Chronic Benign Pain Research Articles

Internet-based cognitive behavioural therapy for insomnia comorbid with chronic benign pain – A randomized controlled trial

BackgroundComorbid sleep disturbances are common among individuals with chronic pain, and Cognitive Behavioural Therapy for Insomnia (CBT-i) has proven effective for such individuals. Nonetheless, research on web-based CBT-i tailored for patients with both chronic pain and insomnia is limited. This study aimed to evaluate the feasibility and efficacy of internet-based CBT-i and to explore potential mechanisms underlying treatment outcomes. MethodsIn this study, 85 participants suffering from comorbid insomnia and chronic pain were randomized into two groups: Internet-based CBT for Insomnia (ICBT-i) and Internet-based Applied Relaxation (IAR). Both interventions spanned eight weeks, supported by therapeutic guidance throughout. ResultsParticipation was modest, with an average module completion of 2.0 out of 8 for ICBT-i and 2.4 for IAR. Both interventions significantly alleviated insomnia symptoms on one of the insomnia measures post-treatment, without notable differences between them. Directly after treatment, IAR outperformed ICBT-i in reducing pain interference, anxiety, and in enhancing self-rated health, though these differences lessened at the 6-month follow-up. Potential therapeutic mechanisms may involve attenuating maladaptive sleep beliefs and augmenting sleep-related willingness. ConclusionsThe study encountered low engagement rates, with approximately one-third of participants not completing any module. The limited efficacy of ICBT-i may be due to low treatment involvement, with few patients completing key techniques like sleep compression and stimulus control. Despite the low adherence, both interventions yielded post-treatment improvements in insomnia symptoms, but to establish internet-based treatments for insomnia as a viable option in chronic pain management, patient engagement must be improved.

Patient Satisfaction Following Intrathecal Targeted Drug Delivery for Benign Chronic Pain: Results of a Single-Center Survey Study

ObjectivesTargeted Drug Delivery (TDD) is commonly used for the management of patients with intractable pain. Past studies have proven efficacy in pain relief and reduction in opioid use and cost‐effectiveness in long‐term pain management. There are few studies investigating satisfaction among patients with implanted pain pumps that are managed with targeted intrathecal medications.Material and MethodsPatients in a single medical practice implanted with pain pumps for relief of intractable pain were identified and extracted from the electronic health record (EHR). Six hundred and ten active TDD patients were identified and an anonymous 18‐question survey was administered to determine satisfaction with TDD therapy. During an 18‐month period from May 2018 to August 2019, patients were invited to take a satisfaction survey. Both primary and secondary outcomes were reported as proportions; P < 0.05 was considered significant.ResultsFour hundred and forty‐three patients (74% of the active pump population) completed the survey. The majority of patients reported improvement in pain, improvement of physical function, improvement in quality of life and reduction in opioid use. Complete discontinuation of oral opioid intake was reported in 38.9% of patients. The majority of patients had a 40 cc reservoir implanted in an upper buttock pocket site and overall, 91% of patients were happy with pump pocket location.ConclusionIntrathecal TDD therapy can relieve pain and improve quality of life in patients with intractable pain and offers a reasonable alternative to long‐term oral or skin patch opioid management. Patients utilizing TDD therapy reported high degrees of satisfaction.

Cognitive, emotional, and behavioral profile in children and adolescents with chronic pain associated with rheumatic diseases: A case-control study.

