1
|
Odsbu I, Hjellvik V, Handal M, Hamina A, Clausen T, Lid TG, Borchgrevink PC, Skurtveit S. Psykiske lidelser og plager ved vedvarende opioidbruk for langvarige ikke-kreftrelaterte smerter – en registerstudie. Tidsskr Nor Laegeforen 2024; 144:23-0414. [PMID: 38349107 DOI: 10.4045/tidsskr.23.0414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Knowledge of mental disorders among patients with persistent opioid use for the treatment of chronic non-cancer pain is essential, as mental disorders and symptoms can exacerbate or perpetuate pain and impact on the ability of patients to manage their illness. We have studied the prevalence of mental disorders and symptoms, including substance use disorders, in patients with persistent opioid use in 2019. Material and method Persons ≥ 18 years with persistent opioid use and persons ≥ 18 years with at least one registered mental disorder in the specialist healthcare service in 2019 were included. Data were retrieved from national health registries in Norway. Patients who received opioids reimbursed for the treatment of chronic pain were compared with those who received opioids without reimbursement. Results The prevalence of mental disorders and symptoms was 34 % among 14 403 persons who received reimbursed opioids, and 42 % among 38 001 persons who received opioids without reimbursement. This is equivalent to a two to threefold increase in prevalence compared to the general population. There was a particularly higher prevalence of anxiety disorders and substance use disorders. The prevalence of mental disorders and symptoms was highest in the age group 18-44 years (49-55 %). Interpretation Among patients with persistent opioid use, a large proportion had mental disorders and symptoms, which are known risk factors for developing problematic opioid use and opioid use disorder.
Collapse
Affiliation(s)
- Ingvild Odsbu
- Avdeling for kroniske sykdommer, Folkehelseinstituttet
| | | | - Marte Handal
- Avdeling for kroniske sykdommer, Folkehelseinstituttet, og, Senter for rus- og avhengighetsforskning (SERAF), Universitetet i Oslo
| | | | - Thomas Clausen
- Senter for rus- og avhengighetsforskning (SERAF), Universitetet i Oslo
| | - Torgeir Gilje Lid
- Regionalt kompetansesenter for rusmiddelforskning i Helse-Vest, Stavanger universitetssjukehus, og, Det helsevitskaplege fakultet, Universitetet i Stavanger
| | - Petter C Borchgrevink
- Avdeling for smerte og sammensatte lidelser, St. Olavs hospital, og, Institutt for sirkulasjon og bildediagnostikk, NTNU
| | - Svetlana Skurtveit
- Avdeling for kroniske sykdommer, Folkehelseinstituttet, og, Senter for rus- og avhengighetsforskning (SERAF), Universitetet i Oslo
| |
Collapse
|
2
|
Myrenget ME, Rustøen T, Myskja A, Småstuen M, Rangul V, Håpnes O, Borchgrevink PC, Butler S, Selbæk G, Husebø B, Sandvik R. The effect of a music-based caregiving intervention on pain intensity in nursing home patients with dementia. A cluster-randomized controlled study. Pain 2024:00006396-990000000-00489. [PMID: 38189182 DOI: 10.1097/j.pain.0000000000003156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/26/2023] [Indexed: 01/09/2024]
Abstract
ABSTRACT Treatment of chronic pain in patients with dementia is challenging because they have reduced ability to report pain and are particularly vulnerable to side effects of analgesics. Different types of music-based therapy have been recommended and are used as an alternative to analgesics, but the evidence is lacking. Therefore, we performed a cluster-randomized controlled study (RCT) to reduce pain intensity using music-based caregiving (MBC) over 8 weeks in nursing home patients with dementia and chronic pain. We also investigated if the amount of MBC and different chronic pain syndromes would impact on the effect. Of the 645 patients, 498 patients from 36 wards in 12 nursing homes were screened for dementia and pain. Using the Clinical Dementia Rating Scale and the Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (range 0-10), 279 (71% females, 42% severe dementia) nursing home patients were randomized to intervention group (n = 134, 18 wards) or control group (n = 145, 18 wards). The main outcome was change in pain intensity before and after the intervention. The study did not reveal any effect of MBC on pain intensity when compared with the control group (B = -0.15, 95% CI [-0.72 to 0.43]). No significant difference was found within the intervention group analyzing the impact of intervention time (B = 0.73, 95% CI [-0.55 to 2.02]) or chronic primary vs secondary pain syndromes (B = 0.45, 95% CI [-0.05 to 0.96]). Our data from this first RCT on music and pain intensity in patients with dementia and chronic pain did not find an effect of MBC on pain.
Collapse
Affiliation(s)
- Martin Elstad Myrenget
- Department of Pain and Complex Disorders, Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tone Rustøen
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Milada Småstuen
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vegar Rangul
- Norwegian Resource Centre for Arts and Health, Nord University, Faculty of Nursing and Health Sciences, Levanger, Norway
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway
| | - Odd Håpnes
- Norwegian Resource Centre for Arts and Health, Nord University, Faculty of Nursing and Health Sciences, Levanger, Norway
| | - Petter C Borchgrevink
- Department of Pain and Complex Disorders, Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stephen Butler
- Department of Public Health & Caring Sciences, Family Medicine & Clinical Epidemiology, Uppsala University, Uppsala, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Geir Selbæk
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bettina Husebø
- Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Reidun Sandvik
- Centre for Care Research, West, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| |
Collapse
|
3
|
Gjerde LC, Skurtveit S, Handal M, Nesvåg R, Clausen T, Lid TG, Hamina A, Borchgrevink PC, Odsbu I. Mental disorder prevalence in chronic pain patients using opioid versus non-opioid analgesics: A registry-linkage study. Eur J Pain 2023. [PMID: 37133299 DOI: 10.1002/ejp.2121] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/29/2023] [Accepted: 04/20/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Chronic pain and mental disorders are leading causes of disability worldwide. Individuals with chronic pain are more likely to experience mental disorders compared to individuals without chronic pain, but large-scale estimates are lacking. We aimed to calculate overall prevalence of mental health diagnoses from primary and secondary care among individuals treated for chronic pain in 2019 and to compare prevalence among chronic pain patients receiving opioid versus non-opioid analgesics, according to age and gender. METHODS It is a population-based cohort study. Linked data from nationwide health registers on dispensed drugs and diagnoses from primary (ICPC-2) and secondary (ICD-10) health care. Chronic pain patients were identified as all patients over 18 years of age filling at least one prescription of an analgesic reimbursed for non-malignant chronic pain in both 2018 and 2019 (N = 139,434, 69.3% women). RESULTS Prevalence of any mental health diagnosis was 35.6% (95% confidence interval: 35.4%-35.9%) when sleep diagnoses were included and 29.0% (28.8%-29.3%) when excluded. The most prevalent diagnostic categories were sleep disorders (14% [13.8%-14.2%]), depressive and related disorders (10.1% [9.9%-10.2%]) and phobia and other anxiety disorders (5.7% [5.5%-5.8%]). Prevalence of most diagnostic categories was higher in the group using opioids compared to non-opioids. The group with the highest overall prevalence was young women (18-44 years) using opioids (50.1% [47.2%-53.0%]). CONCLUSIONS Mental health diagnoses are common in chronic pain patients receiving analgesics, particularly among young individuals and opioid users. The combination of opioid use and high psychiatric comorbidity suggests that prescribers should attend to mental health in addition to somatic pain. SIGNIFICANCE This large-scale study with nation-wide registry data supports previous findings of high psychiatric burden in chronic pain patients. Opioid users had significantly higher prevalence of mental health diagnoses, regardless of age and gender compared to users of non-opioid analgesics. Opioid users with chronic pain therefore stand out as a particularly vulnerable group and should be followed up closely by their physician to ensure they receive sufficient care for both their mental and somatic symptoms.
Collapse
Affiliation(s)
- L C Gjerde
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Promenta Research Center, University of Oslo, Oslo, Norway
| | - S Skurtveit
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Handal
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - R Nesvåg
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - T Clausen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T G Lid
- Centre for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, Stavanger, Norway
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - A Hamina
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - P C Borchgrevink
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pain and Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
| | - I Odsbu
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
4
|
Gotaas ME, Stiles TC, Bjørngaard JH, Borchgrevink PC, Fors EA. Corrigendum: Cognitive behavioral therapy improves physical function and fatigue in mild and moderate chronic fatigue syndrome: A consecutive randomized controlled trial of standard and short interventions. Front Psychiatry 2023; 13:1122220. [PMID: 36994226 PMCID: PMC10041654 DOI: 10.3389/fpsyt.2022.1122220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 03/16/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyt.2021.580924.].
Collapse
Affiliation(s)
- Merethe Eide Gotaas
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- National Competence Centre for Complex Symptom Disorders, St. Olav's University Hospital, Trondheim, Norway
- *Correspondence: Merethe Eide Gotaas
| | - Tore C. Stiles
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Petter C. Borchgrevink
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- National Competence Centre for Complex Symptom Disorders, St. Olav's University Hospital, Trondheim, Norway
| | - Egil A. Fors
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
5
|
Odsbu I, Handal M, Borchgrevink PC, Clausen T, Skurtveit S. Endringer i opioidbruken i Norge må tas på dypeste alvor. Tidsskr Nor Laegeforen 2022; 142:21-0909. [PMID: 35170914 DOI: 10.4045/tidsskr.21.0909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
6
|
Odsbu I, Handal M, Hjellvik V, Borchgrevink PC, Clausen T, Nesvåg R, Skurtveit S. Vedvarende bruk av opioider og samtidig bruk av andre vanedannende legemidler. Tidsskr Nor Laegeforen 2022; 142:21-0659. [PMID: 35170913 DOI: 10.4045/tidsskr.21.0659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Long-term use of opioids may have undesirable consequences. We have investigated long-term opioid use in patient groups that were prescribed opioids for various indications (chronic pain, palliative care, other (white prescriptions, not generally covered by the Norwegian National Insurance Scheme)) as well as the groups' concomitant use of some other addictive medications. MATERIAL AND METHOD Persons registered in the Norwegian Prescription Database with at least one filled prescription of an opioid in the period 2011-19 were included. Long-term use in a calendar year was defined as the dispensing of > 180 defined daily doses or > 4 500 mg oral morphine equivalents distributed over at least 3 periods of 3 months. RESULTS The number of long-term opioid users was 50 422 in 2011 and 59 996 in 2019 (10.1 and 10.7 % of all opioid users). The number who received opioids on blue prescription (partly covered by the Norwegian National Insurance Scheme) for chronic pain increased in the period by 9 952 persons, but the majority (n=38 006, 63.3 %) continued to receive opioids exclusively on white prescription in 2019. A total of 15 623 (41.1 %) and 14 881 (39.2 %), respectively, of the long-term opioid users who received opioids solely on white prescription in 2019 also received benzodiazepines and Z-hypnotics in the same year. Of the 23 967 long-term users who also received benzodiazepines, 88 % were dispensed opioids and benzodiazepines on the same day at least once in 2019. INTERPRETATION Prolonged prescribing of opioids on white prescription and concurrent prescribing of other addictive drugs may indicate undesirable use with no clear indication.
