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  • 1.
    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.

  • 2.
    Hurtig, Ingrid
    et al.
    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.
    Aspegren-Kendall, Sally
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Gerdle, Björn
    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.
    Quantitative sensory testing in fibromyalgia patients and in healthy subjects: identification of subgroups2001In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 17, no 4, p. 316-322Article in journal (Refereed)
    Abstract [en]

    Objective: To determine perception and pain thresholds in patients with fibromyalgia syndrome and in healthy controls, and to investigate whether patients with fibromyalgia syndrome can be grouped with respect to thermal hyperalgesia and whether these subgroups differ from healthy controls and in clinical appearance. Design: The authors conducted a quasi-experimental clinical study. Subjects: Twenty-nine women patients with fibromyalgia syndrome and 21 healthy pain-free age-matched women participated in the study. Methods: Quantitative sensory testing using a Thermotest instrument was performed on the dorsum of the left hand. Sleep and pain intensity were rated using visual analog scales. Results: Cold and heat pain but not perception thresholds differed significantly between patients with fibromyalgia syndrome and healthy subjects. Based on thermal pain thresholds, two subgroups could be identified in fibromyalgia syndrome using cluster analysis. Conclusion: Patients with fibromyalgia syndrome were subgrouped by quantitative sensory testing (i.e., thermal pain thresholds). Subgroups show clinical differences in pain intensities, number of tender points, and sleep quality. Cold pain threshold was especially linked to these clinical aspects.

  • 3.
    Nilsson, Evalill
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV), Biomedicine.
    Raak, Ragnhild
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV), Biomedicine.
    Wahren, Lis Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV), Biomedicine.
    Kristenson, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Centre for Public Health Sciences, Centre for Public Health Sciences.
    Hälsorelaterad livskvalitet i relation till psykologiska förklaringsvariabler2004In: Svenska Läkarsällskapets Riksstämma,2004, 2004, p. 82-82Conference paper (Other academic)
  • 4.
    Raak, Ragnhild
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies.
    Icke nordiska och nordiska kvinnors förväntan på och upplevelse av akut smärta2006In: Svenska läkaresällskapets Riksstämma,2006, 2006Conference paper (Other academic)
    Abstract [sv]

     ABSTRACT Cultural or ethnic background has been shown to be significant for how individuals experience pain. The aim of this study was to examine the expectation and experience of acute pain, the use of stress-coping styles, and the distribution of analgesics among non-Nordic and Nordic women in a dental treatment situation. Instruments used were the Visual Analogue Scale (VAS) and the Jalowiec Coping Scale (JCS). Non-Nordic women rated both expected and experienced pain significantly higher than Nordic women. No significant differences were found in stress-coping styles or in the distribution of analgesics between the two groups. Nurses must be sensitive to variations in pain communication styles across cultures.  

  • 5.
    Raak, Ragnhild
    Linköping University, Department of Medicine and Care, Pharmacology. Linköping University, Faculty of Health Sciences.
    Identification of subgroups in experimental and chronic pain: Sensory, emotional and evaluative aspects2002Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    One hundred and two healthy subjects, 32 fibromyalgia patients and 12 chronic low back pain patients were included in the study. Quantitative sensory tests were performed to identify thermal hyperalgesia in the fibromyalgia group and to compare the results with those in healthy pain-free subjects. Different questionnaires were used to map pain and stress-coping strategies /styles. (Coping Strategy Questionnaire, Jalowiec Coping Scale) and quality of life (Life Satisfaction Questionnaire and the SF-36).

    Both healthy subjects and fibromyalgia patients suffering from chronic pain could be subgrouped according to experimental pain perception. On comparing the fibromyalgia subgroups, differences in both stress and pain-coping strategies were found. Thus, the confrontative stress-coping style was used more in the thermal painsensitive group than the others. Furthermore, attention-diverting and catastrophising pain-coping strategies were more frequent.

