Presentatörer: Lenka Katila, Annica Rhodin, PhD, Rolf Karlsten, PhD.
Dept. of surgical sciences, Uppsala University

Bakground: Opioid agonist therapy (OAT) is used for the treatment av opioid use disorder(OUD) of chronic pain patients(CPP) with iatrogenic OUD. Ongoing study “Substitution therapy of opioid treated patients with iatrogenic addiction development” studies the structure of patients and treatment results of all patients included in the OAT during the last 30 years. Drug induced mortality in OAT was identified to be 42% previously ( Bech et al,2019).

Aim: The aim of this communication is to identify reasons of treatment´s termination of OAT for pain patients with iatrogenic OUD.

Method: Observation study. All CPP accepted for OAT since 1993 were identified through journal notes and a previous study database. Data considering the reason of termination of treatment and cause of death were analyzed descriptively.

Results: In total, 232 persons (48,7% female) were identified. More than one third, (37%) of patients, are still treated. Another one third (31%) completed OAT  treatment due to opioid tapering  or dose minimizing with referral to general practitioner or pain clinic. In total, there were only 18 patients who died (8%) and of those majority died in. somatic diseases (73%), mainly cardiovascular diseases (45%). Overdose was ascertained only in 1 case (5%) and suicide in 1 case (5%) in contrast with usual outcome  in OAT programs.

Conclusion: Cardiovascular diseases are the most prevalent causes of death in çhronic pain patients in OAT program of OUD. OAT with methadone or buprenorphine is mostly terminated because of the total tapering or dose minimizing.

‍

Presentatörer:
Sofia Wagner, PT, M.Sc., Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
Annika Bring, PT, Ph.D., Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
Pernilla Åsenlöf, PT, Ph.D., Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.

Background: Balance assessment scales are important clinical tests to identify balance impairments. Chronic pain (> 3 months) is associated with impaired dynamic balance; however, very few balance assessment scales are psychometrically evaluated for the population.

Aim: To evaluate the construct validity and internal consistency of the Mini-BESTest for individuals with chronic pain in specialized pain care.

Methods: 180 individuals with chronic pain (> 3 months) were included. For construct validity, five alternative factor structures were evaluated using a confirmatory factor analysis. A priori hypotheses about convergent validity with the 10-meter walk test, and divergent validity with the Brief Pain Inventory (BPI): pain intensity, the Tampa Scale of Kinesiophobia-11 (TSK-11), and the Pain Catastrophizing Scale (PCS-SW) were tested. Internal consistency was evaluated for the best fitting model.

Results: A one-factor model with added covariance via the modification indices showed adequate fit. In line with our hypotheses, Mini-BESTest showed convergent validity (rs = >.70) with the 10-meter walk test, and divergent validity (rs = <.50) with BPI pain intensity, TSK-11, and PCS-SW. Internal consistency for the one-factor model was good (α = 0.92).

Conclusion: Our study supported the construct validity and internal consistency of the Mini-BESTest for measuring balance in individuals with chronic pain in specialized pain care. The one-factor model showed an adequate fit. In comparison, models with subscales did not reach convergence, or showed high correlations between subscales, implying that Mini-BESTest is measuring one construct in this sample. We, therefore, propose using the total score, instead of subscale scores, for individuals with chronic pain.

Presentatörer: Ulrika Nyström¹, Kajsa Lidström Holmqvist²

1. Leg arbetsterapeut, Medicine master i arbetsterapi, Smärtrehab, VO Neuro och rehabiliteringsmedicin, Universitetssjukhuset i Örebro
2. Leg arbetsterapeut, Docent, VO Neuro och rehabiliteringsmedicin, Universitetssjukhuset i Örebro, Universitetssjukvårdens forskningscentrum, Fakulteten för medicin och hälsa, Örebro universitet

Bakgrund: I smärtrehabiliteringsprogram är arbetsterapeutens fokus ett hållbart och förbättrat, eller bibehållet, aktivitetstutförande i vardagen. Kunskapen om hur deltagare i smärtrehabiliteringsprogram upplever vilken påverkan det har för deras aktivitetsutförande i vardagen är dock bristfällig. Ökad kunskap kan bidra till att utveckla och förbättra en personcentrerad smärtrehabilitering och ge patienterna bästa möjliga förutsättningar att på ett sätt som är hållbart över tid kunna utföra meningsfulla aktiviteter i vardagen.

Syfte: Att beskriva deltagarnas upplevelser av aktivitetsutförande efter deltagande i smärtrehabiliteringsprogram.

Metod: Metoden hade en kvalitativ ansats där åtta personer intervjuades med semistrukturerade frågor. Data analyserades med kvalitativ innehållsanalys.

Resultat: Ett huvudtema och tre kategorier med underliggande kategorier identifierades. Huvudtemat, Tilltro till egen aktivitetsförmåga för en inre resa mot acceptans, beskriver deltagarnas process mot ett bättre vardagsfungerande. Olika aspekter av detta beskrivs i kategorierna: Förutsättningar för förändring, Implementering i vardagen och En förändrad vardag.

Slutsats: Deltagarna upplevde ett förbättrat och förändrat aktivitetsutförande efter deltagande i smärtrehabiliteringsprogram. Det visar att åtgärder med fokus på aktivitetsutförande i vardagen är en betydelsefull del i behandling av långvarig smärta.

