The aim of this study was to uncover and understand the reality of living with chronic, intractable nonmalignant back pain, as it is understood by sufferers themselves. A narrative autoethnographic research design was chosen, enabling me to interact with participants during the interview process, as well as have the opportunity to further explore my own experiences, as a long time sufferer of chronic, intractable nonmalignant back pain. Thematic analysis of participant interviews, and a deep, introspective scrutiny of my own journey, resulted in four stories being written. These stories illustrate the startlingly similar experiences we share. Although each story is written around one central character, they are in fact composite characters, representing the participants’ experiences as well as my own. The stories are: ‘The merry-go-round: Searching for a cure’, describing the endless visits to various specialists, in search of the elusive ‘cure’. ‘Mourning the loss’, illustrating the grief-like process we must go through when it becomes apparent that a cure is not possible and pain will be with us for the rest of our lives. ‘Walk a mile in my shoes’, giving a snapshot of issues facing us in our daily lives, and ‘Here we go again’, a description of a ‘typical’ pain management hospital stay. A fifth story, ‘We’re not in Kansas anymore’, was added following a bizarre emergency admission I was forced to endure during the course of my research. It is therefore a story where I am the central character. These stories illustrate the impact chronic back pain has on a sufferer’s life, ranging from loss of mobility to an altered body image. They also illustrate the struggle to maintain normality, including masking the pain and facing labelling and stigma. These stories identify and demonstrate the often hidden aspects of chronic intractable back pain, and have the power to inform practicing nurses, students, teachers and the community of the ‘lived experience’.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Study Design. Retrospective analysis. Objective. To determine if the use of adjunctive pain medications (subcutaneous bupivacaine, dexmedetomidine infusion, and intravenous ketorolac) will reduce the need for opioids, reduce postoperative pain, and shorten length of hospital stay in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion. Methods. Retrospective review of children 10 to 18 years with adolescent idiopathic scoliosis receiving posterior spinal fusion surgery over the past 10 years at Phoenix Children’s Hospital. Physicians managed the patients’ pain postoperatively with adjunctive medications in addition to intravenous and oral opioids. Variables of interest were local anesthetic bupivacaine delivered subcutaneously via elastomeric pain pump, sedative/analgesic dexmedetomidine infused for up to 24 hours postoperatively, and the NSAID ketorolac delivered intravenously. These three medications were used either alone or in some combination determined by the physician’s clinical judgment. Primary outcomes analyzed were normalized opioid requirement after surgery, VAS pain scores, and length of stay in the hospital. Results. One hundred and ninety-six children were analyzed with no significant differences in demographics. Univariate analysis showed that all three adjunct medications improved outcomes. A multivariate regression model of the outcomes with respect to the three medication variables of interest was developed to analyze the effects of the three medications simultaneously. The regression analysis showed that subcutaneous bupivacaine significantly reduced normalized opioid requirement by 0.98 mg/kg (P = 0.001) and reduced VAS pain scores by 0.67 points (P = 0.004). Dexmedetomidine significantly reduced the average VAS pain scores in the first 24 hours by 0.62 points (P = 0.005). Ketorolac had no effect in the multiple regression analysis. Conclusion. The use of subcutaneous bupivacaine provides good analgesia with low pain scores. A reduction in opioid requirement is beneficial and may be directly related to presence of the bupivacaine pump, although this may be limited by potential treatment bias. The three adjunct medications improve our outcomes favorably and should be studied prospectively.

No description available.

No description available.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Thesis (doctoral)--Lund University, 1992. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1992. / Added t.p. with thesis statement inserted.