liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
BETA
Karlsson, Linn
Publications (7 of 7) Show all publications
Karlsson, L. (2017). Chronic Pain and Exercise: Studies on pain intensity, biochemistry, adherence and attitudes. (Doctoral dissertation). Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Chronic Pain and Exercise: Studies on pain intensity, biochemistry, adherence and attitudes
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic pain is common in western countries and entails considerable consequences for the afflicted individuals as well as for the society. Furthermore, chronic pain is complex including an advanced interplay between biological-, psychological- and social aspects. Treatment of chronic pain attempts to decrease pain intensity and increase physical-, psychological- and social functioning. However, the treatment of chronic pain is still not optimized. Different types of physical activity and exercise (PA&E) are commonly applied as non-pharmacological treatment strategies for chronic pain, but the most efficient type and dose of PA&E are unclear. In addition, adherence to prescribed PA&E is often troublesome, which further complicates the application of PA&E as treatment for chronic pain.

The aim of this thesis is to increase the knowledge about PA&E as treatment for chronic pain regarding pain intensity, biochemical substances, adherence and attitudes.

The findings of this thesis were that a long-term, home-based PA&E intervention comprising strength exercises as well as stretch exercises decreased pain intensity and increased function in women with chronic neck- and shoulder pain. Using microdialysis technique, differences in pain modulatory biochemical substances were found, before the intervention, in painful trapezius muscle compared to pain-free trapezius muscle. In addition, alterations in pain modulatory substances in painful trapezius muscle after the intervention were found, which possibly could imply peripheral physiological effects of PA&E. Furthermore, psychological factors could be associated to the effects of and adherence to the PA&E intervention. An intention to be physically active were expressed by patients with chronic pain, but a discordance between the intention and PA&E-behaviour were evident, even though the PA&E were experienced as valuable.

In conclusion, this thesis strengthens the importance of PA&E as treatment for chronic pain. Especially, this thesis increases the knowledge about; possible peripheral pain inhibitory effects after long-term exercise; how psychological factors might affect the results of PA&E; and also about important behavioural aspects that might affect adherence to prescribed PA&E. This thesis highlights the need of more research on physiological pain inhibitory effects of long-term PA&E in chronic pain. Furthermore, improved methods for ensured adherence to prescribed PA&E are necessary in order to optimize the effect of PA&E as treatment for chronic pain.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. p. 96
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1575
Keywords
Adherence, biochemical substances, chronic pain, physical activity and exercise, treatment
National Category
Physiotherapy Orthopaedics Sport and Fitness Sciences
Identifiers
urn:nbn:se:liu:diva-137076 (URN)10.3384/diss.diva-137076 (DOI)9789176855188 (ISBN)
Public defence
2017-06-02, Berzeliussalen, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-05-04 Created: 2017-05-04 Last updated: 2019-10-28Bibliographically approved
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
Show others...
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
Gerdle, B., Larsson, B., Forsberg, F., Ghafouri, N., Karlsson, L., Stensson, N. & Ghafouri, B. (2014). Chronic Widespread Pain: Increased Glutamate and Lactate Concentrations in the Trapezius Muscle and Plasma. The Clinical Journal of Pain, 30(5), 409-420
Open this publication in new window or tab >>Chronic Widespread Pain: Increased Glutamate and Lactate Concentrations in the Trapezius Muscle and Plasma
Show others...
2014 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 30, no 5, p. 409-420Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND:: Chronic widespread pain (CWP), including fibromyalgia syndrome (FM), is associated with prominent negative consequences. CWP has been associated with alterations in the central processing of nociception. Whereas some researchers consider CWP/FM as a central hyperexcitability pain condition, others suggest that the central alterations are maintained by peripheral nociceptive input. Microdialysis can be used in vivo to study muscle alterations in chronic myalgia. AIM:: The aim of the study was to investigate the plasma and interstitial concentrations of metabolites and algesics in the trapezius muscle of women with CWP and in pain-free women (CON).