    The chronic back-pain patients who had decreased their catastrophising pain-coping strategy at the 3-year follow-up also perceived an improved quality of life at the 6-year follow-up.

    When. self-scoring life satisfaction, thermal pain-sensitive fibromyalgia patients experienced significantly more physical symptoms than slightly cold pain-sensitive patients and healthy subjects. They also had sleep disturbances, more tender points, more affective hand pain and increased hand pain intensity.

    The relation between sensation and emotion must be regarded as a product of a conscious mind while the emotional part of the pain sensation is not just a passive response to an external stimulus.

    List of papers
    1. Stress coping strategies in thermal pain sensitive and insensitive healthy subjects
    Open this publication in new window or tab >>Stress coping strategies in thermal pain sensitive and insensitive healthy subjects
    2001 (English)In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 7, no 3, p. 162-168Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to investigate stress coping strategies used in relation to heat and cold pain thresholds in healthy subjects. After using the Jalowiec Coping Scale, cold and heat pain thresholds were examined using the Quantitative Somatosensory Test in 47 healthy subjects. The participants were separated into thermal pain sensitive and insensitive groups, based on thermal pain perception. The results showed that subjects sensitive to thermal pain tended to adopt an emotive stress coping style significantly more commonly than the insensitive subjects. Furthermore, women displayed a marked preference for this style compared to men. The conclusion is that emotional stress coping did play a role in the perception of thermal pain in this group of healthy subjects and that clinical nursing interventions need to focus on the relationship between emotion and coping.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-27120 (URN)10.1046/j.1440-172X.2001.00258.x (DOI)11767 (Local ID)11767 (Archive number)11767 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    2. Background pain in fibromyalgia patients affecting clinical examination of the skin
    Open this publication in new window or tab >>Background pain in fibromyalgia patients affecting clinical examination of the skin
    2002 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 1, p. 58-64Article in journal (Refereed) Published
    Abstract [en]

    • The purpose of this study was to investigate the relationship between on-going pain and acute thermal pain in patients suffering from chronic pain.

    •  This experimental study in cold and heat sensitivity was performed in order to test the following hypothesis: that fibromyalgia patients scoring high in current background pain tolerate less experimental thermal pain in the skin than patients with low scores.

    • Ethical aspects of the study are discussed.

    •  The level of tolerable experimental thermal stimuli was tested and compared between the `low-score' and the `high-score' patients.

    • Background pain seemed to affect the intensity of experimental cold pain.

    •  Clinical routine examinations and bodily care of the skin that might interfere with background pain in the fibromyalgia patients are discussed.

    • Clinical practice should be carefully planned in order to assist fibromyalgia patients in understanding and coping with thermal conditions that might influence background pain.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-27119 (URN)10.1046/j.1365-2702.2002.00542.x (DOI)11766 (Local ID)11766 (Archive number)11766 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    3. Quantitative sensory testing in fibromyalgia patients and in healthy subjects: identification of subgroups
    Open this publication in new window or tab >>Quantitative sensory testing in fibromyalgia patients and in healthy subjects: identification of subgroups
    Show others...
    2001 (English)In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 17, no 4, p. 316-322Article in journal (Refereed) Published
    Abstract [en]

