Abstracts presented at SASP 2025, Reykjavik, Iceland. From the Test Tube to the Clinic – Applying the Science

SCIENTIFIC ABSTRACTS PRESENTED IN SASP 2025, REYKJAVIK, ICELAND 21-23 MAY 2025

ABSTRACT #1.

Low pain tolerance is associated with atherosclerosis: Insights from the population-based Tromsø Study

Christian M. Page*^,1, Kristina Fladseth*^,2-4, Ólöf A Steingrímsdóttir^1,5, Audun Stubhaug^6,7, Henrik Schirmer^8,9, Kristin Holvik¹, Ellisiv B Mathiesen^10,11, Bente Halvorsen^2,7, Christopher S Nielsen^6,12

¹Department of Aging and Physical Health, Norwegian Institute of Public Health, Oslo, Norway

²Research Institute of Internal Medicine, Oslo University Hospital, Norway

³Department of Cardiology, University Hospital of North Norway, Tromsø, Norway

⁴Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway

⁵Department of Research, Oral Health Centre of Expertise in Eastern Norway, Oslo, Norway

⁶Department of Pain Management and Research, Oslo University Hospital

⁷Institute of Clinical Medicine, Faculty of Medicine, University of Oslo Norway

⁸Institute of Clinical Medicine, Campus Ahus, University of Oslo

⁹Department of Cardiology, Akershus University Hospital, Lørenskog

¹⁰Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway

¹¹Department of Neurology, University Hospital of North Norway, Tromsø, Norway

¹²Department of Chronic Diseases, Norwegian Institute of Public Health

Objective: Chronic pain increases the risk of cardiovascular disease beyond the traditional risk factors, but the biological mechanism for this is unknown. This study aimed to investigate the association between experimental pain tolerance and atherosclerosis in the Tromsø Study population.

Methods: The population-based Tromsø study has been recruiting participants living in the Tromsø municipality in multiple waves since 1974. The sixth and seventh waves recruited 12977 and 21069 participants, respectively. Of these, 10482 participants in Tromsø6 and 8274 in Tromsø7 completed quantitative sensory test protocols (QST), including the Cold Pressor Test (CPT), out of which 6489 completed CPT in both study waves. Carotid artery ultrasound examination with assessment of atherosclerotic plaque was performed in 8230 of those who completed QTS. Cox proportional hazards models were used to analyse relationships between carotid plaque and pain tolerance, estimated in seconds to hand withdrawal. Analyses were adjusted for age, sex, prevalent/current diabetes, hypertension or hyperlipidaemia, smoking status, body mass index, and educational level.

Results: In total, 5988 unique participants were included, of whom 2904 had carotid plaques. Carotid plaque was associated with decreased cold pain tolerance, with a hazard ratio (HR) of 1.17 (95% CI, 1.05–1.30) and 1.16 (0.95–1.41) in Tromsø6 and Tromsø7, respectively. In Tromsø6, there was a dose–response relationship, where pain tolerance also decreased with increasing plaque number: HR 1.13 (1.004–1.27) for one plaque, and 1.26 (1.11–1.44) for two or more plaques. In Tromsø7, this was less pronounced, with an HR of 1.10 (0.88–1.39) and 1.19 (0.94–1.50), for one plaque and two or more, respectively.

Conclusion: Participants with carotid plaque had lower cold pressor pain tolerance than participants without plaque. We found a dose-response relationship between the number of atherosclerotic plaques and cold pressor pain tolerance in Tromsø6, but not significant in Tromsø7.

Research ethical statement: The regional committee for medical and health research ethics in North Norway approved the study (REK #428472), and all participants gave their informed written consent.”

ABSTRACT #2.

Efficacy and safety of a digital tapering intervention in patients prescribed opioids post-surgery

Bergdís E. Hjaltadóttir¹, Anna B. Blöndal², Elísabet Jónsdóttir¹, Kjartan Þórsson¹, Ragnheiður H. Friðriksdóttir³, Valgerður Rúnarsdóttir³, Á. Johnsen¹, F. McCrate¹, D. Á. Ólafsdóttir⁴, M. Ö. Halldórsson⁴, M. Ó. Bragadóttir⁴, E. Þ. Guðbrandsson⁴, T. V. Sverrisson⁴.

1. Prescriby LLC, Gróska, Bjargargata 2, Reykjavík, Iceland

2. University of Iceland, Reykjavík, Iceland.

3. National Center for Addiction Medicine (SÁÁ), Reykjavík, Iceland

4. Orthopedics department, Landspítali University Hospital, Reykjavík, Iceland

Objectives: The objective of this study is to investigate the efficacy and safety of Prescriby as a tapering intervention in post-operative surgery patients. The efficacy will be measured in tapers successfully completed, doses successfully lowered during tapering, number of “active users,” satisfaction with the intervention, and patients successfully remaining off opioid medication at 6 and 12 months after intervention. Participant safety will be monitored by assessing adverse effects during tapering using the Numeric Pain Rating Scale (NPRS) to assess the severity of pain.

