搜索结果：Scandinavian journal of pain

Pain is a prevalent non-motor symptom in patients with Parkinson's Disease (PD) and associated with significant quality-of-life impairments. Yet, qualitative literature examining how patients with PD experience their pain and pain treatment is scarce. The aim of this study is to understand and report firsthand experiences with pain in PD. Individual interviews (N = 15 patients with PD) following a semi-structured interview guide organized in 7 main topics and 18 subtopics covering both medical and psychological aspects of pain in PD. Data were analyzed by a reflexive thematic analysis. Three major themes emerged: (1) Pain is related to PD: A majority of interviewees were confident pain is caused by motor symptoms and related to sleep disturbances. (2) Healthcare professionals neglect pain in PD: frequently, interviewees expressed satisfaction with general PD treatment, yet urged healthcare professionals to show interest in their pain. Many were uncertain as to who was responsible for pain treatment and wished for increased coordination among healthcare professionals. (3) Treatment of pain is insufficient: self-medication was prevalent. Most interviewees told they hide their pain. Interviewees broadly reported low and/or temporary effect of alternative pain treatment, yet perceived training as efficient. Multiple interviewees called for research on physical or psychological rather than pharmacological pain treatment. Patients with PD yearn for dialogue on pain with healthcare professionals. Frequently, patients take medication unsupervised, suggesting a need for integrating assessment of self-medication in standard treatment regimes. Patients urge healthcare professionals to discuss pain with them and acknowledge that motor symptoms may cause pain.

Persistent pelvic pain (PPP) is often regarded as multifactorial and complex. There is limited knowledge on how patients with PPP resemble and differ from those with persistent non-pelvic pain (PNPP). The specific aims of this study were to compare self-reported background and pain characteristics, affective symptoms, and quality of life at baseline between patients with PPP and those with PNPP at three multidisciplinary pain clinics in Norway, and to explore differences between men and women with PPP. This is a cross-sectional study, using registry data from three tertiary, multidisciplinary pain clinics. Patients ≥17 years answered web-based questionnaires on background, baseline pain symptoms, mental health, and quality of life. We used t-tests, chi square, and multivariable logistic regression. Of 934 consenting patients (71 % of those attending), 30 had missing diagnoses, and 127 (13.6 %) were diagnosed with PPP. PPP patients less often reported widespread pain than PNPP patients (adjusted odds ratio (AOR) 0.2, 95 % confidence interval (CI) 0.2-0.4). We found high prevalence of fatigue, insomnia, and anxiety among all the pain patients, but PPP patients were more likely to report depression (AOR 1.6, 95 % CI 1.0-2.6) and pain catastrophizing (AOR 1.8, 95 % CI 1.2-2.8). All the pain patients had a low health-related quality of life. Women with PPP had higher prevalence of severe fatigue than men with PPP. This study confirms that pain clinic patients generally experience high levels of emotional distress and poor health-related quality of life. PPP patients tend to exhibit higher rates of pain catastrophizing, yet less widespread pain. Understanding the specific symptom profile of PPP patients is crucial for effective treatment in pain clinics. The potential underutilization of pain clinics in the treatment of PPP patients warrants further investigation.

Pain as a long-term outcome following rectal cancer treatment has received limited attention in previous studies. This prospective cohort study examined pain prevalence up to 5 years post-surgery in patients treated with curative intent. Secondary aims included evaluating pain intensity and its interference with daily life, and comparing pain experiences with a reference population. In addition, potential risk factors for pain were explored. Patient/material and methods: The study is based on the multicenter prospective cohort study QoLiRECT including patients from 16 surgical departments in Denmark and Sweden (2012-2015). Questionnaires regarding Quality of Life were administered at diagnosis and at 1, 2 and 5 years after treatment. Information about self-assessed pain was primarily derived from the 'Brief Pain Inventory - Short Form'. Comparisons were made with an age- and sex- matched reference population. Five years post-treatment, 37% of rectal cancer survivors reported pain exceeding common types of pain, with an average pain level of 3.8 and interference score of 3.1 (range 0-10). Pain was mainly located to the lower extremities, back and pelvis. Surprisingly, pain prevalence was higher in the reference population (53%), a difference consistent at all time points. No significant difference was found between groups regarding average pain or interference. Higher pain levels were associated with female sex, severe baseline pain, and elevated Body Mass Index (BMI). Pain was more common in the reference population, while intensity and interference were similar between groups. This suggests that the experience of pain may differ after surviving cancer, and such differences might be considered when studying pain in cancer survivors.

