Home Medicine The Functional Barometer — An analysis of a self-assessment questionnaire with ICF-coding regarding functional/activity limitations and quality of life due to pain — Differences in age gender and origin of pain
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The Functional Barometer — An analysis of a self-assessment questionnaire with ICF-coding regarding functional/activity limitations and quality of life due to pain — Differences in age gender and origin of pain

  • Jan-Rickard Norrefalk EMAIL logo and Kristian Borg
Published/Copyright: October 1, 2017
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Scandinavian Journal of Pain
From the journal Scandinavian Journal of Pain Volume 17 Issue 1

Abstract

Long standing non-malignant pain leads to a variety of limitations which can be assessed by means of the self-assessment questionnaire Functional Barometer. It is designed to assess the extent and limitations in function, activity and decreased quality-of-life and is adapted to the International Classification of Functioning and Health.

Aim

To investigate the outcome and differences in age, gender and origin of pain in patients with longstanding non-malignant pain regarding the subjective experience of functional-, activity- and quality-of-life limitations.

Method

300 patients with a median duration of pain of 49 months referred to a Pain Management Centre filled out the Functional Barometer questionnaire, adapted to the International Classification of Functioning and Health.

Results

66% patients were women and 34% were men. Seventy-five percent were in working age, 18-64 years. The duration before being referred to a pain specialist was over 4 years and 65% reported pain from more than three origins. Significant differences in functioning, activity and quality-of-life were found in comparing gender, age and origin of pain. Men more often reported physiological limitations while women more often reported psychological limitations of functioning, activity and quality-of-life. The most important were that men more often had difficulties in walking and climbing stairs, while women reported problems with concentration, stress and psychological demands, family relations and contact with friends.

Conclusion

The significant differences regarding functioning, activity and quality-of-life between women and men as age and origin of pain must be taken into account when tailoring individual treatment and rehabilitation programmes.

Keywords: Functional Barometer; Pain analysis; Function; Activity; Quality of life

1 Introduction

Long-standing non-malignant pain (LSNMP), leads to varying degrees to function and activity limitations as well as impact on quality-of-life (QoL) and will affect an individual’s life, spare time, economy, psychosocial well-being and capacity for work [1]. LSNMP is also a major reason for prolonged sick leave and early retirement, thereby causing high costs for the national insurance system, health care, employers and society [2,3,4,5,6]. A large number of pain patients are referred to Pain Management Centres, as other specialists do not come to terms with their patients’ pain.

There is a lack of studies in which ICF-coding is included and particularly there is a lack of pain-based studies using the International Classification of Functioning and Health (ICF).The Functional Barometer (FB) is a validated and quality assured self-assessment instrument for patients suffering from pain and is so far the only questionnaire in Swedish using ICF-variables based on pain [7]. Being able to document which limitations LSNMP causes, but also what the patient is capable to perform despite and because of their pain, facilitates how to target treatment and rehabilitation individually. This was also a measure to avoid and prevent ineffective, unnecessary, costly and time-consuming investigations and treatments, and to prevent or interrupt the risk of medicalization. This in turn reduces patient suffering and costs. The saved costs for this over treatment are expected to have a positive effect on society in general as previous research indicates [2,3,4,5,6].

The aim of this study was to investigate the outcome and differences in age, gender and origin of pain in patients with LSNMP regarding the subjective experience of functional-, activity- and QoL limitations.

Method and patient selection: All patients that were referred to the Pain Management Clinic at a University Hospital in Stockholm, filled out the Functional Barometer questionnaire (FB). The FB consists of 28 questions, 12 specified variables cover body function and activities/participation and one additional optional item variable for the patient to assess. Additionally there are 12 QoL variables, and four items of pain (Tables 2,3,4) [7,8,9]. The FB is based on the patient’s experience of pain but is also adapted to the WHO international classification, ICF (International Classification of Functioning and Health) of patients’ disability, activity limitations and participation [10,11,12,13,14,15]. All items are assessed by a verbal descriptive problem scale, the same as the ICF qualifier, the five categories graded 0–4. The categories defined as no (0), slight (1), moderate (2), major (3), and total (4) problems [7].

