Multidisciplinary intervention in patients with musculoskeletal pain: a randomized clinical trial

Background Musculoskeletal pain is associated with comorbidity, extensive use of health services, long-term disability and reduced quality of life. The scientific literature on effects of treatment for musculoskeletal pain is inconclusive. Purpose The purpose of this study is to compare a multidisciplinary intervention (MI), including use of the novel Interdisciplinary Structured Interview with a Visual Educational Tool (ISIVET), with a brief intervention (BI), on effects on mental and physical symptoms, functioning ability, use of health services and coping in patients sick-listed due to musculoskeletal pain. Method Two hundred eighty-four adults aged 18–60, referred to a specialist clinic in physical rehabilitation, were randomized to MI or BI. Patients received a medical examination at baseline and completed a comprehensive questionnaire at baseline, 3 months and 12 months. Results Both groups reported improvements in mental and physical symptoms, including pain, and improved functioning ability at 3 and 12 months, but the MI group improved faster than the BI group except from reports of pain, which had a similar course. Significant interactions between group and time were found on mental symptoms (anxiety (p < 0.05), depression (p < 0.01), somatization (p < 0.01)) and functioning ability (p < 0.01) due to stronger effects in the MI group at 3 months. At 3 and 12 months, the MI group reported significantly less use of health services (general practitioner (p < 0.05)). At 12 months, the MI group reported better self-evaluated capability of coping with complaints (p < 0.001) and they took better care of their own health (p < 0.001), compared to the BI group. Conclusion The results indicate that the MI may represent an important supplement in the treatment of musculoskeletal pain.publishedVersio

Effekten av akutt sult og emosjonelt stress på vommiljø og kjøttkvalitet i rein

Resultatene er derfor hittil negative n&aring;r det gjelder v&aring;r hypotese om at stress p&aring;virkervommilj&oslash;et og dermed kj&oslash;ttkvaliteten. Det er imidlertid tvilsomt om dyrene som var slaktet i Kautokeino var tilstrekkelig stresset til &aring; gi et klart utslag. Det b&oslash;r i denne sammenheng fremheves at det ikke ble p&aring;vist d&aring;rlig lukt eller andre subjektive tegn p&aring; d&aring;rlig kj&oslash;ttkvalitet under slaktingen

Expectancies, Socioeconomic Status, and Self-Rated Health: Use of the Simplified TOMCATS Questionnaire

Background: Coping has traditionally been measured with inventories containing many items meant to identify specific coping strategies. An alternative is to develop a shorter inventory that focusses on coping expectancies which may determine the extent to which an individual attempts to cope actively. Purpose: This paper explores the usefulness and validity of a simplified seven-item questionnaire (Theoretically Originated Measure of the Cognitive Activation Theory of Stress, TOMCATS) for response outcome expectancies defined either as positive (“coping”), negative (“hopelessness”), or none (“helplessness”). The definitions are based on the Cognitive Activation Theory of Stress (CATS; Ursin and Eriksen, Psychoneuroendocrinology, 29(5):567–92, 2004). The questionnaire was tested in two different samples. First, the questionnaire was compared with a traditional test of coping and then tested for validity in relation to socioeconomic differences in self-reported health. Methods: The first study was a comparison of the brief TOMCATS with a short version of the Utrecht Coping List (UCL; Eriksen et al., Scand J Psychol, 38(3):175–82, 1997). Both questionnaires were tested in a population of 1,704 Norwegian municipality workers. The second study was a cross-sectional analysis of TOMCATS, subjective and objective socioeconomic status, and health in a representative sample of the Swedish working population in 2003– 2005 (N011,441). Results: In the first study, the coping item in the TOMCATS questionnaire showed an expected significant positive correlation with the UCL factors of instrumental masteryoriented coping and negative correlations with passive and depressive scores. There were also the expected correlations for the helplessness and hopelessness scores, but there was no clear distinction between helplessness and hopelessness in the way they correlated with the UCL. In the second study, the coping item in TOMCATS and the three-item helplessness scores showed clear and monotonous gradients over a subjective socioeconomic status (SES) ladder. Positive response outcome expectancy (“coping”) was related to high subjective SES and no expectancy (“helplessness”) to low subjective SES. In a model including age and sex, TOMCATS scores explained more variance (r200.16) in self-reported health than both subjective (r200.08) and objective SES (r200.02). Conclusion: The brief TOMCATS questionnaire showed acceptable and significant correlations with a traditional coping questionnaire and is sensitive enough to register systematic differences in response outcome expectancies across the socioeconomic ladder. The results furthermore confirm that psychological and learning factors contribute to the socioeconomic gradient in health.publishedVersio