Methods: This study is a prospective cohort exploratory study. Participants are recruited via referrals to the Prescriby Clinic from orthopedic clinics and orthopedics departments in the hospital after surgery during the 6 month study period, where they will receive a personalized tapering treatment and follow-up with a clinical pharmacist. The usual care procedure for these participants would be discharging patients post surgery with an opioid prescription with verbal instructions on how to taper opioid medication and a printout of the taper upon request. Experimental procedures in the study are the referral to the Prescriby Clinic alongside treatment and follow-up offered by a clinical pharmacist using the Prescriby application.

Results: This is an ongoing study and recruitment of participants will conclude at the end of May 2025. There will be preliminary results of the secondary objectives and a rough outline of conclusions presented at the time of the conference, which will be presented at that time.

Conclusions: Primary results on opioid prescriptions will be available in June 2026 and will be compared to data from Landlæknir on patients with a similar diagnosis profile as the intervention group that underwent the same procedure in the same timeframe.

Research ethical statement: The National Bioethics Committee (https://island.is/en/o/national-bioethics-committee) has given approval for this study and has the registration number VSNb2024090010/03.01.

ABSTRACT #3.

Opioid use and comorbid anxiety/depression among chronic pain patients: a cross-sectional study using eDol cohort data in Tertiary Chronic Pain Centers in France

Marc Labrousse¹, Antoine Elyn², Cécile Lestrade¹, Jules Phalip^3,4, Sigríður Zoéga^2,5, Alice Corteval⁴, Nicolas Authier^3,4, Nathalie Cantagrel¹, Nicolas Kerckhove^3,4

1. Centre d’évaluation et de traitement de la douleur, University Hospital of Toulouse, Toulouse, France

2. Pain Clinic, Landspitali, Reykjavik, Iceland

3. University Hospital of Clermont-Ferrand, University Clermont Auvergne, Pharmacology department, INSERM 1107 NEURO-DOL, Clermont-Ferrand, France

4. Institut Analgesia, Clermont-Ferrand, France

5. University of Iceland, Reykjavik, Iceland

Objectives: In the context of chronic pain, psychiatric comorbidities are associated with worsened outcomes and greater exposure to opioids1,2,3. This study aims to describe and compare the prevalence and patterns of opioid use in a cohort of chronic pain patients, stratified by anxiety/depression symptoms co-occurrence, and/or history.

Methods: We performed a cross-sectional study using eDol cohort data (NCT04880096)4. Patients were recruited after their first contact with French Tertiary Chronic Pain Centers. We stratified patients according to anxiety/depression symptoms co-occurrence or reported history. Patients with a history or co-occurring symptoms or both were compared to patients without. Potentially inappropriate use was defined as: a dose >120 mg MME, or >6 months of fentanyl use, or gabapentinoids/benzodiazepine co-prescription, or cephalalgia/nociplastic pain diagnosis.

Results: We included 873 patients in the present study. Mean age was 47±12 years old with 710 (81%) women. Main diagnoses were fibromyalgia (n=277, 31.7%) and musculoskeletal pain (n=203, 23.3%). A total of 276 (31.6%) of them had a history of anxiety/depressive disorder, 384 (44.0%) had significant symptoms (HADS>=12), and 153 (17.5%) had both history and symptoms.

A total of 349 (40.0%) patients were exposed to opioids, mainly with tramadol (n=149, 42.7%) and opium (n=91, 26.1%). The daily dose’s (in MME) median was 20mg [10–40] and 189 (67.7%) were exposed for more than 6 months. Inappropriate use concerned 286 (81.9%) of them. Patients with both history and symptoms were exposed to higher opioid doses (MME 28.8 mg [17.5–60] vs. 20.0 mg [7.5–40], p-value=0.010), and more exposed to high-risk co-prescriptions (p=0.009).

Conclusions: Patients referred to tertiary chronic pain centers in France are frequently exposed to opioids and potentially inappropriate use of opioids. Those with co-occurring symptoms of anxiety/depression along with a history of anxiety/depression disorder are exposed to higher doses and frequent high-risk co-prescriptions.

Research ethical statement: The eDol cohort study was approved by the research ethics committee – “Comité de Protection des Personnes Ouest II Angers” (Reference number: 2020-A02027-32).

Bibliography

1. Ray WA, Chung CP, Murray KT, et al. Prescription of long-term opioids and mortality in patients with chronic non-cancer pain. JAMA 2016;315:2415–23.

2. Barry DT, Cutter CJ, Beitel M, Kerns RD, Liong C, Schottenfeld RS. Psychiatric Disorders Among Patients Seeking Treatment for Co-Occurring Chronic Pain and Opioid Use Disorder. J Clin Psychiatry. 2016;77(10):1413‑9.

