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  • 1.
    Dahlman, Joakim
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Sjörs, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Ledin, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Falkmer, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Paediatric Habilitation Community Service.
    Could sound be used as a strategy for reducing symptoms of perceived motion sickness?2008In: Journal of NeuroEngineering and Rehabilitation, ISSN 1743-0003, E-ISSN 1743-0003, Vol. 5, no 35Article in journal (Refereed)
    Abstract [en]

    Background: Working while exposed to motions, physically and psychologically affects a person. Traditionally, motion sickness symptom reduction has implied use of medication, which can lead to detrimental effects on performance. Non-pharmaceutical strategies, in turn, often require cognitive and perceptual attention. Hence, for people working in high demand environments where it is impossible to reallocate focus of attention, other strategies are called upon. The aim of the study was to investigate possible impact of a mitigation strategy on perceived motion sickness and psychophysiological responses, based on an artificial sound horizon compared with a non-positioned sound source.

    Method: Twenty-three healthy subjects were seated on a motion platform in an artificial sound horizon or in non-positioned sound, in random order with one week interval between the trials. Perceived motion sickness (Mal), maximum duration of exposure (ST), skin conductance, blood volume pulse, temperature, respiration rate, eye movements and heart rate were measured continuously throughout the trials.

    Results: Mal scores increased over time in both sound conditions, but the artificial sound horizon, applied as a mitigation strategy for perceived motion sickness, showed no significant effect on Mal scores or ST. The number of fixations increased with time in the non-positioned sound condition. Moreover, fixation time was longer in the nonpositioned sound condition compared with sound horizon, indicating that the subjects used more time to fixate and, hence, assumingly made fewer saccades.

    Conclusion: A subliminally presented artificial sound horizon did not significantly affect perceived motion sickness, psychophysiological variables or the time the subjects endured the motion sickness triggering stimuli. The number of fixations and fixation times increased over time in the non-positioned sound condition.

  • 2.
    Dahlman, Joakim
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Sjörs, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Lindström, Johan
    Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Ledin, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Falkmer, Torbjörn
    Jönköping University, Jönköping Sweden.
    Performance and Autonomic Responses during Motion Sickness2009In: Human Factors, ISSN 0018-7208, E-ISSN 1547-8181, Vol. 51, no 1, p. 56-66Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of the study was to investigate how motion sickness, triggered by an optokinetic drum, affects short term memory performance and to explore autonomic responses to perceived motion sickness.

    Background: Previous research has found motion sickness to decrease performance, but it is not known how short term memory in particular is affected.

    Method: Thirty-eight healthy participants performed a listening span test while seated in a rotating optokinetic drum. Measurements of motion sickness, performance, heart rate, skin conductance, blood volume pulse, and pupil size were performed simultaneously throughout the experiment.

    Results: A total of 16 participants terminated the trial due to severe nausea, while the other 22 endured the full 25 minutes. Perceived motion sickness increased over time in both groups, but less among those who endured the trial. Short term memory performance decreased towards the end for those who terminated, while it increased for the other group. Results from the measured autonomic responses were ambiguous.

    Conclusion: The present study concludes that performance, measured as short term memory, declines as perceived motion sickness progresses.

    Application: This research has potential implications for command and control personnel in risk of developing motion sickness.

  • 3.
    Dahlman, Joakim
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Sjörs, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Lundgren, Pontus
    Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    Ledin, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Falkmer, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Paediatric Habilitation Community Service.
    Effects of Motion Sickness on Encoding and Retrieval2010Article in journal (Refereed)
    Abstract [en]

    Objective: In this study, possible effects of motion sickness on encoding and retrieval of words were investigated.

    Background: The impact of motion sickness on human performance has been studied with regards to psychomotor functions and over learned skills, as well as to novel situations requiring encoding and retrieval skills through the use of short term memory. In this study, possible effects of motion sickness on encoding and retrieval of words were investigated.

    Method: Forty healthy participants, half of them males, performed a continuous recognition task (CRT) during exposure to a motion sickness triggering optokinetic drum. The CRT was employed as a measurement of performance and consisted of encoding and retrieval of words. The task consisted of three consecutive phases 1) encoding of familiar words; 2) encoding and retrieval of words under the influence of motion sickness; 3) retrieval of words after exposure.

    Results: Data analysis revealed no significant differences in the ability to encode or retrieve words during motion sickness compared with a control condition. In addition, there were no significant correlations between the level of motion sickness and performance of the CRT.

    Conclusion: The results indicate that encoding and retrieval of words are not affected by moderate levels of motion sickness. Application: This research has implications for operational settings where professionals experience moderate levels of motion sickness.