    Objective: To determine perception and pain thresholds in patients with fibromyalgia syndrome and in healthy controls, and to investigate whether patients with fibromyalgia syndrome can be grouped with respect to thermal hyperalgesia and whether these subgroups differ from healthy controls and in clinical appearance. Design: The authors conducted a quasi-experimental clinical study. Subjects: Twenty-nine women patients with fibromyalgia syndrome and 21 healthy pain-free age-matched women participated in the study. Methods: Quantitative sensory testing using a Thermotest instrument was performed on the dorsum of the left hand. Sleep and pain intensity were rated using visual analog scales. Results: Cold and heat pain but not perception thresholds differed significantly between patients with fibromyalgia syndrome and healthy subjects. Based on thermal pain thresholds, two subgroups could be identified in fibromyalgia syndrome using cluster analysis. Conclusion: Patients with fibromyalgia syndrome were subgrouped by quantitative sensory testing (i.e., thermal pain thresholds). Subgroups show clinical differences in pain intensities, number of tender points, and sleep quality. Cold pain threshold was especially linked to these clinical aspects.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26941 (URN)10.1097/00002508-200112000-00005 (DOI)11569 (Local ID)11569 (Archive number)11569 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    4. Coping strategies and life satisfaction in subgrouped fibromyalgia patients
    Open this publication in new window or tab >>Coping strategies and life satisfaction in subgrouped fibromyalgia patients
    2003 (English)In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 4, no 3, p. 193-202Article in journal (Refereed) Published
    Abstract [en]

    The present study describes pain- and stress-coping strategies and life satisfaction in subgroups of fibromyalgia patients. Thirty-two females with fibromyalgia syndrome (FMS) and 21 healthy pain-free women were studied. Those with FMS were classified as thermal (both heat and cold) pain sensitive or slightly cold pain sensitive based on pain thresholds determined using a Thermotest device. Global stress-coping styles, life satisfaction, and specific pain-coping strategies were measured. Patients classified as thermal pain sensitive were affected by physical symptoms to a greater extent than were those classified as slightly cold pain sensitive. The thermal pain sensitive group used more diverting attention coping strategies than the slightly cold pain sensitive group did. Separating fibromyalgia patients into subgroups might increase the potential for improving nursing care of these patients. Through the use of effective coping strategies in dealing with stress and pain, life satisfaction may also be enhanced.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26942 (URN)10.1177/1099800402239622 (DOI)11570 (Local ID)11570 (Archive number)11570 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    5. Catastrophizing and health related quality of life: A 6-year follow-up of patients with chronic low back pain
    Open this publication in new window or tab >>Catastrophizing and health related quality of life: A 6-year follow-up of patients with chronic low back pain
    Show others...
    2002 (English)In: Rehabilitation Nursing, ISSN 0278-4807, Vol. 27, no 3, p. 110-117Article in journal (Refereed) Published
    Abstract [en]

    A pain rehabilitation model that focused on emotions was implemented to influence catastrophizing by, and health-related quality of life (HRQL) for, persons with chronic low back pain. Twelve individuals, 7 men and 5 women (aged 33 to 57 years), all with long-term pain despite treatment, were included in the study and a single case research experimental design (SCRED) was used to follow the patterns of coping with pain for 6 years. The HRQL was measured before and 6 years after the intervention. Coping strategies and HRQL were evaluated with the Coping Strategy Questionnaire (CSQ) and the SF-36, respectively. The evaluation of pain coping strategies after 3 years found decreased catastrophizing, a decrease that had continued 3 years later. HRQL showed significantly improved mental health and impaired physical capacity at the 6-year follow-up. Changes in catastrophizing or in HRQL did not appear to influence self-scored bodily pain. Altered catastrophizing appeared to be a long-term process. This research indicates the need for rehabilitation programs to assess and evaluate patients' pain and their need for improved quality of life, rather than focusing only on the elimination of pain.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-28114 (URN)10.1002/j.2048-7940.2002.tb01999.x (DOI)12923 (Local ID)12923 (Archive number)12923 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-18Bibliographically approved
  • 6.
    Raak, Ragnhild
    et al.
    Linköping University, Department of Medicine and Care, Pharmacology. Linköping University, Faculty of Health Sciences.
    Hurtig, Ingrid
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wahren, Lis Karin
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Coping strategies and life satisfaction in subgrouped fibromyalgia patients2003In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 4, no 3, p. 193-202Article in journal (Refereed)
    Abstract [en]