3. De La Rosa JS, Brady BR, Ibrahim MM, Herder KE, Wallace JS, Padilla AR, Vanderah TW. Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: prevalence, functional impacts, and opportunities. Pain. 2024;165(3):666-673.

4. Delage N, Cantagrel N, Soriot-Thomas S, et al. Mobile Health App and Web Platform (eDOL) for Medical Follow-Up of Patients With Chronic Pain: Cohort Study Involving the French eDOL National Cohort After 1 Year. JMIR Mhealth Uhealth. 2024;12:e54579.

ABSTRACT #4.

Improving procedural pain with TENS during medial branch block among patients with chronic low-back pain due to facet-joints syndrome: a protocol for a randomized double-blind placebo-controlled superiority study (TENS-INFIDOL)

Marc Labrousse¹, Laura Bonnot¹, Nathalie Cantagrel¹, Laurence Jasse², Vanessa Rousseau³, Maryse Lapeyre-Mestre^3,4, Antoine Elyn⁶

1 Centre d’évaluation et de traitement de la douleur, University Hospital of Toulouse, Toulouse, France

2 Institut HoPeS, Neuroscience Department, University Hospital of Toulouse, Toulouse, France

3 Clinical Investigation Center (CIC 1436), University of Toulouse - University Hospital of Toulouse - INSERM, Toulouse, France

4 Pharmacology Unit, University Hospital of Toulouse, Toulouse, France

5 Pain Clinic, Landspitali, Reykjavik, Iceland

Objective: Procedural pain is frequently inadequately managed.¹ A study in rheumatology found that 81.7% of patients experienced procedural pain, with fewer than half receiving appropriate analgesia². Most analgesic premedications have limitations and side effects. Therefore, a non-pharmacological technique such as Transcutaneous Electrical Nerve Stimulation (TENS) might be of interest³. It has been shown to reduce pain during shoulder arthrodistension⁴. This study aims to assess the analgesic effect of TENS during medial branch blocks (MBB) for chronic low-back pain.

Methods: This is a superiority, monocentric, randomized, placebo-controlled trial, with two double-blind parallel groups. A type I error risk of 5% and a power of 90% require including 26 patients in each group, using a two-sample t-test. In total, we will include 52 patients and follow-up for a total of 3 months. Intervention group will receive gate-control TENS during the procedure, and the control will receive sham-TENS. Chattanooga’s Cefar® TENS will be used. Sham was designed to provide a feeling sensation without antinociceptive modulation. Eligible participants are adults with chronic low-back pain lasting over three months and a diagnosis of lumbar facet joint syndrome. Exclusion criteria include spinal surgery and contraindications to TENS. The physician, the patients, and the research assistant will be blinded. The nurse will perform the randomization and monitor the use of TENS.

Outcomes: The primary endpoint will be the procedural pain intensity, using a Visual Analog Scale (VAS). Secondary outcomes will include the procedure’s comfort and MBB efficacy at 1 and 3 months. This study will evaluate whether TENS offers a non-pharmacological effective strategy to manage procedural pain during MBB for patients with chronic low-back pain.

Research ethical statement: The present study protocol is currently under review by the Research Ethics Committee (“Comité de Protection des Personnes CPP - Sud Ouest et Outre-Mers”). The protocol will be registered in ClinicalTrial.gov depository.

Bibliography

1. Puntillo KA, Wild LR, Morris AB, Stanik-Hutt J, Thompson CL, White C. Practices and Predictors of Analgesic Interventions for Adults Undergoing Painful Procedures. American Journal of Critical Care. 1 sept 2002;11(5):415‑29.

2. Perrot S, Laroche F, Poncet C, Marie P, Payen-Champenois C. Are joint and soft tissue injections painful? Results of a national French cross-sectional study of procedural pain in rheumatological practice. BMC Musculoskelet Disord. 25 janv 2010;11:16.

3. Melzack R. Recent concepts of pain. J Med. 1982;13(3):147‑60.

4. Morgan B, Jones AR, Mulcahy KA, Finlay DB, Collett B. Transcutaneous electric nerve stimulation (TENS) during distension shoulder arthrography: a controlled trial. Pain. févr 1996;64(2):265‑7.

ABSTRACT #5.

Investigation of Inflammatory Biomarkers, Analgesics and Pain Intensity, in Patients with Chronic Pain Before and After Interdisciplinary Pain Rehabilitation Program

S. Hasson, E. Bäckryd, T. F. Kallman, H.J. Dong, B. Ghafouri

Pain and Rehabilitation Center, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden

Objectives: Interdisciplinary pain rehabilitation program (IPRP) is a complex bio-psycho-social intervention, which has been shown to be more effective than only pharmacological treatment. There is a lack of knowledge regarding the changes in medication consumption and their association with inflammatory biomarkers after IPRP, which this study aims to investigate.