Understanding the subjective experiences of patients living with chronic, acute, and cancer pain can significantly enhance the selection of treatment approaches, care, and support, ultimately improving their quality of life. This qualitative systematic review aimed to analyze if the patients' subjective experiences of living with pain differ between acute, chronic, and cancer pain states. After registration in PROSPERO (CRD42023491745), an electronic search was conducted in the databases Medline (Ovid), Embase (embase.com), Cochrane (Wiley), Web of Science (Clarivate Analytics), and CINAHL (EBSCO) from their inception to 19 April 2024. Out of 8443 articles, 62 articles were included. The inclusion criteria that were applied were as follows: (1) participants aged 18 or older; and (2) participants' subjective experiences of chronic, acute, or cancer pain. The exclusion criteria were as follows: (a) studies presented in other languages than English, Spanish, Portuguese, Greek, and Scandinavian languages; (b) editorials, letters, legal cases, case series, and case-control studies; (c) studies and articles based on duplicated data; (d) study population with ages below 18 years. Forty-four articles regarding chronic pain, thirteen regarding cancer pain, and five regarding acute pain were included. Methodological limitations were assessed using the CASP tool for quality appraisal in qualitative evidence synthesis. Certainty of evidence was assessed with GRADE-CERQual. All included studies showed moderate (n = 18) to high (n = 44) confidence. Based on the qualitative synthesis in GRADE-CERQual, four main themes were identified: (1) impact of pain on social life, work life, and family life; (2) challenges in healthcare access; (3) psychological impact and emotional struggles from pain; and (4) barriers to effective pain management. Taken together, patients with chronic, acute, or cancer pain face challenges in social, work, and personal lives. They often lack recognition and support from healthcare providers, relying on self-managed methods and facing barriers to effective management. Therefore, future research examining how the different pain types affect the lives of the patients and at the same time exploring personalized and collaborative treatment approaches is warranted. In conclusion, patients' experiences of living with pain remain unexplored in clinical practice. Understanding the impact of various pain types on mental health, self-esteem, daily life, and relationships is crucial. Also, how personalized treatments, collaborative healthcare access, and long-term management strategies can improve quality of life for patients living with pain. PROSPERO CRD42023491745.

Musculoskeletal pain is among the most prevalent types of pain. However, experimental models that induce acute musculoskeletal pain by everyday activities - on top of sustained daily muscular strain - in a controlled and moderate manner are still lacking. Such models are essential for investigating underlying mechanisms of musculoskeletal pain and evaluating treatment approaches. The present study proposes a novel experimental model to address this gap. A total of 43 pain-free participants completed two motor (lifting objects) and two sensory (hot water immersion, noxious pressure) pain challenges. Participants were randomly assigned to either an experimental group, who wore a suit that induced widespread muscle strain through limb weights and joint restrictions, or a control group without the suit. Both groups performed the additional pain challenges. Numerical pain ratings, pain-related facial expressions (Facial Action Coding System, FACS), heart rate (HR) and its variability (HRV), as well as electrodermal activity (EDA), were recorded. Wearing the experimental suit to induce muscle strain led to increased pain ratings during motor challenges when further muscle power was required (weightlifting). Additionally, pain-specific facial responses and autonomic markers (heart rate and tonic EDA) were significantly elevated in the experimental group during motor tasks. No significant group differences were observed during the sensory pain challenges. This study introduces a novel and effective experimental model for inducing acute musculoskeletal pain by applying light weightlifting on top of sustained muscular strain, with both stressors designed to reflect everyday motor activities. This approach offers a promising tool for future research into pain-relieving interventions and the mechanisms of musculoskeletal pain, including studies involving affected patient populations.

