The studies in this dissertation asses age differences in the experience of pain in humans and animals and the appropriateness of pain assessment tools across the adult life-span. Chapter I reviews age differences in experimental, acute and chronic pain in humans. Chapter 2 reviews age differences in the outcome of psychological treatments for chronic pain. It is concluded do there are age differences in each type of pain and that the elderly appear to benefit from psychological treatments as much as younger groups. Several experiments were conducted to examine the concepts that the elderly believe that pain is an inevitable part of aging and are not distressed by it, and that they experience less interim pain than younger patients. However, Chapter 3 presents two studies which find no age differences in pain beliefs. Furthermore, the studies described in Chapters 4 and 5 suggest that there may be age differences in the perceived qualities of chronic pain, measured with the short and full form of the McGill Pain Questionnaire (MPQ), but no age differences in pain intensity measured with single-item scales The data from Chapters 3, 4 and 5 suggest that the affective and cognitive components of chronic pain do not differ among age groups. Analysis of the psychometric properties of the pain measures suggests that verbal descriptor scales of pain intensity and both forms of the MPQ may be appropriate for use across the adult life-span. However, visual analog scales may not be appropriate for use with the elderly. To further elucidate the effects of aging on pain, Chapter 6 reviews age differences in nociceptive responsivity and pain behaviours in the rat. This review suggests that reflexive responses to nociceptive stimuli may not be age dependent although sensitivity on tests of more highly organized behaviours may decrease with age. Chapter 7 presents studies of age differences in the formalin test, a model of tonic pain, which suggest a curvilinear relationship be

Data from daily diaries were used to examine the relationships between daily pain appraisals (Catastrophizing, Self-Efficacy, and perceived control over pain) and coping strategy use (Distraction, Ignoring Pain, Praying and Hoping, and Reinterpreting Pain Sensation) and nighttime negative mood and pain intensity for 88 women (mean age 46.83 years, SD 11.90) with chronic low back pain who were not attending a specialized pain treatment program. These relationships were examined at two levels using the Hierarchical Linear Modeling program (Bryk & Raudenbush, 1992). The first level of analyses examined whether pain appraisals and coping strategy use during the day predicted levels of nighttime depressed and anxious mood, and pain. This analysis was based on 30 days of monitoring for each participant. The second level of analyses examined whether these daily processes could be predicted by psychosocial and functional variables important to the experience of chronic pain. This analysis was based on the Mutidimensional Pain Inventory (Kerns, Turk, & Rudy, 1985) completed prior to participants beginning the daily monitoring. There were four major findings in this study. First, pain appraisals were more predictive of negative mood and pain intensity than coping strategy use, with Catastrophizing the strongest predictor of depressed and anxious mood, and control the strongest predictor of pain intensity. Second, general affective distress predicted higher levels of negative mood on a daily basis. Third, women who perceived their pain to be interfering a great deal in their lives were more anxious on a daily basis. Fourth, punishing spousal responses predicted nightly negative mood and pain more than solicitous or distracting spousal responses. These results are similar to findings based on patients attending pain treatment programs. This suggests that some of the same processes identified in clinical pain patients may apply to low back pain sufferers in the community who are comparable to study participants. The implications of these findings for pain research and treatment are discussed.