Methods: Data consisted of 65 patients and 31 healthy controls. Blood samples and analgesic consumption data were collected at baseline, after 6 weeks of IPRP, and at 6- and 12-month follow-up. Multiplex immunoassay technology Meso Scale Discovery was used for the analysis of a panel of 71 inflammatory cytokines and chemokines.

Results: Concentrations of 20 proteins differed significantly in patients compared to controls. The most important proteins were IL21, IL29/IFNL1, and Eotaxin which were upregulated in patients, whereas ENA78, SDF1-α, VEGF-A, GROα, IL17E/IL25, TNF-β, IL23, and IL17F were downregulated in patients compared to controls. Six subgroups of patients were identified based on biomarkers. Three of the subgroups underwent IPRP and showed different outcomes after IPRP in regard to pain intensity, consumption of analgesics and inflammation. There were no significant changes in consumption of analgesics after IPRP when analyzed in the whole cohort, however a descending trend was found in two of the IPRP subgroups.

Conclusions: There is an association between pain intensity, consumption of analgesics, and inflammatory biomarkers in patients with chronic pain. Chronic pain is a heterogeneous group consisting of multiple subgroups which should be considered when including patients in IPRP.

Research ethical statement: Dnr: 2014/953-31/1 och Dnr: 2016/239-31.

ABSTRACT #6.

‘Be PainSMART:er’: a co-designed evidence-based educational film for patients with musculoskeletal pain

R. Thompson^1,2, A-S. Kammerlind^1,3, M. Fors^1,4, A. Abbott^1,5, K. Johansson¹

1. Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden

2. Department of Rehabilitation in Finspång, Region Östergötland, Sweden

3. Futurum, Region Jönköping County, Jönköping, Sweden

4. Department of Activity and Health, Linköping, Sweden

5. Department of Orthopaedics, Linköping University Hospital, Region Östergötland, Sweden

Objectives: The objectives were to develop and qualitatively evaluate a digital musculoskeletal pain education tool for primary care by combining patient and clinician co-design and current evidence.

Methods: The educational film ‘Be PainSMART:er’ was developed through a three-stage method involving clinical researchers, patients, primary care clinicians, and cognitive scientists. Stage 1-Needs exploration: Two qualitative interview studies, with patients seeking primary care physiotherapy for musculoskeletal pain (n=10) and primary care clinicians (n=12: physiotherapists, occupational therapists, physicians, and nurses), mapped the participants’ needs and design preferences for a digital pain education tool.

Stage 2-Design synthesis: Combined cognitive and pain research knowledge with the qualitative results to develop the film script and guide production.

Stage 3-Pre-validation: New patients (n=9) and clinicians (n=13) were interviewed. The first part of the interviews mapped the participants’ needs and preferences regarding pain education prior to exposure to the film. The second part explored whether the film had clinical utility by matching their needs and preferences.

Results: The participants in Stage 1 expressed a need for a digital pain education tool. The patients’ preferred an educational film presenting a dialog between a patient and clinician containing simple facts and answers to common questions about musculoskeletal pain. The clinicians expressed that the film should provide explanatory models for musculoskeletal pain and advice on pain management strategies. Stage 2 guided the film’s design to contain animations, be divided into sections, use simple language, and provide evidence-based key messages. Stage 3 confirmed that the film could positively influence patients’ understanding of musculoskeletal pain and facilitate patient-clinician communication. The results were used to make minor edits to the film.

Conclusions: This study exemplifies a three-stage method for the production of healthcare educational tools by co-design. The film ‘Be PainSMART:er’ displayed potential clinical utility. Further research is needed to evaluate its effectiveness.

Research ethical statement: This study does not require approval from a Research Ethics Committee because of national ethics legislation.

ABSTRACT #7.

Measurement properties of the Swedish Brief Pain Coping Inventory-2 in patients seeking primary care physiotherapy for musculoskeletal pain

R. Thompson*^1,2, M. Fors*^1,3, J. Andrée⁴, A-S. Kammerlind^1,5, K. Johansson¹

*RT and MF have shared first authorship of this research study.

1. Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden

2. Department of Rehabilitation in Finspång, Region Östergötland, Sweden

3. Department of Activity and Health, Linköping, Sweden

4. Department of Rehabilitation in Norrköping, Region Östergötland, Sweden

5. Futurum, Region Jönköping County, Jönköping, Sweden

Objectives: This study aimed to evaluate the validity and reliability of the two subscales of a Swedish version of the Brief Pain Coping Inventory-2 (BPCI-2:SWE) in a population of patients seeking primary care physiotherapy for musculoskeletal pain. The BPCI-2 was originally developed to measure traditional pain management strategies and psychological flexibility in chronic pain populations.

