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Background: Studies indicate an association between pain perception and inflammatory response. However, the expression of inflammatory cytokines in the regulation of the interaction between pain and other coexisting symptoms related to pain, such as fatigue, remains largely unknown.

Aim: This study utilizes a comprehensive screening method for inflammatory biomarkers to objectively study their relation to fatigue and other patient reported outcomes, such as depression and sleep disturbances, in a cohort entailing patients with chronic pain and controls reporting no pain.

Material and methods: 36 patients with chronic pain and 36 healthy pain free controls were included. To investigate possible differences between patients and controls, the QUICKPLEX SQ 120 with a panel of 71 pro- and anti-inflammatory proteins was used. Patient reported data covering aspects of fatigue, fatigability, mood and sleep was also administered.

Results: No apparent difference in abundance of inflammatory substances was found between patients and controls. Likewise, no association was between levels of inflammatory biomarkers and performance on objectively measured cognitive fatigability. However, an explorative multivariate PCA analysis with immunological response as the determinant revealed five specific clusters, two clusters of controls and three patient clusters. One patient cluster had an overall lower concentration level of inflammatory substances compared to the other clusters. This cluster reported higher levels of general fatigue (trait fatigue) and state fatigue as well as higher proportions of pain localizations, perceived helplessness, insomnia, depressive symptoms, and anxiety.

Conclusion: This study underscores the complexity of pain perception and its interplay with inflammatory responses, as well as the individual experience of fatigue and other co-occurring symptoms. We argue that patients with chronic pain do not constitute a homogeneous group, and that simple patient–control comparisons may be insufficient to elucidate the underlying inflammatory processes involved. Our findings suggest that chronic pain patients who report higher levels of fatigue, sleep disturbances, and depressive symptoms might exhibit inflammatory response proteins associated with tissue-repair mechanisms. We speculate that this pattern could indicate a response driven more by central pain mechanisms.

Introduction: 

The aim of this study was to explore potential effects of lower extremity Constraint-Induced Movement Therapy (LE-CIMT) on Health-Related Quality of Life (HRQoL) after stroke, and the possible influence of descriptive characteristics.

Materials and methods: 

Twenty men and 10 women (median age 53 years, IQR 45–59) participated in a single-arm, intervention study at an outpatient physiotherapy clinic. Participants underwent intensive, task-specific LE-CIMT for 6 h/day over 10 consecutive weekdays, followed by a home-exercise program until a 3-month follow-up. HRQoL was assessed using the SF-36 questionnaire, and motor function was evaluated with part of the Fugl-Meyer Assessment, Berg Balance Scale, 10-Meter Walk Test, 6-Minute Walk Test, and Timed Up and Go. Assessments were performed pre-intervention and at 3-month follow-up.

Results: 

The SF-36 response rate was 50%. HRQoL improved significantly in the Physical Functioning (median change 10, IQR 5–15, p < 0.001, ES 0.75) and Vitality domains median change 5 (IQR 0–20, p = 0.013, ES 0.46). A negative correlation was observed between time from stroke to LE-CIMT and improvement in Physical Functioning (rS = −0.456, p = 0.013), but not the Vitality domain.

Conclusion: 

Our findings suggest that LE-CIMT may be associated to improvements in HRQoL, particularly in the Physical Functioning and Vitality domains after stroke. Earlier initiation of intervention appears beneficial. These findings need to be validated in randomized controlled trials.

Objectives: Chronic pain is a major health problem and is more common among women than men. Interdisciplinary pain rehabilitation programmes (IPR) are effective in reducing pain and restoring function for patients with chronic pain. However, in Sweden, immigrants who do not speak Swedish are commonly not selected for participation in IPR. There is thus a knowledge gap regarding whether IPR has positive effects for immigrants with chronic pain and inadequate Swedish language skills. The aim of this study was to investigate outcomes in patients with chronic pain and inadequate Swedish language skills at one-year follow-up after participation in an IPR with language interpreters, both on the whole group level and separately for women and men, and in comparison with a reference group of patients.

Methods: Design: prospective multi-centre cohort study. Patients: 74 patients (60 women and 14 men). Pain intensity, anxiety and depression, health-related quality of life, fear of movement and the number of doctor visits due to pain were evaluated at baseline, at treatment conclusion (except for doctor visits) and one year after the programme. Patients were compared with a reference group comprising Swedish-speaking patients in a standard interdisciplinary pain rehabilitation programme (135 patients (122 women and 13 men)).

Results: At one-year follow-up, the patients showed significant improvements in pain intensity, depression, and fear of movement, and when subgrouping, the female patients showed significant improvements in the same variables: pain intensity (p=0.002), depression (p=0.015), and fear of movement (p=0.007). Anxiety was significantly deteriorated, both for the whole group and for the female patients (p=0.011). The men did not improve, but low numbers preclude statistics or conclusions. On the whole group level, there was also a significantly reduced number of doctor visits due to pain (p<0.001) at one-year follow-up. Compared to those in the reference group, the patients rated themselves significantly poorer before the programme for the variables measured over time (p=/<0.004). All variables improved significantly for the patients in the reference group at one-year follow-up.

