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  • 1.
    Björk, Mathilda
    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.
    Thyberg, Ingrid
    Linköping University, Department of Clinical and Experimental Medicine, Rheumatology . Linköping University, Faculty of Health Sciences.
    Peolsson, Mchael
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Multivariate relationships between pain intensity and other aspects of health in rheumatoid arthritis: cross sectional and five year longitudinal analyses (the Swedish TIRA project)2008In: Disability and Rehabilitation, ISSN 0963-8288, Vol. 30, no 19, p. 1429-1438Article in journal (Refereed)
    Abstract [en]

    Objectives: This study analyses the relationships between pain intensity and other aspects of health commonly used to assess disease activity and disability in early rheumatoid arthritis and examines whether such relationships were different between women and men.

    Subjects and methods: This study included the 189 patients (69% women) with early RA (symptoms <12 months at diagnosis) still remaining in the Swedish TIRA cohort 5 years after inclusion. Disease activity and disability was assessed 3, 6, 12, 18, 24, 36, 48, and 60 months (M0-M60) after inclusion by erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), number of swollen and tender joints, physicians global assessment of disease activity (PGA), grip force average over 10 seconds (Grippit), Grip Ability Test (GAT), Signals of Functional Impairment (SOFI) in hand, lower limb and upper limb, Health Assessment Questionnaire (HAQ), and pain intensity measured with a visual analogue scale (VAS). The variables were divided into meaningful blocks according to the correlation structure in a principal component analysis (PCA) at M60. Using hierarchical partial least squares (PLS) analyses, this study investigated the blocks cross-sectionally to test for correlations with pain intensity at M0 and M60. The blocks at M0 were also used as predictors of pain intensity at M60 in a hierarchical PLS.

    Results: The strongest relationship was found between pain intensity and the second block, consisting of HAQ and SOFI-lower limb at the cross-sectional analyses in both women and men. The block representing disease activity (i.e., ESR, CRP, PGA, and swollen and tender joints) had the weakest relation to pain intensity. According to the longitudinal analyses, the disease activity variables (block 1) at M0 had the strongest relationship to pain intensity at M60 in men. In contrast, HAQ and SOFI-lower limb (block 2) at M0 had a strong relation to pain intensity in women.

  • 2.
    Börsbo, Björn
    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, Sinnescentrum, Pain and Rehabilitation Centre.
    Peolsson, Michael
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Impact of the interaction between selfefficacy, symptoms and catastrophizing on disability, quality of life and health in chronic pain patients2010In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 17, p. 1387-1396Article in journal (Refereed)
    Abstract [en]

    This study investigates the interactions between self-efficacy–including subcomponents–and symptoms (pain, depression, and anxiety), catastrophizing, disability, quality of life, and health in a population of chronic pain patients. The study used 433 chronic pain patients including 47 patients with spinal cord injuryrelated pain, 150 with chronic whiplash-associated disorders, and 236 with fibromyalgia. The participants answered a postal questionnaire that provided background data, pain intensity and duration, and psychological- and health-related items. In the multivariate context, depression, anxiety, catastrophizing, and disability were intercorrelated. Self-efficacy correlated positively with variables of quality of life and general health. These two groups of variables were negatively correlated. The pain variables–duration of pain, pain intensity, and spreading of pain–formed a third group of variables. Self-efficacy function was negatively correlated to these three pain variables. When regressing disability, quality of life, and health, we found that self-efficacy had a positive impact whereas symptoms, catastrophizing, and pain had a negative influence on these aspects. Different patterns of influencing variables were discerned for the three different analyses, and specific patterns of the subscales of self-efficacy corresponded to specific patterns of negative factors for the outcome of disability, quality of life, and health.

    Perspective: This article presents the complex interaction of psychological factors and symptoms and their positive and negative influence on disability, quality of life, and health. The results indicate that it might be important to assess and influence both enhancing and detoriating factors to ensure an effective pain management programme.

