Berit Rokne Hanestad

Prevalence and characteristics of chronic pain in the general Norwegian population

Background. Population‐based studies suggest that prevalence of chronic pain is increasing. The purpose of this study was to determine the prevalence of chronic pain in a sample drawn from the general Norwegian population. In addition, the characteristics of chronic pain, as well as differences in demographic characteristics and health‐related variables between persons with and without chronic pain were evaluated.

Fatigue in the general population: A translation and test of the psychometric properties of the Norwegian version of the fatigue severity scale:

Objective: A study was undertaken to test the psychometric properties of the Fatigue Severity Scale (FSS), and to explore the relationship between fatigue and sociodemographic variables in the general population. Method: A national representative sample of 1893 respondents was randomly selected from a pool of 4,000 Norwegians aged 19—81 years. A mailed questionnaire that included the FSS was used to measure fatigue severity. Results: The FSS showed satisfactory internal consistency (Cronbachs alpha 0.88). The prevalence of high fatigue (FSS score>=5) was 23.1% in the total sample. More women (26.2%) than men (19.8%) experienced high fatigue (p=0.004). Respondents with chronic illness (more than six months) reported a higher mean (M=4.69, SD=1.35) than the rest of the sample (M=3.67, SD=1.17) (p<0.001). An inverse correlation was found between fatigue and level of formal education (r=0.20, p<0.001). Conclusion: The psychometric properties of the Norwegian version of FSS were satisfactory. To avoid over-diagnosing people for high level of fatigue, the threshold for high fatigue probably should be 5 on the FSS scale instead of 4 as had been suggested originally, but further validation of the cut-off point is needed.

Age and the experience of chronic pain: differences in health and quality of life among younger, middle-aged, and older adults.

Objectives:To describe age differences in chronic pain and to evaluate for differences in demographic and health-related variables among younger (18-39 years), middle-aged (40-59 years), and older adults (60-81 years) who reported chronic pain. Methods:A total of 4000 Norwegian citizens were mailed a questionnaire that measured pain, quality of life, mood, and demographic and health-related variables. Results:Of the total sample (n = 1912), 19.2% of the younger age group, 27.5% of the middle-aged group, and 31.2% of the older group reported chronic pain (ie, >3 months duration). A total of 58.9% of the participants in chronic pain reported having a chronic disease, with the most common being musculoskeletal problems, chronic pain disorder, and osteoarthritis. Participants in the older age group reported pain of longer duration and more comorbidities and received pain treatment more often. They had higher total quality of life scores, were more satisfied with their material comforts and social life, and reported better mood. The middle-aged group reported the largest number of pain locations, reported having fibromyalgia more frequently, and reported that the cause of their pain was not known. They were less satisfied with their social life than the older age group. The younger age group reported the highest rates of injury and accidents as the cause of their pain, and almost 43% of this age group was not receiving any treatment of their chronic pain. Conclusion:This study found that the prevalence rates for chronic pain do vary with age and that the middle-aged group may be a high-risk group of patients with chronic pain.

History of Foot Ulcer Increases Mortality Among Individuals With Diabetes Ten-year follow-up of the Nord-Trøndelag Health Study, Norway

OBJECTIVE To compare mortality rates for individuals with diabetes with and without a history of foot ulcer (HFU) and with that for the nondiabetic population. RESEARCH DESIGN AND METHODS This population-based study included 155 diabetic individuals with an HFU, 1,339 diabetic individuals without an HFU, and 63,632 nondiabetic individuals who were all followed for 10 years with mortality as the end point. RESULTS During the follow-up period, a total of 49.0% of diabetic individuals with an HFU died, compared with 35.2% of diabetic individuals without an HFU and 10.5% of those without diabetes. In Cox regression analyses adjusted for age, sex, education, current smoking, and waist circumference, having an HFU was associated with more than a twofold (2.29 [95% CI 1.82–2.88]) hazard risk for mortality compared with that of the nondiabetic group. In corresponding analyses comparing diabetic individuals with and without an HFU, an HFU was associated with 47% increased mortality (1.47 [1.14–1.89]). Significant covariates were older age, male sex, and current smoking. After inclusion of A1C, insulin use, microalbuminuria, cardiovascular disease, and depression scores in the model, each was significantly related to life expectancy. CONCLUSIONS AN HFU increased mortality risk among community-dwelling adults and elderly individuals with diabetes. The excess risk persisted after adjustment for comorbidity and depression scores, indicating that close clinical monitoring might be warranted among individuals with an HFU, who may be particularly vulnerable to adverse outcomes.

Measuring self-reported, health-related, quality of life in adolescents with type 1 diabetes using both generic and disease-specific instruments.

Aims: To describe perceived functional health and well‐being and diabetes‐related impact, worry and satisfaction with life in relation to demographic and clinical variables in a population of adolescents with type 1 diabetes. To compare perceived functional health and well‐being between adolescents with diabetes and a group of healthy controls and to analyse the relationship between generic functional health and well‐being and diabetes‐related impact, worry and satisfaction with life. Methods: A total of 130 adolescents were invited to complete the Child Health Questionnaire (CHQ‐CF87) and the Diabetes Quality of Life (DQOL) questionnaire modified for youths. A total of 115 (88.5%) subjects participated in the study; mean age 14.5 y (SD 1.86), mean duration of diabetes 6.99 y (SD 3.77, range 1–16 y), mean HbA1c 9.3% (SD 1.62, range 6.2–14.0%). Forty‐eight percent of the subjects were girls. Results: When compared with healthy adolescents, subjects with diabetes reported a significantly lower degree of general health. The CHQ‐CF87 scales showed that higher age in adolescents with diabetes was associated with lower scores for mental health (p < 0.001), self‐esteem (p < 0.001), behaviour (p= 0.004) and general health (p < 0.001). Findings from the DQOL questionnaire showed that older adolescents were more worried (p < 0.001), perceived a greater impact of diabetes on daily life (p= 0.008) and lower diabetes‐related life satisfaction (p < 0.001). The scores for girls were lower than those for boys in assessment of mental health (p < 0.001), self‐esteem (p= 0.004) and family cohesion (p= 0.002). Girls also reported a greater impact of diabetes (p= 0.028), more worries (p= 0.001) and less satisfaction with life (p= 0.006) than boys. Neither HbA1c nor other clinical variables could sufficiently explain the variations in DQOL or CHQ‐CF87.

