BACKGROUND:Persistent physical symptoms are common and often result in disability and high healthcare use. To capture how such symptoms co-occur, Bodily Distress Syndrome (BDS, also called Functional Somatic Disorders) was developed as an empirically derived construct, in contrast to consensus-based syndromes such as fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). BDS is distinct from ICD-11 Bodily Distress Disorder and reflects the multisystem symptom pattern described in the Functional Somatic Disorder framework. However, its prevalence, symptom structure and prognostic relevance in pain populations have not been mapped. METHODS:This study included 3762 individuals referred to a tertiary pain clinic. At baseline, participants reported standardised measures of fatigue, insomnia, pain catastrophizing, psychological distress, perceived injustice, health-related quality of life and disability. After 12 months, they reported disability and perceived change. BDS severity was classified from predefined symptom cluster criteria. We examined prevalence, clinical correlates and prognostic utility. RESULTS:92.5% met the criteria for moderate or severe BDS. They reported more severe physical symptoms, elevated psychological distress and reduced functioning than those not meeting the criteria. Severe BDS was more common among women, those without higher education and individuals outside the workforce. After 12 months, individuals with BDS showed less improvement in functioning and reported lower perceived treatment benefit. CONCLUSION:BDS was common in this outpatient hospital cohort and may offer a clinically useful lens for capturing multisystem complexity in specialised pain services. Incorporating BDS screening into routine assessment could help identify individuals with complex symptoms and support more mechanism-oriented treatment approaches. SIGNIFICANCE STATEMENT:Bodily Distress Syndrome (BDS) is highly prevalent in tertiary pain care and linked to more severe symptoms, psychosocial burden and poorer long-term outcomes. The findings support BDS as a clinically useful framework for identifying patients with complex symptom profiles and for guiding interdisciplinary, mechanism-oriented approaches to pain management.

Chronic low back pain (CLBP) is a leading cause of work-related disability with limited benefit from biomedical treatments. Multidisciplinary approaches, including cognitive-behavioral therapy (CBT) show promise, but outcomes may depend on readiness to change. The Transtheoretical Model may help identify who benefits most, yet its relevance for return-to-work (RTW) outcomes in CLBP remains underexplored. This secondary analysis of a randomized controlled trial examined whether readiness to change, measured by the Pain Stages of Change Questionnaire (PSOCQ), was associated with back pain intensity and disability, and whether it predicted RTW 12 months after a multidisciplinary intervention for CLBP. 414 participants on long-term sick leave due to CLBP were randomized to either: brief intervention (BI), BI + CBT, BI + seal oil, or BI + soy oil. Baseline measures included PSOCQ, pain intensity, and Oswestry Disability Index. RTW was assessed via registry data at 12 months. Hierarchal regression showed that higher precontemplation scores were significantly associated with greater baseline back pain and disability, while higher maintenance scores were linked to less back pain. In the CBT group, logistic regression revealed that higher precontemplation scores significantly predicted a 63

INTRODUCTION:Unemployment is high among individuals with schizophrenia spectrum disorders (SSDs) and substance use disorders (SUDs). Vocational rehabilitation (VR) programs have demonstrated effectiveness on occupational outcomes for both groups. The aim of this study is to compare characteristics of individuals with SSD and SUD seeking VR. METHODS:This study draws on data from two independent projects: the Job Management Program (JUMP) for individuals with SSD and the IPS in SUD (IPS-SUD) study, comprising a total of 341 participants. Baseline demographic, occupational, and diagnostic characteristics are described, with group comparisons. RESULTS:The groups differed significantly in age, employment history, and benefit status. Restricting the sample to participants aged 18-49, differences in prior employment remained but were attenuated. Overall, SUD participants were older and more frequently received full disability benefits, whereas JUMP participants were younger and more often received partial disability benefits. CONCLUSIONS:These findings highlight the heterogeneity of populations targeted by VR interventions and underscore the need for tailored program adaptations. Demographic and clinical differences should guide the design, implementation, and evaluation of VR services to enhance their relevance and effectiveness.