Background:The prevalence of chronic pain is about 30% in children and adolescents which suffer from severe emotional distress. The aim of this observational study is to investigate cognitive, emotional and behavioral consequences of benign chronic pain in children and adolescents suffering of reumathologic diseases.Materials and Methods:A total of 49 participants, chronic pain participants (CPPs) and controls (CGPs), affected by rheumatic diseases, were enrolled. Assessment included collection of sociodemographic data, pain characteristics, and administration of Visual Analog Scale (VAS), Depression Inventory for Children and Adolescents (CDI), Conners’ Parent Rating Scales–Revised (CPRS-R), Child Behavior Checklist (CBCL), and Screen for Child Anxiety–Related Disorders (SCARED). For the statistical analysis, Student’s t-test for independent samples and Pearson’s correlation were used. The significance value was set at p less than .05.Results:A significant difference of mean scores of CBCL items and of CPRS items between the two groups was found. In CPPs, a significant correlation between VAS and mean scores of several CBCL items and between VAS and mean scores of several CPRS items was found.Conclusion:Chronic pain is a real syndrome in which an interdisciplinary treatment should be applied, considering the psychopathological risk, especially in developmental age.

Development of new extra-glandular manifestations or associated auto-immune diseases after establishing the diagnosis of primary Sjögren's syndrome : A long-term study of the Antonius Nieuwegein Sjögren (ANS) cohort.

To investigate in a long-term study, the development of new extra-glandular manifestations (EGM) or associated auto-immune diseases (AID) from 1 year after establishing the diagnosis of primary Sjögren's syndrome (pSS). The primary goal was to examine the frequency and type of these manifestations and to find out which demographic, clinical and serological profile was most at risk. All outpatients diagnosed with primary Sjögren's syndrome were included in a retrospective study, with at least one check-up per year, from June 1991 until August 2015. Patients also fulfilling the criteria for concomitant connective tissue disorders were excluded. Data were collected with respect to the cumulative prevalence of a new EGM or associated AID. 140 patients were included in the final analysis. After 10 years of follow-up, the cumulative incidence of a new EGM or associated AID was 30.7%. The most frequent events were polyneuropathy, interstitial lung disease, (poly)arthritis, discoid lupus erythematosus (LE)/subacute cutaneous LE and Hashimoto's disease. Non-Hodgkin lymphoma was not diagnosed during the follow-up. Patients without chronic benign pain syndrome (CBP) (HR 2.13; 95% CI [0.94-4.76]; p=0.061), but in particular those with cryoglobulins (HR 2.87; 95% CI [1.20-6.86]; p=0.013), developed more events. Age at diagnosis, gender, the presence of ANA, anti-Ro/SSA, anti-La/SSB, IgM-RF, decreased levels of C3 or C4, or hypergammaglobulinaemia did not show any statistically significant differences. The burden of disease in pSS is higher than expected due to the development of EGM or associated AID. Therefore, we recommend long-term follow-up of all pSS patients, particularly those with cryoglobulinaemia.

P266 Efficacy of transcranial Direct Current Stimulation (tDCS) in somatic symptom disorder, predominantly pain: A randomized, double-blind, sham-controlled study

Introduction Chronic benign pain is a symptom which contributes significantly to morbidity and causes considerable distress affecting various domains in a patient’s life. There is a growing need to address this issue for a safer and a better therapeutic intervention. tDCS is a non-invasive tool that has been found to have therapeutic efficacy in pain syndromes. Objectives To study the changes in pain severity, somatoform symptoms severity and global illness severity with adjuvant tDCS in Somatic Symptoms Disorder as compared to sham stimulation. Materials and methods We investigated in a prospective hospital-based, randomized, double-blind, sham-controlled trial the analgesic effects of a 5 day treatment of anodal (tDCS) with 2 mA current for 40 min duration over the primary motor cortex in Somatic Symptom Disorder, predominantly pain. 26 subjects were assessed on Visual Analogue Scale (VAS) for pain at baseline, at end of 5th day and end of 30 days; somatoform symptom severity and global illness severity were also measured using Quantification inventory for somatoform syndromes (QUISS) scale and Clinical Global Impressions (CGI) at baseline and on follow up of 30 days. Patients were also assessed on WHOQoL-BREF at baseline and on follow up of 30 days for quality of life. Results VAS Scores showed significant change as compared to sham group (Pillai’s Trace F = 74.32, p Conclusion Our findings give preliminary evidence that tDCS of the primary motor cortex is safe and effective for somatoform pain symptoms. These effects may be related to electrical currents induced in pain-related cortical and subcortical regions.