Collapse
|
7
|
Borchgrevink PC, Lundbom J. Om vonde hendelser som påvirker smertetilstander. Tidsskriftet 2022. [DOI: 10.4045/tidsskr.21.0596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
8
|
Borchgrevink PC, Glette M, Woodhouse A, Butler S, Landmark T, Romundstad P, Dale O, Stiles TC, Bonaa KH, Thorsvik D, Thünte S, Kaasa S. A Clinical Description of Chronic Pain in a General Population Using ICD-10 and ICD-11 (The HUNT Pain Examination Study). J Pain 2021; 23:337-348. [PMID: 34551343 DOI: 10.1016/j.jpain.2021.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/17/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022]
Abstract
The purpose was to present a total description, distribution, and ranking of chronic pain conditions in the general population. This was based on structured clinical examinations of a random sample from a population-based survey (HUNT3) with a calculated oversampling of participants with chronic pain. Supplemented with access to hospital reports, the examination was performed by experienced physicians and psychologists using a consistent definition of chronic pain as well as ICD-10- and the new ICD-11-classification. The main findings were that a higher proportion of the 551 participants had chronic pain assessed by clinical examination (399) than by self-report in a survey the same day (337). Among those with examination-verified chronic pain estimated from HUNT3 to represent 27.9% of the general population, 63% had chronic primary pain, 81% musculoskeletal pain, and 77% more than one chronic pain condition. When separating chronic primary from chronic secondary pain according to ICD-11, the weighted prevalence was 17.7% for chronic pain conditions of unknown and 10.2% of known cause. When all the participants' conditions were accounted for, the most prevalent was nonspecific low back (10.8%) and neck pain (7.6%). Participants with chronic primary pain did not have significantly more psychopathology than those with chronic secondary pain: 14.5% versus 12.5%. Perspective: Since this study confirms the high prevalence in self-report surveys and indicates that two thirds of chronic pain conditions cannot be explained by underlying diseases, this huge health and societal problem should be solved primarily on a public health level directed toward prevention and rehabilitation.
Collapse
Affiliation(s)
- Petter C Borchgrevink
- Department of Pain and Complex Disorders, Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Mari Glette
- Department of Pain and Complex Disorders, Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Astrid Woodhouse
- Department of Pain and Complex Disorders, Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stephen Butler
- Department of Public Health & Caring Sciences, Family Medicine & Clinical Epidemiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Tormod Landmark
- Department of Pain and Complex Disorders, Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Romundstad
- Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ola Dale
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore C Stiles
- Department of psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kaare H Bonaa
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dagfinn Thorsvik
- Department of Rehabilitation, Levanger Hospital, Levanger, Norway
| | - Sabina Thünte
- Department of Rehabilitation, Levanger Hospital, Levanger, Norway; Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, Oslo, Norway; European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
9
|
Odsbu I, Handal M, Hjellvik V, Borchgrevink PC, Clausen T, Hamina A, Lid TG, Nesvåg R, Skurtveit S. Bruk av andre vanedannende legemidler blant opioidbrukere med langvarige smerter. Nor J Epidemiol 2021. [DOI: 10.5324/nje.v29i1-2.4045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bakgrunn: Opioider for behandling av langvarige smerter kan forskrives på blå resept, men bør ikke brukessamtidig med andre vanedannende legemidler.Hensikt: Å undersøke bruk av opioider på blå resept i perioden 2009-2019, samt å studere bruk av andre vanedannendelegemidler (benzodiazepiner og z-hypnotika) blant dem som fikk opioider på blå resept i 2019.Metode: Data ble hentet fra Reseptregisteret. En prevalent opioidbruker i 2019 ble definert som en person medminst én utlevering av et smertestillende opioid på blå resept for langvarige smerter også i 2018. Bruk av andrevanedannende legemidler ble definert som minst én utlevering av et annet vanedannende legemiddel i løpet avsamme år.Resultater: Totalt 18 443 personer (67% kvinner) fikk utlevert opioider på blå resept i 2019, en økning fra5 568 i 2009 via 10 693 i 2016 og 16 133 i 2017. Av de 18 443 var 14 202 (77%) prevalente opioidbrukere.Blant de prevalente brukerne fikk 88% utlevert 100 mg orale morfinekvivalenter (OMEQ) eller mindre perdag. Totalt fikk 54% av de prevalente opioidbrukerne utlevert minst ett annet vanedannende legemiddel i 2019.Z-hypnotika var oftest forekommende blant de som brukte 100 mg OMEQ eller mindre per dag, mens benzodiazepineralene eller i kombinasjon med z-hypnotika dominerte blant opioidbrukerne som fikk utlevert merenn 100 mg OMEQ per dag. Mengden utlevert av andre vanedannende legemidler økte med mengden opioiderbrukt per dag. En større andel kvinner enn menn fikk utlevert andre vanedannende legemidler i 2019.Konklusjon: Studien indikerer at bruk av andre vanedannende legemidler forekommer hos en stor andel avdem som får forskrevet opioider på blå resept. Dette er tegn på et uheldig forskrivningsmønster som børstuderes nærmere.
Collapse
|
10
|
Glette M, Stiles TC, Jensen MP, Nilsen TIL, Borchgrevink PC, Landmark T. Impact of pain and catastrophizing on the long-term course of depression in the general population: the HUNT pain study. Pain 2021; 162:1650-1658. [PMID: 33416223 DOI: 10.1097/j.pain.0000000000002168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/07/2020] [Indexed: 12/30/2022]
Abstract
ABSTRACT Pain and depression are episodic conditions that might take a chronic course. They are clearly related, but information on how they influence each other in the process of chronification is limited. Pain catastrophizing is hypothesized to play a role in the development of depression and chronic pain, but few longitudinal studies have investigated their association over a longer term. In this study, a random cohort from the general population (n = 4764) answered questions about pain, catastrophizing, and depression at 5 assessments in yearly intervals. Linear mixed models showed that within persons, increases in pain intensity and catastrophizing were independently associated with increases in depressive symptoms {mean change = -1.12, 95% confidence interval (CI) [-1.32 to -0.91] and -1.29, 95% CI [-1.52 to -1.05], respectively}. In prospective analyses restricted to individuals without depression above cutoff at baseline, chronic pain increased the risk of endorsing depression over the following 4 years (odds ratio = 2.01, 95% CI [1.71-2.37]). Seven percent showed a chronic course of depression, as indicated by scores above cutoff on at least 3 of 5 assessments. The number of years lived with chronic pain was associated with a chronic course of depression, with odds ratios increasing from 1.55 (95% CI [0.87-2.91]) to 14.19 (95% CI [8.99-22.41]) when reporting chronic pain on 2 vs 5 assessments compared with none. The results suggest that when pain intensity or catastrophizing change, depressive symptoms change in the same direction. When pain and catastrophizing become chronic, they seem to be mutually reinforcing determinants for chronic depression.
Collapse
Affiliation(s)
- Mari Glette
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
| | - Tore C Stiles
- National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Tom Ivar Lund Nilsen
- National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Petter C Borchgrevink
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
| | - Tormod Landmark
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
| |
Collapse
|
11
|
Gotaas ME, Stiles TC, Bjørngaard JH, Borchgrevink PC, Fors EA. Cognitive Behavioral Therapy Improves Physical Function and Fatigue in Mild and Moderate Chronic Fatigue Syndrome: A Consecutive Randomized Controlled Trial of Standard and Short Interventions. Front Psychiatry 2021; 12:580924. [PMID: 33912079 PMCID: PMC8071989 DOI: 10.3389/fpsyt.2021.580924] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/17/2021] [Indexed: 01/29/2023] Open
Abstract
Objective: To study whether standard cognitive behavioral therapy (CBT) and a shorter, interpersonal oriented cognitive behavioral therapy (I-CBT) can improve physical function and fatigue in patients diagnosed with mild to moderate chronic fatigue syndrome (CFS) in a multidisciplinary fatigue clinic. Design: Consecutively 236 participants 18-62 years old meeting the Centre of Decease Control, CDC 1994 criteria, with a subsample also fulfilling the Canadian criteria for CFS, were randomly allocated to one of three groups. Two intervention groups received either 16 weeks of standard CBT or 8 weeks of I-CBT vs. a waiting-list control group (WLC). Primary outcome was the subscale Physical Function (PF) from SF-36 (0-100). Secondary outcome was amongst others fatigue measured by Chalder Fatigue Questionnaire (CFQ) (0-33). Outcomes were repeatedly measured up to 52 weeks from baseline. Results: The additional effect relative to baseline at post-intervention for SF-36 physical function was 14.2 (95% CI 7.9-20.4 p < 0.001) points higher for standard CBT and 6.8 (0.5-13.2 p = 0.036) points higher for I-CBT compared with the control group. The additional effect relative to baseline at post-intervention for fatigue was 5.9 (95% CI 0.5-10.5 p = 0.03) points lower for standard CBT compared with the control group but did not differ substantially for I-CBT 4.8 (95% CI -0.4 to 9.9 p = 0.07). The positive change in physical function persisted at 1-year follow-up for both treatment groups, and for standard CBT also in fatigue. The two intervention groups did not differ significantly in self-reported physical function and fatigue at the 1-year follow-up. No serious adverse reactions were recorded in any of the groups during the trial period. Interpretation: A 16-week standard, individual CBT intervention improves physical function and fatigue in CFS outpatients with mild to moderate disease. A shorter 8-week I-CBT program improves physical function. Both treatments are safe, and the effect persist 1 year after baseline. Clinical Trial registration: ClinicalTrials.gov, Identifier: NCT00920777, registered June 15, 2009. REK-project number: 4.2008.2586, registered April 2, 2008. Funding: The Liaison Committee for Education, Research and Innovation in Central Norway.
Collapse
Affiliation(s)
- Merethe Eide Gotaas
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,National Competence Centre for Complex Symptom Disorders, St. Olav's University Hospital, Trondheim, Norway
| | - Tore C Stiles
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Petter C Borchgrevink
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,National Competence Centre for Complex Symptom Disorders, St. Olav's University Hospital, Trondheim, Norway
| | - Egil A Fors
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
12
|
Skurtveit S, Hjellvik V, Sakshaug S, Borchgrevink PC, Larsen BM, Clausen T, Skovlund E, Heggen EE, Handal M. Prescribing of opioids for chronic pain on reimbursable prescription. Tidsskr Nor Laegeforen 2020; 140:20-0153. [PMID: 33118769 DOI: 10.4045/tidsskr.20.0153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND In 2008 the reimbursable prescription scheme was amended so that patients with severe, chronic pain could be prescribed opioids on reimbursable prescription. The purpose of this study was to investigate the prescribing of opioids on reimbursable prescription, the proportion of patients who started opioid treatment on reimbursable prescription who became long-term users, and the number of patients in 2018 who received higher dosages than the reimbursable prescription scheme permits. MATERIAL AND METHOD Data were retrieved from the Norwegian Prescription Registry. Persons aged 18 or over who were dispensed at least one opioid on reimbursable prescription for severe, chronic pain in the period 2008-2018, were included. RESULTS The number of patients who were prescribed opioids on reimbursable prescription increased during the study period, and in 2018 the number was 17 383. Of these, 331 (1.9 %) were prescribed more than 300 mg oral morphine equivalents per day. After nine years, 48 % of the patients who started with opioids in 2009 were still being prescribed opioids on reimbursable prescription. INTERPRETATION A high proportion of patients with severe, chronic pain who started with opioids on reimbursable prescription became long-term users. A number of patients received higher dosages than are recommended.
Collapse
|
13
|
Stedenfeldt M, Kvarstein G, Nilsen TIL, Schjødt B, Borchgrevink PC, Halsteinli V. Pre-consultation biopsychosocial data from patients admitted for management at pain centers in Norway. Scand J Pain 2020; 20:363-373. [DOI: 10.1515/sjpain-2019-0076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/12/2019] [Indexed: 01/13/2023]
Abstract
Abstract
Background and aims
A bio-psycho-social approach has been recommended in multidisciplinary pain clinics, and in Norway patients with severe chronic nonmalignant pain (CNMP, defined as pain that has persisted for more than 3 months) might be treated at a regional multidisciplinary pain center. The specific aims of this study were (1) to describe characteristics of a sample of outpatients referred and accepted for treatment/management to three regional multidisciplinary pain centers in Norway, (2) to examine patient differences between the centers and (3) to study associations between symptom scores (insomnia, fatigue, depression, anxiety) and patient characteristics.
