Fibromyalgia is a complex chronic pain syndrome characterized by widespread muscle pain, tenderness, and fatigue. Women with fibromyalgia report that symptoms limiting their work ability include pain, tiredness, muscle weakness, and... more
Fibromyalgia is a complex chronic pain syndrome characterized by widespread muscle pain, tenderness, and fatigue. Women with fibromyalgia report that symptoms limiting their work ability include pain, tiredness, muscle weakness, and memory and concentration difficulties. Work tasks perceived as “difficult” for women with fibromyalgia are repetitive movements, static muscle work as when holding, standing, or sitting in the same positions for fairly long periods, heavy work, working above shoulder level, power gripping, and frequent carrying and lifting. These difficulties reflect the fibromyalgia pathophysiology. To be able to remain at work, women with fibromyalgia need workplaces, which are flexible and adjustable. They need to be able to change and alternate positions and tasks, take short breaks, and, in many cases, reduce working hours. With appropriate support and adaptation, most are able to continue working to some extent.
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Dysfunctional top-down pain modulation is a hallmark of fibromyalgia (FM) and physical exercise is a cornerstone in FM treatment. The aim of this study was to explore the effects of a 15-week intervention of strengthening exercises, twice... more
Dysfunctional top-down pain modulation is a hallmark of fibromyalgia (FM) and physical exercise is a cornerstone in FM treatment. The aim of this study was to explore the effects of a 15-week intervention of strengthening exercises, twice per week, supervised by a physiotherapist, on exercise-induced hypoalgesia (EIH) and cerebral pain processing in FM patients and healthy controls (HC). FM patients (n = 59) and HC (n = 39) who completed the exercise intervention as part of a multicenter study were examined at baseline and following the intervention. Following the exercise intervention, FM patients reported a reduction of pain intensity, fibromyalgia severity and depression. Reduced EIH was seen in FM patients compared to HC at baseline and no improvement of EIH was seen following the 15-week resistance exercise intervention in either group. Furthermore, a subsample (Stockholm site: FM n = 18; HC n = 19) was also examined with functional magnetic resonance imaging (fMRI) during subjectively calibrated thumbnail pressure pain stimulations at baseline and following intervention. A significant main effect of exercise (post > pre) was observed both in FM patients and HC, in pain-related brain activation within left dorsolateral prefrontal cortex and caudate, as well as increased functional connectivity between caudate and occipital lobe bordering cerebellum (driven by the FM patients). In conclusion, the results indicate that 15-week resistance exercise affect pain-related processing within the cortico-striatal-occipital networks (involved in motor control and cognition), rather than directly influencing top-down descending pain inhibition. In alignment with this, exercise-induced hypoalgesia remained unaltered.
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The present purpose was to explore patients' and involved physicians' needs and requests for improving their management of neuropathic pain following spinal cord injury (SCI). Sixteen... more
The present purpose was to explore patients' and involved physicians' needs and requests for improving their management of neuropathic pain following spinal cord injury (SCI). Sixteen patients with SCI and neuropathic pain, and nine physicians, were interviewed in focus-groups or individual interviews. An emergent design was used and the interviews and analyses were carried out in parallel, making it possible to use and deepen new emerging knowledge. The interviews were transcribed verbatim and processed according to content analysis. A final model with four themes described the results. Three themes covered the current situation: limitations in structure, lack of knowledge and competence, and frustrations. A fourth theme, needs and requests, described suggestions by patients and physicians for future improvements. Suggestions included increased participation, increased patient involvement in the pain rehabilitation process, support in the process of learning to live with pain, implementation of multi-modal pain rehabilitation, and the use of complementary treatments for neuropathic pain. Neuropathic pain following SCI needs to be assessed and treated using a structured, inter-disciplinary, multi-modal rehabilitation approach involving patients in planning and decision-making. Implications for Rehabilitation For improving SCI neuropathic pain management, there is a great need for individually-tailored management, planned in a dialogue on equal terms between health care and the patient. Patients desire continuity and regularity and the possibility of receiving complementary treatments for SCI neuropathic pain. Access to structured pain rehabilitation is needed. Support and tools need to be provided in the learning-to-live with pain process.
