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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 were 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% vs. 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 towards prevention and rehabilitation.

Chronic widespread pain (CWP) is common and associated with loss of functioning and health. Subjects with chronic nonwidespread pain (CnWP) are at increased risk of developing CWP, but few studies have described the nature of the development over time. We followed a random sample of 3105 participants from the population-based HUNT 3 study with 5 annual measurements of pain over 4 years. Although 29% reported CWP on at least 1 occasion, only 7% reported it consistently on 4 or 5 occasions. The average annual cumulative incidence was 5%, and the recovery rate was 38%. In mutual adjusted analysis, the risk of developing CWP from 1 year to the next was higher in subjects with chronic pain (relative risk [RR] = 2.4; 95% confidence interval [CI]: 1.8-3.4), 2 or more pain regions (RR = 3.3; 95% CI: 2.5-4.4), moderate pain or more (RR = 1.8; 95% CI: 1.5-2.6), and with comorbid chronic disease (RR = 1.6; 95% CI: 1.3-1.9). Developing CWP was associated with a modest concurrent change in self-reported mental and physical health. The risk of developing CWP between the fourth and fifth occasions was 80% lower for subjects without a history of CWP, compared to those with a history of CWP. For subjects without previous CWP, the development was associated with previously reported CnWP, but not with the number of occasions with CnWP, in analyses adjusted for sex, age, and pain severity. A substantial proportion of the new cases of CWP originates from subjects floating below and above the definition for CWP over time and, thus, does not seem to involve major transitions in health.

That certain psychological factors are negatively associated with function in patients with chronic pain is well established. However, few studies have evaluated these factors in individuals with chronic pain from the general population. The aims of this study were to: 1) evaluate the unique associations between catastrophizing and perceived solicitous responses and psychological function, physical function, and insomnia severity in individuals with neuropathic pain, osteoarthritis, or spinal pain in the general population; and 2) determine if diagnosis moderates the associations found. Five hundred fifty-one individuals from the general population underwent examinations with a physician and physiotherapist, and a total of 334 individuals were diagnosed with either neuropathic pain (n = 34), osteoarthritis (n = 78), or spinal pain (n = 222). Results showed that catastrophizing was significantly associated with reduced psychological and physical function, explaining 24% and 2% of the variance respectively, whereas catastrophizing as well as perceived solicitous responding were significantly and uniquely associated with insomnia severity, explaining 8% of the variance. Perceived solicitous responding was significantly negatively associated with insomnia severity. Moderator analyses indicated that: 1) the association between catastrophizing and psychological function was greater among individuals with spinal pain and neuropathic pain than those with osteoarthritis, and 2) the association between catastrophizing and insomnia was greater among individuals with spinal pain and osteoarthritis than those with neuropathic pain. No statistically significant interactions including perceived solicitous responses were found. The findings support earlier findings of an association between catastrophizing and function among individuals with chronic pain in the general population, and suggest that diagnosis may serve a moderating role in some of these associations. Perspective When examining persons with pain in the general population, catastrophizing is associated with several aspects of function, and diagnosis serves as a moderator for these associations. The replication of these associations in the general population support their reliability and generalizability.

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.

Background Epidemiological studies of chronic pain frequently report high prevalence estimates. However, there is little information about the development and natural course of chronic pain. Methods We followed a random sample of participants from a population‐based study (HUNT 3) with annual measures over 4 years. Results Among those without chronic pain at baseline, the probability of developing moderate to severe chronic pain (cumulative incidence) during the first year was 5%, a pain status that was maintained among 38% at the second follow‐up. The probability of developing chronic pain diminished substantially for those who maintained a status of no chronic pain over several years. Subjects with moderate to severe chronic pain at baseline had an 8% probability of recovery into no chronic pain, a status that was maintained for 52% on the second follow‐up. The probability of recovery diminished substantially as a status of chronic pain was prolonged for several years. Pain severity, widespread pain, pain catastrophizing, depression and sleep were significant predictors of future moderate to severe chronic pain, both among subjects with and without chronic pain at baseline. Conclusion These findings suggest that the prognosis is fairly good after a new onset of chronic pain. When the pain has lasted for several years, the prognosis becomes poor. The same social and psychological factors predict new onset and the prognosis of chronic pain. Significance The development and recovery of chronic pain is highly dependent on previous pain. The prognosis of chronic pain may be predicted well when considering its duration in combination with other clinical, social and psychological factors. Targeting modifiable prognostic factors may be particularly important for newly developed chronic pain. Locked until 13.5.2019 due to copyright restrictions. This is the peer reviewed version of the following article: [Development and course of chronic pain over 4 years in the general population: The HUNT pain study], which has been published in final form at [https://doi.org/10.1002/ejp.1243]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