MATERIALS AND METHODS:: Seventeen women with CWP and 24 CON went through a clinical examination and completed a questionnaire; the pressure pain thresholds in the upper and lower extremities were registered. Microdialysis was conducted in the trapezius muscle, and a blood sample was drawn. Muscle blood flow, interstitial muscle concentrations, and plasma concentrations of lactate, pyruvate, glutamate, glucose, and glycerol (not in the plasma) were determined.

RESULTS:: CWP patients had significantly increased interstitial muscle (P=0.02 to 0.001) and plasma (P=0.026 to 0.017) concentrations of lactate and glutamate. No significant differences existed in blood flow between CWP and CON. The interstitial concentrations-but not the plasma levels-of glutamate and lactate correlated significantly with aspects of pain such as pressure pain thresholds of the trapezius (R=0.22) and tibialis anterior (R=0.18) and the mean pain intensity (R=0.10) in CWP but not in CON.

CONCLUSIONS:: The present study supports the suggestion that aspects of pain and central alterations in CWP/FM are influenced by peripheral tissue alterations.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2014
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-103741 (URN)10.1097/AJP.0b013e31829e9d2a (DOI)000334597800005 ()23887335 (PubMedID)
Available from: 2014-01-24 Created: 2014-01-24 Last updated: 2017-12-06
Ghafouri, N., Ghafouri, B., Fowler, C. J., Larsson, B., Turkina, M., Karlsson, L. & Gerdle, B. (2014). Effects of Two Different Specific Neck Exercise Interventions on Palmitoylethanolamide and Stearoylethanolamide Concentrations in the Interstitium of the Trapezius Muscle in Women with Chronic Neck Shoulder Pain. Pain medicine (Malden, Mass.), 15(8), 1379-1389
Open this publication in new window or tab >>Effects of Two Different Specific Neck Exercise Interventions on Palmitoylethanolamide and Stearoylethanolamide Concentrations in the Interstitium of the Trapezius Muscle in Women with Chronic Neck Shoulder Pain
Show others...
2014 (English)In: Pain medicine (Malden, Mass.), ISSN 1526-2375, E-ISSN 1526-4637, Vol. 15, no 8, p. 1379-1389Article in journal (Refereed) Published
Abstract [en]

Purpose. Chronic neck/shoulder pain (CNSP) is one of the most common pain conditions. The understanding of mechanisms, including the peripheral balance between nociceptive and antinociceptive processes, is incomplete. N-acylethanolamines (NAEs) are a class of endogenous compounds that regulate inflammation and pain. The aim of this study was to investigate the levels of two NAEs: the peroxisome proliferator-activated receptor type-a ligand palmitoylethanolamide (PEA) and stearoylethanolamide (SEA) in the muscle interstitium of the trapezius muscle in women with CNSP randomized to two different neck specific training programs and in a healthy pain-free control group (CON). Materials and Methods. Fifty-seven women with CNSP were randomized to strength + stretch or stretch alone exercise programs. Twenty-nine subjects underwent microdialysis procedure before and after 4-6 months of exercise. Twenty-four CON subjects underwent microdialysis procedure before and after 4-6 months without any intervention in between. Microdialysate samples were collected from the trapezius muscle and analyzed by mass spectrometry for PEA and SEA levels. Results. PEA and SEA levels were significantly higher in CNSP patients compared with CON. PEA was significantly higher in CNSP than in CON after both training programs. SEA was significantly higher in CNSP than in CON after stretch alone but not after strength + stretch training. A significant positive correlation was found between changes in pain intensity and in SEA levels in the strength + stretch group, but not in the stretch alone group. Conclusion. Our results indicate that exercise interventions differentially affect the levels of the bioactive lipids PEA and SEA in the interstitium of the trapezius muscle in women with CNSP.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keywords
N-Acylethanolamines; Palmitoylethanolamide; Stearoylethanolamide; Exercise; Chronic Muscle Pain; Microdialysis
National Category
Basic Medicine Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-112070 (URN)10.1111/pme.12486 (DOI)000342630800022 ()24995488 (PubMedID)
Note

