Background: Psychological research has consistently demonstrated the importance of cognitions in the form of thoughts and images on an individual’s wellbeing. Having pain-related verbal cognitions has been shown to lead to poorer outcomes for patients (McCracken & Turk, 2002). Research in other conditions has shown mental images have a more powerful impact on emotion than verbal cognitions (Holmes & Matthews, 2005). To date however, little work has explored the role of mental imagery in adjustment to chronic pain. Methods Fourteen semi-structured interviews were conducted with individuals with chronic pain. Interview transcripts were analysed according to grounded theory methods to construct a substantive theory of the impact spontaneously-invoked images of pain have on functioning. Results Eight participants reported pain-related imagery and three reported mental images associated with related symptoms. In line with previous findings (Gillanders et al., 2012; Gosden, 2008) the frequency and intensity of pain-related images influenced the degree of distress experienced. There was a distinction made between intrusive mental images and visual descriptions or metaphors of pain. The former being conceptualised as a visual cognition and playing a role in the aetiology and maintenance of distress in chronic pain and therefore an adverse impact on functioning. Conclusion Enhancing our understanding of pain related imagery and its impact on functioning could inform the design of interventions in clinical practice. Working systematically with patients’ idiosyncratic pain related images and the beliefs that are associated with them could be a helpful specific target for therapy.

A 41-year-old woman presented with burning and erythema in her extremities triggered by warmth and activity, which was relieved by applying ice. Extensive workup was consistent with adult-onset primary erythromelalgia (EM). Several pharmacological treatments were tried including local anesthetics, capsaicin, ziconotide, and dantrolene, all providing 24-48 hours of relief followed by symptom flare. Interventional therapies, including peripheral and sympathetic ganglion blocks, also failed. Thus far, clonidine and ketamine have been the only effective agents for our patient. Genetic testing was negative for an EM-associated mutation in the SCN9A gene, encoding the Na(V)1.7 sodium channel, suggesting a mutation in an alternate gene.

Class of 2017 Abstract / Objectives: Specific Aim 1: Pharmacist will use pharmacological pain self-management strategies over non- pharmacological strategies. Specific Aim 2: Pharmacist pain self-management strategies will differ based on whether or not the pharmacist has chronic pain. Specific Aim 3: Pharmacist pain self-management strategies will differ across age. Specific Aim 4: Pharmacist pain self-management strategies will differ across gender. Methods: A survey was sent to all pharmacists with an email address registered with the State Board of Pharmacy in a single Southwestern state. The survey asked about characteristics of pain, strategies for managing pain, outcomes, and demographics. The primary outcome was severity of pain after treatment. Results: Responses were received from 417 pharmacists; 219 reported acute, 206 reported chronic pain, and 55 reported no pain. The chronic pain group was more likely to have a disability with poor/fair health status (P<0.006) and to report higher levels of pain before treatment (6.9 versus 5.8). Both groups reported similar relief from all strategies (76% versus 78% ; P equals 0.397), but the chronic pain group reported higher levels of pain after treatment (3.2 versus 2.0), less confidence in pain management, and less satisfaction (P less than 0.004). Conclusions: Age and gender did not affect the use of specific pain management strategies or the amount of pain relief received from all strategies used by participants with either acute or chronic pain. However, participants with chronic pain had higher levels of pain before and after treatment.

D.Phil. / Chronic pain is a devastating problem and one of the leading causes of disability internationally with an estimated 25-30% of people in industrialised nations suffering from it. Various approaches are available for the treatment of chronic pain with exercise therapy is often the last resort, after all else has failed. The present study was motivated by the growing prevalence of chronic pain patients and the recent progress in pain science. This study made use of a quasi-experimental design where randomization was a function of participant convenience. It made use of a Pre-Test Post-Test battery consisting both of self-report questionnaires and of a physical assessment evaluating components of chronic pain patients’ experience prior to and following a combined therapeutic intervention programme of 12 sessions. Follow- up was at 12 months. The objectives were to integrate patient reconceptualization of pain by means of an active approach combining pain education and exercise therapy, and to determine the effect of a change in pain cognition on the outcome compared to a control group receiving exercise therapy only. A heterogeneous group of chronic pain patients were randomized into 2 groups who both received exercise therapy twice per week: the experimental group (80) received exercise therapy and a specific 3 hour pain education session with the active control group (74) only receiving exercise therapy. There were no differences in pain related or demographic characteristics between groups at baseline. Both groups had a significant reduction in pain perception after 12 exercise therapy sessions (P<0.05). After a follow up period of 12 months the experimental group sustained the same level of pain reduction (P<0.05). The control group maintained only some the acquired reduction in pain perception. In the experimental group an increased participation in physical activity was also found 12 months after the intervention. Exercise therapy significantly reduces the perception of pain in chronic pain patients after 12 therapy sessions, but the combination of pain education and exercise therapy better maintain these effects after a year. Key Words: chronic pain, exercise, pain education.

