The purpose of this study was to test the relationships between and among the concepts of severity of illness, dependency, uncertainty, functional status and the mediators of self-esteem and mastery relative to the outcome of wellbeing. The conceptual framework was adapted from various sources in the literature which support the concept of wellbeing as an important outcome in arthritis. Evidence also supports self-esteem and mastery as mediators of the chronic illness experience. Dependency, uncertainty and functional status have been shown to be predictors of wellbeing but have never been tested as a complete paradigm. The sample for the study was 128 patients with either rheumatoid arthritis or osteoarthritis. Subjects completed 7 questionnaires which measured the 7 variables under study. Descriptive statistics were used to examine the demographic characteristics of the sample. Multiple regression technique was used to empirically test the predicted theoretical concepts and to estimate predictive validity for the theoretical concepts. The results demonstrated that when self-esteem was used in the causal model, 58% of the variance in wellbeing was explained by self-esteem and uncertainty. When mastery was included instead of self-esteem 52% of the variance of wellbeing was explained by mastery and uncertainty. When tested as mediators, both self-esteem and mastery emerged as significant mediators of dependency, uncertainty and functional status relative to wellbeing. These results are of clinical use to nurses who, by virtue of working with these patients on a daily basis, are in a position to intervene with actions which encourage positive self-esteem and maintain mastery over the environment. If these actions are successful, then wellbeing can be maintained for those patients diagnosed with arthritis.

BACKGROUND: Pain intensity, functional status and beliefs and attitudes towards pain are dynamic elements involved in the experience of chronic pain. Lidocaine infusion (LI) is a therapeutic intervention used to relieve pain. OBJECTIVES: The primary objective of this study was to determine if people with chronic pain who received LI and reported a decrease in pain intensity at 4 days post-infusion differed from those who did not report a decrease in pain intensity with respect to the following: a) baseline beliefs and attitudes towards pain; b) changes in belief and attitudes towards pain; c) and changes in functional status. This study also investigated if these differences were associated with being a novel or repeat LI user. A secondary objective was to estimate the sample size required for a larger study. METHODS: This project was an exploratory study. Thirty-three subjects were monitored for pain intensity using the Visual Analogue Scale (VAS) just before the infusion, and then at four days, two weeks, and three weeks after the infusion. The subjects were separated into groups depending on the criteria of whether or not they had: a) criterion-based pain intensity decrease or not on the fourth day post infusion, and b) received a previous LI or not. Since no subjects who received their first LI reported pain intensity decrease four days later, three groups emerged from this classification: first time LI users with no pain decrease, repeat LI users with no pain decrease, and repeat LI users with pain decrease. The subjects completed two self-administered questionnaires the Survey of Pain Attitudes (SOPA-32) and the Short Musculoskeletal Function Assessment (SMFA) - before the infusion, and at two and three weeks post-infusion. The most important change at two or three weeks post-infusion was used for comparison purposes. RESULTS: No significant changes in function (SMFA) were found. However, changes in specific beliefs and attitudes towards pain (SOPA-32) were associated with the group variable as follows: 1) All three groups showed a significantly stronger belief that 'others, especially family members, should be solicitous in response to their experience of pain' after the infusion. 2) Those who received their first LI and did not report pain intensity decrease also showed a significantly stronger belief that 'medications are an appropriate treatment for chronic pain' after the infusion. 3) Subjects who had previous LI and did not report pain intensity decrease were the only ones to believe significantly less that 'medications are an appropriate treatment for chronic pain' and more 'in a medical cure for their pain problem' after the infusion. 4) Subjects who had previous LI and did report pain intensity decrease had a significantly stronger belief in the appropriateness of medications and that 'that they should avoid exercise' after the infusion. 5) Finally, subjects who believed more that 'medications are an appropriate treatment for chronic pain' and less 'that they should avoid exercise' at baseline, had significantly higher chances of experiencing decrease in pain intensity 4 days after a LI. CONCLUSION: The impact of a LI on the individuals' beliefs and attitudes towards pain differs depending if their pain intensity decreased or not four days after the infusion, and if they had previous LI or not. By contrast, their pre-infusion beliefs and attitudes profile impacts on the efficacy of this intervention. Because of the small sample size, the heterogeneity of the subjects in terms of the localization of their pain, and our choice of measurement tool, it is not possible to determine if LI impacts on function. Nevertheless, this exploratory study generated some novel observations and questions that are of great interest for future research. A particular question of interest would be to determine if repeated LI fosters a more passive attitude towards pain management. It was also determined that a sample size of 70 subjects per group would be necessary for future research on this question. / Keywords: Chronic pain, lidocaine, beliefs and attitudes towards pain, function, pain intensity.

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Objective: Chronic pain is a common condition worldwide that poses significant impact to society in terms of its health and economic costs. It has been found to be related to a number of emotional and cognitive factors that are amenable to psychological treatments. Traditional cognitive-behavioral therapy (CBT) for chronic pain has become the gold standard of psychological treatment with reported efficacy. However, recent meta-analyses have found its effect size to be only modest at most. Moreover, its specific mechanisms of action are not well elucidated. With recent advances in neuroscience on possible neurocognitive processes underlying chronic pain, alternative treatment models targeting these specific neurocognitive processes are worth exploring. The present study tested the effectiveness of the Four-step Mindfulness-based Therapy (FSMT) for chronic pain in a randomized-controlled trial. The FSMT was chosen because of its explicit emphasis on altering neurocognitive processes that appear to be highly relevant in treating chronic pain. Method: Ninety-nine chronic pain patients in a hospital cluster-based outpatient pain clinic were randomly allocated to either the FSMT treatment or wait-list control group. The FSMT was modified for use with chronic pain and incorporated mindfulness exercises, such as mindful breathing and mindful meditation. Treatment consisted of eight weekly two-hour group sessions conducted by a clinical psychologist experienced in the implementation of the FSMT protocol. Assessment took place at baseline and post-treatment for both the FSMT and wait-list control. For the FSMT, assessment also took place at mid-group and 3-month follow-up. Results: Findings showed that the FSMT produced superior outcomes in terms of activity interference (primary endpoint), pain unpleasantness, and depression when compared to the wait-list control group or over time. Improvements were also found in the process measures of pain catastrophizing and pain acceptance. All treatment effects were maintained at follow-up. Further, the effects have been shown to be clinically significant and reliable above and beyond measurement errors. Mediational analyses revealed that pain catastrophizing and pain acceptance mediated the effects of FSMT on the outcomes of activity interference and depression; pain catastrophizing also mediated the effect of FSMT on the outcome of pain unpleasantness. Conclusions: The present study was the first to establish statistical and clinical evidence of the FSMT for chronic pain. It also revealed possible processes and mechanisms that might have brought about the changes in outcome, namely reduction in pain catastrophizing and improvement in pain acceptance. How the FSMT led to the outcome changes via these two processes was discussed and enriched by neurocognitive perspectives. Future studies should seek to further compare the FSMT with other active psychological treatments for chronic pain and collect neuroimaging data to further illustrate the neurocognitive processes involved. / Wong, Chi Ming. / "October 2009." / Adviser: Freedom Leung. / Source: Dissertation Abstracts International, Volume: 72-01, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 139-175). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.