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Research Interests: General Practice, Immunology, Pain, Fear, Medicine, and 14 morePhysical Therapy, Person Centered Therapy, Humans, Fibromyalgia, Female, Resistance Training, Young Adult, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Randomized Controlled Trial, and Avoidance Learning
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<p>PPTs increased in both groups alike during congruent as well as incongruent SCWT. There were no statistically significant differences between congruent and incongruent SCWT regarding the modulation of PPTs. * = p<0.05,... more
<p>PPTs increased in both groups alike during congruent as well as incongruent SCWT. There were no statistically significant differences between congruent and incongruent SCWT regarding the modulation of PPTs. * = p<0.05, ** = p<0.01, *** = p<0.001. The normalization was performed as follows: each PPT value was divided with the individual’s first PPT at baseline and the curves were adjusted (by adding a coefficient) so that the baseline value always corresponded to 1.</p
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Background Persons with dementia encounter time-related problems and significant others often need to provide support in daily time management and use of time assistive technology (AT). Further research has been requested on how time AT... more
Background Persons with dementia encounter time-related problems and significant others often need to provide support in daily time management and use of time assistive technology (AT). Further research has been requested on how time AT for persons with dementia affects the situation of significant others. Moreover, there are a few previous qualitative studies on the experiences of time AT by persons with dementia. This study explores the experiences of persons with dementia and significant others in daily time management and their perceptions on how time AT affects everyday life. Method Semi-structured interviews with persons with mild to moderate dementia (n = 6) and significant others (n = 9) were conducted three months after receiving prescribed time AT. Interviews were analysed using qualitative content analysis. Results A main category “Support by significant others is always part of daily time management”, and three categories “Facing new challenges”, “Using strategies to han...
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IntroductionPersons with dementia experience time‐related problems, but there is a lack of instruments evaluating their time processing ability and daily time management. This study aimed to evaluate the psychometric properties of the... more
IntroductionPersons with dementia experience time‐related problems, but there is a lack of instruments evaluating their time processing ability and daily time management. This study aimed to evaluate the psychometric properties of the instruments KaTid®‐Senior measuring time processing ability, and Time‐S© Senior and Time‐Proxy© measuring daily time management for persons with dementia.MethodsPersons with dementia (n = 53) and their significant others (n = 49) participated in the study. Rasch analyses were used to evaluate the instruments' rating scale functioning; internal scale validity; person‐response validity; unidimensionality; person‐separation reliability; and internal consistency. Versions excluding items with poor fit to the Rasch model were also evaluated.ResultsOverall, the Rasch analyses showed acceptable psychometric properties. All instruments met the criteria for unidimensionality and the reliability was good. More challenging items should be added in KaTid‐Senio...
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BACKGROUND Giving birth is a transformative event. Memories of the birth often remain in a woman's mind for the rest of her life. Key aspects of a mother's overall birth experience include concerns about the safety and health of... more
BACKGROUND Giving birth is a transformative event. Memories of the birth often remain in a woman's mind for the rest of her life. Key aspects of a mother's overall birth experience include concerns about the safety and health of the baby, and the first contact the mother has with her child. To the best of our knowledge, research has not yet been published relating to the ways in which women undergoing caesarean sections in the 1970s and 1980s experienced the birth of their baby and whether or not their mode of delivery has affected their reproductive health and their relationship to their child. OBJECTIVE To describe women's experience of undergoing a caesarean section in the 1970s and 1980s in Sweden. DESIGN A qualitative method using semi-structured questions and content analysis. PARTICIPANTS Twenty-two women were interviewed who underwent caesarean section during the 1970s and 1980s in Sweden. RESULTS The overarching theme surrounding women's experience of having undergone a caesarean section 30-40 years ago is that it is described as "undesired life event". Four categories were established: vaginal birth as the norm; a total loss of control; acceptance and contact with the child. CONCLUSION Undergoing a caesarean section during the 1970s and 1980s was considered to be an undesired life events. The interlocuters who participated in this study had little knowledge about operative childbirth and were poorly prepared for a complicated birth and postpartum care. The women did not suffer any long-term physiological harm yet were harmed psychologically until they came to terms with their negative experience and reached acceptance of it.