Spinal pain is highly prevalent and associated with substantial individual burden. Qualitative studies suggest that family members of individuals with spinal pain may also experience burden; however, quantitative data on family-member burden remain limited. This study had two linked objectives. First, we conducted a pragmatic cognitive debriefing study to evaluate the content validity of the Family-Reported Outcome Measure-16 (FROM-16) in a spinal pain context. Second, we conducted an exploratory cross-sectional survey using FROM-16 to estimate family-member burden in a Danish secondary-care hospital department and explore associations with family-member and patient characteristics. Content validity of FROM-16 was assessed by semi-structured interviews of family members to patients with spinal pain at The Spine Center of Southern Denmark. The burden of spinal pain was assessed in a cohort of family members to spinal pain patients using FROM-16. Family members were asked about descriptive characteristics, and patient characteristics were extracted from a clinical registry. Summary statistics were reported, and regression modeling was used to explore associations. 12 family members were interviewed and raised concerns about some item relevance (e.g., spare time, work and study, sex life). The cohort study included 291 family members, revealing varying burdens, with the highest burden in the emotional domain. However, some items had low response rates. The multivariable model indicated that the burden was highest among younger partners with poor self-rated health and was associated with clinical characteristics, notably disability and pain duration. The burden of spinal pain on family members varied greatly and was predominantly related to the emotional domain of younger partners with poor self-rated health. However, FROM-16's generic nature may underestimate this burden. Developing a more tailored questionnaire could better capture the impact of spinal pain on family members and inform improved care and support interventions for informal caregivers.

Canadian Armed Forces (CAF) Veterans report living with chronic pain at nearly double the rate of comparable Canadians. They have unique pain management needs, highlighting the need for further research. Aquatic exercise is one treatment option that may offer meaningful benefits. This study aimed to explore the lived experiences of CAF Veterans incorporating aquatic exercise as part of their pain management routines, offering insight into its potential role in managing chronic pain among military Veterans. Informed by interpretive phenomenological analysis, ten CAF Veterans with chronic pain and experience with aquatic exercise were interviewed. Three superordinate themes were constructed: Respite from the pain; reconstructing an identity as a physically capable individual; and reclaiming a sense of self and seeing a new path forward. Exercise has the potential to improve pain, function, and quality of life for individuals living with pain. Among CAF Veterans, aquatic exercise can further support personal growth, development, and recovery after release from the military. The findings provide insight for rehabilitation providers of the positive experiences and additional impacts of participating in aquatic exercise for CAF Veterans with chronic pain. Rehabilitation providers may consider incorporating aquatic exercise into physical activity-based rehabilitation programs for CAF Veterans living with musculoskeletal pain. The current investigation was approved by and followed the recommendations of the Health Sciences and Affiliated Teaching Hospitals Research Ethics Board at Queen's University (REH-797-21).