Conclusions: Patients with chronic pain and inadequate language skills in the Swedish language seem to benefit from participating in an interdisciplinary pain rehabilitation programme with language interpreters. The result could be of value for the further development of such rehabilitation programmes, but further studies are needed regarding meńs needs in and after a rehabilitation programme.

Background: Care should be neutral and equal, but normative beliefs may impact the interaction between patients and healthcare professionals in pain management.

Objectives: To explore how patients with jaw and neck pain perceive pain management and the interaction with healthcare professionals in relation to intersectionality, with a specific focus on gender.

Methods: Recruitment was performed at a specialist dentistry clinic in Sweden. Inclusion criteria were patients aged 18-70 years, reporting jaw and neck pain and understanding the Swedish language. Exclusion criteria were rheumatic disease, temporomandibular joint arthralgia or arthritis. Using purposive sampling, 16 patients (11 women) aged 19-56 were interviewed using individual semi-structured interviews. The analysis was performed using thematic analysis.

Results: The analysis resulted in the theme: 'Intersectional bias in healthcare - the inequity borne by the patients', with five subthemes that entailed different types of bias related to the participants' personal characteristics and their interaction with healthcare professionals. Health-related stigmata was one subtheme described among participants, resulting in labelling and burden in the encounter. Other subthemes also described bias in relation to biological differences among pain patients and patients not being taken seriously due to, for example, female gender and younger age. Two subthemes also described bias in relation to the healthcare professionals' gender and age.

Conclusion: Normative beliefs have a negative impact on the interaction between patients and healthcare professionals in pain management. Since patient-provider interaction should be neutral and equal, intersectional bias should be acknowledged to prevent health and care inequalities.Keywords: gender differences; healthcare disparities; intersectionality; neck pain; temporomandibular joint disorders.

Objective: To examine stroke survivors’ satisfaction with hospital-based outpatient rehabilitation and its association with life satisfaction and health-related quality of life (HRQoL), and whether sex and age affect possible associations. 

Design: A longitudinal national register study. 

Methods: Data from the Swedish national quality register were used and included 1,068 patients with stroke performing outpatient rehabilitation. Self-reported questionnaires collected on admission, discharge, and at 1-year follow-up were analysed. Regression analyses were used to assess possible associations between patient satisfaction and life satisfaction (Life Satisfaction Questionnaire, LiSat-11) and HRQoL (EuroQol Five Dimensions questionnaire, EQ-5D).

Results: Over 71% of the included patients were satisfied with their rehabilitation process on discharge. Satisfied patients also reported higher scores on global LiSat-11 and higher EQ-5D values. Older patients (> 58 years) satisfied with their rehabilitation process were more likely to be satisfied with global LiSat-11. Women dissatisfied with the rehabilitation process had lower EQ-5D values on discharge.

Conclusion: Patient satisfaction with hospital-based outpatient rehabilitation was associated with life satisfaction and HRQoL. Potential differences linked to sex and age support the importance of individually tailored rehabilitation strategies. Evaluating self-reported outcomes and experiences over time is essential for improving long-term recovery and for further development of person-centred stroke rehabilitation.

Fatigue is common in patients with chronic pain, but the neural underpinning of this symptom is still poorly understood. In this study, we aimed to investigate resting state connectivity correlates of pain and fatigue in patients with chronic pain. Twenty-four women with chronic pain, and 22 age-matched healthy controls underwent resting state functional magnetic resonance imaging (fMRI), performed a 20-min fatiguing attention task, and underwent an additional resting state fMRI examination. Patients with chronic pain reported a higher degree of both fatigue (p < 0.001) and pain (p < 0.001) than healthy controls. Significant group differences in connectivity to the lateral visual network, the salience network, the auditory network, the executive control network, and especially in regions within the default mode network were detected before the task. After the task, these differences were no longer statistically detectable, and only differences in connectivity between the basal ganglia network and the prefrontal areas between groups were observed. While differences in functional connectivity related to pain were present before performance of the task, only differences related to fatigue were found after the task. This finding indicates that processing of fatigue might overshadow processing of pain after performance of a fatiguing attention task in patients with chronic pain.

Purpose: Cognitive reserve and neuropsychological test results are linked to outcomes after acquired brain injury (ABI), but their interaction and their impact on different types of outcomes remains to be explored. This study aimed to explore how cognitive reserve, measured by education, is related to neuropsychological outcomes, return-to-work and life satisfaction after ABI.

Methods: Long term follow-up of 83 patients with ABI, 5–15 years after specialized brain injury rehabilitation. Logistic regression was used to analyze the relationship between independent variables and outcomes (return-to-work and life satisfaction).

