The purpose of the study was to investigate the structure of coping with chronic pain and to develop a standardised, reliable and valid ~t to measure coping with chronic pain. The use of this instrument as a measure of change in the evaluation of a local Pain Management Programe was investigated. The Pain Coping Questionnaire was developed from analysis of responses of 298 chronic pain patients to a self-report questionnaire concerned with coping with chronic pain. Following empirical psychometric investigations of reliability and validity, four psychologically meaningful dimensions were identified. One dimension, the General Coping Measure, was a measure of psycho-social adjustment to chronic pain. Three dimensions measured beliefs in the use of cognitive and behavioural pain coping strategies. One dimension, Active Coping Strategies, measured active pain coping strategies. Two dimensions, Avoidance and Use of Drugs, measured passive pain coping strategies. Belief in the use of active pain coping strategies was predictive of good psycho-social adjustment. Belief in the use of passive pain coping strategies was predictive of poor psycho-social adjustment. The results from outco~e studies indicated that the Pain Coping Questionnaire was a sensitive measure of change. The Pain Manag~.ment Programne had beneficial effects with respect to short-term outcome. Limitations were discussed. It was concluded that the Pain Coping Questionnaire represents an original contribution that is likely to have broad applications in the assessment and treatment of chronic pain patients.

No description available.

No description available.

No description available.

Morphine is one of the most commonly prescribed medications for the relief of prolonged pain. Both basic science and clinical studies indicate that females require 2-3 times more morphine than males to achieve the same analgesic effect. To date, the mechanisms underlying sex differences in opiate responsiveness are unknown. Recent studies suggest that glial cells are potent modulators of morphine-based analgesia, and in particular, decrease the analgesic effect of opiates. Therefore, we tested the hypothesis that the sexually dimorphic effects of morphine were due to sex differences in glial cell activity. Our studies focused on the midbrain periaqueductal gray (PAG) as this region of the brain is critical for the analgesic effects of morphine. Adult male and female Sprague Dawley rats (250g- 400g) were procured from Charles River Laboratories, and were allowed 7 days to acclimate to the new facility. On the day of the experiment, animals received a subcutaneous injection of morphine (5mg/kg) or were handled in a similar manner. Thirty or 60 minutes after injections or handling, animals were perfused with a 4% paraformaldehyde and 2.5% acrolein tissue fixative solution. Brains were removed and stored in 20% sucrose until ready for sectioning. Brains were sectioned at 25mm using a freezing microtome, and immunohistochemical localization of markers for astrocyte glial cell activity was performed. Antibodies to glial fibrillary acidic protein (GFAP) were used to label activated astrocytes. If our hypothesis is correct, then females will have significantly greater density of the astrocyte cell activity marker GFAP as compared with males. Sex differences in PAG glial cell activity may provide the biological bases for the sexually dimorphic effect of morphine. This research may lead to better treatment for females experiencing prolonged chronic or neuropathic pain.

Johnston (1996) proposed that disability can be predicted by a model integrating biomedical and psychological variables; Johnston’s model has mainly been tested in chronic pain and most studies have found it to predict disability better than impairment alone. The first study replicated Dixon’s (2006) structural equation modelling study, which tested an updated variant of Johnston’s model with ICF constructs in orthopaedic patients on a waiting list for joint replacement surgery. The present study also extended these tests to post-surgery. Supportive results were found before surgery, as Dixon had also found, but also after surgery. However, few tests of the model at the within-person level had been conducted. Methodology of published experimental single-case studies targeting behaviour change was investigated in a large systematic review. Studies varied in quality and robustness of design, and few used statistical analyses. Johnston’s model was tested at the within-person level in a series of five correlational single-case studies; whether mood was predictive was also tested. Community participants with arthritis, chronic pain and activity limitations completed a daily dietary using a PDA of pain, activity level, mood and Johnston’s proposed variables, and wore an accelerometer to collect activity data. Differing from previous findings, pain (impairment) was not predictive, nor was self-efficiency, but motivational constructs (intention and goal-setting) did predict activity (limitations) in several cases. PBC predicted in the direction contrary to theory in two cases and was not predictive in the others. Mood was not predictive. Differences from previous findings suggest that the model may not predict the same way within individuals as between them, requiring further investigation.

Thesis (M.App.Sc. in Physiotherapy)--University of South Australia, 1996.

