Holger Ursin

A scoring system for subjective health complaints (SHC)

The aim of this study is to present a complete scoring system for subjective health complaints (SHC) as they are experienced by the lay population. The scoring system records the complaints, and does not map attributions or medical diagnoses. In all, 1,219 subjects (323 men, 896 women) from various occupations were tested with a scoring system, the SHC inventory, previously referred to as the Ursin Health Inventory (UHI). The SHC consists of 29 questions concerning severity and duration of subjective somatic and psychological complaints. The SHC inventory yields scores on single items and a total number of health complaints categorized into five factors: musculoskeletal pain (α=0.74), pseudoneurology (α=0.73), gastrointestinal problems (α=0.62), allergy (α=0.58) and flu (α=0.67). The SHC inventory is a systematic, easy, and reliable way to score subjective health complaints. The prevalence of these complaints is high, and should be considered before conclusions are reached about new diseases and new attributions of environmental hazards.

Psychobiological mechanisms of socioeconomic differences in health

The association between low socioeconomic status and poor health is well established. Empirical studies suggest that psychosocial factors are important mediators for these effects, and that the effects are mediated by psychobiological mechanisms related to stress physiology. The objective of this paper is to explore these psychobiological mechanisms. Psychobiological responses to environmental challenges depend on acquired expectancies (learning) of the relations between responses and stimuli. The stress response occurs whenever an individual is faced with a challenge. It is an essential element in the total adaptive system of the body, and necessary for adaptation, performance and survival. However, a period of recovery is necessary to rebalance and to manage new demands. Individuals with low social status report more environmental challenges and less psychosocial resources. This may lead to vicious circles of learning to expect negative outcomes, loss of coping ability, strain, hopelessness and chronic stress. This type of learning may interfere with the recovery processes, leading to sustained psychobiological activation and loss of dynamic capacity to respond to new challenges. Psychobiological responses and health effects in humans and animals depend on combinations of demands and expected outcomes (coping, control). In studies of humans with chronic psychosocial stress, and low SES, cortisol baseline levels were raised, and the cortisol response to acute stress attenuated. Low job control was associated with insufficient recovery of catecholamines and cortisol, and a range of negative health effects. Biological effects of choice of lifestyle, which also depends on the acquired outcome expectancies, reinforce these direct psychobiological effects on health. The paper concludes that sustained activation and loss of capacity to respond to a novel stressor could be a cause of the higher risk of illness and disease found among people with lower SES.

Is there a right treatment for a particular patient group? Comparison of ordinary treatment, light multidisciplinary treatment, and extensive multidisciplinary treatment for long-term sick-listed employees with musculoskeletal pain

&NA; In general, randomized controlled studies concerning return to work have failed to demonstrate significant treatment effects for long‐lasting musculoskeletal pain, and most treatments examined have not been economically beneficial. Individuals (n=654) sick‐listed for at least 8 weeks with musculoskeletal pain, selected from the Norwegian mandatory sickness insurance system and volunteering to participate, were categorized into three groups differing in a prognosis score (good, medium, poor) for return to work, based on a brief, standardized screening of psychological and physiotherapy findings. They were then randomly assigned to three outpatient treatments with three different levels of intensity (ordinary treatment, light multidisciplinary, and extensive multidisciplinary treatment). The evaluation was based on 14 months follow‐up data on return to work collected from social security records. The patients with good prognosis for return to work do equally well with ordinary treatment as with the two more intensive treatments. The patients with medium prognosis benefit equally from the two multidisciplinary treatments. The patients with poor prognosis receiving extensive multidisciplinary treatment returned to work at a higher rate than patients with poor prognosis receiving ordinary treatment, 55 vs. 37% (P<0.05) at 14 months. Multidisciplinary treatment is effective concerning return to work, when given to patients who are most likely to benefit from that treatment. Measures of pain or quality of life are not included in this study. The cost–benefit analysis of the economic returns of the light multidisciplinary and the extensive multidisciplinary treatment programs yields a positive net present social value of the treatment. A simple, standardized, screening instrument including only psychological and physiotherapeutic observations may be a useful clinical tool for allocating patients with musculoskeletal pain to the right level of treatment.

Does early intervention with a light mobilization program reduce long-term sick leave for low back pain?

Study Design. A controlled randomized clinical trial was performed. Objective. To investigate the effect of a light mobilization program on the duration of sick leave for patients with subacute low back pain. Summary of Background Data. Early intervention with information, diagnostics, and light mobilization may be a cost-effective method for returning patients quickly to normal activity. In this experiment, patients were referred to a low back pain clinic and given this simple and systematic program as an outpatient treatment. Methods. In this study, 457 patients sick-listed 8 to 12 weeks for low back pain, as recorded by the National Insurance Offices, were randomized into two groups: an intervention group (n = 237) and a control group (n = 220). The intervention group was examined at a spine clinic and given information and advice to stay active. The control group was not examined at the clinic, but was treated with conventional primary health care. Results. At 12-month follow-up assessment, 68.4% in the intervention group had returned to full-duty work, as compared with 56.4% in the control group. Conclusions. Early intervention with examination, information, and recommendations to stay active showed significant effects in reducing sick leave for patients with low back pain.

