Scandinavian Journal of Pain最新文献

Objectives: This study examined the relationship between symbolic function, coping, pain, and long-term outcomes in patients with chronic cervical pain.

Methods: The study population consisted of 104 subjects who could be candidates for cervical spinal surgery at the Department of Neurosurgery. We followed patients for 2 and 6 years, focusing on pain experience, vocational outcome, and sick leave.

Results: The SAT9 test revealed that 28% of the patients had poor symbolic function. The group classified as having poor symbolic function reported using more coping strategies and coping resources but had more of an external locus of control. They showed less objective neurophysiological findings but rated more pain on the VAS scale. The group with poor symbolic function had more sick leave days 2 years after consultation, and the vocational outcome was very poor for persons with impaired symbolic function at the 6-year follow-up. At the 6-year follow-up, patients with poor symbolic function still experienced higher pain levels and had more of an external locus of control.

Conclusions: The SAT9 results indicate that pain could also serve as an expression of distress or discomfort, and the expression of pain can be a way for individuals to communicate their need for rest, recovery, or relief from stressors. In this context, taking sick leave becomes a symbolic action addressing broader well-being concerns. Understanding the symbolic function of stress and pain concerns can be valuable for health professionals and individuals themselves. Open communication, recognizing, and reorganizing the symbolic nature of pain can contribute to a more compassionate understanding of stress-related challenges and pain.

Objectives: Transcutaneous electrical nerve stimulation (TENS) is a noninvasive adjunct to multimodal pain management for acute postoperative care across various surgeries. Despite extensive evidence supporting its efficacy, TENS remains underutilized in clinical practice. This study aimed to assess the knowledge, attitudes, and practices of healthcare professionals regarding TENS in perioperative settings to support its integration into routine clinical practice.

Methods: A web-based questionnaire was distributed to anesthesiology department heads at all university hospitals (n = 7) in Sweden and three smaller, randomly selected hospitals across three geographical areas. Department heads forwarded the questionnaire to anesthesiologists, nurse anesthetists, critical care nurses, and registered nurses with basic education working in perioperative settings. The questionnaire included four sections: demographic information, general postoperative phase information, TENS use for postoperative pain relief, and open-ended questions.

Results: The survey was sent to 870 respondents, yielding a response rate of 28% (n = 246). Among respondents, 69% reported lacking adequate knowledge to administer TENS, and 79% indicated they did not use TENS in their practice. Furthermore, 45% noted an absence of clinical guidelines supporting the use of TENS in their clinic, while 32% were unsure about the existence of guidelines. However, 60% expressed interest in developing theoretical knowledge and practical skills for TENS application.

Conclusions: This study highlights that substantial knowledge gaps and the lack of clear clinical guidelines limit the use of TENS for acute postoperative pain management. These deficiencies may lead to inadequate pain control, increased opioid use, and opioid-related adverse effects. We recommend that hospital leadership and professional bodies develop and implement comprehensive educational programs and establish clear, evidence-based clinical guidelines for TENS use in postoperative pain management. Addressing these gaps is essential for improving clinical practice and empowering patients through greater involvement and autonomy in pain management strategies.

Objectives: Chronic pain causes loss of workability, and pharmacological treatment is often not sufficient, whereas psychosocial treatments may relieve continual pain. This study aimed to investigate the effect of peer group management intervention among patients with chronic pain.

Methods: The participants were 18-65-year-old employees of the Municipality of Helsinki (women 83%) who visited an occupational health care physician, nurse, psychologist, or physiotherapist for chronic pain lasting at least 3 months. An additional inclusion criterion was an elevated risk of work disability. Our study was a stepped wedge cluster, randomized controlled trial, and group interventions used mindfulness, relaxation, cognitive behavioral therapy, and acceptance and commitment therapy. We randomized sixty participants to either a pain management group intervention or to a waiting list with the same intervention 5 months later. After dropouts, 48 employees participated in 6 weekly group meetings. We followed up participants from groups A, B, and C for 12 months and groups D, E, and F for 6 months. As outcome measures, we used the pain Self-Efficacy Questionnaire, the number of areas of pain, the visual analog scale of pain, and the pain self-efficacy. We adjusted the results before and after the intervention for panel data, clustering effect, and time interval.

Results: The peer group intervention decreased the number of areas of pain by 40%, from 5.96 (1-10) to 3.58 (p < 0.001), and increased the pain self-efficacy by 15%, from 30.4 to 37.5 (p < 0.001). Pain intensity decreased slightly, but not statistically significantly, from 7.1 to 6.8.

Conclusions: Peer group intervention for 6 weeks among municipal employees with chronic pain is partially effective. The number of areas of pain and pain self-efficacy were more sensitive indicators of change than the pain intensity. Any primary care unit with sufficient resources may implement the intervention.

