Thesis (Ph.D.)--University of Melbourne, Centre for Neuroscience and Howard Florey Institute, 2009. / Typescript. Includes bibliographical references.

Thesis (Ph. D.)--University of North Texas, August, 2008. / Title from title page display. Includes bibliographical references.

Bakgrund: Patienter med långvarig smärta är en stor grupp i samhället. Långvarig smärta avser en smärta som har varat i minst tre månader. Den innebär ett fysiskt, psykiskt och socialt lidande för patienterna. Mötet mellan patient och vårdpersonal påverkar patienternas förmåga att hantera sin smärta och vardag. Det är således relevant att ta reda på patienternas upplevelser av mötet med vårdpersonalen. Syfte: Syftet var att beskriva hur patienter med långvarig smärta upplever mötet med vårdpersonal. Metod: En litteraturöversikt med induktiv ansats. Litteratursökningen utfördes i CINAHL och MEDLINE. Tio artiklar med kvalitativ design som besvarade syftet valdes ut. Artiklarna analyserades enligt Fribergs femstegsmodell och sammanställdes till ett resultat. Resultat: Resultatet visade att patienterna med långvarig smärta upplevde mötet med vårdpersonalen både vårdande och bristande.  I resultatet framkom två kategorier vilka var Ett vårdande möte och Maktlöshet som beskrevs av respektive underkategorier. Slutsats: Patienterna med långvarig smärta behöver bli bemötta med förståelse och bli trodda. Ökad kunskap hos vårdpersonalen om långvarig smärta och patienternas upplevelse av mötet behövs för att patienterna ska uppleva ett vårdande möte. Ett vårdande möte kan leda till att deras hälsa förbättras och lidandet minskar. / Background: Patients with chronic pain are a large group of society. Chronic pain involves suffering to the patient. A meeting between patient and healthcare professionals affects the patient's ability to handle his pain and everyday life. It is thus relevant to ascertain the patient's experiences of the encounter with healthcare professionals.  Aim: The aim was to describe how patients with chronic pain experience the encounter with healthcare professionals. Method: A literature review with an inductive approach. Ten scientific articles with qualitative design were included. Result: The result showed that patients with chronic pain experienced the relationship in the healthcare both as caring and inadequate. In the result, two categories emerged which were  Caring encounter and  Powerlessness described by the respective subcategories. Conclusion: Patients with chronic pain need to be treated with understanding and being believed. Increased knowledge of healthcare professionals about chronic pain and the patient's experience of the healthcare relationship is necessary for the patient to experience a caring relationship. A caring relationship can lead to their improved health and diminished suffering.

Bakgrund:  Långvarig smärta är idag ett mångfacetterat folkhälsoproblem. Smärtupplevelsen är komplex och påverkar människan utifrån flera dimensioner. Det vardagliga livet påverkas vilket skapar problem på såväl individ- som samhällsnivå. Sjuksköterskans roll är betydelsefull angående bemötandet och för patientens fortsatta utveckling av smärtupplevelsen. Syfte: Att beskriva patienters erfarenheter av att leva med långvarig muskuloskeletal smärta.  Metod: Littereraturöversikt baserad på tio kvalitativa vetenskapliga artiklar framsökta i databaserna CINAHL Complete och PubMed. Artiklarnas resultat analyserades och granskades utifrån skriftliga sammanfattningar och teman framställdes med hjälp av färgkodning. Resultat: Centrala erfarenheter som framkom var att deltagarna upplevde sig känslomässigt involverade, vilket även visades påverka smärtupplevelsen. Inställningen till och hanteringen av smärtan, livet och framtiden påverkades av yttre faktorer och förmågan till acceptans. Analysen genererade fem teman: smärtans påverkan i vardagen, smärtans påverkan av självbilden, strategier, bemötandet från hälso- och sjukvården och balans mellan hopp och förtvivlan. Diskussion: Livet med långvarig smärta innebär ofta ett stort lidande för människan. Eriksson beskrivning av livslidande, vårdlidande och sjukdomslidande ligger till grund för resultatdiskussionen. Även betydelsen av acceptans, omvårdnaden och hoppet diskuteras i förhållande till relevant forskning och litteraturöversiktens resultat.