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a disorder of the autonomic nervous system that has high association with chronic pain syndromes such as fibromyalgia, migraine disorders, and chronic abdominal pain in adolescents with the diagnosis. Many of these disorders are characterized as central sensitization disorders, or pathological pain memory mediated by neural plasticity. Ehlers Danlos Syndrome Type 3 (EDS-3), also called joint hypermobility syndrome (JHS) is a genetic disorder of the connective tissue that causes joint laxity and is also highly associated with chronic pain syndromes as well as POTS. Methods: This study proposed to characterize POTS as a disorder of central sensitization. The hypothesis, presented within the proposed theoretical model, demonstrates that JHS leads to chronic pain that results in central sensitization and autonomic nervous system dysfunction (POTS). Other factors that were evaluated were anxiety and function. A sample size of 40 adolescents between the ages of 12 and 19 years were recruited from the cardiology and pain clinics at Children’s National Medical Center. Analysis of data utilizing Wilcoxon, Chi square, Pearson correlation, and logistic regression tests were completed using SAS 9.3. Results: In comparison to those without POTS, there were no significant associations found between having the diagnosis of POTS and any other variable studied in the model. JHS had a stronger correlation with anxiety, central sensitization, both subjectively, and objectively with hyperalgesia on Aδ sensory nerve fiber when compared to those without JHS. Subjective central sensitization was highly correlated with anxiety, function, age, and female gender. Function and central sensitization had a significant association even when removing anxiety as a covariate. Conclusions: These findings suggest that joint hypermobility may be a factor that contributes to the development of central sensitization in individuals with chronic pain. Dysautonomia is likely not a disorder of central sensitization, but rather a variable related to joint hypermobility and chronic pain in ways yet to be discovered. As previously discussed in other literature, anxiety has strong associations with central sensitization and functional disability in chronic pain syndromes, and when treated effectively may increase function in those that suffer with these disorders.

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Pharmacology & Toxicology Student: Stela Pavlíčková Supervisor: PharmDr. Ludmila Melicharová Title of diploma thesis: Pain therapy with focus on pacients with oncological disease Pain therapy is a part of the oncological illnesses complex treatment. This therapy doesn't solve the cause of cancer, but significantly increase patient's quality of life during oncological treatment, even in the terminal stage. The main target of this work is to give basic information about pain treatment, focusing on the oncological pain, and elaborate a review of pharmacological groups and individual substances most used in oncological pain treatment. Basic pillar of the cancer pain treatment is pharmacotherapy, which goes out of the WHO three-grade analgesic ladder. Basic therapy is made of nonopioid analgesics. In case that they aren't enough, we can add weak opioids, which can be replaced by strong opioids afterwards. Analgesics are usually used repeatedly and often in combinations. Dosage interval depends on pharmacological properties, dosage form and patient condition. Well controlled pain phases are usually interrupted by very strong, cruel pain episodes, which are called break-through pain. Very strong pain, fully or partially...

Psychological and contextual factors play an important role in the development and maintenance of chronic spine-related pain, and effective treatment of pain-related conditions requires an understanding of how these factors contribute to pain and disability. The present study examined the relative contributions of spine pathology, psychological complications, and demographic factors to perceived pain intensity and disability in patients with chronic spine-related pain. Because most patients were assessed in the context of a compensable injury, exaggeration of symptoms and disability was systematically controlled for using multiple validity indicators. A high prevalence of psychological complications was observed in the present sample. Analysis indicated that psychological factors were not significantly related to pain intensity, but were significantly related to reported pain-related disability. Further, psychological factors were found to predict pain-related disability beyond demographics, medical findings, and pain intensity. Clinical implications of these findings are discussed.