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The current study used functional magnetic resonance imaging to directly compare disease-relevant cerebral pain processing in well-characterized patient cohorts of fibromyalgia (FM, nociplastic pain) and rheumatoid arthritis (RA,... more
The current study used functional magnetic resonance imaging to directly compare disease-relevant cerebral pain processing in well-characterized patient cohorts of fibromyalgia (FM, nociplastic pain) and rheumatoid arthritis (RA, nociceptive pain). Secondary aims were to identify pain-related cerebral alterations related to the severity of clinical symptoms such as pain intensity, depression, and anxiety. Twenty-six patients with FM (without RA-comorbidity) and 31 patients with RA (without FM-comorbidity) underwent functional magnetic resonance imaging while stimulated with subjectively calibrated painful pressures corresponding to a pain sensation of 50 mm on a 100-mm visual analogue scale. Stimulation sites were at the most inflamed proximal interphalangeal joint in the left hand in patients with RA and the left thumbnail in patients with FM, 2 sites that have previously been shown to yield the same brain activation in healthy controls. The current results revealed disease-distinc...
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Resistance exercise results in health benefits in fibromyalgia. The aim of this study was to determine the factors that mediate change in muscle strength in women with fibromyalgia as a result of resistance exercise. Sixty-seven women... more
Resistance exercise results in health benefits in fibromyalgia. The aim of this study was to determine the factors that mediate change in muscle strength in women with fibromyalgia as a result of resistance exercise. Sixty-seven women with fibromyalgia (age range 25-64 years) were included. Tests of muscle strength and questionnaires related to pain, fear avoidance and physical activity were carried out. Multivariable stepwise regression was used to analyse explanatory factors for change and predictors for final values of knee-extension force, elbow-flexion force and hand-grip force. Change in knee-extension force was explained by fear avoidance beliefs about physical activity at baseline, together with change in pain intensity, knee-extension force at baseline, age and body mass index (BMI) (R2=0.40, p = 0.013). Change in elbow-flexion force was explained by pain intensity at baseline, together with baseline fear avoidance beliefs about physical activity, BMI and elbow-flexion forc...
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Studies have shown that pain acceptance strategies related to psychological flexibility are important in the presence of chronic musculoskeletal pain. However, the predictors of these strategies have not been studied extensively in... more
Studies have shown that pain acceptance strategies related to psychological flexibility are important in the presence of chronic musculoskeletal pain. However, the predictors of these strategies have not been studied extensively in patients with whiplash-associated disorders (WAD). The purpose of this study was to predict chronic pain acceptance and engagement in activities at 1-year follow-up with pain intensity, fear of movement, perceived responses from significant others, outcome expectancies, and demographic variables in patients with WAD before and after multimodal rehabilitation (MMR). The design of this investigation was a cohort study with 1-year postrehabilitation follow-up. The subjects participated in MMR at a Swedish rehabilitation clinic during 2009-2015. The patients had experienced a whiplash trauma (WAD grade I-II) and were suffering from pain and reduced functionality. A total of 386 participants were included: 297 fulfilled the postrehabilitation measures, and 177...