  • 4.
    Falkmer, Torbjörn
    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, Paediatric Habilitation Community Service.
    Dahlman, Joakim
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine.
    Hasewinkel, Håkan
    FOI, Linköping.
    Sjörs, Anna
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine.
    Ökad körsäkerhet och snabbare målidentifiering genom blickregistrering2006Report (Other academic)
  • 5.
    Forsman, Fredrik
    et al.
    Chalmers University of Technology, Göteborg, Sweden.
    Sjörs-Dahlman, Anna
    Linköping University, Department of Medical and Health Sciences, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dahlman, Joakim
    Chalmers University of Technology, Göteborg, Sweden.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Lee, Hoe C
    Curtin University, Perth, Australia.
    Eye tracking during high speed naviation at sea: Field trial in search of navigational gaze behaviour2012In: Journal of Transportation Technologies, ISSN 2160-0473, E-ISSN 2160-0481, Vol. 2, p. 277-283Article in journal (Refereed)
    Abstract [en]

    Purpose: Professional high speed sea navigational procedures are based on turn points, courses, dangers and steering cues in the environment. Since navigational aids have become less expensive and due to the fact that electronic sea charts can be integrated with both radar and transponder information, it may be assumed that traditional navigation by using paper based charts and radar will play a less significant role in the future, especially among less experienced navigators. Possible navigational differences between experienced and non-experienced boat drivers is thus of interest with regards to their use of navigational aids. It may be assumed that less experienced navigators rely too much on the information given by the electronic sea chart, despite the fact that it is based on GPS information that can be questioned, especially in littoral waters close to land.

    Method: This eye tracking study investigates gaze behaviour from 16 experi- enced and novice boat drivers during high speed navigation at sea.

    Results: The results show that the novice drivers look at objects that are close to themselves, like instrumentation, while the experienced look more at objects far away from the boat. This is in accordance with previous research on car drivers. Further, novice boat drivers used the elec-tronic navigational aids to a larger extent than the experienced, especially during high speed conditions. The experienced drivers focused much of their attention on objects outside the boat.

    Conclusions: The findings verify that novice boat drivers tend to rely on electronic navigational aids. Experienced drivers presumably use the navigational aids to verify what they have observed in the surrounding environment and further use the paper based sea chart to a larger extent than the novice drivers.

  • 6.
    Ghafouri, Bijar
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Larsson, Britt
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Sjörs, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Leandersson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Östergötlands Läns Landsting, Heart and Medicine Centre, Occupational and Environmental Medicine Centre. Linköping University, Faculty of Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Pain and Rehabilitation Centre.
    Interstitial concentration of serotonin is increased in myalgic human trapezius muscle during rest, repetitive work and mental stress - an in vivo microdialysis study2010In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 70, no 7, p. 478-486Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The pathophysiology of trapezius myalgia is not fully elucidated. Serotonin (5-HT) is involved in modulation of nociception and hyperalgesia. Our aim was to compare the interstitial 5-HT levels of the trapezius muscle in women with chronic trapezius myalgia and in pain-free controls.

    MATERIALS AND METHODS: Microdialysate of the trapezius muscle collected every 20 minutes during rest, work (100 min) and stress (20 min) was used to study the dynamics of 5-HT in women with chronic trapezius myalgia (MYA; n=18) and in pain-free controls (CON; n=30).

    RESULTS: MYA had higher levels of 5-HT than CON at baseline, during repetitive work, during mental stress and during recovery. There were no significant time effects on 5-HT levels.

    CONCLUSION: 5-HT has the potential of a biomarker of chronic myalgia. Elevated levels of 5-HT may be involved in maintenance of habitual chronic pain and might contribute to increased pain during exercise by facilitating the effect of released algesic substances linked to such muscle demands.

  • 7.
    Hadrevi, J
    et al.
    Umeå University, Sweden .
    Ghafouri, Bijar
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Östergötlands Läns Landsting, Heart and Medicine Center, Occupational and Environmental Medicine Center. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Sjörs, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Antti, H
    Umeå University, Sweden .
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Crenshaw, A G.
    University of Gavle, Sweden .
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Hellstrom, F
    University of Gavle, Sweden .
    Comparative metabolomics of muscle interstitium fluid in human trapezius myalgia: an in vivo microdialysis study2013In: European Journal of Applied Physiology, ISSN 1439-6319, E-ISSN 1439-6327, Vol. 113, no 12, p. 2977-2989Article in journal (Refereed)
    Abstract [en]

    The mechanisms behind trapezius myalgia are unclear. Many hypotheses have been presented suggesting an altered metabolism in the muscle. Here, muscle microdialysate from healthy and myalgic muscle is analysed using metabolomics. Metabolomics analyse a vast number of metabolites, enabling a comprehensive explorative screening of the cellular processes in the muscle. less thanbrgreater than less thanbrgreater thanMicrodialysate samples were obtained from the shoulder muscle of healthy and myalgic subjects that performed a work and stress test. Samples from the baseline period and from the recovery period were analysed using gas chromatography-mass spectrometry (GC-MS) together with multivariate analysis to detect differences in extracellular content of metabolites between groups. Systematic differences in metabolites between groups were identified using multivariate analysis and orthogonal partial least square discriminate analysis (OPLS-DA). A complementary Mann-Whitney U test of group difference in individual metabolites was also performed. less thanbrgreater than less thanbrgreater thanA large number of metabolites were detected and identified in this screening study. At baseline, no systematic differences between groups were observed according to the OPLS-DA. However, two metabolites, l-leucine and pyroglutamic acid, were significantly more abundant in the myalgic muscle compared to the healthy muscle. In the recovery period, systematic difference in metabolites between the groups was observed according to the OPLS-DA. The groups differed in amino acids, fatty acids and carbohydrates. Myristic acid and putrescine were significantly more abundant and beta-d-glucopyranose was significantly less abundant in the myalgic muscle. less thanbrgreater than less thanbrgreater thanThis study provides important information regarding the metabolite content, thereby presenting new clues regarding the pathophysiology of the myalgic muscle.