Results: Return-to-work was associated with cognitive reserve (OR = 1.31, p = 0.024), age (OR = 0.95, p = 0.042), general fatigue (OR = 0.77, p = 0.034), and Cognitive Profiency Index (measures of working memory and processing speed, OR = 1.06, p = 0.037). Verbal and spatial abilities were related to education, but not to return-to-work. General fatigue was related to satisfaction with mental health in both univariate (OR = 0.78, p = 0.008) and multivariate analyses (OR = 0.8, p = 0.037), but no other variables were significantly associated with life satisfaction in multivariate analyses.

Conclusion: Patients with lower cognitive reserve paired with slower processing speed and poor working memory may need additional support for successful return-to-work, while life satisfaction appears to depend more on other factors.

OBJECTIVES: Chronic pain is a major global public-health issue. In Sweden, 20% adults report moderate to severe chronic pain, with 7% continuously seeking healthcare. Shortcomings in treatment, accessibility, and knowledge in healthcare for chronic pain have previously been reported. A generic treatment structure from primary to specialized care and rehabilitation was missing. This study aims to describe the development process for the creation of a person-centered and coherent care (P3C) pathway for adults with chronic pain in Sweden.

METHODS: A National Action Group with expertise in pain medicine, rehabilitation medicine, psychiatry, anesthesiology, neurosurgery, general medicine, nursing, psychology, physiotherapy, occupational therapy, and patient representation was commissioned to develop the pathway following a stepwise co-designed approach, which included mapping current situation, goals, measures and indicators of the pathway, assessment of consequences and anchoring the process.

RESULTS: Goals were based on challenges identified in the mapping, including improvements in patient's well-being, continuity during and between care contacts, timely self-management, communication between levels of care, and knowledge about pain. Points of pathway entrance and exit were described. Measures focused on areas such as early pain analysis, biopsychosocial approach to assessment and treatment, early rehabilitation plan, teamwork, dialogue and joint plans between levels of care, patient participation, and education on pain and its consequences. Process and outcome indicators, and a report on benefits and risks for patients, ethical aspects, costs, and impacts of the pathway on other areas of healthcare were included.

CONCLUSIONS: The P3C pathway addressed the challenges described by patients and practitioners. By being person-centered and coherent, it can promote patient empowerment and equality in care, with emphasis on early and timely interventions, dialogue between patients and practitioners and between levels of care, self-management of pain instead of prolonged medical intervention, value-driven and coordinated care contacts, and increased knowledge about chronic pain, based on existing evidence and experience.

Objectives: Fatigue is common in patients with chronic pain. However, there is a knowledge gap concerning performance fatigue, cognitive fatigability, and its neural correlates in this patient group. In this study, we therefore aimed to investigate the presence of cognitive fatigability and its neural correlates in patients with chronic pain using functional magnetic resonance imaging (fMRI).

Methods: In this study 24 women with chronic pain and 22 healthy controls, aged 18–45 years, underwent a 20-minute psychomotor vigilance task (PVT) assessing reaction time during blood-oxygen-level dependent (BOLD) fMRI. Reaction time and BOLD signal changes were analyzed using dual regression.

Results: The patients showed significant cognitive fatigability, i.e., prolonged reaction time, during the PVT, while the controls maintained a stable performance (p = .018). No significant neural time on task effect was found on BOLD fMRI. There were however differences in the brain areas activated between the groups throughout task performance. Patients with chronic pain showed stronger activation primarily in prefrontal cortex, including motor areas, while healthy controls demonstrated stronger activation particularly in the left middle orbital gyrus and right insula.

Conclusion: The study indicates that the phenomenon of cognitive fatigability is present in patients with chronic pain. Also, the presence of chronic pain was associated with increased activation in brain regions related to motor and cognitive control, possibly reflecting compensatory mechanisms. Conversely, healthy controls showed higher activity in regions active in motivation, reward, and decision-making, suggesting more motivation-driven and efficient processing.

Further studies are needed to validate the results.

Background: Individuals with more education com-monly have better outcome after brain injury, often attributed to cognitive reserve. However, evidence suggests that individuals with more education have better access to specialized care, potentially affec-ting outcomes.

Objective: To investigate differences in healthcare usage based on cognitive reserve and examine the relationship between healthcare usage and outcomes after stroke and traumatic brain injury.

Design: An observational cohort study with health-care usage data from 3 years before to 4 years after injury, interviewing patients 5–15 years after injury. Patients: A total of 83 participants suffering a stroke or traumatic brain injury.

Results: Healthcare usage over time varied based on educational level (repeated measures ANOVA, F(2, 227) = 4.17, p = 0.008). The differences in healthcare usage between educational levels was significant during the injury year (F(81) = –5.47, p = 0.022). Higher education implied more healthcare usage. Linear regression, controlling for possible confoun-ders, confirmed the relationship between education and healthcare usage, (β = 4.3, p = 0.022). Health-care usage was significantly related to long-term life satisfaction, but not to return to work.

Conclusion: Individuals with more education recei-ved more healthcare in the year after traumatic brain injury or stroke. However, this was not related to long-term outcome regarding return to work, but we found a relationship between healthcare usage and life satisfaction.