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Abstract The purpose was to explore interview data from young adults with long-standing pain about their experience of contacts with caregivers in a primary care setting, in order to synthesize and qualitatively analyse their reports... more
Abstract The purpose was to explore interview data from young adults with long-standing pain about their experience of contacts with caregivers in a primary care setting, in order to synthesize and qualitatively analyse their reports about how they were received. Method: An emergent qualitative design was used. Open thematic research interviews were conducted with 11 young people (1 man, 10 women) (aged 20–31 years) with long-term pain. The interviews were recorded, transcribed verbatim and analysed using inductive thematic content analysis. Result: The analyses resulted in three themes; distrust experienced from care staffs, loneliness and hopelessness forming the main theme Young adult with long-term pain. The informants described how they struggled with living with the pain, fighting with the care system and to obtain help. They reportedly felt they were not trusted and that they were not given any explanations or information why the pain spread and worsened. This left them feeling abandoned and alone and without hope concerning their pain, their feelings; and with doubts concerning their prospects. Much concern and doubt were expressed about their future work situation; whether they would be able to do work for which they had trained, and whether they would ever get any career opportunities. Conclusion: Living with long-term pain as a young adult and experiencing mistrust when in care might lead to feelings of loneliness, dependence and hopelessness and an existence marked by suffering and dependence. The experienced mistrust confined the young adult instead of allowing growth towards an adult identity and opportunities.
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Background and aims Pain is one of the most common reasons for patients to seek primary health care. Pain relief is likely to be achieved for patients suffering from acute pain, but for individuals with chronic pain it is more likely that... more
Background and aims Pain is one of the most common reasons for patients to seek primary health care. Pain relief is likely to be achieved for patients suffering from acute pain, but for individuals with chronic pain it is more likely that the condition will persist. These patients have the option of being referred to specialised pain clinics. However, the complexity surrounding chronic pain patients is not well studied in these settings. This study aimed to describe patients with chronic pain referred to a pain clinic by using the information submitted during their first visit and one year later and also to identify associations between baseline characteristics and improvements in health-related quality of life in the follow-up. Methods This was a longitudinal observational study of a sample consisting of 318 patients referred to a pain clinic. One group of patients containing 271 individuals (median age 48, 64% females) was assessed and received conventional pain treatment (CPT gro...
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Abstract Aims To explore how women perceive and are affected by treatment for painful endometriosis. Method Qualitative methodology with emergent design was used. Sixteen semi-structured interviews (including 3 follow-ups) with 13 women... more
Abstract Aims To explore how women perceive and are affected by treatment for painful endometriosis. Method Qualitative methodology with emergent design was used. Sixteen semi-structured interviews (including 3 follow-ups) with 13 women (age 20–47) treated at a pain clinic, were analysed with Grounded Theory. Results A preliminary model describes how women experience treatment for painful endometriosis and its consequences in one core category and three categories. The core category; Surviving painful endometriosis, described the women’s promoting strategies like Knowledge, Adaption and Planning, and inhibiting reactions as Anxiety and Resignation. The three interacting categories; Woman with painful endometriosis, included experiences of “The self” and “The body”. “The environment/significant others” described the environments’ support. Missed opportunities were described as a lack of participation in important life areas; “Social life”, “Career” and “Descendants”. “New possibilities” were experienced when pain disappeared or could be controlled. Dependent on health care included the experiences of “Treatments” from helpful to harmful and “Encounters with health care” from empowering to humiliating. Conclusions The suffering of women when exposed to painful endometriosis can lead to missed opportunities in several important areas of life. Hormonal and symptomatic treatments, as well as positive encounters of health care are important for the women’s possibility to develop working surviving strategies.
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The overall aims of the present work were to obtain further knowledge of the effects ofmultiprofessional rehabilitation programmes for women with fibromyalgia (FM) or chronicwidespread musculoskeletal pain (CWMP) and to elucidate what... more
The overall aims of the present work were to obtain further knowledge of the effects ofmultiprofessional rehabilitation programmes for women with fibromyalgia (FM) or chronicwidespread musculoskeletal pain (CWMP) and to elucidate what strategies women with FMuse and find successful in controlling their symptoms. The underlying purpose was toimprove rehabilitation further and thereby increase the possibilities for these women to liveactively, return to work and continue working. The Study I was a prospective, non-randomised intervention trial with 43 women with FM orCWMP who were assigned consecutively to a multi-professional rehabilitation programme orto a waiting-list control group. Comparisons were made of e.g. movement quality. Study IIwas an exploratory analytical study where 16 of the women from study I were interviewed.Grounded theory analysis was used to explore what the women remembered and what theyhad gained from the rehabilitation programme one year after discharge. Study...
