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  • 1.
    Andersson, Eva
    et al.
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, SE-40530 Gothenburg, Sweden .
    Persson, Bodil
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Bryngelsson, Ing-Liss
    Magnuson, Anders
    Orebro Univ Hosp, Clin Res Ctr, Stat & Epidemiol Unit, Orebro, Sweden .
    Toren, Kjell
    Sahlgrens Univ Hosp, Dept Occupat & Environm Med, SE-40530 Gothenburg, Sweden .
    Wingren, Gun
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine .
    Westberg, Hakan
    Cohort mortality study of Swedish pulp and paper mill workers - nonmalignant diseases2007In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 33, no 6, p. 470-478Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to determine mortality among pulp and paper mill workers according to the main mill pulping process, department, and gender, particular reference being given to diseases of the circulatory and respiratory systems. Methods The cohort of 18 163 men and 2291 women employed between 1939 and 1999 and with >1 year of employment was followed for mortality from 1952 to 2001 (acute myocardial infarction from 1969). Standardized mortality ratios (SMR) with 95% confidence intervals (95% CI) were estimated by comparing the observed number of deaths with the expected number for the entire Swedish population. Exposure was assessed from personnel files in the mills. Data from an exposure measurement database are also presented. Results There were 5898 deaths in the cohort. Total mortality had an SMR of 1.02 (95% CI 0.98-1.06) for the men in the sulfate mills and an SMR of 0.93 (95% CI 0.90-0.97) for the men in the sulfite mills. Mortality from acute myocardial infarction was increased among the men in both the sulfate and sulfite mills [SMR 1.22 (95% CI 1.12-1.32) and SMR 1.11 (95% CI 1.02-1.21), respectively] and by department in sulfate pulping (SMR 1.29, 95% CI 1.07-1.54), paper production (SMR 1.26, 95% CI 1.06-1.49), and maintenance (SMR 1.16, 95% CI 1.02-1.30). Mortality from cerebrovascular disease, diabetes mellitus, and nonmalignant respiratory diseases was not increased. Conclusions Death from acute myocardial infarction, but not cerebrovascular diseases, was increased in this cohort and was probably related to a combination of different occupational exposures (eg, dust, sulfur compounds, shift work, and noise).

  • 2.
    Antepohl, Wolfram
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Domeij, Erica
    Forsberg, Pia
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Ludvigsson, Johnny
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    A follow-up of medical graduates of a problem-based learning curriculum2003In: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, Vol. 37, no 2, p. 155-162Article in journal (Refereed)
    Abstract [en]

    Introduction: There is little information available on the effects of problem-based undergraduate curricula on doctors and their performances after graduation. Therefore, we conducted a questionnaire study of all graduates of the new medical programme at the Faculty of Health Sciences, Link÷ping University. Methods: All 446 medical students who had graduated from the new programme were asked to fill in a questionnaire about selected activities during their studies and their careers after graduation. They were also asked to evaluate the quality of their undergraduate education retrospectively. Statistical analysis was performed using descriptive, multivariate and bivariate approaches. Results: A total of 77% of the graduates responded. They showed a high degree of overall contentment with their undergraduate education and felt well prepared for professional life during their preregistration period and specialist education (mean = 4.0 on a 6-point Likert scale ranging from 0 to 5). They felt especially well prepared in terms of skills for communication with patients, collaboration with other health professionals and development of critical thinking/scientific attitudes. The students' age at the beginning of their studies correlated positively with their contentment as graduates, especially in terms of preparation for patient communication and collaboration with other health professionals. No differences between students originally admitted via a local admission procedure and those admitted via a national procedure were detected concerning retrospective evaluation of undergraduate medical education. Conclusion: Graduates of the new curriculum showed a high degree of satisfaction with their undergraduate education and its preparation of them for medical practice. Specifically, they were very content with the particular emphases of the new curriculum.

  • 3.
    Antepohl, Wolfram
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine/Pain Clinic. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Herzig, S
    Problem-based learning versus lecture-based learning i a course of basic pharmacology: A controlled, randomized study.1999In: Medical Education, ISSN 0308-0110, E-ISSN 1365-2923, Vol. 33, p. 103-113Article in journal (Refereed)
  • 4.
    Antepohl, Wolfram
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Kiviloog, Liisa
    Andersson, Jan
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Cognitive impairment in patients with chronic whiplash-associated disorder - A matched control study2003In: NeuroRehabilitation (Reading, MA), ISSN 1053-8135, E-ISSN 1878-6448, Vol. 18, no 4, p. 307-315Article in journal (Refereed)
    Abstract [en]

    Aim: To verify the occurrence of cognitive impairment in patients with chronic whiplash-associated disorder (WAD) and to provide a more detailed description of the impairment's character and context. Methods: Thirty (30) patients with chronic WAD and 30 matched healthy controls completed a cognitive test battery. Four computerised tests were used: a) two different types of cognitive tasks (reaction time vs. working memory) and b) two types of information processing (verbal vs. spatial). Before testing and after every randomised subtest, subjects rated their pain level on a visual analogue scale. Results: A worse overall performance among patients with WAD and, specifically, worse results concerning working memory tasks were found. Post-hoc testing revealed a statistically significant difference concerning the single variable "verbal reaction time". Pain intensity among patients increased significantly during testing. Pain intensity after the subtest for verbal mental reaction time (independent of test sequence) was significantly correlated with results in this subtest, the more pain, the more time was needed. Conclusion: Compared to healthy controls, patients performed worse overall. Concerning verbal reaction time, the impairment was correlated with pain intensity. The findings support the hypothesis that pain might be one important factor leading to cognitive impairment in patients with chronic WAD.

  • 5.
    Arendt Nielsen, Lars
    et al.
    Laboratory for Experimental Pain Resarch Ahlborg, Denmark.
    Henriksson, Karl-Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Pathophysiological mechanisms in chronic musculoskeletal pain (fibromyalgia): the role of central and peripheral sensitization and pain disinhibition2007In: Baillière's Best Practice & Research: Clinical Rheumatology, ISSN 1521-6942, E-ISSN 1532-1770, Vol. 21, no 3, p. 465-480Article in journal (Refereed)
    Abstract [en]

    Chronic musculoskeletal pain has biological, psychological and social components. This review deals with the biological factors, with emphasis on the fibromyalgia syndrome (FMS). Studies on central sensitization of pain-transmitting neurons, changes in endogenous pain modulation that give rise to pain disinhibition, referred pain, pain-related decrease in muscle strength and endurance, and pain generators in deep tissues are reviewed. In FMS there is strong scientific support for the statement that the biological part of the syndrome is a longstanding or permanent change in the function of the nociceptive nervous system that can be equated with a disease. Further research is necessary in order to determine which methods are best for diagnosis of the pain hypersensitivity in clinical practice. FMS may be the far end of a continuum that starts with chronic localized/regional musculoskeletal pain and ends with widespread chronic disabling pain. © 2007 Elsevier Ltd. All rights reserved.

  • 6.
    Aspegren Kendall, Sally
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Brolin-Magnusson, Kerstin
    Sörén, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Henriksson, Karl-Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Neurophysiology. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    A pilot study of body awareness programs in the treatment of fibromyalgia syndrome2000In: Arthritis Care and Research, ISSN 0893-7524, E-ISSN 1529-0123, Vol. 13, no 5, p. 304-311Article in journal (Refereed)
    Abstract [en]

    Objective. To compare in a pilot study the effect of two physical therapies, the Mensendieck system (MS) and body awareness therapy (BAT) according to Roxendal, in fibromyalgia patients and to investigate differences in effect between the two interventions. Methods. Twenty female patients were randomized to either MS or BAT in a program lasting 20 weeks. Evaluations were tender point examination and questionnaires, including visual analog scales (pain intensity at worst site, muscular stiffness, evening fatigue, and global health), Fibromyalgia Impact Questionnaire (FIQ), Coping Strategies Questionnaire, Quality of Life Scales, Arthritis Self-Efficacy Scale (ASES), and disability before, immediately after, and at 6 and 18 months followup. Results. The BAT group had improved global health at 18 months followup, but lower results than the MS group. The MS group had improved FIQ, ASES other symptoms, and pain at worst site at 18 months followup. Conclusion. In the present pilot study, MS was associated with more positive changes than BAT.