Understanding chronic pain and disability in young people: A study with Catalan schoolchildren Anna Huguet Roselló Tesis doctoral dirigida pel Dr. Jordi Miró Martínez Departament de Psicologia, Universitat Rovira I Virigili, Tarragona Juny, 2007 El dolor crònic i recurrent és un problema molt estès; de fet és considerat un problema de salut pública (Crombie i col., 1999); que requereix d'una atenció especial pel sofriment i la discapacitat que pot generar tant al mateix individu com a les persones més pròximes a aquest (família). El dolor ha estat motiu d'atenció dels éssers humans des dels inicis de la història (veure per exemple, Sabatowski i col., 2004). No obstant, i paradoxalment, el dolor en nens ha estat totalment mancat d'interès fins a la dècada dels 70. Afortunadament, la situació en l'àmbit del dolor pediàtric ha canviat dràsticament. Durant els últims 25 anys, hi ha hagut un augment d'interès per a l'estudi del dolor en nens. Cada vegada més recursos estan sent invertits pel seu tractament, i la recerca paral·lelament també ha anat en augment. Aquest interès, no obstant, no és evident a tot arreu. Per exemple, i tal i com Reinoso-Barbero reconeix (2003), el dolor crònic és encara el germà pobre de la recerca del dolor en adults a Espanya. A pesar de l'elevat número de nens en necessitat de tractament, pocs clínics i investigadors estan donant a aquest problema l'atenció que es mereix. Per tant, la majoria d'aquests no estan rebent el tractament més apropiat perquè els clínics no estan familiaritzats amb aquestes condicions cròniques, mesures d'avaluació, i estratègies d'intervenció. En general, es pot dir que aquests nens han de combatre contra el seu dolor per ells mateixos, la majoria de les vegades sense rebre un tractament apropiat pel seu problema. Al mateix temps, les preocupacions i el sofriment dels pares augmenta perquè el dolor dels nens no remet, i ells no saben què fer. El propòsit d'aquest estudi és ajudar a entendre millor els problemes de dolor en nens i adolescents. Per això la tesi planteja tres objectius generals. (1) Treballar en l'àmbit de l'avaluació del dolor, i desenvolupar, adaptar i estudiar les propietats psicomètriques d'instruments de mesura que contribueixen a fer una avaluació multicontextual de nens catalano-parlants amb problemes de dolor. (2) Treballar en l'àmbit de l'epidemiologia, i aportar dades sobre els índex de prevalença i incidència dels problemes de dolor crònic en la nostra població de nens i adolescents d'entre 8 i 16 anys. I, aportar dades sobre les característiques d'aquests problemes i l'impacte que aquests problemes tenen sobre la vida del mateix nen. (3) Treballar per en l'àmbit de la prevenció secundària, i identificar predictors de tipus psicosocial del dolor crònic i/o la discapacitat. Understanding chronic pain and disability in young people: A study with Catalan schoolchildren Anna Huguet Roselló Tesis doctoral dirigida pel Dr. Jordi Miró Martínez Departament de Psicologia, Universitat Rovira I Virigili, Tarragona Juny, 2007 Recurrent and chronic pain is a widespread problem; in fact it has been considered to be a public health issue (Crombie, et al., 1999), one that requires careful attention due to the enormous amount of suffering and functional disability that it may cause. Pain has attracted attention of the humans since earliest recorded history (see for example, Sabatowski et al., 2004). However, and somewhat paradoxically, pain in children was completely devoid of interest until 1970s. Fortunately, the field of pediatric pain has changed dramatically. Over the last 25 years, there has been an increased interest in the study of pain as it occurs in youth. More and more resources have been invested into its treatment and prevention, research has paralleled growth too. This interest, however, is not so evident everywhere. For example, and as Reinoso-Barbero acknowledged (2003), pediatric pain still seems to be the poor brother of pain research in Spain. That is, despite the significant number of children in need of treatment, few clinicians and researchers are giving the attention to this problem that it deserves. Thus, most of these children do not receive the most appropriate treatment because clinicians are not familiar with these chronic conditions, assessment tools, and intervention strategies. In general, it can be said that children have to fight against their pain on their own, most of the times without receiving an appropriate treatment for their problem. At the same time, parents' concerns and suffering rise because their child's pain does not remit, and they do not know what to do. The propose of this study is to better understand chronic pain problems among the general population of children and adolescents. This thesis has tree aims. (1) To develop and examine the psychometric properties of assessment measure which allow us to understand pain problems from a biopsychosocial perspective. (2) To estimate the prevalence and incidence of chronic pain problems in Catalan schoolchildren aged 8 to 16 years and to examine the impact of pain problems on children's quality of life. (3) To work on the field of the secondary prevention and to identify psychosocial prognostic factors of the children's functioning and/or the course of pain complaints.

Chronic pain affects approximately 16% to 36% of Canadian adults and is one of the most common reasons for physician visits in Canada. The effects of a self-referral community-based education/exercise program (Y-PEP) on physical function and well-being were initially evaluated in 20 individuals with chronic pain who had attended one of three Y-PEP sessions in 2007. The 10-week program incorporated chronic pain education/self-management and various exercise modalities to allow individuals with chronic pain to try different physical activities in a safe and supported environment. Questionnaires were administered pre-, post-program, and at 10-weeks follow-up and provided data on demographic information, physical activity levels, depression, pain perception, and pain catastrophizing. Maximal activity levels and adjusted activity levels increased 7% and 10% respectively at post-program, but only the adjusted activity levels remained elevated at the 10-week follow-up. No significant changes occurred in any of the other outcome measures, however, the extent to which maximal and daily activity increased was significantly correlated with greater improvements in the extent to which pain interfered with one’s life (r=0.45) and with pain catastrophizing (r=0.45). These latter two improvements were significantly associated with greater decreases in depression score (r=0.50). Overall, these findings suggest that a community-based program for individuals with chronic pain can improve physical function and psycho-social well-being. Further effort is required to establish such programs in communities for individuals with chronic pain. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2009-09-14 13:01:08.784