Table 2a

Duration of pain in months of 220 patients.

No of patients Mean Median SD Minimum Maximum Percentiles
25 50 75
Total 300
Missing 80
Missing Women 62
Missing Men 18
Valid 220 108 49 141 4 804 26 49 120
Women 145 118 48 153 4 732 25 48 150
Men 75 89 55 113 6 804 29 55 96
18–64 years 166 109 49 5 528 26 49 120
>65 years 54 114 47 4 804 26 47 183

Table 2b

Duration of pain in months for the 220 patients before being referred to the pain specialist centre. Presented in total and divided in subgroups of age and gender.

No of patients (%) Mean Median SD Minimum Maximum Percentiles
25 50 75
Total 220 (100%) 108 49 141 4 804 26 49 120
18-64 y 166 (75%) 95 49 106 5 528 26 49 120
>65 y 54 (25%) 150 47 212 4 804 26 47 183
Women18–64y 110 (50%) 102 48 116 5 528 25 48 144
>65 y 35 (16%) 170 40 229 4 732 24 40 265
Men 18–64y 56 (25%) 82 51 84 6 372 27 51 96
>65 y 19 (9%) 112 60 175 20 804 33 60 108

Table 3

Reported number of pain regions from 282 patients.

No of valid 282
patients
Missing 18
Percent Percent Percent
Total Women Men
Pain from 1 38 13 11 18
region
Pain from 2 to 61 22 21 23
3 regions
Pain from more 183 65 67 60
than 3 regions

Table 4

Differences in women and men aged 18–64 vs women and men aged over 65 years. The results are presented with the rate of given answers of the total.

Do you have problem because ofyour pain with
FB no ICF-code Function/Activity Total Women Men
n p-value n p-value n p-value
1 d 540 Dressing. 18–64 221 0.957 150 0.935 71 0.802
➢=65 71 51 20
2 b 710 Joint mobility. 18–64 207 0.317 140 0.296 67 0.830
➢=65 73 51 22
3 b 730 Muscle strength. 18–64 218 0.245 149 0.285 69 0.595
➢=65 70 50 20
4 b 740 Endurance. 18–64 214 0.226 145 0.207 69 0.662
➢=65 67 48 19
5 d 450 Walking. 18–64 211 0.008 141 0.208 70 0.003
➢=65 69 48 21
6 d 4551 Walking in stairs. 18–64 214 0.004 146 0.268 68 <0.001
➢=65 69 47 22
7 d 4153 Keeping posture. 18–64 212 0.651 147 0.509 65 0.865
➢=65 68 48 20
8 d 649 Making the bed. 18–64 219 0.854 150 0.685 69 0.772
➢=65 70 48 22
9 d 640 Ordinary housework. 18–64 214 0.226 144 0.088 70 0.889
65 70 49 21
10 d 430 Lifting/carrying things. 18–64 212 0.526 146 0.730 66 0.571
➢=65 72 50 22
11 d 4751 Driving a car. 18–64 117 0.061 72 0.225 45 0.149
➢=65 44 25 19
12 d 470 Using transportation. 18–64 215 0.179 147 0.288 68 0.512
➢=65 68 49 19
Do you have problem because of your pain with
FB no ICF-code Quality-of-life Total Women Men
n p-value n p-value n p-value
14 b 134 Sleeping. 18–64 215 0.133 145 0.405 70 0.145
➢=65 69 47 22
15 b 130 Energy. 18–64 218 0.140 150 0.103 68 0.823
➢=65 72 50 22
16 b 160 Concentration. 18–64 220 0.002 150 0.003 70 0.165
➢=65 71 49 22
17 d 240 Stress. Psychological demands. 18–64 213 0.001 144 0.009 69 0.030
➢=65 70 48 22
18 b 152 Emotional functions. 18–64 202 0.244 143 0.355 59 0.485
➢=65 70 48 22
19 b 535 Gastro-intestinal functions. 18–64 216 0.435 145 0.449 71 0.833
➢=65 48 48 22
20 d 920 Leisure time. 18–64 148 0.097 148 0.089 68 0.578
➢=65 70 49 21
21 d 760 Family relation. 18–64 212 0.003 145 0.004 67 0.302
➢=65 71 49 22
22 d 750 Contact with friends. 18–64 218 0.054 149 0.033 69 0.718
➢=65 72 50 22
23 d 750 Self-support. 18–64 212 < 0.001 145 < 0.001 67 0.001
➢=65 66 44 22
24 d 850 Managing pay-work. 18–64 157 0.051 103 0.098 57 0.294
➢=65 16 9 7
Do you have problem because of your pain with
FB no ICF-code Quality-of-life Total Women Men
n p-value n p-value n p-value
25 b 280 Pain just now. 18–64 209 0.985 141 0.870 68 0.729
➢=65 69 48 21
26 b 280 Pain the last week. 18–64 212 0.375 145 0.276 67 0.996
➢=65 69 49 20
27 b 280 The mildest pain. 18–64 211 0.957 149 0.977 62 0.910
➢=65 71 49 22
28 b 280 The worst pain. 18–64 215 <0.001 150 <0.001 65 0.221
➢=65 70 48 22

