Dissertation (Ph.D.)--The University of North Carolina at Greensboro, 2010. / Title from PDF t.p. (viewed Jul. 16, 2010). Directed by Anita Tesh; submitted to the School of Nursing. Includes bibliographical references (p. 90-104).

Thesis (Ph.D.)--Ohio University, November, 2004. / Title from PDF t.p. Includes bibliographical references (p. 145-172)

Fibromyalgia syndrome (FMS) is characterised by chronic widespread pain, tender points and fatigue. A clear biological explanation of FIVIS is lacking, and there is debate regarding the 'legitimacy' of the condition. Often, therefore, people with FIVIS do not obtain a straightforward, clear diagnosis - or any diagnosis at all. This research sought to explore the diagnostic and subsequent experience of people with FIVIS. Semi-structured interviews were conducted with 17 people formally diagnosed with FIVIS. Interviews were tape-recorded, transcribed, and analysed by the inductionabduction method. Findings were triangulated through documentary analysis of lay literature on FMS. Participants referred to their symptoms within a dualistic framework, with symptoms seen as an aggressive force that invades the body. Individuals had high expectations of the medical profession. They expected tests to be done, with a diagnosis and prognosis to follow. The diagnostic process was often reported as complex, ambiguous, and ambivalent. Although individuals were initially relieved following the diagnosis, this was often replaced by shock and uncertainty, as no one appeared to know what FIVIS is, what caused it or how to treat it. Consequently, informants had actively to search for a meaning of FMS through lay networks and literature. Several chose to reject the diagnosis, as it did not represent their own understanding and experience of their symptoms.The meaning attached to FIVISin fluenced participants' coping strategies. They had difficulty finding adequate social support, and while significant others assumed this role, the informants felt uncomfortable. Many expected the medical profession should provide social support, but this was not always forthcoming. People diagnosed with FIVIS expect their illness to be satisfactorily understood and explained by the medical profession. Tensions exist between this expectation and their actual experience.

No description available.

Background & Purpose: Chronic pain is a prevalent chronic condition for which the best management options rarely provide complete relief. Individuals with chronic pain with neuropathic characteristics (NC) report more severe pain and experience less relief from interventions. Little is known about current self-management practices. The purpose of this dissertation was to inform self-management of chronic pain with and without NC at the individual, health system, and policy levels using the Innovative Care for Chronic Conditions Framework. Methods: The study included a systematic search and review and cross-sectional survey. The review evaluated the evidence for chronic pain self-management interventions and explored the role of health care providers in supporting self-management. The survey was mailed to 8,000 randomly selected Canadians in November 2011, and non-respondents were followed-up in May 2012. Screening questions were included for both chronic pain and NC. The questionnaire captured pain descriptions, self-management strategies, and self-management barriers, and facilitators. Results: Findings of the review suggested that self-management interventions are effective in improving pain and health outcomes. Health care professionals provided self-management advice and referred individuals to self-management interventions. The questionnaire was completed by 1,520 Canadians. Those with chronic pain (n=710) identified primary care physicians as the most helpful pain management professional. Overall, use of non-pharmaceutical medical self-management strategies was low. While use positive emotional self-management strategies was high, individuals with NC were more likely to use negative emotional self-management strategies compared to those without NC. Multiple self-management barriers and facilitators were identified, however those with NC were more likely than those without NC to experience low self-efficacy, depression and severe pain which may impair the ability to self-management. Conclusions: Health care professionals have the opportunity to improve chronic pain outcomes by providing self-management advice, referring to self-management interventions, and addressing self-management barriers and facilitators. Individuals with NC may require additional health services to address their greater self-management challenges, and further research is needed to identify non-pharmaceutical interventions effective in relieving chronic pain with NC. Public policy is needed to facilitate health systems in providing long-term self-management support for individuals with chronic pain. / Thesis (Ph.D, Nursing) -- Queen's University, 2013-09-25 12:57:58.59

Methods: Three research methodologies were used including a comprehensive literature review, a descriptive study and a qualitative study.  A revised root cause analysis framework (consisting of four major steps) adapted and created by the researcher was also applied as an analytical framework to the whole research programme to facilitate the achievement of the aim and objectives. Results: Antidepressants were the most commonly prescribed drugs followed by a combination of paracetamol and weak opioids.  Drug-drug interactions between antidepressants and opioids were the most common potential MRPs.  Analgesic prescribing was independently associated with cause of pain and health-related quality of life.  Pain level, cause of pain and health-related quality of  life were independent significant factors for adjuvant prescribing.  The poorer the health-related quality of life was, the greater the number of analgesics and adjuvant drugs that were prescribed.  A  model of pain medication taking behaviours was developed, and relationships between MRPs, pain medication taking behaviours and considerations of patients’ perspectives on pain and pain medication taking were identified.  Patient factors were the main root causes of complex MRPs.   A set of recommendations (for both GPs and pharmacists) and evidence-derived questions for primary care pharmacists were proposed to help reduce and prevent MRPs. Conclusion: An intervention based on the findings of this study, and related to the pharmacist’s roles and responsibility could ultimately help to improve pharmaceutical care services for people with chronic pain in primary care.

