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Study Design: A longitudinal design where the questionnaire was completed at a pretest and predictive ability evaluated with a 1-year follow-up. A second sample was employed to provide a replication.Objective: The aim of the study was to validate a short form of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMSPQ).Summary Of Background Data: Several studies demonstrate the research and clinical utility of the ÖMSPQ. Calls have been made for a shorter form that requires less time in administering.Methods: The short version was constructed by taking two items from each of the five factors shown to have predictive power. It was then tested against the long form in two samples of people with musculoskeletal pain where one reflects an occupational health care population (N = 324) and the other a primary care population (N = 183) thus providing a built-in replication. All participants completed the ÖMSPQ and were then followed over the course of a year to evaluate disability as measured by sick leave.Results: The correlation between the short and long forms was 0.91. The receiver operating characteristic curve was nearly identical for the long and short versions of the questionnaire (e.g., primary care sample: 0.84 vs. 0.81; occupational sample: 0.72 vs. 0.70). Of those who developed disability, a cutoff of 50 on the short version identified 85% in the occupational and 83% in the primary care samples which was nearly as good as the full version.Conclusion: The short form of the ÖMSPQ is appropriate for clinical and research purposes, since it is nearly as accurate as the longer version. [ABSTRACT FROM AUTHOR]

Purpose. The primary aim of this study was to analyse the predictive value of cognitive and behavioural factors, in relation to pain, disability and quality of life (QoL) one year after lumbar disc surgery. Method. The study design was prospective. Fifty-nine patients scheduled for first time lumbar disc surgery were included. Pain, disability, QoL, coping, fear avoidance beliefs, expected outcome and sick leave were assessed preoperatively and 12 months after surgery. Multiple backward stepwise logistic regression analyses were performed to study the contribution of the preoperatively measured independent behavioural/cognitive factors (coping, fear avoidance beliefs and assessed chance to return to work within 3 months) to the dependent variables pain, disability and quality of life at 12 months after surgery. Results. Low expectations on work return within 3 months after surgery was significantly predictive for residual leg pain, odds ratio (OR) = 8.2, back pain, OR = 9.7, disability, OR = 13.8 and sick leave, OR = 19.5. Low QoL, was best predicted by preoperatively high scores on fear avoidance beliefs OR = 6.6 and being a woman OR = 6.0. The regression model explained 26-40% of the variance in pain, disability, QoL and sick leave. Conclusions. Eliciting patients' expectations on work return after surgery could contribute to early identification of those who run the risk of developing long-term disability and sick-leave. [ABSTRACT FROM AUTHOR]

Purpose. The high prevalence of musculoskeletal pain generates significant costs for primary health care and the whole of society. The development of appropriate interventions is therefore necessary. The aim of this effectiveness study was to assess the long-term effects of a primary health care multidisciplinary rehabilitation program in Sweden. Methods. An experimental group comprising 89 patients from two primary health care units received individualised treatment interventions after a multidisciplinary investigation. A control group of 69 patients with the same inclusion criteria from four other primary health care units were treated according to routine. All participants completed questionnaires measuring pain, sick leave, quality of life, health care utilisation, drug consumption and psychosocial factors at baseline and at 3-year follow-up. Results. After 3 years, utilisation of primary health care was significantly lower in the experimental group and work capacity was slightly but not significantly higher. The control group showed a trend of having a higher risk of high consumption after 3 years compared to the intervention group. There was no significant difference between the two groups concerning remaining variables such as function, catastrophising and pain. Conclusion. Both groups demonstrated considerable improvement over the course of 3 years. The experimental group had lower health care utilisation and a reduced risk of using large amounts of medication at the 3-year follow-up, indicating that compared with participants in the control group they were coping in a better way with pain. [ABSTRACT FROM AUTHOR]

