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  • 151. Lindström, B.
    et al.
    Kristensen, B.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Dynamic strength and endurance of the thight muscles in patients with minimum sequel after ischaemic stroke.1999In: NeuroRehabilitation (Reading, MA), ISSN 1053-8135, E-ISSN 1878-6448, Vol. 12, p. 157-167Article in journal (Refereed)
  • 152.
    Louca, Sofia
    et al.
    Karolinska Institute, Sweden; SCON, Sweden.
    Christidis, Nikolaos
    Karolinska Institute, Sweden; SCON, 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.
    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.
    Svensson, Peter
    Karolinska Institute, Sweden; SCON, Sweden; University of Aarhus, Denmark.
    List, Thomas
    SCON, Sweden; Malmö University, Sweden.
    Ernberg, Malin
    Karolinska Institute, Sweden; SCON, Sweden.
    Serotonin, glutamate and glycerol are released after the injection of hypertonic saline into human masseter muscles - a microdialysis study2014In: Journal of Headache and Pain, ISSN 1129-2369, E-ISSN 1129-2377, Vol. 15Article in journal (Refereed)
    Abstract [en]

    Chronic myalgia is associated with higher muscle levels of certain algesic biomarkers. The aim of this study was to investigate if hypertonic saline-induced jaw myalgia also leads to release of such biomarkers and if there were any sex differences in this respect. Healthy participants, 15 men and 15 aged-matched women (25.7 +/- 4.3 years) participated. Intramuscular microdialysis into masseter muscles was performed to sample serotonin (5-HT), glutamate, lactate, pyruvate, glucose and glycerol. After 2 hours 0.2 mL hypertonic saline (58.5 mg/mL) was injected into the masseter on one side and 0.2 mL isotonic saline (9 mg/mL) into the contralateral masseter close to the microdialysis catheter. Microdialysis continued for 1 hour after the injections. Pressure pain thresholds (PPT) and pain were assessed before and after injections. The median (IQR) peak pain intensity (0-100 visual analogue scale) after hypertonic saline was 52.5 (38.0) and after isotonic saline 7.5 (24.0) (p less than 0.05). 5-HT, glutamate and glycerol increased after hypertonic saline injection (p less than 0.05). Lactate, pyruvate and glucose showed no change. PPT after microdialysis was reduced on both sides (p less than 0.05) but without side differences. Pain after hypertonic saline injection correlated positively to 5-HT (p less than 0.05) and negatively to glycerol (p less than 0.05). 5-HT, glutamate and glycerol increased after a painful hypertonic saline injection into the masseter muscle, but without sex differences. Since increased levels of 5-HT and glutamate have been reported in chronic myalgia, this strengthens the validity of the pain model. Glycerol warrants further investigations.

  • 153.
    Lundberg, Gunnar
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Anderberg, Ulla Maria
    Uppsala University.
    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.
    Personality Features in Female Fibromyalgia Syndrome2009In: JOURNAL OF MUSCULOSKELETAL PAIN, ISSN 1058-2452, Vol. 17, no 2, p. 117-130Article in journal (Refereed)
    Abstract [en]

    Objectives: Using the Temperament and Character Inventory [TCI], this study investigates whether differences in temperament and character exist in fibromyalgia syndrome [FMS] patients compared with healthy normal controls [HNC] of the community and whether there might be subgroups among FMS patients. Methods: This study asked 191 female patients with FMS and 652 age-matched female HNC of the community to answer the TCI questionnaire. Results: The FMS was associated with high harm avoidance, persistence, self-transcendence, and low self-directedness. Three subgroups of FMS were identified [cluster 1: N = 72; cluster 2: N = 83; and cluster 3: N = 30] based on all scales and subscales of TCI. Conclusions: Both aspects of TCI, temperament and character, are different and changed in FMS compared with HNC, mainly high harm avoidance, high persistence, low self-directedness, and high self-transcendence. The established personality patterns may affect the FMS patients ability to cope with stress and pain in daily-life situations. In future studies it is important to also incorporate pain intensity, depression and anxiety variables, and other personality instruments when interpreting the results.

  • 154.
    Lundberg, Gunnar
    et al.
    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. Östergötlands Läns Landsting, Pain and Occupational Centre, Pain and Rehabilitation Centre. Linköping University, Faculty of Health Sciences.
    Correlations between joint and spinal mobility, spinal sagittal configuration, segmental mobility, segmental pain, symptoms and disabilities in female homecare personnel2000In: Scandinavian Journal of Rehabilitation Medicine, ISSN 0036-5505, E-ISSN 1940-2228, Vol. 32, no 3, p. 124-133Article in journal (Refereed)
    Abstract [en]

    The aim of a study comprising 607 women working as homecare personnel was to investigate general spinal, joint and segmental mobility, different symptoms (pain and strain) and their relation to various aspects of disability. Joint mobility (mainly peripheral) was estimated using the 'Beighton' score and spinal posture and mobility were measured by kyphometer. Passive segmental mobility and pain provocation were estimated manually. Pain intensity and strain during work and leisure were estimated using visual analogue scales for defined anatomical regions. Disability was rated using defined items and two indices. The 7-day prevalence of low back pain was 48%. Peripheral joint mobility, spinal sagittal posture and thoracic sagittal mobility showed low correlations with disability. Lumbar sagittal hypomobility was associated with higher disability. Manually estimated segmental mobility and segmental pain provocation of L4-L5 and L5-S1 correlated with disability; hypo- and hypermobility or positive pain provocation tests at these levels showed higher disability than normal mobility and negative pain provocation tests, respectively. Cluster analysis revealed that the combination of positive pain provocation tests and low lumbar sagittal mobility was associated with particularly high disability levels. In conclusion, positive pain provocation tests were clearly associated with high disability levels.

  • 155.
    Lundberg, Gunnar
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Musculoskeletal signs in female homecare personnel: A longitudinal epidemiological study2017In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 58, no 2, p. 135-147Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In Sweden, homecare services take care of elderly and disabled people, work that often requires heavy lifting and forward bending, resulting in high prevalences of pain and work accidents. OBJECTIVE: Using an eight-year follow-up, this study determines the prognostic importance of certain musculoskeletal signs reported in earlier studies [1, 2] with respect to aspects of pain and perceived disability. METHODS: Baseline data has been reported in earlier studies of 607 women [1-3]. This study uses a postal questionnaire survey and reports the results of eight years post initial study. RESULTS: Segmental pain at L4-L5 and/or L5-S1 levels was associated with higher low back pain intensity and disability at the eight-year follow-up. A decrease in low back pain intensity over eight years was larger for those with segmental pain. The important signs in the longitudinal analyses of pain aspects and disability were lumbar spinal mobility and segmental pain at L4-L5 and L5-S1 levels, but the explained variations were low. CONCLUSION: Evaluation of low lumbar segmental pain provocation and mobility should be considered in routine clinical assessments, as this type of evaluation provides prognostic pain and disability information over time.

  • 156.
    Lundberg, Gunnar
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Tender point scores and their relations to signs of mobility, symptoms, and disability in female home care personnel and the prevalence of fibromyalgia syndrome2002In: Journal of Rheumatology, ISSN 0315-162X, E-ISSN 1499-2752, Vol. 29, no 3, p. 603-613Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In this study of female home care personnel employed in a municipality (n = 643; participation rate 94%) we investigated (1) the prevalence of tender points and fibromyalgia (FM); (2) the relationships between tender point score and other signs and symptoms; (3) if subgroups based on the tender point score differed with respect to signs, symptoms, disability, and health related quality of life; and (4) signs that showed the strongest intercorrelations with disability and health.

    METHODS: The following variables were registered: (1) Signs: joint mobility, spinal posture and mobility, tender points, and segmental mobility and pain provocation at L4-S1 levels of the low back. (2) Symptoms: pain and pain intensity and other symptoms. (3) Disability (i.e., self-rated reduced capacity for everyday activities and employment) and health: 3 indices and sick leave.

    RESULTS: The tender point score correlated with the number of pain regions and the pain intensities, and the amount of other symptoms, sick leave, and disability. Tender point score was the strongest regressor of the investigated signs in regression of the 2 disability indices. Segmental pain showed the strongest correlation with tender point score. Three subgroups identified by tender point score showed significant differences in segmental pain, prevalence and intensity of different symptoms, disability, and health related quality of life. The prevalence of FM was 2.0%.

    CONCLUSION: Tender point score together with different symptoms showed relatively strong correlations with disability. A relatively high prevalence of FM was found in occupationally active female home care personnel.

  • 157.
    Lundberg, Gunnar
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    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.
    The relationships between pain, disability, and health-related quality of life: an 8-year follow-up study of female home care personnel2016In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 3, p. 235-244Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate the development of pain conditions, disability, and health-related quality of life over an 8-year period in home care personnel. Method: In earlier studies of 607 women, we reported baseline data concerning home care personnel. This study reports the results from an 8-year follow-up using a postal questionnaire. Results: The questionnaire was completed by 87%. Prevalences of pain in upper back, lower back, and knees as well as pain intensity of the low back had decreased. Participants with the highest pain intensities of the low back at baseline had relatively lower pain intensities at follow-up. Anatomical spreading of pain was associated with higher average pain intensity. Disability had increased significantly during the time period. In the regression of disability at follow-up, average pain intensity together with disability rating index at baseline were the most important regressors; a similar pattern was found for quality of life. Conclusions: The development of disability differed from that of low-back pain intensity. Spreading of pain and pain intensity across the anatomical regions influenced disability and quality of life over 8 years. When assessing pain, it seems important to determine the spread of pain rather than just focusing on the area with intense pain.Implications for RehabilitationSpreading of pain and the average intensity of pain across the involved anatomical regions have importance for future pain and disability and quality of life.The clinical assessment of subjects with chronic pain prior to rehabilitation interventions has to determine the spreading of pain rather than just focusing on the area with the most intense pain.The different developments over time for pain intensity and disability indicate the need for applying a bio-psycho-social view of pain both when assessing the patient with pain and when discussing the prognosis and course of the actual pain condition with the patient.