The p-values in bold are the significant

300 patient questionnaires were randomly selected for the study. Two hundred and eighty two of these questionnaires could be used to collect data for this study (9% drop out).

By completing the FB questionnaire the patients assessed to what extent pain affected their function, activity and QoL. This gave an ICF code and category grade for each question and provided a clear overview of the patient’s situation and problems due to their pain.

A pain drawing is connected to the FB. It was used to register what kind of pain the patients might be suffering from. The patients pain was also divided into three categories; one origin, 2 or 3 origins or more than 3 origins.

2 Ethics review

An application to the Ethical Review Board in Stockholm was performed. The Ethics Committee concluded that an ethic review was not required for this study as it concerns a qualitative study and not contain sensitive personal data.

2.1 Statistics

All statistical analyses were performed using IBM SPSS Statistics version 23.

To compare the differences between women and men the non- parametric tests such as Mann-Whitney tests, Chi-square tests and Cross tabulation were used. The describing statistics were performed using n, percent (%), mean and standard deviation (SD). For the group statistics regarding age, the T-Test were used. A value of p<0.05 was considered statistically significant.

3 Results

Three hundred, 207 women and 93 men aged between 18 and 88 years, who had filled out the FB questionnaire were randomly selected for the study. As shown in Table 1, 66% patients were women and 34% were men. Seventy-five percent were in working age, 18–64 years. The mean age for women were 49 and for men 52 ranged from 18 to 88 years for both groups.

Table 1

Demographic data ofthe 300 patients.

No of patients Age Age Mean Age Median Age SD Age Minimum Age Maximum Percentiles
25 50 75
Total 300 50 50 18 18 88 35 50 64
Women 207 49 48 18.5 18 88 33 48 64
Men 93 52 53 16.6 18 87 40 53 64

The duration of pain before referral to the pain management unit and occurrence of pain in different regions of the body appear in Table 1. 220 of the patients had answered this question, 145 women and 75 men, a dropout rate of 27%. The median duration of pain before referred to the pain management unit was 49 months. For women between 18 and 64 years of age the median was 48 months (range 5–528 months) and for men in the same age 51 months (range 6–372 months). For women over 65 years the median was 40 months (range 4–732 months) and for men over 65 years of age 60 months (range 20-804 months) (Fig. 1 and Tables 2a and 2b). 282 patients had filled out the question about pain regions, a dropout rate of 9%. Thirteen percent of the patients reported pain from one region, 22% reported pain from 2 to 3 regions and 65% reported pain from more than 3 regions of their body. For women the corresponding percent were 11, 21 and 67% and for men 18, 23 and 60% (Table 3).