  • 7.
    Aspegren Kendall, Sally
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine.
    Börgesson, A
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine.
    Karlsson, E
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    The effect of a session of exercise of moderate intensity level on pressure pain thresholds in healthy women2003In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 5, no 1, p. 15-20Article in journal (Refereed)
    Abstract [en]

    The aim of this investigation was to study in healthy women the effect of a moderately intensive physical exercise session on the pressure pain thresholds of tendon, bone and muscle. Twenty-four healthy women in the 7-14th day of the menstruation cycle took part in a 60-min exercise class. Pressure pain thresholds were measured by electronic algometer at four points before and after the class. Habitual exercise habits and perceived class exercise intensity were recorded. There was no change in pressure pain sensitivity at any site. Increased pressure pain thresholds tended to be linked to older age and later day in the follicular phase of the menstrual cycle. In conclusion, a single session of moderate exercise in an exercise setting outside the healthcare system or the laboratory did not increase pressure pain thresholds at group level in healthy women.

  • 8.
    Aspegren Kendall, Sally
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Ekselius, L
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Sörén, B
    Bengtsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Rheumatology in Östergötland.
    Feldenkrais intervention in fibromyalgia patients: A pilot study2001In: Journal of Musculoskeletal Pain, ISSN 1058-2452, E-ISSN 1540-7012, Vol. 9, no 4, p. 25-35Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the effect of the Feldenkrais intervention, in fibromyalgia patients. Methods: Twenty fibromyalgia patients started Feldenkrais intervention done as one individual and two group sessions weekly for 15 weeks. Nineteen started a group-based pain education program followed by a pool program. Test and self-report questionnaires were administered at the start, at six month follow up, and at the end of intervention. Results: After the Feldenkrais intervention improvement in balance and trends to better lower extremity muscle function were shown, but the improvements were not maintained. Conclusions: No sustained benefit of the Feldenkrais intervention compared to a pool program was seen. Methodological problems are discussed. ⌐ 2001 by The Haworth Press, Inc. All rights reserved.

  • 9.
    Aspegren Kendall, Sally
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Elert, Jessica
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Ekselius, Lisa
    Department of Neuroscience, Psychiatry, University Hospital, Uppsala, Sweden.
    Gerdle, Björn
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Are perceived muscle tension, electromyographic hyperactivity and personality traits correlated in the fibromyalgia syndrome?2002In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 34, no 2, p. 73-79Article in journal (Refereed)
    Abstract [en]

    The study was performed to investigate the relationship between perceived muscle tension and electromyographic hyperactivity and to what extent electromyographic (EMG) hyperactivity relates to personality traits in fibromyalgics. Thirty-six females with fibromyalgia performed isokinetic maximal forward flexions of the shoulder combined with surface EMG recordings of the trapezius and infraspinatus muscles. Signal amplitude ratio and peak torque were calculated in the initial and endurance test phases. Pain intensity, perceived general and local shoulder muscle tension, and personality traits using the Karolinska Scales of Personality were assessed pre-test. Neither perceived muscle tension nor muscular tension personality trait correlated with EMG muscle hyperactivity. Perceived general muscle tension correlated with aspects of anxiety proneness (including muscle tension) of the Karolinska Scales of Personality. Pain intensity interacted with many of the variables. We propose that when patients with fibromyalgia report muscle tension that they may be expressing something other than physiological muscle tension.

  • 10.
    Aspegren Kendall, Sally
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Pain and Rehabilitation Centre. Linköping University, Faculty of Health Sciences.
    Henriksson, Karl-Gösta
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre. Linköping University, Faculty of Health Sciences.
    Hurtig, Ingrid
    Linköping University, Department of Medicine and Care, Pharmacology. Linköping University, Faculty of Health Sciences.
    Raak, Ragnhild
    Linköping University, Department of Medicine and Care, Pharmacology. Linköping University, Faculty of Health Sciences.
    Bengtsson, Ann
    Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Linköping University, Faculty of Health Sciences.
    Sören, Birgitta
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Wahren, Lis Karin
    Linköping University, Department of Medicine and Care, Pharmacology. Linköping University, Faculty of Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre. Linköping University, Faculty of Health Sciences.
    Differences in sensory thresholds in the skin of women with fibromyalgia syndrome: A comparison between ketamine responders and ketamine non-responders2003In: Journal of Musculoskeletal Pain, ISSN 1058-2452, E-ISSN 1540-7012, Vol. 11, no 2, p. 3-9Article in journal (Refereed)
    Abstract [en]

    Objectives: To compare detection and pain thresholds in the skin of female fibromyalgia patients who were either ketamine responders or ketamine nonresponders.

    Methods: Detection thresholds to innocuous warmth, of cold, heat or cold pain, and touch and dynamic touch sensation were determined in the skin. Pressure pain thresholds, local and widespread pain intensity, and pain duration were also registered.

    Results: Ketamine nonresponse was associated with more pronounced hypersensitivity for thermal pain [especially cold pain] than ketamine response.

    Conclusions: Blockade of N-metyl-D-aspartic acid receptors by ketamine and the recording of pain thresholds in the skin, especially for cold pain, might reveal different mechanisms of allodynia.

  • 11.
    Axelson, Olav
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Castleman, B
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Epstein, S
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Franco, G
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Giannasi, F
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Grandjean, P
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Greenberg, M
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Hooper, K
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Huff, J
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Jacobson, M
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Joshi, TK
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Kulkarni, GK
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    LaDou, J
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Mazaheri, M
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Mekonnen, Y
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Melnick, R
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Mirabelli, D
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Ofrin, R
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Partanen, T
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Pott, F
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Sass, J
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Soskolne, CL
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Suplido, ML
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Terracini, B
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Tomatis, L
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Ungvary, G
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Watterson, A
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Wesseling, C
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Yassi, A
    Linkoping Univ, Div Environm & Occupat Med, Linkoping, Sweden Univ Illinois, Chicago, IL 60680 USA Univ Modena, I-41100 Modena, Italy Univ So Denmark, Odense, Denmark Labor Inspectorate, Sao Paulo, Brazil NIEHS, Bethesda, MD USA Univ Tehran Med Sci, Dept Occupat Med, Tehran, Iran Univ Addis Ababa, Addis Ababa, Ethiopia San Giovanni Battista Hosp, Canc Epidemiol Unit, Turin, Italy Univ Turin, Dept Biomed Sci & Human Oncol, I-10124 Turin, Italy Univ Philippines, Open Univ, Fac Hlth Sci, Quezon City 1101, Philippines Univ Dusseldorf, Dept Expt Hyg, D-4000 Dusseldorf, Germany Univ Alberta, Dept Publ Hlth Sci, Edmonton, AB, Canada NIOSH, Budapest, Hungary Univ Stirling, Occupat & Environm Hlth Res Grp, Stirling FK9 4LA, Scotland Occupat Hlth & Safety Agcy Healthcare, Vancouver, BC, Canada.
    Letter to Dr. Gro Harlem Brundtland, Director-General, WHO2002In: International journal of occupational and environmental health, ISSN 1077-3525, E-ISSN 2049-3967, Vol. 8, no 3, p. 271-273Article in journal (Other academic)
    Abstract [en]

    [Abstract not available]

  • 12.
    Bengtsson, Ann
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Rheumatology in Östergötland.
    Henriksson, Chris
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Occupational Therapy.
    Henriksson, Karl-Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Fibromyalgi2006In: Rehabiliteringsmedicin / [ed] Jörgen Borg, Lund: Studentlitteratur , 2006, 1, p. 156-161Chapter in book (Other academic)
    Abstract [sv]

    Kapitel om rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården samt begrepp och metodik inleder boken. I två delar ges därefter rehabiliteringsmedicinska aspekter på de dominerande sjukdomsgrupperna - komplexa smärttillstånd respektive skador och sjukdomar i nervsystemet. Som avslutning beskrivs bland annat  stressrelaterade tillstånd. Läroboken är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under AT-tjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring. Vidareutbildningar av olika vårdyrkesgrupper kan ha nytta av boken och den kan också användas som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.