To compare pain trajectories and acute exercise-induced pain over a 16-week period in patients with hypermobility spectrum disorder (HSD) undergoing high-load (HEAVY) or low-load (LIGHT) shoulder exercise. In this secondary analysis using data from a randomized controlled trial, we included men and women aged 18-65 with HSD and shoulder complaints >3 months. Participants were randomly allocated (1:1 ratio) to 16 weeks of HEAVY or LIGHT shoulder exercise program, performed three times weekly. The HEAVY program consisted of progressive strengthening and full range of motion exercises, while the LIGHT program included low-load exercises performed in neutral to mid-range. Pain was assessed using the numeric rating scale (NRS) before and after each exercise session. Pain trajectories were assessed using pre-exercise pain scores at the final session each week. Exercise-induced pain was evaluated as the change in pain before and after exercise, using the mean of the three sessions each week. Both outcomes were analyzed using linear mixed models. Data from 64 out of 100 patients (HEAVY 34, LIGHT 30) were analyzed (80% women, mean age 39.6, mean Beighton score of 5.8). Shoulder pain was reduced by 0.89 NRS in HEAVY (95% CI 0.4 to 1.4) and 0.33 NRS (95% CI -0.25 to 0.91) in LIGHT. The between-group difference in change in pain from baseline to week 16 was 0.56 (95% CI -0.20 to 1.33, p = 0.149). There was no between-group difference in pain trajectories (group × time interaction, p = 0.321). The mean exercise-induced pain over time was similar in both groups (group × time interaction, p = 0.614), with pain below 0.5 NRS throughout the 16 weeks. Pain trajectories over 16 weeks were similar in patients with HSD and persistent shoulder complaints performing high-load or low-load shoulder exercises. There was minor to no exercise-induced pain during high-load strengthening exercise, challenging previous beliefs.

Nociception monitoring during general anesthesia is evolving to improve intraoperative management and postoperative outcomes. While opioid-based anesthesia (OBA) remains widely used for its strong antinociceptive effects, concerns about opioid-induced adverse effects have fueled interest in opioid-free anesthesia (OFA) approaches. This study aimed to compare perioperative and postoperative hemodynamic parameters, nociceptive dynamics, and depth of consciousness between OFA and OBA. This secondary analysis used data from the multicenter cohort study Opioid-Sparing Person- Centered Care study, a prospective, multicenter randomized controlled trial (ClinicalTrials.gov number: NCT03756961), including 79 patients undergoing bariatric surgery with OFA or OBA. Hemodynamic parameters, depth of consciousness, and nociception level (NOL) index was collected during anesthesia induction, surgery and in post-anesthesia care unit (PACU), while postoperative pain scores, measured with the Numbers Rating Scale (NRS), were recorded only in the PACU. NOL index values were blinded to clinicians throughout the procedure. During anesthesia induction, the OFA group exhibited significantly higher hemodynamic and nociceptive responses compared to the OBA group. NOL index values were elevated in the OFA group, indicating increased nociceptive activity. In contrast, the OBA group showed slightly higher NOL index values in the PACU. Bispectral index monitoring demonstrated a lighter depth of anesthesia in the OFA group compared with the OBA group, although both groups remained within an adequate anesthesia range. OFA regime was identified as a strong predictor of lower postoperative NOL index values. However, the OBA group also included a higher proportion of patients that scored postoperative pain with NRS ≥4 compared with the OFA group. Intraoperative monitoring revealed distinct patterns in nociceptive dynamics and their coupling with anesthetic depth between OFA and OBA techniques. OBA showed a tighter coupling between nociception and anesthetic depth, whereas both approaches appeared suboptimal for postoperative pain control. Despite these intraoperative variations, the overall impact on early postoperative recovery was limited. Larger, prospective studies are warranted to assess how nociception-guided anesthesia strategies and time within specific NOL intervals influence postoperative pain and long-term outcomes.