The Original Pain Recall Assessment form (OPRA) is a technique that allows people to report on their pattern of pain over time. This investigation reports on the psychometric properties of the OPRA. Our results are analyzed from a cognitive-behavioral perspective. Correlation analyses on data from 72 respondents indicate that participants' patterns of symptoms recalled on the OPRA over a 28-day period were positively related to previous daily diary reports. Symptom ratings on an adapted OPRA showed different patterns of association with past symptom reports in distinct subgroups. A hypothesized, primacy recency effect of the diary procedure on symptom recall was supported. Statistics designed for use with paired, ordered categorical data showed acceptable agreement between diary ratings and those made at recall. In a basic research setting, the form offers the potential to evaluate individual correlates of pain recall. It can also be used at an individual level to describe the character of disagreement with prior ratings. PERSPECTIVE: This article presents the psychometric properties of a pain-assessment procedure. Our results suggest that the way people recall their symptoms is related to cognitive, emotional, and behavioral correlates of the pain experience. The importance of individual differences in overt and covert behaviors and their relationship to persistent pain complaints warrants further attention. [ABSTRACT FROM AUTHOR]

Objective To develop a consensus plan for research and practice to encourage routine clinician screening of occupational factors associated with long-term back disability. Methods A 3-day conference workshop including 21 leading researchers and clinicians (the ''Decade of the Flags Working Group'') was held to review the scientific evidence concerning clinical, occupational, and policy factors in back disability and the development of feasible assessment and intervention strategies. Results The Working Group identified seven workplace variables to include in early screening by clinicians: physical job demands, ability to modify work, job stress, workplace social support or dysfunction, job satisfaction, expectation for resuming work, and fear of re-injury. Five evaluation criteria for screening methods were established: reliability, predictive performance, feasibility, acceptability, and congruence with plausible interventions. An optimal screening method might include a stepped combination of questionnaire, interview, and worksite visit. Future research directions include improving available assessment methods, adopting simpler and more uniform conceptual frameworks, and tying screening results to plausible interventions. Discussion There is a clear indication that occupational factors influence back disability, but to expand clinician practices in this area will require that patient screening methods show greater conceptual clarity, feasibility, and linkages to viable options for intervention. [ABSTRACT FROM AUTHOR]

This prospective study investigated how pain catastrophizing was related to labor pain intensity and physical recovery after childbirth. Eighty-eight women giving birth for the first time completed the first questionnaire before delivery. Eighty-two of those returned the second questionnaire after delivery. Participants were classified as catastrophizers (n=38) or non-catastrophizers (n=44) based on their scores on the Pain Catastrophizing Scale. Comparison of the groups showed that catastrophizers anticipated and experienced more intense pain (p<.0125) and had poorer physical recovery (p<.0125), measured as the level of self-reported functioning in activities of daily living, than non-catastrophizers. These results extend the association between catastrophizing and pain, to pain and recovery in childbirth and provide support for the fear-avoidance model. It is concluded that pain catastrophizing plays a role in the experience of pain in childbirth and postpartum recovery. Further research is needed to identify appropriate interventions for catastrophizing women during the latter part of pregnancy. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate whether arousal, distress, and sleep-related beliefs are related to the development of insomnia. From a randomly selected sample of 3600 individuals from the general population (50-60 years), 2239 participants filled out a baseline and 1-year follow-up questionnaire. Logistic regression and cluster analysis were used to investigate whether the psychological mechanisms were related to the development of new cases of insomnia over 1 year and whether it was possible to classify the participants based on their profiles of psychological mechanisms. The results showed that arousal, sleep-related beliefs, and depression were significantly related to the development of new cases of insomnia (13% of the variance). High scores on all three mechanisms were characteristic of one cluster (18% new cases of insomnia) and low scores on the mechanisms of another cluster (5% new cases of insomnia). This study shows that arousal, sleep-related beliefs, and depression are associated with the development of insomnia, and that psychological mechanisms often co-occur in individuals who develop insomnia. [ABSTRACT FROM AUTHOR]