To estimate the prevalence of long-term work disability (LTD) among head and neck cancer (HNC) survivors more than five years posttreatment, compare profiles of employed, retired, and LTD groups, and identify independent predictors of LTD versus employment. Late effects were assessed using the EORTC QLQ-C30, EORTC QLQ-H N35, Chalder Fatigue Questionnaire, and Body Image Scale in a cross-sectional sample of 251 HNC survivors (mean 8.3 years posttreatment). Employment status was categorized as employed, retired, or LTD (> 12 months sick leave). Predictors of LTD were examined among working-age survivors (n = 145) using hierarchical logistic regression. LTD prevalence was 19

Client-perpetrated violence and turnover intentions are widespread problems among child-welfare workers and are associated with both personal and organizational consequences. To elucidate their longitudinal association, the current study built on the cognitive activation theory of stress (CATS) and investigated (H1) whether client-perpetrated violence is associated with increased intention to leave, (H2) whether this forward relationship is mediated by work-related worrying and (H3) whether intention to leave is associated with subsequent reports of client-perpetrated violence. Utilizing a sample of 438 Norwegian public sector child welfare workers, a three-wave cross-lagged panel model was specified. Supporting H1 and H3, the cross-lagged panel model indicated a significant bidirectional relationship. The proposed indirect effect through work-related worrying (H2) was not supported. In conclusion, the current study provides support for client-perpetrated violence to predict increased intentions to leave among child welfare workers. The presence of a reverse causal effect highlights that conducting longitudinal studies alone offers little evidence of causality unless reverse causation is also explicitly tested. Although the study did not find work-related worrying to mediate the relationship between client-perpetrated violence and intentions to leave, it does support the idea of utilizing CATS as a theoretical framework also within organizational research.

PURPOSE:Patients with acquired brain injuries (ABI) and severe traumatic injuries face many persisting and overlapping injury-related consequences. Despite a growing number of self-management (SM) interventions targeting these conditions, no comprehensive reviews exist. This scoping review aims to map the existing SM interventions across these injury populations. MATERIALS AND METHODS:Five databases (MEDLINE, EMBASE, PsycINFO, CINAHL, PubMed) were systematically searched. Studies were included if they adhered to the operational definition by Jonkman et al. and targeted adults with ABI and traumatic injuries. RESULTS:A total of 43 studies were included. Most interventions targeted stroke and spinal cord injuries. The key ingredients were psychoeducation, goal setting, and training in self-management skills. Most interventions were conducted in hospitals by healthcare personnel in the chronic post-injury phase. A considerable variation of reported effects was observed. Additionally, Bandura's social cognitive theory was frequently applied as a theoretical background. CONCLUSIONS:A significant lack of SM interventions for multiple/major trauma and burns was identified. Many studies were poorly described and did not indicate how the interventions were tailored to the patients, and the effects were inconsistent. However, the findings suggest that SM ingredients are applicable to both ABI and traumatic injury populations in clinical settings.

ABSTRACTBackgroundWomen undergoing breast cancer surgery frequently experience postsurgical pain and fatigue, which reduces their quality of life. Although psychological factors have been shown to play a role in predicting postsurgical outcomes, the subacute recovery phase often remains underexplored. In this secondary analysis of data from a randomised controlled trial, we sought to investigate the predictive role of negative affect and experiential avoidance on postsurgical symptoms during both acute and subacute recovery.MethodsFrom the initial sample, 189 women who met the inclusion criteria completed the Acceptance and Action Questionnaire (AAQ‐II) before surgery to assess levels of negative affect and experiential avoidance. Postsurgical pain and fatigue were measured at hospital discharge and again 3–4 weeks later using a 100 mm Visual Analogue Scale (VAS).ResultsBivariate linear regression analyses revealed that higher presurgical negative affect and experiential avoidance significantly predicted increased levels of all acute and subacute postsurgical symptoms (all p ≤ 0.027). After adjusting for covariates in multivariate regression analyses, the AAQ‐II remained a predictor of acute pain unpleasantness (p = 0.011) and fatigue (p = 0.048), although the effect estimates were modest.ConclusionsThese findings underscore the need to take psychological factors into account in treatment planning for acute postsurgical symptoms in order to develop more individualised approaches to optimise recovery for women undergoing breast cancer surgery.SignificanceWomen with higher levels of negative affect and experiential avoidance before undergoing breast cancer surgery appear to be at greater risk for experiencing heightened acute postsurgical pain and fatigue. The identification of these psychological predictors can help clinicians recognise individuals at risk for severe postoperative symptoms and develop targeted preventive and curative interventions to mitigate these symptoms and prevent them from becoming chronic.