Moçambique é um pais que vem passando por profundas mudanças políticas e sociais nos últimos 50 anos. Dentro deste contexto, em 1996, uma Unidade de Dor foi criada no Hospital Central de Maputo. O objetivo do presente estudo foi descrever e analisar os aspectos epidemiológicos, clínicos e emocionais de pacientes com dor crónica atendidos na Unidade de Dor. Um total de 118 pacientes foram entrevistados por um período de 2 meses. Destes, 79 (66,9%) eram mulheres e 39 (33,1%) eram homens. A média de idade foi de 52,4 anos, com um desvio padrão de 13,7. Cento e sete (90,7%) eram negros. Quarenta pacientes (33,9%) tiveram o diagnóstico da dor neuropática, 40 (33,9%) apresentaram dor osteomuscular, 8 (6,8%) tiveram dor relacionada com a SIDA, 17 (14,4%) tiveram dor oncológica. A média da escala numérica de dor foi 8,37 e a media de duração da dor crónica foi 41,75 meses. Entre os medicamentos abortivos para a dor, o paracetamol foi o mais utilizado e amitriptilina profilático foi o mais amplamente utilizado. Independentemente do seu tratamento na unidade de dor, cinquenta e oito pacientes (49,2%) também receberam algum tratamento de curandeiros locais. Quanto aos aspectos emocionais, foram encontrados 39 (33,1%) pacientes que preenchiam os critérios do DSM-IV de transtorno depressivo maior. Estes resultados são discutidos com base nos aspectos culturais envolvidos / Mozambique is a country that has been experiencing profound political and social changes over the last 50 years. Within this context, in 1996 a Pain Unit was set up in the Central Hospital of Maputo. The objective of the present study was to describe and analyze the epidemiological, clinical and emotional aspects of patients with chronic pain attended at the Pain Unit. A total of 118 patients were interviewed over a period of 2 months. Of these, 79 (66.9%) were women and 39 (33.1%) were men. Mean patient age was 52.4 years, with a standard deviation of 13.7. Hundred seven (90.7%) were black. Forty patients (33.9%) had a diagnosis of neuropathic pain, 40 (33,9%) had ostheomuscular pain, 8 (6.8%) had pain related to AIDS, 17 (14.4%) had oncologic pain. Mean of visual analogic scale for pain was 8,37 and chronic pain duration was 41.75 months . Between the abortive medications for pain, paracetamol was the most used and prophylactic amitriptyline was the most widely used. Regardless of their treatment at the Pain Unit, fifty eight patients (49.2%) also received some treatment from local healers. When emotional aspects were considered, 39 (33.1%) patients were found to have depressive symptoms that fulfilled DSM IV criteria of depressive disorder. These results are discussed based on the cultural aspects involved

Background: Chronic pain conditions particularly fibromyalgia (FM) are an important issue considering the demand that they place on health services and the negative impact on an individual’s well-being. Research regarding what impact FM may have on the various domains of health related quality of life is sparse. In addition, research identifying predictors relating to a person’s self-concept on pain outcomes such as quality of life and disability is scarce in a chronic pain population. Self-esteem has been linked to psychological adjustment in various chronic diseases (Chong et al, 2009) and is suspected to be a vulnerability factor in FM (Johnson et al., 1997; Michielsen et al., 2006). Research on self-compassion found that it is a significant predictor of increased psychological adjustment in people with chronic medical conditions (Wren, Somers, & Wright, 2011). The majority of research on self-compassion has been conducted in non-clinical samples. Identifying the predictive values of self-esteem and the self-compassion subscales (self-warmth and self-coldness) in relation to pain outcomes are useful provided they can be enhanced and utilised to inform intervention. Aims: This research portfolio had two aims, to systematically review and carry out a meta-analysis with the literature investigating the impact of FM on health related quality of life using the Short Form-36 version one and to investigate whether self-warmth, self-coldness and self-esteem act as predictors of quality of life and disability for individuals with chronic pain. Method: A systematic review and meta-analysis of studies which assessed the impact of FM on health related quality of life was undertaken. Sensitivity and subgroup analyses were conducted to address the level of heterogeneity in the studies. The empirical study comprised of a cross-sectional design in which 60 individuals with chronic pain were recruited from three NHS sites based in Fife and Lothian and a pain self-management group in Fife to complete six validated psychometric questionnaires: Self Compassion Scale (Neff, 2003), Rosenberg Self-Esteem Scale (Rosenberg, 1965), Brief Pain Inventory- Short Form (Cleeland, 1991), Pain Disability Questionnaire (Anagnostis, Gatchel, & Mayer, 2004), Hospital Anxiety and Depression Scale (Zigmond and Snaith, 1983) and Quality of Life Scale (Burckhardt, Woods, Schultz, & Ziebarth, 2003). Systematic Review Results: In total, 18 studies met the inclusion criteria of the systematic review and demonstrated that the health related quality of life of individuals with FM was lower compared to healthy controls on all eight subdomains of the SF-36 particularly Physical Role. It was found that Social Functioning was the subdomain least affected when comparing participants with FM to healthy controls. Empirical Project Results: Quality of life was lower than previous research with females reporting a higher level of quality of life than males. It was found that after controlling for demographic and clinical variables, self-warmth was the only significant predictor for quality of life but not on levels of disability. Neither self-coldness nor self-esteem were significant predictors on scores of quality of life or disability. Conclusion: The above studies expand literature on the nature of chronic pain and its outcomes such as health related quality of life. The meta-analysis evidenced that HRQoL was lower in individuals with FM than in healthy controls. The association between symptom severity and quality of life requires further investigation in FM. Psychological interventions targeting the development of self-warmth attributes and skills may have a beneficial effect in improving quality of life for people with chronic pain. While the systematic review highlighted that FM has a more significant impact physically rather than mentally in relation to quality of life, both studies highlighted the need for interventions to target the psychological adjustment of people with chronic pain conditions.

No description available.