PURPOSE: Early identification and intervention with those that run the risk of developing long-term disability would offer a great opportunity for reducing costs and personal suffering associated with long-term work absenteeism. The Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) has been used and validated in several studies for participants with mainly acute pain problems. The aim of this study was to validate the OMPSQ for patients with non-acute pain problems (e.g. 1-6 months sick leave) and compare to other relevant questionnaires. METHOD: One hundred and fifty-eight patients with musculoskeletal pain and disability recruited to a multidisciplinary rehabilitation project completed a battery of questionnaires at baseline and at 3-year follow-up visits. The main analysis involved the relationship between risk levels in the questionnaire and sick leave and perceived health after 3 years. RESULTS: The OMSPQ predicted future sick leave and health and was found to have six factors. The function and pain factors were the best predictors of sick leave after 3 years, while the distress factor was the best predictor of perceived mental health and return to work-expectancy was borderline significant. Perceived physical health at 3 years was best predicted by the function and pain factors with the fear-avoidance factor being marginally significant. CONCLUSION: The results demonstrate that psychosocial factors as measured by OMPSQ are related to work disability and perceived health even 3 years after treatment for patients with non-acute pain problems. The OMSPQ was a good predictor of outcome. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purpose of this study was to examine whether arousal, distress and sleep-related beliefs are related to the maintenance of insomnia in old adults. DESIGN: From a randomly selected sample from the general population (N=3,600; 50-60 years old), 2,239 participants filled out a baseline and 1-year follow-up survey. METHODS: Logistic regressions were used to investigate whether psychological mechanisms were related to sleep status (insomnia: N=230; poor sleep: N=210; normal sleep: N=658; good sleep: N=253) over one year. Cluster analysis was employed to assess whether it was possible to classify the participants based on their profiles of psychological functioning. RESULTS: The results showed that arousal, sleep-related beliefs about future consequences and anxiety were significantly related to the maintenance of insomnia (14-66% of the variance). Out of the individuals with persistent insomnia, 67% belonged to a cluster characterized by high scores on arousal, sleep-related beliefs and anxiety, 24% to a cluster defined by medium scores on the three mechanisms and 9% to a cluster characterized by low scores on the three mechanisms. CONCLUSIONS: This investigation shows not only that arousal, sleep-related beliefs and anxiety are associated with the maintenance of persistent insomnia, but also that these mechanisms often co-occur in individuals with persistent insomnia. [ABSTRACT FROM AUTHOR]

Background: Work-related stressors are often viewed as being a source for disturbed sleep. Purpose: This prospective study aimed to examine whether psychosocial work stressors were related to the development and maintenance of insomnia. Method: From a randomly selected sample from the general population (N = 3,600), 1,873 participants aged 50-60 years old in the workforce filled out a baseline and 1-year follow-up questionnaire. Stepwise logistic regressions were used to investigate whether work stressors were related to the development and maintenance of insomnia over 1 year. Results: The results showed that among individuals with no insomnia at baseline, high work demands increased the risk of developing insomnia 1 year later (4% of the variance). Among participants with insomnia at baseline, work stressors did not influence the course of insomnia over 1 year. Finally, low influence over decisions, high professional compromise, and high work demands were related to the maintenance of insomnia (9% of the variance). Conclusion: The findings indicate that perceived work stressors are, although rather weakly, associated with the development and maintenance of insomnia. This might have implications for how insomnia is conceptualized as it places work stressors in the model and for how interventions at different stages of insomnia is implemented. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine the role of perfectionism to pre-existing and future insomnia.Methods: Based on a random sample from the general population (N=3,600), 1,936 participants filled out a baseline and 1-year follow-up survey on perfectionism (concern over mistakes and personal standards), emotional distress and insomnia.Results: The results from sequential logistic regression analyses showed that concern over mistakes was significantly related to pre-existing and future insomnia. When emotional distress was accounted for, none of the perfectionism subscales contributed significantly in explaining pre-existing and future insomnia.Conclusions: The results indicate that though perfectionism seems to be related to both pre-existing and future insomnia, its role seems relatively weak. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the associations between anxiety, depression and insomnia, and to investigate whether anxiety and depression are related to future insomnia. This study employed a combination of a cross-sectional and a prospective design. From a randomly selected sample from the general population (N=3600), 1936 participants filled out a baseline and 1-year follow-up survey on insomnia, anxiety and depression. Odds ratios (ORs) estimations were used to investigate the associations between anxiety, depression, and insomnia. In the cross-sectional study, anxiety (OR: 4.61) and depression (OR: 2.42) showed moderate to strong associations with insomnia. However, the prospective study showed that anxiety (OR: 3.35) was more strongly related than depression (OR: 1.96) to the development of insomnia 1 year later. While anxiety seems to play a key role in the development of insomnia, depression may be considered as a possible precipitating mechanism but even more likely as a consequence of insomnia. [ABSTRACT FROM AUTHOR]