BACKGROUND AND AIM:Unemployment rates among individuals with substance use disorders (SUD) are high, and evidence-based vocational methods are lacking. Employment is important because it improves treatment outcomes and protects against relapse. Individual Placement and Support (IPS) has proven effective in helping patients with psychosis obtain competitive employment. We aimed to investigate the effectiveness of IPS on vocational outcomes for patients with SUD. DESIGN:Randomized controlled trial. SETTING:SUD treatment units at Oslo University Hospital, Norway. PARTICIPANTS:Patients with SUD who wanted to obtain competitive employment. A total of 202 SUD patients were included in the trial, of which eight withdrew consent, five died and two were erroneously included, giving a modified intention to treat analysis set of 187 participants, of which 91 were randomized to IPS and 96 to the enhanced control group condition. INTERVENTION AND COMPARATOR:Treatment as usual plus IPS for up to 13 months versus treatment as usual, a self-help guidebook, a workshop of three two-hour sessions and one session of individual counselling. MEASUREMENTS:Employment data were obtained from Statistics Norway and linked with study data. Primary outcome was at least one day of competitive employment during an 18-month period after inclusion in the trial. Secondary employment-related outcomes described job tenure, number of different jobs, hours worked and employment earnings during the same period. FINDINGS:There was no difference between the groups in the main outcome [39.6% vs. 34.4%; odds ratio (OR) = 1.28, 95% confidence interval (CI) = 0.70-2.35], but participants in the IPS group worked more hours (601 vs. 344; b = 330, 95% CI = 25-635) and had higher total salary in Norwegian krone (141 000 vs 73 000; b = 94 000, 95% CI = 17000-170 000) than control group participants. Control group participants were more likely to receive services from the Social and Welfare Services (53.1% vs. 27.5%; OR = 2.99, 95% CI = 1.64-5.57). CONCLUSION:In this randomized controlled trial of Individual Placement and Support (IPS) versus enhanced self-help for individuals with substance use disorders in Norway, there was no difference between groups regarding job acquisition, defined as at least one day of competitive employment during an 18-month period; however, IPS participants worked more hours and earned a higher total salary than control group participants.

Introduction:Provoked vestibulodynia (PVD) is a prevalent persistent pain disorder, localized to the vulva, not only affecting the sexual health of women suffering from it but also of their partners. Partner's behavioral response to the pain has implications for the affected woman's pain and sexual function, as well as the relational dynamics of the couple. Objectives:The main aim of this study was to explore facilitative, solicitous, and negative male partner responses to women with PVD and their links to demographic and psychosexual characteristics. Further, we investigated the discrepancies in psychosexual health between currently sexually active and inactive participants, as well as levels of anxiety and depressive symptoms within our sample of male partners (N = 127). Methods: Cross-sectional associations were examined using bivariate correlations. Differences in psychosexual health between the two sub-samples were examined using Mann-Whitney U test. Results:Our results showed that facilitative partner responses were significantly associated with higher relationship and sexual satisfaction, as well as with lower sexual distress and more approach goals. Negative partner responses were significantly associated with higher sexual distress, as well as with lower relationship and sexual satisfaction. Negative partner responses were the only responses significantly associated with the men's anxiety and depression, which suggests that mental health plays a role in partners' management of vulvodynia. In our sample, 10.2% scored above cut-off for clinical levels of depressive symptoms and 8.7% for anxiety, similar to a Swedish community sample. Conclusion: Partner responses were associated with psychosexual health. In our sample, male partners of women with PVD did not have more anxiety or depression than other men of the same age in the general population.

Pain, a widespread challenge affecting daily life, is closely linked with psychological and social factors. While pain clearly influences daily function in those affected, the complete extent of its impact is not fully understood. Given the close connection between pain and psychosocial factors, a deeper exploration of these aspects is needed. In this study, we aim to examine the associations between psychosocial factors, pain intensity, and pain-related disability among patients with chronic pain. We used data on 4285 patients from the Oslo University Hospital Pain Registry, and investigated pain-related disability, pain intensity, pain catastrophizing, psychological distress, perceived injustice, insomnia, fatigue, and self-efficacy. We found significant associations between all psychosocial variables and pain-related disability, even after adjusting for demographic factors. In the multiple regression model, sleep problems and pain intensity were identified as primary contributors, alongside psychological distress, and fatigue. Combined, these factors accounted for 26.5% of the variability in pain-related disability, with insomnia and pain intensity exhibiting the strongest associations. While the direction of causation remains unclear, our findings emphasize the potential of interventions aimed at targeting psychosocial factors. Considering the strong link between psychosocial factors and pain-related disability, interventions targeting these factors-particularly insomnia-could reduce disability and enhance quality of life in those who suffer.