Methods: This study followed guidance from the “COnsensus based Standards for the selection of health Measurement INstruments-group” and the stages described by Beaton. The BPCI-2 was translated and cross-culturally adapted from English to Swedish. The BPCI-2:SWE’s content validity was evaluated using the face-validity index and qualitative analysis of semi-structured interviews in a cohort of 13 patients seeking primary care physiotherapy for musculoskeletal pain. The BPCI-2:SWE’s construct validity, floor and ceiling effects, reliability, and measurement error were evaluated using a test-retest design in a cohort of 124 patients seeking primary care physiotherapy for musculoskeletal pain.

Results: The BPCI-2:SWE had excellent content validity, but patients’ experiences indicated that the scoring method may benefit from the amendment.

The psychological flexibility subscale demonstrated good construct validity on hypothesis testing. However, the traditional pain management strategies subscale did not reach the a priori threshold for good construct validity, correlating positively with pain intensity and demonstrating low correlation with all other patient-reported outcome measures.

Neither subscale demonstrated floor or ceiling effects. The psychological flexibility subscale had moderate test-retest reliability (ICC 0.63) and the traditional pain management strategies subscale had good test–retest reliability (ICC 0.75). Measurement error was relatively high for both subscales at the individual patient level but low at the group level.

Conclusions: The BPCI-2:SWE is comprehensible and relevant within a Swedish primary care context. The instrument's psychological flexibility subscale has adequate validity. The reliability can be considered acceptable at the group level. Future research should further evaluate the BPCI-2:SWE’s measurement properties.

Research ethical statement: This study was approved by the Swedish Ethics Review Authority (dnr: 2023-03023-01). Informed consent was obtained from all patients included in the study.

ABSTRACT 8.

Project title: Persistent Pelvic Pain among Women in HUNT4: a Validation of a Survey Question

Authors: Francesca Sofie Weinhold ¹, Signe Nilssen Stafne², Mari Glette^3,4, Ólöf Anna Steingrímsdóttir^5,6, Tom Ivar Lund Nilsen⁷, Cecilie Therese Hagemann^1,8

1 Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway

2 Clinic of Rehabilitation, Department of Occupational Therapy and Physiotherapy, St. Olavs hospital HF, Trondheim, Norway

3 Multidisciplinary Pain Clinic, Department of Anesthesia and Intensive Care, St. Olavs hospital HF, Trondheim, Norway

4 Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway

5 Department of Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway

6 Department of Research, Oral Health Centre of Expertise in Eastern Norway, Oslo, Norway

7 Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway

8 Department of Obstetrics and Gynecology, St. Olavs hospital HF, Trondheim, Norway

Objectives: Persistent pelvic pain (PPP) is cyclic or non-cyclic pain in the lower abdomen or pelvic region lasting over 6 months, though definitions vary. Little is known about how women themselves perceive the term PPP, and whether a single question used in a survey can capture its significance as effectively as a body map.

Therefore, we used a new digital questionnaire to assess the consistency and accuracy of the HUNT4 (2017-2019) PPP question: “Do you have, or have you had, pelvic pain which has lasted at least 6 months”, answered by 29,170 women. We aimed to determine whether this questionnaire effectively identified PPP-affected women.

Methods: The new questionnaire was distributed to 25,528 women from the original HUNT4 field survey in November 2024. It included some HUNT4 items (e.g., dysmenorrhea and dyspareunia), and a digital body map (Graphical Index of Pain, GRIP). A total of women 11,891 responded (46.6%). Validation was conducted through sensitivity, specificity, and reliability testing.

Results: In the HUNT4, the prevalence of PPP, dysmenorrhea, and dyspareunia was 7.3% (2,109/28,744), 43.4% (5,336/12,292), and 34.9% (6,314/18,086), respectively. Data collection from the new questionnaire was finalized in February 2025 and preliminary findings show that 10.3% (1,157/11,225) answered “yes” to the key PPP question in the new questionnaire. The same question was then asked again, this time with a body map highlighting areas the researchers define as “pelvic,” resulting in a 21.8% (2,450/11,252) “yes” response. The overlap between these was 8.7% (962/11,007), hence classified as “true PPP” cases.

Conclusions: Validating the HUNT4 question on PPP will determine its reliability, assess consistency with previous responses, and provide insight into the prevalence and impact of PPP, dysmenorrhea, and dyspareunia. Preliminary findings have already underlined the variability in women's perceptions of PPP and how it is defined.

Research ethical statement: The project received ethical approval from the REK-Midt. Ref: # 394978.

ABSTRACT 9.

WITHDRAWN

ABSTRACT 10.