PURPOSE: There is a paucity of long-term evaluations on rehabilitation of musculoskeletal disorders, e.g., neck, shoulder or back pain. The aim of this study was to assess quality of life and the effect of early multimodal rehabilitation on 91 patients with musculoskeletal pain and disability at a 5-year follow-up. METHOD: The follow-up assessment, which included questions on pain, function, quality of life, perceived health, sick leave and psychosomatic symptoms, was performed 5 years after the assessment of baseline status. RESULTS: Improvements in pain, perceived health and psychosomatic symptoms were maintained at the 5-year follow-up. In addition, improvements in function, quality of life, and level of acceptable pain were significant in comparison to baseline. At the time of the baseline assessment all patients were on sick leave (13% were on partial sick leave). At the 5-year follow-up, 58% of the patients were at work part or full time. The results show that those working differed significantly from those not working at the 5-year follow-up on almost all variables, indicating that those working enjoy better health. The most salient prognostic factors for return to work were perceived health and educational level at the time of the baseline evaluation. CONCLUSIONS: These results show that treatment improved quality of life and the effects were basically maintained at 5 years. Work capacity as reflected in return to work increased greatly (81%) at a 1-year follow-up and was substantial (58%) at the 5-year follow-up. Moreover, perceived health and educational levels were important prognostic factors. Finally, the fact that patients working reported better health underscores the probable importance of return to work. Our results imply that it may be feasible to obtain long-term benefits from such a primary care-based intervention. [ABSTRACT FROM AUTHOR]

This study investigated levels of burnout in the general population irrespective of occupation and relations between burnout and psychosocial work factors. A cross-sectional survey featuring sleep problems, psychological distress, burnout (Maslach Burnout Inventory-General Survey), and psychosocial factors at work, was mailed to a random sample of 3,000 participants, aged 20-60. Response rate was 61%. A high level (18%), a low level (19%), and an intermediate group (63%) for burnout were constructed. The high level group was associated with those who were > 50 years old, women, those experiencing psychological distress, and those with a poor psychosocial work climate. The analyses on variables significant in previous analyses showed that the high level group was strongly related to high demands, low control, lack of social support, and disagreeing about values at the workplace even when accounting for age, gender, and psychological distress. We conclude that psychosocial work factors are important in association to burnout regardless of occupation. [ABSTRACT FROM AUTHOR]

The purpose of this study was to survey the level of fear-avoidance beliefs for practicing general practitioners and physical therapists and to relate this to self-reported practice behaviors for patients with back pain. To this end, 60 general practitioners and 71 physical therapists were recruited. These participants completed a questionnaire including 11 items slightly revised from instruments designed to assess fear-avoidance beliefs in patients, and four items about treatment practices. The results indicated that these health care practitioners on the average generally held beliefs that are consistent with the current evidence, but there were also indications that some practitioners held beliefs reflecting fear-avoidance. More than two-thirds reported that they would advise a patient to avoid painful movements, more than one-third believed a reduction in pain is a prerequisite for return-to-work, while more than 25% reported that they believe sick leave is a good treatment for back pain. These beliefs were found to be related to reported practice behavior. Those with high levels of fear-avoidance beliefs were compared to those with low levels. Those with high levels of fear-avoidance belief had an increased risk for believing sick leave to be a good treatment (RR = 2.0; 90%CI = 1.02-3.92), not providing good information about activities (RR = 1.7; 90%CI = 1.19-2.45), and being uncertain about identifying patients at risk for developing persistent pain problems (RR = 1.5; 90%CI = 1.00-2.27). It is concluded that some practitioners hold beliefs reflecting fear-avoidance and that these beliefs may influence treatment practice. [ABSTRACT FROM AUTHOR]

The Obstacles to Return-to-Work Questionnaire (ORQ) was developed and evaluated. A total of 154 patients with chronic musculoskeletal pain and prolonged work disability participated in the study. Factor analyses reduced the ORQ to 55 items grouped into 9 subscales. The subscales were named 'Depression,' 'Pain intensity,' 'Difficulties at work return,' 'Physical workload and harmfulness,' 'Social support at work,' 'Worry due to sick leave,' 'Work satisfaction,' 'Family situation and support,' and 'Perceived prognosis of work return.' The subscales showed satisfactory reliability. In order to determine predictive validity a discriminant analysis was conducted with sick leave 9 months after assessment as the outcome. This analysis indicated that the scales 'Perceived prognosis of work return,' 'Social support at work,' 'Physical workload and harmfulness,' 'Depression,' and 'Pain intensity' could significantly predict sick leave and correctly classified 79% of the patients. The Multidimensional Pain Inventory and the Disability Rating Index could also significantly predict sick leave in this sample and correctly classified as many patients as the ORQ. However, these questionnaires do not include any work-oriented items and they had a lower specificity than the ORQ. This study suggests that patients' perceptions and beliefs about work and returning to work may be a significant hindrance for actual recovery. [ABSTRACT FROM AUTHOR]