Funding Agencies|Swedish Council for Working Life and Social Research; Swedish Research Council; PAINOMICS(TM) laboratory of Linkoping University

Available from: 2014-11-14 Created: 2014-11-13 Last updated: 2018-01-11Bibliographically approved
Karlsson, L., Takala, E.-P., Gerdle, B. & Larsson, B. (2014). Evaluation of pain and function after two home exercise programs in a clinical trial on women with chronic neck pain - with special emphasises on completers and responders. BMC Musculoskeletal Disorders, 15(6)
Open this publication in new window or tab >>Evaluation of pain and function after two home exercise programs in a clinical trial on women with chronic neck pain - with special emphasises on completers and responders
2014 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 15, no 6Article in journal (Refereed) Published
Abstract [en]

Background: Different types of exercises can help manage chronic neck pain. Supervised exercise interventions are widely used, but these protocols require substantial resources. The aim of this trial, which focused on adherence, was to evaluate two home exercise interventions. Methods: This parallel group randomized controlled trial included 57 women randomly allocated into two groups - a strength training group (STRENGTH, 34 subjects) and a stretching group (STRETCH, 23 subjects). The interventions focused on the neck and shoulder muscles and lasted for 12 months. The STRENGTH group performed weight training and ended each session with stretching exercises. These stretching exercises constituted the entirety of the STRETCH groups training session. Both groups were instructed to exercise three times per week. All the participants kept an exercise diary. In addition, all participants were offered support via phone and e-mail. The primary outcomes were pain intensity and function. The trial included a four-to six-month and a twelve-month follow-up. A completer in this study exercised at least 1,5 times per week during eight unbroken weeks. A responder in this study reported clinically significant improvements on pain and function. The statistical analyses used the Mann Whitney U-test, Wilcoxon signed-rank test, and X-2 test. Results: At four-to six-months, the numbers of completers were 19 in the STRENGTH group and 17 in the STRETCH group. At twelve months, the corresponding numbers were 11 (STRENGTH) and 10 (STRETCH). At four-to six-months, the proportions of subjects reporting clinically important changes (STRENGTH and STRETCH) were for neck pain: 47% and 41%, shoulder pain: 47% and 47%, function: 37% and 29%. At twelve months, the corresponding numbers were for neck pain: 45% and 40%, shoulder pain: 55% and 50%, function: 55% and 20%. Conclusions: No differences in the two primary outcomes between the two interventions were found, a finding that may be due to the insufficient statistical power of the study. Both interventions based on home exercises improved the two primary outcomes, but the adherences were relatively low. Future studies should investigate ways to improve adherence to home exercise treatments.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Neck pain; Shoulder pain; Home exercise; Strength training; Stretching; Function
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-104117 (URN)10.1186/1471-2474-15-6 (DOI)000329854700003 ()
Available from: 2014-02-07 Created: 2014-02-07 Last updated: 2017-12-06
Olausson, P., Gerdle, B., Ghafouri, N., Karlsson, L., Larsson, B. & Ghafouri, B. (2013). Relative recovery over time – an in vivo microdialysisstudy of human skeletal muscle. Scandinavian Journal of Clinical and Laboratory Investigation, 73(1), 10-16
Open this publication in new window or tab >>Relative recovery over time – an in vivo microdialysisstudy of human skeletal muscle
Show others...
2013 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 73, no 1, p. 10-16Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

The microdialysis technique is a method for sampling endogenous molecules from the interstitial compartments of varying tissues and relies on diffusion of molecules between the tissue and a perfusate via a membrane. Such samples do not allow determination of the true interstitial concentration but only a certain percentage. This gives rise to one of the most crucial parameter that needs to be considered for a dependable microdialysis; the relative recovery. Relative recovery states the efficiency of which an analyte is extracted from its external medium. Aim. To investigate the relative recovery of small molecules (< 20 kDa) such as lactate, fluid recovery and the reproducibility of the relative recovery at group and individual level of the microdialysis technique applied in muscle.