Prevalence of non-menstrual Chronic Pelvic Pain in a Norwegian population-based survey

K. Amundsen^1,2, A. P. Årnes³, Ó.A. Steingrímsdóttir^4,5, C. T. Hagemann^6,7, C. S. Nielsen^8,9, H. Tiller^1,2

1 Women’s Health and Perinatology research group, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway

2 University Hospital Northern Norway, Department of Gynaecology and Obstetrics, Tromsø, Norway

3 Occupational Health in the North, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway

4 Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway

5 Department of Research, Oral Health Centre of Expertise in Eastern Norway, Oslo, Norway

6 Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway

7 Department of Obstetrics and Gynaecology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

8 Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway

9 Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway

Objectives: The term Chronic Pelvic Pain (CPP) incorporates a variety of persistent pain symptoms and causes and is associated with complex and potentially severe consequences. Existing prevalence numbers for both genders range between 5% and 27%, reflecting variation in CPP definitions and cohorts. The objective of our study is to estimate CPP prevalence in men and non-menstrual CPP prevalence in women, according to the IASP chronic pain definition/ICD-11 classification of chronic pain with moderate-to-severe chronic pain extension codes and the clinical guideline from the European Association of Urology (EAU).

Methods: We used cross-sectional data from the seventh survey of the Tromsø Study 2015-2016 (Tromsø7). The study included 21,083 participants age ≥40, whereof 20,251 completed the digital body map “Graphical index of Pain” (GRIP). CPP was defined as pain of ≥3 months duration in the lower abdomen and/or groin and/or genital area. We defined three groups of CPP: pelvic pain in the lower abdominal/groin/genital area (CPP), genital pelvic pain only (G-CPP), and moderate-to-severe CPP (MS-CPP; >3 on NRS-scale for how bothersome the pain is, pain intensity and impact on activities of daily living). Prevalence numbers were calculated as cases/number of participants completing GRIP. Prevalences were stratified by sex, and prevalence ratios were calculated.

Results: Preliminary analysis shows an overall prevalence of CPP, G-CPP, and MS-CPP at 7.9%, 3.2%, and 2.1%, respectively. Prevalence of CPP/G-CPP/MS-CPP was significantly different comparing women and men with 9.0%/2.8%/3.0% in women and 6.7%/3.4%/1.2% in men (Chi square test, p <0.05), with corresponding prevalence rate ratios of 1.3/0,8/2.6.

Conclusions: Prevalence of CPP in a Norwegian population aged 40–99 was 7.9%. Prevalence of isolated genital CPP was higher in men than in women; however the prevalence of moderate-to-severe CPP was 2.5 times higher in women than in men, indicating a gender gap in impact and burden of more severe CPP.

Research ethical statement: The research ethics approval number from the Norwegian REK is 578216.

ABSTRACT 11.

Prevalence and risk factors for naloxone use in hospitalized patients at Landspitali University Hospital

S. Ó. Thorsteinsson^1,2, Þ. Jónsdóttir², B. Ö. Hlynsson¹, Þ. K. Guðmundsdóttir^1,3, S. Zoëga^1,3

1 Landspítali University Hospital, Reykjavík, Iceland

2 University of Akureyri, Akureyri, Iceland

3 University of Iceland, Reykjavík, Iceland

Objectives: Opioids are commonly used for pain management in hospitals, but they pose risks like sedation and respiratory depression, which can elevate morbidity and mortality. Risks increase with factors like age, opioid naivety, health conditions, and concurrent sedative use. Monitoring and proper dosing are vital, with naloxone on hand to address severe complications. The objective is to assess the prevalence and risk factors in hospitalized adult patients.

Methods: This retrospective study examined naloxone use in hospitalized patients at Landspitali University Hospital from 2010-2014, 2019, and 2022. The sample included patients aged 18 and older who received naloxone for sedation, altered consciousness, or respiratory depression from selected wards, excluding emergency departments, intensive care units, recovery wards, and psychiatric wards. Data collected encompassed demographics, smoking history, ICD diagnoses, and histories of lung, cardiovascular, kidney, and liver diseases. It also noted opioid naivety, kidney/liver function tests, patient condition before naloxone use, and reasons for administration. Blood pressure, oxygen saturation, respiratory rate, and consciousness measurements were recorded pre- and post-naloxone if available. Information on concurrent medications like pain relievers and sedatives was documented, and opioid use was converted to morphine equivalents.

Results: Data analysis is currently underway and preliminary results on prevalence, risk factors, observation before and after naloxone use, and outcome will be presented at the annual conference.

Conclusion: This ongoing retrospective study aims to provide valuable insights into the risk factors associated with naloxone use and its prevalence in reversing opioid-induced sedation and respiratory depression in hospitalized patients. Preliminary data suggest patient risk factors may vary by inpatient ward, explaining naloxone use differences. Such variations indicate that ward conditions, patient populations, or care practices may affect opioid management, revealing opportunities for targeted patient safety improvements.