Repeated Quantitative Urine Toxicology Analysis May Improve Chronic Pain Patient Compliance with Opioid Therapy

Background: Even though serious efforts have been undertaken by different medical societies to reduce opioid use for treating chronic benign pain, many Americans continue to seek pain relief through opioid consumption. Assuring compliance of these patients may be a difficult aspect of proper management even with regular behavioral monitoring. Objective: The purpose of this study was to accurately assess the compliance of chronic opioidconsuming patients in an outpatient setting and evaluate if utilizing repeated urine drug testing (UDT) could improve compliance. Study Design: Retrospective analysis of prospectively collected data. Setting: Outpatient pain management clinic. Methods: After Institutional Review Board (IRB) approval, a retrospective analysis of data for 500 patients was conducted. We included patients who were aged 18 years and older who were treated with opioid analgesic medication for chronic pain. Patients were asked to provide supervised urine toxicology specimens during their regular clinic visits, and were asked to do so without prior notification. The specimens were sent to an external laboratory for quantitative testing using liquid chromatography-tandem mass spectrometry. Results: Three hundred and eighty-six (77.2%) patients were compliant with prescribed medications and did not use any illicit drugs or undeclared medications. Forty-one (8.2%) patients tested positive for opioid medication(s) that were not prescribed in our clinic; 8 (1.6%) of the patients were positive for medication that was not prescribed by any physician and was not present in the Illinois Prescription Monitoring Program; 5 (1%) patients tested negative for prescribed opioids; and 60 (12%) patients were positive for illicit drugs (8.6% marijuana, 3.2% cocaine, 0.2% heroin). Repeated UDTs following education and disclosure, showed 49 of the 77 patients (63.6%) had improved compliance. Limitations: This was a single-site study and we normalized concentrations of opioids in urine with creatinine levels while specific gravity normalization was not used. Conclusions: Our results showed that repeated UDT can improve compliance of patients on opioid medications and can improve overall pain management. We believe UDT testing should be used as an important adjunctive tool to help guide clinical decision-making regarding opioid therapy, potentially increasing future quality of care. Key words: Urine toxicology analysis, chronic pain, opioids, compliance, pain management, urine drug testing, urine drug screening

Everything is valid in chronic pain: Interventions by older adults for pain relief

ObjectiveTo describe interventions used by older adults with benign chronic pain. MethodsQualitative study with 25 older adults with benign chronic pain, inhabitants of the cities of Medellín and Bogotá. The technique used to collect information was in-depth interview. The analysis was made using the tools of the theory based on the guidelines of Strauss and Corbin. Using open, axial and selective coding, the constant comparison method allowed the identification of categories and subcategories and simultaneously memos and diagrams were made to reach theoretical saturation. ResultsA number of categories were found in this study, suggesting interventions used by the elderly to address chronic pain. They started looking at a number of options such as: taking medication, self-prescribing, feeling fear of taking pills, identifying the damage caused by drugs, using hot water, staying still, taking right postures, walking and exercising, using attachments that help them and making home remedies; all of them become alternatives that can cause pain relief. ConclusionsThe study allowed describing interventions that older adults use to mitigate their pain. This ranged from pharmacological to non-pharmacological interventions, as simple as posture, cold, heat, massage or distractions among others, which play an important role in pain relief. Knowing these interventions helps healthcare professionals consider care options different to medication intake, proposing strategies that are easily accessible and can operate at the time to address a patient with chronic pain.