  • 3.
    Börsbo, Björn
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Peolsson, Michael
    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. Linköping University, Faculty of Health Sciences.
    Catastrophizing, depression, and pain: Correlation with and influence on quality of life and health: A study of chronic whiplash-associated disorders2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 7, p. 562-569Article in journal (Refereed)
    Abstract [en]

    Objective: The aims of this study were: (i) to classify subgroups according to the degree of pain intensity, depression, and catastrophizing, and investigate distribution in a group of patients with chronic whiplash-associated disorders; and (ii) to investigate how these subgroups were distributed and inter-related multivariately with respect to consequences such as health and quality of life outcome measures.

    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: The following data were obtained by means of self-report questionnaires: pain intensity in neck and shoulders, background history, Beck Depression Inventory, the catastrophizing scale of Coping Strategy Questionnaire, Life Satisfaction Checklist, the SF-36 Health Survey, and the EuroQol.

    Results: Principal component analysis was used to recognize subgroups according to the degree of pain intensity, depression, and catastrophizing. These subgroups have specific characteristics according to perceived health and quality of life, and the degree of depression appears to be the most important influencing factor.

    Conclusion: From a clinical point of view, these findings indicate that it is important to assess patients for intensity of pain, depression, and catastrophizing when planning a rehabilitation programme. Such an evaluation will help individualize therapy and intervention techniques so as to optimize the efficiency of the programme.

  • 4.
    Börsbo, Björn
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Peolsson, Michael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine .
    Gerdle, Björn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    The complex interplay between pain intensity, depression, anxiety and catastrophizing with respect to quality of life and disability2009In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, no 19, p. 1605-1613Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 5.
    Gerdle, Björn
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Lemming, Dag
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Kristiansen, Jesper
    Cyncron A/S.
    Larsson, Britt
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Pain and Rehabilitation Centre.
    Peolsson, Michael
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine . Linköping University, Faculty of Health Sciences.
    Rosendal, Lars
    National Research Centre for the Working Environment.
    Biochemical alterations in the trapezius muscle of patients with chronic whiplash associated disorders (WAD): A microdialysis study2008In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 12, no 1, p. 82-93Article in journal (Refereed)
    Abstract [en]

    The mechanisms behind the development of chronic trapezius myalgia in patients with whiplash associated disorders (WAD) appear to involve both peripheral and central components, but the specific contribution of alterations in muscle is not clear. Female patients with WAD and involvement of trapezius (N = 22) and female controls (N = 20; CON) were studied during an experiment compromised of rest (baseline), 20 min repetitive low-force exercise and 120 min recovery. Their interstitial concentrations of serotonin (5-HT), glutamate, lactate, pyruvate, potassium, interleukin-6 (IL-6), and blood flow were determined in the trapezius muscle using a microdialysis technique. Pressure pain thresholds (PPT) over trapezius and tibialis anterior muscles were also assessed. In WAD, we found signs of generalized hypersensitivity according to PPT. The WAD group had significantly higher interstitial [IL-6] and [5-HT] in the trapezius than the CON. [Pyruvate] was overall significantly lower in WAD, and with lactate it showed another time-pattern throughout the test. In the multivariate regression analysis of pain intensity [5-HT] was the strongest regressor and positively correlated with pain intensity in WAD. In addition, blood flow, [pyruvate], and [potassium] influenced the pain intensity in a complex time dependent way. These findings may indicate that peripheral nociceptive processes are activated in WAD with generalized hypersensitivity for pressure and they are not identical with those reported in chronic work-related trapezius myalgia, which could indicate different pain mechanisms.

