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Bakgrund: Smärta framställs som ett flerdimensionellt fenomen och det innebär att teorier och modeller visar att det finns en stark kombination av fysiska, psykiska och sociala fenomen. Sjuksköterskan ansvarar för patienternas omvårdnad och därav är det viktigt att synliggöra patienternas upplevelser av långvarig smärta för att generera betydelsefull kunskap i vårdandet av dessa patienter. Syfte: Syftet var att beskriva patienters upplevelser av att leva med långvarig smärta. Metod: Designen är en litteraturstudie innehållande artiklar med kvalitativt material. Databaserna som har använts för att söka fram artiklarna var Cinahl Complete och PsycINFO. Artiklarna har granskats utifrån Högskolans Kristianstad granskningsmall för kvalitativa artiklar. Artiklarna har analyserats i form av textanalys med inspiration av Fribergs analysmodell. Resultat: Att leva med långvarig smärta är komplext och innefattar flera olika komponenter av upplevelser. För att synliggöra patienters upplevelser har fyra teman tagits fram. En omställning i livet, som handlar om strategier och acceptans. Osäkerhet inför behandling, som handlar om misstro, skam och att inte få tillräckligt med information kring symtomlindring. Förändrade relationer, som handlar om besvikelser och vikten av närståendes stöd. Brist på empati i mötet med vården, som handlar om att inte bli sedd och att leva med långvarig smärta upptar all tid. Dessa teman med tillhörande subteman synliggör patienters upplevelser av att leva med långvarig smärta. Diskussion: Metoden har diskuterats och bedömts utifrån Shentons beskrivning av trovärdighetsbegrepp för kvalitativa studier. Resultatet i studien diskuteras utifrån följande fyra fynd, Att acceptera och erkänna, att sociala relationer förändras, att det finns för-och nackdelar med att medicinera och att bli sedd som en person i vården. Även etik, omvårdnad och samhällsrelevans diskuteras.

Self-management support (SMS) is considered an effective approach to chronic pain (CP) management. However, the provision of SMS for chronic pain patients faces challenges within primary care facilities in Ontario. An innovative SMS program led by a Registered Nurse (RN) at the Bruyère Family Health Team in Ottawa has been created for chronic pain patients. The goal of this program is to improve the current chronic pain management using SMS in an outpatient facility by harnessing the skills of primary health care team members. The hope would be that this program could be spread and scaled across other programs in the region. This thesis exists in two parts: 1. Evaluate the RN-led chronic pain self-management program to determine its effectiveness in terms of self-reported pain scales and Morphine Equivalence Quotient (MEQ) 2. Understand the perspectives of health care practitioners, administrators and patients within the RN-led chronic pain self-management program Patients meet with the RN for initial face-to-face visit for an hour, for SMS and then for at least one follow up visit. The primary outcome variables of interest were their self-reported pain evaluated using validated pain scales. Opioid use was also assessed before and after the porgram based on the MEQ. Results were analyzed using SPSSversion20. An online questionnair was distributed to team members. All responses were conceptually arranged into a SWOT analysis, which will be directed toward the ongoing management needs of the clinic. Between January 2016 and August 2018, 125 patients were seen of these 58 patients (12 males and 46 females) had at least one follow up appointment with the RN. In 46.2% of the population there was a decrease in their total opioid dose from their first to their last appointment and of these 4 patients (15.4%) had a daily MEQ of 0 by their last appointment. There was a significant average difference between patient’s daily MEQs at their first and last appointment (t20= 2.245, p<0.05). On average patients came into their first appointment with a daily MEQ of 23.88 higher than at their last visit (95% CI [1.69, 46.07]). Staff and patients who participated in the online survey identified the following strengths: multidisciplinary approach, increased accessibility for patients, cost effectiveness, better patient engagement, and no refills of opioids Canada needs a better strategy to manage the CP epidemic. This chronic pain self-management program led by an RN focuses on a multidisciplinary approach that is readily accessible to patients and integrated within primary care to best meet and prioritize the needs of chronic pain patients.

OBJECTIVES: The present study aims to collect data on the pain and sensory perception of both male and female healthy individuals. Although the overarching project has been testing female controls for longer, males have been added to the protocol with the goal of expanding our understanding pain norms. This study compares pain and sensation perception between genders and looks at psychosocial factors that may cause differences between the two populations. METHODS: The protocol for this study is divided into quantitative sensory testing (QST) and questionnaires. QST is a non-invasive procedure that is used to study somatosensory functioning in individuals. This study specifically utilizes a QST battery to understand sensation and pain caused by mechanical and thermal stimuli. The deltoid and hand are used as control regions and the abdomen is the experimental area. Additionally, the Health Screening Form, Pain Rating Questionnaire, Pain Sensitivity Questionnaire, Pain Catastrophizing Scale questionnaire, and 36-item Short Form Survey Instrument are all used to gather information on participants’ medical history, mental status, and other psychosocial factors that may affect pain and sensory processing. Data collected from this protocol is then analyzed on SPSS through descriptive statistics and one-way analyses of variance. RESULTS: Throughout the protocol, there are only three values that are significantly different between the male and female control populations: the thermal sensory threshold of cold on the hand, thermal sensory threshold for heat on the hand, and pressure pain threshold on the hand. The p-values for these are 0.001, 0.013, and 0.044 respectively. Additionally, the abdomen is slightly more sensitive than the control site for certain QST measures like the pain threshold for cold temperatures. CONCLUSIONS: The lack of significant variance between genders for the majority of data points shows that both male and female healthy control perceive pain and sensation similarly. Although there may be some differences in anatomy and development, there are no distinct differences in the overall experience of these phenomena. Although these results suggest that gender does not play a significant role in pain and sensory perception, it is important to continue expanding the database in order to find more conclusive results. / 2021-06-14T00:00:00Z