Disturbed sleep and chronic pain are public health concerns. Sleep disturbances seem to influence inflammation and may contribute to the increased pain sensitivity after sleep restriction (SR), such as after night work. The primary objective of this study was to determine the effects of SR on pain sensitivity and on relevant markers of inflammation. A secondary objective was to determine if SR affected pain sensitivity and inflammatory responses differently in men and women. A paired crossover design with block randomization was applied. Subjects were instructed to follow their habitual sleep (HS) rhythm for two nights (HS condition) and to delay their bedtime to shorten their sleep with 50% for two nights (SR condition). Thirty-nine healthy volunteers between 19 and 44 years old participated (21 women). Experimental pain sensitivity was tested with heat-, electrical-, and pressure pain thresholds (PPTs); electrical temporal summation threshold; pinprick pain; suprathreshold heat pain tolerance; and rating of suprathreshold heat and cold pain. The following markers of inflammation were measured in plasma from a blood sample taken between 10:00 and 12:00: C-reactive protein, fractalkine, tumor necrosis factor, interleukin -8, and monocyte chemoattractant protein-1. Most subjects did not comply with the SR instructions. Total sleep time during SR was on average 2.6 h shorter than during HS. Therefore, the SR condition was re-defined to be "at least 40% reduction in the time in bed (TIB) the last night." The HS condition was re-defined to "at least 85% of normally reported TIB." SR produced higher suprathreshold heat pain sensitivity and cold pressor pain, compared to HS, but no significant change in electrical pain threshold, electrical temporal summation threshold, PPT, or any of the measured immune parameters. Sex-stratified analyses indicated that the effect on heat pain only occurred in women and that the effect on cold pressor pain was significant only in men. The present findings indicate that heat and cold pressor pain were rated higher following SR, whereas pain thresholds remained unchanged. We did not find an effect of SR on biomarkers of inflammation. The findings should be cautiously interpreted given the poor adherence to the SR condition.

The aim of this study was to assess the impact of polymorphisms in cytokine genes on pain severity and pain treatment with palliative radiotherapy. 81 patients were enrolled. Pain severity and dose of analgesics were evaluated prior to radiotherapy and at 4, 12 and 24 weeks following treatment. The study analysed 12 gene polymorphisms of 6 cytokines (IL-6, IL-10, TNFα, IL-1α, IL-1β, IL-1RA) involved in the pathogenesis of pain syndrome. Association between severe pain and patients' variables and genotype groups of each cytokine gene studied were analysed. Karnofsky index ≥ 60 % and IL1RN rs2234677 polymorphism GG genotype were found to have significant impact on severe pain prior to radiation. Patients with IL-1α encoding gene IL1A rs1800587 CC genotype and patients with IL-1β encoding gene IL1B rs1143634 CC genotype had significantly better response to radiotherapy. Patients with IL-1RA encoding gene IL1RN rs315952 CC genotype had a faster response to radiation. Findings of this study emphasize the importance of gene polymorphisms which encode inflammatory interleukins in the severity of pain and response to palliative radiotherapy. Regional research ethical committee number BE-2-39 ClinicalTrials.gov registration number NCT02024815.

Pain is a hallmark of musculoskeletal conditions. Some studies suggest that pain is exacerbated by working in cold environments, potentially due to poorly understood mechanisms within the somatosensory system. The aim of this study was to assess whether ambient cold exposure influences the efficiency of endogenous pain inhibition and the potential role of subjective thermal comfort. In a crossover study with 1 week interval and in randomized order, 20 healthy men were exposed to cold (COLD; 10 °C) and thermoneutral (TN; 22 °C) conditions in a controlled environment room (CER) for 2 h. Conditioned pain modulation (CPM), defined as the difference in mean rated pain of a test stimuli (TS) with and without a conditioning stimulus (CS), was calculated before and after CER. Test stimuli (TS) was a 30 s tonic noxious heat stimulation to the dominant volar forearm, and conditioning stimuli (CS) was immersion of the contralateral hand in water holding 4 °C. Subjective TS pain was rated on a 0-10 cm computerized Visual Analogue Scale (VAS). Thermal comfort, encompassing subjective thermal perception, evaluation, and preference, was assessed using standardized subjective judgment scales. The CPM-effect was significantly reduced by COLD exposure, but not by TN exposure. As expected, participants' ratings of thermal comfort changed across exposure conditions; however, this had no significant influence on the CPM-effect. Exposure to cold ambient conditions impaired endogenous pain-inhibitory pathways, an outcome not observed under thermoneutral conditions. Furthermore, the results suggest that thermal comfort does not influence endogenous pain-inhibitory pathways. Further research is required to identify moderators affecting pain processing in cold working environments. Regional Ethics Committee, Norway (REK sør-øst C; application # 2017/1859).

