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  • 1.
    Flink, I. K.
    et al.
    Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden .
    Thomtén, Johanna
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi. Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden .
    Engman, L.
    Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden .
    Hedström, S.
    Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden .
    Linton, S. J.
    Center for Health and Medical Psychology (CHAMP), Institution of Law, Psychology, and Social Work, Örebro University, Örebro, Sweden .
    Coping with painful sex: Development and initial validation of the CHAMP Sexual Pain Coping Scale2015Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 9, s. 74-80Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and purpose: Recurrent vulvar pain is a common and debilitating condition which has received remarkably little attention in pain research. For instance, little is known about how these women cope with sexual activities, and there are no structured assessment tools. The purpose of this study was to explore coping strategies in this group, with a view to develop a measure to assess how women with vulvar pain cope with sexual activities. Methods: The current study is based on a subsample from a longitudinal study about vulvar pain in a student sample consisting of women between 18 and 35 years old (N= 964). Only data from the ones reporting recurrent vulvar pain during the last six months (N= 289) were used in the analyses. First, the CHAMP Sexual Pain Coping Scale (CSPCS) was created, with the aim of assessing how women with vulvar pain cope with sexual activities. The scale was inspired by previous research on women with vulvar pain as well as well-known coping strategies in other pain populations. Second, the psychometric properties of the scale were explored by analyzing the factor structure and internal reliability. Third, validity features were examined in terms of criterion validity and construct validity. Results: The analyses supported a three-factor solution, embracing the strategies endurance, avoidance and alternative coping. The internal reliability of the subscales turned out to be good, and the criterion validity was supported for all three subscales. The construct validity was clearly supported for the endurance and the avoidance subscales, but not for the alternative coping subscale. Conclusions: The findings support the CSPCS as an instrument for assessing how women with vulvar pain cope with sexual activities. The strategies endurance, avoidance and alternative coping correspond with findings from earlier research. Endurance reflects a tendency to engage in and continue with sexual activities despite pain, while attempting to minimize or suppress thoughts of pain. Avoidance, on the other hand, involves efforts to stay away from sexual activities, in particular vaginal penetration, because of fear of pain. Alternative coping refers to endeavours to find alternative sexual activities that do not necessarily involve vaginal penetration. Even though this first study indicates that the CSPCS may be psychometrically sound, more studies are needed to confirm the psychometric properties and clinical application of this instrument. In particular, the construct validity of the alternative coping subscale needs to be further evaluated. Implications: A valid instrument for assessing strategies for coping with sexual activities in this population has important clinical implications, since it provides a method that may enhance assessment procedures, be used in research, and stimulate the development of treatment. © 2015 Scandinavian Association for the Study of Pain.

  • 2.
    Flink, Ida
    et al.
    Örebro Universitet.
    Engman, Linnea
    Örebro Universitet.
    Ter Kuile, Monique
    Leiden University, Netherlands.
    Ekdahl, Johanna
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi.
    Linton, Steven James
    Örebro Universitet.
    Coping with pain in intimate situations: applying the avoidance-endurance model to women with vulvovaginal pain2017Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 17, nr October 2017, s. 302-308Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims

    Chronic vulvovaginal pain is strikingly common and has a serious impact on women's lives. Nevertheless, there are few longitudinal studies focusing on mechanisms involved in the pain development. One area of interest is how women cope with sexual activities and how this affects their pain. In this study, avoidance and endurance coping behaviors were explored as possible mediators of the relation between catastrophizing and pain, cross-sectionally and longitudinally.

    Methods

    251 women (18–35 years old) with vulvovaginal pain were recruited in university settings and filled out questionnaires about their pain, catastrophizing and coping behaviors at two occasions, with five months in between. Multiple mediation models were tested, exploring avoidance and endurance as mediators of the relation between catastrophizing and pain.

    Results

    The results showed that avoidance was an influential mediator of the link between catastrophizing and pain. Using multiple mediation models we found that although the indirect effects of both avoidance and endurance were significant cross-sectionally, only avoidance was a significant mediator in the combined model exploring associations over time.

    Conclusions

    This study indicates that the strategies women with vulvovaginal pain use for coping with sexual activities are important for the course of pain. Avoidance and, to a lesser degree, endurance strategies were identified as important mediators of the effects of catastrophizing on pain. When exploring the links over time, only avoidance emerged as a significant mediator.

    Implications

    In this longitudinal study, catastrophizing was linked to vulvovaginal pain, via avoidance and endurance of sexual activities. Hence, targeting catastrophizing early on in treatment, as well as addressing coping, may be important in clinical interventions.