Methods
Patients, aged 17 years or older with CNMP admitted to and given a date for first consultation at one of three tertiary, multidisciplinary pain centers: St. Olavs Hospital Trondheim University Hospital (STO), Haukeland University Hospital (HUS) and University Hospital of North Norway (UNN), were included in the study. Data on demographics, physical activity, characteristics of pain, previous traumatic events, social network, Insomnia Severity Index (ISI), Chalder Fatigue Questionnaire (CFQ), Hopkins Symptom Checklist-25 (HSCL-25) and SF-36v2® were retrieved from the local quality registry at each pain center.
Results
Data from 1563 patients [mean age 42 (SD 15) years and 63% females] were available for analyses. Average years with pain were 9.3 (SD 9.1). Primary education as highest level of education was reported by 20%, being actively working/student/military by 32%, and no physical activity by 31%. Further, 48% reported widespread pain, 61% reported being exposed to serious life event(s), and 77% reported having a close friend to talk to. Non-worker status, no physical activity, lack of social network, reports of being exposed to serious life event(s) and widespread pain were all characteristics repeatedly associated with clinically high symptom scores. No significant differences between the centers were found in the proportions of patients reporting fatigue nor mean levels of insomnia symptoms. However, the proportion of patients reporting symptoms of anxiety and depression was a little lower at UNN compared with STO and HUS.
Conclusions
Analyses of registry data from three tertiary multidisciplinary pain centers in Norway support previous findings from other registry studies regarding patient characterized: A large proportion being women, many years of pain, low employment rate, low physical activity rate, and a large proportion reporting previous traumatic event(s). Characteristics such as non-work participation, no physical activity, lack of social network, have been exposed to serious life event(s), and chronic widespread pain were all associated with high clinical score levels of insomnia, fatigue, and mental distress. Health related quality of life was low compared to what has been reported for a general population and a range of other patient groups.
Implications
The findings of this study indicate that physical activity and work participation might be two important factors to address in the rehabilitation of patients with chronic non-malignant pain. Future studies should also explore whether pre consultation self-reported data might give direction to rehabilitation modalities.
Collapse
Affiliation(s)
- Mona Stedenfeldt
- Regional Center for Health Care Improvement, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway , Phone: 0047 – 97676008
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
- National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway
| | - Gunnvald Kvarstein
- Department of Clinical Medicine, UiT , The Arctic University of Norway , Tromsø , Norway
- Department of Pain Management , University Hospital of Northern Norway , Tromsø , Norway
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing , Norwegian University of Science and Technology , Trondheim , Norway
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway
| | - Borrik Schjødt
- Centre for Pain Management and Palliative Care, Haukeland University Hospital , Bergen , Norway
| | - Petter C. Borchgrevink
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
- National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway
| | - Vidar Halsteinli
- Regional Center for Health Care Improvement, St. Olavs Hospital , Trondheim University Hospital , Trondheim , Norway , Phone: 0047 – 97676008
- Department of Public Health and Nursing , Norwegian University of Science and Technology , Trondheim , Norway
| |
Collapse
|
14
|
Skagseth M, Fimland MS, Rise MB, Johnsen R, Borchgrevink PC, Aasdahl L. Effectiveness of adding a workplace intervention to an inpatient multimodal occupational rehabilitation program: A randomized clinical trial. Scand J Work Environ Health 2019; 46:356-363. [PMID: 31834410 PMCID: PMC8506308 DOI: 10.5271/sjweh.3873] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives This study aimed to evaluate the effectiveness of a workplace intervention (WI) added to an inpatient multimodal occupational rehabilitation program (I-MORE) on sickness absence. Methods In this researcher-blinded randomized controlled trial with parallel groups, individuals on sick leave due to musculoskeletal, unspecified- or common mental health disorders were randomized to I-MORE (N=87) or I-MORE+WI (N=88). I-MORE lasted 2+1 weeks (with one week at home in between) and consisted of “acceptance and commitment therapy”, physical exercise, and work-related problem solving. The additional WI consisted of a preparatory part, a workplace meeting involving the sick-listed worker, the employer, and the primary rehabilitation therapist at the rehabilitation center, and follow-up work related to the meeting. The primary outcomes were number of sickness absence days and time until sustainable return to work (RTW) during 12 months of follow-up, measured by registry data. Results The median number of sickness absence days during the 12-month follow-up for I-MORE was 115 days [interquartile range (IQR) 53–183] versus 130 days (IQR 81–212) for I-MORE+WI. The difference between groups was not statistically significant (P=0.084). The hazard ratio for sustainable RTW was 0.74 (95% confidence interval 0.48–1.16; P=0.192) in favor of I-MORE. Conclusions This study provided no evidence in favor of I-MORE+WI compared to only I-MORE for long-term sickness absent individuals with musculoskeletal-, common mental- or unspecified disorders.
Collapse
Affiliation(s)
- Martin Skagseth
- Norwegian University of Science and Technology, Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Postboks 8905, 7491 Trondheim, Norway.
| | | | | | | | | | | |
Collapse
|
15
|
Glette M, Stiles TC, Borchgrevink PC, Landmark T. The Natural Course of Chronic Pain in a General Population: Stability and Change in an Eight-Wave Longitudinal Study Over Four Years (the HUNT Pain Study). J Pain 2019; 21:689-699. [PMID: 31698134 DOI: 10.1016/j.jpain.2019.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/06/2019] [Accepted: 10/30/2019] [Indexed: 12/22/2022]
Abstract
Epidemiological studies have to a little extent addressed the potential fluctuations of chronic pain over time, and there is a lack of information about the long-term course of pain using repeated measurements. We wanted to identify different trajectories of pain during 8 waves of follow-up over 4 years among individuals in the general population reporting pain lasting at least 6 months at baseline. Secondarily, we wanted to investigate whether biopsychosocial factors at baseline were associated with the different pain trajectories. Longitudinal Latent Class Analysis was performed to classify a random sample of 1905 participants from a larger population-based study (HUNT3) into groups based on their longitudinal pain severity reporting. A five-class solution gave the best fit. The terms chosen to describe the pain trajectories were: "fluctuating" (n = 586 [31%]), "persistent mild" (n = 449 [24%]), "persistent moderate" (n = 414 [22%]), "persistent severe" (n = 251 [13%]), and "gradual improvement" (n = 205 [11%]). In a multinomial logistic regression model using "gradual improvement" as the reference category, the "persistent moderate", "persistent severe", and "fluctuating" pain groups were associated with chronic widespread pain, elevated levels of catastrophizing, and poorer mental health. The "persistent mild" group was associated with sleep difficulties only. This study finds that although most individuals have a stable pain course, individuals in the largest distinct trajectory reports pain that fluctuate between mild and moderate levels, thus fluctuating under and above the chronic pain definition using moderate pain or more as a criterion. PERSPECTIVE: When examining the long-term course of chronic pain in the general population, 5 trajectories emerge. Although most individuals have stable pain, the largest distinct trajectory fluctuated under and above the chronic pain cut-off, using moderate pain or more as a criterion. A dichotomous categorization of chronic pain may be overly simplistic.
Collapse
Affiliation(s)
- Mari Glette
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway.
| | - Tore C Stiles
- National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway; Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Petter C Borchgrevink
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
| | - Tormod Landmark
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; National Competence Centre for Complex Symptom Disorders, Clinic of Anesthesia and Intensive Care, St. Olav's University Hospital, Trondheim, Norway
| |
Collapse
|
16
|
Fluge Ø, Rekeland IG, Lien K, Thürmer H, Borchgrevink PC, Schäfer C, Sørland K, Aßmus J, Ktoridou-Valen I, Herder I, Gotaas ME, Kvammen Ø, Baranowska KA, Bohnen LMLJ, Martinsen SS, Lonar AE, Solvang AEH, Gya AES, Bruland O, Risa K, Alme K, Dahl O, Mella O. B-Lymphocyte Depletion in Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. Ann Intern Med 2019; 170:585-593. [PMID: 30934066 DOI: 10.7326/m18-1451] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Previous phase 2 trials indicated benefit from B-lymphocyte depletion in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). OBJECTIVE To evaluate the effect of the monoclonal anti-CD20 antibody rituximab versus placebo in patients with ME/CFS. DESIGN Randomized, placebo-controlled, double-blind, multicenter trial. (ClinicalTrials.gov: NCT02229942). SETTING 4 university hospitals and 1 general hospital in Norway. PATIENTS 151 patients aged 18 to 65 years who had ME/CFS according to Canadian consensus criteria and had had the disease for 2 to 15 years. INTERVENTION Treatment induction with 2 infusions of rituximab, 500 mg/m2 of body surface area, 2 weeks apart, followed by 4 maintenance infusions with a fixed dose of 500 mg at 3, 6, 9, and 12 months (n = 77), or placebo (n = 74). MEASUREMENTS Primary outcomes were overall response rate (fatigue score ≥4.5 for ≥8 consecutive weeks) and repeated measurements of fatigue score over 24 months. Secondary outcomes included repeated measurements of self-reported function over 24 months, components of the Short Form-36 Health Survey and Fatigue Severity Scale over 24 months, and changes from baseline to 18 months in these measures and physical activity level. Between-group differences in outcome measures over time were assessed by general linear models for repeated measures. RESULTS Overall response rates were 35.1% in the placebo group and 26.0% in the rituximab group (difference, 9.2 percentage points [95% CI, -5.5 to 23.3 percentage points]; P = 0.22). The treatment groups did not differ in fatigue score over 24 months (difference in average score, 0.02 [CI, -0.27 to 0.31]; P = 0.80) or any of the secondary end points. Twenty patients (26.0%) in the rituximab group and 14 (18.9%) in the placebo group had serious adverse events. LIMITATION Self-reported primary outcome measures and possible recall bias. CONCLUSION B-cell depletion using several infusions of rituximab over 12 months was not associated with clinical improvement in patients with ME/CFS. PRIMARY FUNDING SOURCE The Norwegian Research Council, Norwegian Regional Health Trusts, Kavli Trust, MEandYou Foundation, and Norwegian ME Association.