Background: Chronic pain is prevalent worldwide and is estimated to range from 2% to 55% in the general population. There is a limited understanding of the prevalence and incidence of chronic pain in Canada. Furthermore, our understanding of the sociodemographic predictors of chronic pain is limited; thus we are poorly positioned to identify potential populations at risk. Objectives: The primary objectives for this study included: 1) to determine the prevalence and incidence of chronic pain and pain-related interference in Canada over time and, 2) to determine the influence of sociodemographic predictors on the development of chronic pain by sex in the Canadian adult population over 12 years. Methods: Using data from the cross-sectional components of the National Population Health Survey (NPHS) (1994/95, 1996/97, 1998/99) and the Canadian Community Health Survey (2000/01, 2003, 2005, 2007/08), we examined the prevalence and interference of chronic pain. The longitudinal component of the NPHS was used to determine the incidence and sociodemographic predictors of chronic pain. Chronic pain was defined as the presence of “usual pain”. Results: The prevalence in the cross-sectional samples ranged from 15.1% to 18.9%. In the longitudinal sample, the incidence ranged from 5.4% to 7.8% and the prevalence ranged from 15.3% to 19.5%. Women, compared to men, had a higher prevalence, but not incidence of chronic pain each year. Of those individuals reporting chronic pain, the majority reported at least a few activities prevented. Women who were older, with lower education, and widowed, separated, or divorced were more likely to develop chronic pain. There were no sociodemographic risk factors for chronic pain in men. Conclusion/Implications: This population-based study supports previous research findings indicating that chronic pain affects daily activities of many Canadians. Furthermore, this is the first population-based prospective study examining the incidence and sociodemographic predictors of chronic pain in Canadians. Further study with more detailed definitions of pain and pain-related interference is warranted. Moreover, our findings suggest that older women are more likely to develop chronic pain and that men and women may have different risk factors for chronic pain, suggesting the need for gender-based preventative interventions. / Thesis (Master, Nursing) -- Queen's University, 2010-07-20 13:38:13.996

No description available.

Introduction: The effects of chronic pain on health-related Quality of Life (HRQoL) among older Canadian adults with disability was not well known. Study Objectives: This study was conducted to examine the relationship between chronic pain and HRQoL among older Canadian adults with disability aged 55+. Methods: This study was a secondary analysis of cross-sectional data from the 2006 Participation and Activity Limitation Survey (PALS). Weighted data was used to examine the relationship between chronic pain and HRQoL using multivariate logistic regression techniques. Results: An estimated 68% of older Canadian adults with disability reported having chronic pain. Multivariate regression analysis confirmed a significant independent effect of chronic pain on self-reported HRQoL. Conclusion: Our results highlight the importance of pain assessment and management for older adults with disabilities in general and in particular among those with limited communication abilities.

Chronic pain is a public health problem that is likely to increase as the population ages, and has few effective treatments. Although viewed by many as profoundly distressing and disabling, there are a surprising number of people (approximately 30%) who cope well with their chronic pain and do not continue to seek treatment. There is little theory to explain how and why these individuals manage their pain well. This means there is limited knowledge about the approaches used by people who cope well and whether these strategies could help those who have more difficulty. This thesis presents a substantive grounded theory of living well with chronic pain, the theory of re-occupying self. Seventeen individual interviews were recorded, with data collection, analysis and theory generation following classical grounded theory methodological approach. Constant comparison, theoretical sampling, theoretical coding, and theoretical sensitivity were used to identify the main concern of people who cope well with pain. This concern is achieving self-coherence, and is resolved by re-occupying self. Resolution involves making sense to develop an idiographic model of their pain; deciding to turn from patient to person, facilitated or hindered by interactions with clinicians and occupational drive; and flexibly persisting where occupational engaging and coping allow individuals to develop future plans. By completing this process, individuals form a coherent self-concept in which they re-occupy the important or valued aspects of themselves. This study supports using Acceptance and Commitment Therapy because of its functional contextual view of people and their actions. This study illustrates that coping strategies are used in different ways depending on the primary goal within that context. Occupations, or active; purposeful; meaningful; contextualised and human activities, are used by people to make sense of their situation, and as a key motivation for developing coping strategies. These findings lead to new research questions about values-aligned activity, coping with identity change, and acceptance.

This qualitative study sought to answer: How may I, as an artist, use art for my own transformation and healing? I am an artist and teacher living with chronic pain and fatigue and wanted to find healing through art and inspire others to do the same. During the three month study, I made artwork, reflected in my journal, and practiced guided imagery. The journal was used to reflect on my health, the creative process, and to record ideas generated through guided imagery. Findings showed that short term relief was provided during the act of creation, but no long-term relief was achieved. The primary conclusion was that I was able to use art for healing and transformation, but only after experimentation and reflection. By adapting the creative process to accommodate for my illness, I was able to include art making as part of a healthy life.

The association between pain and depression is well documented across various populations, but not in puerperal women. This study examined the association of childbirth pain with postpartum depression (PPD) in a nationally representative sample of Canadian women. Data from the Canadian Maternity Experiences Survey (n=6421) was used. Multivariate logistic regressions and partial proportional odds models were fitted and included socio-demographic, obstetric, health, psychological, and psychosocial factors. Chronic pain sufferers at mean 7.3 months postpartum had adjusted odds of PPD of 2.4 (95% CI: 1.6, 3.6) compared to women without pain. Adjusted odds of PPD increased with the number of areas of chronic pain, reaching 4.2 (95% C.I.: 0.7, 25.0) for 3 or more areas. Immigration, obesity, cesarean section and social support increased the strength of the association while smoking and the use of pain relief were protective effect modifiers. Persistent postpartum pain is a major risk factor for PPD.