Thesis (MHSc--Health Science) -- Auckland University of Technology, 2004. / Also held in print (111 leaves, 30 cm.) in Akoranga Theses Collection (T 615.82 ALE)

Thesis (M.S.)--University of Michigan, 1998. / Includes bibliographical references.

Thesis (M.S.)--West Virginia University, 1999. / Title from document title page. Document formatted into pages; contains iv, 54 p. Includes abstract. Includes bibliographical references (p. 49-54).

Thesis (Ph.D.) - University of Queensland, 2003. / Includes bibliography.

Thesis (M.A.)--York University, 2005. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 90-101). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url%5Fver=Z39.88-2004&res%5Fdat=xri:pqdiss &rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:MR11852

This participatory action research study evaluated whether, bringing people who have chronic pain together in collaborative learning communities can have an impact upon the way they manage their chronic pain. Participatory action research has been used with other patient groups, but not with people who have chronic pain. People who have chronic pain are often marginalised and restricted from playing a fuller role in society. In this thesis, I consider these processes to be indicators that people with chronic pain may be experiencing a form of social oppression. This justifies the use of participatory action research methods with this group, as these methods are intended to promote wellness and produce liberation from social oppression. A Dionysian inquiry was established in order to promote consciousness-raising among participants in learning communities. Three learning communities were initiated and two were sustained. Nine participants fully immersed in the learning communities. They reported feelings of liberation, identified ways in which their involvement in the learning community had caused them to change their attitudes and acted to improve their situation. This is my original contribution to knowledge, as this demonstrates that the generation of learning communities using PAR, with a Dionysian approach among people who have chronic pain is feasible. This has not been previously published in the literature. Three action cycles have been identified and are discussed in this thesis. These demonstrate the consciousness-raising and individual action that characterised transformation as a result of collaboration. In participatory action research, the production of an action cycle is viewed as the generation of new emergent knowledge, when viewed through the lens of critical theory. Although this knowledge is limited to the learning community and in this study is participant specific. Subsequent findings that emerge from this inquiry, identify that lived experience of chronic pain may be a product of civilised oppression, from which participants might become liberated using consciousness-raising techniques. These findings are significant, as the articulation of chronic pain as an oppressive force and the possible structures by which this is enacted, has seldom occurred in the literature. Without a discussion around oppression and pain and considering ways to raise awareness, people who experience chronic pain are unlikely to overcome these obstructions and attain empowerment.

abstract: Socioeconomic status (SES) is linked with poorer health outcomes across the range of SES. The Reserve Capacity Model (RCM) proposes that low SES fuels repeated and/or chronic exposure to elevated levels of stress, producing deleterious emotional, psychological, social, and physiological changes that result in development of disease over time. The RCM further asserts that a relative lack of social and psychological resources, including efficacy and social support, among low SES individuals accounts for their greater vulnerability to the effects of stress. Although the links between stress, reserve capacity, and health outcomes are framed in the RCM as an ongoing process that produces disease, the majority of investigations testing the model have not examined its utility in explaining 1) coping with daily stressors or 2) symptom flares among individuals managing a chronic illness. This study investigated the effects of SES, reflected in income level, on the: 1) levels of daily financial events and financial worry; 2) relations between daily financial worry and symptoms of pain and fatigue; and 3) extent to which daily coping efficacy and social support mediated the daily financial worry-symptom relation across 21 daily diary reports collected from 220 individuals with fibromyalgia (FM). Simple correlations showed that income was inversely related to frequency of financial events and level of financial worry across 21 days. Results from multilevel models indicated that daily increases in financial worry were unrelated to pain regardless of income level, but were related to increased fatigue among individuals with lower relative to higher income. Daily efficacy and support mediated the relations between financial worry and pain and fatigue, but the extent of mediation did not differ based on high versus low income level. Taken together, the findings suggest that individuals of low versus high income encounter more frequent financial stress and experience greater daily fatigue exacerbation related to that stress, in line with the RCM. Over time, the greater exposure and reactivity to financial strain may account for the inverse relation between income and disability among those with chronic pain. / Dissertation/Thesis / Masters Thesis Psychology 2017

Chronic neuropathic pain is a disease that impacts the livelihood of millions of people in the United States with no effective pain treatments and limited information pertaining to the underlying mechanisms. Opioid therapy is considered the gold standard for pain therapeutics, but chronic use of these medications brings about serious side effects such as tolerance, addiction, and respiratory depression which limit their overall therapeutic potential. Herein, two approaches are discussed to circumvent these issues: i) a multifunctional approach using N-phenyl-N-piperidin-4-yl-propionamide (Ppp) coupled to various endogenous opioid ligand scaffolds, and ii) non-opioid dynorphin A (DYN A) ligands at the Bradykinin-2 receptor (B2R). The μ-opioid receptor (MOR) upon agonist stimulation provides analgesia and concomitant activation of the δ-opioid receptor (DOR) leads to an increased antinociceptive effect. Chronic activation of the MOR has been correlated with an upregulation of the κ-opioid receptor (KOR) and KOR associated side effects such as anxiety and depression. The discovery of a new class of opioid receptor (OR) ligands that have the biological profile of MOR/DOR agonists and KOR antagonists would be beneficial considering they would have an increased analgesic effect, leading to a lower dosage being administered and thus lower overall side effects, and block symptoms elicited from KOR stimulation. Discussed are various structure activity relationships (SARs) of numerous scaffolds that present novel biological profiles. Ultimately, we discovered a compound that, to our knowledge, is the 1st MOR/DOR agonist and KOR antagonist. DYN A is the endogenous ligand for the KOR and its [des-Tyr1]-DYN A fragment interacts with the B2R, but not the KOR, promoting hyperalgesia. Peptidomimetic non-opioid DYN A analogues were synthesized and evaluated at the B2R. A minimum pharmacophore was identified and antagonists with both improved biological stability and affinity were discovered.

