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Mackenzie Shanahan DissertationMackenzie Lynmarie DeMuth (12987965) 09 September 2022 (has links)
<p> Older adults with persistent pain experience reduced physical functioning, increased disability, and higher rates of depression. Previous research suggests that different types of positive and negative expectancies (e.g., optimism and hopelessness) may be associated with the severity of these pain-related outcomes. Moreover, different types of expectancies may interact with perceived control to predict these outcomes. However, it is unclear whether different types of expectancies are uniquely predictive of changes in pain-related outcomes over time in older adults and whether perceived control moderates these relationships. The primary aims of the current study were to 1) examine how the shared and unique aspects of optimism and hopelessness differentially predict changes in pain-related outcomes (i.e., pain severity, pain interference, disability, and depressive symptoms) in older adults experiencing persistent pain over a 10-year and 2-year timeframe and 2) examine whether perceptions of control over one’s health moderate these relationships. The present study sampled older adults with persistent pain who participated in a nationally representative, longitudinal study (i.e., The Health and Retirement Study) at three timepoints across a 10-year period. First, confirmatory factor analyses (CFA) were conducted to determine appropriate modeling of expectancy variables. Second, mixed latent and measured variable path analyses were created to examine the unique relationships between expectancy variables and changes in pain-related outcomes over both a 10- year and 2-year period. Finally, mixed latent and measured variable path analyses and PROCESS were used to test perceived control as moderator of the relationships between expectancy variables and changes in pain-related outcomes over time. CFA results suggested that measures of optimism and hopelessness were best understood in terms of their valence, as positive (i.e., optimism) or negative (i.e., pessimism and hopelessness) expectations. Results from path analyses suggested that only negative, not positive, expectancies were significantly associated with worsening pain severity, pain interference, disability, and depressive symptoms across both 10-year and 2-year periods. Moderation analyses demonstrated inconsistent results and difficulties with replication. However, post-hoc path analyses found that perceptions of control over one’s health independently predicted some changes in pain-related outcomes over time, even when controlling for expectancies. Altogether, the current findings expand our knowledge of the associations between expectancies and pain by suggesting that negative expectancies are 10 predictive of changes in mental and physical pain-related outcomes across years of time. The current study also suggests that positive and negative expectancies may be related, but distinct factors in older adults with persistent pain and that health-related perceived control may be predictive of changes in pain over time. The current discussion reviews these extensions of our current knowledge in greater detail, discusses the potential mechanisms driving these relationships through a theoretical lens, and identifies the implications of this work. </p>
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Vitamin D and Chronic Pain: A Comprehensive ReviewSinger, Jonathan A. January 2013 (has links)
In recent years vitamin D has gained popularity in the media, on the internet, and throughout alternative treatment practitioners as a cheap and effective option to treat many diseases. Research showing that vitamin D receptors are present in virtually all cells of the body, and the increasing data demonstrating a relationship of vitamin D metabolites to chronic diseases, have led to widespread treatment of medical conditions with vitamin D supplementation. Chronic pain and inflammatory conditions are increasingly linked to vitamin D deficiency. The question posed in this review is whether there is significant, quality research to recommend vitamin D supplementation for patients with chronic pain conditions. Utilizing publications from PubMed for the review, various search terms were entered for vitamin D (vitamin D; vitamin D2; vitamin D3; 1,25-dihydroxyvitamin D3; 1,25-dihydroxycholecalciferol; 25 hydroxycholecalciferol; 25-hydroxyvitamin D; alfacalcidol; calcidiol; calcitriol; calcifediol; calciferol; ergocalciferal; cholecalciferol); and "pain." The search was continued from the last day of the Straub et. al. review, September 8th, 2008. The last search was conducted on December 5, 2012. The search protocol from Straub et. al was followed as well. Also, added to this search protocol were the terms: vitamin D receptor; VDR and "pain." These terms enabled a search for genetic links between vitamin D and pain. The search criteria resulted in nine relevant articles (from the original 1,069 studies) with varying treatment protocols in each article making any statistical representation impossible. Results on the effectiveness of vitamin D correlation with chronic pain were extremely variable, with most papers drawing the conclusion that more quality research needs to be implemented on the subject. Due to the variability and lack of quality randomized controlled trials, the current literature can only suggest a possible link between vitamin D levels and pain. Also, recent research into Vitamin D Receptors (VDR) has opened up a possible connection between VDR polymorphisms and pain. So, after a comprehensive review of vitamin D, Vitamin D Receptors, and pain, there is still not enough evidence to recommend supplementation to treat chronic pain conditions. However, enough evidence is available to recommend future high quality, randomized controlled trials to help determine the influence vitamin D and VDRs have on pain issues. / Oral Biology
