The present study investigated the influence of a brief, intensive biofeedback-assisted imagery training regimen on psychological, physiological and neuroendocrinological measures of pain and stress in injury related chronic pain patients. The subjects were 36 patients (myelography examcandidates) who were assigned to the imagery or wait-list control group by order of referral presentation and to formulate equivalent groups.

Background: Chronic pain is a common and occurring disease that creates pain and suffering for many people. The painful experience is individually unique and is affected by many different factors. The insufficient knowledge regarding the assessment of chronic pain makes it difficult to abate the suffering from the individuals. Nurses´ perception and comprehension about chronic pain may hinder them from listening to the patient´s need. The nurse creates conditions for a functioning dialogue. An increased understanding from a patient´s point of view is necessary in order to comprehend the patient´s need. Aim: The aim is to highlight the experiences of people living with chronic pain. Method: This literature review is influenced by Friberg (2012). 12 qualitative scientific articles were obtained and analyzed from three different databases. Results: The result demonstrates two main categories with related sub-categories. The first category highlights how pain affects peoples´physical, emotional, social and existential aspects when the pain takes over. The latter describes how people manage the pain through strategies and acceptance. Discussion: The result is discussed from Armstrong´s symptoms experience model that demonstrates that people living with chronic pain gives meaning to their experience of pain in various ways, which may tend to give positive and negative impact in their daily life. Moreover, the result connects to Ericsson´s concepts regarding the Caring Science such as, suffering in illness, life, and healthcare. It also describes the theory of a person in suffering which can affect the individual as a whole. / Bakgrund: Långvarig smärta är vanligt förekommande och skapar ett lidande hos människor. Smärtupplevelsen är unik för varje individ och påverkas av många olika faktorer. Otillräcklig kunskap i bedömningen av långvarig smärta medför svårigheter i att lindra lidande. Sjuksköterskors föreställningar om smärta kan vara hinder för att lyssna på patienten. Sjuksköterskan skapar förutsättningar för en väl fungerande dialog. En ökad förståelse för patientens perspektiv är nödvändigt för att förstå patientens behov. Syfte: Syftet är att belysa människors upplevelser av att leva med långvarig smärta. Metod: Metoden är en litteraturöversikt influerad av Friberg (2012). 12 kvalitativa vetenskapliga artiklar inhämtade ur tre olika databaser har analyserats. Resultat: Resultatet presenterar två huvudkategorier med tillhörande underkategorier. Den första huvudkategorin: När smärtan tar över belyser hur smärta påverkar människor ur fysiska, psykiska, sociala och existentiella aspekter. Den andra huvudkategorin: Vägen till att kunna hantera smärtan uppmärksammar människors sätt att hantera smärtan genom strategier och acceptans. Diskussion: Resultatet diskuteras utifrån Armstrongs symtomupplevelsemodell som visar att människor ger mening åt smärtupplevelser på olika sätt, vilket kan medföra en positiv eller negativ inverkan i deras liv. Vidare knyts resultatet till Erikssons vårdvetenskapliga begrepp: sjukdomslidande, livslidande och vårdlidande samt teorin om den lidande människan som beskriver att smärtan kan påverka människan som helhet.

Psychosocial functioning is a key component of screening and treatment of Temporomandibular Disorders (TMD) in adults; however, psychosocial functioning in adolescents with TMD has received little empirical attention. The present study aims to examine group difference between adolescents and adults with TMD on pain and prominent psychosocial factors, such as anxiety, depression, and somatization, as well as to explore additional developmentally sensitive psychosocial factors that may be associated more with the adolescent TMD pain. Participants included 35 adolescents aged 12-17 (M=14.89 years, SD=1.84) with TMD muscle pain who completed pain questionnaires and a comprehensive dental examination. Patients and their primary caregivers completed behavioral questionnaires to examine psychosocial functioning. Thirty-five adults matched on gender, diagnosis, and duration of pain were selected from a large pre-existing database of previous orofacial pain patients. Adolescents and adults reported descriptively similar TMD pain and equivalent rates of anxiety, depression, and somatization; however, the relationship between these psychosocial factors and TMD pain appear to be more salient for adults compared to adolescents. In adolescents, increased pain-related interference was significantly associated with positive attitudes toward school, better anger control, and deficits in functional communication; whereas, more frequent TMD pain was significantly associated with sense of inadequacy and parent-reported withdrawal, though not in the expected direction. Screening for TMD in adults typically focuses on anxiety, depression, and somatization; however, these psychosocial factors overall did not appear as salient in adolescents as attitude toward school, anger control, sense of inadequacy, withdrawal, and functional communication, suggesting that adult psychosocial screen may need to be revised to include developmentally sensitive targets that may be particularly important for screening of TMD in adolescents.