  • 6.
    Hydén, Lars-Christer
    et al.
    Linköping University, The Tema Institute, Department of Communications Studies. Linköping University, Faculty of Arts and Sciences.
    Peolsson, Michael
    Linköping University, The Tema Institute, Department of Communications Studies. Linköping University, Faculty of Arts and Sciences.
    Pain Gestures: The Orchestration of Talk and Body Gestures2002In: Health, ISSN 1363-4593, E-ISSN 1461-7196, Vol. 6, no 3, p. 325-345Article in journal (Refereed)
    Abstract [en]

    This article is about the use and function of gestures in pain communication. More specifically how we can communicate an internal bodily experience like pain with the help of gestures. This is of great importance both in everyday situations and in medical consultations of various types. Our focus in this article is on the issues of the gesture as a communicative resource, how verbal and nonverbal communicative resources are related to each other and in what way gestures contribute to the structure of different types of pain. Thirty-seven patients have been interviewed about their pain experiences and the main result is that several communicative modalities are interwoven in the pain accounts. Three different functions of gestures were identified: the pointing, iconic and symbolic functions. The clinical relevance of this approach to gestures in pain communication is to take note of the intricate interplay of different communicative resources used in the pain description, and to emphasize both verbal and nonverbal interaction in the clinical conversation as a resource in the care situation.

  • 7.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Health Sciences. University of Queensland, St Lucia, Brisbane, Australia.
    Marstein, Eivin
    University of of Queensland, St Lucia, Brisbane, Australia.
    McNamara, Timothy
    University of of Queensland, St Lucia, Brisbane, Australia.
    Nolan, Damien
    University of of Queensland, St Lucia, Brisbane, Australia.
    Sjaaberg, Espen
    University of of Queensland, St Lucia, Brisbane, Australia.
    Peolsson, Michael
    Umeå University, Sweden.
    Jull, Gwendolen
    University of of Queensland, St Lucia, Brisbane, Australia.
    OLeary, Shaun
    University of of Queensland, St Lucia, Brisbane, Australia; Royal Brisbane and Womens Hospital, Queensland Health, Australia.
    Does posture of the cervical spine influence dorsal neck muscle activity when lifting?2014In: Manual Therapy, ISSN 1356-689X, E-ISSN 1532-2769, Vol. 19, no 1, p. 32-36Article in journal (Refereed)
    Abstract [en]

    Previous studies have shown that postural orientations of the neck, such as flexed or forward head postures, are associated with heightened activity of the dorsal neck muscles. While these studies describe the impact of variations in neck posture alone, there is scant literature regarding the effect of neck posture on muscle activity when combined with upper limb activities such as lifting. The purpose of this study was to evaluate the effect of three different neck postures on the activity of the different layers of the dorsal neck muscles during a lifting task. Ultrasound measurements of dorsal neck muscle deformation were compared over two time points (rest, during lift) during a lifting task performed in three different neck postural conditions (neutral, flexed and forward head posture) in 21 healthy subjects. Data were analysed by post-process speckle tracking analysis. Results demonstrated significantly greater muscle deformation induced by flexed and forward head postures, compared to the neutral posture, for all dorsal neck muscles at rest (pless than. 0.05). Significant condition by time interactions associated with the lift was observed for four out of the five dorsal muscles (pless than. 0.02). These findings demonstrate that posture of the cervical spine influenced the level of muscle deformation not only at rest, but also when lifting. The findings of the study suggest that neck posture should be considered during the evaluation or design of lifting activities as it may contribute to excessive demands on dorsal neck muscles with potential detrimental consequences.

  • 8.
    Peolsson, Anneli
    et al.
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Peolsson, Michael
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Predictive factors for long-term outcome of anterior cervical decompression and fusion: a multivariate data analysis2008In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 17, no 3, p. 406-414Article in journal (Refereed)
    Abstract [en]