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REWARD-RELATED BEHAVIORAL EFFECTS OF PRESCRIPTION OPIOIDS AS A FUNCTION OF PUTATIVE ACUTE AND CHRONIC PAIN-LIKE STATES IN MALE AND FEMALE C57BL/6 MICENeelakantan, Harshini January 2014 (has links)
Pain is a leading cause of disability and the most common reason for clinical care. The field of pain research has focused on sex differences in the recent years with an expansive body of literature demonstrating sex-related differences in pain behavior and responsiveness to pharmacological interventions. Prescription opioids are potent analgesics and the mainstay for the clinical management of moderate-to-severe acute and chronic pain conditions. However, the long-term clinical use of prescription opioids for chronic pain remains controversial due to concerns about severe adverse effects, including tolerance, dependence, and addiction associated with opioid use. The non-medical use and abuse of prescription opioids has become a public health crisis, the problem even arising in a subset of chronic pain patients receiving opioid therapy. The vulnerability factors, specifically the role of pain in the propensity to prescription opioid abuse, are poorly understood. The present research project sought to investigate the propensity to opioid reward as a function of pain in male and female mice by incorporating acute (acetic acid-induced) visceral nociceptive and chronic chemotherapy (paclitaxel)-induced peripheral neuropathic pain models. Sexually dimorphic variations in the sensitivities of mice to nociceptive and allodynic behaviors were initially assessed using the two putative pain models. Following that, the two prescription opioids, morphine and oxycodone were examined under both pain contexts and the capacity of the two prescription opioids to produce reward-related behavioral effects were measured using drug discrimination, conditioned place preference, and intravenous drug self-administration procedures. The presence of acute noxious state but not chronic pain selectively attenuated the discriminative stimulus effects of the prescription opioid, morphine in male mice. The magnitude of modulation of the stimulus effects of opioids by the acute noxious state were further observed to be inversely related to the relative intrinsic antinociceptive effectiveness of the two opioids in reversing the acute noxious state and sex-specific sensitivities of mice to opioid-induced antinociception. In contrast, while no change was observed in opioid-reward as a function of the acute noxious state in both sexes, the presence of paclitaxel-induced chronic pain opioid-selectively and dose-selectively enhanced the conditioned rewarding effect of morphine (0.3 mg/kg dose), and the effect was more pronounced in male relative to female mice. These data were further supported by the self-administration results, in that the reinforcing efficacy (breakpoints under progressive ratio (PR) responding) and the incentive-motivational salience of morphine significantly increased in the presence of chronic pain in male mice, while non-selectively increasing regardless of the presence/absence of pain in female mice. Overall, the converging empirical evidence presented here suggest that these models provide preclinical tools to further understand the overlapping neurobiology of pain and opioid abuse, the behavioral effects of prescription opioids, and advance the development of novel sex-specific pain therapeutics with low addiction liability. / Pharmaceutical Sciences
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The relationship of antidepressant use, depression, depressive symptomatology and reported pain to multidisciplinary chronic pain treatment outcome measuresKnuppel, MarLane 06 June 2008 (has links)
This study was conducted to analyze various objective measures of treatment outcome among patients that participated in a multidisciplinary chronic pain treatment program and to compare these measures to the absence or presence of antidepressant medication, the level of depression, and the quality of pain and depression reported. In addition, this study examined whether there are certain patient characteristics that are related to treatment outcome measures.
Data was collected from the medical records of 232 patients who were admitted to and treated for various chronic pain syndromes at the Lewis-Gale Hospital Pain Center in Salem, Virginia.
Results of the study indicate that when chronic pain patients are subdivided into groups based on antidepressant drug use, depression level, reported quality of pain, and depressive symptomatology, there are distinct and significant differences before treatment when between-group comparisons are made. Within-group comparisons revealed significant differences between pre and post test measures for most groups studied, however, those with the most significant changes in scores included those patients on antidepressant medication, those patients with greater cognitive symptoms of depression, and those patients who were non-depressed. Patient characteristics that were significantly related to outcome included age, gender, duration of pain, employment, workers compensation, and litigation status. / Ph. D.