    The present study describes pain- and stress-coping strategies and life satisfaction in subgroups of fibromyalgia patients. Thirty-two females with fibromyalgia syndrome (FMS) and 21 healthy pain-free women were studied. Those with FMS were classified as thermal (both heat and cold) pain sensitive or slightly cold pain sensitive based on pain thresholds determined using a Thermotest device. Global stress-coping styles, life satisfaction, and specific pain-coping strategies were measured. Patients classified as thermal pain sensitive were affected by physical symptoms to a greater extent than were those classified as slightly cold pain sensitive. The thermal pain sensitive group used more diverting attention coping strategies than the slightly cold pain sensitive group did. Separating fibromyalgia patients into subgroups might increase the potential for improving nursing care of these patients. Through the use of effective coping strategies in dealing with stress and pain, life satisfaction may also be enhanced.

  • 7.
    Raak, Ragnhild
    et al.
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Raak, Anders
    Health Department, SAAB Aerospace, Linköping.
    Work attendance despite headache and its economic impact: a comparison between two workplaces2003In: Headache, ISSN 0017-8748, E-ISSN 1526-4610, Vol. 43, no 10, p. 1097-1101Article in journal (Refereed)
    Abstract [en]

    Objective.—To study work attendance despite headache in 2 different workplaces and its economic impact.

    Background.—Literature on the economic impact of headache traditionally has focused on direct costs. Little is known concerning headache experienced at work and its costs due to loss of effectiveness and productivity.

    Method.—We sent a questionnaire to 800 employees in Sweden—400 at a technology company (private employee population) and 400 at a university hospital (public employee population). We attempted to assess the prevalence of headache, work attendance despite the presence of acute headache, and the impact of acute headache upon work effectiveness. Subjects self-scored decreased work effectiveness resulting from headache during the previous 3 months and recorded the number of days at work despite headache. From these data, we estimated the economic loss resulting from headache.

    Results.—The survey response rate was 71.5%. The prevalence of headache was 64% in the private employee population and 78% in the public employee population. Thirty-nine percent of the private employees and 57% of the public employees reported experiencing headache as a result of stress. Fifty percent reported that they went to work despite headache, and the mean number of days at work despite headache, during the previous 3 months, was 6.6 days in the private employee group and 6.1 days in the public employee group. A 25% decrease in work effectiveness was estimated, and, extrapolating from our data, we calculated the cost of lost effectiveness due to headache among employers in Sweden to be approximately 1.4 billion euros a year.

    Conclusion.—The economic burden of headache experienced at work is substantial, suggesting that workplace-based treatment and prevention programs emphasizing stress management may be financially, as well as clinically, advantageous.

  • 8.
    Raak, Ragnhild
    et al.
    Linköping University, Department of Medicine and Care, Pharmacology. Linköping University, Faculty of Health Sciences.
    Wahren, Lis Karin
    Linköping University, Department of Medicine and Care, Pharmacology. Linköping University, Faculty of Health Sciences.
    Background pain in fibromyalgia patients affecting clinical examination of the skin2002In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 1, p. 58-64Article in journal (Refereed)
    Abstract [en]

    • The purpose of this study was to investigate the relationship between on-going pain and acute thermal pain in patients suffering from chronic pain.

    •  This experimental study in cold and heat sensitivity was performed in order to test the following hypothesis: that fibromyalgia patients scoring high in current background pain tolerate less experimental thermal pain in the skin than patients with low scores.

    • Ethical aspects of the study are discussed.

    •  The level of tolerable experimental thermal stimuli was tested and compared between the `low-score' and the `high-score' patients.

    • Background pain seemed to affect the intensity of experimental cold pain.

    •  Clinical routine examinations and bodily care of the skin that might interfere with background pain in the fibromyalgia patients are discussed.

    • Clinical practice should be carefully planned in order to assist fibromyalgia patients in understanding and coping with thermal conditions that might influence background pain.