  • 8.
    Lemming, Dag
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Börsbo, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Sjörs, Anna
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Single-point but not tonic cuff pressure pain sensitivity is associated with level of physical fitness: a study of non-athletic healthy subjects2015Data set
    Abstract [en]

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

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

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

  • 9.
    Lemming, Dag
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Börsbo, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Sjörs, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Lind, Eva-Britt
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Arendt-Nielsen, Lars
    Laboratory for Experimental Pain Research and Center for Neuroplasticity and Pain, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
    Graven-Nielsen, Thomas
    Center for Neuroplasticity and Pain, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Cuff Pressure Pain Detection Is Associated with Both Sex and Physical Activity Level in Nonathletic Healthy Subjects2017In: Pain medicine (Malden, Mass.), ISSN 1526-2375, E-ISSN 1526-4637, Vol. 18, no 8, p. 1573-1581Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 10.
    Lemming, Dag
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Börsbo, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Sjörs, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Lind, Eva-Britt
    Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Arendt-Nielsen, Lars
    Center for Sensory-Motor Interaction (SMI), Laboratory for Experimental Pain Research, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
    Graven-Nielsen, Thomas
    Center for Sensory-Motor Interaction (SMI), Laboratory for Experimental Pain Research, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Single-point but not tonic cuff pressure pain sensitivity is associated with level of physical fitness: a study of non-athletic healthy subjects2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0125432Article in journal (Refereed)
    Abstract [en]

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

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

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

  • 11.
    Palstam, Annie
    et al.
    Gothenburg University, Sweden; University of Gothenburg Centre Person Centre Care GPCC, Sweden.
    Larsson, Anette
    Gothenburg University, Sweden; University of Gothenburg Centre Person Centre Care GPCC, Sweden.
    Bjersing, Jan
    Gothenburg University, Sweden.
    Lofgren, Monika
    Karolinska Institute, Sweden.
    Ernberg, Malin
    Karolinska Institute, Sweden.
    Bileviciute-Ljungar, Lndre
    Karolinska Institute, Sweden.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Östergötlands Läns Landsting, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Sjörs, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Kosek, Eva
    Karolinska Institute, Sweden; Karolinska Institute, Sweden.
    Mannerkorpi, Kaisa
    Gothenburg University, Sweden; University of Gothenburg Centre Person Centre Care GPCC, Sweden .
    PERCEIVED EXERTION AT WORK IN WOMEN WITH FIBROMYALGIA: EXPLANATORY FACTORS AND COMPARISON WITH HEALTHY WOMEN2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 8, p. 773-780Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate perceived exertion at work in women with fibromyalgia. Design: A controlled cross-sectional multi-centre study. Subjects and methods: Seventy-three women with fibromyalgia and 73 healthy women matched by occupation and physical workload were compared in terms of perceived exertion at work (0-14), muscle strength, 6-min walk test, symptoms rated by Fibromyalgia Impact Questionnaire (FIQ), work status (25-100%), fear avoidance work beliefs (0-42), physical activity at work (7-21) and physical workload (1-5). Spearmans correlation coefficient and linear regression analysis were conducted. Results: Perceived exertion at work was significantly higher in the fibromyalgia group than in the reference group (p=0.002), while physical activity at work did not differ between the groups. Physical capacity was lower and symptom severity higher in fibromyalgia compared with references (pless than0.05). In fibromyalgia, perceived exertion at work showed moderate correlation with physical activity at work, physical workload and fear avoidance work beliefs (r(s) = 0.53 0.65, pless than0.001) and a fair correlation with anxiety (r(s) = 0.26, p=0.027). Regression analysis indicated that the physical activity at work and fear avoidance work beliefs explained 50% of the perceived exertion at work. Conclusion: Women with fibromyalgia perceive an elevated exertion at work, which is associated with physical work-related factors and factors related to fear and anxiety.