    We conducted a prospective randomized study to investigate predictive factors for short- and long-term outcome of anterior cervical decompression and fusion (ACDF) as measured by current pain intensity on the Visual Analogue Scale (VAS) and by disability using the Neck Disability Index (NDI). Current understanding about how preoperative and short-term outcome data predict long-term outcome is sparse, and there are few studies involving analysis of short-term follow-up using multivariate approaches with quantification of the relative importance of each variable studied. A total of 95 patients were randomly allocated for ACDF with the cervical intervertebral fusion cage or the Cloward procedure. The mean follow-up time was 19 months (range 12-24) for short-term follow-up and 76 months (range 56-94 months) for long-term. Background factors, radiologically detected findings, physiological measurements, treatment type, pain, and disability were used as potential predictors. Multivariate statistical analysis by projection to latent structures was used to investigate predictors of importance for short- and long-term outcome of ACDF. A "preoperative" low disability and pain intensity, non-smoking status, male sex, good hand strength, and an active range of motion (AROM) in the neck were significant predictors for good short- and long-term outcomes. The short-term outcome data were better at predicting long-term outcome than were baseline data. Radiologically detected findings and surgical technique used were mainly insignificant as predictors. We suggest that the inclusion criteria for ACDF should be based on a bio-psycho-social model including NDI. NDI may also be regarded as an important outcome measurement in evaluation of ACDF.

  • 9.
    Peolsson, Michael
    Linköping University, The Tema Institute, Department of Communications Studies. Linköping University, Faculty of Arts and Sciences.
    Att beskriva kronisk smärta: en lärprocess2000Licentiate thesis, comprehensive summary (Other academic)
    Abstract [sv]

    Sammanfattningsvis syftar denna uppsats till att studera hur patienter beskriver sin smärta samt på vilka sätt de beskriver hur de utforskar sin smärta i vardagen. Jag vill med dessa beskrivningar som bakgrund lyfta fram patienters egen lärprocess om sin smärta. Avhandlingen syftar vidare till att diskutera hur vårdgivare kan lära sig av patienters smärtbeskrivningar. I detta sammanhang vill jag lyfta fram några begrepp som kan belysa hur patienterna i mina studier delger vad jag tolkar som smärtupplevelser.

    List of papers
    1. Experiencing and Knowing Pain: Patients’ Perspectives
    Open this publication in new window or tab >>Experiencing and Knowing Pain: Patients’ Perspectives
    2000 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 2, no 4, p. 146-155Article in journal (Refereed) Published
    Abstract [en]

    This article focuses on patients’ accounts of chronic pain and the manner in which they communicate their experiences. The data have been generated through interviews with chronic pain patients undergoing treatment for their problems. The results show that patients develop a set of discursive markers by means of which they are able to make distinctions between different kinds of pain. These distinctions are made with respect to pain qualities and pain localizations in the body. Further, a majority of the patients report that one pain generally transforms into another. This subjectively perceived patterning we refer to as pain transformations and these, in turn, contain different pain phases. Most patients report pains as dynamic and tients report pains as dynamic and stable and consistent sensation. The results also show that some patients identify certain pain phases as precursors of more severe phases, and that they use this knowledge as a means for taking preventive actions. Since experiencing pain often involves a discursive element gaining linguistic control over one’s pain provides the person with an important resource for dealing with pain

    Keywords
    pain communication, pain discrimination, pain learning, pain localization, pain quality, pain phase, pain transformation
    National Category
    Social Sciences Interdisciplinary
    Identifiers
    urn:nbn:se:liu:diva-79050 (URN)10.1080/140381900750063409 (DOI)
    Available from: 2012-06-28 Created: 2012-06-28 Last updated: 2018-01-12Bibliographically approved
    2. Living with chronic pain: A dynamic learning process
    Open this publication in new window or tab >>Living with chronic pain: A dynamic learning process
    2000 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 7, no 3, p. 114-125Article in journal (Refereed) Published
    Abstract [en]

    This study focuses on how patients describe and manage their pain in their everyday life. The data consist of interviews with 37 patients undergoing treatment for chronic pain. The study focuses on how experiences of pain are mediated and interpreted with the help of the individual's discursive resources. It is argued that this kind of resource is important in constituting a structure of relations between a suffering person, pain and context. In the analysis of the material a four-step procedure was used, including both formal and content-related aspects. It was found that the patients describe chronic pain as a dynamic phenomenon. Patients learn about their pain by actively constituting relations among themselves, the pain and their activities. For the patients, chronic pain is a structured phenomenon. Patients often describe how pain is initiated, worsens and is alleviated. Patients thereby learn to distinguish different figures in their pain, which they are able to relate to in their management of pain. This suggests that a life in pain could be seen as an apprenticeship process. The heart of the matter in this process is learning to become sensitive to and flexible towards variations in the pain and potential pain triggers in the environment. This knowledge is important, as mastering pain is a balancing act between inner resources and environmental circumstances.