Presentatörer:
‍Axel Kutschke^1,2,3, Bilsan Ahmad⁴, Birgitta Häggman-Henrikson^2,5, Anders Wänman⁵, Justin Durham^6,7, Anna Lövgren^5
1 Department of Clinical Oral Physiology, Folktandvården Gävleborg AB, Gävle, Sweden
‍² Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
‍³ Centre for Research and Development, Uppsala University/Region Gävleborg, Sweden
‍⁴ Medai.ai GmbH, Frankfurt/Main, Germany
‍⁵ Department of Odontology, Clinical Oral Physiology, Faculty of Medicine, Umeå University, Umeå, Sweden
‍⁶ School of Dental Sciences, Newcastle University, Newcastle, UK
‍⁷ Newcastle Hospitals’ NHS Foundation Trust, Newcastle, UK

‍Background: Psychosocial screening is an important part of the assessment of patients with chronic pain. Currently, extensive analogue questionnaires are used to assess the degree of such comorbidity. Digital alternatives for questionnaires may be cost-effective and resource-saving if well-accepted by patients.Aim: To evaluate how patients perceive digital psychosocial screening in dentistry.

‍Method: Using a qualitative approach, individual semi-structured interviews were conducted with a purposive sample of adult patients (n=16) recruited from orofacial pain specialist dental clinics in Umeå and Gävle. In preparation for the study, pilot-testing of the software had been conducted. All patients completed first the analogue and then the digital version of the questionnaires before the interviews. A flexible topic guide and a mind map were used to allow a structured but evolving open-ended approach to the interviews. The interviews were transcribed and analysed with Qualitative Content Analysis.

‍Results:

The preliminary analysis of patients’ experience revealed two categories:

1. Perceptions about health shape patients' initial expectations of dental care; but with deeper understanding, patients value the incorporation of a holistic approach that includes psychosocial factors.
2. Digital screening is perceived as a reliable, meaningful and environmentally sustainable method.

Conclusion: In general, patients appreciate a holistic approach in dentistry and understand the value of psychosocial screening as part of this. From the patients' perspective, digital psychosocial screening is well accepted and can be introduced into daily dental practice.

‍

‍

Presentatörer: Sabina Chilianu, ST-läkare Neuro- och Rehabiliteringsmedicinska kliniken Örebro/ ledamot ST-rådet SFRM (under handledning av Hans Ruborg, överläkare Neuro- och Rehabiliteringsmedicinska kliniken Örebro)

Bakgrund: Beskrivna behandlingsprogram för CRPS är vanligtvis multimodala och omfattar medicinering, arbetsterapi, sjukgymnastik och psykologiska interventioner. Neuromodulering anses vara en behandling som används i svåra fall.

Syfte: En litteraturöversikt utfördes för att undersöka effektiviteten av ryggmärgsstimulering (SCS) hos patienter som har en bekräftad CRPS-diagnos och undersöka primära potentiella prediktorer för utfall: minskning av smärtintensitet och funktionshinder och ökad livskvalitet.

Metod: En litteratursökning genomfördes mellan september och november 2021 med hjälp av PubMed, Cochrane-databaser och manuell sökning. Ett specialiserat ramverk, kallat PICO användes för att definiera frågan. De artiklar som ingår i resultaten var tre randomiserade kontrollerade studier, två prospektiva kohortstudier och en retrospektiv kohortstudie. Dessa publicerades mellan 2005 och 2021.

Resultat: Fem av sex studier har visat att ryggmärgsstimulering kan signifikant minska smärta och samtidigt förbättra livskvaliteten.

I två studier minskade ryggmärgsstimulering signifikant poängen för funktionshinder jämfört med en annan studie som inte kunde hitta någon signifikant förbättring.

När DRG-stimulering jämfördes med SCS visade den en större genomsnittlig procentuell minskning av smärta än SCS (84,1 % mot 70,9 %) med den signifikanta minskningen kvar till 12 månader.

Tre av studierna rapporterade hög grad av tillfredsställelse och vilja att välja SCS igen för samma resultat.

En signifikant minskning av användare av opioder och tricykliska antidepressiva medel, som en följd av SCS-behandling, har visats i två studier.

Slutsats: Studier av medelhög eller högre kvalitet visar en minskning av smärta och en förbättring av livskvalitet. Ytterligare forskning behövs för att bevisa effektiviteten av analgetika. SCS hållbarhet, som behandling för CRPS, bör också undersökas ytterligare.

Presentatör: Karolina af Ekenstam, MD, PhD-student, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute.

Co-authors: Joana Menezes, MS, Emerson Krock, PhD, Angelica Sandström, PhD, Jeanette Tour, MD, Katalin Sandor, PhD, Alexandra Jurczak, PhD, Matthew Hunt, PhD, Azar Baharpoor, MS, Diana Kadetoff, MD, PhD, Camilla I. Svensson, Professor*, Eva Kosek, Professor*, Karolinska Institute, *contributed equally

Bakgrund: IgG-antibodies from persons with fibromyalgia (FM) have been shown to bind to satellite glia cells (SGC) in dorsal root ganglia and induce a FM-like condition in mice (1). Furthermore, compared to healthy controls (HC), FM subjects show elevated IgG binding to murine and human SGC, and within the FM group, subjects with elevated levels of anti-SGC IgG-antibodies present with more severe symptoms (2).

Syfte: The aim of this study was to investigate if these results could be replicated in a larger cohort and, assess if the association could be extended to typical FM symptoms such as depression/anxiety, disturbed sleep, and fatigue.

Metod: Levels of anti-SGC IgG were quantified using an immunofluorescence assay exhibiting percentage of murine SGC, in cell cultures, binding human IgG (2). FM subjects (n=93, whereof 30 also included in (2)) were compared to HC (n=40, whereof 29 included in (2)), and the correlations between anti-SGC IgG and symptom severity were assessed in the FM group.