Objectives: The ICEPAIN study is a longitudinal research project focused on building an extensive database on health-related quality of life (HRQoL), lifestyle, and pain among the general population in Iceland. The project started with a cross-sectional data collection and will be followed by similar data collection after 5 and 10 years from participants who have agreed to be contacted again. In this article, descriptive data on the prevalence and nature of chronic pain in the Icelandic general population will be presented in relation to sociodemographic factors, lifestyle, adverse life experiences, and HRQoL.

Methods: Data were collected through a web-based platform using a national panel representing a randomised population sample of 12,400 individuals aged 18-80 years from the National Population Register of Iceland. The instruments consisted of questionnaires on pain, lifestyle factors, adverse life experiences, and HRQoL. The sample was stratified according to age, gender, and residence.

Results: The response rate was 45% (N = 5,557), and most participants (81%) agreed to be contacted again for later data collection. The mean age of the respondents was 54.8 years (SD = 13.7). Half of the participants (50.3%) had experienced some pain the previous week, and 40% had chronic pain (≥3 months). The prevalence of chronic pain was inversely related to educational level and satisfaction with household income and positively associated with body mass index. A significant correlation was found between chronic pain prevalence and several lifestyle variables, such as physical exercises, smoking habits, sleep, and adverse life experiences. Chronic pain had a significant negative impact on both physical and mental components of HRQoL.

Conclusion: These results indicate a complex relationship between chronic pain, lifestyle, and adverse life experiences. The longitudinal design will provide further information on the long-term development among these variables.

Objectives: A significant subset of patients with mental health disorders (MHDs) fail to respond to standard management and are termed as treatment-resistant. This cohort has limited options for managing their condition. Autonomic dysfunction has been reported in the neurobiology of MHDs including anxiety, depression, obsessive-compulsive disorder (OCD), panic disorder, and bipolar disorder (BD). Stellate ganglion block (SGB) is an emerging treatment that dampens sympathetic activity and has been shown to be of benefit in the management of post-traumatic stress disorder.

Methods: Patients with treatment-resistant disparate MHDs were reviewed by a multidisciplinary team comprising a psychiatrist, a clinical psychologist, and a pain medicine physician. Patients were offered SGB as a novel strategy in the management of treatment-resistant conditions. Validated outcome measures were completed at baseline, 4 weeks, and 16 weeks post-intervention.

Results: Four patients with heterogenous treatment-resistant MHDs who received SGB are presented in this report. SGB resulted in an improvement in BD, OCD with alcohol addiction, opioid addiction, and health anxiety.

Conclusion: SGB could have a role in the management of treatment-resistant MHDs.

Objective: The objective of this scoping review was to investigate the available literature on physical and quality of life (QoL) outcomes of underwater treadmill exercise trials in clinical chronic pain samples.

Methods: A scoping search of studies of the effectiveness of underwater treadmill exercise trials from 1947 to 2024 was conducted using the following databases: EMBASE, MEDLINE, SPORTDiscus, CINAHL, and Cochrane Reviews. To be included, studies were required to have included adult participants living with chronic pain (defined as pain lasting for 3 months or longer) who participated in an active underwater treadmill exercise intervention. No restrictions on pain diagnosis were applied. All clinical trials, including but not limited to randomized controlled trials (RCTs), feasibility trials, and pilot studies, were included in the search. Two independent reviewers determined whether studies met inclusion criteria, and a third reviewer resolved any disagreement on study inclusion.

Results: The initial search identified 2,209 studies: 314 articles were removed for duplications, 1,781 were removed because they did not meet inclusion criteria, and 113 were retained for full-text review. The full-text review yielded nine studies, all of which included samples consisting of participants with osteoarthritis. The following variables were investigated in the included studies to varying degrees: pain, QoL, mobility, balance, strength, and changes in gait kinematics. Multiple studies identified significant differences between control groups or pre-intervention groups and underwater treadmill groups or post-intervention groups in chronic pain, balance, mobility, strength, and QoL.

Conclusion: Findings suggest that underwater treadmill exercise leads to positive changes in chronic pain, balance, mobility, strength, and QoL. However, more studies, particularly RCTs with larger samples that include individuals with chronic pain conditions other than osteoarthritis, are warranted.

Objectives: The association between baseline laboratory parameters and experienced well-being in healthy individuals remains uncertain. This study explored the relationship between clinical laboratory profiles and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness, and physical functional limitation in healthy individuals in Qatar.

Methods: Clinical laboratory data were collected from 1,764 Qatar Biobank participants who also completed the WOMAC questionnaire: lipid profiles (high-density lipoprotein, low-density lipoprotein, cholesterol, and triglycerides), endocrine markers (TSH, T3, T4, estradiol, and testosterone), and two inflammatory markers (CRP and fibrinogen). Multiple linear regression was used with 11 clinical indicators as independent variables and the subscale and total WOMAC scores as dependent variables. Multivariate effects of each indicator on the outcomes were assessed, and univariate effects were examined when significant.