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Objective Interdisciplinary pain rehabilitation (IPR) usually employs a cognitive–behavioural therapeutic (CBT) approach. However, there is growing support for chronic pain treatments based on acceptance and commitment therapy (ACT). Most... more
Objective Interdisciplinary pain rehabilitation (IPR) usually employs a cognitive–behavioural therapeutic (CBT) approach. However, there is growing support for chronic pain treatments based on acceptance and commitment therapy (ACT). Most studies of ACT and CBT for chronic pain have evaluated their effects after psychological interventions, not after IPR. We compared the results of an ACT-based IPR programme with two CBT-based IPR programmes. Methods We used a retrospective multicentre pretest–posttest design with matched patient groups at three centres. Data were collected from the Swedish Quality Registry for Pain Rehabilitation before and after IPR participation. Participants completed the EQ-5D health-related quality of life questionnaire, the Chronic Pain Acceptance Questionnaire, (CPAQ) and the Hospital Anxiety and Depression Scale (HADS). Analyses were performed to compare the effects of the different interventions. Results Neither EQ-5D nor HADS depression scores were affect...
Research Interests: Applied Psychology, Rehabilitation, Depression, Chronic Pain, Medicine, and 11 morePhysical Therapy, Acceptance and Commitment Therapy, Anxiety, Interdisciplinary, Cognitive Behavioural therapy, Psychological Intervention, Hospital Anxiety and Depression Scale, ANXIETY, Medical, multicentre study, and Medical and Health Sciences
This study investigated associations between time processing ability (TPA), daily time management (DTM), and dementia severity. Persons with dementia (PwDs) (n = 53) and their significant others (n = 49) participated in this... more
This study investigated associations between time processing ability (TPA), daily time management (DTM), and dementia severity. Persons with dementia (PwDs) (n = 53) and their significant others (n = 49) participated in this cross-sectional study. Bivariate analyses were used to investigate associations between TPA and DTM and the dementia severity. Linear regression models were used to further predict the contribution of the subtests in the Mini Mental State Examination (MMSE) for TPA results. The results showed significant correlations between TPA and dementia severity, where visuospatial functions were the most highly correlated. TPA also showed a significant correlation to proxy-rated DTM. In addition, proxy-rated DTM was significantly correlated with dementia severity and PwDs’ own self-ratings of their DTM. Knowledge of the association between TPA, dementia severity, and visuospatial functions can enable early detection of TPA impairments. For a comprehensive assessment of TPA...