  • 9.
    Raak, Ragnhild
    et al.
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Wahren, Lis Karin
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Headache and coping in a female working population2005In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 19, no 4, p. 325-329Article in journal (Refereed)
    Abstract [en]

    Tension-type headache is a common disorder amongst working people and, because of its very high prevalence, represents one of the most costly ailments in modern society. To study the frequency of tension-type headache in a working female population and to investigate how females who have experienced tension-type headache cope with pain compared with the way healthy pain-free subjects cope with stress. A total of 400 females working at a university hospital in Sweden were asked about their experience of headache in the previous 3 months. Instruments used were a specific Headache Questionnaire, the Jalowiec Stress-coping Questionnaire and Coping Strategy Questionnaire. Before the study, approval from the board of directors and the employees’ council was obtained. About 257 females (64.3%) answered the questionnaire and 78% of them (n = 199) reported that they had experienced headache in the previous 3 months. About 90% of the participants had never had an appointment with a doctor concerning headache and 57% reported a relationship between stress and headache. Regarding pain-coping strategy, increased pain behaviour was the most frequent strategy used. With regard to stress-coping style, a significant difference in the use of emotive style was found between females reporting headache and females not reporting headache. The results indicate that prevention programmes emphasizing stress management and coping may influence the experience of tension-type headache.

  • 10.
    Raak, Ragnhild
    et al.
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Wahren, Lis Karin
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Health experiences and employment status in subjects with chronic back pain: a long-term perspective2006In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, Vol. 7, no 2, p. 64-70Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to describe health experiences, focused on gender and return to work, in subjects with chronic low back pain in a long-term perspective. The convenient sample consisted of 12 subjects who had attended a pain rehabilitation program 6 years earlier. Typed interviews were transcribed, and a content analysis approach was used. Five categories were found: coping, root causes, control/influence, pain, and sleep. The interviews showed that the subjects expressed well-being, although pain had become part of their daily life. However, both gender and well-being group differences were identified. The women and the group with reduced well-being used the root causes category in a higher degree than the men and the well-being group did. The conclusion is that there are differences according to both gender and return to work within the subjects with chronic pain and that these differences are related to both root causes and coping pattern.

  • 11.
    Raak, Ragnhild
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Wahren, Lis Karin
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Health related quality of life in subgroups of WAD (Whiplash associated disorder) individuals with respect to cold hyperalgesia in quantitative sensory testing (QST)2006In: EFIC Pain in Europe V,2006, 2006Conference paper (Other academic)
    Abstract [en]

     Background and aims The term Whiplash associated disorders (WAD) includes a wide range of complaints, with neck pain as predominating symptom. Living with long term pain influences quality of life. In previous studies of other chronic pain patients, subgrouping has been made according to cold pain thresholds measured in QST. The aims of the present study are threefold, (1) to evaluate thermal pain thresholds and health related quality of life in WAD patients compared to healthy pain-free individuals, (2) to explore whether subgrouping of the WAD patients was possible according to cold pain thresholds (CPT), and (3) to explore differences between the subgroups. Methods: Thermal pain thresholds were measured using QST. The SF-36 was used to assess health related quality of life. Results: WAD patients showed significantly decreased CPT (p=0.007) and lower scores on the SF-36 in all scales when compared with healthy pain-free individuals. After analyzing clusters (K-means algorithm) two subgroups of WAD emerged, slightly cold pain sensitive and highly pain sensitive. The slightly pain sensitive group differed significantly from the highly sensitive group on in the Role Emotional scale of SF-36 (p=0.025). Conclusions: Cold pain hyperalgesia seems to be a determinant for subgrouping of WAD patients, with respect to health related quality of life, and might be the result of central sensitization or peripheral mechanisms or as a result of personal characteristics. These group differences might be of importance when guiding patients to treatment interventions as well as when exposing subjects to cold in the clinical situation.    

  • 12.
    Raak, Ragnhild
    et al.
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Wahren, Lis Karin
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Reply to Dellinger2002In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 5, p. 698-698p. 698-Article in journal (Refereed)
    Abstract [en]

    No abtract available.

  • 13.
    Raak, Ragnhild
    et al.
    Linköping University, Department of Medicine and Care, Pharmacology. Linköping University, Faculty of Health Sciences.
    Wahren, Lis Karin
    Linköping University, Department of Medicine and Care, Pharmacology. Linköping University, Faculty of Health Sciences.
    Stress coping strategies in thermal pain sensitive and insensitive healthy subjects2001In: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 7, no 3, p. 162-168Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate stress coping strategies used in relation to heat and cold pain thresholds in healthy subjects. After using the Jalowiec Coping Scale, cold and heat pain thresholds were examined using the Quantitative Somatosensory Test in 47 healthy subjects. The participants were separated into thermal pain sensitive and insensitive groups, based on thermal pain perception. The results showed that subjects sensitive to thermal pain tended to adopt an emotive stress coping style significantly more commonly than the insensitive subjects. Furthermore, women displayed a marked preference for this style compared to men. The conclusion is that emotional stress coping did play a role in the perception of thermal pain in this group of healthy subjects and that clinical nursing interventions need to focus on the relationship between emotion and coping.

  • 14.
    Raak, Ragnhild
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Wallin, Mia
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Thermal thresholds and catastrophizing in individuals with chronic pain after whiplash injury2006In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 8, no 2, p. 138-146Article in journal (Refereed)
    Abstract [en]

    Thermal sensitivity, thermal pain thresholds, and catastrophizing were examined in individuals with whiplash associated disorders (WAD) and in healthy pain-free participants. Quantitative sensory testing (QST) was used to measure skin sensitivity to cold and warmth and cold and heat pain thresholds over both the thenar eminence and the trapezius muscle (TrM) in 17 participants with WAD (age 50.8± 11.3 years) and 18 healthy participants (age 44.8± 10.2 years). The Pain Catastrophizing Scale (PCS) was used to determine pain coping strategies, and visual analogue scales were used for self-assessment of current background pain in individuals in the WAD group as well as experienced pain intensity and unpleasantness after QST and sleep quality in all participants. There were significant differences in warmth threshold and cold and heat pain thresholds of the TrM site between the WAD and pain-free groups. Significant differences between the two groups were also found for the catastrophizing dimension of helplessness in the PCS and in self-assessed quality of sleep. A correlational analysis showed that current background pain is significantly correlated with both cold discrimination and cold pain threshold in the skin over the TrM in individuals with WAD. These findings imply that thermal sensitivity is an important factor to consider in providing nursing care to individuals with WAD. Because biopsychosocial factors also influence the experience of pain in individuals with WAD, the role of nurses includes not only the description of the pain phenomenon but also the identification of relieving and aggravating factors.

  • 15.
    Raak, Ragnhild
    et al.
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Wikblad, Karin
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Raak, Anders
    Health Department at SAAB Aerospace in Linköping.
    Carlsson, Marianne
    Health Department at SAAB Aerospace in Linköping.
    Wahren, Lis Karin
    Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
    Catastrophizing and health related quality of life: A 6-year follow-up of patients with chronic low back pain2002In: Rehabilitation Nursing, ISSN 0278-4807, Vol. 27, no 3, p. 110-117Article in journal (Refereed)
    Abstract [en]

    A pain rehabilitation model that focused on emotions was implemented to influence catastrophizing by, and health-related quality of life (HRQL) for, persons with chronic low back pain. Twelve individuals, 7 men and 5 women (aged 33 to 57 years), all with long-term pain despite treatment, were included in the study and a single case research experimental design (SCRED) was used to follow the patterns of coping with pain for 6 years. The HRQL was measured before and 6 years after the intervention. Coping strategies and HRQL were evaluated with the Coping Strategy Questionnaire (CSQ) and the SF-36, respectively. The evaluation of pain coping strategies after 3 years found decreased catastrophizing, a decrease that had continued 3 years later. HRQL showed significantly improved mental health and impaired physical capacity at the 6-year follow-up. Changes in catastrophizing or in HRQL did not appear to influence self-scored bodily pain. Altered catastrophizing appeared to be a long-term process. This research indicates the need for rehabilitation programs to assess and evaluate patients' pain and their need for improved quality of life, rather than focusing only on the elimination of pain.