Thesis--PlanA (M.S.)--University of Wisconsin--Stout, 1999. / Includes bibliographical references.

Background/aim: Chronic low back pain (CLBP) is a variant of chronic pain and an overarching term for a diverse number of painful and benign conditions of the lower spine. Research has shown that CLBP challenges biomedical explanation and treatments and incurs passive coping strategies. Despite the enduring nature of CLBP there are few longitudinal studies. The aim of this investigation was to gain understandings of any consistencies and changes in the experiences of participants' experiences of living with CLBP. Design: A qualitative, longitudinal IP A research project that explored participants' pain experiences over two years (2005-2007). Methods: Semi-structured interviews were conducted with a purposeful sample of ten participants recruited from the waiting list of a chronic pain clinic. Each participant was interviewed prior to attendance and twice after treatment. The data were recorded and transcribed accounts were analysed using IPA. Results: The participants foreground the physicality of the pain. Further interpretive work showed that whilst participants emphasised the physicality of their condition they experienced embodied, multidimensional experiences characterised by loss. Most participants' continued to manage their pain within a biomedical model of understanding and behavioural focused coping strategies. In comparison, participants who experienced a period of painlessness due to medical interventions demonstrated a reappraisal of their situation and a trend towards adopting a wider, biopsychosocial understanding accompanied by changing coping strategies. Conclusion: The accounts revealed the relationship between the participants' painful body and self concept. For some participants, a respite from pain paralleled increasing psychosocial coping strategies and a future orientation that reflected changes in illness beliefs in the absence of a formal psychological intervention. In comparison, remaining participants continued to demonstrate a narrow repertoire of coping and loss orientation. Participants' responses to CLBP resonated with the grieving processes of bereaved individuals. Clinical implications are discussed with recommendations for future research.

Ce travail questionne la place du féminin dans l’expérience subjective des personnes atteintes de fibromyalgie, maladie touchant majoritairement des femmes et dont la douleur et la fatigue chroniques occupent le devant de la scène. Notre hypothèse principale nous conduit à investiguer l’existence d’un trouble primaire du féminin chez les personnes qui en sont atteintes. Ce trouble serait lié à un échec de l’accès à la voie passive. Le modèle identificatoire serait celui de la mère des premiers soins, mal différenciée, mais représentant un idéal de toute-puissance narcissique. Dans ce contexte, les éprouvés douloureux de la passivité primaire laisseraient la place à une difficulté majeure face à la position passive, comprise comme une défense contre l’emprise maternelle. Des travaux de recherche proposent de considérer cette maladie comme étant une manifestation moderne de l’hystérie de conversion. Nous mettons cette hypothèse à l’épreuve à travers les cas cliniques étudiés. Nous investiguons également la question de la dépression en suivant l’idée que la fatigue chez les fibromyalgiques pourrait être interprétée comme une forme de dépression, non réactionnelle, préexistante à la maladie et caractérisée par une susceptibilité mélancolique. Les douleurs éprouvées constitueraient ainsi la composante mélancolique de cette dépression. Notre travail s’appuie sur le cadre théorique de la psychopathologie psychanalytique et sur des outils d’investigation qui sont les entretiens cliniques de recherche et les épreuves projectives (Rorschach et TAT). / This work questions the place of the feminine in the subjective experience of people suffering from fibromyalgia, a disease that mostly affects women and which chronic pain and fatigue occupy center stage. Our main hypothesis leads us to investigate the existence of a primary disorder of the feminine in people suffering from this disease. This disorder would be linked to a failure of reaching the passive way. The role model would be the first care mother, poorly differentiated, but which represents an omnipotent narcissistic ideal. In this context, the pain felt in primary passivity would leave room for a major difficulty regarding the passive position which is seen as a defense against the mother’s control. Some research intends to consider this disease as a modern expression of conversion hysteria. We challenge this hypothesis through the clinical cases that we studied. We also investigate the question of depression by following the idea that the fatigue of fibromyalgic people could be interpreted as a form of depression, non-reactive, pre-existing from the disease and characterized by a melancholic susceptibility. Then, the pain would consist in the melancholic component of the depression. Our work is based on the theoretical framework of psychoanalytical psychology and on investigation tools which are clinical research interviews and projective tests (Rorschach and TAT).