Collapse
Affiliation(s)
- Øystein Fluge
- Haukeland University Hospital, Bergen, Norway (Ø.F., I.G.R., K.S., J.A., I.K., O.B., K.R., K.A.)
| | - Ingrid G Rekeland
- Haukeland University Hospital, Bergen, Norway (Ø.F., I.G.R., K.S., J.A., I.K., O.B., K.R., K.A.)
| | - Katarina Lien
- Oslo University Hospital, Oslo, Norway (K.L., I.H., S.S.M.)
| | | | | | - Christoph Schäfer
- University Hospital of Northern Norway, Tromsø, Norway (C.S., L.M.B., A.E.G.)
| | - Kari Sørland
- Haukeland University Hospital, Bergen, Norway (Ø.F., I.G.R., K.S., J.A., I.K., O.B., K.R., K.A.)
| | - Jörg Aßmus
- Haukeland University Hospital, Bergen, Norway (Ø.F., I.G.R., K.S., J.A., I.K., O.B., K.R., K.A.)
| | - Irini Ktoridou-Valen
- Haukeland University Hospital, Bergen, Norway (Ø.F., I.G.R., K.S., J.A., I.K., O.B., K.R., K.A.)
| | - Ingrid Herder
- Oslo University Hospital, Oslo, Norway (K.L., I.H., S.S.M.)
| | - Merethe E Gotaas
- St. Olavs Hospital, Trondheim, Norway (P.C.B., M.E.G., Ø.K., K.A.B., A.H.S.)
| | - Øivind Kvammen
- St. Olavs Hospital, Trondheim, Norway (P.C.B., M.E.G., Ø.K., K.A.B., A.H.S.)
| | | | - Louis M L J Bohnen
- University Hospital of Northern Norway, Tromsø, Norway (C.S., L.M.B., A.E.G.)
| | | | - Ann E Lonar
- Notodden Hospital, Notodden, Norway (H.T., A.E.L.)
| | - Ann-Elise H Solvang
- St. Olavs Hospital, Trondheim, Norway (P.C.B., M.E.G., Ø.K., K.A.B., A.H.S.)
| | - Arne E S Gya
- University Hospital of Northern Norway, Tromsø, Norway (C.S., L.M.B., A.E.G.)
| | - Ove Bruland
- Haukeland University Hospital, Bergen, Norway (Ø.F., I.G.R., K.S., J.A., I.K., O.B., K.R., K.A.)
| | - Kristin Risa
- Haukeland University Hospital, Bergen, Norway (Ø.F., I.G.R., K.S., J.A., I.K., O.B., K.R., K.A.)
| | - Kine Alme
- Haukeland University Hospital, Bergen, Norway (Ø.F., I.G.R., K.S., J.A., I.K., O.B., K.R., K.A.)
| | - Olav Dahl
- Haukeland University Hospital and University of Bergen, Bergen, Norway (O.D., O.M.)
| | - Olav Mella
- Haukeland University Hospital and University of Bergen, Bergen, Norway (O.D., O.M.)
| |
Collapse
|
17
|
Borchgrevink PC, Rustøen T. The prevalence of recurrent pain in childhood is high and increases with age. Scand J Pain 2019; 18:341-342. [PMID: 29958185 DOI: 10.1515/sjpain-2018-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Petter C Borchgrevink
- Department of Pain Complex Symptom Disorders, Clinic of Anaesthesia and Intensive Care, St. Olavs University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
18
|
Fredheim OMS, Kaasa S, C. Borchgrevink P. Smertebehandling ved kronisk kreftsykdom. Tidsskriftet 2019; 139:19-0226. [DOI: 10.4045/tidsskr.19.0226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
19
|
Vethe D, Kallestad H, Jacobsen HB, Landrø NI, Borchgrevink PC, Stiles TC. The Relationship Between Improvement in Insomnia Severity and Long-Term Outcomes in the Treatment of Chronic Fatigue. Front Psychol 2018; 9:1764. [PMID: 30298037 PMCID: PMC6160743 DOI: 10.3389/fpsyg.2018.01764] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/31/2018] [Indexed: 11/22/2022] Open
Abstract
Background: The current treatments of choice for patients with chronic fatigue are moderately effective. One way to advance treatments is identifying process variables associated with good treatment outcomes. There is little knowledge regarding a possible association between insomnia and long-term outcomes in the treatment of chronic fatigue. Aims: Testing whether (1) improvement in insomnia is associated with improvement in levels of fatigue at 1-year follow-up, and (2) if such a relationship remains when controlling for improvement in levels of anxiety and depression, and pain in patients with chronic fatigue. Methods: Patients having been on sick leave 8 weeks or more due to chronic fatigue were referred to a return-to-work program. They received an intensive 3.5-week inpatient treatment program based on acceptance and commitment therapy (ACT). Before treatment and at 1-year follow-up the patients completed questionnaires assessing levels of insomnia severity, pain, anxiety and depression, and fatigue. Results: A regression analysis found that changes in insomnia-severity were associated with changes in fatigue-levels at 1-year follow-up. When changes in levels of anxiety and depression were entered in the regression analysis, anxiety and depression was significantly associated with levels of fatigue but insomnia was not. The association between anxiety and depression and fatigue was at a trend level when pain was entered into the model. Conclusion: Long-term improvement in insomnia severity was significantly associated with long-term improvement in chronic fatigue, but not independently of long-term improvement in anxiety and depression, and pain. Trial Registration:https://clinicaltrials.gov/, identifier NCT01568970.
Collapse
Affiliation(s)
- Daniel Vethe
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olav's University Hospital, Trondheim, Norway
| | - Henrik B Jacobsen
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway.,National Competence Center for Pain and Complex Disorders, St. Olav's University Hospital, Trondheim, Norway.,Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Nils Inge Landrø
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway.,National Competence Center for Pain and Complex Disorders, St. Olav's University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Petter C Borchgrevink
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway.,National Competence Center for Pain and Complex Disorders, St. Olav's University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore C Stiles
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
20
|
Glette M, Landmark T, Jensen MP, Woodhouse A, Butler S, Borchgrevink PC, Stiles TC. Catastrophizing, Solicitous Responses From Significant Others, and Function in Individuals With Neuropathic Pain, Osteoarthritis, or Spinal Pain in the General Population. The Journal of Pain 2018; 19:983-995. [DOI: 10.1016/j.jpain.2018.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 02/28/2018] [Accepted: 03/26/2018] [Indexed: 01/22/2023]
|
21
|
Hara KW, Bjørngaard JH, Jacobsen HB, Borchgrevink PC, Johnsen R, Stiles TC, Brage S, Woodhouse A. Biopsychosocial predictors and trajectories of work participation after transdiagnostic occupational rehabilitation of participants with mental and somatic disorders: a cohort study. BMC Public Health 2018; 18:1014. [PMID: 30111291 PMCID: PMC6094579 DOI: 10.1186/s12889-018-5803-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/04/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Group-based transdiagnostic occupational rehabilitation programs including participants with mental and somatic disorders have emerged in clinical practice. Knowledge is sparse on subsequent participation in competitive work. This study aimed to investigate trajectories for (re)entry to work for predefined subgroups in a diagnostically heterogeneous sample of sick-listed participants after completing occupational rehabilitation. METHODS A cohort of 212 participants aged 18-69 on long-term sick leave (> 8 weeks) with chronic pain, chronic fatigue and/or common mental disorders was followed for one year after completing a 3½-week rehabilitation intervention based on Acceptance and Commitment Therapy. Self-reported, clinical and registry data were used to study the associations between predefined biopsychosocial predictors and trajectories for (re)entry to competitive work (≥ 1 day per week on average over 8 weeks). Generalized estimating equations analysis was used to investigate trajectories. RESULTS For all biopsychosocial subgroups (re)entry to work increased over time. Baseline employment, partial sick leave and higher expectation of return to work (RTW) predicted higher probability of having (re)entered work at any given time after discharge. The odds of increasing reentry over time (statistical interaction with time) was weaker for the group receiving the benefit work assessment allowance compared with those receiving sickness benefit (OR = 0.92, p = 0.048) or for those on partial sick leave compared with full sick leave (OR 0.77, p < 0.001), but higher for those who at baseline had reported having a poor economy versus not (OR 1.16, p = 0.010) or reduced emotional functioning compared with not (OR 1.11, p = 0.012). Health factors did not differentiate substantially between trajectories. CONCLUSIONS Work participation after completing a transdiagnostic occupational rehabilitation intervention was investigated. Individual and system factors related to work differentiated trajectories for (re)entry to work, while individual health factors did not. Having a mental disorder did not indicate a worse prognosis for (re)entry to work following the intervention. Future trials within occupational rehabilitation are recommended to pivot their focus to work-related factors, and to lesser extent target diagnostic group.
Collapse
Affiliation(s)
- Karen Walseth Hara
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- The Norwegian Labour and Welfare Service of Trøndelag, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Forensic Department and Research Centre Brøset, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Henrik Børsting Jacobsen
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Petter C. Borchgrevink
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Roar Johnsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tore C. Stiles
- Department of Psychology, Faculty of Social Sciences and Educational Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Søren Brage
- The Norwegian Directorate for Labour and Welfare, Oslo, Norway
| | - Astrid Woodhouse
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| |
Collapse
|
22
|
Fredheim OMS, Skurtveit S, Borchgrevink PC. [Provision of analgesics to children before and after the new recommendations on codeine]. Tidsskr Nor Laegeforen 2017; 137:881-884. [PMID: 28655238 DOI: 10.4045/tidsskr.16.0717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
23
|
Jacobsen HB, Kallestad H, Landrø NI, Borchgrevink PC, Stiles TC. Processes in acceptance and commitment therapy and the rehabilitation of chronic fatigue. Scand J Psychol 2017; 58:211-220. [DOI: 10.1111/sjop.12363] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/03/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Henrik Børsting Jacobsen
- Hysnes Rehabilitation Center; St. Olav's University Hospital; Trondheim Norway
- National Competence Center for Complex Symptom Disorders; St. Olav's University Hospital; Trondheim Norway
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
| | - Håvard Kallestad
- Norwegian University of Science and Technology; Department of Neuroscience; Trondheim Norway
- Department of Psychiatry; St. Olav's University Hospital; Trondheim Norway
| | - Nils Inge Landrø
- National Competence Center for Complex Symptom Disorders; St. Olav's University Hospital; Trondheim Norway
- Clinical Neuroscience Research Group; Department of Psychology; University of Oslo; Oslo Norway
| | - Petter C. Borchgrevink
- Hysnes Rehabilitation Center; St. Olav's University Hospital; Trondheim Norway
- National Competence Center for Complex Symptom Disorders; St. Olav's University Hospital; Trondheim Norway
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
| | - Tore C. Stiles
- National Competence Center for Complex Symptom Disorders; St. Olav's University Hospital; Trondheim Norway
- Department of Psychology; Norwegian University of Science and Technology; Trondheim Norway
| |
Collapse
|
24
|
Aasvik JK, Woodhouse A, Stiles TC, Jacobsen HB, Landmark T, Glette M, Borchgrevink PC, Landrø NI. Effectiveness of Working Memory Training among Subjects Currently on Sick Leave Due to Complex Symptoms. Front Psychol 2017; 7:2003. [PMID: 28111555 PMCID: PMC5216020 DOI: 10.3389/fpsyg.2016.02003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 12/12/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction: The current study examined if adaptive working memory training (Cogmed QM) has the potential to improve inhibitory control, working memory capacity, and perceptions of memory functioning in a group of patients currently on sick leave due to symptoms of pain, insomnia, fatigue, depression and anxiety. Participants who were referred to a vocational rehabilitation center volunteered to take part in the study. Methods: Participants were randomly assigned to either a training condition (N = 25) or a control condition (N = 29). Participants in the training condition received working memory training in addition to the clinical intervention offered as part of the rehabilitation program, while participants in the control condition received treatment as usual i.e., the rehabilitation program only. Inhibitory control was measured by The Stop Signal Task, working memory was assessed by the Spatial Working Memory Test, while perceptions of memory functioning were assessed by The Everyday Memory Questionnaire-Revised. Results: Participants in the training group showed a significant improvement on the post-tests of inhibitory control when compared with the comparison group (p = 0.025). The groups did not differ on the post-tests of working memory. Both groups reported less memory problems at post-testing, but there was no sizeable difference between the two groups. Conclusions: Results indicate that working memory training does not improve general working memory capacity per se. Nor does it seem to give any added effects in terms of targeting and improving self-perceived memory functioning. Results do, however, provide evidence to suggest that inhibitory control is accessible and susceptible to modification by adaptive working memory training.