  • 13.
    Borg, Jörgen
    et al.
    Uppsala Universitet.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Stibrant Sunnerhagen, Katharina
    Göteborgs universitet.
    Rehabiliteringsmedicin - bakgrund och aktuell roll i sjukvården2006In: Rehabiliteringsmedicin-Teori och praktik / [ed] Borg, Jörgen, Lund: Studentlitteratur , 2006, 1, p. 11-19Chapter in book (Other academic)
    Abstract [sv]

              Kapitel om rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården samt begrepp och metodik inleder boken. I två delar ges därefter rehabiliteringsmedicinska aspekter på de dominerande sjukdomsgrupperna - komplexa smärttillstånd respektive skador och sjukdomar i nervsystemet. Som avslutning beskrivs bland annat  stressrelaterade tillstånd. Läroboken är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under AT-tjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring. Vidareutbildningar av olika vårdyrkesgrupper kan ha nytta av boken och den kan också användas som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.

  • 14.
    Börsbo, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine.
    Lemming, Dag
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Utredning och klinisk undersökning av personer med kronisk smärta2006In: Rehabiliteringsmedicin - Teori och praktik / [ed] Jörgen Borg, Lund: Studenlitteratur , 2006, 1, p. 91-96Chapter in book (Other academic)
    Abstract [sv]

      Kapitel om rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården samt begrepp och metodik inleder boken. I två delar ges därefter rehabiliteringsmedicinska aspekter på de dominerande sjukdomsgrupperna - komplexa smärttillstånd respektive skador och sjukdomar i nervsystemet. Som avslutning beskrivs bland annat  stressrelaterade tillstånd. Läroboken är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under AT-tjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring. Vidareutbildningar av olika vårdyrkesgrupper kan ha nytta av boken och den kan också användas som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.

  • 15.
    Börsbo, Björn
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Peolsson, Michael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine .
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    The complex interplay between pain intensity, depression, anxiety and catastrophizing with respect to quality of life and disability2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 19, p. 1605-1613Article in journal (Refereed)
    Abstract [en]

    Purpose: To identify subgroups of chronic pain patients based on the occurrence of depression, anxiety, and catastrophizing and the duration of pain and pain intensity. In addition to this, to investigate the relationship between the subgroups with respect to background variables, diagnosis, pain-related disability, and perceived quality of life.

    Methods: This study used 433 chronic pain patients including 47 patients with spinal cord injury related pain, 150 with chronic whiplash associated disorders, and 236 with fibromyalgia. The participants answered a postal questionnaire that provided background data, pain intensity and duration and psychological and health related items.

    Results: Based on depression, anxiety, catastrophizing, pain intensity and duration, we identified subgroups of chronic pain patients that differed with respect to perceived quality of life, disability and diagnosis. The psychological factors, especially depression, significantly influenced perceived quality of life and disability. Pain intensity and duration play a minor role with respect to quality of life although pain intensity is associated contributes more to perceived disability.

    Conclusions: The results of this study highlight the importance of not looking at chronic pain patients as a homogenous entity. A detailed assessment, including psychological factors with emphasis on depressive symptoms, might be essential for planning and carrying through treatment and rehabilitation.

  • 16. Carville, S F
    et al.
    Arendt-Nielsen, S
    Bliddal, H
    Blotman, F
    Branco, J C
    Buskila, D
    Da Silva, J. A.
    Danneskiold-Samsøe, B
    Dincer, F
    Henriksson, Chris
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies.
    Henriksson, Karl-Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Kosek, E
    Longley, K
    McCarthy, G M
    Perrot, S
    Puszczewicz, M
    Sarzi-Puttini, P
    Silman, A
    Späth, M
    Choy, E H
    EULAR evidence-based recommendations for the management of fibromyalgia syndrome2008In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 67, no 4, p. 536-541Article in journal (Refereed)
    Abstract [en]

    Objective: To develop evidence-based recommendations for the management of fibromyalgia syndrome. Methods: A multidisciplinary task force was formed representing 11 European countries. The design of the study, including search strategy, participants, interventions, outcome measures, data collection and analytical method, was defined at the outset. A systematic review was undertaken with the keywords "fibromyalgia", "treatment or management" and "trial". Studies were excluded if they did not utilise the American College of Rheumatology classification criteria, were not clinical trials, or included patients with chronic fatigue syndrome or myalgic encephalomyelitis. Primary outcome measures were change in pain assessed by visual analogue scale and fibromyalgia impact questionnaire. The quality of the studies was categorised based on randomisation, blinding and allocation concealment. Only the highest quality studies were used to base recommendations on. When there was insufficient evidence from the literature, a Delphi process was used to provide basis for recommendation. Results: 146 studies were eligible for the review. 39 pharmacological intervention studies and 59 non-pharmacological were included in the final recommendation summary tables once those of a lower quality or with insufficient data were separated. The categories of treatment identified were antidepressants, analgesics, and "other pharmacological" and exercise, cognitive behavioural therapy, education, dietary interventions and "other non-pharmacological". In many studies sample size was small and the quality of the study was insufficient for strong recommendations to be made. Conclusions: Nine recommendations for the management of fibromyalgia syndrome were developed using a systematic review and expert consensus.

  • 17. Crenshaw, A.G.
    et al.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Heiden, M.
    Karlsson, S.
    Fridén, J.
    Intramuscular pressure and electromyographic responses of the vastus lateralis muscle during repeated maximal isokinetic knee extensions.2000In: Acta Physiologica Scandinavica, ISSN 0001-6772, E-ISSN 1365-201X, Vol. 170, p. 119-126Article in journal (Refereed)
  • 18.
    Cöster, Lars
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Östergötlands Läns Landsting, Centre for Medicine, Department of Rheumatology in Östergötland.
    Kendall, Sally
    Multidisciplinary Pain Centre Copenhagen University Hospital, Copenhagen, Denmark.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Henriksson, Chris
    Department of Clinical and Experimental Medicine Linköping University.
    Henriksson, Karl-Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Bengtsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Östergötlands Läns Landsting, Centre for Medicine, Department of Rheumatology in Östergötland.
    Chronic widespread musculoskeletal pain - A comparison of those who meet criteria for fibromyalgia and those who do not2008In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, no 5, p. 600-610Article in journal (Refereed)
    Abstract [en]

    Fibromyalgia is currently classified as chronic widespread pain with widespread allodynia to pressure pain. There are few data describing pain characteristics, quality of life, consequences for daily living, and psychosocial status in patients who meet the classification criteria for fibromyalgia proposed by the American College of Rheumatology compared with patients with chronic widespread pain but not widespread allodynia. This study used a randomly selected sample from the general population. A postal questionnaire and a pain mannequin were sent to 9952 people. The response rate was 76.7%. The pain drawings showed that 345 people had widespread pain, that is, they noted pain in all four extremities and axially. Clinical examination, which included a manual tender point examination, was performed in 125 subjects. These people answered commonly used questionnaires on pain, quality of life, coping strategies, depression, and anxiety. Compared with chronic widespread pain without widespread allodynia, fibromyalgia was associated with more severe symptoms/consequences for daily life and higher pain severity. Similar coping strategies were found. Chronic widespread pain without widespread allodynia to pressure pain was found in 4.5% in the population and fibromyalgia in 2.5%. © 2007 European Federation of Chapters of the International Association for the Study of Pain.

  • 19.
    Dahlström, Örjan
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Timpka, Toomas
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Rheumatology in Östergötland.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Prognostic components and predictive modelling of prognosis in early RAManuscript (preprint) (Other academic)
    Abstract [en]

    Introduction: There is a need for tools that are easy to use in clinical practice supporting decision making upon treatment in early rheumatoid arthritis (RA). Aim: The aim was to identify components of prognosticators in early RA and to identify individual patients with a poor prognosis as early as possible.

    Methods: Two cohorts from the Swedish TIRA project including 320+408 patients with recent onset RA were included in the study. Disease activity was measured by C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and the 28-joint count disease activity score (DAS-28), and by the physicians’ global assessment of disease activity (PGA). Disability was assessed as activity limitation by the Swedish version of the Health Assessment Questionnaire (HAQ) and impairment was reported by pain on a visual analogue scale of 0–100 mm. Serological markers were rheumatoid factor (RF) and anti-CCP. RF was measured at the time for diagnosis, and anti-CCP at the time of diagnosis or at one or some of the follow-ups. If at least one anti-CCP test was positive, the patient was judged to be anti-CCP-positive. Assuming different clinical practice in the different cohorts, two different treatment strategies were assumed based on clinical practice in real-world settings. Principal Component Analysis and Multiple Linear Regression Analysis were used to identify prognosticators. Prediction rules were identified by data-driven approach, controlling for different treatment strategies.