Objectives Establishment of effective evidence-based interventions in rehabilitation of working memory (WM) deficits after acquired brain injury (ABI) is sorely needed. Despite robust evidence for the efficiency of clinical hypnosis in a wide range of clinical conditions, and improved understanding of mechanisms underlying its effects, the potential of clinical hypnosis in cognitive rehabilitation is underexplored. A recent study has shown large effects of hypnotic suggestion on WM capacity following ABI. This randomized controlled trial aims to evaluate and explore the replicability of these findings and examine the generalization of treatment effects. The study will also explore possible mechanisms of change. Methods Ninety patients will be recruited from the Sunnaas Rehabilitation Hospital. Inclusion criteria are nonprogressive ABI, minimum 12-month post-injury, ongoing WM deficits, and age between 18 and 67 years. Patients will be randomized to either (a) an intervention group receiving four weekly 1-h sessions with induction and hypnosis, (b) an active control group receiving four weekly 1-h sessions of induction and mindfulness, or (c) a passive control group without intervention. The targeted procedure consists of suggestions about enhancing WM functions, for example through the instantiation of preinjury WM capacity in the present using age regression or through visualizations of brain plasticity. The non-targeted suggestions contain no explicit mention of ABI- or WM-related abilities. Each participant will be assessed at baseline, immediately after intervention, and 6 months after baseline. The primary outcome is the WM index from WAIS-IV and self- and informant-reported WM subscale from BRIEF-A, a questionnaire exploring executive functioning in everyday life. Secondary outcomes include a cognitive composite score derived from tests measuring processing speed, executive functions, learning capacity and memory, and self-reported measures of emotional distress, quality of life, and community integration. Exploratory measures include self-rated ABI and WM-related self-efficacy. Discussion Rehabilitation of impaired WM after ABI has hitherto yielded limited transfer effects beyond the training material, i.e., improvement effects on everyday WM capacity, and clinical trials of new interventions are thus warranted. Long-standing empirical evidence demonstrates that hypnosis is an effective therapeutic technique in a wide range of conditions, and recent exploratory research has suggested a high efficacy of hypnosis in improving WM capacity in patients with ABI. However, these extraordinary findings need replication in studies applying scientifically rigorous designs. If successful, our ambition is to provide recommendations and materials to implement hypnotic suggestion as an adjunct treatment following ABI. Study findings may inform future studies exploring the use of clinical hypnosis in other areas of rehabilitation, such as mild TBI, and in other neurological conditions where WM deficit is prominent. Trial registration ClinicalTrials.gov NCT05287542. Registered on March 2022 Protocol version Protocol version 2.0, December 2023.

Bullying, physical violence, sexual abuse, loss of loved ones, accidents, disasters or other potentially traumatic events or situations in childhood are associated with a range of health problems and related functional impairment. New research findings suggest that such childhood trauma can lead to young people developing chronic pain with frequent use of painkillers already in childhood and adolescence. The high risk of adverse trajectories may indicate that young people who develop pain after childhood trauma lack access to early effective interventions. Trauma-exposed children and young people with long-term pain and other accompanying post-traumatic reactions may benefit little from established pain management. Knowledge of risk, resiliency and key pain mechanisms following childhood trauma can strengthen clinical management. This review article explores theoretical and empirical perspectives on how childhood trauma and related biological, psychological and social factors and reactions can contribute to the development of chronic pain and the use of painkillers among children and adolescents. Keywords: Childhood trauma, posttraumatic stress, chronic pain, PTSD, analgesics

BackgroundOpioid exposure after surgery increases risk of persistent opioid use. Here, we characterize at-home use of opioid rescue medication during 1–2 days after outpatient surgery (N=270) in a postoperative opioid-sparing context at a Norwegian hospital.MethodsThe postsurgical pain management plan included non-steroidal anti-inflammatory drugs and up to six pills of 5 mg oxycodone as rescue analgesics. In this observational study we assessed risk factors for taking rescue opioids after surgery, by comparing patients who did, with those who did not.ResultsOnly 35% (N=228) of patients reported taking rescue opioids 1–2 days after discharge. Patients taking rescue opioids after surgery (opioid-takers) differed from non-takers by prevalence of preoperative chronic pain (>3 months; 74% vs 48%), higher pain severity and interference before and after surgery, reporting lower ability to cope with postsurgical pain, higher nervousness about the surgery, being younger, and having received more opioid analgesics in the recovery room. Exploratory predictive modeling identified opioid administration in the recovery room as the most important predictor of at-home rescue medication use. Follow-up after >4 months indicated low acute pain levels (mean±SD = 1.1±1.8), with only four patients (2%, N=217) reporting opioid analgesic use.ConclusionFactors related to at-home rescue medication use closely mirrored known risk factors for persistent opioid use after surgery, such as prior chronic pain, prior substance use, affective disturbances, and pain severity before surgery. These findings are potential targets in patient-centered care. Nevertheless, and reassuringly, findings are consistent with the idea that opioid-sparing postsurgical care can prevent large-scale chronic opioid use.

Mental health care that is open to patients’ existential needs requires well-trained professionals who work in teams and use an open conceptualization of spirituality, religion and other meaning-making domains. Using a mixed methods approach, this article explores how professionals (n = 262) in secular Norway perceive obstacles and opportunities in existential care. The results show correlations between age group, personal religiosity, terminology and perceived expertise. Commitment is high, but collaboration with chaplains and team training are neglected.