Live Landmark

• Abrahamsen, Cathrine; Beadsworth, Mike; Bostock, Will; Chalder, Trudie; Flottorp, Signe & Fors, Egil A. [Show all 16 contributors for this article] (2026). Persistent physical symptoms not explained by structural abnormalities or disease processes: a primary care approach to promote recovery. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1). doi: 10.1080/02813432.2026.2633765. Full text in Research Archive
• Landmark, Live; Sunde, Hans Fredrik; Fors, Egil Andreas; Kennair, Leif Edward Ottesen & Reme, Silje Endresen (2026). Prevalence of Bodily Distress Syndrome and Prediction of Patient Outcomes: Cohort Study of 3762 Individuals With Persistent Pain. European Journal of Pain. ISSN 1090-3801. 30(2), p. 1–13. doi: 10.1002/ejp.70212. Full text in Research Archive Show summary

  ABSTRACT 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.

• Landmark, Live; Smits, Martijn; Fors, Egil Andreas; Dahm, Øyvin Nydal; Kennair, Leif Edward Ottesen & Jacobsen, Henrik Børsting (2026). Insomnia symptom severity predicts long-term pain intensity and bothersomeness across ICD-11 chronic pain categories: a registry-based cohort study. Scandinavian Journal of Pain. ISSN 1877-8860. 26(1). doi: 10.1515/sjpain-2025-0050. Full text in Research Archive Show summary

  Abstract Objectives Sleep and pain are reciprocally linked, each exacerbating functional impairments. In this observational cohort study, we examined differences in insomnia symptom severity among patients whose pain diagnoses, originally classified according to the International Classification of Diseases, 10th edition (ICD-10), were transformed into ICD-11 chronic pain categories. We further investigated whether the severity of insomnia symptoms at intake at a specialized pain clinic could predict pain outcomes 12 months later. Methods Data were drawn from 4,283 patients registered in the Oslo University Hospital Pain Registry. Baseline data from 3,705 patients were analyzed for differences in insomnia severity (measured using the Insomnia Severity Index, ISI) across ICD-11 chronic pain categories. At follow-up, 1,163 patients were included to test whether baseline insomnia severity predicted pain intensity and bothersomeness at 12-month follow-up using hierarchical linear regression models. Results The severity of insomnia symptoms (0–28, ISI) was slightly lower in chronic primary pain (Mean 15.3, SD=6.77) compared to chronic neuropathic pain (Mean 16.3, SD=6.65), adjusted p=0.017. No differences were observed between other chronic pain categories. After adjusting for age, gender, baseline pain scores, and psychological characteristics, a higher baseline severity of insomnia symptoms predicted greater pain intensity and bothersomeness at follow-up. Conclusions While the severity of insomnia symptoms appears to be equally distributed across ICD-11 chronic pain categories and has a substantial impact on the long-term intensity and bothersomeness of pain, it is largely ignored in clinical guidelines. Findings suggest that early, targeted interventions for insomnia symptoms may benefit patients.

• Landmark, Live; Sunde, Hans Fredrik; Fors, Egil A.; Kennair, Leif Edward Ottesen; Sayadian, Annahita & Backelin, Caroline [Show all 7 contributors for this article] (2024). Associations between pain intensity, psychosocial factors, and pain-related disability in 4285 patients with chronic pain. Scientific Reports. 14(1), p. 1–12. doi: 10.1038/s41598-024-64059-8. Full text in Research Archive Show summary

  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.

• Alme, Tomas Nordheim; Andreasson, Anna; Asprusten, Tarjei Tørre; Bakken, Anne Karen; Beadsworth, Michael BJ & Boye, Birgitte [Show all 51 contributors for this article] (2023). Chronic fatigue syndromes: real illnesses that people can recover from. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 41(4), p. 372–376. doi: 10.1080/02813432.2023.2235609. Full text in Research Archive Show summary

  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.

View all works in NVA

• Paulsen, Martin; Granum, Siri; Muri, Helene & Landmark, Live (2026). Ytringsklima under press: Hvorfor ytrer akademikere seg sjeldnere enn før. doi: https:/open.spotify.com/episode/01gHTv5WsoB3n0vpepYPm0?si=uMNVlLYhRKyXhwuh8-ymlA. Full text in Research Archive
• Reme, Silje Endresen; Landmark, Live; Asprusten, Tarjei Tørre; Suvatne, Christer; Herner, Linn Breen & Drivenes, Elin [Show all 63 contributors for this article] (2026). Gi pasientene livet tilbake. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 146. doi: 10.4045/tidsskr.26.0480. Full text in Research Archive Show summary

  Vi vet nok til å kunne hjelpe langt flere pasienter med langvarige symptomer. Likevel holder vi tilbake håpet, av frykt for å skuffe. Det kan koste pasientene store deler av livet. Denne kronikken er et faglig opprop fra 63 klinikere, forskere og fagpersoner fra hele landet. Vi har klinisk og forskningsmessig erfaring med vedvarende fysiske symptomer, som smerter, utmattelse, «hjernetåke», svimmelhet og mageplager og har samlet oss om et felles budskap: Ny kunnskap om hvordan slike symptomer oppstår og opprettholdes gir grunn til langt større håp om bedring enn mange pasienter får formidlet i dag.

• Landmark, Live; Kennair, Leif Edward Ottesen; Bendixen, Mons; Fors, Egil Andreas; Wyller, Vegard Bruun Bratholm & Reme, Silje Endresen [Show all 7 contributors for this article] (2026). Towards an integrative model of persistent physical symptoms: Studies in a specialised pain setting. Norges teknisk-naturvitenskapelige universitet. ISSN 9788235300089. Full text in Research Archive Show summary

  Persistent physical symptoms such as pain, sleep problems, and fatigue are common and among the leading causes of functional impairment. Patients referred to specialised pain care often present with symptom profiles that extend far beyond pain alone, raising fundamental questions about whether pain-focused classifications adequately capture the full extent of these presentations. This thesis addresses these questions in a large clinical cohort of approximately 4,000 patients referred to specialised pain services, examining overall symptom burden, psychosocial mechanisms, and prognostic factors within a transdiagnostic framework. Study I showed that insomnia symptoms showed associations with functioning that were comparable to or stronger than pain intensity, while fatigue and psychological distress contributed independently but with smaller effects. Study II demonstrated that insomnia symptoms were pronounced across all ICD-11 chronic pain categories, and that baseline levels of insomnia symptoms predicted both pain intensity and pain bothersomeness at 12-month follow-up, independent of baseline pain and psychosocial factors. Study III found that more than 90% of the cohort met criteria for moderate or severe Bodily Distress Syndrome (BDS), and that greater extent of multisystem symptoms at baseline predicted poorer function and lower perceived improvement at 12-month follow-up. Taken together, the findings indicate that this specialised pain population is characterised by high overall symptom burden in addition to pain. The findings support a transdiagnostic and integrated approach that moves beyond both organ-based classifications and a narrow focus on pain alone, and instead targets factors associated with functional impairment.

View all works in NVA