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Objective Fibromyalgia is associated with central hyperexcitability, but it is suggested that peripheral input is important to maintain central hyperexcitability. The primary aim was to investigate the levels of pro-inflammatory cytokines... more
Objective Fibromyalgia is associated with central hyperexcitability, but it is suggested that peripheral input is important to maintain central hyperexcitability. The primary aim was to investigate the levels of pro-inflammatory cytokines released in the vastus lateralis muscle during repet-itive dynamic contractions of the quadriceps muscle in patients with fibromyalgia and healthy controls. Secondarily, to investigate if the levels of pro-inflammatory cytokines were correlated with pain or fatigue during these repetitive dynamic contractions. Material and Methods 32 women with fibromyalgia and 32 healthy women (controls) participated in a 4 hour micro-dialysis session, to sample IL-1β, IL-6, IL-8, and TNF from the most painful point of the vas-tus lateralis muscle before, during and after 20 minutes of repeated dynamic contractions. Pain (visual analogue scale; 0–100) and fatigue Borg’s Rating of Perceived Exertion Scale;
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Although chronic pain is common in patients with Ehlers–Danlos syndrome (EDS) and hypermobility syndromes (HMS), little is known about the clinical characteristics of these groups. The main aim was to compare EDS/HMS with common local and... more
Although chronic pain is common in patients with Ehlers–Danlos syndrome (EDS) and hypermobility syndromes (HMS), little is known about the clinical characteristics of these groups. The main aim was to compare EDS/HMS with common local and generalized pain conditions with respect to Patient Reported Outcome Measures (PROMs). Data from the Swedish Quality Register for Chronic Pain (SQRP) from 2007 to 2016 (n = 40,518) were used, including patients with EDS/HMS (n = 795), fibromyalgia (n = 5791), spinal pain (n = 6693), and whiplash associated disorders (WAD) (n = 1229). No important differences in the PROMs were found between EDS and HMS. Women were represented in > 90% of EDS/HMS cases and fibromyalgia cases, and in about 64% of the other groups. The EDS/HMS group was significantly younger than the others but had a longer pain duration. The pain intensity in EDS/HMS was like those found in spinal pain and WAD; fibromyalgia had the highest pain intensity. Depressive and anxiety sym...
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Long-term symptoms after whiplash injury often comprise neck pain, headache, anxiety, depression, functional impairment and low quality of life. In an observational cohort study, we examined physical and mental health effects in patients... more
Long-term symptoms after whiplash injury often comprise neck pain, headache, anxiety, depression, functional impairment and low quality of life. In an observational cohort study, we examined physical and mental health effects in patients with subacute to chronic whiplash-associated disorders (WAD) after participation in a multimodal rehabilitation (MMR) program. MMR is a team-based multi-professional method based on a bio-psycho-social model with a cognitive focus to reach an individualized and common goal for the team and patient together. Standardized self-report questionnaires were filled in three times: before MMR, after MMR, and one year after MMR. A total of 322 participants completed the program, 161 of whom responded in full and were further analyzed. At one-year follow-up after MMR, a significant improvement was seen in the evaluation of the primary outcomes (physical and mental health) and secondary outcomes (anxiety, depression, pain intensity and interference with life)....
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Health and physical capacity are commonly associated with disease, age, and socioeconomic factors. The primary objective of this study was to investigate the degree to which physical capacity, defined as muscle strength and walking... more
Health and physical capacity are commonly associated with disease, age, and socioeconomic factors. The primary objective of this study was to investigate the degree to which physical capacity, defined as muscle strength and walking ability, is decreased in women with fibromyalgia (FM), as compared to healthy women, who are matched for age and level of education. The secondary aim was to investigate whether muscle strength and walking ability are associated with age, symptom duration, activity limitations and, Body Mass Index (BMI) in women with FM and control subjects. This controlled, cross-sectional, multi-center study comprised 118 women with FM and 93 age- and education-level-matched healthy women. The outcome measures were isometric knee-extension force, isometric elbow-flexion force, isometric hand-grip force, and walking ability. Differences between the groups were calculated, and for the women with FM analyses of correlations between the measures of physical capacity and var...