Fig. 1 The duration of pain of 220 patients before referred to the pain management unit was 108 months, for women 118 months (range 4–732 months) and for men 89 months (range 6-804 months).
Fig. 1

The duration of pain of 220 patients before referred to the pain management unit was 108 months, for women 118 months (range 4–732 months) and for men 89 months (range 6-804 months).

In Table 4 the differences between women and men aged 18-64 versus women and men over 65 years of age are seen. Regarding function and activities on a total the ICF variables “walking” (d 450) and “walking in stairs” (d 4551) seems to be the most difficult activities for pain patients in the study group, p = 0.008 and p = 0.004. This is also the fact for men over 65, p = 0.003 and p< 0.001, but for men under 65 years of age and for women there was no significant difference found.

In this study the activities and ICF variables “dressing” (d 540) and “making the bed” (d 649) did not seem to be affected due to pain p = 0.957 and p = 0.854.

Men seems to have less problems with “joint mobility” (b 710), “muscle strength” (b 730), “muscle endurance” (b 740), and “ordinary housework” (d 640) than women but there was no significant difference found.

Pain was a significant factor to reduce QoL regarding “concentration” (b 160) p = 0.002, “stress and psychological demands” (d 240) p = 0.001, “family relation” (d 760) p = 0.003 and “economical self-support” (d 870) p< 0.001 for patients over 65 years. Women over 65 reported a statistically significant problem with “concentration” p = 0.003, “stress and psychological demands” (d 240) p = 0.009, “family relation” (d 760) p = 0.004 and “contact with friends” (d 750) p = 0.033 in comparison to men and younger women.

In the ICF variable “economical self-support” there was a clear difference p< 0.001 in the groups men and women over 65 years, in comparison to younger patients. Comparing men aged 18-64 and men over 65, “stress and psychological demands” p = 0.030 and “economical self-support” p = 0.001 were the ICF variables that elderly men found most affected due to their pain.

ICF variables like “energy” (b 130),“leisure time” (d 920) and “contact with friends” (d 750) does not seem to affect men in this study to the same extent as women but there is no significant deferens found.

The question how pain affected the patients overall, the elderly over 65 assessed that when their pain was “at its worse” (b 280) p< 0.001 it had a negative impact on functioning, activity and QoL. This was also the fact for women over 65, but not statistically significant for men (p = 0.221).

Regarding the number of origins of pain, the pain drawing was used and the patients divided into three categories; one origin, 2 or 3 origins or more than 3 origins. Almost all ICF variables showed statistically significance for difficulties in functioning, activity and QoL if the patients had more than three origins of pain. The only variables who were not significant was “driving car”, “pain just now” and “worst pain” (Figs. 2,3,4).

Fig. 2 Origins of pain function/activity.
Fig. 2

Origins of pain function/activity.

Fig. 3 Origins of pain quality of life.
Fig. 3

Origins of pain quality of life.

Fig. 4 Perceived pain and origins of pain.
Fig. 4

Perceived pain and origins of pain.

4 Discussion

The aim of this study was to investigate and evaluate the outcome and differences in age, gender and origin of pain in patients suffering from LSNMP regarding the subjective experience of functional-, activity- and QoL limitations. In this study the majority of the patients were women and in working age. This seems to be in co-ordinance with most studies of persistent pain. One explanation for the skew numbers of patients in working age compared with patients over the age of 65 could be that elderly patients will not be referred to pain specialists rather than being treated in primary care. The mean age for women were 49 and for men 52. This might indicate that it is the older patients in working age that are preferably referred to pain specialists.