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’.

Morphine is one of the most commonly prescribed medications for the relief of prolonged pain. Both basic science and clinical studies indicate that females require 2-3 times more morphine than males to achieve the same analgesic effect. To date, the mechanisms underlying sex differences in opiate responsiveness are unknown. Recent studies suggest that glial cells are potent modulators of morphine-based analgesia, and in particular, decrease the analgesic effect of opiates. Therefore, we tested the hypothesis that the sexually dimorphic effects of morphine were due to sex differences in glial cell activity. Our studies focused on the midbrain periaqueductal gray (PAG) as this region of the brain is critical for the analgesic effects of morphine. Adult male and female Sprague Dawley rats (250g- 400g) were procured from Charles River Laboratories, and were allowed 7 days to acclimate to the new facility. On the day of the experiment, animals received a subcutaneous injection of morphine (5mg/kg) or were handled in a similar manner. Thirty or 60 minutes after injections or handling, animals were perfused with a 4% paraformaldehyde and 2.5% acrolein tissue fixative solution. Brains were removed and stored in 20% sucrose until ready for sectioning. Brains were sectioned at 25mm using a freezing microtome, and immunohistochemical localization of markers for astrocyte glial cell activity was performed. Antibodies to glial fibrillary acidic protein (GFAP) were used to label activated astrocytes. If our hypothesis is correct, then females will have significantly greater density of the astrocyte cell activity marker GFAP as compared with males. Sex differences in PAG glial cell activity may provide the biological bases for the sexually dimorphic effect of morphine. This research may lead to better treatment for females experiencing prolonged chronic or neuropathic pain.

Thesis--PlanB (M.S.)--University of Wisconsin--Stout, 2002. / Includes bibliographical references.

Objective: Chronic back pain is highly prevalent in orthopaedic clinics. The aim of the study was to investigate the relationship of psychological factors affecting disability and distress outcomes in chronic low back pain patients. Clinicians shared the impression that chronic pain patients resulted from Injury on Duty (IOD) were particularly difficult to manage. Profiles of IOD patients and non-IOD patients were compared. Methods: The present study is a prospective follow-up study. Fifty-four patients from a public orthopaedic out-patient clinic were assessed with low back pain as their primary complaint. Self-report inventories together with semi-structured interview were used to assess patients’ pain intensity, pain disability, psychological distress, positive and negative affect, as well as relevant pain-related parameters including pain catastrophizing thought, pain-related fear, pain self-efficacy and chronic pain acceptance. Patients were interviewed during their first visit to the orthopaedic out-patient clinic (i.e. Time 1), after 6 months (i.e. Time 2) and after 1 year (i.e. Time 3) of the first consultation. Both qualitative and quantitative analyses were conducted. Results: Chronic pain acceptance predicted mid-term and long-term pain disability and psychological distress at a period of one year after their initial assessment. However, the pain-related parameters of pain catastrophizing, pain-related fear and pain self-efficacy did not show a significant predictive effect on outcomes. Pain rating is an inadequate estimate to assess patients’ level of disability and psychological status. The meaning of pain is important for patients to make sense of their pain experience and employ appropriate coping strategies. Attaching a positive value to pain helps patients to accept their pain. In addition, half of the chronic pain patients showed a need for psychiatric services at one year follow-up, pointing to a high co-morbidity between chronic pain and psychiatric problems. Among the 54 patients, 17 (31.5%) were injured on duty (IOD). More IOD patients than non-IOD patients took sick leaves or were not working during the year. However, there is no significant difference between IOD group and non-IOD group on psychological distress, pain disability and other pain-related measures across 3 time points. Discussion and Conclusion: Pain problems in the context of chronic pain are different from those in the context of acute pain. Intervention focusing on pain relief is inadequate to treat patients’ chronic pain. A multi-factorial perspective is needed to understand and develop suitable models to account for chronic pain experience instead of just relying on the prevalent fear-avoidance model. A more comprehensive assessment that is tailored to patients’ needs is necessary for more effective rehabilitation. Chronic pain patients’ need for psychiatric intervention is also highlighted, with a focus on work-related issues for IOD patients. / published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy