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Björn Gerdle,1 Elena Dragioti,1 Marcelo Rivano Fischer,2,3 Åsa Ringqvist2 1Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; 2Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden; 3Department of Health Sciences, Faculty of Medicine, Lund University, Lund, SwedenCorrespondence: Björn Gerdle, Email bjorn.gerdle@liu.seBackground: Factors that influence outcomes of interdisciplinary pain rehabilitation programs (IPRP) are poorly known. It is unclear how outcomes are influenced by pain intensity, psychological distress, and coping strategies.Aim: This clinical registry-based longitudinal cohort study has three aims: 1) to determine the relative importance of pain intensity, psychological distress, acceptance, and fear-avoidance for changes in three outcomes of IPRP at 12-month follow-up; 2) to investigate whether the effects of pain intensity and psychological distress on the three outcomes are mediated via acceptance and fear-avoidance; and 3) to determine whether sex is a moderator.Methods: This study uses Patient-Reported Outcome Measures (PROMs) from specialist units reporting data (2008– 2016) to the Swedish Quality Registry for Pain Rehabilitation (SQRP). Adult chronic pain patients (N = 1991) answered the PROMs (background, pain, psychological distress, coping, participation, and health-related quality of life (HRQoL)). Partial Least Squares Structural Equation Modelling (PLS-SEM) was used to explore the aims.Results: Changes in acceptance (β:0.424– 0.553; all P< 0.001) were the strongest predictor of the three outcomes (changes in life control, interference, and HRQoL) at 12-month follow-up. The next strongest predictor was baseline acceptance (β: 0.177– 0.233; all P< 0.001) and changes in fear-avoidance (β: − 0.152– − 0.186; all P< 0.001). Baseline pain intensity and psychological distress showed weak positive associations. Their effects on the three outcomes were mediated via acceptance aspects. Sex was not a moderator.Discussion and Conclusion: Acceptance aspects (baseline and changes) were important predictors of IPRP outcomes. Changes in fear-avoidance were also important although to a lesser degree. Some of the effects of pain intensity and psychological distress on outcomes were mediated via acceptance at baseline. Future PLS-SEM analysis of real-world IPRP should include more potential mediators (eg, catastrophizing and more facets of psychological flexibility and fear-avoidance) and the components of IPRP.Keywords: anxiety, chronic pain, coping strategies, depression, health, pain management

Abstract Background Opioids are still widely prescribed to long-term pain patients although they are no longer recommended for long-term treatments due to poor evidence for long-term efficacy, risks of serious side effects, and the possibility of inducing opioid hyperalgesia. In a Cochrane study from 2017, the authors identified an urgent need for more randomized controlled trials investigating the efficiency and effects of opioid tapering. The study aimed to assess (1) the efficiency of a structured intervention in causing stable reductions of opioid consumption in a population with long-term non-malignant pain and (2) effects on pain, pain cognitions, physical and mental health, quality of life, and functioning in response to opioid tapering. Methods The study is a randomized controlled trial. The sample size was set to a total of 140 individuals after estimation of power and dropout. Participants will be recruited from a population with long-term non-malignant pain who will be randomly allocated to (1) the start of tapering immediately or (2) the control group who return to usual care and will commence tapering of opioids 4 months later. A 12-month follow-up is included. When all follow-ups are closed, data from the Swedish drug register of the National Board of Health and Welfare will be collected and individual mean daily opioid dose in morphine equivalents will be calculated at three time points: baseline, 4 months, and 12 months after the start of the intervention. At the same time points, participants fill out the following questionnaires: Numeric Pain Rating Scale (NPRS), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Chronic Pain Acceptance Questionnaire (CPAQ-8), Hospital Anxiety and Depression Scale (HADS), and RAND-36. At baseline and follow-up, a clinical assessment of opioid use disorder is performed. Discussion A better understanding of the efficiency and effects of opioid tapering could possibly facilitate attempts to taper opioid treatments, which might prove beneficial for both the individual and society. Trial registration ClinicalTrials.gov NCT03485430 . Retrospectively registered on 26 March 2018, first release date. “Tapering of Long-term Opioid Therapy in Chronic Pain Population. RCT with 12 Months Follow up (TOPIO).” First patient in trial 22 March 2018.