Resultat: FM subjects had significantly higher anti-SGC IgG than HC (p = 0.0122). Anti-SGC IgG-levels correlated with high pain intensity ratings (VAS) and high impact of fibromyalgia (FIQ), thus replicating our previous results (2). In addition, we found a weak positive correlation with depression (HAD). We found no significant associations between anti-SGC IgG-levels and anxiety (HAD), fatigue (MFI), or disturbed sleep (PSQI).

Slutsats: A subset of fibromyalgia subjects have elevated levels of anti-satellite glia cell antibodies, and these levels are associated with higher pain intensity and higher impact of fibromyalgia.

1. Goebel A, Krock E, Gentry C, Israel MR, Jurczak A, Urbina CM, et al. Passive transfer of fibromyalgia symptoms from patients to mice. J Clin Invest. 2021;131(13).

2. Krock E, Morado-Urbina CE, Menezes J, Hunt MA, Sandström A, Kadetoff D, et al. Fibromyalgia patients with elevated levels of anti-satellite glia cell immunoglobulin G antibodies present with more severe symptoms. Pain. 2023;164(8):1828-40.

Presentatörer: Nina Bendelin, PhD ¹, Björn Gerdle, PhDProf ¹, Gerhard Andersson PhD Prof ^2,3,4.

¹Pain andRehabilitation Centre, and Department of Health, Medicine and Caring Sciences,Linköping University, Linköping, Sweden,

²Departmentof Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,

³Departmentof Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden,

⁴Departmentof Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden

Bakgrund: Internet-delivered psychological interventions can be regarded as evidence-based practices and have been implemented in psychiatric and somatic care at primary and specialist levels. Specifically, internet-delivered Acceptance and Commitment Therapy (IACT), has been found helpful for chronic pain patients and might aid in developing pain rehabilitation services. However, the integration of IACT into regular health care has not yet been described from an implementation science perspective.

Syfte: The aim of this hybrid 1 effectiveness-implementation study was to evaluate the process of implementing IACT in a pain rehabilitation setting, to guide future implementation initiatives.

Metod: In this retrospective study, we described actions taken during an implementation initiative, in which IACT was delivered as part of an interdisciplinary pain rehabilitation program (IPRP) at a specialist clinic. All documents relevant for the study were reviewed and coded using the Quality Implementation Framework (QIF).

Resultat: The QIF-analysis of implementation actions resulted in two categories: Facilitators and Challenges for implementation. Buy-in from leadership, infrastructure for multidisciplinary communication and dedicated key champion team members facilitated implementation. However, insufficient contextual considerations and structure challenged assessment and capacity-building and caused difficulties to adapt to hurdles. Possible influential factors, hypotheses and key process challenges are presented in a logic model to guide future initiatives and move implementation of IACT in IPRPs forward.

Slutsats: Sustainable implementation may depend on both the continuity of facilitating implementation actions and flexibility to the dynamic and changing needs and interests among end-users, providers and stakeholders. We recommend the use of logic models to ease implementation of IACT into IPRP.

Presentatör: Romana Stehlik, läkare, PhD, Smärtcentrum
Uppsala Akademiska sjukhuset/Uppsala Universitet

Background: The chronic pain (CP) and chronic multi-site pain (CMP) condition is a highly prevalent health problem. Several studies have reported a high (31–64%) prevalence of co-morbid restless legs syndrome (RLS) and dyssomnia (60-90%) in patients with fibromyalgia, one specifically defined form of chronic widespread pain. Dyssomnia refers to the collection of sleep disorders that negatively impact the quantity and quality of sleep. This study aimed to investigate quality of life in subjects with pain, dyssomnia and Restless legs syndrome.  

Method: The study included 4040 respondents to a postal questionnaire sent to 10,000 women in the age range of 18–64 years and randomly selected from the general population in Dalarna, Sweden. Complete questionnaire data on type (acute/chronic), degree (mild to severe) and spreading (0–5 body zones) of pain, as well as RLS symptoms (validated questionnaire), self-reported sleep quality and quality of life (SF-36) were obtained from 3060 subjects. Information on lifestyle, anthropometrics, co-morbidities and medication was collected.

Results: Subjects with pain, RLS and dyssomnia scored substantially lower on all SF-36 subscales compared to subjects with no pain; pain only; pain, RLS and pain and dyssomnia (Kruskal-Wallis p<0,0001). The quality of life decreases with increasing amount of pain localization and RLS diagnosis (Kruskal-Wallis p<0,001). Subjects with RLS, pain and dyssomnia exhibited lowest scores on all SF-36 mean scores and on the Physical Composite Score and Mental Composite Score controlling for anxiety and depression in a multiple regression analysis.

Conclusion: Subjects with pain, dyssomnia and RLS exhibits the lowest quality of life compared to subjects with pain only, pain and dyssomnia and pain and RLS. The quality of life deteriorates also with the degree of pain spreading in women recruited from the general population.

Presentatörer: Adriana Miclescu,¹ Clara Rönngren, ¹ Mats Bengtsson, ² Anders Hedin ^{2 ,} Torsten Gordh, ^1
1Dept. of Surgical Sciences, Uppsala University, ²Dept. of Immunology, Genetics and Pathology, Uppsala University, Sweden‍

Background: It is not known why some patients develop persistent pain after surgery (PPS) while others do not. Among multiple risk factors for the development of PPS, a neuropathic mechanism due to iatrogenic nerve lesion has been proposed as the major cause of PPS.

Aim: As there is some evidence that the Human Leukocyte Antigen (HLA) system plays a role in PPS, this study aimed to identify the genetic risk factors specifically among HLA-loci associated with persistent pain after trauma and surgery of the nerve injuries in the upper extremities.