The statistical analysis of time for the study population before they were referred to a pain specialist showed no normal distribution. Therefore it is not sufficient to present the months in mean but in median and percentiles (Fig. 1 and Table 2b). If patients with severe pain conditions have to wait for more than four years before they are referred to a pain specialist centre, something is lacking in the health organization in the Stockholm area. There is a lack of pain specialists and one may anticipate it must be even worse in other parts of Sweden [6]. The same problem was also reported in a European survey by Breivik et al. [2] and in Pain Proposal, a European Consensus Report (2010) [3].

The majority of the patients in this study suffered from pain from more than three regions of their body (65%). This was independent of gender. As most of the patients had different kinds of pain from different regions of their body, it was not possible to make subgroups out of their pain classification. This would of cause have been of interest as one may anticipate differences in limitations of functioning, activity and QoL, depending on differences in type of pain. The patients often suffered from a combination of different pain, pain qualities and origins. However, the FB could be useful in helping to find symptoms pointing in a diagnosis of a more neuropathic or nociceptive pain direction.

This study points in the direction that men seems to have less problems with “joint mobility”, “muscle strength”, “muscle endurance” and “ordinary housework” than women. Even if there was no significant difference found it might indicate a difference in gender and gender roles. However, there was a clear significant difference between younger and older patients and especially for women over 65 years regarding problems with the ICF items “concentration”, “stress and psychological demands”, “family relation” and “contact with friends” in comparison to men and younger women. Men over 65, in opposite to men aged from 18 to 64 years reported more problems with “stress and psychological demands” due to their pain. One may speculate that the increased QoL for men with pain could be attributed to response shift [16]. Men with pain might have a response shift for physiological factors, i.e. QoL for physiological factors are increased during ageing and QoL increases with age in the normal population. Increased Qol, with age has also been described for pain in patients suffering from post-polio syndrome [17,18,19].

Almost all ICF variables showed statistically significance for difficulties in functioning, activity and QoL if the patients had more than three origins of pain. The question how pain affected the patients overall, elderly assessed that when their pain was “at its worse” it had a significant negative impact on functioning, activity and QoL. This was also the fact for women over 65, but not statistically significant for men.

This study has methodological limitations with no comparison group from another pain management centre. Furthermore, there is no follow-up data presented. However, this was not the aim of this study. Furthermore, the population in the actual area has an over-representation of socio-economic problems, immigrants and people with a low level of education [4,5,20,21,22,23], which may have had an influence of the results. Another common limitation in studies like this, with a self-assessment questionnaire like the FB there is more of a rule than exception that patients for some reason have not filled in all answers. This makes the whole interpretation of the answers more unsecure. For example of the 300 participants in this study only 220 filled in the duration of their pain a dropout of 27% and 282 patients registered their regions of pain a dropout of 9%. It can always be discussed if the patients then should be asked to fill in the missing data or not and to that extent they could be enrolled in the study. This might influence the answers in one way or another. In this study the given answers for every item was studied as it was given by the patient.

5 Conclusion

Pain affects the patients overall, especially elderly and it has a negative impact on functioning, activity and QoL. This study shows that men have more difficulties with “walking” and “climbing stairs” while women especially over 65 years of age reported statistically significant problems with “concentration”, “stress and psychological demands”, “family relation” and “contact with friends” in comparison to men and younger women. The FB with the included ICF variables can be useful in the assessment of the pain patient’s limits and possibilities. The differences must be taken into account when tailoring individual treatment and rehabilitation programmes.

  1. Conflicts of interest: The authors state they have no conflict of interest.

Acknowledgements

The study was supported by grants from, Neuro-Förbundet (Neuro Sweden). A special thanks to Lisbet Broman at the Department of Rehabilitation, Danderyd Hospital, for statistical support and to Lovisa Pernskold for admin support and to all the team members at the Pain Management Unit at Södersjukhuset University Hospital.