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What can we bring to the therapeutic relationship? A qualitative study of the beliefs and experiences of physiotherapists working with people with chronic painCarus, Catherine, Hunter, S.J. January 2017 (has links)
Yes / Objectives: To explore experienced physiotherapists’ attitudes, beliefs and experiences regarding their personal role in contributing to effective therapeutic relationships when working with people with chronic musculoskeletal pain. Design: Descriptive qualitative design using semi-structured interviews. Setting: Within physiotherapy departments in two National Health Service acute secondary care trusts in the North West of England. Participants: Six experienced physiotherapists working with people with chronic musculoskeletal pain. Data Analysis: Thematic coding analysis of transcribed interview recordings Main outcomes: Four overarching themes emerged from the data: Listening to the person; a caring understanding of the person’s situation; engaging the person and coming together; and moving forwards. Results: Participants emphasized the importance of building effective therapeutic relationships when working with people with chronic pain, seeking to create these by engaging with the person, to promote a strong collaborative partnership. Participants highlighted the themes of listening to the person’s story and showing a caring understanding of their situation through empathy and belief with validation. The final theme of moving forward emphasized how positive therapeutic relationships aid the rehabilitation process in enabling people to make positive changes in their lives. Conclusions: A clearer understanding of how physiotherapists engender positive therapeutic relationships has the potential to improve training and service development priorities for physiotherapists working in the area of chronic musculoskeletal pain. Future studies should seek to further define the core dimensions impacting therapeutic relationships, from the perspectives of both physiotherapists and people with chronic musculoskeletal pain. / Health Education Yorkshire and the Humber
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Promoting the role of pharmacists in chronic pain management: how can we make an impact on policy and practice?Hadi, M.A., Alldred, David P. 13 April 2015 (has links)
No
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Understanding long-term opioid prescribing for non-cancer pain in primary care: A qualitative studyMcCrorie, C., Closs, S.J., House, A., Petty, Duncan R., Ziegler, L., Glidewell, L., West, R., Foy, R. 12 November 2019 (has links)
Yes / Background: The place of opioids in the management of chronic, non-cancer pain is limited. Even so their use is
escalating, leading to concerns that patients are prescribed strong opioids inappropriately and alternatives to
medication are under-used. We aimed to understand the processes which bring about and perpetuate long-term
prescribing of opioids for chronic, non-cancer pain.
Methods: We held semi-structured interviews with patients and focus groups with general practitioners (GPs).
Participants included 23 patients currently prescribed long-term opioids and 15 GPs from Leeds and Bradford,
United Kingdom (UK). We used a grounded approach to the analysis of transcripts.
Results: Patients are driven by the needs for pain relief, explanation, and improvement or maintenance of quality
of life. GPs’ responses are shaped by how UK general practice is organised, available therapeutic choices and their
expertise in managing chronic pain, especially when facing diagnostic uncertainty or when their own approach is
at odds with the patient’s wishes. Four features of the resulting transaction between patients and doctors influence
prescribing: lack of clarity of strategy, including the risk of any plans being subverted by urgent demands; lack of
certainty about locus of control in decision-making, especially in relation to prescribing; continuity in the doctor-patient
relationship; and mutuality and trust.
Conclusions: Problematic prescribing occurs when patients experience repeated consultations that do not meet their
needs and GPs feel unable to negotiate alternative approaches to treatment. Therapeutic short-termism is perpetuated
by inconsistent clinical encounters and the absence of mutually-agreed formulations of underlying problems and plans
of action. Apart from commissioning improved access to appropriate specialist services, general practices should also
consider how they manage problematic opioid prescribing and be prepared to set boundaries with patients. / National Institute for Health Research (NIHR) under its Research for Patient Benefit Programme (Grant Reference Number PB-PG- 1010–23041).
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MMPI-2 Correlates of Chronic Pain: An Examination of the Role of AngerNieberding, Ron J. 08 1900 (has links)
The primary purpose of the present study was to examine the potential relationships that exist between anger expression, as measured by several MMPI-2 scales, and chronic pain.