Factors explaining variance in perceived pain in women with fibromyalgia

BACKGROUND: We hypothesized that a substantial proportion of the subjectively experienced variance in pain in fibromyalgia patients would be explained by psychological factors alone, but that a combined model, including neuroendocrine and autonomic factors, would give the most parsimonious explanation of variance in pain. METHODS: Psychometric assessment included McGill Pain Questionnaire, General Health Questionnaire, Hospital Anxiety and Depression Rating Scale, Eysenck personality Inventory, Neuroticism and Lie subscales, Toronto Alexithymia Scale, and Multidimensional Health Locus of Control Scale and was performed in 42 female patients with fibromyalgia and 48 female age matched random sample population controls. A subgroup of the original sample (22 fibromyalgia patients and 13 controls) underwent a pharmacological challenge test with buspirone to assess autonomic and adrenocortical reactivity to serotonergic challenge. RESULTS: Although fibromyalgia patients scored high on neuroticism, anxiety, depression and general distress, only a minor part of variance in pain was explained by psychological factors alone. High pain score was associated with high neuroticism, low baseline cortisol level and small drop in systolic blood pressure after buspirone challenge test. This model explained 41.5% of total pain in fibromyalgia patients. In population controls, psychological factors alone were significant predictors for variance in pain. CONCLUSION: Fibromyalgia patients may have reduced reactivity in the central sympathetic system or perturbations in the sympathetic-parasympathetic balance. This study shows that a biopsychosocial model, including psychological factors as well as factors related to perturbations of the autonomic nervous system and hypothalamic-pituitary-adrenal axis, is needed to explain perceived pain in fibromyalgia patients

Social inequalities in health: biological, cognitive and learning theory perspectives

Increasing social inequalities in health have been ascribed to unequal distribution of resources, and to exposure factors. We propose that these differences also may be explained by principles from cognitive stress theory. There seems to be consensus in the stress literature that the stress response is not predicted from the external situation. The acquired expectancies to stimuli and response outcome are determining the response. These expectancies are learned. Based on available reinforcement contingencies and resources, the individual learns positive response outcome expectancies (“coping”), or that nothing helps (“helplessness”), or that everything goes wrong (“hopelessness” – negative outcome expectancy). These expectancies are associated with social position and social success, in man and animals. High levels of coping are associated with high social position, and low stress values. Low level or lack of coping is associated with high and maintained stress levels, which may produce somatic changes. Lack of coping also affects choice of life style. Social inequalities in health, therefore, may depend on the learning history of the individuals. Expectancies of failure produce direct somatic effects via maintained high stress levels, and via learning of life styles and motivation for change

Tiltak for å fremme helse på arbeidsplassen

Previous attempts to improve health in working life were directed at somatic health variables. At present, such interventions are also directed at life quality and subjective health. Complaints without objectively verifiable disease constitute as much as 50 % of long term sickness compensation and permanent disability. It is a major source of absence of well being and positive health. There are only a few randomized, controlled studies of interventions improving health in working life. Published studies show moderate, but significant effects on objective as well as subjective health variables, from physical exercise, stress management training, and general health promotion, in particular life style modifications (diet, exercise, reduced alcohol and tobacco consumption