    Keywords
    apprenticeship, communication, coping, chronic pain, dynamic, language, learning, patient perspective
    National Category
    Social Sciences Interdisciplinary
    Identifiers
    urn:nbn:se:liu:diva-22853 (URN)10.1080/110381200300006069 (DOI)2193 (Local ID)2193 (Archive number)2193 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2018-01-13Bibliographically approved
  • 10.
    Peolsson, Michael
    Linköping University, The Tema Institute, Department of Communications Studies. Linköping University, Faculty of Arts and Sciences.
    Smärtans mosaik: kommunikation och lärande om långvarig smärta2001Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis focuses on how people, living with long-term pain, exploreand communicate their pain, by way of speech as a means for producingrelations between themselves, the. pain and everyday activities. The datamaterial consists of focused research interviews with patients undergoingtreatment for their pain at a pain clinic. The thesis takes as a point ofdeparture that people living with pain in various situations need tocommunicate their pain experiences which posits the person in acommunicational dilemma giving_ shape to a multi-dimensionalexperience. Different kinds of communicative resources are used in thesecommunication situations, verbal and figurative talk together withgestures. It is argued that learning about one's pain could be described as an apprenticeship process, which concerns as well the relations between the afflicted person and the her/his pain as how these relations are to be communicated. An important result is that mastering one's pain is about an on-going, situated, searching and communicative practice.

    List of papers
    1. Living with chronic pain: A dynamic learning process
    Open this publication in new window or tab >>Living with chronic pain: A dynamic learning process
    2000 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 7, no 3, p. 114-125Article in journal (Refereed) Published
    Abstract [en]

    This study focuses on how patients describe and manage their pain in their everyday life. The data consist of interviews with 37 patients undergoing treatment for chronic pain. The study focuses on how experiences of pain are mediated and interpreted with the help of the individual's discursive resources. It is argued that this kind of resource is important in constituting a structure of relations between a suffering person, pain and context. In the analysis of the material a four-step procedure was used, including both formal and content-related aspects. It was found that the patients describe chronic pain as a dynamic phenomenon. Patients learn about their pain by actively constituting relations among themselves, the pain and their activities. For the patients, chronic pain is a structured phenomenon. Patients often describe how pain is initiated, worsens and is alleviated. Patients thereby learn to distinguish different figures in their pain, which they are able to relate to in their management of pain. This suggests that a life in pain could be seen as an apprenticeship process. The heart of the matter in this process is learning to become sensitive to and flexible towards variations in the pain and potential pain triggers in the environment. This knowledge is important, as mastering pain is a balancing act between inner resources and environmental circumstances.

    Keywords
    apprenticeship, communication, coping, chronic pain, dynamic, language, learning, patient perspective
    National Category
    Social Sciences Interdisciplinary
    Identifiers
    urn:nbn:se:liu:diva-22853 (URN)10.1080/110381200300006069 (DOI)2193 (Local ID)2193 (Archive number)2193 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2018-01-13Bibliographically approved
    2. Experiencing and Knowing Pain: Patients’ Perspectives
    Open this publication in new window or tab >>Experiencing and Knowing Pain: Patients’ Perspectives
    2000 (English)In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 2, no 4, p. 146-155Article in journal (Refereed) Published
    Abstract [en]