Everything is valid in chronic pain: Interventions by older adults for pain relief

To describe interventions used by older adults with benign chronic pain. Qualitative study with 25 older adults with benign chronic pain, inhabitants of the cities of Medellín and Bogotá. The technique used to collect information was in-depth interview. The analysis was made using the tools of the theory based on the guidelines of Strauss and Corbin. Using open, axial and selective coding, the constant comparison method allowed the identification of categories and subcategories and simultaneously memos and diagrams were made to reach theoretical saturation. A number of categories were found in this study, suggesting interventions used by the elderly to address chronic pain. They started looking at a number of options such as: taking medication, self-prescribing, feeling fear of taking pills, identifying the damage caused by drugs, using hot water, staying still, taking right postures, walking and exercising, using attachments that help them and making home remedies; all of them become alternatives that can cause pain relief. The study allowed describing interventions that older adults use to mitigate their pain. This ranged from pharmacological to non-pharmacological interventions, as simple as posture, cold, heat, massage or distractions among others, which play an important role in pain relief. Knowing these interventions helps healthcare professionals consider care options different to medication intake, proposing strategies that are easily accessible and can operate at the time to address a patient with chronic pain.

Patient expectations for a multimodal pain rehabilitation programme: active participation and coping skills. A qualitative study

Purpose: To describe what patients with chronic pain expect from a multimodal pain rehabilitation programme.Material and method: Qualitative interviews were used to uncover expectations about a multimodal rehabilitation programme offered at the Pain and Rehabilitations Centre, The University Hospital; Linköping, Sweden. Sixteen women and two men (mean age 37 years; standard deviation 10 years) with chronic benign pain participated. The interviews were analysed using qualitative content analyses.Results: To participate actively in the multimodal pain rehabilitation programme and to learn adequate coping strategies to improve daily life emerged as a main category. It was based on the following four categories comprising expectations about: participating actively in the programme, interacting with the professionals and fellow patients, cognitive effects of the programme and tools for coping, and explicit effects from the programme.Conclusions: Many patients expressed expectations which may reflect that the information before the programme had started rehabilitation process at the time point for this study. The results could be applied in rehabilitation programmes by acknowledging expectations to interact with professional team members and fellow patients, by early addressing of positive and negative expectations about the future pain and by incorporating and strengthen expectations of learning to cope with pain.Implications for RehabilitationPatients' expectations to interact with professional team members and fellow patients by participating actively in the pain rehabilitation programme should be acknowledged in each rehabilitation situation.Patients expressed both positive and negative expectations about their future pain situation and these expectations should be addressed as early as possible in the rehabilitation screening process.Patients' expectations of learning to cope with pain should be incorporated and strengthened in multimodal pain rehabilitation programmes.

Adaptation to chronic benign pain in elderly adults.

This study sought to comprehend and analyze the experience of living with chronic benign pain during aging from the perspective of the adaptation model by Callista Roy. Ours was an exploratory descriptive study using for analysis tools from the theory based on criteria by Strauss and Corbin. The strategy involved in-depth interviews of 10 elderly adults residing in Medellín, Antioquia, and Chía, Cundinamarca (Colombia) with chronic benign pain. In elderly adults, behaviors were identified that were secondary to the presence of pain and which are consequence of the capacity to adapt to their experience, managing to modify the environment by using internal and external resources that permitted their controlling the pain-generating stimuli in the human beings adaptation means based on the Adaptation model by Callista Roy. Elderly adults respond effectively to their new secondary condition: presence of benign pain in all the means of adaptation.

Adaptation to chronic benign pain in elderly adults.

Adaptation to chronic benign pain in elderly adults.

Aggression, impulsivity, and suicide risk in benign chronic pain patients - a cross-sectional study.

