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Background and aims: In the spring of 2019, Professor Steven J. Linton, the founder of the Center for Health and Medical Psychology (CHAMP) at Örebro University, Sweden, formally retired. As a tribute to his scholarly work covering decades of influence and inspiration to the field of pain psychology, the research center organized a topical conference titled "Pain in the 21st century: Where do we come from and where are we going?", which resulted in this state-of the-art synthesis. The aim of this declaration is to highlight lessons learned but not in the least is meant to inspire and guide our continued journey forward, developing pain psychology into the 21st century. Methods: Several collaborators of Professor Linton have summarized and reflected on the current state-of-the-art of pain psychology from the perspective of his input to the field, as well as on developments from the last years of advancements in pain psychology. Results: The topics have been divided into six themed sections covering the fear avoidance model, transdiagnostics, secondary prevention, risk- and protective factors, communication and contextual factors. The sections cover a broad spectrum, from basic experimental studies, integrating emotion and motivational theories into current theoretical models, to applied research on the effect of early interventions as well as sophisticated emotion-focused treatment models for pain patients with concurrent emotional ill-health. Conclusions: There have been major advancements within pain psychology research during the last decades, moving the field towards a more comprehensive picture, taking emotional and motivational aspects into account to understand pain sufferers. Although psychologically informed interventions in general mainly focus on the individual, it has been put forward that pain management is highly influenced by the surrounding environment, including communication with health care providers, and the occupational and social context. Implic

Background: Traumatic injury can lead to loss, suffering and feelings of injustice. Previous research has shown that perceived injustice is associated with poorer physical and mental wellbeing in persons with chronic pain. This study aimed to identify the relative association between injury, compensation and pain-related characteristics and perceived injustice 12-months after traumatic injury. Methods: 433 participants were recruited from the Victorian Orthopedic Trauma Outcomes Registry and Victorian State Trauma Registry, and completed questionnaires at 12-14 months after injury as part of an observational cohort study. Using hierarchical linear regression we examined the relationships between baseline demographics (sex, age, education, comorbidities), injury (injury severity, hospital length of stay), compensation (compensation status, fault, lawyer involvement), and health outcomes (SF-12) and perceived injustice. We then examined how much additional variance in perceived injustice was related to worse pain severity, interference, self-efficacy, catastrophizing, kinesiophobia or disability.Results: Only a small portion of variance in perceived injustice was related to baseline demographics (especially education level), and injury severity. Attribution of fault to another, consulting a lawyer, health-related quality of life, disability and the severity of pain-related cognitions explained the majority of variance in perceived injustice. While univariate analyses showed that compensable injury led to higher perceptions of injustice, this did not remain significant when adjusting for all other factors, including fault attribution and consulting a lawyer. Conclusions: In addition to the "justice" aspects of traumatic injury, the health impacts of injury, emotional distress related to pain (catastrophizing), and the perceived impact of pain on activity (pain self-efficacy), had stronger associations with perceptions of injustice than either injury or pain s

Systemic Sclerosis (SSc) is a rheumatic disease characterized by fibrosis of the skin and internal organs. Patients are at risk for poor quality of life, including significant pain. This dissertation evaluated a biopsychosocial model of pain-related quality of life in SSc. Data from the Genetics versus ENvironment In Scleroderma Outcome Study (GENISOS), a prospective cohort study of patients with SSc were used to test the study aims. Study 1 used baseline data to evaluate the factor structure of the Illness Behavior Questionnaire. Four previously derived solutions were tested but none were sufficiently valid or reliable. Exploratory analysis suggested that there were five factors that were relevant to SSc patients : Symptom Bother, Health Worry, Interpersonal Functioning, Other Life Worries, and Affective Inhibition. These indices were related to fatigue, pain, disability, social support, and mental health but not disease severity. Study 2 utilized baseline data to derive biopsychosocial profiles of SSc patients based on indicators of disease severity, perceived physical health, health worry, mental health, and social support. Three classes, which were distinguished by different trait patterns, were termed Managing, Resilient, and Distressed. Results suggested that the Distressed group, which represented individuals with less severe disease but poor psychosocial functioning had the highest pain and analgesic usage. Study 3 evaluated pain over time with regard to medical, psychological, and social characteristics. Pain generally improved for all patients. Individuals with diffuse disease reported worse initial pain, although both classifications had same rate of change. However, when psychosocial characteristics were added to the model, disease classification was no longer a significant predictor. Individuals with better mental health and perceived physical health reported better pain at disease onset. Change in pain over time was moderated by perceived physical heal

Systemic Sclerosis (SSc) is a rheumatic disease characterized by fibrosis of the skin and internal organs. Patients are at risk for poor quality of life, including significant pain. This dissertation evaluated a biopsychosocial model of pain-related quality of life in SSc. Data from the Genetics versus ENvironment In Scleroderma Outcome Study (GENISOS), a prospective cohort study of patients with SSc were used to test the study aims. Study 1 used baseline data to evaluate the factor structure of the Illness Behavior Questionnaire. Four previously derived solutions were tested but none were sufficiently valid or reliable. Exploratory analysis suggested that there were five factors that were relevant to SSc patients : Symptom Bother, Health Worry, Interpersonal Functioning, Other Life Worries, and Affective Inhibition. These indices were related to fatigue, pain, disability, social support, and mental health but not disease severity. Study 2 utilized baseline data to derive biopsychosocial profiles of SSc patients based on indicators of disease severity, perceived physical health, health worry, mental health, and social support. Three classes, which were distinguished by different trait patterns, were termed Managing, Resilient, and Distressed. Results suggested that the Distressed group, which represented individuals with less severe disease but poor psychosocial functioning had the highest pain and analgesic usage. Study 3 evaluated pain over time with regard to medical, psychological, and social characteristics. Pain generally improved for all patients. Individuals with diffuse disease reported worse initial pain, although both classifications had same rate of change. However, when psychosocial characteristics were added to the model, disease classification was no longer a significant predictor. Individuals with better mental health and perceived physical health reported better pain at disease onset. Change in pain over time was moderated by perceived physical heal

Research on pain often concerns suffering, focusing on areas like chronic pain and stigmatization (Jackson 2005), the interdependency between pain and drug use (Connors 1994), or distress expressed through physical pain (Trnka 2007). Within research on labor pain, many focus on pain-coping methods from a birthing woman’s perspective (Abushaikha 2007; Leap et al. 2010; McNeil and Jomeen 2010), or how midwives assist or teach birthing women to manage labor pain through alternative as well as pharmacological pain relief (Benfield et al. 2010; Iliadou 2009; Yerby 2001). In this article, I will problematize this perspective by showing that midwives normally perceive women’s experience of pain during childbirth as something good and normal, a perception that has to be learnt through emotion management. My discussion is based on fieldwork at a delivery ward in Sweden, on interviews with three midwifery teachers at a midwifery education program, and on scenes from a Swedish documentary about the everyday life of midwives at a delivery ward. Pain will here be referred to in terms of physical pain. In line with a definition by Jean E. Jackson, pain can be described as “an aversive feeling experienced in the body that cannot be measured directly.” She continues by stating that pain is a “symptom rather than a disease” (Jackson 2005: 333). Sara Ahmed, like Jackson, refers to pain as an aversive feeling, but adds that there is more to pain than a mere physical experience: [Pain] as an unpleasant or negative sensation is not simply reducible to sensation: how we experience pain involves the attribution of meaning through experience, as well as associations between different kinds of negative or aversive feelings. So pain is not simply the feeling that corresponds to bodily damage.