Results: Testosterone had a significant impact on all WOMAC subscales (pain, stiffness, and functional limitation) and the total WOMAC score. Higher testosterone levels were associated with a reduction in pain (β = -0.03, t = -3.505, p < 0.001, 95% CI = -0.052, -0.015), stiffness (β = -0.01, t = -2.265, p = 0.024, 95% CI = -0.018, -0.001), physical dysfunction (β = -0.08, t = -3.265, p = 0.001, 95% CI = -0.135, -0.034), and total WOMAC scores (β = -0.127, t = -3.444, p < 0.001, 95% CI = -0.199, -0.055). Elevated fibrinogen levels were associated with an increase in stiffness (β = 0.155, t = 2.241, p = 0.025, 95% CI = 0.019, 0.290), physical dysfunction (β = 1.17, t = 2.808, p = 0.005, 95% CI = 0.354, 1.997), and total WOMAC scores (β = 1.610, t = 2.691, p = 0.007, 95% CI = 0.437, 2.784).

Conclusion: Testosterone may protect against pain, stiffness, and physical dysfunction, while high fibrinogen levels might be a surrogate of systemic inflammation that enhances stiffness and limits physical function. Measuring multiple clinical and laboratory markers in healthy individuals may enhance our understanding of the molecular mechanisms underlying pain.

Objectives: Autonomic regulation has been identified as a potential regulator of pain via vagal nerve mediation, assessed through heart rate variability (HRV). Non-invasive vagal nerve stimulation (nVNS) and heart rate variability biofeedback (HRVB) have been proposed to modulate pain. A limited number of studies compare nVNS and HRVB in persons with chronic pain conditions. This systematic review compared interventions of nVNS and HRVB in adults with long-standing pain conditions.

Methods: PubMed, MEDLINE, CINAHL, SPORTDiscus, Google Scholar, and Cochrane library were used to retrieve the randomized controlled trials for this review between the years 2010 and 2023. Search terms included chronic pain, fibromyalgia, headache, migraine, vagus nerve stimulation, biofeedback, HRV, pain assessment, pain, and transcutaneous.

Results: Ten full-text articles of 1,474 identified were selected for full qualitative synthesis, with a combined population of 813 subjects. There were n = 763 subjects in studies of nVNS and n = 50 subjects for HRVB. Six of the nine nVNS studies looked at headache disorders and migraines (n = 603), with two investigating effects on fibromyalgia symptoms (n = 138) and one the effects on chronic low back pain (n = 22). Of the nVNS studies, three demonstrated significant results in episode frequency, six in pain intensity (PI) reduction, and three in reduced medication use. The HRVB study showed statistically significant findings for reduced PI, depression scores, and increased HRV coherence.

Conclusion: Moderate to high-quality evidence suggests that nVNS is beneficial in reducing headache frequency and is well-tolerated, indicating it might be an alternative intervention to medication. HRVB interventions are beneficial in reducing pain, depression scores, use of non-steroidal anti-inflammatory medication, and in increasing HRV coherence ratio. HRVB and nVNS appear to show clinical benefits for chronic pain conditions; however, insufficient literature exists to support either approach.

Objectives: The efficacy of long-term opioid therapy (LTOT) in treating patients with chronic non-cancer pain (CnCP) is questionable, and the potential risks of adverse effects are well established. The aims were as follows: (1) compare characteristics in patients exposed to LTOT vs non-exposed. (2) Regarding opioid-exposed patients, describe characteristics of patients with risk factors for opioid use disorder or overdose in relation to opioid dosage.

Method: A cross-sectional study was conducted at a Swedish tertiary pain rehabilitation clinic serving CnCP patients. The study population comprised 1,604 patients ≥18 years old registered in the Swedish Quality Registry for Pain Rehabilitation between 2018 and 2020. Data on dispensed opioids were extracted from the Swedish Prescribed Drug Register. Dependent variables were as follows: LTOT vs non-LTOT and exposed opioid dosage <50 mg morphine equivalent/day (MME/day) vs ≥50 MME/day.

Results: Of the included patients, 681 (42.5%) had at least one dispensation of opioids 180 days prior to assessment, 601 with a calculated opioid dosage ≥1 MME/day, and 424 (26.4%) were exposed to LTOT. The type of opioid prescribed was, in descending order, oxycodone (42.3% of all dispensations), codeine in combination with paracetamol (17.6%), tramadol (13.8%), and morphine (8.1%). A total of 89 cases had dosages of ≥50 MME/day and 430 patient dosages <50 MME/day. Patients exposed to LTOT exhibited an increased odds ratio (OR) of 2.685 (95% CI, 1.942-3.711) for concomitant use of benzodiazepines and male sex (OR, 1.694; 95% CI, 1.227-2.337). Patients receiving doses ≥50 MME/day were all, except one, exposed to LTOT. The concomitant use of benzodiazepines (OR 1.814, 95% CI 1.264-3.331) and male sex (OR, 1.777; 95% CI, 1.178-3.102) indicated a higher OR for opioid doses ≥50 MME/day.

Conclusions: LTOT strongly influenced the opioid dose. Furthermore, concomitant benzodiazepine dispensation and male sex were over-represented in patients exposed to LTOT as well as those exposed to opioid doses ≥50 MME/day.