Collapse
Affiliation(s)
- Julie K. Aasvik
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and TechnologyTrondheim, Norway
| | - Astrid Woodhouse
- Hysnes Rehabilitation Center, St. Olav's University HospitalTrondheim, Norway
- National Competence Centre for Complex Disorders, St. Olav's University HospitalTrondheim, Norway
- Department of Public Health and General Practice, Norwegian University of Science of TechnologyTrondheim, Norway
| | - Tore C. Stiles
- Hysnes Rehabilitation Center, St. Olav's University HospitalTrondheim, Norway
- National Competence Centre for Complex Disorders, St. Olav's University HospitalTrondheim, Norway
- Department of Psychology, Norwegian University of Science and TechnologyTrondheim, Norway
| | - Henrik B. Jacobsen
- Hysnes Rehabilitation Center, St. Olav's University HospitalTrondheim, Norway
- National Competence Centre for Complex Disorders, St. Olav's University HospitalTrondheim, Norway
| | - Tormod Landmark
- National Competence Centre for Complex Disorders, St. Olav's University HospitalTrondheim, Norway
| | - Mari Glette
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and TechnologyTrondheim, Norway
| | - Petter C. Borchgrevink
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and TechnologyTrondheim, Norway
- Hysnes Rehabilitation Center, St. Olav's University HospitalTrondheim, Norway
- National Competence Centre for Complex Disorders, St. Olav's University HospitalTrondheim, Norway
| | - Nils I. Landrø
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and TechnologyTrondheim, Norway
| |
Collapse
|
25
|
Dale O, Klepstad P, Tveita T, Thoner J, Borchgrevink PC. Re: Fra ketobemidon til oksykodon. Tidsskriftet 2017; 137:423. [DOI: 10.4045/tidsskr.17.0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
26
|
Jacobsen HB, Aasvik JK, Borchgrevink PC, Landrø NI, Stiles TC. Metacognitions Are Associated with Subjective Memory Problems in Individuals on Sick Leave due to Chronic Fatigue. Front Psychol 2016; 7:729. [PMID: 27242634 PMCID: PMC4866616 DOI: 10.3389/fpsyg.2016.00729] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/29/2016] [Indexed: 11/13/2022] Open
Abstract
Background: Subjective cognitive impairments are frequent, but poorly understood in patients with chronic fatigue. We hypothesized that maladaptive metacognitive beliefs at baseline were associated with baseline subjective cognitive impairments, that they predict subjective cognitive impairments at treatment termination, and that a reduction in maladaptive metacognitive beliefs was associated with less subjective cognitive impairments at treatment termination, independent of changes in fatigue, pain, insomnia, depression, and anxiety. Methods: In this non-controlled study, patients (n = 137) on sick leave due to chronic fatigue received a 3.5-week inpatient RTW rehabilitation program. Of these patients 69 (50.4%) was referred with a ICPC-2 diagnosis of chronic fatigue. Patients completed questionnaires about metacognitive beliefs, somatic complaints, psychological complaints, and cognitive impairments before and after treatment. To test the hypotheses we performed paired t-tests of change, as well as seven hierarchical linear regressions. Results: Results showed that baseline maladaptive metacognitive beliefs were significantly associated with subjective cognitive impairments at baseline, controlling for symptoms. Score on baseline metacognitive beliefs did not predict impairments post-treatment. Testing specific maladaptive beliefs, pre-treatment scores on cognitive confidence were associated with subjective cognitive impairments both pre and post-treatment, controlling for symptoms. Post-treatment metacognitive beliefs and post-treatment cognitive confidence were associated with post-treatment subjective cognitive impairments, controlling for pre-treatment impairments and pre-treatment metacognitive beliefs, as well as pre and post-scores on symptom measures. Conclusion: This study reports associations between maladaptive metacognitive beliefs and subjective cognitive impairments in patients with chronic fatigue. Targeting metacognitive beliefs could prove an effective therapeutic intervention for subjective cognitive impairments in these patients.
Collapse
Affiliation(s)
- Henrik B Jacobsen
- Hysnes Rehabilitation Center, St. Olav's University HospitalTrondheim, Norway; National Competence Center for Pain and Complex Disorders, St. Olav's University HospitalTrondheim, Norway
| | - Julie K Aasvik
- Hysnes Rehabilitation Center, St. Olav's University HospitalTrondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and TechnologyTrondheim, Norway
| | - Petter C Borchgrevink
- Hysnes Rehabilitation Center, St. Olav's University HospitalTrondheim, Norway; National Competence Center for Pain and Complex Disorders, St. Olav's University HospitalTrondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and TechnologyTrondheim, Norway
| | - Nils I Landrø
- National Competence Center for Pain and Complex Disorders, St. Olav's University HospitalTrondheim, Norway; Clinical Neuroscience Research Group, Department of Psychology, University of OsloOslo, Norway
| | - Tore C Stiles
- National Competence Center for Pain and Complex Disorders, St. Olav's University HospitalTrondheim, Norway; Department of Psychology, Norwegian University of Science and TechnologyTrondheim, Norway
| |
Collapse
|
27
|
Hansen AB, Borchgrevink PC, Skurtveit S, Romundstad P, Fredheim OM. Consumption of and satisfaction with health care among opioid users with chronic non-malignant pain. Acta Anaesthesiol Scand 2016; 60:276. [PMID: 26508281 DOI: 10.1111/aas.12645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
|
29
|
Aasvik JK, Woodhouse A, Jacobsen HB, Borchgrevink PC, Stiles TC, Landrø NI. Subjective memory complaints among patients on sick leave are associated with symptoms of fatigue and anxiety. Front Psychol 2015; 6:1338. [PMID: 26441716 PMCID: PMC4561749 DOI: 10.3389/fpsyg.2015.01338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022] Open
Abstract
Objective: The aim of this study was to identify symptoms associated with subjective memory complaints (SMCs) among subjects who are currently on sick leave due to symptoms of chronic pain, fatigue, depression, anxiety, and insomnia. Methods: This was a cross-sectional study, subjects (n = 167) who were currently on sick leave were asked to complete an extensive survey consisting of the following: items addressing their sociodemographics, one item from the SF-8 health survey measuring pain, Chalder Fatigue Questionnaire, Hospital Anxiety and Depression Scale, Insomnia Severity Index, and Everyday Memory Questionnaire – Revised. General linear modeling was used to analyze variables associated with SMCs. Results: Symptoms of fatigue (p-value < 0.001) and anxiety (p-value = 0.001) were uniquely and significantly associated with perceived memory failures. The associations with symptoms of pain, depression, and insomnia were not statistically significant. Conclusions: Subjective memory complaints should be recognized as part of the complex symptomatology among patients who report multiple symptoms, especially in cases of fatigue and anxiety. Self-report questionnaires measuring perceived memory failures may be a quick and easy way to incorporate and extend this knowledge into clinical practice.
Collapse
Affiliation(s)
- Julie K Aasvik
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology Trondheim, Norway
| | - Astrid Woodhouse
- Hysnes Rehabilitation Center, St. Olav's University Hospital Trondheim, Norway ; National Competence Centre for Complex Disorders, St. Olav's University Hospital Trondheim, Norway ; Department of Public Health and General Practice, Norwegian University of Science of Technology Trondheim, Norway
| | - Henrik B Jacobsen
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology Trondheim, Norway ; Hysnes Rehabilitation Center, St. Olav's University Hospital Trondheim, Norway ; National Competence Centre for Complex Disorders, St. Olav's University Hospital Trondheim, Norway
| | - Petter C Borchgrevink
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology Trondheim, Norway ; Hysnes Rehabilitation Center, St. Olav's University Hospital Trondheim, Norway ; National Competence Centre for Complex Disorders, St. Olav's University Hospital Trondheim, Norway
| | - Tore C Stiles
- Hysnes Rehabilitation Center, St. Olav's University Hospital Trondheim, Norway ; National Competence Centre for Complex Disorders, St. Olav's University Hospital Trondheim, Norway ; Department of Psychology, Norwegian University of Science and Technology Trondheim, Norway
| | - Nils I Landrø
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology Trondheim, Norway ; National Competence Centre for Complex Disorders, St. Olav's University Hospital Trondheim, Norway ; Clinical Neuroscience Group, Department of Psychology, University of Oslo Oslo, Norway
| |
Collapse
|
30
|
Elvemo NA, Landrø NI, Borchgrevink PC, Håberg AK. A particular effect of sleep, but not pain or depression, on the blood-oxygen-level dependent response during working memory tasks in patients with chronic pain. J Pain Res 2015; 8:335-46. [PMID: 26185465 PMCID: PMC4500611 DOI: 10.2147/jpr.s83486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Patients with chronic pain (CP) are often reported to have deficits in working memory. Pain impairs working memory, but so do depression and sleep problems, which are also common in CP. Depression has been linked to changes in brain activity in CP during working memory tasks, but the effect of sleep problems on working memory performance and brain activity remains to be investigated. Methods Fifteen CP patients and 17 age-, sex-, and education-matched controls underwent blood-oxygen-level dependent (BOLD) functional magnetic resonance imaging at 3T while performing block design 0-back, 2-back, and paced visual serial addition test paradigms. Subjects also reported their level of pain (Brief Pain Inventory), depression (Beck Depression Inventory II), and sleep problems (Pittsburgh Sleep Quality Index) and were tested outside the scanner with neuropsychological tests of working memory. Results The CP group reported significantly higher levels of pain, depression, and sleep problems. No significant performance difference was found on the neuropsychological tests in or outside the scanner between the two groups. There were no correlations between level of pain, depression, and sleep problems or between these and the neuropsychological test scores. CP patients exhibited significantly less brain activation and deactivation than controls in parietal and frontal lobes, which are the brain areas that normally show activation and deactivation during working memory tasks. Sleep problems independently and significantly modulated the BOLD response to the complex working memory tasks and were associated with decreased brain activation in task-positive regions and decreased deactivation in the default mode network in the CP group compared to the control group. The pain and depression scores covaried with working memory activation. Discussion Sleep problems in CP patients had a significant impact on the BOLD response during working memory tasks, independent of pain level and depression, even when performance was shown not to be significantly affected.
Collapse
Affiliation(s)
- Nicolas A Elvemo
- Department of Neuroscience, Medical Faculty, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Nils I Landrø
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway ; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Petter C Borchgrevink
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway ; National Norwegian Advisory Unit for Complex Disorders, St Olav University Hospital, Trondheim, Norway
| | - Asta K Håberg
- Department of Neuroscience, Medical Faculty, Norwegian University of Science and Technology (NTNU), Trondheim, Norway ; Department of Medical Imaging, St Olav University Hospital, Trondheim, Norway
| |
Collapse
|
31
|
Abstract
BACKGROUND Breakthrough pain affects 40%-90% of patients with cancer pain. Nasal fentanyl is one of the recommended treatments, particularly if the breakthrough pain is of rapid onset. AIM To investigate the prevalence of use of nasal fentanyl, to study which strong opioids have been used prior to nasal fentanyl and to examine which opioids are used concomitantly with nasal fentanyl. DESIGN Longitudinal cohort study based on death cohorts defined according to year of death. SETTING/PARTICIPANTS The study is based on data from the complete national Norwegian Prescription Database. The study population included all persons in Norway who died in the years 2010, 2011 and 2012 and who had received nasal fentanyl with reimbursement for palliative treatment. RESULTS Of those who died from cancer in 2010, 2011 and 2012, 611 persons (2%) received dispensed prescriptions of nasal fentanyl. Two-thirds had received other short-acting strong opioids before nasal fentanyl. One quarter did not receive a long-acting opioid concomitantly with nasal fentanyl, but 68% of these received only one dispensed prescription of nasal fentanyl. Of those who received a long-acting opioid together with nasal fentanyl, transdermal fentanyl was the most common drug (65%). One-third received another short-acting opioid concomitantly with nasal fentanyl. CONCLUSION The use of nasal fentanyl was surprisingly low. There is a need for clinical research addressing the use of nasal fentanyl without a long-acting opioid for background pain and the use of nasal fentanyl together with another short-acting opioid.