Bakgrund: Smärta är en subjektiv upplevelse som är svår att sätta ord på. Det finns många personer i Sverige som lider av långvarig smärta och dessa är frekventa besökare hos sjukvården. Långvarig smärta är ett komplext tillstånd som kan vara svår att behandla. För att patienten ska få god vård bör dennes livsvärld beaktas. Syfte:Syftet var att belysa hur patienter med långvarig, icke-malign smärta upplever tillvaron. Metod: En litteraturstudie som har baserats på 13 vetenskapliga artiklar publicerade mellan åren 2007-2018. Artiklarna har hittats genom sökningar i databaserna CINAHL Complete, PubMed och SveMed+. Några av de sökord som använts var “chronic pain”, “patient” och “experience”. Litteraturstudien utgår från Callista Roy´s Adaptionsmodell. Resultat: Resultatet i denna litteraturstudie består av fyra huvudteman. Under “Mötet med vårdpersonalen” har det visat sig att många patienter kände att de blir misstrodda och inte tagna på allvar av vårdpersonalen. Det andra temat är “Smärtan påverkar livsvärlden” där patienterna uttryckte att hela livet förändrats och att de inte alltid känner igen sig själva .“Ibland räcker orden inte till”, det tredje temat, visade att patienterna upplevde smärta som något svårt att både skatta och förmedla. I “Behandling” som är det sista temat framkom det att många var oroliga för biverkningarna samt den höga beroenderisken som smärtstillande läkemedel kan ha. Diskussion: Resultatet diskuteras utifrån Callista Roys Adaptionsmodell och de fyra adaptiva lägena; fysiologiska funktioner, ömsesidigt beroendeläge självkoncept och rollfunktion. Sjuksköterskans roll och skyldigheter diskuteras även i samband med dessa lägen. / Background: Pain is a subjective feeling that is hard to put in to words. There are many people in Sweden that suffer from chronic pain and these are frequent users of the healthcare. Chronic pain is a complex condition that can be hard to treat. Aim: The aim was to illustrate how patients with chronic, nonmalignant pain experience their existence. Method: A literature review that is based on 13 peer reviewed articles that have been published between 2007-2018. The articles have been found in the following databases; CINAHL Complete, PubMed och SveMed+. Some of the keywords were “chronic pain”, “patient” and “expectations”. This literature review is based on Callista Roys Adaption Model. Results: The result in this literature review contains four main themes. In the first theme “The interaction with the healthcare professionals” showed that many patients felt disbelieved and not taken seriously. The second theme “The pain affected the patients’ quality of life“, the patients expressed that their whole life changed and that they cannot recognise themselves. “Sometimes the words are not enough”, the third theme, showed that patients experienced pain that is difficult to estimate and explain. Under “Treatment”, the last theme, many patients were worried about the side effects and the high risk of addiction that painkillers may have. Discussion: The result is discussed from Callista Roys Adaption Model and the four adaptive modes; physiological functions, interdependence, self-concept and role function. Nursing's roles and obligations are also discussed during these adaptive modes.