  • 158.
    Lundberg, Gunnar
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Östergötlands Läns Landsting, Pain and Occupational Centre, Pain and Rehabilitation Centre. Linköping University, Faculty of Health Sciences.
    The relationships between spinal sagittal configuration, joint mobility, general low back mobility and segmental mobility in female homecare personnel1999In: Scandinavian Journal of Rehabilitation Medicine, ISSN 0036-5505, E-ISSN 1940-2228, Vol. 31, no 4, p. 197-206Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to investigate joint mobility, segmental and general spinal mobility and their interrelationship in 607 women working as homecare personnel. Joint mobility (mainly peripheral) was estimated using the "Beighton" score. Spinal posture and mobility were measured by Debrunner's kyphometer. Passive segmental mobility and pain provocation were estimated manually. Reliability tests between two physiotherapists of segmental mobility and pain provocation (n = 150 subjects) were performed. Positive correlations were found between joint mobility, sagittal thoraco-lumbar mobility and segmental mobility. Hyperlordosis (>39 degrees) was associated with greater lumbar mobility. The reliability of manual segmental mobility and segmental pain provocation was good, especially in the lowest back segments (kappa approximately 0.7). Joint mobility, general mobility and segmental spinal mobility intercorrelated. Segmental mobility manually estimated showed intertester reliability. The good positive correlation between sagittal lumbar mobility and manually tested segmental mobility indicates criterion validity for the latter.

  • 159.
    Lundberg, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Linköping University, Faculty of Medicine and Health Sciences.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Medicine and Health Sciences.
    van Ettinger-Veenstra, Helene
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Pain disrupts thalamic and nucleus accumbens functional connectivity in chronic widespread pain2016Conference paper (Refereed)
  • 160. Lundblad, I.
    et al.
    Elert, Jessica
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Randomized controlled trial of physiotherapy and Feldenkrais interventions in female workers with neck-shoulder complaints.1999In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 9, p. 179-193Article in journal (Refereed)
  • 161. Lundqvist, A
    et al.
    Alinder, J
    Alm, H
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Levander, S
    Rönnberg, Jerker
    Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences, The Swedish Institute for Disability Research.
    Drivers with cerebral lesion: Neuropsychological diagnosis, simulator study, and on road driving1997In: Applied neuropsychology, ISSN 0908-4282, E-ISSN 1532-4826, Vol. 4, p. 220-230Article in journal (Refereed)
  • 162.
    Lundqvist, Anna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . 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.
    Rönnberg, Jerker
    Linköping University, The Swedish Institute for Disability Research. Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    Neuropsychological aspects of driving after a stroke: in the simulator and on the road2000In: Applied Cognitive Psychology, ISSN 0888-4080, Vol. 14, no 2, p. 135-150Article in journal (Refereed)
    Abstract [en]

    Thirty patients with stroke and 30 matched controls participated in the study (mean age 68 years, mean interval since stroke onset 8.6 months). The patients performed significantly worse on cognitive and attentional processing measured by a neuropsychological test battery. The patients had significantly greater difficulty in allocating processing resources to a secondary information processing task during driving in an advanced simulator. The patients performed worse driving in real traffic, and had less driving skill; fifty per cent did not pass the driving test. The neuropsychological test battery showed a pattern with three factors: (1) attentional processing (2) executive capacity, and (3) cognitive processing. Regression models based on simulator driving variables and neuropsychological test variables respectively, overall classified correctly in 85% and 83% of the cases with respect to driving skill. Decreased cognitive and attentional processing were suggested to be associated with an overall speed impairment.

  • 163.
    Milovanovic, Micha
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Primary Health Care in Norrköping.
    Pirjo, Harakka
    Department of Neurobiology, Society and Caring Sciences, Karolinska Institutet, Stockholm, Sweden.
    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.
    Augmented serotonin content in density separated platelets of fibromyalgia patients2016In: Clinical and Diagnostic Pathology, ISSN 2399-5297Article in journal (Refereed)
  • 164.
    Molander, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dong, Huan-Ji
    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.
    Äng, Björn
    Department of Neurobiology, Care Science and Society, Karolinska Institute, Stockholm, Sweden. School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Enthoven, Paul
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    The role of pain in chronic pain patients' perception of health-related quality of life: a cross-sectional SQRP study of 40,000 patients.2018In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 18, no 3, p. 417-429, article id /j/sjpain.2018.18.issue-3/sjpain-2018-0003/sjpain-2018-0003.xmlArticle in journal (Refereed)
    Abstract [en]

    Background and aims Health-related quality of life (Hr-QoL) reflects the burden of a condition on an overarching level. Pain intensity, disability and other factors influence how patients with chronic pain perceive their condition, e.g. Hr-QoL. However, the relative importance of these factors is unclear and there is an ongoing debate as to what importance pain measures have in this group. We investigated the importance of current pain level and mood on aspects of Hr-QoL in patients with chronic pain and investigated whether such relationships are influenced by demographics. Methods Data was obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP), between 2008 and 2016 on patients ≥18 years old who suffered from chronic pain and were referred to participating specialist clinics. Dependent variables were general Hr-QoL [using two scales from European Quality of Life instrument: EQ5D Index and the European Quality of Life instrument health scale (EQ thermometer)] and specific Hr-QoL [from the Short Form Health Survey (SF36) the physical component summary (SF36-PCS) and the mental (psychological) component summary (SF36-MCS)]. Independent variables were sociodemographic variables, pain variables, psychological distress and pain attitudes. Principal component analysis (PCA) was used for multivariate correlation analyses of all investigated variables and Orthogonal Partial Least Square Regression (OPLS) for multivariate regressions on health aspects. Results There was 40,518 patients (72% women). Pain intensity and interference showed the strongest multivariate correlations with EQ5D Index, EQ thermometer and SF36-PCS. Psychological distress variables displayed the strongest multivariate correlations with SF36-MCS. Demographic properties did not significantly influence variations in the investigated Hr-QoL variables. Conclusions Pain, mood and pain attitudes were significantly correlated with Hr-QoL variables, but these variables cannot explain most of variations in Hr-QoL variables. The results pinpoint that broad assessments (including pain intensity aspects) are needed to capture the clinical presentation of patients with complex chronic pain conditions.

  • 165.
    Olausson, Patrik
    et al.
    Linköping University, Department of Medical and Health Sciences, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Gerdle, Björn
    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.
    Ghafouri, Nazdar
    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.
    Karlsson, Linn
    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.
    Larsson, Britt
    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.
    Ghafouri, Bijar
    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. Östergötlands Läns Landsting, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Relative recovery over time – an in vivo microdialysisstudy of human skeletal muscle2013In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 73, no 1, p. 10-16Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

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

    MATERIALS AND METHODS:

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

    RESULTS:

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

    CONCLUSIONS:

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

  • 166.
    Olausson, Patrik
    et al.
    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.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Ghafouri, Nazdar
    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.
    Larsson, Britt
    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.
    Ghafouri, Bijar
    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. Östergötlands Läns Landsting, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Identification of Proteins from Interstitium of Trapezius Muscle in Women with Chronic Myalgia Using Microdialysis in Combination with Proteomics2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 12Article in journal (Refereed)
    Abstract [en]

    Background: Microdialysis (MD) of the trapezius muscle has been an attractive technique to investigating small molecules and metabolites in chronic musculoskeletal pain in human. Large biomolecules such as proteins also cross the dialysis membrane of the catheters. In this study we have applied in vivo MD in combination with two dimensional gel electrophoresis (2-DE) and mass spectrometry to identify proteins in the extracellular fluid of the trapezius muscle. Materials and Methods: Dialysate from women with chronic trapezius myalgia (TM; n = 37), women with chronic wide spread pain (CWP; n = 18) and healthy controls (CON; n = 22) was collected from the trapezius muscle using a catheter with a cut-off point of 100 kDa. Proteins were separated by two-dimensional gel electrophoresis and visualized by silver staining. Detected proteins were identified by nano liquid chromatography in combination with tandem mass spectrometry. Results: Ninety-seven protein spots were identified from the interstitial fluid of the trapezius muscle; 48 proteins in TM and 30 proteins in CWP had concentrations at least two-fold higher or lower than in CON. The identified proteins pertain to several functional classes, e.g., proteins involved in inflammatory responses. Several of the identified proteins are known to be involved in processes of pain such as: creatine kinase, nerve growth factor, carbonic anhydrase, myoglobin, fatty acid binding protein and actin aortic smooth muscle. Conclusions: In this study, by using in vivo microdialysis in combination with proteomics a large number of proteins in muscle interstitium have been identified. Several of the identified proteins were at least two-fold higher or lower in chronic pain patients. The applied techniques open up for the possibility of investigating protein changes associated with nociceptive processes of chronic myalgia. © 2012 Olausson et al.

  • 167.
    Olausson, Patrik
    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.
    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.
    Ghafouri, Nazdar
    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.
    Sjöström, Dick
    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.
    Blixt, Emelie
    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.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Protein alterations in women with chronic widespread pain: An explorative proteomic study of the trapezius muscle2015In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 5, no 11894Article in journal (Refereed)
    Abstract [en]

    Chronic widespread pain (CWP) has a high prevalence in the population and is associated with prominent negative individual and societal consequences. There is no clear consensus concerning the etiology behind CWP although alterations in the central processing of nociception maintained by peripheral nociceptive input has been suggested. Here, we use proteomics to study protein changes in trapezius muscle from 18 female patients diagnosed with CWP compared to 19 healthy female subjects. The 2-dimensional gel electrophoresis (2-DE) in combination with multivariate statistical analyses revealed 17 proteins to be differently expressed between the two groups. Proteins were identified by mass spectrometry. Many of the proteins are important enzymes in metabolic pathways like the glycolysis and gluconeogenesis. Other proteins are associated with muscle damage, muscle recovery, stress and inflammation. The altered expressed levels of these proteins suggest abnormalities and metabolic changes in the myalgic trapezius muscle in CWP. Taken together, this study gives further support that peripheral factors may be of importance in maintaining CWP.

  • 168.
    Olausson, Patrik
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ghafouri, Bijar
    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.
    Bäckryd, Emmanuel
    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.
    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.
    Clear differences in cerebrospinal fluid proteome between women with chronic widespread pain and healthy women - a multivariate explorative cross-sectional study2017In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 10, p. 575-590Article in journal (Refereed)
    Abstract [en]

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

  • 169.
    Olausson, Patrik
    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.
    Ghafouri, Bijar
    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.
    Ghafouri, Nazdar
    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.
    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.
    Specific proteins of the trapezius muscle correlate with pain intensity and sensitivity - an explorative multivariate proteomic study of the trapezius muscle in women with chronic widespread pain2016In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 9, p. 345-356Article in journal (Refereed)
    Abstract [en]

    Chronic widespread pain (CWP) including fibromyalgia syndrome (FMS) has a high prevalence and is associated with prominent negative consequences. CWP/FMS exhibits morphological and functional alterations in the central nervous system. The importance of peripheral factors for maintaining the central alterations are under debate. In this study, the proteins from biopsies of the trapezius muscle from 18 female CWP/FMS patients and 19 healthy female controls were analyzed. Pain intensity and pressure pain thresholds (PPT) over the trapezius muscles were registered. Twelve proteins representing five different groups of proteins were important regressors of pain intensity in CWP/FMS (R-2=0.99; P amp;lt; 0.001). In the regression of PPT in CWP/FMS, it was found that 16 proteins representing six groups of proteins were significant regressors (R-2=0.95, P amp;lt; 0.05). Many of the important proteins were stress and inflammation proteins, enzymes involved in metabolic pathways, and proteins associated with muscle damage, myopathies, and muscle recovery. The altered expression of these proteins may reflect both direct and indirect nociceptive/inflammatory processes as well as secondary changes. The relative importance of the identified proteins and central alterations in CWP need to be investigated in future research. Data from this and the previous study concerning the same cohorts give support to the suggestion that peripheral factors are of importance for maintaining pain aspects in CWP/FMS.

  • 170.
    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.

  • 171.
    Palstam, Annie
    et al.
    University of Gothenburg, Sweden.
    Larsson, Anette
    University of Gothenburg, Sweden; University of Gothenburg, Sweden.
    Lofgren, Monika
    Danderyd Hospital, Sweden; Danderyd Hospital, Sweden.
    Ernberg, Malin
    Karolinska Institute, Sweden; Scandinavian Centre Orofacial Neurosci SCON, Sweden.
    Bjersing, Jan
    Sahlgrens University Hospital, Sweden.
    Bileviciute-Ljungar, Indre
    Danderyd Hospital, Sweden; Danderyd Hospital, Sweden.
    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.
    Kosek, Eva
    Karolinska Institute, Sweden; Stockholm Spine Centre, Sweden.
    Mannerkorpi, Kaisa
    University of Gothenburg, Sweden; University of Gothenburg, Sweden.
    Decrease of fear avoidance beliefs following person-centered progressive resistance exercise contributes to reduced pain disability in women with fibromyalgia: secondary exploratory analyses from a randomized controlled trial2016In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 18, no 116Article in journal (Refereed)
    Abstract [en]

    Background: Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. Women with FM also report disability, in terms of negative consequences on activities of daily living. Our recent randomized controlled trial (RCT) is the first study of resistance exercise to show positive effects on pain disability. The resistance exercise program of our RCT emphasized active involvement of participants in planning and progression of the exercise, using the principles of person-acenteredness, to support each participants ability to manage the exercise and the progress of it. The aim of this sub-astudy was to investigate explanatory factors for reduced pain disability in women with FM participating in a 15-aweek person-acentered progressive resistance exercise program. Methods: A total of 67 women with FM were included in this sub-astudy of an RCT examining the effects of person-acentered progressive resistance exercise performed twice a week for 15 weeks. Tests of physical capacity and health-arelated questionnaires were assessed at baseline and after the intervention period. Multivariable stepwise regression was used to analyze explanatory factors for improvements in pain disability. Results: Reduced pain disability was explained by higher pain disability at baseline together with decreased fear avoidance beliefs about physical activity (R-2 = 28, p = 0.005). The improvements in the disability domains of recreation and social activity were explained by decreased fear avoidance beliefs about physical activity together with higher baseline values of each disability domain respectively (R-2 = 32, p = 0.025 and R-2 = 30, p = 0.017). The improvement in occupational disability was explained by higher baseline values of occupational disability (R-2 = 19, p = 0.001). Conclusion: The person-centered resistance exercise intervention, based on principles of self-efficacy, had a positive effect on recreational, social and occupational disability. The reduced pain disability seemed to be mediated by decreased fear avoidance beliefs. Age, symptom duration, pain intensity, and muscle strength at baseline had no explanatory value for reduced pain disability, indicating that the person-centered resistance exercise program has the potential to work for anyone with FM who has interest in physical exercise.

  • 172.
    Peolsson, Michael
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Börsbo, Björn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . 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.
    Generalized pain is associated with more negative consequences than local or regional pain: A study of chronic whiplash-associated disorders2007In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, no 3, p. 260-269Article in journal (Refereed)
    Abstract [en]

    Objective: The main aims of this study were: (i) to determine, for chronic whiplash-associated disorders, whether widespread pain has more severe consequences for other symptoms and different aspects of perceived health than does local/regional pain; (ii) to investigate whether pain, depression, and symptoms not directly related to pain are intercorrelated and to what extent these symptoms correlate with catastrophizing according to the Coping Strategy Questionnaire.

    Design: Descriptive cross-sectional study.

    Patients: A total of 275 consecutive chronic pain patients with whiplash-associated disorders who were referred to a university hospital.

    Methods: Background history, Beck Depression Inventory, Coping Strategy Questionnaire, Life Satisfaction Checklist, the SF-36 Health Survey and EuroQol were used to collect data.

    Results: Spreading of pain was associated with negative consequences with respect to pain intensity and prevalence of other symptoms, life satisfaction/quality and general health. The subjects differ with respect to the presence of symptoms not directly related to pain. A minor part of the variation in Back Depression Inventory was explained by direct aspects of pain, indicating that, to some extent, generalization of pain is related to catastrophizing thoughts.

    Conclusion: Widespread pain was associated with negative consequences with respect to pain intensity, prevalence of other symptoms including depressive symptoms, some aspects of coping, life satisfaction and general health.

  • 173.
    Peolsson, Michael
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Gerdle, Björn
    Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre. Linköping University, Faculty of Health Sciences.
    Coping in patients with chronic whiplash-associated disorders: a descriptive study2004In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 36, no 1, p. 28-35Article in journal (Refereed)
    Abstract [en]

    Objective: There are few studies of the way patients with chronic whiplash-associated disorders cope with pain and other aspects of the condition. This study analyses: (a) gender differences in coping strategies; (b) whether the patients can be sub-grouped based on their coping strategies and whether the sub-groups differ clinically; and (c) the relative importance of background variables, symptoms and coping for quality of life.

    Design: A descriptive study. Patients: A total of 275 consecutive chronic patients with whiplash-associated disorders referred to a university hospital.

    Methods: A questionnaire covering background data, pain in different regions, symptoms not directly related to pain, Beck depression inventory, a Coping Strategy Questionnaire, a Life Satisfaction checklist (LiSat-11), SF-36 Health Survey and EuroQol instrument.

    Results: Three groups of patients were identified with respect to coping. Whether or not active coping strategies were used had little influence on health-related quality of life. When regressing health-related quality of life items, the following regressors were the most important: degree of depression of not directly pain-related symptoms, and catastrophizing cognitions influenced by pain intensities. Conclusion: A mixture of symptoms (pain and depression) and coping (catastrophizing) seem to be interwoven and explain patients' health-related quality of life. These characteristics should be assessed when planning rehabilitation.

  • 174.
    Peolsson, Michael
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine .
    Larsson, Britt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Brodin, L.-A.
    School of Technology and Health, Royal Institute of Technology, Stockholm, Sweden.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    A pilot study using tissue velocity ultrasound imaging (TVI) to assess muscle activity pattern in patients with chronic trapezius myalgia2008In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 9, no 127Article in journal (Refereed)
    Abstract [en]

    Background. Different research techniques indicate alterations in muscle tissue and in neuromuscular control of aching muscles in patients with chronic localized pain. Ultrasound can be used for analysis of muscle tissue dynamics in clinical practice. Aim. This study introduces a new muscle tissue sensitive ultrasound technique in order to provide a new methodology for providing a description of local muscle changes. This method is applied to investigate trapezius muscle tissue response - especially with respect to specific regional deformation and deformation rates - during concentric shoulder elevation in patients with chronic trapezius myalgia and healthy controls before and after pain provocation. Methods. Patients with trapezius myalgia and healthy controls were analyzed using an ultrasound system equipped with tissue velocity imaging (TVI). The patients performed a standardized 3-cm concentric shoulder elevation before and after pain provocation/exercise at a standardized elevation tempo (30 bpm). A standardized region of interest (ROI), an ellipsis with a size that captures the upper and lower fascia of the trapezius muscle (4 cm width) at rest, was placed in the first frame of the loop registration of the elevation. The ROI was re-anchored frame by frame following the same anatomical landmark in the basal fascia during all frames of the concentric phase. In cardiac measurement, tissue velocities are measured in the axial projection towards and against the probe where red colour represents shortening and red lengthening. In the case of measuring the trapezius muscle, tissue deformation measurements are made orthogonally, thus, indirectly. Based on the assumption of muscle volume incompressibility, blue represents tissue contraction and red relaxation. Within the ROI, two variables were calculated as a function of time: deformation and deformation rate. Hereafter, max, mean, and quadratic mean values (RMS) of each variable were calculated and compared before and after pain provocation/ exercise. Results. This new methodology seems valuable when looking at local muscle changes and studying the mechanism behind chronic muscle pain. The univariate analyses indicate that patients with chronic trapezius myalgia after pain provocation due to exercise at group level showed decreased strain and unchanged strain rate while healthy controls had unchanged strain and increased strain rate. However, the multivariate analysis indicates that most patients showed lower levels according to both strain and strain rate after exercise compared to most controls. Conclusion. Tissue velocity imaging can help describe musculoskeletal tissue activity and dynamics in patients with chronic pain conditions. An altered muscle tissue dynamic after pain provocation/exercise among the majority of trapezius myalgia patients compared with the healthy controls was found. © 2008 Peolsson et al, licensee BioMed Central Ltd.

  • 175.
    Persson, Mats
    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. Clinical Department of Operation and Intensive Care, Pain Unit, County Hospital Ryhov, Jönköping.
    Sörensen, Jan
    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.
    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.
    Chronic Whiplash Associated Disorders (WAD): Responses to Nerve Blocks of Cervical Zygapophyseal Joints.2016In: Pain medicine (Malden, Mass.), ISSN 1526-2375, E-ISSN 1526-4637, Vol. 17, no 12, p. 2162-2175Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This study explores the prevalence of facet joint pain in chronic Whiplash Associated Disorder (WAD).

    DESIGN: Forty-seven patients with chronic WAD were scheduled for medial branch blocks of the cervical spine.

    METHODS: The patient's localization of the pain together with established pain maps guided to the first level of zygapophyseal joint to be tested. The joint was anesthetized by injecting bupivacaine (0.5 ml; 5 mg/ml) to the medial branches of the cervical dorsal rami above and below the joint. If a positive response was noted, the schedule continued with a double-blinded sequence with a placebo (saline) and bupivacaine. If a negative response was noted, other joint levels were anesthetized until all joints from C2 to C7 were tested. The responses were assessed using a visual analog scale (VAS) in a predefined protocol.The study was carried through with a definition of a positive response to a diagnostic block as a VAS decrease ≥50% compared with baseline during a minimum of 3 hours after the block. All other responses were regarded as negative. The data were also analyzed using a definition of a positive response as a VAS decrease ≥80%, and figures from this analysis are presented as the main result of the study.

    RESULTS: The study yielded 29% true positive responders, 60% non-responders, and 11% placebo responders.

    CONCLUSIONS: A substantial amount of patients with chronic WAD have their persistent pain emanating from cervical zygapophyseal joints.

  • 176.
    Persson, Mats
    et al.
    Linköping University, Department of Medical and Health Sciences, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Sörensen, Jan
    Linköping University, Department of Medical and Health Sciences, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Pain and Rehabilitation Centre.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Pain and Rehabilitation Centre.
    Whiplash Associated Disorders (WAD): Responses to pharmacological challenges and psychometric tests2012In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 3, no 3, p. 151-163Article in journal (Refereed)
    Abstract [en]

    Objectives

    The present study challenges chronic WhiplashAssociatedDisorders (WAD)-subjects to a pharmacological intravenous (i.v.) test with morphine, ketamine, and active placebo (midazolam). The aim was to describe the short-term responses to drugs and the assumed heterogeneity in the patterns of responses. We related the different responder groups to the results from psychometrictests.

    Methods

    The study includes 95 patients, all with chronic WAD and referred to our departments. They answered a questionnaire including the following psychometric instruments relevant for chronic pain: Beck Depression Inventory, Coping Strategies Questionnaire, Multidimensional Pain Inventory, Life Satisfaction Checklist, SF36 and EuroQol. The subjects also went through sessions with separate infusions of morphine (0.3 mg/kg), ketamine (0.3 mg/kg) and midazolam (0.05 mg/kg). Infusion time was 30 min followed by a 2-h post-infusion assessment. Assessments were made using a Visual Analogue Scale (VAS) for pain intensity and unpleasantness and by statements of per cent pain relieved. A categorical pain rating scale was also used. A positive response was defined as ≥50% decrease of the VAS-level on two consecutive assessment points during the test sessions, anything less was a non response. The placebo responders were defined as those with a positive response to the active placebo infusion.

    Results

    The tests were completed by 94 subjects and 26% of these were placebo responders. Among the placebo non responders, 47% responded to morphine, 41% to ketamine, 25% to both drugs and 37% to neither morphine nor ketamine (pain intensity assessments). Similar proportions were found in the assessments of pain unpleasantness and per cent pain relieved. Approximately one in four subjects (27%, pain intensity assessment) did not respond to any of the drugs tested. This relatively high proportion of non responders seemed to be worst cases in some aspects of the psychometrictests. Generally, this non responder group had a trend to score worse for most items in the psychometrictests with some reaching significance in a univariate analysis. This result was confirmed in a multivariate context, although the results indicated only small differences between the groups. All three substances showed significant pain relief compared to baseline on all assessment points. On most variables, morphine and ketamine were significantly more effective compared to the active placebo.

    Conclusions

    There are different subgroups among subjects with chronic WAD with variations in responses to i.v. morphine, ketamine, and midazolam (active placebo). Subjects with chronic WAD who did not respond to any of the drugs tested scored badly in some aspects of the psychometric instruments.

    Implications

    The present study confirms one aspect of the heterogeneity in the population with chronic WAD. The study does not elucidate precise pain mechanisms but taken together with other studies exploring other aspects, it stresses the importance of individualizing the assessment and treatment of subjects with chronic WAD. A common clinical experience is that depression, anxiety and maladaptive coping strategies often are obstacles for successful medical treatment of chronic pain. The present study supports this experience and emphasizes the need for assessment of psychometric variables when planning the treatment of chronic WAD.

  • 177.
    Peterson, Anna
    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.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Schaller, Anne
    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.
    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.
    Larsson, Britt
    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.
    Using education and support strategies to improve the way nurses assess regular and transient pain: A quality improvement study of three hospitals2017In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 16, no 1, p. 15-21Article in journal (Refereed)
    Abstract [en]

    Background and aims

    Systematic and regular pain assessment has been shown to improve pain management. Well-functioning pain assessments require using strategies informed by well-established theory. This study evaluates documented pain assessments reported in medical records and by patients, including reassessment using a Numeric Rating Scale (NRS) after patients receive rescue medication.

    Methods

    Documentation surveys (DS) and patient surveys (PS) were performed at baseline (BL), after six months, and after 12 months in 44 in-patient wards at the three hospitals in Östergötland County, Sweden. Nurses and nurse assistants received training on pain assessment and support. The Knowledge to Action Framework guided the implementation of new routines.

    Results

    According to DS pain assessment using NRS, pain assessment increased significantly: from 7% at baseline to 36% at 12 months (p < 0.001). For PS, corresponding numbers were 33% and 50% (p < 0.001). According to the PS, the proportion of patients who received rescue medication and who had been reassessed increased from 73% to 86% (p = 0.003). The use of NRS to document pain assessment after patients received rescue medication increased significantly (4% vs. 17%; p < 0.001).

    Conclusions

    After implementing education and support strategies, systematic pain assessment increased, an encouraging finding considering the complex contexts of in-patient facilities. However, the achieved assessment levels and especially reassessments related to rescue medication were clinically unsatisfactory. Future studies should include nursing staff and physicians and increase interactivity such as providing online education support. A discrepancy between documented and reported reassessment in association with given rescue medication might indicate that nurses need better ways to provide pain relief.

    Implications

    The fairly low level of patient-reported pain via NRS and documented use of NRS before and 12 months after the educational programme stresses the need for education on pain management in nursing education. Implementations differing from traditional educational attempts such as interactive implementations might complement educational programmes given at the work place. Standardized routines for pain management that include the possibility for nurses to deliver pain medication within well-defined margins might improve pain management and increase the use of pain assessments. Further research is needed that examines the large discrepancy between patient-reported pain management and documentation in the medical recording system of transient pain.

  • 178.
    Ringqvist, Asa
    et al.
    Skane Univ Hosp, Sweden.
    Dragioti, Elena
    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.
    Björk, Mathilda
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Larsson, Britt
    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.
    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.
    Moderate and Stable Pain Reductions as a Result of Interdisciplinary Pain Rehabilitation: A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)2019In: JOURNAL OF CLINICAL MEDICINE, ISSN 2077-0383, Vol. 8, no 6, article id 905Article in journal (Refereed)
    Abstract [en]

    Few studies have investigated the real-life outcomes of interdisciplinary multimodal pain rehabilitation programs (IMMRP) for chronic pain. This study has four aims: investigate effect sizes (ES); analyse correlation patterns of outcome changes; define a multivariate outcome measure; and investigate whether the clinical self-reported presentation pre-IMMRP predicts the multivariate outcome. To this end, this study analysed chronic pain patients in specialist care included in the Swedish Quality Registry for Pain Rehabilitation for 22 outcomes (pain, psychological distress, participation, and health) on three occasions: pre-IMMRP, post-IMMRP, and 12-month follow-up. Moderate stable ES were demonstrated for pain intensity, interference in daily life, vitality, and health; most other outcomes showed small ES. Using a Multivariate Improvement Score (MIS), we identified three clusters. Cluster 1 had marked positive MIS and was associated with the overall worst situation pre-IMMRP. However, the pre-IMMRP situation could only predict 8% of the variation in MIS. Specialist care IMPRPs showed moderate ES for pain, interference, vitality, and health. Outcomes were best for patients with the worst clinical presentation pre-IMMRP. It was not possible to predict who would clinically benefit most from IMMRP.

  • 179.
    Roeleveld, Karin
    et al.
    Norwegian University Science and Technology, Human Movement Science Programme, N-7034 Trondheim, Norway .
    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.
    Lundstrom, Ronnie
    Umea University Hospital, Department Biomed Engn, S-90185 Umea, Sweden .
    Obituary: Dr. Jan Stefan Karlsson2009Other (Other academic)
    Abstract [en]

    n/a

  • 180.
    Rosendahl, Lars
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Larsson, Britt
    Kristiansen, Jesper
    Peolsson, Michael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine.
    Sögaard, Karen
    Kjaer, Michael
    Sörensen, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Increase in muscle nociceptive substances and anaerobic metabolism in patients with trapezius myalgia: Microdialysis in rest and during exercise2004In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 112, no 3, p. 324-334Article in journal (Refereed)
    Abstract [en]

    Local metabolic changes are suggested to be involved in muscle pain development in humans. Nineteen women with chronic work-related trapezius myalgia (TM) and 20 healthy female controls (CON) were studied during baseline rest, 20 min repetitive low-force exercise, and 120 min recovery. Interstitial serotonin (5-HT), glutamate, lactate, pyruvate, and blood flow were determined by microdialysis in the trapezius muscle. Baseline pressure pain threshold (PPT) was lower (143±18 (TM) vs. 269±17 (CON) kPa) (mean±SEM), pain intensity (visual analogue scale, VAS) higher (33±5 vs. 2±1 mm), muscle 5-HT higher (22.9±6.7 vs. 3.8±1.3 nmol/l), and glutamate higher (47±3 vs. 36±4 μmol/l) in TM than in CON (all P<0.05), whereas muscle blood flow was similar in groups. Furthermore, muscle pyruvate was higher (180±15 vs. 135±12 μmol/l) and lactate higher (4.4±0.3 vs. 3.1±0.3 mmol/l) in TM than in CON (P<0.001). In response to exercise, VAS and glutamate increased in both TM and CON (all P<0.05). In TM only, lactate and pyruvate increased significantly (P<0.02), whereas blood flow increased to similar levels in both groups. During the initial 20 min recovery period, blood flow remained increased in TM (P<0.005) whereas it decreased to baseline levels in CON. In conclusion, patients with chronic work-related TM have increased levels of muscle 5-HT and glutamate that were correlated to pain intensity (r=0.55, P<0.001) and PPT (r=-0.47, P<0.001), respectively. In addition, TM was associated with increased anaerobic metabolism, whereas a normal rise in blood flow was seen with exercise. These findings indicate that peripheral nociceptive processes are active in work-related TM. © 2004 International Association for the Study of Pain.

  • 181.
    Rosendal, Lars
    et al.
    Arbetsmiljöinstitutet, Köpenhamn, Danmark.
    Kristiansen, Jesper
    Arbetsmiljöinstitutet, Köpenhamn, Danmark.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Sögaard, Karen
    Arbetsmiljöinstitutet, Köpenhamn, Danmark.
    Peolsson, Michael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine.
    Kjaer, Michael
    Bispebjerg sjukhus, Köpenhamn, Danmark.
    Sörensen, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Larsson, Britt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Increased levels of interstitial potassium but normal levels of muscle IL-6 and LDH in patients with trapezius myalgia2005In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 119, no 1-3, p. 201-209Article in journal (Refereed)
    Abstract [en]

    The mechanisms behind the development of work-related trapezius pain are suggested to involve both peripheral and central components, but the specific contribution of alterations in muscle nociceptive and other substances is not clear. Female patients with chronic trapezius myalgia (N=19, TM) and female controls (N=20, CON) were studied at rest, during 20 min repetitive low-force exercise and recovery, and had their interstitial concentrations of potassium (K+), lactate dehydrogenase (LDH), interleukin-6 (IL-6) and collagen turnover determined in the trapezius muscle by the microdialysis technique. K+ levels were at all time points higher in TM than in CON (P<0.0001). Baseline levels of LDH and IL-6 were similar in both groups. In response to exercise pain intensity, rated perceived exertion, and the concentrations of K+, LDH and IL-6 increased significantly in both groups. [K+] immediately decreased to baseline levels in CON but remained elevated during the first 20 min of recovery in TM (P<0.01) whereafter it returned to baseline level. In all subjects taken together mean [K+] correlated negatively with pressure pain threshold of trapezius (P<0.001), positively with mean pain intensity VAS (P<0.001) and mean perceived exertion (P<0.001). Rises in muscle LDH and IL-6 as well as the anabolic ratio for collagen type I was not significantly different between groups. In conclusion, patients with chronic pain in the trapezius muscle had increased levels of interstitial potassium. This finding could be causally related to myalgia or secondary to pain due to deconditioned muscle or altered muscle activity pattern. © 2005 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  • 182.
    Rovner, Graciela S.
    et al.
    University of Gothenburg, Sweden; Danderyd Hospital, Sweden; Karolinska Institute, Sweden.
    Sunnerhagen, Katharina S.
    University of Gothenburg, Sweden.
    Björkdahl, Ann
    University of Gothenburg, Sweden; Ersta Skondal University of Coll, Sweden.
    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.
    Börsbo, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. County Hospital Ryhov, Sweden.
    Johansson, Fredrik
    Danderyd Hospital, Sweden.
    Gillanders, David
    University of Edinburgh, Scotland.
    Chronic pain and sex-differences; women accept and move, while men feel blue2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 4, article id e0175737Article in journal (Refereed)
    Abstract [en]

    Purpose The aim of this study is to explore differences between male and female patients entering a rehabilitation program at a pain clinic in order to gain a greater understanding of different approaches to be used in rehabilitation. Method 1371 patients referred to a specialty pain rehabilitation clinic, completed sociodemographic and pain related questionnaires. They rated their pain acceptance (CPAQ-8), their kinesiophobia (TSK), the impact of pain in their life (MPI), anxiety and depression levels (HAD) and quality of life scales: the SF-36, LiSat-11, and the EQ-5D. Because of the large sample size of the study, the significance level was set at the p amp;lt;= .01. Results Analysis by t-test showed that when both sexes experience the same pain severity, women report significantly higher activity level, pain acceptance and social support while men report higher kinesiophobia, mood disturbances and lower activity level. Conclusion Pain acceptance (CPAQ-8) and kinesiophobia (TSK) showed the clearest differences between men and women. Pain acceptance and kinesiophobia are behaviorally defined and have the potential to be changed.

  • 183.
    Rovner, Graciela S
    et al.
    Sahlgrenska Academy, Gothenburg University, Sweden.
    Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linnaeus University, Kalmar, 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.
    Börsbo, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. County Hospital Ryhov, Jönköping, Sweden.
    McCracken, Lance M
    Institute of Psychiatry, King’s College London, UK.
    Psychometric properties of the 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8) in a Swedish Chronic pain cohort2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 1, p. 73-80Article in journal (Refereed)
    Abstract [en]

    Background: Acceptance and Commitment Therapy for chronic pain has good empirical support. Pain acceptance is most often assessed with the Chronic Pain Acceptance Questionnaire (CPAQ). Recently a shorter 8-item version, the CPAQ-8, was developed. Objectives: To further validate the CPAQ-8 in a Swedish context and to test its sensitivity to treatment effects, an as-yet unknown property of the instrument. Methods: A total of 891 patients completed the CPAQ, along with scales for anxiety and depression (Hospital Anxiety and Depression scale), kinesiophobia (Tampa Scale for Kinesiophobia) and quality of life (Short Form-36). Confirmatory factor analyses were performed to examine the factor structure. Convergent validity was tested with Pearson's correlations. Changes over time were evaluated with paired t-test. Results: The confirmatory factor analyses showed that the CPAQ 2-factor model had a better fit compared with the 1-factor model, both for the 8- and 20-item versions. All CPAQ-8 scales demonstrated good internal consistency (alpha ≥ 0.80). They also correlated significantly with related constructs, supporting convergent validity. The CPAQ-8 explained a large share of the total variance in CPAQ-20 and was also able to track rehabilitation changes (large effect size, d = 0.89). Conclusion: CPAQ-8 demonstrated good psychometric properties and sensitivity to rehabilitation changes. Further research that considers other cultural contexts may lead enhance the applications of this instrument.

  • 184.
    Rovner, Graciela
    et al.
    Karolinska Institute, Sweden; University of Gothenburg, Sweden; SmartRehab, Sweden; Karolinska Institute, Sweden.
    Vowles, Kevin E.
    University of New Mexico, NM 87131 USA.
    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.
    Gillanders, David
    University of Edinburgh, Scotland.
    Latent Class Analysis of the Short and Long Forms of the Chronic Pain Acceptance Questionnaire: Further Examination of Patient Subgroups2015In: Journal of Pain, ISSN 1526-5900, E-ISSN 1528-8447, Vol. 16, no 11, p. 1095-1105Article in journal (Refereed)
    Abstract [en]

    A substantial literature indicates that pain acceptance is a useful behavioral process in chronic pain rehabilitation. Pain acceptance consists of willingness to experience pain and to engage in important activities even in the presence of pain and is often measured using the Chronic Pain Acceptance Questionnaire (CPAQ). Previous traditional cluster analyses of the 20-item CPAQ identified 3 patient clusters that differed across measures of patient functioning in meaningful ways. The aims of this study were to replicate the previous study in a new sample, using the more robust method of latent class analysis (LCA), and to compare the cluster structure of the CPAQ and the shorter CPAQ-8. In total, 914 patients with chronic pain completed the CPAQ and a range of measures of psychological and physical function. Patient clusters identified via LCA were then used to compare patients across functional measures. Contrary to previous research, LCA demonstrated that a 4-cluster structure was superior to a 3-cluster structure. Consistent with previous research, cluster membership based on patterns of pain willingness and activity engagement was significantly associated with specific patterns of psychological and physical function, in line with theoretical predictions. These cluster structures were similar for both CPAQ-20 and CPAQ-8 items. These results provide further evidence of the relevance of chronic pain acceptance, and a more nuanced understanding of how the components of acceptance are related to function. Perspective: Pain acceptance is important in chronic pain. The findings of the present study, which included 914 individuals with chronic pain, provide support for 4 discrete groups of patients based on levels of acceptance (low, medium, and high), as well as a group with a high level of activity engagement and low willingness to have pain. These groups appear statistically robust and differed in predictable ways across measures of functioning. (C) 2015 by the American Pain Society

  • 185.
    Samuelsson, Kersti
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Tropp, Hans
    Department of Orthopedic Surgery, Vrinnevi Hospital, Norrköping, Sweden.
    Gerdle, Björn
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Shoulder pain and its consequences in paraplegic spinal cord-injured, wheelchair users2004In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 42, no 1, p. 41-46Article in journal (Refereed)
    Abstract [en]

    Study design: Cross-sectional.

    Objectives: To describe the consequences of shoulder pain on activity and participation in spinal cord-injured paraplegic wheelchair users. To describe the prevalence and type of shoulder pain.

    Setting: Two spinal cord injury (SCI) centres in Sweden.

    Methods: All subjects with paraplegia due to an SCI of more than 1 year living in the counties of Uppsala and Linköping, Sweden were contacted by mail and asked to fill in a questionnaire (89 subjects). Those of the responding 56 subjects with current shoulder pain were asked to participate in further examination and interviews. A physiotherapist examined 13 subjects with shoulder pain in order to describe type and site of impairment. To describe consequences of shoulder pain on activity and participation, the Constant Murley Scale (CMS), the Wheelchair Users Shoulder Pain Index (WUSPI) the Klein & Bell adl-index and the Canadian Occupational Performance Measure (COPM) were used.

    Results: Out of all respondents, 21 had shoulder pain (37.5%). Data from 13 of those subjects were used in the description of type and consequences of shoulder pain. Findings of muscular atrophy, pain, impingement and tendinits were described. We found no difference in ADL-performance with, respectively without, shoulder pain (P=0.08) using the Klein & Bell adl-index. No correlation was found between the various descriptions of impairment, activity limitations and participation restriction (P>0.08). All together 52 problems with occupational performance due to shoulder pain were identified using the COPM. Of these, 54% were related to self-care activities.

    Conclusion: The consequences of shoulder pain in paraplegic wheelchair users are mostly related to wheelchair activities. Since the wheelchair use itself presumably cause shoulder problems, this will become a vicious circle. More research is needed in order to reduce shoulder problems in wheelchair users.

  • 186.
    Samuelsson, Kersti
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Consequences of a change in rear-wheel position on seating ergonomics and mobility in spinal cord injured wheelchair usersManuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to analyse the consequences of a change in rear-wheel position on mobility and seating ergonomic aspects. Twelve randomly selected paraplegic wheelchair users were tested iu two different activities, treadmill propulsion and computer work, in two different seating positions. The change in wheel position did affect chair ergonomics with respect to weight distribution and seat-inclination. These changes did have an effect on push frequency and stroke angle during treadmill, propulsion. We found no consistent effect on mechanical efficiency, estimated exertion, breathlessness or seating quality in this group. Nor did we find any consistent significant effect on pelvic position or under-seat pressure. There are effects from wheelchair adaptation, but these seem to be individual. With the knowledge of risk factors related to seating posture in mind, future research concerning effects of wheelchair adaptation has to be performed with considerations for individual changes.

  • 187.
    Samuelsson, Kersti
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Reconstruction Centre, Department of Rehabilitation Medicine UHL.
    Tropp, Hans
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Orthopaedics and Sports Medicine. Östergötlands Läns Landsting, Orthopaedic Centre, Department of Orthopaedics Linköping.
    Nylander, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    The effect of rear-wheel position on seating ergonomics and mobility efficiency in wheelchair users with spinal cord injuries: A pilot study2004In: Journal of rehabilitation research and development, ISSN 0748-7711, E-ISSN 1938-1352, Vol. 41, no 1, p. 65-74Article in journal (Refereed)
    Abstract [en]

    This study analyzed the effect of rear-wheel position on seating comfort and mobility efficiency. Twelve randomly selected paraplegic wheelchair users participated in the study. Wheelchairs were tested in two rear-wheel positions while the users operated the wheelchair on a treadmill and while they worked on a computer. Propulsion efficiency, seating comfort, and propulsion qualities were registered at different loads during the treadmill session. During the computer session, pelvic position, estimated seating comfort, and estimated activity performance were measured. The change in rear-wheel position affected wheelchair ergonomics with respect to weight distribution (p < 0.0001) and seat inclination angle (position I = 5° and position II = 12°). These changes had a significant effect on push frequency (p < 0.05) and stroke angle (p < 0.05) during wheelchair propulsion. We found no consistent effect on mechanical efficiency, estimated exertion, breathlessness, seating comfort, estimated propulsion qualities, pelvic position, or activity performance.

  • 188.
    Sandberg, Margareta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Larsson, Britt
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Gerdle, Björn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Different patterns of blood flow response in the trapezius muscle following needle stimulation (acupuncture) between healthy subjects and patients with fibromyalgia and work-related trapezius myalgia2005In: European Journal of Pain, ISSN 1090-3801, Vol. 9, no 5, p. 497-510Article in journal (Refereed)
    Abstract [en]

    Needle stimulation (acupuncture) has recently been shown to increase blood flow in the tibialis anterior muscle and overlying skin in healthy subjects (HS) and patients with fibromyalgia (FM). The aim of the present study was to examine the effect of needle stimulation on local blood flow in the trapezius muscle and overlying skin in HS and two groups of patients suffering from chronic pain in the trapezius muscle, i.e., FM and work-related trapezius myalgia (TM) patients. Two modes of needling, deep muscle stimulation (Deep) and subcutaneous needle insertion (SC), were performed at the upper part of the shoulder and blood flow was monitored for 60 min post-stimulation. Blood flow changes were measured non-invasively by using a new application of photoplethysmography. Increased blood flow in the trapezius muscle and overlying skin was found in all three groups following both Deep and SC. In HS, Deep was superior to SC in increasing skin and muscle blood flow, whereas in FM, SC was as effective as, or even more effective, than Deep. In the severely affected TM patients, no differences were found between the stimuli, and generally, a lesser blood flow response to the stimuli was found. At Deep, the muscle blood flow increase was significantly larger in HS, compared to the two patient groups. Positive correlations were found between muscle blood flow at Deep and pressure pain threshold in the trapezius muscle, neck movement and pain experienced at the stimulation, and negative correlations were found with spontaneous pain-related variables, symptom duration and age, pointing to less favorable results with worsening of symptoms, and to the importance of nociceptor activation in blood flow increase. It was hypothesized that the different patterns of muscle blood flow response to the needling may mirror a state of increased sympathetic activity and a generalized hypersensitivity in the patients. The intensity of stimulation should be taken into consideration when applying local needle stimulation (acupuncture) in order to increase the trapezius muscle blood flow in chronic pain conditions.

  • 189.
    Sandberg, Margareta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    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.
    Peripheral effects of needle stimulation (acupuncture) on skin and muscle blood flow in fibromyalgia2004In: European Journal of Pain, ISSN 1090-3801, Vol. 8, no 2, p. 163-171Article in journal (Refereed)
    Abstract [en]

    Acupuncture has become a widely used treatment modality in various musculoskeletal pain conditions. Acupuncture is also shown to enhance blood flow and recovery in surgical flaps. The mechanisms behind the effect on blood flow were suggested to rely on vasoactive substances, such as calcitonin gene-related peptide, released from nociceptors by the needle stimulation. In a previous study on healthy subjects, one needle stimulation into the anterior tibial muscle was shown to increase both skin and muscle blood flow. The aim of this study was to examine the effect of needle stimulation on local blood flow in the anterior tibial muscle and overlying skin in patients suffering from a widespread chronic pain condition. Fifteen patients with fibromyalgia (FM) participated in the study. Two modes of needling, deep muscle stimulation and subcutaneous needle insertion were performed at the upper anterior aspect of the tibia, i.e., in an area without focal pathology or ongoing pain in these patients. Blood flow changes were assessed non-invasively by photoplethysmography (PPG). The results of the present study were partly similar to those earlier found at a corresponding site in healthy female subjects, i.e., deep muscle stimulation resulted in larger increase in skin blood flow (mean (SE)): 62.4% (13.0) and muscle blood flow: 93.1% (18.6), compared to baseline, than did subcutaneous insertion (mean (SE) skin blood flow increase: 26.4% (6.2); muscle blood flow increase: 46.1% (10.2)). However, in FM patients subcutaneous needle insertion was followed by a significant increase in both skin and muscle blood flow, in contrast to findings in healthy subjects where no significant blood flow increase was found following the subcutaneous needling. The different results of subcutaneous needling between the groups (skin blood flow: p=0.008; muscle blood flow: p=0.027) may be related to a greater sensitivity to pain and other somatosensory input in FM.

  • 190.
    Sandberg, Margareta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Lundeberg, Thomas
    Division of Physiology II, Karolinska Institutet, Stockholm, Sweden.
    Gerdle, Björn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Manual Acupuncture in Fibromyalgia: A Long-Term Pilot Study1999In: Journal of Musculoskeletal Pain, ISSN 1058-2452, Vol. 7, no 3, p. 39-58Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this cross-over designed pilot study was to investigate the short-term and long-term effects on pain and other common symptoms present in fibromyalgia [FMS] of manual acupuncture with needles inserted into traditional Chinese acupuncture points.

    Methods: Nine out of 10 consecutive FMS patients completed the study. Acupuncture was given in 10-14 sessions over two to three months, followed by an observation period of six months. The control regime consisted of continuous medical management. The patients were evaluated immediately after the completion of the treatment and at 4, 8, 12, and 24 weeks. Pain, sleep, medication, muscle tension, psychological tension, general well-being, the number of tender points, and range of movement in shoulders and neck were assessed.

    Results: In general, significantly greater changes occurred for the variables under investigation during the acupuncture period than during the control period. Nine of the 11 outcome variables showed a significant improvement after acupuncture period. The number of tender points was significantly decreased and the sense of well-being significantly improved up to 12 week follow-up. A significant decrease in general pain persisted for eight weeks. Muscle tension and local pain in head, neck, and shoulder regions were significantly reduced throughout the whole 24 week follow-up period. According to the patients' evaluation of global treatment outcome, improvements remained significant until the four week follow-up. Base-line values of well-being and sleep patterns were the most important predictors of treatment outcome.

    Conclusion: We conclude that for some FMS patients 10-14 acupuncture sessions seem to give additional benefits over a limited period.

  • 191.
    Sandberg, Margareta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Lundeberg, Thomas
    Division of Physiology II, Karolinska Institutet, Stockholm, Sweden.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    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.
    Effects of acupuncture on skin and muscle blood flow in healthy subjects2003In: European Journal of Applied Physiology, ISSN 1439-6319, Vol. 90, no 1-2, p. 114-119Article in journal (Refereed)
    Abstract [en]

    In 14 healthy female subjects, the effects of needle stimulation (acupuncture) on skin and muscle blood flow were investigated using a non-invasive custom-designed probe and photoplethysmography (PPG). In randomised order, 2–7 days apart, three modes of needle stimulation were performed on the anterior aspect of the tibia: superficial insertion (SF), insertion into the anterior tibial muscle (Mu), and insertion into the muscle including manipulation of the needle in order to elicit a distinct sensation of distension, heaviness or numbness (DeQi). Before intervention, the subjects rested for 30 min. After the intervention, the needle was left in situ for 20 min. Blood flow recordings were performed intermittently from 10 min prior to the intervention to the end of the trial. In a fourth session, serving as control, corresponding measurements were performed without any needle stimulation. Area under curve was calculated for 5-min periods prior to and after stimulation, respectively, and for the remaining 15-min period after stimulation. Compared to the control situation, muscle blood flow increased following both Mu and DeQi for 20 min, with the latter being more pronounced for the initial 5 min. Skin blood flow increased for 5 min following DeQi. However, no increase was found following SF. The DeQi stimulation was preceded by higher visual analogue scale ratings of anxiety prior to stimulation, which might have influenced skin blood flow to some extent. The results indicate that the intensity of the needling is of importance, the DeQi stimulation resulting in the most pronounced increase in both skin and muscle blood flow.

  • 192.
    Sandberg, Margareta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Zhang, Qiuxia
    Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Styf, Jorma
    Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Gerdle, Björn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Lindberg, Lars-Göran
    Linköping University, Department of Biomedical Engineering, Physiological Measurements. Linköping University, The Institute of Technology.
    Non-invasive monitoring of muscle blood perfusion by photoplethysmography: Evaluation of a new application2005In: Acta Physiologica Scandinavica, ISSN 0001-6772, E-ISSN 1365-201X, Vol. 183, no 4, p. 335-343Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate a specially developed photoplethysmographic (PPG) technique, using green and near-infrared light sources, for simultaneous non-invasive monitoring of skin and muscle perfusion.

    Methods: Evaluation was based on assessments of changes in blood perfusion to various provocations, such as post-exercise hyperaemia and hyperaemia following the application of liniment. The deep penetrating feature of PPG was investigated by measurement of optical radiation inside the muscle. Simultaneous measurements using ultrasound Doppler and the new PPG application were performed to elucidate differences between the two methods. Specific problems related to the influence of skin temperature on blood flow were highlightened, as well.

    Results: Following static and dynamic contractions an immediate increase in muscle perfusion was shown, without increase in skin perfusion. Liniment application to the skin induced a rapid increase in skin perfusion, but not in muscle. Both similarities and differences in blood flow measured by Ultrasound Doppler and PPG were demonstrated. The radiant power measured inside the muscle, by use of an optical fibre, showed that the near-infrared light penetrates down to the vascular depth inside the muscle.

    Conclusions: The results of this study indicate the potentiality of the method for non-invasive measurement of local muscle perfusion, although some considerations still have to be accounted for, such as influence of temperature on blood perfusion.

  • 193.
    Sandqvist, Jan
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Björk, Mathilda
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Gullberg, Mats
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Henriksson, Chris
    Linköping University, Department of Social and Welfare Studies. 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.
    Construct validity of the Assessment of Work Performance (AWP)2009In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 32, no 2, p. 211-218Article in journal (Refereed)
    Abstract [en]

    The instrument Assessment of Work Performance (AWP 1.1) can be used to assess an individuals skills during work performance-how efficient and appropriate a client performs a work task. The instrument is currently used by over 300 assessors working in a variety of work rehabilitation settings in Sweden, and it has been used with over 10,000 clients. In this study, the construct validity of the AWP 1.1 was tested with 364 assessments of clients with a variety of various work-related problems assessed by six occupational therapists in a Social Insurance Office in Sweden between 2004 and 2005. Principal Component Analysis shows construct validity of the AWP 1.1. Further, the findings indicate that the instrument is sensitive and discriminates between clients, and no gender related patterns were identified.

  • 194.
    Sandqvist, Jan
    et al.
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Henriksson, Chris
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Gullberg, Mats
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Content Validity and Utility of the Assessment of Work Performance (AWP)2008In: Work, ISSN 1051-9815, Vol. 30, no 4, p. 441-450Article in journal (Refereed)
    Abstract [en]

    In the area of work rehabilitation, many decisions about future interventions for the client are based on the results of various kinds of assessments. Therefore, it is important that the assessment instruments used are adequate, useful, and reliable. The purpose of this study was to investigate the content validity and utility of the instrument Assessment of Work Performance (AWP) which is used to assess an individual's observable (working) skills during work performance, i.e. how efficient and appropriate a client performs a work activity. A questionnaire was answered by 67 respondents who used the AWP in various work rehabilitation settings in Sweden. The result indicates content validity and utility for the AWP that supports further testing of the instrument.

  • 195.
    Shimada, A.
    et al.
    Aarhus University, Denmark; SCON, Denmark.
    Castrillon, E. E.
    Aarhus University, Denmark; SCON, Denmark.
    Baad-Hansen, L.
    Aarhus University, Denmark; SCON, Denmark.
    Ghafouri, Bijar
    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.
    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.
    Wåhlén, Karin
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Ernberg, M.
    SCON, Denmark; Karolinska Institute, Sweden.
    Cairns, B. E.
    University of British Columbia, Canada.
    Svensson, P.
    Aarhus University, Denmark; SCON, Denmark.
    Increased pain and muscle glutamate concentration after single ingestion of monosodium glutamate by myofascial temporomandibular disorders patients2016In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 20, no 9, p. 1502-1512Article in journal (Refereed)
    Abstract [en]

    BackgroundA randomized, double-blinded, placebo-controlled study was conducted to investigate if single monosodium glutamate (MSG) administration would elevate muscle/serum glutamate concentrations and affect muscle pain sensitivity in myofascial temporomandibular disorders (TMD) patients more than in healthy individuals. MethodsTwelve myofascial TMD patients and 12 sex- and age-matched healthy controls participated in two sessions. Participants drank MSG (150mg/kg) or NaCl (24mg/kg; control) diluted in 400mL of soda. The concentration of glutamate in the masseter muscle, blood plasma and saliva was determined before and after the ingestion of MSG or control. At baseline and every 15min after the ingestion, pain intensity was scored on a 0-10 numeric rating scale. Pressure pain threshold, pressure pain tolerance (PPTol) and autonomic parameters were measured. All participants were asked to report adverse effects after the ingestion. ResultsIn TMD, interstitial glutamate concentration was significantly greater after the MSG ingestion when compared with healthy controls. TMD reported a mean pain intensity of 2.8/10 at baseline, which significantly increased by 40% 30min post MSG ingestion. At baseline, TMD showed lower PPTols in the masseter and trapezius, and higher diastolic blood pressure and heart rate than healthy controls. The MSG ingestion resulted in reports of headache by half of the TMD and healthy controls, respectively. ConclusionThese findings suggest that myofascial TMD patients may be particularly sensitive to the effects of ingested MSG. What does this study add? Elevation of interstitial glutamate concentration in the masseter muscle caused by monosodium glutamate (MSG) ingestion was significantly greater in myofascial myofascial temporomandibular disorders (TMD) patients than healthy individuals. This elevation of interstitial glutamate concentration in the masseter muscle significantly increased the intensity of spontaneous pain in myofascial TMD patients.

  • 196.
    Shimada, Akiko
    et al.
    Aarhus University, Denmark; SCON, Denmark.
    Baad-Hansen, Lene
    Aarhus University, Denmark; SCON, Denmark.
    Castrillon, Eduardo
    Aarhus University, Denmark; SCON, Denmark.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Stensson, Niclas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    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.
    Ernberg, Malin
    Karolinska Institute, Sweden.
    Cairns, Brian
    University of British Columbia, Canada.
    Svensson Odont, Peter
    Aarhus University, Denmark; SCON, Denmark.
    Differential effects of repetitive oral administration of monosodium glutamate on interstitial glutamate concentration and muscle pain sensitivity2015In: Nutrition (Burbank, Los Angeles County, Calif.), ISSN 0899-9007, E-ISSN 1873-1244, Vol. 31, no 2, p. 315-323Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to determine the relationship of high daily monosodium glutamate (MSG) consumption with glutamate concentrations in jaw muscle, saliva, and serum, and muscle pain sensitivity in healthy participants. Methods: A randomized, double-blinded, placebo-controlled study was conducted to investigate the effect of repetitive consumption of high-dose MSG on glutamate concentration in the masseter muscles measured by microdialysis and muscle pain sensitivity. In five contiguous experimental daily sessions, 32 healthy participants drank MSG (150 mg/kg) or NaCl (24 mg/kg) diluted with a 400 mL soda. The concentrations of glutamate before and after the ingestion were assessed in dialysate and plasma samples on the first and last days. Saliva glutamate concentration was assessed every day. Pressure pain threshold, pressure pain tolerance, autonomic parameters (heart rate, systolic and diastolic blood pressures) and reported side effects also were assessed. Results: No significant change was noted in the baseline concentration of glutamate in the masseter muscle, blood, or saliva, but the peak concentration in the masseter muscle increased significantly between day 1 and 5. A statistically significant increase in systolic and diastolic blood pressures after MSG administration was observed, as well as a significantly higher frequency of reports of nausea and headache in the MSG group. No robust effect of MSG on muscle sensitivity was found. Conclusion: Interstitial glutamate concentration in the masseter muscle is not highly disturbed by excessive repetitive intake of MSG in healthy man. (C) 2015 Elsevier Inc. All rights reserved.

  • 197.
    Shimada, Akiko
    et al.
    Aarhus University, Denmark; SCON, Denmark.
    Castrillon, Eduardo
    Aarhus University, Denmark; SCON, Denmark.
    Baad-Hansen, Lene
    Aarhus University, Denmark; SCON, Denmark.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    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.
    Ernberg, Malin
    SCON, Denmark; Karolinska Institute, Sweden.
    Cairns, Brian
    University of British Columbia, Canada.
    Svensson, Peter
    Aarhus University, Denmark; SCON, Denmark.
    Muscle pain sensitivity after glutamate injection is not modified by systemic administration of monosodium glutamate2015In: Journal of Headache and Pain, ISSN 1129-2369, E-ISSN 1129-2377, Vol. 16, no 68Article in journal (Refereed)
    Abstract [en]

    Background: Monosodium glutamate (MSG) is often thought to be associated with headache and craniofacial pains like temporomandibular disorders. This randomized, double-blinded, placebo-controlled study was performed to investigate how ingestion of MSG affects muscle pain sensitivity before and after experimentally induced muscle pain. Methods: Sixteen healthy adult subjects participated in 2 sessions with at least 1-week interval between sessions. In each session, two injections of glutamate (Glu, 0.5 M, 0.2 ml) and two injections of saline (0.9 %, 0.2 ml) into the masseter and temporalis muscles, respectively, were undertaken, with a 15 min interval between each injection. Injections of saline were made contralateral to Glu injections and done in a randomized order. Participants drank 400 mL of soda mixed with either MSG (150 mg/kg) or NaCl (24 mg/kg, placebo) 30 min before the intramuscular injections. Pressure pain thresholds (PPT), autonomic parameters and pain intensity were assessed prior to (baseline) and 30 min after ingestion of soda, as well as 5 min and 10 min after the intramuscular injections and at the end of the session. Whole saliva samples were collected prior to and 30, 45, 60, and 75 min after the ingestion of soda. Results: MSG administration resulted in a significantly higher Glu level in saliva than administration of NaCl and was associated with a significant increase in systolic blood pressure. Injections of Glu were significantly more painful than injections of NaCl. However, ingestion of MSG did not change the intensity of Glu-evoked pain. Glu injections also significantly increased systolic and diastolic blood pressure, but without an additional effect of MSG ingestion. Glu injections into the masseter muscle significantly reduced the PPT. However, pre-injection MSG ingestion did not significantly alter this effect. Interestingly, PPT was significantly increased in the trapezius after MSG ingestion and intramuscular injection of Glu in the jaw muscles. Conclusion: The main finding in this study was that systemic intake of a substantial amount of MSG does not influence either pain intensity or pressure pain sensitivity in the masseter and temporalis muscles into which Glu injections were made.

  • 198.
    Sjogaard, Gisela
    et al.
    University South Denmark.
    Rosendal, Lars
    Trial Consult, Gentofte, Denmark .
    Kristiansen, Jesper
    National Research Centre for Working Environment.
    Blangsted, Anne K
    National Research Centre for Working Environment.
    Skotte, Jorgen
    National Research Centre for Working Environment.
    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.
    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.
    Saltin, Bengt
    University of Copenhagen.
    Sogaard, Karen
    University South Denmark.
    Muscle oxygenation and glycolysis in females with trapezius myalgia during stress and repetitive work using microdialysis and NIRS2010In: EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY, ISSN 1439-6319, Vol. 108, no 4, p. 657-669Article in journal (Refereed)
    Abstract [en]

    The aim of this investigation was to study female workers active in the labour market for differences between those with trapezius myalgia (MYA) and without (CON) during repetitive pegboard (PEG) and stress (STR) tasks regarding (1) relative muscle load, (2) trapezius muscle blood flow, (3) metabolite accumulation, (4) oxygenation, and (5) pain development. Among 812 female employees (age 30-60 years) at 7 companies with high prevalence of neck/shoulder complaints, clinical examination identified 43 MYA and 19 CON. At rest, during PEG, and STR the trapezius muscle was measured using (1) EMG and MMG, (2) microdialysis, and (3) NIRS. Further, subjective pain ratings were scored (VAS). EMGrms in %MVE (Maximal Voluntary EMG-activity), was significantly higher among MYA than CON during PEG (11.74 +/- A 9.09 vs. 7.42 +/- A 5.56%MVE) and STR (5.47 +/- A 5.00 vs. 3.28 +/- A 1.94%MVE). MANOVA showed a group and time effect regarding data from the microdialysis: for MYA versus CON group differences demonstrated lower muscle blood flow and higher lactate and pyruvate concentrations. Potassium and glucose only showed time effects. NIRS showed similar initial decreases in oxygenation with PEG in both groups, but only in CON a significant increase back to baseline during PEG. VAS score at rest was highest among MYA and increased during PEG, but not for CON. The results showed significant differences between CON and MYA regarding muscle metabolism at rest and with PEG and STR. Higher relative muscle load during PEG and STR, insufficient muscle blood flow and oxygenation may account for the higher lactate, pyruvate and pain responses among MYA versus CON.

  • 199.
    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.

  • 200.
    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.

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