Collapse
Affiliation(s)
- Olav Magnus S Fredheim
- Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Disorders, St. Olav's University Hospital, Trondheim, Norway Centre of Palliative Medicine, Surgical Division, Akershus University Hospital, Lørenskog, Norway
| | - Milada Mahic
- Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Svetlana Skurtveit
- Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Petter C Borchgrevink
- Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
| |
Collapse
|
32
|
Dale O, Borchgrevink PC, Fredheim OMS, Mahic M, Romundstad P, Skurtveit S. Prevalence of use of non-prescription analgesics in the Norwegian HUNT3 population: Impact of gender, age, exercise and prescription of opioids. BMC Public Health 2015; 15:461. [PMID: 25934132 PMCID: PMC4428499 DOI: 10.1186/s12889-015-1774-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/22/2015] [Indexed: 11/10/2022] Open
Abstract
Background There are concerns about potential increasing use of over-the-counter (OTC) analgesics. The aims of this study were to examine 1) the prevalence of self-reported use of OTC analgesics; 2) the prevalence of combining prescription analgesics drugs with OTC analgesics and 3) whether lifestyle factors such as physical activity were associated with prevalence of daily OTC analgesic use. Methods Questionnaire data from the Nord–Trøndelag health study (HUNT3, 2006–08), which includes data from 40,000 adult respondents. The questionnaire included questions on use of OTC analgesics, socioeconomic conditions, health related behaviour, symptoms and diseases. Data were linked to individual data from the Norwegian Prescription Database. A logistic regression was used to investigate the association between different factors and daily use of paracetamol and/or non-steroid anti-inflammatory drugs (NSAIDs) in patients with and without chronic pain. Results The prevalence of using OTC analgesics at least once per week in the last month was 47%. Prevalence of paracetamol use was almost 40%, compared to 19% and 8% for NSAIDs and acetylsalicylic acid (ASA), respectively. While the use of NSAIDs decreased and the use of ASA increased with age, paracetamol consumption was unaffected by age. Overall more women used OTC analgesics. About 3-5% of subjects using OTC analgesics appeared to combine these with the same analgesic on prescription. Among subjects reporting chronic pain the prevalence of OTC analgesic use was almost twice as high as among subjects without chronic pain. Subjects with little physical activity had 1.5-4 times greater risk of daily use of OTC compared to physically active subjects. Conclusions Use of OTC analgesics is prevalent, related to chronic pain, female gender and physical inactivity.
Collapse
Affiliation(s)
- Ola Dale
- Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Research and Innovation, St. Olav's University Hospital, Trondheim, Norway.
| | - Petter C Borchgrevink
- Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. .,National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Disorders, St. Olav's University Hospital, Trondheim, Norway.
| | - Olav Magnus S Fredheim
- Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. .,National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Disorders, St. Olav's University Hospital, Trondheim, Norway. .,Centre of palliative medicine, Akershus University Hospital, Lorenskog, Oslo, Norway.
| | - Milada Mahic
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, 0473, Norway.
| | - Pål Romundstad
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Svetlana Skurtveit
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, 0473, Norway. .,Norwegian Centre of Addiction Research, University of Oslo, Oslo, Norway.
| |
Collapse
|
33
|
Kallestad H, Jacobsen HB, Landrø NI, Borchgrevink PC, Stiles TC. The role of insomnia in the treatment of chronic fatigue. J Psychosom Res 2015; 78:427-432. [PMID: 25498318 DOI: 10.1016/j.jpsychores.2014.11.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 11/26/2014] [Accepted: 11/30/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND The definition of Chronic Fatigue Syndrome (CFS) overlaps with definitions of insomnia, but there is limited knowledge about the role of insomnia in the treatment of chronic fatigue. AIMS To test if improvement of insomnia during treatment of chronic fatigue was associated with improved outcomes on 1) fatigue and 2) cortisol recovery span during a standardized stress exposure. METHODS Patients (n = 122) with chronic fatigue received a 3.5-week inpatient return-to-work rehabilitation program based on Acceptance and Commitment Therapy, and had been on paid sick leave>8 weeks due their condition. A physician and a psychologist examined the patients, assessed medication use, and SCID-I diagnoses. Patients completed self-report questionnaires measuring fatigue, pain, depression, anxiety, and insomnia before and after treatment. A subgroup (n = 25) also completed the Trier Social Stress Test for Groups (TSST-G) before and after treatment. Seven cortisol samples were collected during each test and cortisol spans for the TSST-G were calculated. RESULTS A hierarchical regression analysis in nine steps showed that insomnia improvement predicted improvement in fatigue, independently of age, gender, improvement in pain intensity, depression and anxiety. A second hierarchical regression analysis showed that improvement in insomnia significantly predicted the cortisol recovery span after the TSST-G independently of improvement in fatigue. CONCLUSION Improvement in insomnia severity had a significant impact on both improvement in fatigue and the ability to recover from a stressful situation. Insomnia severity may be a maintaining factor in chronic fatigue and specifically targeting this in treatment could increase treatment response.
Collapse
Affiliation(s)
- Håvard Kallestad
- Norwegian University of Science and Technology, Department of Neuroscience, Trondheim, Norway; St. Olav's University Hospital, Department of Østmarka, Trondheim, Norway.
| | - Henrik B Jacobsen
- St. Olav's University Hospital, Hysnes Rehabilitation Center, Trondheim, Norway; St. Olav's University Hospital, National Competence Center for Pain and Complex Disorders, Trondheim, Norway; Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway
| | - Nils Inge Landrø
- St. Olav's University Hospital, Hysnes Rehabilitation Center, Trondheim, Norway; Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway; University of Oslo, Department of Psychology, Oslo, Norway
| | - Petter C Borchgrevink
- St. Olav's University Hospital, Hysnes Rehabilitation Center, Trondheim, Norway; St. Olav's University Hospital, National Competence Center for Pain and Complex Disorders, Trondheim, Norway; Norwegian University of Science and Technology, Department of Circulation and Medical Imaging, Trondheim, Norway
| | - Tore C Stiles
- St. Olav's University Hospital, National Competence Center for Pain and Complex Disorders, Trondheim, Norway; University of Oslo, Department of Psychology, Oslo, Norway; Norwegian University of Science and Technology, Department of Psychology, Trondheim, Norway
| |
Collapse
|
34
|
Abstract
BACKGROUND It is proposed that changes in reward processing in the brain are involved in the pathophysiology of pain based on experimental studies. The first aim of the present study was to investigate if reward drive and/or reward responsiveness was altered in patients with chronic pain (PCP) compared to controls matched for education, age and sex. The second aim was to investigate the relationship between reward processing and nucleus accumbens volume in PCP and controls. Nucleus accumbens is central in reward processing and its structure has been shown to be affected by chronic pain conditions in previous studies. METHODS Reward drive and responsiveness were assessed with the Behavioral Inhibition Scale/Behavioral Activation Scale, and nucleus accumbens volumes obtained from T1-weighted brain MRIs obtained at 3T in 19 PCP of heterogeneous aetiologies and 20 age-, sex- and education-matched healthy controls. Anhedonia was assessed with Beck's Depression Inventory II. RESULTS The PCP group had significantly reduced scores on the reward responsiveness, but not reward drive. There was a trend towards smaller nucleus accumbens volume in the PCP compared to control group. There was a significant positive partial correlation between reward responsiveness and nucleus accumbens volume in the PCP group adjusted for anhedonia, which was significantly different from the same relationship in the control group. CONCLUSIONS Reward responsiveness is reduced in chronic pain patients of heterogeneous aetiology, and this reduction was associated with nucleus accumbens volume. Reduced reward responsiveness could be a marker of chronic pain vulnerability, and may indicate reduced opioid function.
Collapse
Affiliation(s)
- N A Elvemo
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - N I Landrø
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,National Competence Centre for Complex Symptom Disorders, St. Olav's University Hospital, Trondheim, Norway
| | - P C Borchgrevink
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,National Competence Centre for Complex Symptom Disorders, St. Olav's University Hospital, Trondheim, Norway
| | - A K Håberg
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Medical Imaging, St. Olav's University Hospital, Trondheim, Norway
| |
Collapse
|
35
|
Jacobsen HB, Bjørngaard JH, Borchgrevink PC, Woodhouse A, Fimland MS, Hara KW, Stiles TC. Describing patients with a duration of sick leave over and under one year in Norway. Scand J Occup Ther 2014; 22:72-80. [PMID: 25328021 DOI: 10.3109/11038128.2014.957241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to describe the somatic, social, psychological, and work-related factors that characterize participants with a duration of sick leave over and under one year. METHODS During 2012, 181 patients on long-term sick leave were consecutively recruited and asked to answer an extensive survey. Several outcomes were reported, addressing work-related factors and somatic, psychological, and social symptoms. In cross-sectional analyses, sick leave duration was dichotomized as > or < one year, based on Norwegian legislation. Linear and logistic regressions were used to estimate population probabilities and means. RESULTS The estimated prevalence of pain, fatigue, anxiety, and depression was overall high. There was a tendency towards a higher prevalence of fatigue, anxiety, and depression in those with sick leave duration less than one year, with the exception of sleep problems, which was more frequent in the population with longer duration. Relationship with friends, family, co-workers, and the last workplace were worse in the population with longer duration. CONCLUSIONS Cross-sectional analyses indicated that social and work-related problems are more adverse in patients with longer duration of sick leave, while psychological and somatic symptoms appear less adverse. This is one of the first studies quantitatively demonstrating these differences through comprehensive, simultaneously measured self-report questionnaires.
Collapse
Affiliation(s)
- Henrik B Jacobsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology , Trondheim , Norway
| | | | | | | | | | | | | |
Collapse
|
36
|
Jacobsen HB, Bjørngaard JH, Hara KW, Borchgrevink PC, Woodhouse A, Landrø NI, Harris A, Stiles TC. The role of stress in absenteeism: cortisol responsiveness among patients on long-term sick leave. PLoS One 2014; 9:e96048. [PMID: 24788346 PMCID: PMC4008526 DOI: 10.1371/journal.pone.0096048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 04/03/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aimed to (1) See whether increased or decreased variation relate to subjective reports of common somatic and psychological symptoms for a population on long-term sick leave; and (2) See if this pattern in variation is correlated with autonomic activation and psychological appraisal. METHODS Our participants (n = 87) were referred to a 3.5-week return-to-work rehabilitation program, and had been on paid sick leave >8 weeks due to musculoskeletal pain, fatigue and/or common mental disorders. An extensive survey was completed, addressing socio-demographics, somatic and psychological complaints. In addition, a physician and a psychologist examined the participants, determining baseline heart rate, medication use and SCID-I diagnoses. During the 3.5-week program, the participants completed the Trier Social Stress Test for Groups. Participants wore heart rate monitors and filled out Visual Analogue Scales during the TSST-G. RESULTS Our participants presented a low cortisol variation, with mixed model analyses showing a maximal increase in free saliva cortisol of 26% (95% CI, 0.21-0.32). Simultaneously, the increase in heart rate and Visual Analogue Scales was substantial, indicating autonomic and psychological activation consistent with intense stress from the Trier Social Stress Test for Groups. CONCLUSIONS The current findings are the first description of a blunted cortisol response in a heterogeneous group of patients on long-term sick leave. The results suggest lack of cortisol reactivity as a possible biological link involved in the pathway between stress, sustained activation and long-term sick leave.