MATERIALS AND METHODS:

Using in vivo microdialysis of the trapezius muscle of 65 women from two separate occasions 4-6 months apart. Relative recovery of small molecules was measured from samples collected every 20 min during a period of 220 min.

RESULTS:

Good reproducibility at group level of catheters with cut-offs 100 and 20kDa were found. Furthermore, there was a high and steady relative recovery with an overall good fluid recovery. Poor reproducibility was found at the individual level for both catheters.

CONCLUSIONS:

This study demonstrates that when using microdialysis in skeletal muscle relative recovery is stable over time and is not affected by low-force exercise. Although there is a good reproducibility at group level this is not the case at the individual level. Thus in vivo, the relative recovery should be determined for each test subject and at each test occasion.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
Blood flow, internal reference, relative loss, repeatability, reproducibility, trapezius muscle
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-86714 (URN)10.3109/00365513.2012.729081 (DOI)000313288700002 ()23088726 (PubMedID)
Available from: 2012-12-25 Created: 2012-12-25 Last updated: 2018-10-02Bibliographically approved
Ghafouri, N., Ghafouri, B., Larsson, B., Turkina, M., Karlsson, L., Fowler, C. J. & Gerdle, B. (2011). High Levels of N-Palmitoylethanolamide and N-Stearoylethanolamide in Microdialysate Samples from Myalgic Trapezius Muscle in Women. PLoS ONE, 6(11)
Open this publication in new window or tab >>High Levels of N-Palmitoylethanolamide and N-Stearoylethanolamide in Microdialysate Samples from Myalgic Trapezius Muscle in Women
Show others...
2011 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 6, no 11Article in journal (Refereed) Published
Abstract [en]

Background: N-acylethanolamines (NAEs) are endogenous compounds that regulate inflammation and pain. These include the cannabinoid ligand anandamide (AEA) and the peroxisome proliferator-activated receptor-a ligand palmitoylethanolamide (PEA). Little is known as to the levels of NAEs in pain states in human, particularly in the skeletal muscle. The aim of this study was to investigate the levels of these lipid mediators in muscle dialysate from women with chronic neck-/shoulder pain compared to healthy controls. Methods: Eleven women with chronic neck-/shoulder pain and eleven healthy women participated in this study. All participants went through microdialysis procedures in the trapezius muscle. Muscle dialysate samples were collected during four hours and analysed by nano liquid chromatography tandem mass spectrometry (nLC-MS/MS). Results: We were able to detect AEA, PEA, N-stearoylethanolamine (SEA) and 2-arachidonoylglycerol (2-AG) in a single chromatographic run. Of the NAEs studied, PEA and SEA were clearly detectable in the muscle microdialysate samples. The muscle dialysate levels of PEA and SEA were significantly higher in myalgic subjects compared to healthy controls. Conclusion: This study demonstrates that microdialysis in combination with mass spectrometry can be used for analysing NAEs in human muscle tissue regularly over time. Furthermore the significant group differences in the concentration of PEA and SEA in this study might fill an important gap in our knowledge of mechanisms in chronic myalgia in humans. In the long run this expanded understanding of nociceptive and anitinociceptive processes in the muscle may provide a base for ameliorating treatment and rehabilitation of pain.

Place, publisher, year, edition, pages
Public Library of Science, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-73333 (URN)10.1371/journal.pone.0027257 (DOI)000297789200009 ()
Available from: 2012-01-03 Created: 2012-01-02 Last updated: 2017-12-08
Organisations

Search in DiVA

Show all publications