Björn Gerdle,1 Marcelo Rivano Fischer,2,3 Matti Cervin,4 Åsa Ringqvist2 1Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping SE-58185, Sweden; 2Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund SE-22185, Sweden; 3Research Group Rehabilitation Medicine,Dept of Health Sciences, Lund University, Lund, Sweden; 4Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund SE-22100, SwedenCorrespondence: Björn GerdlePain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping SE-581 85, SwedenTel +46763927191Email bjorn.gerdle@liu.seIntroduction: The extent to which pain is distributed across the body (spreading of pain) differs largely among patients with chronic pain conditions and widespread pain has been linked to poor quality of life and work disability. A longer duration of pain is expected to be associated with more widespread pain, but studies are surprisingly scarce. Whether spreading of pain is associated with clinical presentation and treatment outcome in patients seen in interdisciplinary multimodal pain rehabilitation programs (IMMRPs) is unclear. The association between spreading of pain and (1) pain duration (2) clinical presentation (eg, pain intensity, pain-related cognitions, psychological distress, activity/participation aspects and quality of life) and (3) treatment outcome were examined.Methods: Data from patients included in the Swedish Quality Registry for Pain Rehabilitation were used (n=39,916). A subset of patients that participated in IMMRPs (n=14,666) was used to examine whether spreading of pain at baseline predicted treatment outcome. Spreading of pain was registered using 36 predefined anatomical areas which were summarized and divided into four categories: 1– 6 regions with pain (20.6% of patients), 7– 12 regions (26.8%), 13– 18 regions (22.0%) and 19– 36 regions (30.6%).Results: More widespread pain was associated with a longer pain duration and a more severe clinical picture at baseline with the strongest associations emerging in relation to health and pain aspects (pain intensity, pain interference and pain duration). Widespread pain was associated with a poorer overall treatment outcome following IMMRPs at both posttreatment and at a 12-month follow-up, but effect sizes were small.Discussion: Spreading of pain is an indicator of the duration and severity of chronic pain and to a limited extent to outcomes of IMMRP. Longer pain duration in those with more widespread pain supports the concept of early intervention as clinically important and implies a need to develop and improve rehabilitation for patients with chronic widespread pain.Keywords: chronic pain, interdisciplinary, outcome, pain spreading, rehabilitation, spatial distribution

Drawing on insights from the sociology of work, this article contributes to job demands–resources (JD-R) theory by arguing that collective employee voice should be considered within the framework as an antecedent of job demands and job resources. An empirical test is offered to substantiate the theoretical argument, hypothesizing that collective voice – measured as trade union influence at the workplace level – reduces job demands and increases job resources. Based on the notion that some jobs may be inherently demanding, an additional hypothesis posits that collective voice balances demands with job resources by supplementing resources particularly where demands are high. Drawing on data from the European Social Survey covering 27 countries, results of multi-level analyses reveal that while not associated negatively with job demands, collective voice enhances job resources, particularly where demands are high. On this basis the article encourages further sociologically informed analyses of the JD-R model. [ABSTRACT FROM AUTHOR]

This article contributes to debates about trade unions and the environment by studying international variation in the association between union membership and support for government spending on environmental protection. Building on research which demonstrates a positive membership effect on support for environmental protection, the article extends the geographical scope beyond the more economically developed contexts studied previously. Using World Systems Theory as a comparative framework, distinguishing between core, semi-periphery, and periphery states, the article explores whether the positive membership effect extends beyond more affluent core states and reveals an intriguing empirical puzzle: while public support for environmental spending is substantially weaker in core states relative to non-core states, the latter being subject to more extensive environmental threats, the reverse holds for the membership effect on environmental spending support which instead tends to be more positive in core states. Union membership thus tends to have the largest positive impact on environmental spending support in countries where public support for such spending tends to be lower. Theoretical and practical implications of these findings for the global effort to address an ongoing environmental crisis are discussed by considering the notion of a solidarity effect. [ABSTRACT FROM AUTHOR]

Objective: To review the theoretical benefits of airway pressure release ventilation (APRV), summarize the evidence for its use in clinical practice, and discuss different titration strategies. Data Source: Published randomized controlled trials in humans, observational human studies, animal studies, review articles, ventilator textbooks, and editorials. Data Summary: Airway pressure release ventilation optimizes alveolar recruitment, reduces airway pressures, allows for spontaneous breathing, and offers many hemodynamic benefits. Despite these physiologic advantages, there are inconsistent data to support the use of APRV over other modes of ventilation. There is considerable heterogeneity in the application of APRV among providers and a shortage of information describing initiation and titration strategies. To date, no direct comparison studies of APRV strategies have been performed. This review describes 2 common management approaches that bedside providers can use to optimally tailor APRV to their patients. Conclusion: Airway pressure release ventilation remains a form of mechanical ventilation primarily used for refractory hypoxemia. It offers unique physiological advantages over other ventilatory modes, and providers must be familiar with different titration methods. Given its inconsistent outcome data and heterogeneous use in practice, future trials should directly compare APRV strategies to determine the optimal management approach.