Bakgrund: Långvarig benign smärta är ett stort hälsoproblem i samhället. För att räknas som långvarig smärta ska smärtan ha varat i minst tre månader. Personer upplever långvarig smärta som fysiskt och psykiskt påfrestande. Sjuksköterskan har en viktig roll i bedömning, smärtskattning och behandling av smärtan. Det är således av betydelse att ta reda på personers upplevelse av långvarig smärta.   Syfte: Syftet med studien var att beskriva personers upplevelse av att leva med långvarig benign smärta.   Metod: En litteraturöversikt med induktiv ansats. Databaserna CINAHL och PsycINFO användes för att göra litteratursökningen. Syftet besvarades med tio artiklar som användes för att bygga upp resultatet. Fribergs femstegsmodell användes för att bearbeta och analysera resultatet i artiklarna.   Resultat: I resultatet framkom två huvudteman som var: Bemötande i vården och Påverkan på det dagliga livet. Båda huvudtemana hade tre subteman.   Slutsats: Personerna behöver bli betrodda och bekräftade i upplevelsen av sin smärta. En ökad kunskap i bemötandet av personer med långvarig smärta behövs för att mötet ska upplevas givande. Ett givande möte kan leda till minskad smärta eller upplevelse av god hälsa, trots smärtan. / Background: Chronic benign pain is a big worldwide health problem in the society. To be defined as chronic the pain must have lasted for at least three months. The chronic pain causes physical as well as psychic stress. The caregiver has a vital role in judging, pain scaling and treatment. It is thereby of importance to find out how people experience the chronic pain.   Aim: The purpose of the study was to describe people's experience of living with benign chronic pain   Method: A literature review with inductive approach. The databases CINAHL and PsycInfo was used to make the literature search. The aim was answered with 10 qualitative results articles. Fribergs fivestepsmodell was used to process and analyse the articles result.   Result: In the result two heads themes emerged: Treatment in healthcare and  Impact on daily life. Both head themes consisted of three subheadings.   Conclusion: There is a need to be believed and acknowledge in the experience of pain. An increased knowledge in treatment of people with chronic pain is needed for the meeting to be experienced as rewarding. A rewarding meeting can lead to reduced pain or experience of good health, despite pain.

INTRODUCTION: It is estimated that 100 million individuals suffer from chronic pain in the United States. Many of the options involved in chronic pain management have limited effectiveness come with risks of addiction, and/or have numerous side effects. The toll of chronic pain is even more substantial when complications with addiction arise. With an estimated 13.7% of adults having admitted to using pain relief medication for nonmedical purposes in the United States totaling a cost of approximately 55 billion dollars annually, the combined burden of chronic pain and addiction is considerable. To curb the sufferings created by chronic pain, it is essential to investigate its sources, the risks involved with current treatments, and alternative methods to alleviate chronic pain. PURPOSE: The objective of this study is to review the current literature on the topic of nonopioid therapies in the treatment of chronic pain, their ability to reduce opioid prescriptions, and assess their pros and cons. Three different forms of alternative treatments were chosen: 1) psychotherapeutic treatment Cognitive Behavioral Therapy, 2) Eastern Medicine Acupuncture, and 3) pharmacological class cannabinoids. RESULTS AND CONCLUSION: The current literature on alterative therapies show that cannabinoids had the most potential to decrease pain, followed by CBT, and acupuncture showing the least consistent efficacy. The literature on CBT elucidate a great potential to decrease the use of prescribed opioids without increasing pain while cannabinoids showed a synergistic effect with opioids. The combined results for acupuncture were not consistent, with only one of the studies showing potential to reduce the use of opioids, while the others showed no difference between real and sham acupuncture.

Complex regional pain syndrome (CRPS) is a chronic neuropathic pain disorder characterized by both central and peripheral symptoms that can be debilitating in children. CRPS treatment typically consists of intensive physical, occupational, and psychological therapy with evidence supporting the efficacy of this approach. Among these outcomes, some patients report significant improvements in pain while others report no change. Identifying baseline predictors of treatment resistance would refine our treatment approach and provide additional targets for intervention. The current study examined baseline brain structure via cortical thickness and gray matter volume (GMV) in 29 pediatric CRPS patients enrolled in an intensive pain rehabilitation program. All participants underwent MRI using a high-resolution T1-weighted sequence. Patients were categorized as pain treatment “responders” (n=19) or “non-responders” (n=10) based on change in reported pain levels from admission to follow up. Compared to treatment responders, non-responders demonstrated significantly less GMV in the bilateral nucleus accumbens p<0.05 and right: putamen p<0.01, pallidum p<0.05, and amygdala p<0.05. Furthermore, treatment non-responders exhibited significant cortical thickening in the left anterior insular cortex and medial frontal gyrus, and cortical thinning in the bilateral precentral gyrus and superior frontal gyrus; right: middle frontal gyrus, fusiform gyrus, inferior temporal gyrus, middle temporal gyrus, and anterior prefrontal cortex; and left: parahippocampal gyrus. Though we did see significant thinning of the primary motor cortex in treatment non-responders compared to responders, the majority of our findings were localized to regions associated with reward, motivation, learning, and emotion. We, therefore, postulate that treatment non-responders, when compared to responders, likely have an intrinsically reduced reward responsiveness, diminished motivation, and impaired learning, overall contributing to their negative treatment outcomes and chronification of pain. In conclusion, these baseline differences overall suggest these regional morphometric alterations may potentially serve as predictors of treatment response in pediatric CRPS. Furthermore, these areas may also indicate possible targets for future treatment.