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Research Interests: General Practice, Rheumatology, Immunology, Fatigue, Medicine, and 14 morePhysical Therapy, Sweden, Population, Humans, Fibromyalgia, Female, Resistance Training, Young Adult, Clinical Sciences, Middle Aged, Adult, Public health systems and services research, Randomized Controlled Trial, and Surveys and Questionnaires
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Research Interests: General Practice, Immunology, Pain, Fear, Medicine, and 14 morePhysical Therapy, Person Centered Therapy, Humans, Fibromyalgia, Female, Resistance Training, Young Adult, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Randomized Controlled Trial, and Avoidance Learning
Research Interests: General Practice, Immunology, Pain, Fear, Medicine, and 14 morePhysical Therapy, Person Centered Therapy, Humans, Fibromyalgia, Female, Resistance Training, Young Adult, Clinical Sciences, Aged, Middle Aged, Adult, Public health systems and services research, Randomized Controlled Trial, and Avoidance Learning
When suffering a spinal cord injury (SCI), the patient and family face numerous challenges regardless of socio-economic level. The stigmatisation of persons with disabilities has been reported, however, reports from Southern Africa are... more
When suffering a spinal cord injury (SCI), the patient and family face numerous challenges regardless of socio-economic level. The stigmatisation of persons with disabilities has been reported, however, reports from Southern Africa are largely lacking. To explore the experiences of living with a traumatic SCI in Botswana concerning perceived attitudes, obstacles and challenges. A qualitative approach with semi-structured interviews was conducted. Thirteen community-dwelling persons who have lived with an SCI for at least two years participated. A theoretical model was formed that illustrate the associations between the core category, Self, and the categories Relationships and Society. The model illustrates that personal resources, including a strong identity and a positive attitude, are crucial to the experience of inclusion in the community. A supportive family, a source of income, and faith were strong facilitators, while inaccessibility and devaluing attitudes were barriers. Havi...
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Background and aims Multimodal rehabilitation (MMR) programmes, including, physical training, educational and psychological interventions by an interdisciplinary team are found to be more successful for patients with disabling chronic... more
Background and aims Multimodal rehabilitation (MMR) programmes, including, physical training, educational and psychological interventions by an interdisciplinary team are found to be more successful for patients with disabling chronic pain compared with less comprehensive treatments. MMR programmes are based on the biopsychosocial model and the goal is usually to improve function, quality of life and facilitate and enable return to work. As pain clinics traditionally offer conventional medical pain treatment, there is limited knowledge about MMR given in this context. The aim of our study was to describe characteristics of patients with chronic pain, treated with a MMR programme at a conventional pain clinic, to evaluate patient-reported outcome measures (PROM) from start to one year after, and to study possibly associated factors for the improvement of health-related quality of life after one year. Methods A prospective, observational study with a one-year follow-up was performed. ...
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The study aimed to elucidate the meaning of acceptance in relation to the lived body and sense of self when entering a pain rehabilitation programme. Six women and three men with long-term pain were interviewed. The interviews were... more
The study aimed to elucidate the meaning of acceptance in relation to the lived body and sense of self when entering a pain rehabilitation programme. Six women and three men with long-term pain were interviewed. The interviews were analysed according to interpretative phenomenological analysis. The analysis revealed three different meaning structures, first: acceptance as a process of personal empowerment, "the only way forward". Here, the individuals expressed that the body felt integrated: a trusting cooperation between self and body gave rise to hope. Second: acceptance as an equivocal project, a possible but challenging way forward. The hopeful insight was there, acknowledging that acceptance was the way to move forward, but there was also uncertainty and doubt about one's ability with a body ambiguous and confusing, difficult but important to understand. Third, in acceptance as a threat and a personal failure, "no way forward" the integration of the achi...
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The present purpose was to explore patients&amp;amp;amp;amp;#39; and involved physicians&amp;amp;amp;amp;#39; needs and requests for improving their management of neuropathic pain following spinal cord injury (SCI). Sixteen... more
The present purpose was to explore patients&amp;amp;amp;amp;#39; and involved physicians&amp;amp;amp;amp;#39; needs and requests for improving their management of neuropathic pain following spinal cord injury (SCI). Sixteen patients with SCI and neuropathic pain, and nine physicians, were interviewed in focus-groups or individual interviews. An emergent design was used and the interviews and analyses were carried out in parallel, making it possible to use and deepen new emerging knowledge. The interviews were transcribed verbatim and processed according to content analysis. A final model with four themes described the results. Three themes covered the current situation: limitations in structure, lack of knowledge and competence, and frustrations. A fourth theme, needs and requests, described suggestions by patients and physicians for future improvements. Suggestions included increased participation, increased patient involvement in the pain rehabilitation process, support in the process of learning to live with pain, implementation of multi-modal pain rehabilitation, and the use of complementary treatments for neuropathic pain. Neuropathic pain following SCI needs to be assessed and treated using a structured, inter-disciplinary, multi-modal rehabilitation approach involving patients in planning and decision-making. Implications for Rehabilitation For improving SCI neuropathic pain management, there is a great need for individually-tailored management, planned in a dialogue on equal terms between health care and the patient. Patients desire continuity and regularity and the possibility of receiving complementary treatments for SCI neuropathic pain. Access to structured pain rehabilitation is needed. Support and tools need to be provided in the learning-to-live with pain process.