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. Copyright © 2017 Aasvik, Woodhouse, Stiles, Jacobsen, Landmark, Glette, Borchgrevink and Landrø. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Purpose: Health-related quality of life (HRQoL) has been characterized as the ultimate goal for health interventions such as physical activity (PA). We assessed how frequency, duration, and intensity of PA were related to HRQoL in younger (

Background: Population-based studies have reported conflicting findings on the relationship between physical activity and pain, and most studies reporting a relationship are cross sectional. Temporal relationships are therefore difficult to infer and associations may be subject to confounding from a variety of other factors. The aim of the current study was to investigate the association between exercise and pain longitudinally and to use within subjects analyses to remove between subjects confounding. Methods: In the population-based HUNT 3 study, participants reported both pain and level of exercise. A random sub-sample of 6419 participants was in addition invited to report their last week pain and exercise every three months over a 12 month period (five measurements in total). We used multilevel mixed effects linear regression analyses to prospectively estimate the association between regular levels of exercise (measured in HUNT 3) and subsequent longitudinal reporting of pain. We also estimated within-subjects associations (i.e. the variation in pain as a function of variation in exercise, over time, within individuals) to avoid confounding from between subject factors. Results: Among those invited to participate (N = 6419), 4219 subjects returned at least two questionnaires. Compared with subjects who reported no or light exercise, those who reported moderate levels of exercise or more at baseline, reported less pain in repeated measures over a 12 month period in analyses adjusted for age, sex,education and smoking. Adjusting for baseline level of pain distinctly attenuated the findings. Within subjects, an increase in exercise was accompanied by a concurrent reduction in intensity of pain. However, we found no indication that exercise level at one occasion was related to pain reporting three months later. Conclusion: This longitudinal population-based study indicates that exercise is associated with lower level of pain and that this association is close in time. © 2013 Landmark et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Background and objectives: Fibromyalgia (FM) and depression has been suggested to share a common underlying etiology. Few studies have investigated the role of emotional regulation processes in FM compared to depressive disorders. The purpose of the current study was to explore the use of defense mechanisms in FM patients with and without comorbid lifetime depressive disorder (LDD), and to compare their use of defenses to healthy control subjects and patients with Major Depressive Disorder (MDD). Methods: A total of 91 participants were included (17 with FM and LDD, 25 with FM but not LDD, 24 with MDD, and 25 healthy controls). Depressive disorders were identified by using the Structured Clinical Interview for DSM Axis I disorders (SCID-I). All diagnosis of FM were confirmed to meet the American College of Rheumatology’s criteria for FM. The Life Style Index (LSI) was used to measure defense mechanisms. Results and Conclusions: Group comparisons indicated that MDD patients and FM patients with LDD made significantly more use of defenses than healthy controls, whereas FM patients without LDD made significantly less use of defenses than both MDD patients and FM patients with LDD, but did not differ from healthy controls. Follow up analyses indicated significant main effects for the defense mechanisms of regression, compensation and displacement. This study suggests that FM and depression do not share common risk factors in terms of restricted affects or avoidance of conflicted feelings. Received 1 October 2007 Revised 26 June 2008 Accepted 11 July 2008 186 TORMOD LANDMARK ET AL.

