of pain and concentrations of substances with algesic, analgesic and metabolic functions differ between women with chronic neck shoulder pain (CNSP) and healthy women (CON) and whether changes are found after an exercise intervention for CNSP. MethodsForty-one women with CNSP and 24 CON subjects were included. The participants attended two microdialysis sessions with 4-6 months between the experiments. During this period, the CNSP subjects underwent an exercise intervention. Expression levels of substance P, beta-endorphin, cortisol, glutamate, lactate and pyruvate as well as pain intensity and pressure pain thresholds were analysed. ResultsAt baseline, higher concentrations of glutamate and beta-endorphin and lower concentrations of cortisol in CNSP than CON were found. After exercise, decreased levels of substance P and possibly of glutamate, increased levels of beta-endorphin and cortisol as well as decreased pain intensity and increased pain pressure thresholds were found for CNSP. ConclusionsThe findings at baseline indicated algesic and analgesic alterations in the painful trapezius muscles. The findings for CNSP after the exercise intervention, with changes in peripheral substances and decreased pain intensity and sensitivity, could reflect a long-term physiological effect of the exercise.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2015
National Category
Physiotherapy Physiology
Identifiers
urn:nbn:se:liu:diva-121426 (URN)10.1002/ejp.630 (DOI)000360180300005 ()25430591 (PubMedID)
Note

Funding Agencies|Swedish Research Council [K2011-69X-21874-01-6]; Swedish Council for Working Life and Social Research [2010-0913]

Available from: 2015-09-18 Created: 2015-09-18 Last updated: 2018-01-11
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4420-418X

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