    Results: Progression of disease and disability measures and inflammation measures the first three months after inclusion predicted a considerable part of DAS-28 at the 1-year follow-up. Serological markers had a larger explanatory power for men than for women. Anti-CCP was a significant predictor for men, but not for women. Two versions of rules, one for women and one for men, predicting good or poor prognosis at one year after inclusion were produced by using measures of disability (Health Assessment Questionnaire), DAS-28, relative change in DAS-28 during first three months, sex, and test of anti-CCP. The rules demanded high prognostic specificity but the prognostic sensitivity was moderate.

    Conclusion: A considerable part of DAS-28 at one year after inclusion could be explained by the first 3 months’ progression of disease, disability and inflammation. Anti-CCP was predictive for men but not for women, and needs further investigation. A decision tree predicting poor prognosis among individual early RA-patients showed high specificity and moderate sensitivity on a validationcohort. The medical informatics approach used, controlling for different treatment strategies, yields promising results and further studies will control for more specific differences in treatment strategies, e.g. different DMARDs initiated.

  • 20.
    Ekman, Bertil
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, MC - Medicincentrum, EMT-endo.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Arnqvist, Hans
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Biomedicine and Surgery, Cell biology. Östergötlands Läns Landsting, MC - Medicincentrum, EMT-endo.
    Growth hormone substitution titrated to obtain IGF-I levels in the physiological range in hypopituitary adults: Effects upon dynamic strength, endurance and EMG2003In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 90, no 5-6, p. 496-504Article in journal (Refereed)
    Abstract [en]

    We studied the effects of individualised growth hormone (GH) substitution, aiming at normal insulin-like growth factor I (IGF-I) levels, on biomechanical output and surface electromyogram (EMG) of isokinetic muscle strength and endurance performance in 18 hypopituitary adults and compared with 17 matched healthy controls. The muscle function tests consisted of isokinetic contractions of the right knee extensors, from which torque and EMG were recorded. Three patients were excluded from the final analysis of the muscle function tests due to technical errors and one control subject moved from the area during the study. We found that GH-deficient adults without GH substitution were weaker and had less endurance than healthy control subjects. At the group level, plasma levels of IGF-I were normalised but generally no significant effects upon biomechanical output and EMG were found after dose titration and 6 months of a constant GH dose. However, subjects with the largest changes in IGF-I had significantly better biomechanical output and EMG compared to those with small changes in IGF-I. This finding may indicate that the net increase in IGF-I levels is critical for improvements in biomechanical output, EMG and perception of fatigue to occur.

  • 21.
    Elert, Jessica
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine.
    Aspegren Kendall, Sally
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Larsson, Barbro
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine.
    Månsson, Bjarne
    Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Chronic pain and difficulty in relaxing postural muscles in patients with fibromyalgia and chronic whiplash associated disorders2001In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 28, no 6, p. 1361-1368Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate if muscle tension according to the surface electromyogram (EMG) of the shoulder flexors is increased in consecutive patients with fibromyalgia (FM) or chronic whiplash associated disorders (WAD). Methods. A total of 59 consecutive patients with FM (n = 36) or chronic WAD (n = 23) performed 100 maximal isokinetic contractions combined with surface electromyography of the trapezius and infraspinatus. A randomized group of pain-free female (n = 27) subjects served as control group. Peak torque initially (Pti) and absolute and relative peak torque at endurance level (PTe, PTer) were registered as output variables, together with the EMG level of unnecessary muscle tension, i.e., the signal amplitude ratio (SAR). Results. The patient groups had a higher level of unnecessary tension initially and at the endurance level. The patients had lower absolute output (PTi and PTe), but the relative levels (PTer) did not differ comparing all 3 groups. Subjects with FM had significantly higher body mass index (BMI) than the other groups. BMI did not influence the SAR but correlated positively with PTi. Conclusion. The results confirmed earlier findings that groups of patients with chronic pain have increased muscle tension and decreased output during dynamic activity compared to pain-free controls. However, the results indicated there is heterogeneity within groups of patients with the same chronic pain disorder and that not all patients with chronic pain have increased muscle tension.

  • 22.
    Elert, Jessica
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy.
    Sterner, Ylva
    Nyberg, Vanja
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Lack of gender differences in the ability to relax between repetitive maximum isokinetic shoulder forward flexions: A population-based study among northern Swedes2000In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 83, no 4-5, p. 246-256Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to analyse the effects of gender and age in a population-based sample of clinically healthy subjects on: (1) strength, endurance and perception of fatigue, (2) mean frequency (MNF) of the electromyogram (EMG), and (3) the ability to relax between active contractions (signal amplitude ratio, SAR) of the surface EMG of an isokinetic shoulder forward flexion test. With this aim we have analysed aspects of the validity of MNF as an indicator of fatigue, using peak torque as a criterion variable. The subjects were 27 men and 28 women (age range: 20-60 years), who were obtained by random sample from the official census lists (participation rate: 66%). The peak torque and surface EMG of two portions of the trapezius, deltoid and infraspinatus muscles were recorded throughout 100 repetitive maximal isokinetic shoulder forward flexions. No significant differences in the perception of fatigue and relative endurance levels of peak torque and work were found between males and females. Males were significantly stronger than females and, on average, females produced approximately 60% of the output of the males, 76% after normalisation for body mass. The men had significantly lower MNF endurance levels for three of the investigated muscles. When controlled for age and body mass, the men had a significantly higher MNF of the deltoid muscle than did the females. These differences were only found for the deltoid muscle. Significant correlations existed between the MNF of the four muscles and biomechanical output, indicating criterion validity for the MNF variable with respect to fatigue. There were no significant effects of gender or age on the ability to relax between repetitive contractions (SAR). The higher prevalence of musculoskeletal complaints of the neck-shoulder region in females cannot be explained by a higher intrinsic muscle tension. Age, gender, body mass index and biomechanical output can have significant effects upon MNF. These effects are important considerations in the interpretation of MNF, for instance in ergonomic situations.

  • 23.
    Elert, Jessica
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Sydnerth, S-B.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine/Pain Clinic. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Åbjörnsson, L.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Aspects of criterion validity and sensitivity of the BAS-health scale in chronic pain patients - a pilot study of patients at a multidisciplinary pain centre.1999In: Advances in Physics, ISSN 0001-8732, E-ISSN 1460-6976, Vol. 1, p. 83-97Article in journal (Refereed)
  • 24.
    Flodin, Ulf
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Landtblom, Anne-Marie
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Axelson, Olav
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Multiple sclerosis in nurse anaesthetists2003In: Occupational and Environmental Medicine, ISSN 1351-0711, E-ISSN 1470-7926, Vol. 60, no 1, p. 66-68Article in journal (Refereed)
    Abstract [en]

    Background: Volatile anaesthetics are chemically related to organic solvents used in industry. Exposure to industrial solvents may increase the incidence of multiple sclerosis (MS). Aim: To examine the risk among nurse anaesthetists of contracting MS. Methods: Nurses with MS were identified by an appeal in the monthly magazine of the Swedish Nurse Union and a magazine of the Neurological Patients Association in Sweden. Ninety nurses with MS responded and contacted our clinic. They were given a questionnaire, which was filled in by 85 subjects, 13 of these were nurse anaesthetists. The questionnaire requested information about work tasks, exposure, diagnosis, symptoms, and year. The number of active nurse anaesthetists was estimated based on information from the National Board of Health and Welfare and The Nurse Union. Incidence data for women in the region of Gothenburg and Denmark were used as the reference to estimate the risk by calculation of the standardised incidence ratio (SIR). Results: Eleven of the 13 nurse anaesthetists were exposed to anaesthetic gases before onset of MS. Mean duration of exposure before diagnosis was 14.4 years (range 4-27 years). Ten cases were diagnosed in the study period 1980-99, resulting in significantly increased SIRS of 2.9 and 2.8 with the Gothenburg and the Danish reference data, respectively. Conclusion: Although based on crude data and a somewhat approximate analysis, this study provides preliminary evidence for an excess risk of MS in nurse anaesthetists. The risk may be even greater than observed, as the case ascertainment might have been incomplete because of the crude method applied. Further studies in this respect are clearly required to more definitely assess the risk.