  • 12.
    Sjors, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    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.
    Dahlman, Joakim
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Falkmer, Torbjorn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Paediatric Habilitation Community Service.
    Gerdle, Bjorn
    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.
    Physiological responses to low-force work and psychosocial stress in women with chronic trapezius myalgia2009In: BMC MUSCULOSKELETAL DISORDERS, ISSN 1471-2474, Vol. 10, no 63Article in journal (Refereed)
    Abstract [en]

    Background: Repetitive and stressful work tasks have been linked to the development of pain in the trapezius muscle, although the underlying mechanisms still remain unclear. In earlier studies, it has been hypothesized that chronic muscle pain conditions are associated with imbalance in the autonomic nervous system, predominantly expressed as an increased sympathetic activity. This study investigates whether women with chronic trapezius myalgia show higher muscle activity and increased sympathetic tone at baseline and during repetitive low-force work and psychosocial stress, compared with pain-free controls. Methods: Eighteen women with chronic trapezius myalgia (MYA) and 30 healthy female controls (CON) were studied during baseline rest, 100 min of repetitive low-force work, 20 min of psychosocial stress (Trier Social Stress Test, TSST), and 80 min recovery. The subjects rated their pain intensity, stress and energy level every 20 min throughout the experiment. Muscle activity was measured by surface electromyography in the trapezius muscle (EMGtrap) and deltoid muscle (EMGdelt). Autonomic reactivity was measured through heart rate (HR), skin conductance (SCL), blood pressure (MAP) and respiration rate (Resp). Results: At baseline, EMGtrap, stress ratings, and HR were higher in MYA than in CON. Energy ratings, EMGdelt, SCL, MAP and Resp were, however, similar in the two groups. Significant main group effects were found for pain intensity, stress ratings and EMGtrap. Deltoid muscle activity and autonomic responses were almost identical in MYA and CON during work, stress and recovery. In MYA only, pain intensity and stress ratings increased towards the end of the repetitive work. Conclusion: We found increased muscle activity during uninstructed rest in the painful muscle of a group of women with trapezius myalgia. The present study could not confirm the hypothesis that chronic trapezius myalgia is associated with increased sympathetic activity. The suggestion of autonomic imbalance in patients with chronic local or regional musculoskeletal pain needs to be further investigated.

  • 13.
    Sjörs, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine .
    I feel terrible! Can you measure that?: Exploring psychophysiological stress responses and their interactions with performance, subjective reports and health status2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Despite recent research advances, there are still several common medical conditions whose underlying mechanisms are poorly understood. In conditions with few or diffuse physical findings, it can be difficult to diagnose and determine the state of the condition and its effects on working ability or performance, and the health care practitioners have to rely on the patient’s self-reports. Identification of objective measurements that are sensitive enough to aid in diagnosis or determination of the state of these conditions would thus be valuable. Psychophysiological measurements are generally non-invasive and have the potential to serve as such diagnostic or prognostic tools. In this thesis, psychophysiological reactions to different stressors were recorded in two selected medical conditions; namely motion sickness and chronic trapezius myalgia (musculoskeletal pain). These subjective conditions are unpleasant, unwanted and apparently serve no survival purpose. It is therefore important to elucidate any physical findings associated with them to, eventually, find new means to prevent the development of these conditions or to ameliorate symptoms.

    The overall aim of the thesis was to explore the development of psychophysiological responses to stressors in relation to performance and subjective reports in healthy individuals and in women with chronic trapezius myalgia. More in detail, the purpose was to identify psychophysiological responses that could provide information about the mechanisms behind, or serve as candidates for characterization of motion sickness and chronic trapezius myalgia, respectively.

    Responses to motion sickness, triggered by optokinetic stimulation, were studied in healthy individuals, whereas responses to repetitive low-force work and psychosocial stress were studied in women with chronic trapezius myalgia and in pain-free controls. In both medical conditions, the psychophysiological responses were accompanied by subjective reports. The effects of motion sickness on two different aspects of memory performance were tested during exposure to optokinetic stimulation. In the studies of chronic trapezius myalgia, psychophysiological responses were also related to health status, i.e., being a patient or a pain-free control and measurements of pain intensity, psychological symptoms, sleep-related problems and quality of life.

    The psychophysiological responses to optokinetic stimulation were inconclusive. Moderate levels of motion sickness did not affect memory performance, whereas decreased short term memory performance was seen in subjects reporting high levels of motion sickness. The autonomic responses and stress hormone secretion in response to low-force repetitive work and psychosocial stress in the chronic trapezius myalgia group were similar to those of the pain-free controls. However, muscle activity in the trapezius muscle was generally higher in the chronic trapezius myalgia group. There were indications of negative psychological states being related to a slower response and lower circadian variations of stress hormone secretion.

    With the present methods, it was possible to measure general stress responses but none of the measurements showed sufficient specificity to serve as predictors or indicators of motion sickness and chronic musculoskeletal pain, respectively. Summarizing, I cannot objectively measure how you feel; I still have to rely on your description of your condition.

    List of papers
    1. Performance and Autonomic Responses during Motion Sickness
    Open this publication in new window or tab >>Performance and Autonomic Responses during Motion Sickness
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    2009 (English)In: Human Factors, ISSN 0018-7208, E-ISSN 1547-8181, Vol. 51, no 1, p. 56-66Article in journal (Refereed) Published
    Abstract [en]

    Objective: The aim of the study was to investigate how motion sickness, triggered by an optokinetic drum, affects short term memory performance and to explore autonomic responses to perceived motion sickness.