ObjectivesThe objective of this study was to investigate the role that psychopathological dimensions as overt aggression and impulsivity play in determining suicide risk in benign chronic pain patients (CPPs). Furthermore we investigated the possible protective/risk factors which promote these negative feelings, analyzing the relationship between CPPs and their caregivers.MethodsWe enrolled a total of 208 patients, divided into CPPs and controls affected by internistic diseases. Assessment included collection of sociodemographic and health care data, pain characteristics, administration of visual analog scale (VAS), Modified Overt Aggression Scale (MOAS), Barratt Impulsiveness Scale Version 11 (BIS), Hamilton Depression Rating Scale (HDRS), and a caregiver self-administered questionnaire. All variables were statistically analyzed.ResultsA significant difference of VAS, MOAS-total/verbal/auto-aggression, HDRS-total/suicide mean scores between the groups were found. BIS mean score was higher in CPPs misusing analgesics. In CPPs a correlation between MOAS-total/verbal/auto-aggression with BIS mean score, MOAS with HDRS-suicide mean score and BIS with HDRS-suicide mean scores were found. The MOAS and BIS mean scores were significantly higher when caregivers were not supportive.ConclusionIn CPPs, aggression and impulsivity could increase the risk of suicide. Moreover, impulsivity, overt aggression and pain could be interrelated by a common biological core. Our study supports the importance of a multidisciplinary approach in the CPPs management and the necessity to supervise caregivers, which may become risk/protective factors for the development of feelings interfering with the treatment and rehabilitation of CPPs.

Features and organization of Pain Centers in the Lazio Region, Italy, in 2011.

Evidence on pain management highlights the importance of a multidisciplinary approach in order to achieve optimal therapeutic results. Such programs can be guaranteed by the Centers for Pain Management (CPMs), in which multidisciplinary teams are able to provide advanced and specialized activities for the assessment, diagnosis and treatment of chronic benign pain. To date, information related to healthcare supply and the organizational structure of these centers in Italy is incomplete. The aim of this paper was to provide an overview of the healthcare network of the CPMs in the Lazio region. A descriptive survey was conducted in all the 37 CPMs existing in the Lazio region in 2011 of which 28 participated. CPMs were located either in Universities or in public or private hospital facilities. They included a clinic, a Day Hospital service, Day surgery and day-beds. CPMs were managed by anaesthesiologists who, in most instances, did not work in a multidisciplinary team. The number of other health professionals available, such as nurses, psychologists and physiotherapists, was limited. CPMs mainly provided drug therapy, Complementary Alternative Medicine (CAM) and complex interventional treatments. The median waiting time was 30 days. The clinics were not homogeneously distributed in the region with a higher concentration in Rome (56%), followed by other provinces of the Lazio region (26%) and the province of Rome (18%). Clearly, Rome was the city which offered the greatest range of healthcare services and the highest number of consultations with patients, which significantly differed from those of the other areas (χ²=19.6 p<0.01). In 2011, the availability of CPMs was not equally distributed throughout the territory, and there was an over-utilization of the facilities in Rome and an under-utilization in the provincial areas. Moreover, this study showed a lack of a multi-professional approach to chronic pain management.

Accessibility to the treatment of chronic benign pain: Survey into Italian pain clinics

Accessibility to the treatment of chronic benign pain: Survey into Italian pain clinics

Chronic Pain: Fundamental Scientific Considerations, Specifically for Legal Claims

Abstract Scientific findings have indicated that psychological and social factors are the driving forces behind most chronic benign pain presentations, especially in a claim context, and are relevant to at least three of the AMA Guides publications: AMA Guides to Evaluation of Disease and Injury Causation, AMA Guides to Work Ability and Return to Work, and AMA Guides to the Evaluation of Permanent Impairment. The author reviews and summarizes studies that have identified the dominant role of financial, psychological, and other non–general medicine factors in patients who report low back pain. For example, one meta-analysis found that compensation results in an increase in pain perception and a reduction in the ability to benefit from medical and psychological treatment. Other studies have found a correlation between the level of compensation and health outcomes (greater compensation is associated with worse outcomes), and legal systems that discourage compensation for pain produce better health outcomes. One study found that, among persons with carpal tunnel syndrome, claimants had worse outcomes than nonclaimants despite receiving more treatment; another examined the problematic relationship between complex regional pain syndrome (CRPS) and compensation and found that cases of CRPS are dominated by legal claims, a disparity that highlights the dominant role of compensation. Workers’ compensation claimants are almost never evaluated for personality disorders or mental illness. The article concludes with recommendations that evaluators can consider in individual cases.