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Received: 2017-04-28
Accepted: 2017-06-11
Published Online: 2017-10-01
Published in Print: 2017-10-01

© 2017 Scandinavian Association for the Study of Pain

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  80. Is the search for a “pain personality” of added value to the Fear-Avoidance-Model (FAM) of chronic pain?
  81. Editorial comment
  82. Importance for patients of feeling accepted and understood by physicians before and after multimodal pain rehabilitation
  83. Editorial comment
  84. A glimpse into a neglected population – Emerging adults
  85. Observational study
  86. Assessment and treatment at a pain clinic: A one-year follow-up of patients with chronic pain
  87. Clinical pain research
  88. Randomized, double-blind, placebo-controlled, dose-escalation study: Investigation of the safety, pharmacokinetics, and antihyperalgesic activity of L-4-chlorokynurenine in healthy volunteers
  89. Clinical pain research
  90. Prevalence and characteristics of chronic pain: Experience of Niger
  91. Observational study
  92. The use of rapid onset fentanyl in children and young people for breakthrough cancer pain
  93. Original experimental
  94. Acid-induced experimental muscle pain and hyperalgesia with single and repeated infusion in human forearm
  95. Original experimental
  96. Swearing as a response to pain: A cross-cultural comparison of British and Japanese participants
  97. Clinical pain research
  98. The cognitive impact of chronic low back pain: Positive effect of multidisciplinary pain therapy
  99. Clinical pain research
  100. Central sensitization associated with low fetal hemoglobin levels in adults with sickle cell anemia
  101. Topical review
  102. Targeting cytokines for treatment of neuropathic pain
  103. Original experimental
  104. What constitutes back pain flare? A cross sectional survey of individuals with low back pain
  105. Original experimental
  106. Coping with pain in intimate situations: Applying the avoidance-endurance model to women with vulvovaginal pain
  107. Clinical pain research
  108. Chronic low back pain and the transdiagnostic process: How do cognitive and emotional dysregulations contribute to the intensity of risk factors and pain?
  109. Original experimental
  110. The impact of the Standard American Diet in rats: Effects on behavior, physiology and recovery from inflammatory injury
  111. Educational case report
  112. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series
  113. Original experimental
  114. Hyperbaric oxygenation alleviates chronic constriction injury (CCI)-induced neuropathic pain and inhibits GABAergic neuron apoptosis in the spinal cord
  115. Observational study
  116. Predictors of chronic neuropathic pain after scoliosis surgery in children
  117. Clinical pain research
  118. Hospitalization due to acute exacerbation of chronic pain: An intervention study in a university hospital
  119. Clinical pain research
  120. A novel miniature, wireless neurostimulator in the management of chronic craniofacial pain: Preliminary results from a prospective pilot study
  121. Clinical pain research
  122. Implicit evaluations and physiological threat responses in people with persistent low back pain and fear of bending
  123. Original experimental
  124. Unpredictable pain timings lead to greater pain when people are highly intolerant of uncertainty
  125. Original experimental
  126. Initial validation of the exercise chronic pain acceptance questionnaire
  127. Clinical pain research
  128. Exploring patient experiences of a pain management centre: A qualitative study
  129. Clinical pain research
  130. Narratives of life with long-term low back pain: A follow up interview study
  131. Observational study
  132. Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption
  133. Clinical pain research
  134. Chronic pain disrupts ability to work by interfering with social function: A cross-sectional study
  135. Original experimental
  136. Evaluation of external vibratory stimulation as a treatment for chronic scrotal pain in adult men: A single center open label pilot study
  137. Observational study
  138. Impact of analgesics on executive function and memory in the Alzheimer’s Disease Neuroimaging Initiative Database
  139. Clinical pain research
  140. Visualization of painful inflammation in patients with pain after traumatic ankle sprain using [11C]-D-deprenyl PET/CT
  141. Original experimental
  142. Developing a model for measuring fear of pain in Norwegian samples: The Fear of Pain Questionnaire Norway
  143. Topical review
  144. Psychoneuroimmunological approach to gastrointestinal related pain
  145. Letter to the Editor
  146. Do we need an updated definition of pain?
  147. Narrative review
  148. Is acetaminophen safe in pregnancy?
  149. Book Review
  150. Physical Diagnosis of Pain
  151. Book Review
  152. Advances in Anesthesia
  153. Book Review
  154. Atlas of Pain Management Injection Techniques
  155. Book Review
  156. Sedation: A Guide to Patient Management
  157. Book Review
  158. Basics of Anesthesia
https://doi.org/10.1016/j.sjpain.2017.06.004
Keywords for this article
Functional Barometer; Pain analysis; Function; Activity; Quality of life