  • 3.
    Styrke, J.
    et al.
    Division of Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden .
    Sojka, Peter
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för hälsovetenskap.
    Björnstig, U.
    Division of Surgery, Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden .
    Stålnacke, B. -M
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden .
    Symptoms, disabilities, and life satisfaction five years after whiplash injuries2014Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 5, nr 4, s. 229-236Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Chronic whiplash-associated disorders (WADs) are often associated with social functioning problems and decreased ability to perform previous activities. This may lead to decreased life satisfaction, which is insufficiently studied in the context of whiplash injuries. Symptoms included in chronic WAD are similar to symptoms frequently reported by persons who have sustained mild traumatic brain injury (MTBI)/concussion. In cases of MTBI, the severity and number of symptoms have been suggested to have a diagnostic value. The corresponding importance of symptoms in chronic WAD has not been documented. Most studies of whiplash injuries have focused on neck pain because this is the dominant complaint, while other symptoms are less studied. The frequency of long-term symptoms after whiplash injuries seems to vary. It is difficult to compare the long-term outcome since the follow-up after whiplash injury in most studies has been rather short. Therefore, the primary aim of this investigation was to study neck pain and other symptoms, disability, and life satisfaction five years after whiplash injury in a defined population and geographical area. Methods: The study was carried out at a public hospital in northern Sweden and was a cross-sectional survey of patients five years after the injury event in a cohort of whiplash-injured patients. Five years after the emergency department visit, 186 persons aged 18-64 answered questionnaires on symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ), disabilities (Rivermead Head Injury Follow Up Questionnaire, RHFUQ), and life satisfaction (LiSat-11). The answers were compared to those of a comparison cohort. Results: The most common symptoms five years after whiplash injury were fatigue (41%), poor memory (39%), and headache (37%). Inability to sustain previous workload (44%) and fatigue at work (43%) were frequently reported disabilities. Only 39% were satisfied with their somatic health and 60% with their psychological health. Compared with healthy controls, the whiplash injured exhibited more symptoms and had lower life satisfaction. Women reported significantly higher pain intensity than men. Few significant differences between women and men regarding the other parameters were found. Conclusions: This study shows that five years after a whiplash injury, patients reported symptoms that are typical of mild traumatic brain injury. Further, this study emphasizes the possibility of screening patients with chronic WAD for these symptoms as a complement to the assessment. Implications: Untreated symptoms may negatively affect the outcome of pain rehabilitation. This implies that it might be clinically meaningful to quantify symptoms earlier in the rehabilitation process.

  • 4.
    Thomtén, Johanna
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi. Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden .
    Living with genital pain: Sexual function, satisfaction, and help-seeking among women living in Sweden2014Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 5, nr 1, s. 19-25Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims: Female genital pain is a debilitating problem that negatively affects several aspects of the life of women. Several studies present figures of prevalence indicating that the problem affects nearly 20% of young women. However, many women fail to consult health care and the estimated prevalence therefore remains insecure. Historically, genital pain was commonly viewed as either physiological or psychosexual. Although the current field of research and clinical expertise in general agree upon a biopsychosocial conceptualization, less is known about the manifestation of the problem in everyday life and the experience of seeking health care among afflicted women. The objectives of the present study was to examine genital pain in a general female population living in Sweden cross-sectionally in terms of prevalence, sexual function, sexual satisfaction and help seeking, and to identify possible predictors of genital pain among women. Methods: The study was a population-based study using a postal questionnaire administered to 4052 women (age 18--35). Of these 944 (response rate: 23%) took part in the study. Results: Genital pain of six months duration was reported by 16.1% of the women. Women with pain more commonly reported fungal infections, other pain problems, sexual dysfunctions and symptoms of anxiety than pain-free women and in addition lower sexual satisfaction. There were no differences in sexual frequency. Pain was most commonly reported during sexual intercourse, but many women also experienced pain during non-sexual activities, with pain durations of several hours after the pain eliciting activity was interrupted. Of those reporting pain, 50% had sought care for their pain. The most common was to counsel a doctor and to receive topical treatment. However, the experienced effects of the treatments were on average low. In the explanatory model, fungal infections, and sexual dysfunctions were associated with genital pain. Conclusions: The study had a low response rate, but still indicates that genital pain is common and negatively affects several aspects of women' life, not just sexual activities. Although many women report pro-longed pain experiences, many fail to consult health care and among those who seek care the effects of treatment are on average poor. There are strong associations between sexual dysfunctions (lack of sexual arousal, vaginal muscle tension hindering intercourse) and genital pain that, based on previous findings in this field of research, might be viewed in terms of circular maintaining processes. Implications: Female genital pain is not just limited to the sexual context, but often negatively affects several situations in women' life. The size of the problem calls for immediate development of preventive interventions and treatment programs that focus on sexual education and to encourage a healthy sexuality among women and their partners. There is a need to identify methods in order to assemble evidence based interventions of female genital pain. Such methods are currently lacking, resulting in poor treatment options for women with pain. © 2013 Scandinavian Association for the Study of Pain.