To examine the mediating role of catastrophizing in the relationship between pain and disability among patients with carpal tunnel syndrome (CTS). Cross-sectional register of 141 patients with CTS. Pain Catastrophizing Scale (PCS) was used. Mediation analysis was used to assess the indirect effect of pain catastrophizing on pain-related disability. The average age was 54.0 (SD 16.1) years and 89 (63 %) were women. For the total PCS score, the indirect effect was responsible for 31 % (95 % CI 15 %-47 %) to 33 % (95 % CI 15 %-52 %). The highest proportion was observed in the helplessness domain, 37 % (95 % CI 19 %-55 %). The lowest effect of 11 % (95 % CI 0 %-23 %) was seen for the magnification domain. The mediating effect of catastrophizing was responsible for over 30 % of the total effect seen in correlation between pain and disability experienced by patients with CTS. While the effect of magnification sub-score was borderline and could probably be ignored in clinical context, domain of helplessness reached the effect size of almost 40 %. The results suggest that catastrophizing should be considered when treating or rehabilitating people with CTS. Catastrophizing may play a significant role in the development of pain-related disability.

Chronic pain and personality disorders frequently co-occur. This co-occurrence may pose challenges in pain management and should be addressed by clinicians to optimize outcomes. The Level of Personality Functioning Scale - Brief Form 2.0 (LPFS-BF) is a time-efficient screening tool for impairments in personality functioning based on the Alternative DSM-5 Model for Personality Disorders. This cross-sectional study evaluates the psychometric properties of the LPFS-BF in a sample of adults with chronic pain. Data was retrieved from the Oslo University Hospital Pain Registry and includes 892 participants referred to outpatient pain management. The psychometric properties of the LPFS-BF were investigated in terms of factor structure, scale reliability, and concurrent validity with anxiety and depression, health-related quality of life, and past week usual pain intensity. Mean age was 49 years and 64 % were female. A bifactor structure showed best model fit: Comparative fit index=0.995, Tucker-Lewis index=0.993, root mean square error of approximation=0.023, standardized root mean square residual=0.030. Scale reliability was good for the general factor (ω t =0.89, ω h =0.79), poor for the self domain (ω t =0.25, ω h =0.05), and questionable for the interpersonal domain (ω t =0.68, ω h =0.40). Explained common variance for the general factor was 68 % which supported essential unidimensionality. The magnitudes of the associations between the LPFS-BF and the investigated variables were comparable to previous research, thus supporting its concurrent validity. The results suggest that the LPFS-BF is best viewed as a unidimensional scale in the current sample and support the LPFS-BF as a valid and reliable screening tool for impairments in personality functioning among individuals with chronic pain.

Chronic pain represents a major public health challenge, substantially affecting daily functioning and overall well-being. While self-management strategies can be effective, they are often introduced only after pharmacological or surgical treatments have proven insufficient, highlighting the need for more personalized, accessible, and early interventions in primary care. However, the feasibility and practical implementation of such approaches remain insufficiently explored. Considering these challenges, the aims of this study were to co-create and to evaluate the feasibility of a personalized, multidisciplinary, and coordinated intervention for chronic pain management within municipal healthcare services. The intervention included a generic pain management course (part one) and a personalized second part offering various group-based courses. Participants (n = 70) were recruited through an orthopedic outpatient clinic and general practitioners. Individual consultations with course leaders were conducted before, during, and after the intervention. Questionnaires assessing health-related quality of life, alcohol consumption, medication use, and sleep were administered at baseline, midway, and post-intervention, along with a self-reported evaluation of the intervention after completion. Among the total participants (n = 70), 81% completed Part 1 of the intervention, while 61% completed the entire intervention. At baseline, participants had a mean EQ-5D-5L score of 0.65 and an EQ-VAS score of 48.8. Regarding alcohol use, 47% were drinking once a month or less, and no participants were drinking alcohol four or more times a week. Insomnia was reported by 84%. Paracetamol was the most used daily medication (41%), followed by non-steroidal anti-inflammatory drugs and weak opioids (26% each). In Part 2 of the intervention, stress management courses were the most frequently selected (26%), followed closely by physical activity and body-mind activity at 23%. Most participants reported benefit, with 63% (Part 1) and 56% (Part 2) indicating good or very good benefit, and 98% would recommend it to others. This feasibility study demonstrates the potential for addressing the complex needs of individuals with chronic pain through a personalized and multidisciplinary intervention in primary care. The high completion rates indicate feasibility and acceptability. The findings support further evaluation of resource use, implementation, and effectiveness in future controlled trials.