    This article focuses on patients’ accounts of chronic pain and the manner in which they communicate their experiences. The data have been generated through interviews with chronic pain patients undergoing treatment for their problems. The results show that patients develop a set of discursive markers by means of which they are able to make distinctions between different kinds of pain. These distinctions are made with respect to pain qualities and pain localizations in the body. Further, a majority of the patients report that one pain generally transforms into another. This subjectively perceived patterning we refer to as pain transformations and these, in turn, contain different pain phases. Most patients report pains as dynamic and tients report pains as dynamic and stable and consistent sensation. The results also show that some patients identify certain pain phases as precursors of more severe phases, and that they use this knowledge as a means for taking preventive actions. Since experiencing pain often involves a discursive element gaining linguistic control over one’s pain provides the person with an important resource for dealing with pain

    Keywords
    pain communication, pain discrimination, pain learning, pain localization, pain quality, pain phase, pain transformation
    National Category
    Social Sciences Interdisciplinary
    Identifiers
    urn:nbn:se:liu:diva-79050 (URN)10.1080/140381900750063409 (DOI)
    Available from: 2012-06-28 Created: 2012-06-28 Last updated: 2018-01-12Bibliographically approved
    3. The Metaphors for pain: a study of pain metaphors as communication
    Open this publication in new window or tab >>The Metaphors for pain: a study of pain metaphors as communication
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    When describing pain the spoken language one is used to is often inadequate. This article takes as departure this communicative problem. The datamaterial consists of semi-structured interviews with thirty-seven patients undergoing treatment for their chronic pain.The metaphor consists of two parts or domains: the domain to be described and the domain from which a description is borrowed. 145 metaphors were identified in the data material. The analysis concernedboth the domains, their relationship and the metaphor's communicative function. The results shows that different types of 'linguisticimages' were used to describe pain, and that the relationship between the two domains were of two kinds: experiential and semantic,respectively. Further, five communicative functions of the metaphorical talk were found: a comparative, structuring, contextulising,problematising and interactive, function respectively. It is argued that professional caregivers by metaphorical talk could acquire indirect access to fragment of patients' experiences of pain, create interactivity and compliance.

    Keywords
    pain, metaphor, communication, patient description, patient counseling
    National Category
    Social Sciences Interdisciplinary
    Identifiers
    urn:nbn:se:liu:diva-79052 (URN)
    Available from: 2012-06-28 Created: 2012-06-28 Last updated: 2018-01-12Bibliographically approved
    4. Pain Gestures: The Orchestration of Talk and Body Gestures
    Open this publication in new window or tab >>Pain Gestures: The Orchestration of Talk and Body Gestures
    2002 (English)In: Health, ISSN 1363-4593, E-ISSN 1461-7196, Vol. 6, no 3, p. 325-345Article in journal (Refereed) Published
    Abstract [en]

    This article is about the use and function of gestures in pain communication. More specifically how we can communicate an internal bodily experience like pain with the help of gestures. This is of great importance both in everyday situations and in medical consultations of various types. Our focus in this article is on the issues of the gesture as a communicative resource, how verbal and nonverbal communicative resources are related to each other and in what way gestures contribute to the structure of different types of pain. Thirty-seven patients have been interviewed about their pain experiences and the main result is that several communicative modalities are interwoven in the pain accounts. Three different functions of gestures were identified: the pointing, iconic and symbolic functions. The clinical relevance of this approach to gestures in pain communication is to take note of the intricate interplay of different communicative resources used in the pain description, and to emphasize both verbal and nonverbal interaction in the clinical conversation as a resource in the care situation.