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  3. Clinical pain research
  4. Prospective, double blind, randomized, controlled trial comparing vapocoolant spray versus placebo spray in adults undergoing intravenous cannulation
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  34. Effects of validating communication on recall during a pain-task in healthy participants
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  36. Comparison of spatial summation properties at different body sites
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  38. Behavioural inhibition in the context of pain: Measurement and conceptual issues
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  42. Quantitative sensory tests (QST) are promising tests for clinical relevance of anti–nociceptive effects of new analgesic treatments
  43. Educational case report
  44. Pregabalin as adjunct in a multimodal pain therapy after traumatic foot amputation — A case report of a 4-year-old girl
  45. Editorial comment
  46. Severe side effects from intrathecal morphine for chronic pain after repeated failed spinal operations
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  48. Opioids in chronic pain – Primum non nocere
  49. Editorial comment
  50. Finally a promising analgesic signal in a long-awaited new class of drugs: TRPV1 antagonist mavatrep in patients with osteoarthritis (OA)
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  52. The relationship between chronic musculoskeletal pain, anxiety and mindfulness: Adjustments to the Fear-Avoidance Model of Chronic Pain
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  56. Sleep, widespread pain and restless legs — What is the connection?
  57. Editorial comment
  58. Broadening the fear-avoidance model of chronic pain?
  59. Observational study
  60. Identifying characteristics of the most severely impaired chronic pain patients treated at a specialized inpatient pain clinic
  61. Editorial comment
  62. The burden of central anticholinergic drugs increases pain and cognitive dysfunction. More knowledge about drug-interactions needed
  63. Editorial comment
  64. A case-history illustrates importance of knowledge of drug-interactions when pain-patients are prescribed non-pain drugs for co-morbidities
  65. Editorial comment
  66. Why can multimodal, multidisciplinary pain clinics not help all chronic pain patients?
  67. Topical review
  68. Individual variability in clinical effect and tolerability of opioid analgesics – Importance of drug interactions and pharmacogenetics
  69. Editorial comment
  70. A new treatable chronic pain diagnosis? Flank pain caused by entrapment of posterior cutaneous branch of intercostal nerves, lateral ACNES coined LACNES
  71. Clinical pain research
  72. PhKv a toxin isolated from the spider venom induces antinociception by inhibition of cholinesterase activating cholinergic system
  73. Clinical pain research
  74. Lateral Cutaneous Nerve Entrapment Syndrome (LACNES): A previously unrecognized cause of intractable flank pain
  75. Editorial comment
  76. Towards a structured examination of contextual flexibility in persistent pain
  77. Clinical pain research
  78. Context sensitive regulation of pain and emotion: Development and initial validation of a scale for context insensitive avoidance
  79. Editorial comment
  80. Is the search for a “pain personality” of added value to the Fear-Avoidance-Model (FAM) of chronic pain?
  81. Editorial comment
  82. Importance for patients of feeling accepted and understood by physicians before and after multimodal pain rehabilitation
  83. Editorial comment
  84. A glimpse into a neglected population – Emerging adults
  85. Observational study
  86. Assessment and treatment at a pain clinic: A one-year follow-up of patients with chronic pain
  87. Clinical pain research
  88. Randomized, double-blind, placebo-controlled, dose-escalation study: Investigation of the safety, pharmacokinetics, and antihyperalgesic activity of L-4-chlorokynurenine in healthy volunteers
  89. Clinical pain research
  90. Prevalence and characteristics of chronic pain: Experience of Niger
  91. Observational study