  • 25.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Förekomst av kroniska/långvariga smärtor2006In: Rehabiliteringsmedicin Teori och praktik / [ed] Jörgen Borg,Björn Gerdle, Gunnar Grimby, Katharina Stibrant Sunnerhagen, Lund: Studenltitteratur , 2006, 1, p. 73-77Chapter in book (Other academic)
    Abstract [sv]

        Kapitel om rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården samt begrepp och metodik inleder boken. I två delar ges därefter rehabiliteringsmedicinska aspekter på de dominerande sjukdomsgrupperna - komplexa smärttillstånd respektive skador och sjukdomar i nervsystemet. Som avslutning beskrivs bland annat  stressrelaterade tillstånd. Läroboken är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under AT-tjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring. Vidareutbildningar av olika vårdyrkesgrupper kan ha nytta av boken och den kan också användas som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.

  • 26.
    Gerdle, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Björk, Jonas
    Competence Centre for Clinical Research Lund University Hospital.
    Cöster, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Östergötlands Läns Landsting, Centre for Medicine, Department of Rheumatology in Östergötland.
    Henriksson, Karl-Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Henriksson, Chris
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies.
    Bengtsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Östergötlands Läns Landsting, Centre for Medicine, Department of Rheumatology in Östergötland.
    Prevalence of widespread pain and associations with work status: A population study2008In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 9Article in journal (Refereed)
    Abstract [en]

    Background. This population study based on a representative sample from a Swedish county investigates the prevalence, duration, and determinants of widespread pain (WSP) in the population using two constructs and estimates how WSP affects work status. In addition, this study investigates the prevalence of widespread pain and its relationship to pain intensity, gender, age, income, work status, citizenship, civil status, urban residence, and health care seeking. Methods. A cross-sectional survey using a postal questionnaire was sent to a representative sample (n = 9952) of the target population (284,073 people, 18-74 years) in a county (Östergötland) in the southern Sweden. The questionnaire was mailed and followed by two postal reminders when necessary. Results. The participation rate was 76.7% (n = 7637), the non-participants were on the average younger, earned less money, and male. Women had higher prevalences of pain in 10 different predetermined anatomical regions. WSP was generally chronic (90-94%) and depending on definition of WSP the prevalence varied between 4.8-7.4% in the population. Women had significantly higher prevalence of WSP than men and the age effect appeared to be stronger in women than in men. WSP was a significant negative factor - together with age 50-64 years, low annual income, and non-Nordic citizen - for work status in the community and in the group with chronic pain. Chronic pain but not the spreading of pain was related to health care seeking in the population. Conclusion. This study confirms earlier studies that report high prevalences of widespread pain in the population and especially among females and with increasing age. Widespread pain is associated with prominent effects on work status. © 2008 Gerdle et al, licensee BioMed Central Ltd.

  • 27.
    Gerdle, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Björk, Jonas
    Lunds Universitet.
    Henriksson, Chris
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Occupational Therapy.
    Bengtsson, Ann
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Rheumatology. Östergötlands Läns Landsting, Centre for Medicine, Department of Rheumatology in Östergötland.
    Prevalence of current and chronic pain and their influences upon work and healthcare-seeking: A population study2004In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 31, no 7, p. 1399-1406Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate the prevalence of current and chronic pain and their relationship to pain intensity, sex, age, income, employment status, citizenship, marital status, urban residence, occupational activity, and healthcare-seeking based on a representative sample from a Swedish county. Methods. A cross-sectional survey using a postal questionnaire was sent to a representative sample (n = 9952) of the target population (284,073 people, age 18-74 yrs) in a county (Östergötland) in southern Sweden. A questionnaire was mailed and followed by 2 postal reminders if necessary. Results. The participation rate was 76.7% (n = 7637), nonparticipants were on average younger, male, and earned less money. The overall point prevalence of pain was 48.9%. The corresponding one-month period prevalence was 63.0%, and pain on several occasions during the previous 3 months was reported by 61.3% of participants. The prevalence of chronic pain (pain > 3 months) was 53.7%. Female sex, age, and sick leave/early retirement were generally of significant importance in the regressions of pain. No sex factor was found in the regressions of pain frequency and pain intensity. Chronic pain - especially frequent and intensive pain - showed clear associations with healthcare-seeking and occupational activity. Conclusion. High prevalence of current pain (48.9%) and chronic pain (53.7%) were found in this community-based study. Being female, older, and on sick leave or early retirement were generally of significant importance in the regressions of pain. Chronic pain showed clear associations with healthcare-seeking and occupational activity, indicating considerable socioeconomic costs.

  • 28.
    Gerdle, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Boivie, Jörgen
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Neurology. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Johansson, Eva
    Umeå Universitet.
    Inledning2006In: Metoder för behandling av långvarig smärta - en systematisk litteraturöversikt / [ed] Statens beredning för medicinsk utvärdering, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2006, 2, p. 47-107Chapter in book (Other academic)
    Abstract [sv]

      

    Syftet med rapporten är att sammanfatta det vetenskapliga underlaget rörande effekter, biverkningar samt kostnadseffektivitet för metoder som används för att behandla långvarig, icke-cancerrelaterad smärta. Behandling som innebär öppen kirurgi har exkluderats från genomgången.

  • 29.
    Gerdle, Björn
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Gronlund, Christer
    Umeå University Hospital.
    Karlsson, Stefan J
    Umeå University Hospital.
    Holtermann, Andreas
    National Research Centre Working Environment, Copenhagen.
    Roeleveld, Karin
    Norwegian University Science and Technology.
    Altered neuromuscular control mechanisms of the trapezius muscle in fibromyalgia2010In: BMC MUSCULOSKELETAL DISORDERS, ISSN 1471-2474, Vol. 11, no 42Article in journal (Refereed)
    Abstract [en]

    Background: fibromyalgia is a relatively common condition with widespread pain and pressure allodynia, but unknown aetiology. For decades, the association between motor control strategies and chronic pain has been a topic for debate. One long held functional neuromuscular control mechanism is differential activation between regions within a single muscle. The aim of this study was to investigate differences in neuromuscular control, i.e. differential activation, between myalgic trapezius in fibromyalgia patients and healthy controls. Methods: 27 fibromyalgia patients and 30 healthy controls performed 3 minutes bilateral shoulder elevations with different loads (0-4 Kg) with a high-density surface electromyographical (EMG) grid placed above the upper trapezius. Differential activation was quantified by the power spectral median frequency of the difference in EMG amplitude between the cranial and caudal parts of the upper trapezius. The average duration of the differential activation was described by the inverse of the median frequency of the differential activations. Results: the median frequency of the differential activations was significantly lower, and the average duration of the differential activations significantly longer in fibromyalgia compared with controls at the two lowest load levels (0-1 Kg) (p andlt; 0.04), but not at the two highest load levels (2 and 4 Kg). Conclusion: these findings illustrate a different neuromuscular control between fibromyalgia patients and healthy controls during a low load functional task, either sustaining or resulting from the chronic painful condition. The findings may have clinical relevance for rehabilitation strategies for fibromyalgia.

  • 30.
    Gerdle, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Gullacksen, Ann-Christine
    Malmö Högskola.
    Multimodal rehabilitering2006In: Metoder för behandling av långvarig smärta - En systematisk litteraturöversikt / [ed] Statens beredning för medicinsk utvärdering, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2006, 2, p. 159-213Chapter in book (Other academic)
    Abstract [sv]

    Syftet med rapporten är att sammanfatta det vetenskapliga underlaget rörande effekter, biverkningar samt kostnadseffektivitet för metoder som används för att behandla långvarig, icke-cancerrelaterad smärta. Behandling som innebär öppen kirurgi har exkluderats från genomgången.

  • 31.
    Gerdle, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Gullacksen, Ann-Christine
    Malmö Högskola.
    Rehabilitering vid kronisk smärta-särskilt multimodal rehabiltiering2006In: Rehabiliteringsmedicin - Teori och praktik / [ed] Jörgen Borg,Björn Gerdle, Gunnar Grimby, Katharina Stibrant Sunnerhagen, Lund: Studentlitteratur , 2006, 1, p. 97-107Chapter in book (Other academic)
    Abstract [sv]

      Kapitel om rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården samt begrepp och metodik inleder boken. I två delar ges därefter rehabiliteringsmedicinska aspekter på de dominerande sjukdomsgrupperna - komplexa smärttillstånd respektive skador och sjukdomar i nervsystemet. Som avslutning beskrivs bland annat  stressrelaterade tillstånd. Läroboken är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under AT-tjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring. Vidareutbildningar av olika vårdyrkesgrupper kan ha nytta av boken och den kan också användas som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.