Research ethical statement: The Research Ethics Committee of the University Hospital of Iceland, Landspítali, approved this study (approval no. 23/2023).

ABSTRACT 12.

Associations between physical activity patterns and recurrent extremity pain in Icelandic schoolchildren: Results from the WHO collaborative Health Behaviour in School-aged Children (HBSC) survey

Scott Gribbon^a,b, Rúnar Vilhjálmsson^a, Guðrún Kristjánsdóttir^a,c

^aFaculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Eirberg, Eiríksgata 34, 101 Reykjavík, Iceland

^bDepartment of endocrinology, Landspitali University Hospital, Eiríksgata 5, 101 Reykjavík, Iceland

^cLandspitali University Hospital, Children’s Hospital, Hringbraut, 101, Reykjavík, Iceland

Corresponding author

Scott Gribbon, scg3@hi.is, correspondence address as above

Phone number +354 6900103

Objectives: Recurrent extremity pain is common among children and adolescents and is influenced by physical activity patterns. Understanding these associations is critical for designing targeted interventions. This study investigates the relationships between weekly extremity pain and different activity types, levels of participation, and within and across grades and sexes in Icelandic schoolchildren.

Methods: Data from the Icelandic Health Behaviors of School-aged Children survey (n=11019 participants aged 11, 13, and 15 years) were analysed. Weekly extremity pain was evaluated in relation to three activity categories: activities outside of school, vigorous activities, and activities in sports clubs. Participation was categorized as low (<1 time per week), moderate (1 – 3 times per week), and high (>3 times per week). Associations were analyzed using chi-square tests and logistic regression.

Results: Moderate participation was consistently associated with the lowest prevalence of weekly extremity pain across activity types. Grade 6 children with low participation in activities outside of school exhibited the highest pain prevalence (32.4%). Among grade 8 children, high vigorous activity levels were linked to the highest pain (25.6%), while for grade 10 children this was seen with high sports participation (25.3%). Boys and girls with low activity outside of school showed the highest pain prevalence (26.4% and 25.9%). Furthermore, among girls, both low and high participation in sports clubs was related to higher pain prevalence.

Conclusions: This study highlights the critical role of balanced physical activity in mitigating weekly extremity pain among children and adolescents. The findings suggest that moderate participation in both structured and unstructured activities may provide protective benefits, with lower pain prevalence across sexes and developmental stages. Conversely, insufficient or excessive activity is associated with higher pain prevalence. These results underscore the urgency of designing targeted interventions that address biological and motivational drivers unique to each age group and sex.

Research ethical statement: The 2014 Icelandic HBSC survey followed ethical standards set by the UN Convention on the Rights of the Child, Iceland’s research review board, and the Data Protection Authority. Informed consent was obtained from children and parents, with participation voluntary and anonymous. This study used anonymized data, requiring no additional ethical approval under Icelandic regulations.

ABSTRACT 13.

Lived experience of Co-Morbid Insomnia and Pain (COMIP)

A. Albertsdottir^1,2, A.S. Islind¹, H. Skuladottir³, K.A. Oladottir¹, E. Bjornsdottir¹, E.S. Arnardottir¹.

1. Reykjavik University, Reykjavik, Iceland

2. Reykjalundur Rehabilitation Hospital, Mosfellsbaer, Iceland

3. University of Akureyri, Akureyri, Iceland

Objectives: Increase understanding and knowledge of Co-Morbid Insomnia and Pain (COMIP) from the perspective of adults who have experienced it. Also, to learn about the participants' experiences of treatments for sleep problems.

Methods: A qualitative study using the Vancouver School of Doing Phenomenology with open-ended interviews. The researcher asks questions, but the interviews resemble a conversation. Participants are adults with COMIP who are finishing interdisciplinary rehabilitation. One to three interviews will be conducted with up to 20 participants, until data saturation is reached. The research process involves iteratively (although not linearly) going through seven phases in a total of twelve steps.

Preliminary results (from one participant):

Adam (pseudo-name) described the experience of COMIP as a negative bidirectional combination: “You're sleeping worse because of the pain and you're waking up because of it so the pain is having, as I say, a huge impact on your insomnia. This is a really bad combo, waking up because of the pain and having such a hard time falling asleep because of your head [insomnia symptom]. This is such a cycle, such a circular nonsense, with cross-effects, back and forth.”

When asked what treatments had been least helpful for sleep problems, Adam described that sleep medicine had made him sleepy the next day, so he found that least helpful. He found interdisciplinary rehabilitation most helpful for sleep problems and described multiple parts of the interdisciplinary approach.

Conclusions: Preliminary results from one participant indicate that the nature of COMIP is bidirectional and that interdisciplinary approach might be effective in treating sleep problems for adults with COMIP.

Research ethical statement: The study has been approved by the Icelandic Research Ethics Committee. Approval number VSN 2501010.