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Four-step mindfulness-based therapy for chronic pain: a pilot randomized controlled trial. / 用於長期痛症的四部內觀療法: 一個先導的隨機對照研究 / CUHK electronic theses & dissertations collection / Yong yu chang qi tong zheng de si bu nei guan liao fa: yi ge xian dao de sui ji dui zhao yan jiuJanuary 2010 (has links)
Objective: Chronic pain is a common condition worldwide that poses significant impact to society in terms of its health and economic costs. It has been found to be related to a number of emotional and cognitive factors that are amenable to psychological treatments. Traditional cognitive-behavioral therapy (CBT) for chronic pain has become the gold standard of psychological treatment with reported efficacy. However, recent meta-analyses have found its effect size to be only modest at most. Moreover, its specific mechanisms of action are not well elucidated. With recent advances in neuroscience on possible neurocognitive processes underlying chronic pain, alternative treatment models targeting these specific neurocognitive processes are worth exploring. The present study tested the effectiveness of the Four-step Mindfulness-based Therapy (FSMT) for chronic pain in a randomized-controlled trial. The FSMT was chosen because of its explicit emphasis on altering neurocognitive processes that appear to be highly relevant in treating chronic pain. Method: Ninety-nine chronic pain patients in a hospital cluster-based outpatient pain clinic were randomly allocated to either the FSMT treatment or wait-list control group. The FSMT was modified for use with chronic pain and incorporated mindfulness exercises, such as mindful breathing and mindful meditation. Treatment consisted of eight weekly two-hour group sessions conducted by a clinical psychologist experienced in the implementation of the FSMT protocol. Assessment took place at baseline and post-treatment for both the FSMT and wait-list control. For the FSMT, assessment also took place at mid-group and 3-month follow-up. Results: Findings showed that the FSMT produced superior outcomes in terms of activity interference (primary endpoint), pain unpleasantness, and depression when compared to the wait-list control group or over time. Improvements were also found in the process measures of pain catastrophizing and pain acceptance. All treatment effects were maintained at follow-up. Further, the effects have been shown to be clinically significant and reliable above and beyond measurement errors. Mediational analyses revealed that pain catastrophizing and pain acceptance mediated the effects of FSMT on the outcomes of activity interference and depression; pain catastrophizing also mediated the effect of FSMT on the outcome of pain unpleasantness. Conclusions: The present study was the first to establish statistical and clinical evidence of the FSMT for chronic pain. It also revealed possible processes and mechanisms that might have brought about the changes in outcome, namely reduction in pain catastrophizing and improvement in pain acceptance. How the FSMT led to the outcome changes via these two processes was discussed and enriched by neurocognitive perspectives. Future studies should seek to further compare the FSMT with other active psychological treatments for chronic pain and collect neuroimaging data to further illustrate the neurocognitive processes involved. / Wong, Chi Ming. / "October 2009." / Adviser: Freedom Leung. / Source: Dissertation Abstracts International, Volume: 72-01, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 139-175). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.
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Heart rhythm variability in persons with chronic pain.Saxon, LaDonna Christine 08 1900 (has links)
The present study evaluated the utility of heart rhythm coherence (HRC) feedback to reduce the reported pain intensity of patients enrolled in a multimodal pain management program. Participants were recruited and assigned to a usual treatment group (UT) or a heart rhythm coherence feedback group (UT+HRC). It was hypothesized that UT+HRC participants who achieved heart rhythm coherence would report a reduction of pain intensity, as measured by the McGill Pain Inventory. For those whose pain intensity decreased, it was also expected that their self reported levels of depression as measured by the Beck Depression Inventory-Second Edition and state anger as measured by the State Trait Anger Inventory would decrease. It is also hypothesized that with a reduction in pain levels, anger, and depression, blood pressure would also decrease among those who had high blood pressure prior to the intervention. Multivariate analyses of variance (MANOVA) were used to investigate the relationship between treatment condition, coherence status and pain levels. A series of independent t-tests were utilized to investigate the change in pain, depression, and state anger from baseline to posttest, followed by Pearson product moment correlation coefficients on difference scores to understand the relationship between the outcome variables for Hypothesis 2. Standard multiple regression analyses were computed using difference scores to determine if the outcome measures were significant predictors of systolic blood pressure and diastolic blood pressure. Results indicated a failure to reject the null with regard to hypothesis one. No relationship between treatment assignment, coherence status or pain levels were found. Hypothesis 2 was partially supported. Although there was a positive significant relationship between depression and anger when utilizing difference scores, these affective measures were not related to difference scores on either pain measure. In regard to Hypothesis 3, there was also a failure to reject the null. None of the outcome measures utilized in this study emerged as being significantly related to changes in systolic or diastolic blood pressure. Limitations of the study and implications for future research are offered.
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