    Background: Previous research has found motion sickness to decrease performance, but it is not known how short term memory in particular is affected.

    Method: Thirty-eight healthy participants performed a listening span test while seated in a rotating optokinetic drum. Measurements of motion sickness, performance, heart rate, skin conductance, blood volume pulse, and pupil size were performed simultaneously throughout the experiment.

    Results: A total of 16 participants terminated the trial due to severe nausea, while the other 22 endured the full 25 minutes. Perceived motion sickness increased over time in both groups, but less among those who endured the trial. Short term memory performance decreased towards the end for those who terminated, while it increased for the other group. Results from the measured autonomic responses were ambiguous.

    Conclusion: The present study concludes that performance, measured as short term memory, declines as perceived motion sickness progresses.

    Application: This research has potential implications for command and control personnel in risk of developing motion sickness.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-15916 (URN)10.1177/0018720809332848 (DOI)
    Available from: 2008-12-16 Created: 2008-12-16 Last updated: 2017-12-14Bibliographically approved
    2. Effects of motion sickness on encoding and retrieval performance and on psychophysiological responses
    Open this publication in new window or tab >>Effects of motion sickness on encoding and retrieval performance and on psychophysiological responses
    Show others...
    2010 (English)Article in journal (Refereed) Submitted
    Abstract [en]

    Motion sickness has previously been found to deteriorate performance, e.g., regarding psychomotor functions and short term memory. Sustained ability to perform, despite motion sickness, is crucial in complex working environments. This study focuses on effects of motion sickness on encoding and retrieval of words through the use of long term memory. In addition, the temporal development of different psychophysiological responses and their relationship with perceived motion sickness were investigated. Forty healthy participants performed an encoding and retrieval task during exposure to an optokinetic drum. The results were compared with data from 20 controls that performed the task without motion sickness exposure. Measurements of heart rate, heart rate variability, skin conductance, blood volume pulse, respiration rate, and skin temperature were made throughout optokinetic drum exposure. Data analyses revealed no significant effects of moderate levels of motion sickness on the ability to encode or retrieve words. We found positive relationships between subjective motion sickness ratings and heart rate, blood volume pulse and skin temperature whereas respiration rate was negatively related to perceived motion sickness. The psychophysiological measurements did not show consistent patterns of sympathetic activation and parasympathetic withdrawal, as could be expected. Hence, they are not recommended as predictors of motion sickness.

    Keywords
    Motion sickness, memory, autonomic responses, performance, optokinetic drum
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-54332 (URN)
    Available from: 2010-03-10 Created: 2010-03-10 Last updated: 2018-03-17
    3. Physiological responses to low-force work and psychosocial stress in women with chronic trapezius myalgia
    Open this publication in new window or tab >>Physiological responses to low-force work and psychosocial stress in women with chronic trapezius myalgia
    Show others...
    2009 (English)In: BMC MUSCULOSKELETAL DISORDERS, ISSN 1471-2474, Vol. 10, no 63Article in journal (Refereed) Published
    Abstract [en]

    Background: Repetitive and stressful work tasks have been linked to the development of pain in the trapezius muscle, although the underlying mechanisms still remain unclear. In earlier studies, it has been hypothesized that chronic muscle pain conditions are associated with imbalance in the autonomic nervous system, predominantly expressed as an increased sympathetic activity. This study investigates whether women with chronic trapezius myalgia show higher muscle activity and increased sympathetic tone at baseline and during repetitive low-force work and psychosocial stress, compared with pain-free controls. Methods: Eighteen women with chronic trapezius myalgia (MYA) and 30 healthy female controls (CON) were studied during baseline rest, 100 min of repetitive low-force work, 20 min of psychosocial stress (Trier Social Stress Test, TSST), and 80 min recovery. The subjects rated their pain intensity, stress and energy level every 20 min throughout the experiment. Muscle activity was measured by surface electromyography in the trapezius muscle (EMGtrap) and deltoid muscle (EMGdelt). Autonomic reactivity was measured through heart rate (HR), skin conductance (SCL), blood pressure (MAP) and respiration rate (Resp). Results: At baseline, EMGtrap, stress ratings, and HR were higher in MYA than in CON. Energy ratings, EMGdelt, SCL, MAP and Resp were, however, similar in the two groups. Significant main group effects were found for pain intensity, stress ratings and EMGtrap. Deltoid muscle activity and autonomic responses were almost identical in MYA and CON during work, stress and recovery. In MYA only, pain intensity and stress ratings increased towards the end of the repetitive work. Conclusion: We found increased muscle activity during uninstructed rest in the painful muscle of a group of women with trapezius myalgia. The present study could not confirm the hypothesis that chronic trapezius myalgia is associated with increased sympathetic activity. The suggestion of autonomic imbalance in patients with chronic local or regional musculoskeletal pain needs to be further investigated.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-20186 (URN)10.1186/1471-2474-10-63 (DOI)
    Note
    Original Publication: Anna Sjors, Britt Larsson, Joakim Dahlman, Torbjorn Falkmer and Bjorn Gerdle, Physiological responses to low-force work and psychosocial stress in women with chronic trapezius myalgia, 2009, BMC MUSCULOSKELETAL DISORDERS, (10), 63, . http://dx.doi.org/10.1186/1471-2474-10-63 Licencee: BioMed Central http://www.biomedcentral.com/ Available from: 2009-09-02 Created: 2009-08-31 Last updated: 2018-03-17
    4. Salivary cortisol response to acute stress and its relation to psychological factors in women with chronic trapezius myalgia – a pilot study
    Open this publication in new window or tab >>Salivary cortisol response to acute stress and its relation to psychological factors in women with chronic trapezius myalgia – a pilot study
    Show others...
    2010 (English)In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 35, no 5, p. 674-685Article in journal (Refereed) Published
    Abstract [en]