Persistent severe intensity pain after groin hernia repair (PSPG; 200-400/10,000 repairs) is a significant surgical complication impacting the activity of daily living (ADL) and psychosocial functioning. This PhD synopsis presents an outline and a summary of three clinical studies examining outcomes and pathophysiology behind the post-surgical pain state. The studies assessed (I) treatment outcomes, i.e., re-surgery with meshectomy and selective neurectomy vs pharmacotherapy, (II) temporal trajectories of pain intensity following the primary repair, and (III) somatosensory profiles before and after re-surgery. On a national basis, patients experiencing PSPG (>3 months) with an activity-related or maximal pain intensity >7 (NRS; 0-10) referred to our unit were examined. Validated questionnaires classifying NRS, ADL functions, and psychometrics, and standardized quantitative sensory testing assessing somatosensory phenotypes were used. Study I was a prospective, questionnaire-based cohort analysis comparing outcomes from a 5-year perspective. Study II retrospectively examined patient-reported pain intensity trajectories. Study III followed somatosensory outcomes before and after re-surgery. In Study I (responder ratio: 172/204 [84%]), patients were allocated to re-surgery (n = 54) or to pharmacotherapy (n = 118). Compared to baseline, both cohorts showed significant improvements in pain intensity and ADL functions (P < 0.0001), with a slight superiority in ADL functions for the re-surgical cohort (P = 0.02). The number needed to operate for one patient to achieve a positive outcome (&#x2265;25% change in NRS/ADL) ranged between 1.5 and 1.9, and for experiencing a negative outcome, between 14 and 28. Study II (n = 95) identified two main prototypes of post-surgical pain intensity trajectories, where 51% experienced undiminished pain after the primary repair, while 29% experienced normal post-surgical recovery followed by late development of PSPG. Study III (n = 60) indicated that re-surgery was associated with a loss in the cutaneous somatosensory function and deep mechanical nociceptive function (decrease in evoked pain sensitivity). The thesis corroborates that both re-surgical intervention and pharmacotherapy may ameliorate high-intensity pain and increase ADL functions in PSPG. Since the study design cannot account for non-specific therapeutic effects, a high-quality RCT is still needed. The pathophysiologic results indicate that the implanted mesh acts as a "pain generator", and future research should be targeted at dampening the immuno-inflammatory response to the implanted mesh.

Sleep and pain are reciprocally linked, each exacerbating functional impairments. In this observational cohort study, we examined differences in insomnia symptom severity among patients whose pain diagnoses, originally classified according to the International Classification of Diseases, 10th edition (ICD-10), were transformed into ICD-11 chronic pain categories. We further investigated whether the severity of insomnia symptoms at intake at a specialized pain clinic could predict pain outcomes 12 months&#xa0;later. Data were drawn from 4,283 patients registered in the Oslo University Hospital Pain Registry. Baseline data from 3,705 patients were analyzed for differences in insomnia severity (measured using the Insomnia Severity Index, ISI) across ICD-11 chronic pain categories. At follow-up, 1,163 patients were included to test whether baseline insomnia severity predicted pain intensity and bothersomeness at 12-month follow-up using hierarchical linear regression models. The severity of insomnia symptoms (0-28, ISI) was slightly lower in chronic primary pain (Mean 15.3, SD=6.77) compared to chronic neuropathic pain (Mean 16.3, SD=6.65), adjusted p=0.017. No differences were observed between other chronic pain categories. After adjusting for age, gender, baseline pain scores, and psychological characteristics, a higher baseline severity of insomnia symptoms predicted greater pain intensity and bothersomeness at follow-up. While the severity of insomnia symptoms appears to be equally distributed across ICD-11 chronic pain categories and has a substantial impact on the long-term intensity and bothersomeness of pain, it is largely ignored in clinical guidelines. Findings suggest that early, targeted interventions for insomnia symptoms may benefit patients.