Collapse
Affiliation(s)
- Henrik B. Jacobsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
- * E-mail:
| | - Johan Håkon Bjørngaard
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Forensic Department and Research Centre Brøset, St. Olav's University Hospital, Trondheim, Norway
| | - Karen W. Hara
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
| | - Petter C. Borchgrevink
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
| | - Astrid Woodhouse
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nils Inge Landrø
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
| | - Anette Harris
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Tore C. Stiles
- Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway
- National Centre for Complex Disorders, St. Olav's University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
37
|
Fimland MS, Vasseljen O, Gismervik S, Rise MB, Halsteinli V, Jacobsen HB, Borchgrevink PC, Tenggren H, Johnsen R. Occupational rehabilitation programs for musculoskeletal pain and common mental health disorders: study protocol of a randomized controlled trial. BMC Public Health 2014; 14:368. [PMID: 24735616 PMCID: PMC3996166 DOI: 10.1186/1471-2458-14-368] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term sick leave has considerably negative impact on the individual and society. Hence, the need to identify effective occupational rehabilitation programs is pressing. In Norway, group based occupational rehabilitation programs merging patients with different diagnoses have existed for many years, but no rigorous evaluation has been performed. The described randomized controlled trial aims primarily to compare two structured multicomponent inpatient rehabilitation programs, differing in length and content, with a comparative cognitive intervention. Secondarily the two inpatient programs will be compared with each other, and with a usual care reference group. METHODS/DESIGN The study is designed as a randomized controlled trial with parallel groups. The Social Security Office performs monthly extractions of sick listed individuals aged 18-60 years, on sick leave 2-12 months, with sick leave status 50% - 100% due to musculoskeletal, mental or unspecific disorders. Sick-listed persons are randomized twice: 1) to receive one of two invitations to participate in the study or not receive an invitation, where the latter "untouched" control group will be monitored for future sick leave in the National Social Security Register, and 2) after inclusion, to a Long or Short inpatient multicomponent rehabilitation program (depending on which invitation was sent) or an outpatient cognitive behavioral therapy group comparative program. The Long program consists of 3 ½ weeks with full rehabilitation days. The Short program consists of 4 + 4 full days, separated by two weeks, in which a workplace visit will be performed if desirable. Three areas of rehabilitation are targeted: mental training, physical training and work-related problem solving. The primary outcome is number of sick leave days. Secondary outcomes include time until full sustainable return to work, health related quality of life, health related behavior, functional status, somatic and mental health, and perceptions of work. In addition, health economic evaluation will be performed, and the implementation of the interventions, expectations and experiences of users and service providers will be investigated with different qualitative methods. TRIAL REGISTRATION ClinicalTrials.gov: NCT01926574.
Collapse
Affiliation(s)
- Marius S Fimland
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olavs University Hospital, Trondheim, Norway
| | - Ottar Vasseljen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigmund Gismervik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs University Hospital, Trondheim, Norway
| | - Marit By Rise
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vidar Halsteinli
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Henrik B Jacobsen
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Petter C Borchgrevink
- Hysnes Rehabilitation Center, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hanne Tenggren
- Hysnes Rehabilitation Center, St. Olavs University Hospital, Trondheim, Norway
| | - Roar Johnsen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
38
|
Fredheim OMS, Mahic M, Skurtveit S, Dale O, Romundstad P, Borchgrevink PC. Chronic pain and use of opioids: a population-based pharmacoepidemiological study from the Norwegian prescription database and the Nord-Trøndelag health study. Pain 2014; 155:1213-1221. [PMID: 24637039 DOI: 10.1016/j.pain.2014.03.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 03/08/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
In previous studies on prescription patterns of opioids, accurate data on pain are missing, and previous epidemiological studies of pain lack accurate data on opioid use. The present linkage study, which investigates the relationship between pain and opioid use, is based on accurate individual data from the complete national Norwegian prescription database and the Nord-Trøndelag health study 3, which includes about 46,000 people. Baseline data were collected in 2006 to 2008, and the cohort was followed up for 3 years. Of 14,477 people who reported chronic nonmalignant pain, 85% did not use opioids at all, 3% used opioids persistently, and 12% used opioids occasionally. Even in the group reporting severe or very severe chronic pain, the number not using opioids (2680) was far higher than the number who used opioids persistently (304). However, three quarters of people using opioids persistently reported strong or very strong pain in spite of the medication. Risk factors for the people with chronic pain who were not persistent opioid users at baseline to use opioids persistently 3 years later were occasional use of opioids, prescription of >100 defined daily doses per year of benzodiazepines, physical inactivity, reports of strong pain intensity, and prescription of drugs from 8 or more Anatomical Therapeutic Chemical groups. The study showed that most people having chronic nonmalignant pain are not using opioids, even if the pain is strong or very strong. However, the vast majority of patients with persistent opioid use report strong or very strong pain in spite of opioid treatment.
Collapse
Affiliation(s)
- Olav Magnus S Fredheim
- Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Disorders, St. Olav University Hospital, Trondheim, Norway Centre of Palliative Medicine, Surgical Division, Akershus University Hospital, Lørenskog, Norway Department of Pharmacoepidemiology, Division of Epidemiology, The Norwegian Institute of Public Health, Oslo, Norway Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway Department of Emergency Medicine, St. Olav University Hospital, Trondheim, Norway Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | | | | | |
Collapse
|
39
|
Landrø NI, Fors EA, Våpenstad LL, Holthe Ø, Stiles TC, Borchgrevink PC. Response to letter to the Editor. Pain 2014; 155:646-647. [DOI: 10.1016/j.pain.2013.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 12/09/2013] [Indexed: 11/28/2022]
|
40
|
Landmark T, Romundstad P, Dale O, Borchgrevink PC, Vatten L, Kaasa S. Chronic pain: One year prevalence and associated characteristics (the HUNT pain study). Scand J Pain 2013; 4:182-187. [DOI: 10.1016/j.sjpain.2013.07.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 07/18/2013] [Indexed: 11/29/2022]
Abstract
Abstract
Background
The reported prevalence of chronic pain ranges from 11% to 64%, and although consistently high, the calculated economic burden estimates also vary widely between studies. There is no standard way of classifying chronic pain. We have repeated measurements of pain in a longitudinal population study to improve validity ofthe case ascertainment. In this paper, associations between chronic pain and demographic characteristics, self reported health and functioning, work Incapacity and health care use were investigated in a sample from the general Norwegian population.
Methods
A random sample of 6419 participants from a population study (the HUNT 3 Study) was invited to report pain every three months during a 12 month period. Chronic pain was defined as moderate pain or more (on the SF-8 verbal rating scale) in at least three out of five consecutive measurements. Self reported health and functioning was measured by seven of the eight subscales on the SF-8 health survey (bodily pain was excluded). Health care utilisation during the past 12 months was measured by self report, and included seeing a general practitioner, seeing a medical specialist and seeing other therapists. The survey data was combined with information on income, education, disability pension awards and unemployment by Statistics Norway, which provided data from the National Education database (NUDB) and the Norwegian Labour and Welfare Administration (NAV).
Results
The total prevalence of chronic pain was 36% (95% CI34-38) among women and 25% (95% CI 22–26) among men. The prevalence increased with age, was higher among people with high BMI, and in people with low income and low educational level. Smoking was also associated with a higher prevalence of chronic pain. Subjects in the chronic pain group had a self-reported health and functioning in the range of 1–2.5 standard deviations below that of those without chronic pain. Among the chronic pain group 52% (95% CI 49–55), of participants reported having seen a medical specialist during the 12 month study period and 49%(95% CI 46–52) had seen other health professionals. The corresponding proportions for the group without chronic pain were 32% (95% CI 29–34) and 22% (95% CI 20–25), respectively. Work incapacity was strongly associated with chronic pain: compared with those not having chronic pain, the probability of being a receiver of disability pension was four times higher for those with chronic pain and the probability of being unemployed was twice has high for those with chronic pain. The population attributable fraction (PAF) suggested that 49% (95% CI 42–54) of the disability pension awards and 20% (13–27) of the unemployment were attributable to chronic pain.
Conclusion and implications
Chronic pain is a major challenge for authorities and health care providers both on a national, regional and local level and it is an open question how the problem can best be dealt with. However, a better integration of the various treatments and an adequate availability of multidisciplinary treatment seem to be important.
Collapse
Affiliation(s)
- Tormod Landmark
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine , Norwegian University of Science and Technology , Trondheim , Norway
- National Competence Centre for Complex Symptom Disorders , St. Olav’s University Hospital , Trondheim , Norway
| | - Pål Romundstad
- Department of Public Health, Faculty of Medicine , Norwegian University of Science and Technology , Trondheim , Norway
| | - Ola Dale
- Department of Circulation and Medical Imaging, Faculty of Medicine , Norwegian University of Science and Technology , Trondheim , Norway
- Department of Anaesthesia and Emergency Medicine , St. Olav’s University Hospital , Trondheim , Norway
| | - Petter C. Borchgrevink
- National Competence Centre for Complex Symptom Disorders , St. Olav’s University Hospital , Trondheim , Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine , Norwegian University of Science and Technology , Trondheim , Norway
| | - Lars Vatten
- Department of Public Health, Faculty of Medicine , Norwegian University of Science and Technology , Trondheim , Norway
| | - Stein Kaasa
- National Competence Centre for Complex Symptom Disorders , St. Olav’s University Hospital , Trondheim , Norway
- Department of Oncology , St. Olav’s University Hospital , Trondheim , Norway
| |
Collapse
|
41
|
Fredheim OMS, Borchgrevink PC, Mahic M, Skurtveit S. A pharmacoepidemiological cohort study of subjects starting strong opioids for nonmalignant pain: a study from the Norwegian Prescription Database. Pain 2013; 154:2487-2493. [PMID: 24075311 DOI: 10.1016/j.pain.2013.07.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/17/2013] [Accepted: 07/18/2013] [Indexed: 11/17/2022]
Abstract
Clinical studies of short duration have demonstrated that strong opioids improve pain control in selected patients with chronic nonmalignant pain. However, high discontinuation rates and dose escalation during long-term treatment have been indicated. The aim of the present study was to determine discontinuation rates, dose escalation, and patterns of co-medication with benzodiazepines. The Norwegian Prescription Database provides complete national data at an individual level on dispensed drugs. A complete national cohort of new users of strong opioids was followed up for 5 years after initiation of therapy with strong opioids. Of the 17,248 persons who were new users of strong opioids in 2005, 7229 were dispensed a second prescription within 70 days and were assumed to be intended long-term users. A total of 1233 persons in the study cohort were still on opioid therapy 5 years later. This equals 24% of the study cohort who were still alive. Of the participants, 21% decreased their annual opioid dose by 25% or more, whereas 21% kept a stable dose (± 24%) and 34% more than doubled their opioid dose from the first to the fifth year. High annual doses of opioids were associated with high annual doses of benzodiazepines at the end of follow-up. It is an issue of major concern that large dose escalation is common during long-term treatment, and that that high doses of opioids are associated with high doses of benzodiazepines. These findings make it necessary to question whether the appropriate patient population receives long-term opioid treatment.