This study examined quantitative EEGs of six individuals with chronic pain and compared them to an age- and gender-matched normative database of healthy control subjects in an attempt to discern whether a particular pattern of resting state EEG activity is associated with chronic pain. In the chronic pain group, significantly reduced absolute power was seen in delta and theta bandwidths at frontal sites in the eyes-closed condition. In the eyes-open condition, significantly reduced absolute power was seen in delta, theta, and alpha bandwidths at frontal, central, and temporal sites, and increased relative high beta power was seen in the parietal region. Reduced theta/high beta and delta/high beta ratios were seen in the parietal region. Quantitative EEG neuromarkers of chronic pain are suggested.

Magister Scientiae Dentium - MSc(Dent) / There are both physical and emotional components which are associated with the chronic pain of TMD patients. One of the difficuhies in making an accurate assessment of each component, is the lack of objective criteria for quantitative measurement of the emotional component. This need, lead to the development of Research Diagnostic Criteria (RDC) by Dworkin and LeResche (1992). The aim of this study was to use RDC criteria to record the prevalence, and associations between Axis I (physical) and AXIS TI(emotional) factors in a sample of 100 patients attending a TMD Clinic. Patients were examined using the RDC guidelines and the diagnosis classified as either, myogenic, disc displacement or arthritis. Patients completed a self-administered personal history questiotmaire which analyzed emotional factors including, chronic graded pain, depression and nonspecific physical symptoms such as headaches, faintness and lower back pain.

Neuropathic pain is a common problem in clinical practice, affecting patients physically, emotionally, financially, and socially. Current treatment includes antidepressants, antiepileptics, and opioid analgesics. Bupropion is a specific inhibitor of neuronal noradrenaline reuptake and a weak inhibitor of dopamine reuptake, which shows some promise in the treatment of neuropathic pain.

Indiana University-Purdue University Indianapolis (IUPUI) / In 2017, the United States government declared that the opioid epidemic was a public health emergency. Among responses to address the epidemic, the Centers for Disease Control and Prevention released a set of opioid prescribing guidelines for primary care clinicians. Since their release, federal agencies and experts have been interested and concerned about their application in policy and clinical practice. This dissertation examines how some of these federal recommendations were implemented in clinic practice and state law, as well as the effects of related prescribing laws. This dissertation includes three studies 1) a qualitative analysis of clinician and patient discussions about opioid-related risks, benefits, and treatment goals, 2) a policy surveillance study of state tapering laws and their consistency with the CDC guideline’s opioid tapering recommendations, and 3) an empirical study of the effects of morphine milligram equivalent daily dose laws and acute opioid prescribing laws on pain medication prescribing for patients with Medicaid. Overall, this dissertation attempts to understand the translation of national opioid prescribing guidelines into policy and their effects on healthcare delivery. / 2021-02-28

Current research has demonstrated that stress is a contributing factor to many chronic disease states in our world today. Diabetes, hypertension, and high cholesterol are just a few health conditions in which stress can worsen these disease states in individuals. Stress is apparent in individuals with chronic disease but can also appear in those dealing with high-performance anxiety such as student-athletes. Stress does not discriminate in how it can affect people physically, mentally, and emotionally. Even though stress can affect a diverse range of people, there may be similarities among different groups affected by stress such that lessons can learn from each other. For example, research has shown the overwhelming benefits of exercise on physical health and mental health. Yet, even though athletes train consistently, they can still feel the adverse effects of stress on their mental well-being and emotional health. This feeling may be due to the pressure incited to perform at a high level during athletic events. Another adverse area of stress for athletes is the reality that their career will at some point end. This reality may be in their early 30s or 40s. The feelings of loss of purpose are common for many prior athletes and instills additional fear in navigating life direction after sports. In contrast, chronically ill patients go through different events because their stress is directly due to their illness. However, many studies reveal similarities between athletes and those who have a chronic disease regarding mental and emotional coping mechanisms for stress. This thesis addresses these similarities and discusses how both groups even though they have vital differences can learn from one another when dealing with stress.

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