  • 32.
    Gerdle, Björn
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Hilgenfeldt, Ulrich
    University of Heidelberg.
    Larsson, Britt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Kristiansen, Jesper
    National Research Centre for the Working Environment.
    Sogaard, Karen
    National Research Centre for the Working Environment.
    Rosendal, Lars
    Cyncron A/S.
    Bradykinin and kallidin levels in the trapezius muscle in patients with work-related trapezius myalgia, in patients with whiplash associated pain, and in healthy controls - A microdialysis study of women2008In: PAIN, ISSN 0304-3959, Vol. 139, no 3, p. 578-587Article in journal (Refereed)
    Abstract [en]

    The origins of chronic Muscle pain development and maintenance are debated regarding the relative contributions of peripheral nociception and central pain processing. Bradykinin (BKN) and kallidin (KAL) have been suggested to be algesic kinins involved in muscle pain. This in vivo study investigates whether there were significant differences in interstitial muscle concentrations of BKN and KAL between chronic work-related trapezius myalgia (TM), chronic whiplash associated disorders (WAD), and healthy controls (CON). These subjects were studied Lit rest, during a 20-min repetitive low-force exercise and recovery. The interstitial concentrations of BKN and KAL of trapezius were determined using the microdialysis technique. The interstitial concentration of KAL was overall significantly higher in TM than in CON. [KAL] and [BKN] increased significantly during the brief exercise in all groups. The increase in [BKN] during exercise was significantly higher in TM than in the other two groups,whereas the increase in [KAL] during exercise was highest in WAD. In chronic pain, positive correlations existed between the two kinins and the difference in pain intensity between recovery and baseline. In this in vivo study of two groups of patients with chronic pain clinically involving the trapezius muscle, we found alterations - most prominent in TM in the interstitial concentrations of BKN and KAL. The results indicated that the two kinins were involved in aspects of hyperalgesia.

  • 33.
    Gerdle, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Karlsson, S
    Crenshaw, AG
    Elert, Jessica
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Physiotherapy.
    Fridén, J
    The influences of muscle fibre proportions and areas upon EMG during maximal dynamic knee extensions2000In: European Journal of Applied Physiology and Occupational Physiology, ISSN 0301-5548, E-ISSN 1432-1025, Vol. 81, no 1-2Article in journal (Refereed)
    Abstract [en]

    This study is an investigation of the relationship between muscle morphology and surface electromyographic (EMG) parameters [mean frequency of the power spectrum (MNF), signal amplitude (root mean square, RMS) and the signal amplitude ratio (SAR, i.e. the ratio between the RMS level during the passive part of the contraction cycle and the RMS level during the active part of the contraction cycle)] during 100 maximal dynamic knee extensions at 90░.s-1. Each contraction cycle comprised of 1 s of active knee extension and 1 s of passive knee flexion. The surface EMG was recorded from the vastus lateralis muscle. Twenty clinically healthy subjects participated in the study, and muscle biopsy samples of the vastus lateralis were obtained from 19 of those subjects. The relationships between muscle morphology and EMG were investigated at three stages of the test: initially, during the fatigue phase (initial 40 contractions), and at the endurance level (the final 50 contractions). Major findings on correlations are that SAR and MNF tended to correlate positively with the proportion of type 1 fibres, and RMS correlated positively with the proportion of type 2 muscle fibres. The muscle fibre areas showed little correlation with the EMG variables under investigation. The results of the present study showed that the three EMG variables of a dynamic endurance test that were investigated (RMS, MNF and SAR were clearly correlated with the proportions of the different fibre types, but only to a small extent with fibre areas. These findings contradict some of the theoretical models of the EMG, especially for parameters in the frequency domain.

  • 34.
    Gerdle, Björn
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Lemming, Dag
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Kristiansen, Jesper
    Cyncron A/S.
    Larsson, Britt
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Peolsson, Michael
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Rosendal, Lars
    National Research Centre for the Working Environment.
    Biochemical alterations in the trapezius muscle of patients with chronic whiplash associated disorders (WAD): A microdialysis study2008In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, no 1, p. 82-93Article in journal (Refereed)
    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.

  • 35.
    Gerdle, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Sandberg, Margaretha
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Akuta och kroniska nociceptiva smärtor. Den biopsykosociala helhetssynen och aspekter på de neurobiologiska mekanismerna2006In: Rehabiliteringsmedicin - Teori och praktik / [ed] Jörgen Borg, Lund: Studenlitteratur , 2006, 1, p. 78-89Chapter in book (Other academic)
    Abstract [sv]

           Kapitel om rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården samt begrepp och metodik inleder boken. I två delar ges därefter rehabiliteringsmedicinska aspekter på de dominerande sjukdomsgrupperna - komplexa smärttillstånd respektive skador och sjukdomar i nervsystemet. Som avslutning beskrivs bland annat  stressrelaterade tillstånd. Läroboken är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under AT-tjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring. Vidareutbildningar av olika vårdyrkesgrupper kan ha nytta av boken och den kan också användas som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin

  • 36.
    Gerdle, Björn
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Soderberg, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine .
    Salvador Puigvert, Laia
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Rosendal, Lars
    TrialConsult, Gentofte, Denmark.
    Larsson, Britt
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    INCREASED INTERSTITIAL CONCENTRATIONS OF PYRUVATE AND LACTATE IN THE TRAPEZIUS MUSCLE OF PATIENTS WITH FIBROMYALGIA: A MICRODIALYSIS STUDY2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 7, p. 679-687Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to compare the interstitial concentrations of pyruvate, lactate and glutamate in the trapezius muscle between patients with fibromyalgia syndrome and healthy controls. Design: Comparative cross-sectional study. Subjects: Patients with fibromyalgia (n=19) and healthy controls (n=19); all women. Methods: Subjects answered a questionnaire about different aspects of pain. Pressure pain thresholds over the trapezius and tibialis anterior muscles were determined. The interstitial concentrations of pyruvate, lactate and glutamate were determined in the resting trapezius muscle by the microdialysis technique, with samples collected every hour for 5 consecutive hours. Pain intensity was also rated. Results: Significantly higher interstitial concentrations of pyruvate and lactate were found in patients with fibromyalgia syndrome. The multivariate regression analyses of group membership and pressure pain thresholds of the trapezius confirmed the importance of pyruvate and lactate. Conclusion: Different mechanisms that may increase pyruvate and lactate in patients with fibromyalgia syndrome are discussed. Improved understanding of peripheral muscle alterations in patients with fibromyalgia syndrome could lead to mechanism-based rehabilitation.

  • 37.
    Gerdle, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Sörensen, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Radiofrekvensbehandling2006In: Metoder för behandling av långvarig smärta: En systematisk litteraturöversikt / [ed] Statens beredning för medicinsk utvärdering, Stockholm: Statens beredning för medicinsk utvärdering (SBU) , 2006, p. 339-343Chapter in book (Other academic)
    Abstract [sv]

    I denna rapport sammanfattas det vetenskapliga underlaget för behandling av långvariga smärttillstånd. Smärta vid cancer innefattas inte. Smärtlindrande effekter, liksom biverkningar och andra negativa konsekvenser av behandling berörs samt hälsoekonomiska aspekter.

  • 38.
    Gerdle, Björn
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Östlund, Nils
    Department of Biomedical Engineering and Informatics University Hospital, Umeå.
    Grönlund, Christer
    Department of Biomedical Engineering and Informatics University Hospital, Umeå.
    Roeleveld, Karin
    Human Movement Sciences Programme Norwegian University of Science and Technology, Trondheim.
    Karlsson, J. Stefan
    Department of Biomedical Engineering and Informatics University University Hospital, Umeå.
    Firing rate and conduction velocity of single motor units in the trapezius muscle in fibromyalgia patients and healthy controls2008In: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 18, no 5, p. 707-716Article in journal (Refereed)
    Abstract [en]

    Fibromyalgia is a common chronic pain condition in the population (2-4%), which often is associated with prominent negative consequences with respect to participation in daily activities. There are several reports in the literature concerning the effects of acute experimental pain on motor control. However, a more heterogeneous picture exists in the literature with respect to whether chronic pain conditions affect motor control. This study compares firing rate and conduction velocity (CV) of single motor units (MUs) in the trapezius muscle of fibromyalgia patients (FM) and healthy controls (CON). Multi-channel surface electromyography was used to estimate both MU firing rate and CV because this technique allows simultaneous estimation of both these variables and the measurements are easy and non-invasive. In this study, 29 FM and 30 CON subjects participated and performed isometric shoulder elevations using weights up to 4 kg. No significant differences in the firing rate of MUs in the trapezius muscle were found between the FM and CON groups (95% confidence interval was -1.9 and 1.3 pulses per second). There were no significant differences in CV between the groups at 1 and 2 kg load. However, the FM group had significantly higher CV in contractions without external load (p = 0.004). We were unable to confirm the pain-adaptation model since no differences in firing rate between the two groups were found. CV was significantly higher in FM than in healthy controls, this might be due to alterations in histopathology and microcirculation. © 2007 Elsevier Ltd. All rights reserved.