Method: Blood samples were taken to investigate the contribution of HLA alleles (i.e. HLA-A, HLA-B, HLA-DRB1, HLA-DQB1, HLA-DPB1) in a group of subjects with persistent neuropathic pain (n=70) and a group of patients with neuropathy without pain (n=61). All subjects had intraoperatively verified nerve damage in the upper extremity. They underwent bedside clinical neurological examination to identify the neuropathic pain component according to the present grading system of neuropathic pain. Statistical analyses on the allele, haplotype were carried out using the BIGDAWG package.

Results: We found that the HLA-haplotype A*02:01-B*15:01-C*03:04-DRB1*04:01-DQB1*03:02, was associated with an increased risk of developing persistent neuropathic pain in the upper extremity (OR=9.31 [95% CI 1.28-406.45], p<0.05). No significant associations were found on an allele level when correcting for multiple testing.

Slutsats: An association between HLA and the risk of developing persistent neuropathic pain after trauma was found in the carriers of the A*02:01-B*15:01-C*03:04-DRB1*04:01-DQB1*03:02 haplotype who displayed an increased risk of chronic neuropathic pain and increased risk of PPS. Further studies are needed to investigate if this association is on a haplotypic level or if certain alleles may be causing the association.

‍

Presentatörer:
‍Uhlin K, MD^a,b, Persson E, PhD, Bäärnhielm S, Associate Professor^c, Borg K Professor^a,b, Löfgren M, Associate Professor^a,b, Stålnacke BM, Professor^a,d
aKarolinska Institutet, Department of Clinical Sciences, Division of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden, ^bDanderyd University Hospital, Department of Rehabilitation Medicine, Stockholm, Sweden, ^cCentre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Transcultural Centre, Region Stockholm, Sweden, ^dDepartment of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden

Background: Although interdisciplinary pain rehabilitation (IPR) is an evidence-based treatment for patients with chronic pain, those not speaking the native language are commonly not selected for participation in IPR.  There is a knowledge gap regarding IPR for culturally diverse patients with chronic pain.

Aim: The aim was to investigate the outcomes in patients with chronic pain after participating in  IPR with language interpreter (IPR-LI) and to investigate the outcomes in women and men separately.

Method: A prospective longitudinal cohort study of 95 patients with chronic pain who participated in IPR-LI at two Swedish specialist pain rehabilitation centres. Duration and intensity of pain, anxiety and depression, health related quality of life and fear of movement were evaluated prior and after the program. Patients were compared with a reference group of patients, Swedish speaking and participants in IPR.

Results: Before the IPR-LI all variables except pain duration differed significantly to the detriment of the studied group.  The studied group showed significant improvements after the IPR-LI on pain intensity, depression and fear of movement. The reference group improved significantly on all variables.

The women in the studied group showed significant improvements in the same variables as the whole group, while the men in the studied group did not improve in any of the variables.  

Conclusion: This study indicates that patients, at least women, seem to benefit from participating in IPR-LI. Men might need further support during the program.

The result could be of value for further development of rehabilitation programs with language interpreters.

Presentatörer

K Bothelius ^a, SJernelöv ^b,c, V Kaldo ^b,d, C Lu ^e, M-M Stråle ^e,& M Jansson-Fröjmark ^b
a Department of Surgical Sciences, UppsalaUniversity, Uppsala, Sweden
^b Centre for Psychiatry Research,Department of Clinical Neuroscience, Karolinska Institutet, and StockholmHealth Care Services, Region Stockholm, Stockholm, Sweden
^c Division of Psychology, Department ofClinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
^d Department of Psychology, Faculty of Health andLife Sciences, Linnaeus University, Växjö, Sweden
^e Department of Psychology, UppsalaUniversity, Uppsala, Sweden

Background: Most individuals with longstanding pain experience comorbid sleep problems, and cognitive behavioural therapy for insomnia (CBT-i) has been shown to be effective for this population. However, studies on internet-based CBT-i (ICBT-i) have been sparse.

Aim: The aims of the present study were to examine the effects and feasibility of ICBT-I and to assess putative treatment mechanisms.

Method: Eighty-five participants with insomnia comorbid with chronic pain were randomised to ICBT-i or internet-based applied relaxation, IAR. The treatments were delivered over a period of eight weeks with therapist support provided during the entire period.

Results: Both groups showed a statistically significant improvement in insomnia symptoms after treatment, but there was no statistically significant interaction effect. However, IAR gave a larger improvement than ICBT-i regarding pain-related interference, anxiety severity, and self-rated health directly after treatment. These between-group differences were reduced at follow-up. Decreased sleep-related dysfunctional cognitions and increased sleep-related willingness were shown to be possible treatment-moderating mechanisms. The average number of completed treatment modules was 2.0 out of 8.

Conclusion: Both groups showed improvement in insomnia symptoms after treatment, but there was no difference between the two treatments, and the group differences in secondary outcome measures seen after treatment had diminished at follow-up. One notable finding was a high dropout rate; around a third of the subjects dropped out before finishing any treatment modules. For internet-based insomnia treatments to be a valuable clinical option in chronic pain management, this risk of dropout needs to be addressed.

‍

‍

Presentatör: Victoria Arana, leg sjukgymnast, Smärtcentrum, Akademiska sjukhuset

Bakgrund: Långvarig smärta innebär ett stort lidande för individen. Multimodal rehabilitering har positiv påverkan på långvarig smärta, men det är ej känt vilken multimodal rehabilitering som är effektivast. Ökad kunskap om vilka delar i smärtrehabilitering som gör nytta är viktigt för att kunna optimera vården.

Syfte: Syftet med studien var att undersöka kroppsmedvetenhet, tilltro till egen förmåga att vara fysiskt aktiv och självskattad fysisk aktivitetsnivå för personer med långvarig smärta samt att undersöka hur dessa variabler förändrades av multimodal smärtrehabilitering. Syftet var även att undersöka korrelationen mellan kroppsmedvetenhet och tilltro till egen förmåga att vara fysiskt aktiv.