Class of 2011 Abstract / OBJECTIVES: The purpose of this study was to survey prescribers who manage patients with chronic pain to evaluate how pharmacy services are perceived to affect patients’ quality of life. METHODS: Surveys were sent to prescribers who manage patients with chronic pain. Prescribers rated pharmacy services on a scale of 0 – 5 (0 being not important at all, and 5 being extremely important) to the quality of life of patients with chronic pain. RESULTS: Surveys were completed by 23 subjects. Prescribers ranked pharmacy services as follows: the pharmacy fills opioid prescriptions for all pain conditions (mean = 4.2; SD = 1.0), the patient is able to obtain the entire quantity of pain medication (mean = 4.1; SD = 1.5), the pharmacy treats the patient as dependent on, not addicted to opioids (mean = 3.9; SD = 1.6), the pharmacy collaborates with the prescriber to manage opiate therapy (mean = 3.9; SD = 1.5), the pharmacy stocks new and recently approved pain medications (mean = 3.8; SD = 1.1), the pharmacy provides the patient with information on adverse effects of pain medications (mean = 3.8; SD = 1.5), the pharmacy is able to use manufacturer co-pay cards to minimize out-of-pocket costs (mean = 3.5; SD = 1.7), the patient can have prescriptions delivered to their home (mean = 2.1; SD = 1.8) and the patient can obtain a prescription without having to wait a specified time period determined by their pharmacy (mean = 1.8; SD = 1.5). CONCLUSION: Prescribers in this study felt that certain pharmacy services are very important in the treatment of patients with chronic pain. Pharmacies may improve patients’ quality of life in the management of their chronic pain by providing these services.

Class of 2006 Abstract / Objectives: To assess perceived efficacy and patient satisfaction at a single point in time during a course of therapy with a compounded topical formulation containing at least ketoprofen in an anhydrous gel base. Methods: Patients aged 18 and older, currently using one of the topical pain relief compounds of interest obtained from Reed’s Compounding Pharmacy in Tucson, Arizona were recruited and then interviewed (in person or by telephone) for this study. Data collected during patient interviews were recorded on a form designed solely for the purposes of this study. Interview questions pertained to the nature of the participant’s pain, their assessment of their pain both before treatment with the medication of interest and at the time of the interview, frequency and duration of patient use of the pain relief gel, disclosure of any other pain relief medications the patient was using at the time, and their overall satisfaction with the medication. Results: Interviews were conducted with a total of 50 patients with chronic pain conditions representing several different etiologies and anatomical locations. The average pain assessment score at the time of the interview (representing perceived patient pain after use of the topical pain relief compound) was significantly lower than the average before treatment pain assessment score (p<0.001). After treatment with the gel had commenced, perceived pain scores dropped by average of 3.56 units (SD 2.28), or 44%. Increased frequency of application of the topical pain relief gel was not associated with greater pain relief or changes in overall patient satisfaction with the product. A longer duration of use of the topical pain relief was also not associated with greater pain relief or overall patient satisfaction with the product. Whether or not a patient utilized other pain relief medication(s) while undergoing treatment with the topical pain relief gel had no bearing on the assessment of their pain either before use of the gel or at the time of interview. The average overall patient satisfaction with the topical pain relief compound was rated at 6.6 out of a possible 10 units (SD 3.13). Thirty-six patients (72%) rated their satisfaction with the topical medication of interest with a satisfaction score of ≥ 6, 10 patients (20%) rated their satisfaction with a score of 10 (completely satisfied), and 6 patients (12%) rated their satisfaction with a score of 0 (not at all satisfied). It was observed that the lower the perceived pain assessment score at the time of the interview (after using the gel), the greater the patient satisfaction with the product. Additionally, patients were observed to be more satisfied with the product if the difference between their perceived pain assessment scores (before and after) was greater (i.e.: greater patient satisfaction with greater pain relief). Conclusions: Treatment of chronic pain with a topical pain relief compound containing at least ketoprofen in an anhydrous gel base is associated with patient satisfaction and perceived analgesic benefits. During the one-time interview, most patients reported a significant improvement in their pain relief, and the great majority of patients were very satisfied with the compounded topical treatment they received from Reed’s Compounding Pharmacy.