ABSTRACT 14.

Unveiling the interplay of depression and anxiety with demographic characteristics in painful neuropathy

V.A. Adzika¹, B. Armah-Mensah², D. Y. Mensah³, M.L.Y Adzika⁴

1 Department of Nursing, Methodist University of Ghana, Accra, Ghana

2 Department of Health Psychology, University of Coast, Cape Coast, Ghana

3 Department of Statistics, Dominion University College, Ghana , Accra, Ghana

4 Department of Biomedical Sciences, Kwame Nkrumah University of Science and Technology Ghana Kumasi, Ghana

Background: Both biological and psychological factors influence the chronic pain associated with painful diabetic neuropathy. A repeated attempt to solve the problem of painful diabetic neuropathy from a biomedical perspective alone has resulted in a cycle of low health and quality of life, depression, and anxiety. This underscores the importance of considering psychosocial factors in a patient's overall quality of life with painful diabetic neuropathy. By understanding and targeting these factors and their association with social demographic characteristics for treatment, we can contribute to a reduction in pain, thereby improving the lives of these patients.

Objective: The study aimed to examine the associations between socio-demographic variables (i.e., age, sex, marital status, education, and occupation) and depression, anxiety, and painful diabetic neuropathy.

Method: Systematic random sampling was adopted in a cross-sectional descriptive design to select 125 respondents attending the clinic to complete the Leeds Assessment of Neuropathic Symptoms and Signs –LANSS, and the Hospital Depression/Anxiety Scale (HADS). An ANOVA was used to determine differences in the effect of demographic variables on depression, anxiety, and painful diabetic neuropathy.

Results: Depression score was the highest predictor of anxiety (t = 19.061, p < 0.001), compared with demographic characteristics. Secondly, anxiety score was also found to be the highest predictor of depression (t = 19.061, p < 0.001), compared with demographic characteristics. These implied that with a unit rise in depression score, anxiety score also rises by almost one unit.

Conclusion: Significant Findings: this study found that age, marital status, educational level, and sex are not significant determinants of depression among this population. However, there was an association between depression and anxiety. This indicates that anxiety is an essential determinant of depression and vice versa, and as anxiety increases, depression also increases. These findings underscore the importance of considering anxiety in the management of depression in patients with painful diabetic neuropathy.

Keywords: Diabetes; Depression; Anxiety; Demographic Characteristics; Neuropathy

Research ethical statement: The study protocol was approved by the REC with registration number BM19/6/1.

ABSTRACT 15.

The Long Shadow of Childhood Adversity: Associations with Chronic Pain and Adult Violence

Th. Jonsdottir ¹, S.I. Karlsdottir¹, H. Skuladottir¹, E.C. Halapi¹, G.K. Oskarsson²

1 School of Health, Business and Natural Sciences, Faculty of Nursing, University of Akureyri, Akureyri, Iceland

2 School of Health, Business and Natural Sciences, Faculty of Business Administration, University of Akureyri, Akureyri, Iceland

Objectives: Chronic pain is a health problem that is a leading cause of disability. Studies have shown that various aspects of a person's history, such as difficult experiences in early life, can affect health later. The aim was to examine the relationship between chronic pain, adverse childhood experience (ACE), and exposure to violence in adulthood in the general population of Iceland.

Methods: This retrospective cross-sectional study is part of a larger population-based study, the ICAPAIN study. The sample consisted of 12.400 individuals, 18-80 years of age, randomly selected from the respondents' group of the data collection company MASKINA (National Portal, randomly drawn from the National Population Register of Iceland). The instruments consisted of questionnaires on pain, lifestyle factors, quality of life, and adverse life experiences. Data were collected through a web-based platform. Data on chronic pain, adverse childhood experiences (ACE) and experience of violence in adulthood are introduced here.

Results: The response rate was 45% (N = 5,557; 57.3% female; mean age 54.8 years (SD = 13.7)). Half of the participants (50.3%) had experienced pain the previous week, and 40.1% had chronic pain (Constant or recurrent for >3 months). The majority of those with chronic pain reported constant or daily pain (65%) and 35% had frequent (pain most days but pain-free days in between) or periodic pain (pain-free periods for days or weeks but pain episodes in between). A total of 91% answered questions about ACE, of which 17.7% had four ACE scores or higher. There was a positive relationship between ACE and chronic pain. Those who had ≥4 ACE scores were also more likely to have experienced violence in adulthood.

Conclusions: Chronic pain in adulthood can be associated with ACE, and ACE can increase the risk of being exposed to violence in adulthood which increases the likelihood of chronic pain even more.

Research ethical statement: The study protocol was approved by the Icelandic National Bioethics Committee (VSN-19-096).

Competing interests: Sigríður Zoëga and Mads U. Werner are editors of the Scandinavian Journal of Pain.