Metod: Studien hade en deskriptiv, korrelerande kvasiexperimentell design. Patienter med långvarig smärta som vårdades inneliggande för ett 4 veckors långt multimodalt smärtrehabiliteringsprogram besvarade direkt före och efter rehabiliteringen frågeformulären Multidimensional Assessment of interoceptive Awareness (MAIA), Exercise Self-efficacy Scale (S-ESES) samt Socialstyrelsens indikatorfrågor för fysisk aktivitet.

Resultat: Tjugofem personer deltog i studien. Interventionen ökade tilltron till egen förmåga att vara fysiskt aktiv samt vissa dimensioner av kroppsmedvetenhet. Den självskattade fysiska aktivitetsnivån var låg och ökade ej av interventionen. Korrelationen mellan MAIA och S-ESES var statistiskt signifikant efter interventionen.

Slutsats: Multimodal smärtrehabilitering kan öka kroppsmedvetenhet samt tilltro till egen förmåga att vara fysiskt aktiv för personer med långvarig smärta.

Presentatörer:
‍Sofia Wagner, PT, M.Sc., Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
Hanna Ljungvall, Ph.D., Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
Annika Bring, PT, Ph.D., Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
R Karlsten, MD, Ph.D., Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
L Ekselius, MD, Ph.D., Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
P Åsenlöf, PT, Ph.D. Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.‍

Background: Chronic pain (> 3 months) is associated with balance impairments and falls. Long-term opioid use in chronic pain is associated with falls, but little is known about the contribution of opioid use to variation in balance.

Aim: To examine the extent to which bio-psycho-social variables, including opioid use, explain variation in dynamic balance for individuals with chronic pain in specialized pain care.

Methods: In total, 179 patients with chronic pain referred to specialized pain care were included in this cross-sectional study. Univariable and multivariable linear regression analyses with forward selection were performed.

Results: In the sample, 111 individuals (60%) were using opioids. The most common opioid was oxycodone (n=47). Multiple regression analysis demonstrated that oxycodone use (B = -3.1; p = .002), female sex (B = -2.3; p = .015), high age (B = -0.1; p = <.001), low educational level (B = 0.9; p = .007), low pain self-efficacy (B = 0.3; p = .009), and low levels of everyday physical activity (B = 0.5; p = .03) accounted for 33% of the variance in balance (R2 = .33).

Conclusion: These findings support the association between balance and variables that have not been shown to be associated with balance previously, such as oxycodone use, pain self-efficacy, and educational level. Contrary to previous findings, pain-related fears were not associated with balance. Larger, prospective studies are warranted to further explore the association between balance and opioid use, giving special attention to the type of opioid and its mechanisms.

‍

Presentatörer: Lena Hedén, Associate Professor, RN, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
Ida Kleye, PhD-student, RN, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Background: Children still report needle procedures as the worst source of fear and pain during care and treatment. A psychological intervention distraction is suggested to reduce children's fear and pain during needle procedures. However, for those children who prefer to have control and to be involved in care, distraction may be distressing. Thus, an intervention iCanChoose (iCC) aiming to reduce fear and pain during needle procedures was developed based on the children's preferred choices.

Aim: To examine whether children experience less fear or pain using iCC and if there were any differences between the intervention group and the control group regarding heart rate, time required for the procedure, success rate for the needle insertion, and patient satisfaction.

Method: A total of 105 children 6-12 years of age participated. The intervention group (n=65) received standard care plus iCC intervention and the control group (n=40) received standard care only. The children self-reported levels of pain, fear and satisfaction. Pain behavior, heart rate, procedure time and success rate of the needle insertion were measured.

Results: Child self-reported fear or pain levels did not reveal any differences between intervention compared with controls. However, according to observations the effects of the intervention were lower fear and pain, decreased procedure time, and more children in the intervention group were satisfied with the needle procedure compared with the children in the control group.

Conclusion: The iCanChoose intervention provides reduced observed distress related to fear and pain in children undergoing a needle procedure and reduced total procedure time.

‍

Presentatörer:
‍Vallin S¹, Visscher CM², Lobbezoo F², Häggman-Henrikson B³, Bernt Lindahl⁴, Lövgren A^1
1Department of Odontology, Umeå, Sweden
‍²Department of Orofacial Pain and Dysfunction, Amsterdam, the Netherlands
‍³Department of Orofacial Pain and Jaw Function, Malmö, Sweden
‍⁴Department of Public Health and Clinical Medicine, Umeå, Sweden‍

Background: Chronic pain from temporomandibular disorders (TMD), significantly impacts the lives of those affected. The multifactorial etiology and association with lifestyle factors necessitate further exploration to target interventions for effective management.

Aim: to determine the representativeness of a merged cohort for TMD and explore the ability to predict individual susceptibilities using available registries.

Methods: This study was conducted in Västerbotten during 2010-2017, using the community sample of a TMD register (n=203,208). Individuals with a positive response to at least one of the three screening questions (3Q/TMD) were classified as 'TMD cases'. The Västerbotten Intervention Programme (VIP) provided comprehensive socio-demographic, lifestyle, and health-related data (n ≈ 100,000).

Results: Merging the TMD and VIP data resulted in a cohort of 59,408 unique individuals. Of these, 51.1% were women with a mean age of 44.9 years. The prevalence of TMD was 8.5%. Women reported a higher prevalence of TMD (12.3%) than men (5.2%). Individuals with TMD reported more sick leave (X2 P<0.001) and rated their general health as worse (X2 P<0.001).