BACKGROUND: Disparities in access to quality chronic pain treatment options disproportionately affect minorities. Although there is increasing evidence about the effectiveness of complementary and integrative medicine (CIM) to help in the treatment of pain, little is known about how low income minorities would benefit from having greater access to CIM. The Integrative Medical Group Visit (IMGV) model incorporates CIM in a medical group visit setting with the goal of increasing access to CIM. OBJECTIVE: The aims of this pilot study were to test 1) the feasibility of a Spanish language IMGV and 2) its effectiveness to reduce pain and improve function in Spanish speakers with chronic pain. METHODS: The study setting is the Family Medicine Clinic at Boston Medical Center. Adult Spanish speakers with chronic pain for at least 12 weeks were included; those pregnant, with psychosis, suicidal ideation or active substance abuse disorder were excluded. The intervention consisted of weekly, two-hour sessions for a total of 9 weeks. Main outcomes were pain level, pain interference, and physical and emotional function measured by the PROMIS 29 pre- and post-intervention, depression and stress, measured by PHQ-8 and PSS-10, respectively. Focus group participants discussed the feasibility of the intervention. Analyses involved t-tests to examine our outcome data, and qualitative thematic analysis for focus group data. RESULTS: This open study recruited 11 subjects, 10 women, average age of 51.9 years; 50% of participants attended more than four sessions. The outcomes showed a trend toward reduced depression, pain, fatigue, and anxiety. Qualitative themes of reduced pain, increased knowledge for healthier living, and improved access to pain treatment using an appropriately adapted intervention were found. CONCLUSIONS: It was feasible to implement the Latino IMGV model in the outpatient setting at BMC. Trends in reduction of pain and depression, as well as increased knowledge for healthier living and better access to CIM modalities were found. Future powered studies are needed to further implement this model.

The motor symptoms of Parkinson's disease (PD) have been linked to the emergence of exaggerated oscillatory activity in the 13 - 35 Hz beta range in recordings of the basal ganglia (BG) thalamocortical circuit of PD patients and animal models. PD patients and animal models also express dopamine-dependent cognitive impairments, implying effects of dopamine loss on the function of the anterior cingulate cortex (ACC). This thesis examines the electrophysiological behavior of the BG thalamocortical circuit in PD and dopamine-normal states during cognitive and motor activity. In vivo recordings in the BG of PD and dystonic patients were used to study the influence of dopamine during a test of executive function. Normal executive function was also investigated in the dopamine-healthy ACC of chronic pain patients. Both the BG and ACC exhibited lateralized electrophysiological responses to feedback valence. The BG also exhibited dopamine-sensitive event-related behavior. In additional experiments, chronically implanted recording electrodes in awake, behaving hemiparkinsonian rats were used to examine the transmission of synchronized oscillatory activity from the BG, through the ventral medial (VM) thalamus, to the ACC. Modulation of subthalamic nucleus, VM thalamus, and ACC activity during a simple cognitive/movement task was also investigated in hemiparkinsonian rats. Findings in the rat model suggest that ACC-mediated executive function is dopamine-sensitive and is reflected in the region's electrophysiology. These results may provide further insight into the significance of excessive oscillatory activity in PD and its influence on cognitive systems.