  • 5.
    Thomtén, Johanna
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi.
    Boersma, Katja
    Örebro universitet.
    Flink, Ida
    Örebro universitet.
    Tillfors, Maria
    Örebro universitet.
    Social Anxiety, Pain Catastrophizing and Return to Work Self-efficacy in chronic pain: A Cross-sectional Study2016Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 11, nr April, s. 98-103Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims

    Returning to work after periods of sick-leave due to chronic pain problems, involve a number of situations of interpersonal nature (e.g. meeting supervisors/insurance companies to adapt work setting to present functional level, receive help from colleagues, express pain, etc.). Since chronic pain has shown co-morbidity with social anxiety, it is of interest to investigate restraining factors in return to work among chronic pain sufferers from a social perspective. Catastrophizing is identified in both pain and social anxiety as a mechanism that might fuel a continuous bias in how situations are perceived (threat) and by hindering the development of functional behavior strategies. The presence of social anxiety in chronic pain patients might be seen as a stressor that limits the individuals’ ability to effectively communicate pain-related needs to colleagues, and/or employers and therefore act as a hindering factor in return-to-work. Hence, the overall aim of this study was to examine the relationship between social anxiety, pain catastrophizing, and perceived ability to communicate pain-related needs to the work environment in a clinical pain population.

  • 6.
    Thomtén, Johanna
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi. Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Sweden.
    Karlsson, Andreas
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi.
    Psychological factors in genital pain: The role of fear-avoidance, pain catastrophizing and anxiety sensitivity among women living in Sweden2014Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 5, nr 3, s. 193-199Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: One in five women under the age of 30 report recurrent genital pain and pain during sexual intercourse. Female genital pain negatively affects sexual and general health, as well as dyadic function and quality of life. Although the current field of research and clinical expertise in general agree upon a biopsychosocial conceptualization, there is still a lack of theoretical models describing the psychosocial mechanisms involved in the development of genital pain. Originally developed to outline the transition from acute to chronic back pain, the fear avoidance (FA) model has lately been proposed as a possible tool in illustrating the mechanisms involved in genital pain. However, only few studies have empirically tested the components of the FA model empirically. The aim of the present study is to examine fear avoidance beliefs, pain catastrophizing, and symptoms of depression and anxiety among women reporting genital pain, and to relate these concepts to sexual satisfaction/function and the characteristics of pain. Methods: The study was a population-based study using a postal questionnaire administered to 4052 women (age 18-35). Of these 944 (response rate: 23%) took part in the study. Results: Genital pain of six months duration was reported by 16.1% of the women. Women with pain reported elevated levels of symptoms of anxiety, fear avoidance beliefs, pain catastrophizing and anxiety sensitivity. Symptoms of anxiety also predicted pain in the explanatory model together with vaginal tension and fungal infection. Vaginal tension has previously been described as a fear-response to painful intercourse and the results thereby seem to give further support to viewing genital pain from a fear avoidance perspective. Furthermore, fear avoidance beliefs seem to be of similar importance as lack of desire for the experience of sexual satisfaction and could also predict pain during specific activities among women with pain. The results also indicate that sexual satisfaction is related to a specific pain-related fear, rather than a heightened level of general anxiety. Conclusions: The study had a low response rate, but still indicates that genital pain is common and is associated with several aspects of fear and avoidance. In sum, the results support the FA model by giving strong support for fear reactions (vaginal tension) and fear avoidance beliefs, and moderate support for negative affect. In the model negative affect drives pain catastrophizing. Implications: It seems that the experience of genital pain among women in the general population is common and could be associated with increased levels of anxiety and fear-avoidance beliefs. However, the associations should not be understood in isolation from physiological mechanisms but seem to indicate interactions between, e.g. fungal infections, negative appraisals of pain and symptoms, lack of sexual function and satisfaction and increased pain experience. It is possible that psychological mechanisms work in the transition from acute physiological pain to chronic psychologically maintained pain in terms of secondary reactions to, e.g. repeated fungal infections by adding emotional distress, fear of pain and avoidance behaviours. © 2014 Scandinavian Association for the Study of Pain.