  • 16.
    Wallin, Mia
    et al.
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Raak, Ragnhild
    Linköping University, Department of Welfare and Care (IVV). Linköping University, Faculty of Health Sciences.
    Health related quality of life and catastrophizing in subgroups of individuals with Whiplash Associated Disorders (WAD) based on thermal pain thresholds2007In: International Whiplash Trauma Cenference, IWTC 2007,2007, 2007, p. 31-31Conference paper (Refereed)
    Abstract [en]

      

  • 17.
    Wallin, Mia
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Raak, Ragnhild
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Non-Scandinavian and Scandinavian women´s expectations and experiences of acute pain2007In: Acute Pain, ISSN 1366-0071, E-ISSN 1873-6319, Vol. 9, no 1, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Background

    Cultural or ethnic background has been shown to be significant for how individuals experience pain. The aim of this study was to examine the expectation and experience of acute pain, the use of stress-coping styles, and the distribution of analgesics among non-Scandinavian and Scandinavian women in a dental treatment situation.

    Methods

    Instruments used were the Visual Analogue Scale (VAS) and the Jalowiec Coping Scale (JCS).

    Results

    Non-Scandinavian women rated both expected and experienced pain significantly higher than Scandinavian women. No significant differences were found in stress-coping styles or in the distribution of analgesics between the two groups.

    Conclusion

    Nurses in acute pain situations must be aware of the need for appropriate assessment tools as well as the need to be sensitive to variations in both verbal and non-verbal communication styles across cultures.

  • 18.
    Wallin, Mia
    et al.
    Linköping University, Department of Social and Welfare Studies. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Raak, Ragnhild
    Linköping University, Department of Social and Welfare Studies. Linköping University, Faculty of Health Sciences.
    Quality of life in subgroups of individuals with whiplash associated disorders2008In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, no 7, p. 842-849Article in journal (Refereed)
    Abstract [en]

    Background: The term whiplash associated disorders (WAD) includes a wide range of complaints, with neck pain as predominating symptom. Living with long term pain influences quality of life. In previous studies of other chronic pain patients, subgrouping has been made according to thermal pain thresholds measured in quantitative sensory testing (QST).

    Aims: The aims of the present study are threefold, (1) to evaluate thermal pain thresholds and health related quality of life in WAD patients compared to healthy pain-free individuals, (2) to explore whether subgrouping of the WAD patients is possible according to thermal pain thresholds over trapezius, and if so (3) to explore differences between the subgroups.

    Methods: Twenty-six patients with WAD and 18 healthy pain-free controls took part in the study. Thermal pain thresholds were measured in two sites (over the thenar and the trapezius muscle) using quantitative sensory testing (QST). Health related quality of life (HRQoL) was assessed using the SF-36. The visual analogue scale was used to rate pain intensity and unpleasantness related to the experimental situation.

    Results: WAD patients are more sensitive to thermal pain, and scored lower on the SF-36 in all scales when compared with healthy pain-free individuals. After analyzing clusters (K-means algorithm) two subgroups of WAD emerge, pain insensitive and pain sensitive. The pain insensitive group differed significantly from the pain sensitive group in the Role Emotional subscale of SF-36 (p=0.025).

    Conclusions: Thermal pain hyperalgesia, especially for cold, seems to be a determinant for subgrouping WAD patients. These results support that such a classification of a heterogenous group could be of importance in tailoring treatment and early interventions.

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