  • 39. Graven-Nilsen, T
    et al.
    Aspegren Kendall, Sally
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine/Pain Clinic. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Henriksson, Karl-Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine/Pain Clinic. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Bengtsson, M
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Sörensen, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Johnson, A
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, MKC - Medicin och kirurgicentrum, Anestesi.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine/Pain Clinic. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Arendt-Nielsen, L
    Ketamine reduces muscle pain, temporal summation, and referred pain in fibromyalgia patients2000In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 85, no 3, p. 483-491Article in journal (Refereed)
    Abstract [en]

    Central mechanisms related to referred muscle pain and temporal summation of muscular nociceptive activity are facilitated in fibromyalgia syndrome (FMS) patients. The present study assessed the effects of an NMDA-antagonist (ketamine) on these central mechanisms. FMS patients received either i.v. placebo or ketamine (0.3 mg/kg, Ketalar(«)) given over 30 min on two separate occasions. Habitual pain intensity was assessed on a visual analogue scale (VAS). Initially, 29 FMS patients received ketamine or isotonic saline to determine which patients were ketamine responders (>50% decrease in pain intensity at rest by active drug on two consecutive VAS assessments). Fifteen out of 17 ketamine-responders were included in the second part of the study. Before and after ketamine or placebo, experimental local and referred pain was induced by intramuscular (i.m.) infusion of hypertonic saline (0.7 ml, 5%) into the tibialis anterior (TA) muscle. The saline-induced pain intensity was assessed on an electronic VAS, and the distribution of pain drawn by the subject. In addition, the pain threshold (PT) to i.m. electrical stimulation was determined for single stimulus and five repeated (2 Hz, temporal summation) stimuli. The pressure PT of the TA muscle was determined, and the pressure PT and pressure pain tolerance threshold were determined at three bilaterally located tenderpoints (knee, epicondyle, and mid upper trapezius). VAS scores of pain at rest were progressively reduced during ketamine infusion compared with placebo infusion. Pain intensity (area under the VAS curve) to the post-drug infusion of hypertonic saline was reduced by ketamine (-18.4▒0.3% of pre-drug VAS area) compared with placebo (29.9▒18.8%, P<0.02). Local and referred pain areas were reduced by ketamine (-12.0▒14.6% of pre-drug pain areas) compared with placebo (126.3▒83.2%, P<0.03). Ketamine had no significant effect on the PT to single i.m. electrical stimulation. However, the span between the PT to single and repeated i.m. stimuli was significantly decreased by the ketamine (-42.3▒15.0% of pre-drug PT) compared with placebo (50.5▒49.2%, P<0.03) indicating a predominant effect on temporal summation. Mean pressure pain tolerance from the three paired tenderpoints was increased by ketamine (16.6▒6.2% of pre-drug thresholds) compared with placebo (-2.3▒4.9%, P<0.009). The pressure PT at the TA muscle was increased after ketamine (42.4▒9.2% of pre-drug PT) compared with placebo (7.0▒6.6%, P<0.011). The present study showed that mechanisms involved in referred pain, temporal summation, muscular hyperalgesia, and muscle pain at rest were attenuated by the NMDA-antagonist in FMS patients. It suggested a link between central hyperexcitability and the mechanisms for facilitated referred pain and temporal summation in a sub-group of the fibromyalgia syndrome patients. Whether this is specific for FMS patients or a general phenomena in painful musculoskeletal disorders is not known. Copyright (C) 2000 International Association for the Study of Pain. Published by Elsevier Science B.V.

  • 40.
    Grip, Helen
    et al.
    Universitetssjukhuset Umeå.
    Sundelin, Gunnevi
    Umeå universitet.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Karlsson, Stefan
    Universitetssjukhuset Umeå.
    Variations in the axis of motion during head repositioning - A comparison of subjects with whiplash-associated disorders or non-specific neck pain and healthy controls2007In: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 22, no 8, p. 865-873Article in journal (Refereed)
    Abstract [en]

    Background: The ability to reproduce head position can be affected in patients after a neck injury. The repositioning error is commonly used as a measure of proprioception, but variations in the movement might provide additional information. Methods: The axis of motion and target performance were analyzed during a head repositioning task (flexion, extension and side rotations) for 24 control subjects, 22 subjects with whiplash-associated disorders and 21 with non-specific neck pain. Questionnaires regarding pain intensity and fear avoidance were collected. Head position and axis of motion parameters were calculated using a helical axis model with a moving window of 4°. Findings: During flexion the whiplash group had a larger constant repositioning error than the control group (-1.8(2.9)° vs. 0.1(2.4)°, P = 0.04). The axis was more inferior in both neck pain groups (12.0(1.6) cm vs. 14.5(2.0) cm, P < 0.05) indicating movement at a lower level in the spine. Including pain intensity from shoulder and neck region as covariates showed an effect on the axis position (P = 0.03 and 0.04). During axial rotation to the left there was more variation in axis direction for neckpain groups as compared with controls (4.0(1.7)° and 3.7(2.4)° vs. 2.3(1.9)°, P = 0.01 and 0.05). No significant difference in fear avoidance was found between the two neck pain groups. Interpretation: Measuring variation in the axis of motion together with target performance gives objective measures on proprioceptive ability that are difficult to quantify by visual inspection. Repositioning errors were in general small, suggesting it is not sufficient as a single measurement variable in a clinical situation, but should be measured in combination with other tests, such as range of motion.

  • 41. Grip, Helena
    et al.
    Sundelin, Gunnevi
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Karlsson, J. Stefan
    Cervical helical axis characteristics and its center of rotation during active head and upper arm movements-comparisons of whiplash-associated disorders, non-specific neck pain and asymptomatic individuals2008In: Journal of Biomechanics, ISSN 0021-9290, E-ISSN 1873-2380, Vol. 41, no 13, p. 2799-2805Article in journal (Refereed)
    Abstract [en]

    The helical axis model can be used to describe translation and rotation of spine segments. The aim of this study was to investigate the cervical helical axis and its center of rotation during fast head movements (side rotation and flexion/extension) and ball catching in patients with non-specific neck pain or pain due to whiplash injury as compared with matched controls. The aim was also to investigate correlations with neck pain intensity. A finite helical axis model with a time-varying window was used. The intersection point of the axis during different movement conditions was calculated. A repeated-measures ANOVA model was used to investigate the cervical helical axis and its rotation center for consecutive levels of 15° during head movement. Irregularities in axis movement were derived using a zero-crossing approach. In addition, head, arm and upper body range of motion and velocity were observed. A general increase of axis irregularity that correlated to pain intensity was observed in the whiplash group. The rotation center was superiorly displaced in the non-specific neck pain group during side rotation, with the same tendency for the whiplash group. During ball catching, an anterior displacement (and a tendency to an inferior displacement) of the center of rotation and slower and more restricted upper body movements implied a changed movement strategy in neck pain patients, possibly as an attempt to stabilize the cervical spine during head movement. © 2008 Elsevier Ltd. All rights reserved.