Collapse
Affiliation(s)
- Olav Magnus S Fredheim
- Pain and Palliation Research Group, Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Disorders, St. Olav's University Hospital, Trondheim, Norway Department of Emergency Medicine, Oslo University Hospital, Oslo, Norway Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | | | | | | |
Collapse
|
42
|
Landrø NI, Fors EA, Våpenstad LL, Holthe Ø, Stiles TC, Borchgrevink PC. The extent of neurocognitive dysfunction in a multidisciplinary pain centre population. Is there a relation between reported and tested neuropsychological functioning? Pain 2013; 154:972-7. [DOI: 10.1016/j.pain.2013.01.013] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 01/08/2013] [Accepted: 01/29/2013] [Indexed: 11/17/2022]
|
43
|
Pedersen L, Hansen AB, Svendsen K, Skurtveit S, Borchgrevink PC, Fredheim OMS. Reimbursement of analgesics for chronic pain. Tidsskr Nor Laegeforen 2013; 132:2489-93. [PMID: 23338029 DOI: 10.4045/tidsskr.11.1214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND The prevalence of chronic non-malignant pain in Norway is between 24% and 30%. The proportion of the population using opioids for non-malignant pain on a long-term basis is around 1%. The purpose of our study was to investigate how many were prescribed analgesics on reimbursable prescription under reimbursement code -71 (chronic non-malignant pain) in 2009 and 2010, which analgesics were prescribed and whether prescribing practices were in accordance with national guidelines. MATERIAL AND METHOD We retrieved pseudonymised data from the National Prescription Database on all those who received drugs with reimbursement code -71 in 2009 and 2010. The data contain information on drug, dosage, formulation, reimbursement code and date of issue. RESULTS 90,731 patients received reimbursement for drugs indicated for chronic non-malignant pain in 2010. Of these, 6,875 were given opioids, 33,242 received paracetamol, 25,865 non-steroid inflammatory drugs (NSAIDs), 20,654 amitryptiline and 16,507 gabapentin. Oxycodone was the most frequently prescribed opioid, followed by buprenorphine, tramadol and codeine/paracetamol. Of those who were prescribed opioids, 4,047 (59%) received mainly slow-release opioids, 2,631 (38%) also received benzodiazepines and 2,418 (35%) received benzodiazepine-like sleep medications. CONCLUSION The number of patients who received analgesics and opioids on reimbursable prescriptions was low compared to the proportion of the population with chronic pain and the proportion using opioids long-term. 38% of those reimbursed for opioids also used benzodiazepines, which is contrary to official Norwegian guidelines.
Collapse
Affiliation(s)
- Line Pedersen
- National Competence Centre for Complex Symptom Disorders, Norwegian University of Science and Technology, Norway.
| | | | | | | | | | | |
Collapse
|
44
|
Mellbye A, Svendsen K, Borchgrevink PC, Skurtveit S, Fredheim OMS. Concomitant medication among persistent opioid users with chronic non-malignant pain. Acta Anaesthesiol Scand 2012; 56:1267-76. [PMID: 22946822 DOI: 10.1111/j.1399-6576.2012.02766.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recent guidelines for opioid treatment of chronic non-malignant pain discourage co-medication with benzodiazepines and benzodiazepine-related hypnotics, whereas co-medication with non-opioid analgesics and co-analgesics may offer a beneficial opioid sparing effect, and is recommended. The aim of this study was to describe 1-year periodic prevalence of co-medication with benzodiazepines, benzodiazepine-related hypnotics, non-opioid analgesics, co-analgesics and antidepressants in persistent opioid users with chronic non-malignant pain. METHODS The study is based on data from the Norwegian Prescription Database, covering all drugs dispensed to outpatients in 2008. Concomitant medication levels were compared between users in two definitions of persistent opioid use, all Norwegian adults dispensed opioids in 2008 and the Norwegian background population. RESULTS Of the Norwegian adult population studied, 1.2% met the criteria of persistent opioid use based on prescription pattern and prescription level. Sixty percent of persistent opioid users were dispensed a benzodiazepine or benzodiazepine-related hypnotic in amounts indicating regular use, with 15% dispensed a high amount of both classes. Sixty-two percent of persistent opioid users were dispensed one or more non-opioid analgesics, 47% an antidepressant and 33% were dispensed an antiepileptic drug. CONCLUSION Approximately 60% of persistent opioid users also receive benzodiazepines or benzodiazepine-related hypnotics in amounts indicating regular use. This is in conflict with recent guidelines for the treatment of chronic non-malignant pain and may indicate that these users are at an increased risk of developing problematic opioid use.
Collapse
Affiliation(s)
- A Mellbye
- Department of Circulation and Medical Imaging, Pain and Palliation Research Group, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | | | | | | |
Collapse
|
45
|
Fredheim OMS, Moksnes K, Borchgrevink PC, Skurtveit S. Opioid switching to methadone: a pharmacoepidemiological study from a national prescription database. Palliat Med 2012; 26:804-12. [PMID: 21697266 DOI: 10.1177/0269216311412415] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Opioid switching to methadone is reported frequently to improve pain control in patients with an unacceptable balance between pain control and side effects during treatment with first line opioids, but carries a risk of drug accumulation and respiratory depression. To justify this risk it is required that less risky treatments are tried beforehand and that a sufficiently large proportion of patients experience a long-lasting improvement in pain control. RESEARCH QUESTIONS How large was the proportion of patients remaining on long term methadone treatment after a switch from a strong opioid to methadone? How long had the patients been treated with opioids before the switch to methadone? METHODS Longitudinal pharmacoepidemiological study from the complete national Norwegian Prescription Database. RESULTS One hundred and thirty (77%) cancer patients received more than one dispensed prescription of methadone. Forty-nine (40%) chronic non-malignant pain (CNMP) patients continued to have methadone prescriptions dispensed more than 6 months after the switch. Of 168 cancer patients, 48 (29%) had tried two strong opioids prior to the switch to methadone whereas 21 (12.5%) had tried three or more strong opioids. Similar numbers for 124 CNMP patients were 26 (21%) and 34 (27%), respectively. INTERPRETATION Opioid switching to methadone appears to provide a long lasting improvement in pain control in a significant proportion of patients. However, the study raises concerns that treatment options with less risk are not being exhausted prior to switching to methadone.
Collapse
Affiliation(s)
- Olav Magnus S Fredheim
- St Olav University Hospital, Norway; Norwegian University of Science and Technology, Norway.
| | | | | | | |
Collapse
|
46
|
Skollerud LM, Fredheim OM, Svendsen K, Skurtveit S, Borchgrevink PC. Laxative prescriptions to cancer outpatients receiving opioids: a study from the Norwegian prescription database. Support Care Cancer 2012; 21:67-73. [PMID: 22653367 DOI: 10.1007/s00520-012-1494-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 04/30/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND During opioid treatment of cancer pain, constipation is one of the most prevalent and bothersome side effects. Guidelines suggest that treatment with laxatives should be initiated when opioid therapy is started. AIM This study aims: (1) to determine to what extent patients, starting on opioids due to cancer pain, receive laxatives; (2) to examine the temporal relationship between initiation of opioid therapy and initiation of treatment with laxatives; and (3) to study to which extent the treatment follows current guidelines. METHODS Data from the Norwegian prescription database (NorPD) were used to investigate dispensed prescriptions of laxatives to outpatients in Norway, who are receiving opioids for cancer pain. Data from NorPD cover all dispensed prescriptions of drugs to outpatients, making it possible to follow patients over time. The study cohort was followed from 2005 to the end of 2008. RESULTS Of 2,982 patients who started opioid therapy directly with WHO step III opioids, 1,325 patients (44.4 %) did not receive laxatives during the study period. Only 738 patients (24.7 %) received laxatives at the same time as opioid therapy was initiated. Another 657 patients (22.0 %) received laxatives after their initiation of opioids at some time during the study period. CONCLUSION Of those who started directly on a strong opioid, only one fourth received laxatives concomitantly with the first opioid, and nearly half did not receive laxatives at all. These findings indicate that the current guidelines are not followed.
Collapse
Affiliation(s)
- Lars Morten Skollerud
- National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Symptom Disorders, St. Olavs University Hospital, Trondheim, Norway.
| | | | | | | | | |
Collapse
|
47
|
Skurtveit S, Furu K, Kaasa S, Borchgrevink PC. Introduction of low dose transdermal buprenorphine - Did it influence use of potentially addictive drugs in chronic non-malignant pain patients? Eur J Pain 2012; 13:949-53. [DOI: 10.1016/j.ejpain.2008.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 10/20/2008] [Accepted: 11/02/2008] [Indexed: 11/27/2022]
|
48
|
Dale O, Svendsen K, C. Borchgrevink P. The Morphine Manifesto. Tidsskriftet 2012; 132:935-6. [DOI: 10.4045/tidsskr.12.0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
49
|
Svendsen K, Skurtveit S, Romundstad P, Borchgrevink PC, Fredheim OMS. Differential patterns of opioid use: defining persistent opioid use in a prescription database. Eur J Pain 2011; 16:359-69. [PMID: 22337119 DOI: 10.1002/j.1532-2149.2011.00018.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2011] [Indexed: 11/09/2022]
Abstract
AIM The aim of this study was to develop definitions to identify persons with clinically different patterns of persistent opioid use based on data from prescription databases. METHODS The study is based on data from the Norwegian Prescription Database using all dispensed opioid prescriptions during 2005-2008. Three definitions of persistent opioid use were developed using the following patient criteria: different levels of dispensed opioid amounts, number of prescriptions and the number of quarters out of the year in which prescriptions were dispensed. The three definitions each have some typical patient characteristics attached to them. The strict definition describes a typical patient using opioids to achieve a continuous serum concentration in the therapeutic range, the intermediate definition represents a typical patient using opioids daily but not around the clock and the wide definition describes a typical patient who uses opioids most of the days. To study whether the definitions accurately represent long-term use, the patient population was followed for 3 years, and the retention rate within each definition was measured. RESULTS The point prevalence of persistent opioid use in Norway (4,681,134 inhabitants) as defined by the strict, intermediate and wide definitions was 0.16% (n = 7663), 0.50% (n = 23,498) and 1.08% (n = 50,791), respectively, as of 31 December 2007. At the end of the 3-year study period, the retention within any of the definitions was 83%, 84% and 68% for patients who met the criteria of the strict, intermediate and wide definitions, respectively. CONCLUSION In the patient populations identified by the three definitions, a high rate of retention was observed, indicating that the proposed definitions can identify patients with long-term persistent use of opioids.
Collapse
Affiliation(s)
- K Svendsen
- Pain and Palliation Research Group, Institute of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | | | | | | |
Collapse
|
50
|
Abstract
BACKGROUND Relief of post-operative pain has a bearing on the patient's well-being, mobilisation and time confined to bed. The article discusses indications, contraindications and the efficacy of the various treatment modalities. MATERIAL AND METHOD We have examined review articles, meta-analyses and randomised controlled trials, identified through literature searches in PubMed. RESULTS The use of several medicines and techniques (multimodal pain treatment) is necessary to achieve a good balance between pain relief, side effects and risk. Systemic administration of paracetamol, NSAIDs, opioids and glucocorticoids is effective for post-operative pain. The same applies to epidural analgesia, peripheral nerve blocks and local anaesthetic wound infiltration. Subanaesthetic doses of ketamine have an opioid-sparing effect, but the optimal dosing regimen is uncertain. Gabapentinoids have an effect on post-operative pain, but the effect appears to vary depending on the type of operation and analgesic regimen. The effect of one analgesic will depend on which other drugs are used in multimodal pain treatment. Epidural analgesia, peripheral nerve blocks or extensive local infiltration analgesia is often necessary to relieve movement-related pain. INTERPRETATION Many treatment modalities are effective for post-operative pain. It is crucial that the treatment is well organised and that it includes routines for systematic pain assessment, efficacy and side effects of the pain management.
Collapse
Affiliation(s)
- Olav Magnus S Fredheim
- Nasjonalt kompetansesenter for sammensatte lidelser og Avdeling for smerte og sammensatte lidelser, Klinikk for anestesi og akuttmedisin, St. Olavs hospital, Norway.
| | | | | |
Collapse
|