Conclusions: The merged cohort, consisting of TMD community samples and VIP participants, reflects the age and gender distribution of the general population, allowing extensive large-scale analysis.

‍

Presentatör: Volker Tanke, specialistläkare ANIVA, ST i smärtlindring.
VO Neurokirurgi och smärtrehabilitering, Skånes Universitetssjukhus (SUS), Lund.

Bakgrund: Spinal Cord Stimulation (SCS) har visat sig vara effektiv i smärtlindrande syfte mot bl.a. kronisk behandlingsresistent neuropatisk smärta. En psykosocial problematik kan utgöra ett hinder för lyckad SCS-behandling.

Vid rehabilitering av kronisk smärta fokuseras arbete kring smärthantering. En önskan om smärtlindring kan då utgöra ett hinder. Patienter som kan bli föremål för SCS-behandling är kroniska smärtpatienter.

Med detta som bakgrund är det oklart hur SCS och smärtrehabilitering bäst kan komplettera varandra.

Vid SUS Lund har ett samarbete mellan neurokirurgen och smärtrehabilitering påbörjats, där SCS-behandlingar kommer att ske inom en biopsykosocial ACT-baserad rehabiliteringsram (Acceptance and Commitment Therapy).

Syfte: Beskriva hur olika rehabiliteringsinsatser och SCS har visat sig kunna främja varandra.

Metod: Systematisk sökning augusti 2022 – april 2023 i databaserna PubMed, Cochrane, NICE, ClinicalTrials och Google Scholar med sökalgoritm kring SCS och rehabilitering.

Resultat: Fyra relevanta artiklar hittades samt en pågående studie.

En artikel presenterar europeisk konsensus om SCS-indikationer och psykosociala hindrande faktorer.

En artikel rekommenderar att genomföra SCS före rehabiliteringsåtgärder, framför allt hos patienter med Complex Regional Pain Syndrome. En annan artikel visar att rehabiliteringsåtgärder kan vara effektiva trots vetskap om kommande SCS-behandling. En artikel konkluderar rehabiliteringsåtgärder som effektiva efter SCS-behandling med utebliven effekt.

En pågående RCT jämför effekten av SCS med och utan efterföljande biopsykosociala rehabiliteringsåtgärder.

Slutsats: Få studier undersöker samspelet mellan rehabiliteringsåtgärder och SCS. Slutsatserna är motstridiga. Svårigheter att jämföra studierna föreligger pga olika metodologi och patientgrupper.

Rehabiliteringsåtgärder kan vara effektiva både före och efter SCS-behandling, samt efter SCS-behandling med utebliven effekt. Detta tycks ge utrymme för individuella bedömningar.

Presentatör: Caroline Bornelind, Leg Fysioterapeut, Karolinska Institutet

Bakgrund: Äldre ensamboende kvinnor är en växande grupp i samhället och en stor del av dessa kvinnor lever med långvarig muskuloskeletal smärta. Tidigare studier har visat att långvarig smärta begränsar aktivitetsförmåga och vardagsliv hos berörd patientgrupp. Det är dock inte klarlagt i vilken utsträckning långvarig smärta är relaterad till livskvalitet och fysisk funktion.

Syfte: Syftet med denna studie var att undersöka sambanden mellan smärtintensitet, upplevd mental och fysisk hälsorelaterad livskvalitet samt nivå av fysisk funktion hos äldre ensamboende kvinnor med långvarig muskuloskeletal smärta.

Metod: Till denna tvärsnittsstudie inkluderades 92 norska äldre ensamboende kvinnor med långvarig muskuloskeletal smärta. Smärtintensitet, hälsorelaterad livskvalitet och fysisk funktion mättes med standardiserade mätmetoder. Analyserna bestod av deskriptiva analyser samt korrelations- och regressionsanalyser.

Resultat: Deltagarna upplevde en måttlig smärtintensitet, skattade en låg grad av mental och fysisk hälsorelaterad livskvalitet samt uppvisade en låg fysisk funktion. Det fanns ett svagt till medelstarkt samband mellan kvinnornas upplevda smärtintensitet och den skattade mentala och fysiska hälsorelaterade livskvaliteten. Inget samband kunde ses mellan upplevd smärtintensitet och fysisk funktion.

Slutsats: Studien indikerar att äldre ensamboende kvinnor med långvarig muskuloskeletal smärta har en låg nivå av fysisk funktion samt skattar en lägre upplevd hälsorelaterad livskvalitet jämfört med referensvärden från kvinnor i samma åldersgrupp. Studien indikerar även att det finns samband mellan smärtintensitet och hälsorelaterad livskvalitet.

Presentatörer: A. Hållstam¹, J. Eriksson-Carnander¹,C. Angelhoff ², L. Gellerstedt ^1
1 Karolinska Institutet, Stockholm, Sweden, ²Linköpings University, Linköping, Sweden

Background: Persons with chronic pain and simultaneous insomnia have more severe and widespread pain, increased disability, anxiety, and depression. Persons with insomnia on the other sides are more likely to develop chronic pain. Multimodal rehabilitation (MMR) by interprofessional teams based on the bio-psycho-social understanding is an evidence-based intervention for chronic pain. Insomnia therapy is also based on educational and cognitive behavioral principles. The literature proposes simultaneous interventions for patients living with chronic pain and insomnia. Persons’ experiences of MMR focusing on sleep and health-related quality of life (HRQoL) is scarcely described.

Aims:

• to explore persons’ experience of sleep and HRQoL in MMR
• to describe patient reported measures of insomnia, HRQoL and pain before and after the program.

Methods:

• Transcripts of 2- 4 focus group interviews with persons who passed MMR will be analyzed by thematic analysis.
• Patient reported outcome measures (PROMs) for insomnia, HRQoL and pain before and after MMR will be analyzed by statistical methods.

