Scandinavian Journal of Pain最新文献

Objectives: To evaluate the psychometric properties of pain catastrophizing scale (PCS) using item response theory (IRT) amongst people with carpal tunnel syndrome (CTS).

Methods: Retrospective cross-sectional register-based study amongst 1,597 patients with CTS. Two-parameter IRT analysis with rating scale model.

Results: The average age was 55.3 (16.3) years and 896 (56%) were women. The average PCS total score was 15.1 (11.6) points. For all 13 items, the estimates of difficulty parameter indicated a shift towards higher PCS scores. This was also seen in item characteristic curves and item information function. Respectively, the entire composite score showed the same shift towards higher PCS scores. The discrimination of PCS was excellent 1.98 (95% CI 1.89-2.07).

Conclusions: Overall, the psychometric properties of the PCS were found to be sufficiently good to recommend this scale for clinical use in CTS. The PCS is well able to distinguish between people with different levels of pain catastrophizing, even if performing better in elevated levels of catastrophizing. Also, the respondents may have a slight tendency to underestimate the severity of their catastrophizing when responding to the PCS. The results may be of interest to both clinicians and researchers in planning and implementing conservative or operative treatment for CTS, setting rehabilitation goals, and evaluating treatment or rehabilitation outcomes.

Objectives: This study aimed to explore barriers experienced by patients with chronic pain to completing the PainData questionnaire (PDq) at the Interdisciplinary Pain Centre, Herlev and Gentofte Hospital (HGH). The PDq collects patient-reported data relevant for treatment decisions and research. However, at HGH the response rate prior to treatment initiation is only 67% despite a national response rate of over 80%.

Methods: This qualitative study used individual, semi-structured interviews with patients from HGH. Content analysis was performed, and the study adhered to the COREQ guideline.

Results: Fifteen participants (4 men, 11 women; median age 57) were interviewed. Four major categories were identified: (1) challenges originating from pain deterioration and stress hindering questionnaire completion, (2) lack of opportunity for nuanced responses, (3) inadequate patient understanding of the questionnaire's purpose, and (4) appreciation among participants of PainData's recognition of the long-term consequences of chronic pain.

Conclusion: This study highlighted key barriers to completing the PDq, including challenges related to its design and patients' resources. To address these issues, administrators could simplify the questionnaire. Individual clinics could enhance response rates by improving communication about the importance of patient-reported data, refining invitation strategies, and providing additional practical support. Despite these challenges, completion of the PDq encouraged participants to reflect on critical aspects of chronic pain, including its physical and mental health impacts. While the study provided valuable insights, the limited duration of interviews, due to participant fragility, was a notable limitation.

Objectives: Patients with chronic pain need healthcare services for pain management. Many also require social security services due to potential negative influence of chronic pain on social and work-related issues. The aim of this study was therefore to investigate the experiences of taking part in cross-sectoral collaborative meetings between social security service and healthcare service for chronic pain patients.

Methods: A qualitative study using semi-structured individual interviews with 15 informants, including healthcare providers, patients, and social security supervisors who had taken part in 8 different meetings, was conducted. The focus of the interviews was how the informants experienced cross-sectoral collaborative meetings. The data were analyzed following the systematic text condensation method, including the steps of total impression, identifying meaning units, condensation, and synthesizing.

Results: The findings were categorized into four themes: "Joining the meeting with preconceptions," which showed how some informants experienced that negative preconceptions toward the social security service were addressed in the cross-sectoral collaborative meetings and solved in some cases. "Get to know each other," which highlighted that the meetings provided opportunities for participants to increase their knowledge about the involved actors. "Access to detailed health information?" indicated that although concerns about whether sensitive health information should be shared with social security supervisors were raised by healthcare providers, the supervisors found this issue to be less concerning. Finally, "Who has the final word?", which showed that unclarity over decision-making processes during the meetings was experienced to create disagreement between participants.

Conclusions: The informants experienced that cross-sectoral collaborative meetings between patients, social security supervisors, and healthcare providers, while challenging, can play a significant role in managing the needs of patients with chronic pain. The study highlights the need for clarification over the roles of the actors and a jointly agreed-upon agenda for the meetings to ensure effective collaboration.

Objectives: Diabetic distal symmetric polyneuropathy, affecting up to 50% of adults with diabetes, often leads to painful symptoms; yet current treatments are largely ineffective with standard therapies providing limited relief. The aim of this systematic review is to address the knowledge gap in understanding the neural networks associated with painful diabetic polyneuropathy (P-DPN). By synthesizing evidence from neuroimaging studies, it seeks to identify potential targets for neuromodulation-based treatments, ultimately guiding clinicians and researchers in developing novel, more effective therapeutic interventions for P-DPN.

Content: A comprehensive search following the preferred reporting items for systematic reviews and meta-analysis was conducted across Embase, PsycINFO, and MEDLINE databases to identify relevant neuroimaging studies from 2010 to May 2024. The search focused on studies involving P-DPN and excluded animal research. After the removal of duplicates and irrelevant studies, 18 studies were included and critically appraised for their contributions to understanding the neural correlates of P-DPN.

Summary: The review highlights that P-DPN is associated with alterations in brain networks involved in pain perception, particularly in the primary somatosensory cortex highlighting its role in sensory and pain perception. Regions such as the anterior cingulate cortex and thalamus exhibit altered functional connectivity, with the former showing responses to pain treatment. The review also identified increased connectivity between the cingulate cortex, medial prefrontal cortex, medial temporal region, and insula in individuals with P-DPN, pointing to the involvement of these regions in the emotional and cognitive aspects of pain processing.

Outlook: This review provides a foundational understanding of the neural networks involved in P-DPN, offering potential targets for future neuromodulation therapies. Further research is required to deepen the understanding of these brain alterations and to explore how they can be leveraged for more effective P-DPN treatments.

Background: Well-being is closely related to health, recovery, and longevity. Chronic musculoskeletal pain (CMP) is a major health challenge in the general population, which can have a negative effect on subjective well-being. The ability to identify patients' well-being protective factors, including psychological, social, and lifestyle components, can help guide the therapeutic process in the management of CMP. Recognizing the absence of a dedicated well-being questionnaire, tailored specifically for CMP populations, an 11-item well-being in pain questionnaire (WPQ) was developed.

Objectives: The objectives were to develop a valid and reliable patient-reported measure of personal pain-specific well-being protective factors and to evaluate its psychometric properties, including (i) internal consistency; (ii) known-group validity between subjects with chronic low back pain (CLBP) and healthy pain-free controls; (iii) convergent validity between the WPQ and measures of health-related quality of life, catastrophizing, sleep quality, symptoms of central sensitization, and anxiety; and (iv) structural validity with exploratory factor analysis.

Design: This is a cross-sectional validation study.

Methods: After reviewing previous CMP and well-being literature, the novel WPQ items were constructed by expert consensus and target population feedback. The psychometric properties of the WPQ were evaluated in a sample of 145 participants, including 92 subjects with CLBP and 53 pain-free controls.

Results: Feedback from a preliminary group of CMP patients about the relevance, content, and usability of the test items was positive. Internal consistency showed acceptable results (α = 0.89). The assessment of convergent validity showed moderate correlations (≤0.4 or ≥-0.4.) with well-established subject-reported outcome measures. The assessment of structural validity yielded a one-factor solution, supporting the unidimensionality of the WPQ.

Conclusions: The psychometric results provided evidence of acceptable reliability and validity of the WPQ. Further research is needed to determine the usability of the WPQ as an assessment and outcome tool in the comprehensive management of subjects with CMP.

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.