The purpose of this review was to summarize current knowledge concerning the role of psychological workplace variables in back pain. To this end the literature on psychological factors and back pain was systematically searched and analyzed. Psychological and medical databases and cross-referencing were used to locate 975 studies. To be included in this review, studies had to have a prospective design, include a psychological predictor variable, report on back pain, and be published in English. Twenty-one studies fulfilled the criteria, for psychological workplace factors. The results showed a clear association between psychological variables and future back pain. There was strong evidence that job satisfaction, monotonous tasks, work relations, demands, stress, and perceived ability to work were related to future back pain problems. Further, moderate evidence was established for work pace, control, emotional effort at work, and the belief that work is dangerous. There was inconclusive evidence about work content. The attributable fraction indicated that substantial reductions in the number of cases of back pain could be achieved if the exposure to the psychological risk factor was eliminated. Although the methodological quality of the studies varied, they were deemed to provide 'best evidence,' and the consistency of the findings suggests that they are relatively robust. It is concluded that psychological work factors play a significant role in future back pain problems. However, there is still a lack of knowledge concerning the mechanisms by which these operate. These results suggest that a change in the way we view and deal with back pain is needed. Applying knowledge about psychological factors at work might enhance prevention as well as rehabilitation. [ABSTRACT FROM AUTHOR]

We investigated the association between psychological factors, physical function, and moderate levels of spinal pain. Participants were 720 people selected from a general population survey with either No Pain (n = 449) or Moderate Pain (n = 271). The Moderate Pain group reported an average intensity of 4.7 (on a 0 to 10 scale), no health care visits, and only 1 day of work absence during the past year. A questionnaire containing items about physical function, work, and psychological factors including abuse, fear-avoidance beliefs, anxiety, depression, distress, and catastrophizing was employed. A series of discriminant analyses showed that distress, perceived workload, physical function, sexual abuse, and catastrophizing were associated with moderate pain. The final solution correctly classified 77% of the participants. These findings underscore that psychological and functional factors are relevant, even for moderate pain problems and before health care or insurance authorities have become involved. Because of the cross-sectional nature of the study more work is needed to understand the process by which persistent pain and disability develop. [ABSTRACT FROM AUTHOR]

Because sleep may directly or indirectly be related to disability, we examined the prevalence of sleep problems in working-age people in the general population and explored the relationship among sleep, health, and work. A cross-sectional survey, mailed to 3,000 people aged 20-60, was employed, featuring criteria to define sleep problems and standardized items to assess work and health. Although the criteria for insomnia was met by 8% of the sample, the 3-month prevalence of sleep problems was 35%. Sleep was related to self-reported mental, physical, and social health as well as to health-care utilization. As for work, poor sleep was linked to absenteeism, employment status, work hours, and the psychosocial work environment. Moreover, poor sleep was associated with reduced work capacity, for example, reduced concentration, listlessness, and difficulties in making decisions. Multivariate analyses that controlled age, gender, and health factors found that not being employed and poor work-content increased the risk for sleep problems. We conclude that sleep problems are prevalent among working-age people and that there is a bilateral link between sleep and work. There is a need to develop treatment as well as preventive interventions oriented towards workers and the workplace. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the effects of how goals are established in operant, graded activity training. Consequently, five men and one woman with long-term back pain served as their own controls and each subject participated in two exercises: sit-ups and trunk extensions. In the Predetermined Condition, the goals were established, as in many programs, by the physical therapist for the entire treatment period after an examination, interview with the patient, and a baseline period of training. By contrast, in the Negotiated Condition, training goals were based on the individual subject's and the physical therapist's views as well as prior results. All subjects received both types, of training programs, but the assignment of exercise type to the condition was randomized to control for possible differences inherent in the exercise itself Results showed that every subject obtained larger improvements in the Negotiated Condition regardless of type of exercise than in the Predetermined Condition. The difference was particularly clear for four of the six subjects and the overall average improvement was more than twice as great for the Negotiated Condition (median increase = 149%) relative to the Predetermined Condition (median increase = 67%). Part of the difference appeared to be that the Negotiated Condition increased variability in results so that some subjects produced much higher increases. These data suggest that the method employed to determine the training goals in operant activities training is an important variable. This information might be utilized to enhance the effects of the program. [ABSTRACT FROM AUTHOR]