  • 42.
    Grip, Helena
    et al.
    Department of Biomedical Engineering and Informatics, University Hospital, Umeå, Sweden.
    Öhberg, Fredrik
    Department of Biomedical Engineering and Informatics, University Hospital, Umeå, Sweden.
    Wiklund, Urban
    Department of Biomedical Engineering and Informatics, University Hospital, Umeå, Sweden.
    Sterner, Ylva
    Community Medicine and Rehabilitation, University Hospital, Umeå, Sweden.
    Karlsson, J. Stefan
    Department of Biomedical Engineering and Informatics, University Hospital, Umeå, Sweden.
    Gerdle, Björn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Classification of Neck Movement Patterns Related to Whiplash-Associated Disorders Using Neural Networks2003In: IEEE transactions on information technology in biomedicine, ISSN 1089-7771, E-ISSN 1558-0032, Vol. 7, no 4, p. 412-418Article in journal (Refereed)
    Abstract [en]

    This paper presents a new method for classification of neck movement patterns related to Whiplash-associated disorders (WAD) using a resilient backpropagation neural network (BPNN). WAD are a common diagnosis after neck trauma, typically caused by rear-end car accidents. Since physical injuries seldom are found with present imaging techniques, the diagnosis can be difficult to make. The active range of the neck is often visually inspected in patients with neck pain, but this is a subjective measure, and a more objective decision support system, that gives a reliable and more detailed analysis of neck movement pattern, is needed. The objective of this study was to evaluate the predictive ability of a BPNN, using neck movement variables as input. Three-dimensional (3-D) neck movement data from 59 subjects with WAD and 56 control subjects were collected with a ProReflex system. Rotation angle and angle velocity were calculated using the instantaneous helical axis method and motion variables were extracted. A principal component analysis was performed in order to reduce data and improve the BPNN performance. BPNNs with six hidden nodes had a predictivity of 0.89, a sensitivity of 0.90 and a specificity of 0.88, which are very promising results. This shows that neck movement analysis combined with a neural network could build the basis of a decision support system for classifying suspected WAD, even though further evaluation of the method is needed.

  • 43.
    Gullaksen, Ann-Christine
    et al.
    Malmö högskola.
    Gerdle, Björn
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Multimodal rehabilitering vid långvarig smärta . systematisk översikt från SBU2006In: Svensk rehabilitering, ISSN 1403-4468, Vol. 2, p. 18-21Article in journal (Refereed)
    Abstract [sv]

       

  • 44. Hatzinikolaou, DG
    et al.
    Lagesson, Verner
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Stavridou, AJ
    Pouli, AE
    Lagesson-Andrasko, L
    Stavrides, JC
    Analysis of the gas phase of cigarette smoke by gas chromatography coupled with UV-diode array detection2006In: Analytical Chemistry, ISSN 0003-2700, E-ISSN 1520-6882, Vol. 78, no 13, p. 4509-4516Article in journal (Refereed)
    Abstract [en]

    A gas chromatography method, coupled with diode array photometric spectral detection in the ultraviolet region (167-330 nm), was developed for the analysis of the gas phase of cigarette smoke. The method enabled us to identify more than 20 volatiles present in the vapor phase of cigarette smoke. In that way, all major volatile organic compounds ( including aldehydes, conjugated dienes, ketones, sulfides, furans, and single-ring aromatics), as well as nitric oxide ( NO) and hydrogen sulfide (H2S), can be analyzed in a straightforward manner through a single chromatographic run of < 50-min duration. The method can easily be applied by the introduction of a small volume of the gas-phase stream into the GC injection loop directly through the smoking apparatus exhaust circuit, thus providing an excellent alternative to available methods, which usually require extraction or concentration steps prior to any chromatographic analysis. Furthermore, all problems concerning aging of the gas phase are eliminated. Twelve compounds ( including NO) were chosen for quantification through the use of appropriate calibration standards. Comparison of the vapor phase yields of these compounds for the reference cigarette Kentucky 1R4F with already reported data indicates that this method is very reliable as far as accuracy and reproducibility of the results are concerned. Finally, the proposed methodology was used to compare the concentration of these cigarette smoke gas-phase constituents among individual puffs.

  • 45.
    Henriksson, Chris
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Occupational Therapy.
    Liedberg, Gunilla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Occupational Therapy.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Women with fibromyalgia: Work and rehabilitation2005In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 27, no 12, p. 685-695Article in journal (Refereed)
    Abstract [en]

    Purpose. To explore disability in women with fibromyalgia with a focus on their work situation. Method. Review of literature on work status of women with fibromyalgia. Results. Major differences exist between studies in reported disability and in the percentages of women working. Limitations caused by pain, fatigue, decreased muscle strength, and endurance influence work capacity. However, 34-77% of the women work. Individual adjustments in the work situation are reported. When the women find a level that matches their ability, they continue to work and find satisfaction in their work role. Many factors besides degree of impairment or disability influence whether clients with longstanding pain can remain in their work role or return to work after sickness leave. Conclusion. The total life situation, other commitments, type of work tasks, the ability to influence the work situation, and the physical and psychosocial work environment are important factors in determining whether a person can remain in a work role. More knowledge is needed about how to adjust work conditions for people with partial work ability to the benefit of society and the individual.

  • 46.
    Henriksson, Karl-Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Fibromyalgi - funktionsstörning i det nociceptiva nervsystemet.2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, p. 4118-4119Article in journal (Other (popular science, discussion, etc.))
  • 47.
    Henriksson, Karl-Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Fibromyalgia - From syndrome to disease. Overview of pathogenetic mechanisms2003In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, p. 89-94Article in journal (Refereed)
    Abstract [en]

    According to the classification criteria proposed by the American College of Rheumatology, fibromyalgia is a long-standing multifocal pain condition combined with generalised allodynia/hyperalgesia. It is the generalised allodynia/hyperalgesia that distinguishes fibromyalgia from other conditions with chronic musculoskeletal pain. Central sensitisation of nociceptive neurons in the dorsal horn due to activation of N-methyl-D-aspartic acid receptors and disinhibition of pain due to deficient function of the descending inhibitory system are probable pathogenic factors for allodynia/hyperalgesia. Furthermore, chronic pain is a chronic emotional and physical stressor. Chronic stress and chronic sleep disturbance are not specific for fibromyalgia but could be the causes of symptoms like fatigue, cognitive difficulties and other stress-related symptoms. They may also cause neuroendocrinological and immunological aberrations.

  • 48.
    Henriksson, Karl-Gösta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Hypersensitivity in muscle pain syndromes2003In: Current Pain and Headache Reports, ISSN 1531-3433, E-ISSN 1534-3081, Vol. 7, p. 426-432Article in journal (Refereed)
  • 49.
    Henriksson, Karl-Gösta
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Is fibromyalgia a central pain state?2002In: Journal of Musculoskeletal Pain, ISSN 1058-2452, E-ISSN 1540-7012, Vol. 10, no 1-2, p. 45-57Article in journal (Refereed)
    Abstract [en]

    Objective: To review the literature concerning pain mechanisms in fibromyalgia [FMS]. Findings and Conclusions: Thirteen investigations using different methods, comprising 250 patients with FMS, confirm a biological dysfunction of the nociceptive system, especially in the central nervous system in the majority of patients with FMS. The hyperexcitability in the nociceptive nervous system may have different causes in the individual patient. Localized long-standing muscle pain, chronic stress, genetic factors, and hormonal changes may all play a role. Pain generators in the muscle may not be specific for FMS but may be of importance for initiating and maintaining pain and allodynia/hyperalgesia. © 2002 by The Haworth Press, Inc. All rights reserved.

  • 50.
    Henriksson, Karl-Gösta
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    The Fibromyalgia Syndrome: Translating Science into Clinical Practice2009In: JOURNAL OF MUSCULOSKELETAL PAIN, ISSN 1058-2452, Vol. 17, no 2, p. 189-194Article in journal (Refereed)
    Abstract [en]

    Objectives: The first objective is to present the arguments in favor of considering the biological component of the fibromyalgia syndrome [FMS], a disease of the nociceptive nervous system. The second aim is to present reliable methods for diagnosing such a disease. Findings: Studies confirm that there is long-standing or permanent pain hypersensitivity in FMS. The main causes of the pain amplification are central and peripheral sensitization of pain transmission neurons and/or pain disinhibition due to a disturbed endogenous pain modulation. The manual palpation method for determining the number of tender points is a measure of pressure-pain thresholds and degree of pain perception. Pain perception is influenced by psychological factors. More objective measures of pain thresholds are available and are presented in the article. Conclusions: The biological part of FMS reflects a long-standing or permanent change in the function of the nociceptive nervous system, that can be equated with a disease. It is hoped that upgrading FMS from illness to disease will increase the awareness of FMS among health personnel. This will in turn help patients with FMS to get correct diagnosis and treatment.

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