Comorbid subjective health complaints in low back pain

Study Design. Cross-sectional study. Objectives. To compare subjective health complaints in subacute patients with low back pain with reference values from a Norwegian normal population. Summary of Background Data. Comorbidity is common with nonspecific low back pain. We wanted to investigate if these complaints were specific or part of a more general unspecific condition comparable to subjective health complaints in the normal population. Materials and Methods. The study group consisted of 457 patients sick-listed 8 to 12 weeks for low back pain. All subjects filled out questionnaires. The subjective health complaints in the study group were compared with reference values from a Norwegian normal population using logistic regression analysis. Results. Compared with the normal reference population, the patients with low back pain had significantly more low back pain, neck pain, upper back pain, pain in the feet during exercise, headache, migraine, sleep problems, flushes/heat sensations, anxiety, and sadness/depression. The prevalence of pain in arms, pain in shoulders, and tiredness was also high, but not significantly higher than in the reference population. Conclusions. Our findings indicate that patients with low back pain suffer from what may be referred to as a “syndrome,” consisting of muscle pain located to the whole spine as well as to legs and head, and accompanying sleep problems, anxiety, and sadness/depression.

Relative cost-effectiveness of extensive and light multidisciplinary treatment programs versus treatment as usual for patients with chronic low back pain on long-term sick leave: randomized controlled study.

Study Design. A subgroup of 195 patients with chronic low back pain, being part of a larger study of other musculoskeletal patients, were included in a randomized controlled prospective clinical study. Objectives. To evaluate the outcome in terms of return to work and cost-effectiveness of a light multidisciplinary treatment program with an extensive multidisciplinary program and treatment as usual initiated by their general practitioner. Summary of Background Data. Light multidisciplinary programs seem to reduce sick leave in patients with subacute low back pain. There are few, if any, previous studies of the effectiveness of light versus extensive multidisciplinary treatment on return to work in patients with chronic low back pain. Methods. Patients with chronic low back pain (n = 195), on an average sick-listed for 3 months, were included. The patients were randomized to a light multidisciplinary treatment program, an extensive multidisciplinary program, or treatment as usual by their primary physician. Full return to work was used as outcome response, and follow-up was 26 months after the end of treatment. Cost–benefit was calculated for the treatment programs. Results. In men significantly better results for full return to work were found for the light multidisciplinary treatment compared with treatment as usual, but no differences were found between extensive multidisciplinary treatment and treatment as usual. No significant differences between any of the two multidisciplinary treatment programs and the controls were found for women. Productivity gains for the society from light multidisciplinary treatment versus “treatment as usual” of 57 male patients with low back pain would during the first 2 years accumulate to U.S.

Psychological factors and somatic symptoms in functional dyspepsia. A comparison with duodenal ulcer and healthy controls.

852.000. Conclusions. The light multidisciplinary treatment model is a cost-effective treatment for men with chronic low back pain.

Psychological factors and self-reports of muscle pain.

One hundred patients with functional dyspepsia, 100 patients with duodenal ulcer and 100 healthy controls were assessed on anamnestic factors, somatic symptoms and psychological measures. Patients with functional dyspepsia had significantly higher levels of state-trait anxiety, general psychopathology, depression, a lower general level of functioning and more somatic complaints from different organ systems, especially the musculo-skeletal system, compared to patients with duodenal ulcer and healthy controls. Patients with functional dyspepsia had more frequent dyspepsia symptoms and a longer disease history than duodenal ulcer patients. Discriminant analyses using a model of fifteen psychological and anamnestic variables, classified correctly 71.5% of the subjects due to diagnoses. The test for multiple somatic complaints (Giessener Beschwerdebogen) was the most important discriminating factor (Eigenvalue 0.78). Seventy-five per cent of the patients were correctly classified, 71% by diagnosis with respect to diagnoses of duodenal ulcer and functional dyspepsia using frequency of dyspeptic symptoms as discriminating factor (Eigenvalue 0.40). Functional dyspepsia seems to be a disease entity of its own, distinct from duodenal ulcer and strongly associated with psychological factors.

Personality, Activation and Somatic Health a New Psychosomatic Theory

SummaryFactorial analyses of subjectively felt health complaints in a population of 400 males and 74 females revealed nine orthogonal (independent) factors. One factor (Factor 4) involved pain in the neck, pain in the back, pain in arms and shoulders, and migraine. This type of complaint did not relate to anxiety and depression. The prevalence of muscle pains varied between the sexes, and the types of occupations. Shiftwork was also important. 54% of the women and 40% of the men in the total population had some forms of muscle pain, but only 8% of the women and 3% of the men felt this to be a really serious problem. Psychological factors explained only moderate amounts of variance of muscle pain when the population was taken as a whole. However, within each type of occupation, psychological factors explained a considerable amount of the variance.

Health complaints and job stress in Norwegian physicians: the use of an overlapping questionnaire design

Over the last decades, brain sciences including psychoneuroendocrinology have established that the main source of variance in autonomic and endocrine activity is the central nervous system (CNS — Mason, 1971). The somatic response to external and internal CNS Stimulation is a widespread, general response, affecting most or all bodily processes. Some specificity or bias may exist, as individual response profiles, either specific to the stimulation, or to the individual. This general response will be referred to as activation. Activation may lead to somatic pathology under certain circumstances which it now seems possible to describe. This offers a new psychosomatic theory built on several disciplines within experimental and clinical psychology as well as traditional medical disciplines like physiology, endocrinology and epidemiology. Recent multifactorial evidence points to several psychoendocrine response types. Activation is still a general response, but individual variance is present in humans. This individual variance seems related to specific personality traits. Such evidence, together with knowledge of coping and defense mechanisms, suggests hypotheses which make the new psychosomatic theory more specific and perhaps more useful than previous theories.