Work supervisors (N = 58) were given a 1 day training course to aid the reintegration of employees (N = 46) treated for musculoskeletal pain with a cognitive-behavioral program of rehabilitation. The effects of the training program were measured at three occasions covering the supervisors' knowledge about spinal pain and how to reintegrate employees to work. The effect of the training program was also assessed by asking the employees about their perception of supervisor behavior in their integration to work. The results show that the supervisors felt they had acquired a great deal of new knowledge about pain and as well as the reintegration of employees. They reported changes in supervisory behavior, i.e., conducting follow-up meetings, as was emphasized during the course. These improvements were, however, not entirely confirmed by their employees. More than half the employees in a comparison group where supervisors did not participate in the training program, reported follow-up meetings with their supervisors. Follow-up meetings, regardless of group, were associated with more ergonomic changes carried out at the working place, according to the reports from the employees. The reported quality of social support from supervisors was also higher for those employees who had participated in follow-up meetings. Patients who had participated in follow-up meetings also had fewer days on sick leave during the follow-up period In order to increase the return-to-work rate of employees, training courses of supervisory behavior may need to further emphasize active participation in the rehabilitation process. [ABSTRACT FROM AUTHOR]

A low rate of compliance for exercise regimens is a difficult problem for programs aimed at treating or preventing musculoskeletal pain. In fact, the utility of exercise for common pain problems has been debated since poor compliance confounds proper program evaluation. Thus, the purpose of the present study was to evaluate the effects of a compliance enhancement measure and subsequently to assess the effects of physical activity on pain perception. Forty-eight employees (mean age = 42, 20 females) currently working at two companies and who reported musculoskeletal pain, but no exercise habit voluntarily served as subjects. The Comparison Group was provided with information and free membership at a health center. The Exercise Compliance Enhancement Group met individually with a behavioral psychologist, who employed cognitive-behavioral techniques, to plan their activity program. Results showed that the Compliance Enhancement Group had a higher rate of adherence and participated in significantly more exercises over the course of 6 months than did the Comparison Group. However, analyses based on pre- and posttest gain scores showed that the differences between the groups for aerobic capacity and pain intensity were not significant. However, when compliers were compared with noncompliers, those complying with the activity program were found to have improved their aerobic capacity more than noncompliers. Yet for overall pain intensity ratings, the difference between compliers and noncompliers was still not significant. Intensity ratings made immediately before and after exercising indicated that exercise activities were related to a significant increase in pain intensity. These results indicate that compliance for exercise may be significantly improved, but the effect of exercise activities on overall pain intensity was not significant relative to the comparison group. [ABSTRACT FROM AUTHOR]

Background & Objective: Psychologically informed care has been proposed to improve treatment outcomes for chronic pain and aligns with a person-centered approach. Yet implementation lags behind, and studies suggest that a lack of competency leads to poor results. It is unclear what training clinicians require to deliver this care. We examine how we might improve psychologically informed care guided by the needs of the patient and in congruence with the scientific literature with a particular focus on how competencies might be upgraded and implementation enhanced., Methods: We selectively review the literature for psychologically informed care for pain. The patient's view on what is needed is contrasted with the competencies necessary to meet these needs and how treatment should be evaluated., Results: Patient needs and corresponding competencies are delineated. A number of multi-professional skills and competencies are required to provide psychologically informed care. Single-subject methodologies can determine whether the care has the desired effect for the individual patient and facilitate effectiveness. We argue that becoming a competent "pain clinician" requires a new approach to education that transcends current professional boundaries., Conclusions: Providing person-centered care guided by the needs of the patient and in line with the scientific literature shows great potential but requires multiple competencies. We propose that training the pain clinician of the future should focus on psychologically informed care and the competencies required to meet the individual's needs. Single-subject methodology allows for continual evaluation of this care., (© 2024 the author(s), published by De Gruyter.)