  • 7.
    Thomtén, Johanna
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi. Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden .
    Linton, S. J.
    Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden .
    When sex hurts: Female genital pain with sexual consequences deserves attention: A position paper2014Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 5, nr 3, s. 202-205Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims: The problem of sexual pain is an area that has been shamefully ignored by both the pain community and the health service authorities. Although about 40% of women report such pain and 30% report it during their last intercourse, sexual pain has historically not even been considered a pain problem. The objectives of the present study was to present a background to the problem of female sexual pain, further elaborate on the problem and offer some direction for how advances might be concretely made. Discussion: Genital pain is common and many women describe pain during several non-sexual activities. Therefore describing the pain strictly as a sexual problem, threatens to lose important information about the experience of pain which will be misleading both in assessment and treatment. Instead, seeing the problem as a multidimensional pain condition with debilitating sexual consequences is suggested. It has become apparent that although biological aspects are central in the experience of genital pain, psychological and social aspects may play a major role. The fear avoidance model which has played a major role in our understanding of the development of chronic musculoskeletal pain, also seems to be applicable in genital pain conditions. However, one has to be aware of certain differences when comparing genital pain from musculoskeletal conditions. In addition, there is a lack of established guidelines for assessing or treating unexplained genital pain conditions, and there is a risk of not acknowledging the role of socio-cultural context on how female sexuality is viewed. The problem of recurrent sexual pain is a highly volatile, personal, and socially weighted experience. Because of the lack of understanding of the mechanisms, it is a risk of over-emphasizing the role of vaginal penetration in the assessment and treatment of female sexual pain and clinicians may simply fail to investigate sexual function from a broader perspective. Conclusions and implications: There is a growing interest in the problem of female genital pain and associated problems with sexual pain. However, research predominately refers to the field of sex research, and the involvement from the pain community has to date been relatively low. There is an immediate need to identify the psychosocial mechanisms involved in the transition from acute to chronic genital pain in women and to address these components in treatment using established methods. Since sexual pain is far more than pain during vaginal penetration, there is a risk of treatment interventions being oriented towards performance in terms of a narrowly defined sexual behavior instead of focusing on valued activities, meaning and pleasure for the individual. Assessment and treatment have to include a broad perspective on pain and on sex. © 2014 Scandinavian Association for the Study of Pain.

  • 8.
    Thomtén, Johanna
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för samhällsvetenskap.
    Soares, Joaquim
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Sundin, Örjan
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för samhällsvetenskap.
    Pain among women: Associations with socioeconomic factors over time and the mediating role of depressive symptoms2012Ingår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 3, nr 2, s. 62-67Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims: Lower socioeconomic status (SES), based on economic situation, education and occupation, has been associated with greater morbidity and mortality in a wide range of diseases, and socioeconomic inequalities have been found in several chronic pain populations. Sincewomen are overrepresented in several clinical pain conditions, there is a need to understand the influence of SES among women with pain. In a previous cross-sectional study, socioeconomic- and work conditions were associated with pain among women from the general population of Sweden. In the present study, based on baseline and follow-up measures from 2300 of the same sample, we examined associations between painvariables, socioeconomic status and work conditions over time by means of multiple logistic/linear regression analyses. Additionally, a possible mediating role of depressive symptoms on the relationship between SES and pain was examined. Methods: The study was a prospective panel survey with two measurements 12 months apart among 2300 women with and without pain from the general population in Stockholm (aged 18-64). Logistic and linear regression analyses were used to identify associations between SES and pain outcomes. Results: Results revealed that pain is a rather stable condition with large impact on daily functioning among many women. Certain SES variables (educational level, financial strain, occupational level) were related to pain and pain related disability prospectively. Financial strain and to be a blue-collar worker were related to the incidence of pain among all women, while educational level was related to worse pain outcomes among women with pain in terms of pain intensity,pain frequency, number of pain locations and pain-related disability. Symptoms of depression were associated with pain incidence and with painvariables (intensity, number of pain locations and pain-related disability) and with lower SES. Conclusions: Financial strain and occupational level were here identified as risk factors for the incidence of pain, and could be interpreted as increasing both physical and psychological stress and thereby work both as predisposing the individual to pain and to perpetuate the development of a pain condition. Educational level was associated with the course of pain in terms of pain duration and pain-related disability which may indicate that once affected by pain, lower educational level may be related to less functional coping strategies in the adaptation to the pain condition. Depressive symptoms could be understood as a mediator of the relationship between SES and pain among women in terms of limiting the individual's strategies to handle pain in a functional manner by increasing passive behavior patterns such as avoidance. Implications: The interplay between SES and symptoms of depression should be regarded in preventive interventions and in treatment of pain among women. An overall risk-profile in terms of psychosocial and biological factors needs to be assessed early on within pain treatment for women. Increased knowledge of socioeconomic risk factors for long term pain, e.g. low educational level, is needed on all levels among all professionals within the healthcare system in order to facilitate effective communication in the treatment of womenwith pain. © 2012 Scandinavian Association for the Study of Pain.

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