Sleep and depression assessment in patients with non-malignant chronic pain with extended release hydromorphone treatment

Chronic benign pain has been correlated with sleep disorders and depression. The objective of this study is to describe the relationship between sleep disorders, doses of OROS hydromorphone and depression symptoms in the management of patients with non malignant severe chronic pain. A descriptive retrospective study of 32 patients. Pittsburgh Sleep Quality Index (PSQI), Beck depression questionnaire (DBI) and VAS before and 1 month after inclusion in the treatment with OROS hydromorphome was accomplished through medical record review.

Health and distress predictors of heart rate variability in fibromyalgia and other forms of chronic pain

ObjectiveTo examine health, psychological, and autonomic impairment differences between individuals with fibromyalgia and those with other chronic benign pain in these conditions. The possible role of the autonomic nervous system in the maintenance of chronic benign pain can be examined using heart rate variability (HRV), which measures the interplay between the excitatory sympathetic and the inhibitory parasympathetic nervous system. Predictors of HRV will also be examined. MethodsThis study examined resting HRV in a sample of 84 patients with chronic benign pain, a subgroup of whom had fibromyalgia. Participants completed a battery of self-report measures and underwent measurements of resting HRV. ResultsIndividuals with fibromyalgia experienced higher levels of depression (t (82)=−2.27, p<.05) and significantly greater difficulty with physical functioning (t (75.8)=2.65, p<.01) than did those with other chronic benign pain, there were no significant differences in any of the HRV indices. Across all pain conditions, we found that age, gender, physical health functioning, pain anxiety, and pain sensations were all significant predictors of HRV, suggesting that each are involved in the relationship between chronic benign pain and autonomic function. ConclusionsThese findings emphasize the importance of addressing psychological distress and physical functioning in chronic pain populations and specifically fibromyalgia. Future research can further examine the role of physical health functioning, psychological distress, and pain severity in the relationship between chronic pain and autonomic abnormalities.

Prescription Narcotics: An Obstacle to Maximum Medical Improvement

Abstract The increasingly severe epidemic of overuse, abuse, and death involving prescription narcotics is of specific relevance to workers’ compensation, which is the primary venue for use of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). Because of the scientific knowledge base regarding prescription narcotics for chronic benign pain, evaluators may question how any patient could credibly be considered to have reached maximum medical improvement (MMI) if that patient has a prescription for a narcotic. Hyperalgesia associated with narcotics does not appear to be permanent, but evidence indicates that prescription narcotics cause significant problems in addition to worsening pain: endocrine disruption, sleep abnormalities, immune system compromise, cognitive impairment, substance abuse, and generalized ill health and disability, among others. Evaluators may worry that refusing to evaluate a person who is not at MMI because they are receiving a prescription narcotic may unintentionally delay resolution of the person's claim. In a more efficient approach, an evaluator could undertake the complete evaluation process, including creating an impairment rating, and document in the evaluation report that the rating is being provided despite reasons to be concerned that the impairment is artificially inflated in a nonpermanent way by the unjustifiable narcotic prescription. Evaluators should not state that the impairment from side effects of the opioids is permanent.

Affect School for chronic benign pain patients showed improved alexithymia assessments with TAS-20.