Background: Sexual communication is a common target in psychological treatments for vulvodynia, and associations with sexual function and distress, as well as pain intensity, have been demonstrated. However, structured observations of the communication patterns of couples with vulvodynia are lacking, as these are needed to guide treatment efforts., Aim: To explore (1) the sexual communication patterns in couples with vulvodynia in terms of observed communication quality (operationalized as validating and invalidating responses), self-reported sexual assertiveness, and self-disclosure and (2) associations between sexual communication quality and pain intensity., Methods: In a case-control design with within- and between-group comparisons, 62 couples engaged in videotaped discussions about their sexual relationship. Trained coders assessed the discussions by rating sexual communication (validation and invalidation) according to a structured behavioral coding scheme. Group differences in sexual communication quality were examined with parametric and nonparametric tests. Dyadic associations among observed communication quality, self-rated sexual assertiveness, and self-disclosure were examined within the actor-partner interdependence model. Multiple regression was used to test the predictive value of partners' validation/invalidation on the pain intensity of the women with vulvodynia., Outcomes: Observed communication quality (ie, validation and invalidation), self-reported sexual assertiveness, self-disclosure, and pain intensity., Results: Partners of women with vulvodynia were more invalidating toward their partners than those of women without pain. There were no significant differences in validating/invalidating communication between women in the 2 groups or in validation between partners. Partners' validating communication were significantly associated with women's lower pain intensity. The sexual communication patterns differed between couples with and without vulvodynia, and the associations between validating/invalidating responses and sexual assertiveness were stronger in the vulvodynia group than in the group without pain. Results on validation/invalidation and self-disclosure were inconclusive., Clinical Implications: The results indicate a need to direct treatment interventions toward couples' sexual communication quality (ie, levels of validation and invalidation)., Strengths and Limitations: Strengths include systematic behavioral coding and dyadic analyses. Limitations include the cross-sectional design and self-selection of participants., Conclusion: This study demonstrated sexual communication patterns specific to couples with vulvodynia, and we conclude that validation and invalidation are important components of the sexual communication of couples with vulvodynia as they relate to sexual assertiveness, women's self-disclosure, and pain intensity., (© The Author(s) 2023. Published by Oxford University Press on behalf of The International Society of Sexual Medicine.)

Background: The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) was developed to identify psychological and functioning-related risk factors among individuals with musculoskeletal pain at risk of work disability. This study aimed to examine whether the short version of the ÖMPSQ (ÖMPSQ-SF) can be used for this purpose, using registry-based outcomes., Methods: The ÖMPSQ-SF was completed by the members of the Northern Finland Birth Cohort 1966 at the age of 46 years (baseline). These data were enriched with national registers, including information on sick leaves and disability pensions (indicators of work disability). The associations between the ÖMPSQ-SF categories (low-, medium- and high risk) and work disability over a 2-year follow-up were analysed using negative binomial regression and binary logistic regression models. We made adjustments for sex, baseline education level, weight status and smoking., Results: Overall, 4063 participants provided full data. Of these, 90% belonged to the low-risk, 7% to the medium-risk and 3% to the high-risk group. Compared to the low-risk group, the high-risk group had a 7.5 [Wald 95% confidence interval (CI) 6.2-9.0] times higher number of sick leave days and 16.1 (95% CI 7.1-36.8) times higher odds of disability pension after adjustments in the 2-year follow-up., Conclusions: : Our study suggests that the ÖMPSQ-SF could be used for predicting registry-based work disability at midlife. Those allocated to the high-risk group seemed to have a particularly great need of early interventions to support their work ability., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Public Health Association.)

Purpose Pain and stress-related ill-health are major causes of long-term disability and sick leave. This study evaluated the effects of a brief psychosocial program, which previously has been tested for an at-risk population of employees. Methods The Effective Communication within the Organization (ECO) program, where supervisors and employees were trained in communication and problem solving, was compared to an active control consisting of psychoeducative lectures (PE) about pain and stress in a cluster randomized controlled trial. First-line supervisors were randomized to ECO or PE, and a total of 191 mainly female employees with self-reported pain and/or stress-related ill-health were included. The hybrid format programs consisted of 2-3 group sessions. Sick leave data was collected from social insurance registers, before and 6-months after the program. Secondary outcomes (work ability, work limitations, pain-disability risk, exhaustion symptoms, perceived stress, perceived health, quality of life, perceived communication and support from supervisors) were assessed at baseline, post intervention, and at 6-months follow-up. Results No effects were observed on primary or secondary outcome variables. Pain symptoms were common (89%), however a lower proportion (30%) were identified as at risk for long-term pain disability, which might explain the lack of evident effects. The Covid-19 pandemic affected participation rates and delivery of intervention. Conclusion In this study, preventive effects of the ECO program were not supported. Altogether, the findings point at the importance of selecting participants for prevention based on screening of psychosocial risk. Further research on workplace communication and support, and impact on employee health is warranted., (© 2022. The Author(s).)