Results: Preliminary findings of two focus group interviews show how poor sleep had a negative impact on daily activity, pain, and relations to neighbors. The informants also described a vicious circle between pain and poor sleep. PROMs show significant improvement in social functioning and decrease of insomnia from pre to post MMR.

Conclusions: Persons with chronic pain suffer from insomnia which also affects health related quality of life. A multimodal rehabilitation program can increase sleep and thus quality of life. The most significant intervention for the change was sleep ergonomics.

Presentatörer:
‍¹Anna-Carin Robertz PhD-student, ²Stefan Nilsson Professor, ¹Viola Nyman PhD, ^3,4Carl-Johan Törnhage Docent, ¹Anne-Katrin Kantzer PhD
‍¹ NU-sjukvården Västra Götalandsregionen,² Institutionen för vårdvetenskap och hälsa, Göteborgs Universitet, ³ SKAS Västra Götalandsregionen,⁴ Sahlgrenska akademin, Göteborgs Universitet.

Bakgrund: Uppmärksamhets- och hyperaktivitetsstörningar (ADHD= attention deficit hyperactivity disorder) hos ungdomar har en prevalens på 5% och påverkar deras funktionsnivå och livskvalitet. Kopplat till ADHD är det vanligt med en förhöjd smärtpåverkan jämfört med normalpopulationen. Studiens syfte var att undersöka taktil massage som en komplementär behandling för ungdomar diagnostiserade med ADHD.

Metod: Materialet som presenteras ingår i en pilotstudie som är del av en större undersökning. Fjorton ungdomar, 15–17 år, inskrivna på barn- och ungdomspsykiatriska kliniken i NU-sjukvården i Västra Götalandsregionen erbjöds att få 10 behandlingar med taktil massage, en gång per vecka. Inklusionskriterierna var ICD-10 (the International Statistical Classification of Diseases and Related Health Problems) diagnostiserad ADHD, omedicinerad alternativt behandlad med centralstimulantia eller Atomoxetin. Här presenteras data som registrerades sex veckor före (T0) och direkt efter sista massagebehandlingen (T3). PROMIS (Patient Reported Outcomes Measurement Information System) smärtpåverkan har ett medianvärde för T score på 50 (referens 34–78) där värden över 50 indikerar smärtpåverkan. SDQ (Strengths and Difficulties Questionnaire), domän hyperaktivitet har ett cut off värde på 7 (referens 0–10) där värden > 7 indikerar hyperaktivitet.

Resultat: PROMIS: Vid T0 var medianvärdet 43,5 (min 34 n=5 och max 60,6) och vid T3 34 (min 34 n=7 och max 59,5). SDQ domän hyperaktivitet: Frekvensen för symtom (över cut off) på hyperaktivitet var 6/14 ungdomar (42,9%) vid T0 och 3/12 (25%) vid T3. Symtom på hyperaktivitet har avtagit och smärtpåverkan har minskat i gruppen.

Slutsats: Taktil massage förefaller ha en positiv effekt på hyperaktivitet och smärtpåverkan. Resultaten behöver bekräftas med en undersökning i en större jämförbar population.

Presentatör: Nikola Stanisic, dentist/ double PhD-student, Malmö university /Aarhus universitet

Background: Medical research aims to study conditions and diseases, including pain, with effective models. The Dental Impaction Pain Model is favored for studying acute pain due to its reproducibility and affordability. Chronic orofacial pain, linked to jaw joints and muscles with musculoskeletal overload, overlaps significantly with other chronic pain, making it a valuable study model for chronic musculoskeletal pain.

Aim: Using the jaw-system to evaluate the relationships between chronic pain, musculoskeletal overload and family history – Is pain intensity the effect of increased overload?

Method: A nested case-control study based on a random sample (young adults and parents) of 120 cases with orofacial pain and 120 pain free controls. Musculoskeletal- overload of the jaw system will be studied by i) questionnaires; ii) 7-day ecological momentary assessment using a smartphone application for repeated sampling of behavior in real time and in a natural environment; and iii) 24-hour assessment of jaw muscle activity using a electromyographic device.

Results: Preliminary results suggest a significant relationship between intensity of orofacial pain and the frequency of musculoskeletal overload in the jaw system. A correlation was found between parents and off-spring regarding presence of chronic pain and their musculoskeletal overload behavior.

Conclusion: The intensity of chronic orofacial pain is affected by the degree of jaw-overload. Family history can be used to risk assess chronic orofacial pain and musculoskeletal overload behavior.

Presentatörer: Märta Segerdahl¹, Magnus Halldin¹, Rolf Karlsten², Karin Ellström³, Adriana Miclescu².
‍¹ AlzeCure Pharma AB, ² Smärtcentrum, Akademiska sjukhuset, ³SDS LifeScience

Bakgrund: Det behövs nya behandlingsalternativ vid neuropatisk smärta, då flertalet patienter upplever en otillräcklig smärtlindring med befintliga behandlingar. ACD440 Gel är en TRPV1-antagonist under utveckling som perifert verkande precisionsbehandling av perifer neuropatisk smärta (PNS) med sensorisk överkänslighet. ACD440 Gel har tidigare visats minska laserutlöst smärta hos friska försökspersoner.

Syfte: Studien har undersökt om ACD440 Gel kan minska temperaturutlöst smärta hos patienter med PNS med sensorisk överkänslighet. Detta som ett förberedande steg inför större effektstudier.