Introduction: While there has been a reduction in specific homicide categories in Sweden, the last decade has witnessed an increase in the overall rate. The escalation is predominantly linked to heightened gun violence associated with criminal gangs. As a result, Sweden faces an extreme rate of shootings and firearmrelated homicides, constituting one of the most severe instances across Europe. However, comprehensive scientific studies on this phenomenon are lacking. This paper presents the design of the Violent Crimes in Skåne (ViCS) project, which aims to investigate violent crimes requiring hospitalization or causing death in Sweden’s region Skåne from a medical, forensic, and criminological perspective. The project aims to examine the epidemiology and trends of violent crimes, injury profiles, treatments, patient outcomes, causes of death, and victim demographics. Methods and analysis: Using a retrospective cross-sectional design, ViCS will examine trauma by violent crimes from 2000 to 2019. Data will be sourced from several institutions, including hospital records from nine emergency hospitals, and the National Board of Forensic Medicine Agency. The project aims to study medical and criminological aspects of violent crimes, primarily focusing on assaults involving firearms, sharp weapons, blunt instruments, kicks, punches, and other types of assault like strangulation. Data analysis will involve descriptive and inferential statistics. Discussion: ViCS aims to contribute to the limited body of knowledge about victims of violent crimes in Sweden. The findings may inform evidence-based interventions in medical, forensic, and criminological fields, potentially enabling targeted prevention strategies and improvements in emergency care for victims. [ABSTRACT FROM AUTHOR]

Active comets have been detected in several exoplanetary systems, although so far only indirectly, when the dust or gas in the extended coma has transited in front of the stellar disk. The large optical surface and relatively high temperature of an active cometary coma also makes it suitable to study with direct imaging, but the angular separation is generally too small to be reachable with present-day facilities. However, future imaging facilities with the ability to detect terrestrial planets in the habitable zones of nearby systems will also be sensitive to exocomets in such systems. Here we examine several aspects of exocomet imaging, particularly in the context of the Large Interferometer for Exoplanets (LIFE), which is a proposed space mission for infrared imaging and spectroscopy through nulling interferometry. We study what capabilities LIFE would have for acquiring imaging and spectroscopy of exocomets, based on simulations of the LIFE performance as well as statistical properties of exocomets that have recently been deduced from transit surveys. We find that for systems with extreme cometary activities such as β Pictoris, sufficiently bright comets may be so abundant that they overcrowd the LIFE inner field of view. More nearby and moderately active systems such as є Eridani or Fomalhaut may turn out to be optimal targets. If the exocomets have strong silicate emission features, such as in comet Hale-Bopp, it may become possible to study the mineralogy of individual exocometary bodies. We also discuss the possibility of exocomets as false positives for planets, with recent deep imaging of α Centauri as one hypothetical example. Such contaminants could be common, primarily among young debris disk stars, but should be rare among the main sequence population. We discuss strategies to mitigate the risk of any such false positives. [ABSTRACT FROM AUTHOR]

Regional anesthesia is frequently employed in efforts to improve postoperative analgesia and reduce opioid requirements following abdominal surgery. The purpose of the current analysis was to determine if there was a difference in postoperative pain and opioid consumption between patients who underwent open total abdominal hysterectomy (TAH) and received ultrasound-guided bilateral transversus abdominis plane (TAP) blocks using either liposomal bupivacaine or ropivacaine. A single-center retrospective analysis was conducted of 215 patients from November 2018 through March 2020 who underwent an open TAH and received bilateral TAP blocks with either liposomal bupivacaine or ropivacaine. The primary outcome measure was opioid consumption at regular intervals until discharge, and the secondary outcome measures included pain scores, incidence of nausea/vomiting, and use of antiemetics at the same time intervals. Intraoperative opioid consumption and postanesthesia recovery unit opioid requirements were similar between the two groups. Opioid requirements at 24 hours (P < 0.04) and 48 hours (P < 0.01), as well as total morphine equivalent requirements (P < 0.05), were significantly lower in the liposomal bupivacaine group compared to the ropivacaine group. Patients undergoing open TAH who received liposomal bupivacaine TAP blocks required fewer postoperative opioids to achieve similar pain scores when compared to patients who received ropivacaine TAP blocks. [ABSTRACT FROM AUTHOR]

This prospectively designed, clinical quality improvement project compared pain scores and opioid consumption between ultrasound-guided, erector spinae plane blocks (ESPB) and thoracic paravertebral blocks (PVB) in patients undergoing total bilateral mastectomies without reconstruction. Twenty-five patients were included in an enhanced recovery pathway and received an ESPB on one side and a PVB on the contralateral side. Numeric rating scores at rest and with movement for each side were recorded in the recovery room at 2, 6, 12, 24, and 48 hours and on days 3 to 7. There were no significant differences in the resting or movement-evoked pain scores between sides receiving ESPB or PVB at any time point up to day 7 after surgery. Both ESPB and PVB confer equal analgesic effects in patients undergoing mastectomies. ESPB provides an alternative to PVB in reducing postoperative pain in patients undergoing mastectomy as part of an enhanced recovery pathway. [ABSTRACT FROM AUTHOR]