  92. The use of rapid onset fentanyl in children and young people for breakthrough cancer pain
  93. Original experimental
  94. Acid-induced experimental muscle pain and hyperalgesia with single and repeated infusion in human forearm
  95. Original experimental
  96. Swearing as a response to pain: A cross-cultural comparison of British and Japanese participants
  97. Clinical pain research
  98. The cognitive impact of chronic low back pain: Positive effect of multidisciplinary pain therapy
  99. Clinical pain research
  100. Central sensitization associated with low fetal hemoglobin levels in adults with sickle cell anemia
  101. Topical review
  102. Targeting cytokines for treatment of neuropathic pain
  103. Original experimental
  104. What constitutes back pain flare? A cross sectional survey of individuals with low back pain
  105. Original experimental
  106. Coping with pain in intimate situations: Applying the avoidance-endurance model to women with vulvovaginal pain
  107. Clinical pain research
  108. Chronic low back pain and the transdiagnostic process: How do cognitive and emotional dysregulations contribute to the intensity of risk factors and pain?
  109. Original experimental
  110. The impact of the Standard American Diet in rats: Effects on behavior, physiology and recovery from inflammatory injury
  111. Educational case report
  112. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series
  113. Original experimental
  114. Hyperbaric oxygenation alleviates chronic constriction injury (CCI)-induced neuropathic pain and inhibits GABAergic neuron apoptosis in the spinal cord
  115. Observational study
  116. Predictors of chronic neuropathic pain after scoliosis surgery in children
  117. Clinical pain research
  118. Hospitalization due to acute exacerbation of chronic pain: An intervention study in a university hospital
  119. Clinical pain research
  120. A novel miniature, wireless neurostimulator in the management of chronic craniofacial pain: Preliminary results from a prospective pilot study
  121. Clinical pain research
  122. Implicit evaluations and physiological threat responses in people with persistent low back pain and fear of bending
  123. Original experimental
  124. Unpredictable pain timings lead to greater pain when people are highly intolerant of uncertainty
  125. Original experimental
  126. Initial validation of the exercise chronic pain acceptance questionnaire
  127. Clinical pain research
  128. Exploring patient experiences of a pain management centre: A qualitative study
  129. Clinical pain research
  130. Narratives of life with long-term low back pain: A follow up interview study
  131. Observational study
  132. Pain catastrophizing, perceived injustice, and pain intensity impair life satisfaction through differential patterns of physical and psychological disruption
  133. Clinical pain research
  134. Chronic pain disrupts ability to work by interfering with social function: A cross-sectional study
  135. Original experimental
  136. Evaluation of external vibratory stimulation as a treatment for chronic scrotal pain in adult men: A single center open label pilot study
  137. Observational study
  138. Impact of analgesics on executive function and memory in the Alzheimer’s Disease Neuroimaging Initiative Database
  139. Clinical pain research
  140. Visualization of painful inflammation in patients with pain after traumatic ankle sprain using [11C]-D-deprenyl PET/CT
  141. Original experimental
  142. Developing a model for measuring fear of pain in Norwegian samples: The Fear of Pain Questionnaire Norway
  143. Topical review
  144. Psychoneuroimmunological approach to gastrointestinal related pain
  145. Letter to the Editor
  146. Do we need an updated definition of pain?
  147. Narrative review
  148. Is acetaminophen safe in pregnancy?
  149. Book Review
  150. Physical Diagnosis of Pain
  151. Book Review
  152. Advances in Anesthesia
  153. Book Review
  154. Atlas of Pain Management Injection Techniques
  155. Book Review
  156. Sedation: A Guide to Patient Management
  157. Book Review
  158. Basics of Anesthesia
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