A History of Foot ulcer increases Mortality among Persons with Diabetes. 10-year Follow-up of the Nord-Trøndelag Health Study, Norway

OBJECTIVE To compare mortality rates for individuals with diabetes with and without a history of foot ulcer (HFU) and with that for the nondiabetic population. RESEARCH DESIGN AND METHODS This population-based study included 155 diabetic individuals with an HFU, 1,339 diabetic individuals without an HFU, and 63,632 nondiabetic individuals who were all followed for 10 years with mortality as the end point. RESULTS During the follow-up period, a total of 49.0% of diabetic individuals with an HFU died, compared with 35.2% of diabetic individuals without an HFU and 10.5% of those without diabetes. In Cox regression analyses adjusted for age, sex, education, current smoking, and waist circumference, having an HFU was associated with more than a twofold (2.29 [95% CI 1.82–2.88]) hazard risk for mortality compared with that of the nondiabetic group. In corresponding analyses comparing diabetic individuals with and without an HFU, an HFU was associated with 47% increased mortality (1.47 [1.14–1.89]). Significant covariates were older age, male sex, and current smoking. After inclusion of A1C, insulin use, microalbuminuria, cardiovascular disease, and depression scores in the model, each was significantly related to life expectancy. CONCLUSIONS AN HFU increased mortality risk among community-dwelling adults and elderly individuals with diabetes. The excess risk persisted after adjustment for comorbidity and depression scores, indicating that close clinical monitoring might be warranted among individuals with an HFU, who may be particularly vulnerable to adverse outcomes.

Postoperative Pain and Convalescence in Living Kidney Donors—Laparoscopic Versus Open Donor Nephrectomy: A Randomized Study

The aim of the present study was to compare postoperative pain and convalescence in patients randomized to laparoscopic or open donor surgery in a prospective, controlled trial. The donors were randomly assigned to undergo laparoscopic (n = 63) or open (n = 59) donor nephrectomy. Our end points were amount of administered analgesics in the recovery period, postoperative pain on the second postoperative day and at one month after surgery and duration of sick leave.

Quality of life, perceived difficulties in adherence to a diabetes regimen, and blood glucose control

The first aim of the present study was to investigate if self‐assessed quality of life was associated with perceived difficulties in adherence to a regimen, and the second, if perceived difficulties in adherence were associated with poor blood glucose control. A self‐administered questionnaire was completed by 247 patients with Type 1 diabetes who consecutively attended a Norwegian diabetes clinic. Results from multiple linear regression analysis indicated that a higher level of quality of life was associated with greater perceived ease of adherence to the regimen. Adherence to control of smoking, increased physical exercise, and control of weight and diet were perceived as most difficult. Analysis of covariance showed that women who perceived difficulties in adherence to self‐care behaviour had on average less satisfactory blood glucose control than those reporting less difficulty in adherence.

Cutpoints for mild, moderate and severe pain in patients with osteoarthritis of the hip or knee ready for joint replacement surgery

BackgroundCutpoints (CPs) for mild, moderate and severe pain are established and used primarily in cancer pain. In this study, we wanted to determine the optimal CPs for mild, moderate, and severe pain in joint replacement surgery candidates with osteoarthritis (OA) of the hip or knee, and to validate the different CPs.MethodsPatients (n = 353) completed the Brief Pain Inventory (BPI), the WOMAC Arthritis Index, and the SF-36 health status measure. Optimal CPs for categorizing average pain with three severity levels were derived using multivariate analysis of variance, using different CP sets for average pain as the independent variable and seven interference items from the BPI as the dependent variable. To validate the CPs, we assessed if patients in the three pain severity groups differed in pain as assessed with WOMAC and SF-36, and if BPI average pain with the optimal CPs resulted in higher correlation with pain dimensions of the WOMAC and SF-36 than other CPs.ResultsThe optimal CPs on the 0–10 point BPI scale were CP (4,6) among hip patients and CP (4,7) among knee patients. The resulting pain severity groups differed in pain, as assessed with other scales than those used to derive the CPs. The optimal CPs had the highest association of average pain with WOMAC pain scores.ConclusionCPs for pain severity differed somewhat for patients with OA of the hip and knee. The association of BPI average pain scores categorized according to the optimal CPs with WOMAC pain scores supports the validity of the derived optimal CPs.

The Bodily Suffering of Living with Severe Psoriasis: In-Depth Interviews with 22 Hospitalized Patients with Psoriasis

Psoriasis is one of the most common chronic skin diseases. The author presented results from a qualitative study focusing on patients with severe psoriasis in an acute phase and their experience of living with the disease. Twenty-two hospitalized patients with psoriasis were interviewed in depth. The interviews were consecutively analyzed according to grounded theory methodology. Bodily suffering emerged as a core variable in the data. Bodily suffering includes the following categories: the visible body, staying on an even keel, coping with an all-consuming disease, and social vulnerability. The results of this study indicate that the criterion for the management of psoriasis should be the patients’own perception of the consequences of the disease.