BackgroundAlexithymia is a disturbance associated with psychosomatic disorders, pain syndromes, and a variety of psychiatric disorders. The Affect School (AS) based on Tomkins Affect Theory is a therapy focusing on innate affects and their physiological expressions, feelings, emotions and scripts. In this pilot study we tried the AS-intervention method in patients with chronic benign pain.MethodsThe AS-intervention, with 8 weekly group sessions and 10 individual sessions, was offered to 59 patients with chronic non-malignant pain at a pain rehabilitation clinic in Sweden 2004-2005. Pre and post intervention assessments were done with the Hospital Anxiety and Depression scale (HAD), the Toronto Alexithymia Scale-20 (TAS-20), the Visual Analogue Scale for pain assessment (VAS-pain), the European Quality of Life health barometer (EQoL) and the Stress and Crisis Inventory-93 (SCI-93). After the group sessions we used Bergdahl's Questionnaire for assessing changes in interpersonal relations, general well-being and evaluation of AS.ResultsThe AS intervention was completed by 54 out of 59 (92%) patients. Significant reductions in total TAS-20 post-test scores (p = 0.0006) as well as TAS-20 DIF and DDF factors (Difficulties Identifying Feelings, and Difficulties Describing Feelings) were seen (p = 0.0001, and p = 0.0008) while the EOT factor (Externally Oriented Thinking) did not change. Improvements of HAD-depression scores (p = 0.04), EQoL (p = 0.02) and self-assessed changes in relations to others (p < 0.001) were also seen. After Bonferroni Correction for Multiple Analyses the TAS-20 test score reduction was still significant as well as Bergdahl's test after group sessions. The HAD, EQoL, SCI-93, and VAS-pain scores were not significantly changed. The AS-intervention was ranked high by the participants.ConclusionsThis pilot study involving 59 patients with chronic benign pain indicates that the alexithymia DIF and DDF, as well as depression, social relations and quality of life may be improved by the Affect School therapeutic intervention.

The Course of Nonspecific Work-Related Upper Limb Disorders and the Influence of Demographic Factors, Psychologic Factors, and Physical Fitness on Clinical Status and Disability

van Eijsden-Besseling MD, van den Bergh KA, Staal JB, de Bie RA, van den Heuvel WJ. The course of nonspecific work-related upper limb disorders and the influence of demographic factors, psychologic factors, and physical fitness on clinical status and disability. Objective To assess the course of nonspecific work-related upper limb disorders (WRULD) and the influence of sociodemographic factors, psychologic factors, and physical fitness on clinical status and functional disability. Design Retrospective cohort study with cross-sectional analysis among computer workers with several stages of nonspecific WRULD; average follow-up 4 years. Sociodemographic and medical characteristics were assessed based on medical records at onset and diagnosis. After informed consent at follow-up, participants received a questionnaire assessing psychologic and physical fitness characteristics. Setting Outpatient department of rehabilitation medicine, University Hospital Maastricht; tertiary referral center for nonspecific WRULD. Participants Computer workers (N=182) with nonspecific WRULD, 18 to 50 years, first consultation 1998 to 2001; those with specific WRULD and incomplete medical records and treatment charts were excluded. Interventions Not applicable. Main Outcome Measures Stage of nonspecific WRULD (clinical status) and Disabilities of Arm, Shoulder and Hand questionnaire [DASH] (functional disability). Results A total of 104 patients (57%) returned the completed questionnaire at follow-up (November 2003). Fourteen percent developed chronic benign pain syndrome, 9% recovered. The remaining (77%) worsened slightly. A higher DASH score was associated with being elderly (unstandardized regression coefficient [B=.64]), being a woman (B=10.42), having a lower educational achievement (B=9.72), and poorer self-reported physical fitness level (B=1.68); lower educational achievement and poorer self-reported physical fitness were associated with a more severe clinical status. Psychologic factors did not influence disability or clinical status. Conclusions The prognosis of computer workers with nonspecific WRULD is not favorable. Those with a lower educational achievement and poorer self-reported physical fitness are at risk for a more severe clinical status and functional disability. Being elderly and a woman are also risk factors for further disability. A prospective cohort study is needed to unravel these relationships. Nevertheless, computer workers with nonspecific WRULD should be encouraged to enter fitness programs.