    This study investigated differences in HPA axis function, measured as salivary cortisol concentrations, between 18 women with chronic trapezius myalgia (MYA) and 30 healthy female controls. In addition, the interactions between HPA axis reactions to psychosocial stress and aspects of pain, health and psychological symptoms were analyzed. Salivary cortisol was measured both in daily life, to assess the circadian profile, and in the laboratory during light repetitive work and standardized psychosocial stress (Trier Social Stress Test, TSST). MYA and CON exhibited similar circadian rhythms and comparable salivary cortisol response magnitudes after TSST. In subjects defined as responders to the TSST, the mean peak time point of the cortisol response after TSST differed significantly between MYA and CON. Furthermore, negative psychological states and higher pain intensity were related to a slower HPA axis response to TSST. Low circadian variations in cortisol and smaller cortisol responses to TSST were found among subjects scoring high on anxiety sensitivity. Thus, a relatively favorable sample of female chronic trapezius myalgia patients exhibited normal circadian rhythm and normal salivary cortisol response magnitudes after a psychosocial stress test. In the subgroup of responders, the MYA group showed indications of a slower salivary cortisol response to psychosocial stress. Further studies are needed to elucidate the possibility of altered HPA axis activity in terms of a slower salivary cortisol response.

    Keywords
    salivary cortisol; HPA axis; chronic pain; musculoskeletal disorders; stress; Trier Social Stress Test (TSST)
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-54334 (URN)10.1016/j.psyneuen.2009.10.007 (DOI)000278431500005 ()19900762 (PubMedID)
    Available from: 2010-03-10 Created: 2010-03-10 Last updated: 2017-12-12
  • 14.
    Sjörs, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Dahlman, Joakim
    Human Factors, Shipping and Marine Technology, Chalmers University of Technology, Göteborg, Sweden.
    Lundgren, Pontus
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    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.
    Ledin, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Reconstruction Centre.
    Falkmer, Torbjörn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Habilitation in Central County.
    Effects of motion sickness on encoding and retrieval performance and on psychophysiological responses2010Article in journal (Refereed)
    Abstract [en]

    Motion sickness has previously been found to deteriorate performance, e.g., regarding psychomotor functions and short term memory. Sustained ability to perform, despite motion sickness, is crucial in complex working environments. This study focuses on effects of motion sickness on encoding and retrieval of words through the use of long term memory. In addition, the temporal development of different psychophysiological responses and their relationship with perceived motion sickness were investigated. Forty healthy participants performed an encoding and retrieval task during exposure to an optokinetic drum. The results were compared with data from 20 controls that performed the task without motion sickness exposure. Measurements of heart rate, heart rate variability, skin conductance, blood volume pulse, respiration rate, and skin temperature were made throughout optokinetic drum exposure. Data analyses revealed no significant effects of moderate levels of motion sickness on the ability to encode or retrieve words. We found positive relationships between subjective motion sickness ratings and heart rate, blood volume pulse and skin temperature whereas respiration rate was negatively related to perceived motion sickness. The psychophysiological measurements did not show consistent patterns of sympathetic activation and parasympathetic withdrawal, as could be expected. Hence, they are not recommended as predictors of motion sickness.

  • 15.
    Sjörs, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Jansson, P-A
    University of Gothenburg, Sweden .
    Eriksson, J W
    Sahlgrens University Hospital, Sweden AstraZeneca RandD, Sweden .
    Jonsdottir, I H
    Institute Stress Med, Sweden University of Gothenburg, Sweden .
    Increased insulin secretion and decreased glucose concentrations, but not allostatic load, are associated with stress-related exhaustion in a clinical patient population2013In: Stress, ISSN 1025-3890, E-ISSN 1607-8888, Vol. 16, no 1, p. 24-33Article in journal (Refereed)
    Abstract [en]