    Keywords
    gesture, interaction, nonverbal, pain
    National Category
    Social Sciences Interdisciplinary
    Identifiers
    urn:nbn:se:liu:diva-22857 (URN)10.1177/136345930200600305 (DOI)2198 (Local ID)2198 (Archive number)2198 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2018-01-13Bibliographically approved
  • 11.
    Peolsson, Michael
    Linköping University, The Tema Institute, Department of Communications Studies. Linköping University, Faculty of Arts and Sciences.
    The Metaphors for pain: a study of pain metaphors as communicationManuscript (preprint) (Other academic)
    Abstract [en]

    When describing pain the spoken language one is used to is often inadequate. This article takes as departure this communicative problem. The datamaterial consists of semi-structured interviews with thirty-seven patients undergoing treatment for their chronic pain.The metaphor consists of two parts or domains: the domain to be described and the domain from which a description is borrowed. 145 metaphors were identified in the data material. The analysis concernedboth the domains, their relationship and the metaphor's communicative function. The results shows that different types of 'linguisticimages' were used to describe pain, and that the relationship between the two domains were of two kinds: experiential and semantic,respectively. Further, five communicative functions of the metaphorical talk were found: a comparative, structuring, contextulising,problematising and interactive, function respectively. It is argued that professional caregivers by metaphorical talk could acquire indirect access to fragment of patients' experiences of pain, create interactivity and compliance.

  • 12.
    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.

  • 13.
    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.

  • 14.
    Peolsson, Michael
    et al.
    Linköping University, The Tema Institute, Department of Communications Studies. Linköping University, Faculty of Arts and Sciences.
    Hydén, Lars-Christer
    Linköping University, The Tema Institute, Department of Communications Studies. Linköping University, Faculty of Arts and Sciences.
    Sätterlund-Larsson, U.
    Trollhättan | Uddevalla University, Vänersborg, Sweden.
    Living with chronic pain: A dynamic learning process2000In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 7, no 3, p. 114-125Article in journal (Refereed)
    Abstract [en]

    This study focuses on how patients describe and manage their pain in their everyday life. The data consist of interviews with 37 patients undergoing treatment for chronic pain. The study focuses on how experiences of pain are mediated and interpreted with the help of the individual's discursive resources. It is argued that this kind of resource is important in constituting a structure of relations between a suffering person, pain and context. In the analysis of the material a four-step procedure was used, including both formal and content-related aspects. It was found that the patients describe chronic pain as a dynamic phenomenon. Patients learn about their pain by actively constituting relations among themselves, the pain and their activities. For the patients, chronic pain is a structured phenomenon. Patients often describe how pain is initiated, worsens and is alleviated. Patients thereby learn to distinguish different figures in their pain, which they are able to relate to in their management of pain. This suggests that a life in pain could be seen as an apprenticeship process. The heart of the matter in this process is learning to become sensitive to and flexible towards variations in the pain and potential pain triggers in the environment. This knowledge is important, as mastering pain is a balancing act between inner resources and environmental circumstances.

  • 15.
    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.

  • 16.
    Peolsson, Michael
    et al.
    Linköping University, The Tema Institute, Department of Communications Studies. Linköping University, Faculty of Arts and Sciences.
    Säljö, Roger
    Linköping University, The Tema Institute, Department of Communications Studies. Linköping University, Faculty of Arts and Sciences.
    Sätterlund Larsson, U.
    Trollhättan | Uddevalla University, Vänersborg, Sweden.
    Experiencing and Knowing Pain: Patients’ Perspectives2000In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 2, no 4, p. 146-155Article in journal (Refereed)
    Abstract [en]

    This article focuses on patients’ accounts of chronic pain and the manner in which they communicate their experiences. The data have been generated through interviews with chronic pain patients undergoing treatment for their problems. The results show that patients develop a set of discursive markers by means of which they are able to make distinctions between different kinds of pain. These distinctions are made with respect to pain qualities and pain localizations in the body. Further, a majority of the patients report that one pain generally transforms into another. This subjectively perceived patterning we refer to as pain transformations and these, in turn, contain different pain phases. Most patients report pains as dynamic and tients report pains as dynamic and stable and consistent sensation. The results also show that some patients identify certain pain phases as precursors of more severe phases, and that they use this knowledge as a means for taking preventive actions. Since experiencing pain often involves a discursive element gaining linguistic control over one’s pain provides the person with an important resource for dealing with pain

  • 17.
    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.

  • 18.
    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.

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