Background: Psychological treatments for common mental disorders are increasingly being delivered remotely via the internet. Evidence suggests that internet-delivered cognitive behavioural therapy (iCBT) is superior to waitlist. However, the benefits are unclear of using this treatment modality as an add-on to treatment as usual (TAU) in regular healthcare., Methods: The literature was systematically searched up to August 2021 for randomized trials of internet-delivered psychological treatments using TAU as the comparator. Eligible participants were diagnosed with depressive, anxiety, obsessive-compulsive, or trauma- and stress-related disorders. Outcomes of interest were symptoms, functioning, quality of life, healthcare utilization, and negative effects. Results were synthesized using random-effects meta-analyses. Quality of evidence was assessed using GRADE., Results: The included studies evaluated iCBT for adults with depression (k = 9), depressive or anxiety disorders (k = 4), and post-traumatic stress disorder (k = 2) and were conducted in primary care or similar settings. For depression, low-certainty evidence suggested beneficial short-term effects on symptoms (g = -0.23; 95 % CI: = -0.37, -0.09), response rate (OR = 2.46; 1.31, 4.64), and remission (OR = 1.70; 1.19, 2.42;). The certainty of evidence was very low for long-term effects, other outcomes, and other disorders., Limitations: TAU varied across studies and was often insufficiently described., Conclusions: iCBT as a complement to usual care for adult with depression may result in a small incremental effect, which potentially could be clinically important. Studies are lacking for several common disorders and for children, adolescents, and the elderly. More robust studies of long-term effects are also needed, to better inform clinical decision-making., Competing Interests: Conflict of interest All authors declare that they have no conflicts of interest., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Vulvodynia is common and has an immense impact on affected women and their partners. Psychological factors have been found to contribute to pain maintenance and exacerbation, and treatments addressing psychological factors have yielded positive results. This study employed a replicated single-case experimental design to examine a cognitive behavioral therapy (CBT) group treatment with partner involvement in vulvodynia. Repeated measures of pain intensity related to pain-inflicting behaviors were collected weekly throughout baseline and treatment phases. Associated outcomes were measured pre-, post- and at two follow-up assessments. Participants were 18-45-year-old women, in a stable sexual relationship with a man, experiencing vulvodynia. Five women completed the treatment consisting of 10 group sessions and 3 couple sessions. Data were analyzed through visual inspection and supplementary nonparametric calculations. The study showed promising results of the CBT treatment in alleviating pain intensity in connection to specific pain-inflicting behavior since three out of five participants showed improvements. For the participants who improved, sexual function, pain catastrophizing, avoidance, and endurance behavior changed during treatment and were maintained at follow-ups. These results warrant further study of the CBT treatment, in larger, and controlled formats.

Objectives: Male pelvic pain is a common yet poorly understood condition, strongly influencing quality of life of those affected. Research on psychological and sexual factors is lacking, specifically on younger men in family-forming ages. This study aims to explore psychological and sexual factors related to pelvic pain in younger men (<40 years) through a cross-sectional design., Methods: Participants were recruited via social media, and completed a digital survey regarding sexual health and psychological distress (n=2,647). Men with varying levels of pelvic pain were compared on levels of psychological distress and self-reported sexual health., Results: Men with pelvic pain (n=369) reported significantly higher levels of catastrophizing, anxiety and premature ejaculation compared to men without pelvic pain. Furthermore, men with higher pain intensity reported significantly higher levels of catastrophizing, anxiety and depressive symptoms compared to men experiencing lower pain intensity. Hierarchical regression analysis revealed catastrophizing and depressive symptoms as significantly predictors of pain intensity., Conclusions: These findings underscore the role of psychological factors in male pelvic pain, and points to the need for integrating a psychological understanding for further treatment development., (© 2022 the author(s), published by De Gruyter, Berlin/Boston.)