    Allostatic load (AL) has been shown to be a useful marker of physiological strain during chronic stress and burnout in non-clinical working populations. The usability of the AL index for a clinical population with severe stress-related exhaustion was tested in this study. Thirteen biomarkers assembled as an AL index were analysed using blood samples from 90 patients with stress-related exhaustion (43 men and 47 women, age 31-61 years) and 90 healthy controls (46 men and 44 women, age 25-56 years). The AL scores did not differ between patients and controls. For men, some indication of higher cardiovascular risk was seen in the patient group: male patients had higher body mass index and waist-hip ratio and a poorer blood lipid status than male controls. We found lower plasma glucose concentrations in both female and male patients than those in controls. The male patients also showed increased fasting serum insulin concentrations. Further analysis using homeostasis model assessment for insulin resistance and beta-cell function showed indications of insulin resistance in the patient group, particularly in the males, and an increased insulin secretion in both male and female patients. In conclusion, AL index does not seem to capture plausible physiological strain in patients diagnosed with stress-related exhaustion. The finding of lower plasma glucose concentrations, probably due to higher insulin secretion, in patients with severe stress-related exhaustion, needs to be further investigated, including mechanisms and the clinical relevance.

  • 16.
    Sjörs, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Larsson, Britt
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Pain and Rehabilitation Centre.
    Karlson, Björn
    Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
    Österberg, Kai
    Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Sweden.
    Dahlman, Joakim
    Human Factors, Shipping and Marine Technology, Chalmers University of Technology, Göteborg, Sweden.
    Gerdle, Björn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Pain and Rehabilitation Centre.
    Salivary cortisol response to acute stress and its relation to psychological factors in women with chronic trapezius myalgia – a pilot study2010In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 35, no 5, p. 674-685Article in journal (Refereed)
    Abstract [en]

    This study investigated differences in HPA axis function, measured as salivary cortisol concentrations, between 18 women with chronic trapezius myalgia (MYA) and 30 healthy female controls. In addition, the interactions between HPA axis reactions to psychosocial stress and aspects of pain, health and psychological symptoms were analyzed. Salivary cortisol was measured both in daily life, to assess the circadian profile, and in the laboratory during light repetitive work and standardized psychosocial stress (Trier Social Stress Test, TSST). MYA and CON exhibited similar circadian rhythms and comparable salivary cortisol response magnitudes after TSST. In subjects defined as responders to the TSST, the mean peak time point of the cortisol response after TSST differed significantly between MYA and CON. Furthermore, negative psychological states and higher pain intensity were related to a slower HPA axis response to TSST. Low circadian variations in cortisol and smaller cortisol responses to TSST were found among subjects scoring high on anxiety sensitivity. Thus, a relatively favorable sample of female chronic trapezius myalgia patients exhibited normal circadian rhythm and normal salivary cortisol response magnitudes after a psychosocial stress test. In the subgroup of responders, the MYA group showed indications of a slower salivary cortisol response to psychosocial stress. Further studies are needed to elucidate the possibility of altered HPA axis activity in terms of a slower salivary cortisol response.

  • 17.
    Sjörs, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Larsson, Britt
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Persson, Ann L
    Rehabil and Research Centre Torture Victims, Copenhagen.
    Gerdle, Björn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain2011In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 12, p. 230-230Article in journal (Refereed)
    Abstract [en]

    Background: Neck-shoulder pain conditions, e. g., chronic trapezius myalgia, have been associated with sensory disturbances such as increased sensitivity to experimentally induced pain. This study investigated pain sensitivity in terms of bilateral pressure pain thresholds over the trapezius and tibialis anterior muscles and pain responses after a unilateral hypertonic saline infusion into the right legs tibialis anterior muscle and related those parameters to intensity and area size of the clinical pain and to psychological factors (sleeping problems, depression, anxiety, catastrophizing and fear-avoidance). less thanbrgreater than less thanbrgreater thanMethods: Nineteen women with chronic non-traumatic neck-shoulder pain but without simultaneous anatomically widespread clinical pain (NSP) and 30 age-matched pain-free female control subjects (CON) participated in the study. less thanbrgreater than less thanbrgreater thanResults: NSP had lower pressure pain thresholds over the trapezius and over the tibialis anterior muscles and experienced hypertonic saline-evoked pain in the tibialis anterior muscle to be significantly more intense and locally more widespread than CON. More intense symptoms of anxiety and depression together with a higher disability level were associated with increased pain responses to experimental pain induction and a larger area size of the clinical neck-shoulder pain at its worst. less thanbrgreater than less thanbrgreater thanConclusion: These results indicate that central mechanisms e. g., central sensitization and altered descending control, are involved in chronic neck-shoulder pain since sensory hypersensitivity was found in areas distant to the site of clinical pain. Psychological status was found to interact with the perception, intensity, duration and distribution of induced pain (hypertonic saline) together with the spreading of clinical pain. The duration and intensity of pain correlated negatively with pressure pain thresholds.

