Gymnastik- och idrottshögskolan, GIH

Long-term effects of lumbar disc herniation treatment on brain function are poorly understood, and it is unclear when surgery should be recommended over non-operative treatment. The overall aim of the present study was to determine potential long-term effects on brain networks among individuals who received either surgical or non-operative treatment for lumbar disc herniation in adolescence. Brain network connectivity was assessed for individuals who received surgical treatment or non-operative treatment, and controls with no history of lumbar disc herniation. Prior to analysis, brain connectivity measures between groups were determined as main outcome, using functional magnetic resonance imaging. On average 12 years after treatment onset, the surgically treated cohort exhibited distinctly different functional brain connectivity, compared with both non-operative treatment and controls. The difference was neither attributed to self-reported pain, nor lumbar spine morphology. The findings suggest that surgical treatment for lumbar disc herniation in adolescence may be associated with a long-term imprint on the functional brain connectome.

Background. Online treatments are increasing in number and are currently available for a wide range of clinical problems. To date little is known about the role of treatment expectations and other placebo-like mechanisms in online settings compared to traditional face-to-face treatment. To address this knowledge gap, we analyzed individual participant data from randomized clinical trials that compared online and face-to-face psychological interventions.Methods. MEDLINE (Ovid) and PsycINFO (Ovid) were last searched on 2 February 2021. Randomized clinical trials of therapist guided online v. face-to-face psychological interventions for psychiatric or somatic conditions using a randomized controlled design were included. Titles, abstracts, and full texts of studies were independently screened by multiple observers. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Authors of the matching trials were contacted for individual participant data. Ratings from the Credibility and Expectancy Questionnaire and the primary outcome measure from each trial were used to estimate the association between expectation ratings and treatment outcomes in online v. face-to-face interventions, using a mixed-effects model.Results. Of 7045 screened studies, 62 full-text articles were retrieved whereof six studies fulfilled the criteria and provided individual participant data (n = 491). Overall, CEQ ratings predicted clinical outcomes (beta = 0.27) at end of treatment with no moderating effect of treatment modality (online v. face-to-face).Conclusions. Online treatment appears to be equally susceptible to expectancy effects as face-to-face therapy. This furthers our understanding of the importance of placebo-like factors in online treatment and may aid the improvement of healthcare in online settings.

Introduction: In many pain conditions, there is lingering pain despite healed tissue damage. Our previous study shows that individuals who underwent surgery for lumbar disk herniation (LDH) during adolescence have worse health, more pain, and increased disk degeneration mean 13 years after surgery compared with controls. It is unclear if walking patterns segregate surgically treated LDH adolescents and controls at mean 13-year follow-up. Objectives: Here, we analyzed the relationship between gait, back morphology and other health outcomes in a cohort of individuals treated surgically because of lumbar disk herniation compared with controls. Methods: We analyzed gait during a walking paradigm, back morphology at the site of surgery, and standardized health outcomes, among individuals who received surgery for LDH as adolescents, "cases" (n = 23), compared with "controls" (n = 23). Results: There were gait differences in head (P = 0.021) and trunk angle (P = 0.021) between cases and controls in a direction where cases exhibited a posture associated with sickness. The gait variance was explained by subjective pain and exercise habits rather than objective disk degeneration. Conclusion: Over a decade after surgery for LDH during adolescence, health among cases is worse compared with controls. The head and trunk angles differ between cases and controls, indicating that the residual pain lingers and may cause changes in movement patterns long after a painful episode in early life. Gait may be a useful target for understanding maintenance of pain and disability among individuals treated surgically for LDH during adolescence.

The 'Oslo Chronic Fatigue Consortium' consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brain's response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation.Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them.

Background: Chronic sickness behavior is implicated in ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome) and chronic pain but the level of subjective sickness behavior in these conditions has not been investigated or compared to other clinical and non-clinical samples, or to the level in experimental inflammation. Furthermore, the relationship between sickness behavior and self-rated health and functioning is not known in patients with ME/CFS and chronic pain. The aim of the present study was to investigate how sickness behavior in patients with chronic conditions differs from that in individuals with experimental acute sickness, primary care patients, the general population and healthy subjects. In addition, we wanted to explore how sickness behavior is related to self-rated health and health-related functioning.Methods: Sickness behavior was quantified using the sickness questionnaire (SicknessQ). Self-ratings were collected at one time-point in 6 different samples. Levels of sickness behavior in patients with ME/CFS (n = 38) and patients with chronic pain (n = 190) were compared to healthy subjects with lipopolysaccharide(LPS)induced inflammation (n = 29), primary care patients (n = 163), individuals from the general population (n = 155) and healthy subjects (n = 48), using linear regression. Correlations and moderated regression analyses were used to investigate associations between sickness behavior and self-rated health and health-related functioning in ME/CFS, chronic pain and the general population.Results: LPS-injected individuals (M = 16.3), patients with ME/CFS (M = 16.1), chronic pain (M = 16.1) and primary care patients (M = 10.7) reported significantly higher SicknessQ scores than individuals from the general population (M = 5.4) and healthy subjects (M = 3.6) all p's < 0.001). In turn, LPS-injected individuals, patients with ME/CFS and chronic pain reported significantly higher SicknessQ scores than primary care patients (p's < 0.01). Higher levels of sickness behavior were associated with poorer self-rated health and health-related functioning (p's < 0.01), but less so in patients with ME/CFS and chronic pain than in individuals from the general population.Conclusions: Patients with ME/CFS and chronic pain report similar high levels of sickness behavior; higher than primary care patients, and comparable to levels in experimental inflammation. Further study of sickness behavior in ME/CFS and chronic pain populations is warranted as immune-to-brain interactions and sickness behavior may be of importance for functioning as well as in core pathophysiological processes in subsets of patients.