Background Little is known about contextual effects on chronic pain, and how vulnerability factors influence pain in different contexts. We wanted to examine if fibromyalgia (FM) pain varied between two social contexts, i.e. at home versus in a doctor office, when it was measured the same day, and if pain was stable for 14 years when measured in similar contexts (doctor office). Our secondary aim was to explore if pain vulnerability factors varied in the two different contexts. Findings Fifty-five female FM patients were included in the study and scored pain in both contexts at baseline. Their age ranged between 21–68 years (mean 45.7), mean education level was 11 years and mean FM-duration was 15.6 years. Their mean pain was perceived significantly lower at home than in a doctor context the same day. However, pain was much more stable when measured in two similar contexts 14 year apart where 30 subjects (54.5%) completed. Predictor analyses revealed that pain vulnerability factors apparently varied by home and doctor contexts. Conclusion Pain and pain predictors seem to vary by contexts and time, with less pain at home than to a doctor the same day, but with unchanged pain in the same context after 14 years. Thus, contextual pain cues should be accounted for when pain is measured and treated, e.g. by focusing more on home-measured pain and by optimizing the doctor office context. This explorative study should be followed up by a larger full-scale study. © 2012 Fors et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sammendrag Formål: I masteroppgaven undersøkes det assosiasjoner mellom angst og depresjon, smerte og ADL-funksjon, tre måneder etter hjerneslag. I hvor stor grad disse komponentene har en forsterkende faktor på hverandre og hvordan dette kan påvirker rehabiliteringen. Metode: Studien baserer seg på oppfølgingsskjema gjort tre måneder etter hjerneslaget. 5941 observasjoner fra Norsk hjerneslagregister (2020) ble delt i to gruppert basert på ADL-funksjon (MRS). Deretter ble det utført logistisk regresjonsanalyse for å se eventuell sammenheng med henholdsvis angst og depresjon, smerte og styrke på symptomene. Disse dataene ble samlet inn ved hjelp av EQ-5D-5L. Resultatene ble også juster for alvorlighetsgrad på slaget (NIHSS), kjønn og alder. Resultat: Resultatene indikerer at det er en høyere odds for at man har en funksjonsnedsettelse dersom man er eksponert for smerter eller angst/depresjon. Denne sammenhengen styrket seg i takt med økt grad av henholdsvis smerte og angst/depresjon. Den statistiske signifikansen var sterkest der deltagerne hadde lave til moderate symptomer, men ble svekket når deltagerne hadde høy grad av smerte eller angst/depresjon. Konklusjon: Resultatene er konsistente med gjeldende litteratur på feltet, og styrker hypotesen om at det er en sammenheng mellom funksjon, angst/depresjon og smerte etter hjerneslag. Abstract Purpose: The master's thesis examines associations between anxiety and depression, pain and ADL function, three months after a stroke. To what extent do these components have a reinforcing factor on each other and how this can affect rehabilitation. Method: The study is based on a follow-up form made three months after the stroke. 5941 observations from the Norwegian Stroke Register (2020) were divided into two groups based on ADL function (MRS). A logistic regression analysis was then carried out to see any connection with anxiety and depression, pain, and strength of the symptoms, respectively. These data were collected using the EQ-5D-5L. The results were also adjusted for stroke severity (NIHSS), gender and age. Result: The results indicate that there is a higher odds that one has a functional impairment if one is exposed to pain or anxiety/depression. This connection strengthened as the degree of pain and anxiety/depression increased, respectively. The statistical significance was strongest where the participants had low to moderate symptoms but was weakened when the participants had a high degree of pain or anxiety/depression. Conclusion: The results are consistent with current literature in the field and strengthen the hypothesis that there is a connection between function, anxiety/depression, and pain after stroke.

Mange CFS/ME pasienter sliter med kroniske smerter. Likevel fant Nijs et al., (2012) at klinikere ofte ignorerer pasientenes smertesymptomer, selv om smerte er et av de sentrale utmattelsessymptomene i CFS/ME. I et utvalg norske pasienter (N=236) ble det undersøkt effektiviteten av kognitiv adferdsterapibehandling hos CFS/ME pasienter som erfarer smertesymptomer. Masteroppgaven retter seg mot å undersøke behandlingssuksessen til CBT så vel som en kort-CBT etter – og 1 år etter behandlingslutt, der pasientenes vurdering av egen allmenntilstand ble brukt som mål. Jeg fant delvis støtte til mine forventninger om at smerte var negativt assosiert med utfallet på kognitiv adferdsterapi. I de primære analysene ble begge behandlingsmetodene analysert, og viste at smerte var ikke-signifikant etter behandling. Smerte var derimot signifikant 1 år etter behandling, noe som gjør at man må tolke resultatene med forsiktighet. Endring i smerte viste en sterkere sammenheng med allmenntilstand, med signifikante verdier både etter- og 1 år etter behandling. Det var interaksjonseffekter mellom smerte og behandlingsmetodene, samt smerteendring og behandlingsmetodene. Dette ledet til individuelle analyser av KCBT og CBT. Resultatene av de individuelle analysene viste forskjeller i hvordan smerte påvirker ulike former for kognitiv adferdsterapi. Jeg fant signifikante sammenhenger mellom smerte og allmenntilstand i KCBT, men ikke CBT. Endring i smerte viste derimot signifikant sammenheng med allmenntilstand i CBT, og kun delvis i KCBT. Nøkkelord: CFS/ME, smerte, allmenntilstand