  • 18.
    Sjörs, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. The Institute of Stress Medicine, Gothenburg, Sweden.
    Ljung, Thomas
    Mid Sweden University and County Council of Jämtland, Sweden.
    Jonsdottir, Ingebjörg
    Institute of Stress Medicine, Gothenburg and University of Gothenburg, Sweden .
    Diurnal salivary cortisol in relation to perceived stress at home and at work in healthy men and women2014In: Biological Psychology, ISSN 0301-0511, E-ISSN 1873-6246, Vol. 99, p. 193-197Article in journal (Refereed)
    Abstract [en]

    This study investigated the association between diurnal salivary cortisol profile and perceived stress at work and at home. Healthy participants (N = 180, 52% women) collected saliva cortisol samples immediately after waking up, 15 min later, 30 min later, and at 9:00, 12:00, 15:00, 18:00 and 21:00. The area under the cortisol awakening curve with respect to ground (AUCgCAR) and increase (AUCiCAR), and diurnal slope between 9:00 and 21:00 were analyzed. Perceived stress at work and at home was measured with the Stress-Energy Questionnaire. Participants reporting stress at home had significantly lower AUCgCAR and a flatter diurnal slope. When performing separate analyses for men and women, this association was only significant among women. Perceived stress at work was not associated with any cortisol measure. This study highlights the importance of stress outside the workplace. The sex differences may indicate an increased vulnerability to non-work stress in women.

  • 19.
    Sjörs, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Ljung, Thomas
    County Council of Jämtland, R&D-unit, Östersund, Sweden and Mid Sweden University, IHV, Östersund, Sweden.
    Jonsdottir, Ingibjorg H.
    The Institute of Stress Medicine, Gothenburg, Sweden and Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden .
    Long-term follow-up of cortisol awakening response in patients treated for stress-related exhaustion2012In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, no 4Article in journal (Refereed)
    Abstract [en]

    Objectives Studies on hypothalamus–pituitary–adrenal (HPA) axis activity in stress-related exhaustion and burnout have revealed incongruent results, and few longitudinal studies on clinical populations have been performed. This study was designed to investigate differences in HPA axis activity between patients with stress-related exhaustion and healthy controls and to investigate longitudinal changes in HPA axis activity in the patient group as they entered a multimodal treatment programme.

    Design HPA axis activity was assessed through the cortisol awakening response (CAR). Salivary cortisol was sampled at awakening and after 15 min. Follow-up measurements were performed in the patient group after 3, 6, 12 and 18 months.

    Setting An outpatient clinic specialising in stress-related illness.

    Participants Patients with clinically diagnosed stress-related exhaustion (n=162) and healthy controls (n=79).

    Primary and secondary outcome measures The primary measure was CAR measured as the difference between the two salivary cortisol samples. Changes in CAR during follow-up were related to changes in symptoms of burnout, depression and anxiety.

    Results Patients showed similar CAR as the controls and their CAR did not change significantly during treatment. No association was found between CAR and symptom development during treatment.

    Conclusions The authors conclude that CAR does not seem to discriminate clinically defined patients with exhaustion from healthy controls and it appears not to change during treatment. CAR, measured as salivary cortisol, at awakening and after 15 min, is thus not a valid marker for stress-related exhaustion.

  • 20.
    Sjörs Dahlman, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Institute Stress Med, Sweden.
    Jonsdottir, Ingibjorg H.
    Institute Stress Med, Sweden; University of Gothenburg, Sweden.
    NO ALTERATIONS IN DIURNAL CORTISOL PROFILES BEFORE AND DURING THE TREATMENT IN PATIENTS WITH STRESS-RELATED EXHAUSTION2015In: International Journal of Occupational Medicine and Environmental Health, ISSN 1232-1087, E-ISSN 1896-494X, Vol. 28, no 1, p. 120-129Article in journal (Refereed)
    Abstract [en]

    Objectives: Several theories have emerged in recent years suggesting that neuroendocrinological alterations, mainly changes in cortisol, could be of importance with respect to the link between chronic stress and disease. This study investigated possible deviations in the diurnal cortisol profiles of patients with clinically diagnosed stress-related exhaustion (exhaustion disorder - ED) compared with healthy controls. Material and Methods: Salivary cortisol samples taken at home in the morning directly after waking up, 30 min later, and in the evening were compared between ED patients (N = 122; 25% men) and healthy controls (N = 98; 44% men). Follow-up measurements were performed after 6 months (79 patients) and 12 months (68 patients) of the treatment. Results: There were no clear differences in diurnal salivary cortisol profiles between the patients and healthy controls. Moreover, salivary cortisol levels and diurnal profiles did not change significantly during the treatment in the patient group. There was some indication of a smaller cortisol awakening response in the male patients compared to the male controls, but the difference appeared to be mainly related to the antidepressant use. Conclusions: Diurnal salivary cortisol profiles, at least as measured in this study, give a rather poor reflection of the prolonged stress exposure experienced by patients with ED. Such basal salivary cortisol measurements do not seem suitable as biomarkers for stress-related conditions such as ED or burnout, or as an aid to assess the effects of prolonged stress load in a routine clinical practice.

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