Background: Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) often present with a range of flu-like symptoms resembling sickness behavior as well as widespread pain and concentration deficits. The aim of this study was to explore the association between inflammatory markers previously shown to be related to fatigue severity in ME/CFS and common ME/CFS symptoms post-exertional fatigue, impaired cognitive processing, musculoskeletal pain and recurrent flu-like symptoms, and the moderating effect of sex on these associations. Methods: 53 adult patients diagnosed with ME/CFS at a specialist clinic were included in the study. Fasting blood plasma was analyzed using the Olink Proseek Multiplex Inflammation panel (beta-NGF, CCL11, CXCL1, CXCL10, IL-6, IL-7, IL-8, IL-10, IL-18, TGF-alpha, TGF-beta-1 and SCF) and BioRad Human Cytokine Type 1 assay (TNF-alpha). Participants rated the average severity of symptoms (0-10) based on the 2011 International Consensus Criteria of ME/CFS during a structured clinical interview. Associations between inflammatory markers and symptom severity were analyzed using bivariate correlations and moderated regression analyses bootstrapped with 5000 repetitions. Results and conclusions: Only beta-NGF was associated with the fatigue severity measure. However, higher levels of CCL11, CXCL10, IL-7, TNF-alpha and TGF-beta-1 were significantly associated with higher levels of impaired cognitive processing and musculoskeletal pain, and sex was a significant moderator for CXCL10, IL-7 and TGF-beta-1. Future studies should investigate the relationship between inflammatory markers and key symptoms in ME/CFS in a longitudinal design in order to explore if and for whom low-grade inflammation may contribute to illness development.

Background: Acceptance and Commitment Therapy has not been evaluated for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) to date. However, recent studies indicate the importance of psychological flexibility for well-being in this condition. The present study is a preliminary evaluation of the feasibility of an ACT-based behavior medicine treatment protocol for ME/CFS. Methods: 40 adult individuals, fulfilling the 1994 Centers for Disease Control and Prevention and the 2003 clinical case criteria for ME/CFS, consecutively started an individual 13-session ACT-treatment. Data were collected pre-treatment, mid-treatment, post-treatment, and at 3- and 6-month follow-ups. Linear mixed effects modeling was used to analyze treatment effects on ME/CFS-related disability, psychological flexibility, ME/CFS symptoms, anxiety, depression and health-related quality of life. Results: 80% (32) of the participants completed the treatment. ME/CFS-related disability (d = 0.80, p < .001) and psychological flexibility (d = 1.07, p < .001) improved between pre- and post-treatment and remained stable between follow-ups. Similar results were found for secondary outcomes. Conclusions: Results indicate that the treatment was accepted by the participants, with a small drop-out rate and was safe with no harmful effects during or after treatment and also efficient with stable improvements in numerous outcomes.

Background: It is still not clear whether the diagnosis Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) constitutes one single disease entity, as diagnosis depends on clinical case definitions. The variation of symptoms across individuals indicates important differences between individuals diagnosed with ME/CFS. Also, the variation in daily functioning and quality of life measures among subgroups of symptoms is still unclear. Purpose: The present study examines the associations between symptoms in ME/CFS, and evaluates the relationships between symptom subgroups, functioning and quality of life. Methods: Data were collected from 106 adults as part of the assessment at a tertiary specialist clinic for ME/CFS. Principal component analyses (PCA) were utilized to identify symptom subgroups, and the relationships with functioning and quality of life were evaluated using bivariate correlations. Results: The PCA suggested four statistically distinct and clinically meaningful subgroups of symptoms. The latent constructs were labeled Inflammatory, Pain, Neurocognitive, and Autonomic. All symptom subgroups correlated significantly with measures of fatigue, mood, functioning and quality of life. Notably, the correlations between symptom subgroups and criteria variables (e.g. mood) varied in strength, indicating a difference in the relative importance of symptom subgroups. Conclusions: Although tentative, the results from this study support previous research and suggest that there are important symptom subgroups among individuals with ME/CFS. Furthermore, these results indicate that symptom profiles may be of importance to understand the variation between individuals in the impact of symptoms on functioning. Thus, more research is warranted to validate these findings and investigate possible differences in etiology between patient subgroups.