Metod: Patienter med PNS med sensorisk överkänslighet, inkluderades i en dubbelblind, placebokontrollerad, randomiserad crossoverstudie. Patienterna behandlades med ACD440 Gel (14 mg/g) respektive placebo, 2 gånger dagligen i 7 dagar. Stimulusutlöst (evokerad) smärta undersöktes med standardiserat ”bedsidetest”, innefattande övertrösklig stimulering av värme (37°C), kyla (6°C), pensel och ”pinprick”. Smärtintensitet skattades med NRS (0-10). Evokerad smärta av intensitet NRS 4-7/10 var inklusionskriterium. Mätningar gjordes före och efter varje 7-dagars behandlingsperiod.

Resultat: Fjorton patienter, män och kvinnor (50-85 år) med måttlig till svår PNS av olika etiologier inkluderades. Alla patienter fullföljde studien. Smärtduration var i median 4,75 år (range 0,67 – 7,5), spontansmärtans intensitet 5,6 (SD 1,4) och evokerad smärta 6,7 (SD 2,5). Efter 7 dagars behandling minskade den temperaturutlösta evokerade smärtan med ca 50 %, p=0,0064. Den minskade också värmeutlöst smärta signifikant, p=0,0058. Inga behandlingsrelaterade biverkningar rapporterades.

Slutsats: ACD440 kan efter en kort topikal behandling minska temperaturutlöst smärta hos patienter med PNS med sensorisk överkänslighet. ACD440 Gel är säkert och tolererades väl. Större och längre studier behövs för att undersöka om ACD440 Gel även kan minska spontan smärta.

‍

Presentatörer: Alexander Rosenström, MD^1, Aisha Siddiqah Ahmed, PhD^2, Kim Kultima, PhD^{3, 4,} Eva Freyhult, PhD^5, Svante Berg, MD, PhD^2, Vinko Palada, PhD^6, Camilla I. Svensson, PhD⁴  *, Eva Kosek, MD, PhD^{1, 7}  ** Both contributed equally

1. Department of surgical sciences, Uppsala university
2. Department of molecular medicine and surgery, Karolinska Institute
3. Department of medical sciences, Uppsala university
4. Department of physiology and pharmacology, Karolinska Institute
5. Department of cell and molecular biology, Uppsala university
6. Department of Physiology, University of Helsinki
7. Department of clinical neuroscience, Karolinska Institute

Background: Recent evidence highlights the importance of the neuroimmune interface, including periphery-to-CNS neuroimmune crosstalk, in chronic pain. While neuroinflammatory processes have been implicated in central sensitization for a long time, their potential neuroprotective and analgesic effects remain relatively elusive.

Aim: We've investigated the relationships between cytokine release and symptom severity, and explore possible candidates for periphery-to-CNS crosstalk.

Method: Patients with degenerative disc disease (DDD) (nociceptive pain) or patients with lumbar disc herniation (LDH) with radiculopathy (predominantly neuropathic pain) completed questionnaires regarding pain and functional disability, underwent quantitative sensory testing, and provided blood and CSF samples. Proximity extension assay (PEA) was used to measure the levels of 92 inflammatory proteins in the CSF and serum from a total of 160 patients and controls.

Resultat: Several cytokines were upregulated in the CSF of both patient groups compared to controls, indicating neuroimmune activation, while serum protein expression was generally downregulated compared to controls. Regarding periphery-to-CNS neuroimmune crosstalk, several cytokines, including CCL11, CD5, IL8, and MMP-10, were elevated in the CSF also had positive correlations between CSF and serum levels. These cytokines were also associated with back, but not leg, pain intensity in the LDH group and none with back pain intensity in DDD patients. The association between CSF cytokines and pain was complex.

Conclusion: In conclusion, we found evidence for neuroimmune activation in the CNS of both patient groups in the absence of systemic inflammation, and signs of a communication between CSF and serum. Complex and disease-specific associations were found between cytokines in CSF and back pain intensity.

Presentatör: Maria Isik, fysioterapeut, Ronna Rehab, Södertälje

Bakgrund: Långvarig smärta är en vanlig orsak till att människor söker vård och är vanligare hos kvinnor än hos män, i synnerhet hos invandrarkvinnor. Trots att andlighet/religion utgör en viktig del för en holistisk och patientcentrerad vård glöms denna dimension ofta bort. Fysioterapeuter och andra professioner kan behöva en tydligare förståelse för denna dimensions effekter på hälsa och hälsobeteende.

Syfte: Syftet med denna studie var att beskriva hur kristna invandrarkvinnor från Mellanöstern med långvarig smärta upplever sin hälsa i relation till sin andliga tro samt betydelsen av att fysioterapeuten bemöter andlighet.

Metod: Data samlades in genom semistrukturerade intervjuer med åtta kvinnor. Analysen genomfördes med hjälp av kvalitativ innehållsanalys enligt Graneheim och Lundman (2004)

Resultat: Två teman framkom: 1) Andlighet – en läkande kraft och Vårdmöte med värdighet och respekt. Kvinnornas upplevelse av sin hälsa utgår från en stark tro på Gud som har en viktig och central roll i deras liv och som påverkar hälsan positivt på olika nivåer och hjälper kvinnorna att hantera smärta. Resultatet visar även att fysioterapeuten har en viktig uppgift i att identifiera och möta eventuella andliga behov vid rehabilitering. För att kunna göra detta krävs en viss förförståelse men också ett genuint intresse och lyhördhet hos fysioterapeuten.

Slutsats: Andlig/religiös kompetens behövs för att kunna utföra individanpassad vård i vårt mångkulturella samhälle och bör integreras mer i fysioterapeututbildningen för att ge en ökad kunskap och förståelse. Dessutom bör fysioterapeuten själv ha reflekterat kring egna värderingar och sin egen trosuppfattning för att bättre kunna bemöta patienters andliga behov.