Patients with non-specific neck, back, and/or chronic pain increasingly seek information about their condition on websites of healthcare practitioners. This information can influence their treatment expectation and should align with contemporary biopsychosocial (BPS) understanding of pain. It is unclear whether Dutch websites in the fields of rehabilitation and anaesthesiology align with the BPS model. The aim of this study is to assess the BPS content about non-specific neck, back, and chronic pain in Dutch rehabilitation and anaesthesiology websites. All Dutch rehabilitation and anaesthesiology webpages were potentially eligible for inclusion. All webpages focusing on the topics of neck, back, and chronic pain were included. BPS content analyses were performed according to a standardised rating method with criteria for biomedical, limited-, and reasonably BPS. Analyses were performed separately for specialisms, and for the three topics. Additionally, frequency of nocebo words usage on the websites is explored. A total of 71 webpages were included, of which 42 (59.2%) were rehabilitation, 28 (39.4%) were anaesthesiology webpages, and 1 webpage described both. Across all webpages, 7 (9.7%) were rated as biomedical, 54 (75.0%) limited BPS, and 11 (15.3%) reasonably BPS. Differences between specialisms were not significantly different (p = 0.055). Differences between BPS ratings and the topics were significant (p = 0.005). Nocebos were present on 22.2% (n = 16) of the webpages. Majority of the anaesthesiology and rehabilitation webpages (84.7%) did not achieve a "reasonable biopsychosocial" rate. Improvements are particularly needed in describing pain as a universal and/or normal phenomenon experienced by most individuals, as well as in explaining how an individual's environment influences their thoughts, emotions, and behaviours regarding pain perception.

Low back pain (LBP) is the leading cause of disability worldwide. Unhelpful beliefs, low pain resilience, and overreliance on imaging contribute to chronicity and poor outcomes. Despite growing recognition of psychosocial influences, culturally adapted assessment tools for Urdu-speaking populations are lacking. This study aimed to translate and cross-culturally adapt Urdu versions of the back pain attitudes questionnaire (BackPAQ), pain resilience scale (PRS), and medical scans beliefs questionnaire (MSBQ), and to conduct an initial evaluation of their structural validity and internal consistency. Following Beaton's six-step protocol and COSMIN guidelines, the BackPAQ, PRS, and MSBQ were translated and culturally adapted into Urdu. A cross-sectional sample of 461 adults with LBP (mean age=38.5&#xa0;&#xb1;&#xa0;12.3 years; 66.6&#x202f;% female) completed the translated instruments. Item distributions, internal consistency, and exploratory factor analyses (EFA) were examined. Reliability was evaluated using Cronbach's &#x3b1; and standard error of measurement (SEM). Associations with established Urdu versions of the oswestry disability index and pain catastrophizing scale, were visually examined using scatter&#xa0;plots. EFA supported a four-factor structure for the Urdu BackPAQ (14 items, 46.0&#x202f;% variance explained, &#x3b1;=0.69). The PRS retained its original two-factor structure (51.5&#x202f;% variance explained, &#x3b1;=0.88), and the MSBQ demonstrated a unidimensional structure (46.2&#x202f;% variance explained, &#x3b1;=0.71). Scatter plots indicated small, directionally consistent associations between the Urdu instruments with disability and catastrophizing. The Urdu versions of the BackPAQ, PRS, and MSBQ demonstrated acceptable structural validity and internal consistency, with the PRS showing excellent content validity. Test-retest reliability, responsiveness, and predictive validity should be evaluated in future clinical and longitudinal studies before broader clinical application.