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To investigate perceived exertion at work in women with fibromyalgia. A controlled cross-sectional multi-centre study. Seventy-three women with fibromyalgia and 73 healthy women matched by occupation and physical workload were compared in... more
To investigate perceived exertion at work in women with fibromyalgia. A controlled cross-sectional multi-centre study. 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). Spearman's correlation coefficient and linear regression analysis were conducted. 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 (p < 0.05). In fibromyalgia, perceived exertion at work showed moderate correlation with physical activity at work, physical wor...
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Nociceptive and neuropathic pain (NP) are common consequences following spinal cord injury (SCI), with large impact on sleep, mood, work, and quality of life. NP affects 40% to 50% of individuals with SCI and is sometimes considered the... more
Nociceptive and neuropathic pain (NP) are common consequences following spinal cord injury (SCI), with large impact on sleep, mood, work, and quality of life. NP affects 40% to 50% of individuals with SCI and is sometimes considered the major problem following SCI. Current treatment recommendations for SCI-NP primarily focus on pharmacological strategies suggesting the use of anticonvulsant and antidepressant drugs, followed by tramadol and opioid medications. Unfortunately, these are only partly successful in relieving pain. Qualitative studies report that individuals with SCI-related long-lasting pain seek alternatives to medication due to the limited efficacy, unwanted side effects, and perceived risk of dependency. They spend time and money searching for additional treatments. Many have learned coping strategies on their own, including various forms of warmth, relaxation, massage, stretching, distraction, and physical activity. Studies indicate that many individuals with SCI are...
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To explore and obtain increased knowledge about (i) strategies and treatments used by individuals with neuropathic pain following spinal cord injury (SCI) for handling long-term pain, and (ii) their experience, needs and expectations of... more
To explore and obtain increased knowledge about (i) strategies and treatments used by individuals with neuropathic pain following spinal cord injury (SCI) for handling long-term pain, and (ii) their experience, needs and expectations of SCI neuropathic pain management. Qualitative methods with an emergent research design were used. Eighteen informants who suffered from long-term SCI neuropathic pain participated. Data were collected with diaries and thematized research interviews. Content analysis and constant comparison according to grounded theory were used for the analyses. A model with four categories emerged: &amp;amp;amp;amp;amp;amp;quot;Pain is my main problem&amp;amp;amp;amp;amp;amp;quot; explained the impact of pain in the informants&amp;amp;amp;amp;amp;amp;#39; everyday life; &amp;amp;amp;amp;amp;amp;quot;Drugs--the health care solution&amp;amp;amp;amp;amp;amp;quot; described the informants&amp;amp;amp;amp;amp;amp;#39; experience of pain management; &amp;amp;amp;amp;amp;amp;quot;The gap in my meeting with health care&amp;amp;amp;amp;amp;amp;quot; described the discrepancy between what the informants wanted and what health care could offer. &amp;amp;amp;amp;amp;amp;quot;But...this works for me&amp;amp;amp;amp;amp;amp;quot; described treatments and strategies, which the informants found helpful for pain control and pain relief. Neuropathic pain, one of the major problems following SCI, is difficult to treat successfully. To improve treatment outcome, health care needs to listen to, respond to and respect the patient&amp;amp;amp;amp;amp;amp;#39;s knowledge, experience and wishes. Future research needs to address treatments that patients find effective.