<p>This thesis deals with a behavioural medicine approach to the management of patients with persistent musculoskeletal pain in primary health care physical therapy. The main aims of the thesis were; to develop, and evaluate the psychometric properties of, a screening instrument for risk of disability and; to evaluate the implementation and effects of a targeted and tailored treatment. </p><p>The studies comprise four samples of patients with musculoskeletal pain exceeding one month. All subjects were recruited when consulting physical therapists in Swedish primary health care settings. For development and evaluation of the Pain Belief Screening Instrument (PBSI) four samples were used; two samples (n₁ = 215 and n₂ = 93) in Study I, one sample (n = 168) in Study II, and one sample (n = 45) in Study III. For evaluation of implementation and effects of targeted and tailored treatment the 32 patients who completed treatment in Study III were used. In Study IV treatment documents of 18 patient cases from Study III were studied to evaluate treatment integrity. </p><p>The concurrent and predictive validity of the PBSI was good, and the instrument was therefore used to define subgroups with either a high or low risk for disability. A low treatment dosage of a tailored treatment for low risk patients was tried and found equally efficient as a longer treatment focusing physical exercise. Subjects who received a treatment tailored to individual patient characteristics perceived a better global outcome of treatment compared to subjects in the control group. However, no between-group differences in the disability measures were found. The evaluation of treatment integrity displayed low therapist adherence to the treatment rationale for the tailored treatment. </p><p>The studies demonstrate ways to systematically integrate a behavioural medicine approach and physical therapy. The results indicate efficiency in managing patients with persistent musculoskeletal pain in primary health care.</p>

Despite recent research advances, there are still several common medical conditions whose underlying mechanisms are poorly understood. In conditions with few or diffuse physical findings, it can be difficult to diagnose and determine the state of the condition and its effects on working ability or performance, and the health care practitioners have to rely on the patient’s self-reports. Identification of objective measurements that are sensitive enough to aid in diagnosis or determination of the state of these conditions would thus be valuable. Psychophysiological measurements are generally non-invasive and have the potential to serve as such diagnostic or prognostic tools. In this thesis, psychophysiological reactions to different stressors were recorded in two selected medical conditions; namely motion sickness and chronic trapezius myalgia (musculoskeletal pain). These subjective conditions are unpleasant, unwanted and apparently serve no survival purpose. It is therefore important to elucidate any physical findings associated with them to, eventually, find new means to prevent the development of these conditions or to ameliorate symptoms. The overall aim of the thesis was to explore the development of psychophysiological responses to stressors in relation to performance and subjective reports in healthy individuals and in women with chronic trapezius myalgia. More in detail, the purpose was to identify psychophysiological responses that could provide information about the mechanisms behind, or serve as candidates for characterization of motion sickness and chronic trapezius myalgia, respectively. Responses to motion sickness, triggered by optokinetic stimulation, were studied in healthy individuals, whereas responses to repetitive low-force work and psychosocial stress were studied in women with chronic trapezius myalgia and in pain-free controls. In both medical conditions, the psychophysiological responses were accompanied by subjective reports. The effects of motion sickness on two different aspects of memory performance were tested during exposure to optokinetic stimulation. In the studies of chronic trapezius myalgia, psychophysiological responses were also related to health status, i.e., being a patient or a pain-free control and measurements of pain intensity, psychological symptoms, sleep-related problems and quality of life. The psychophysiological responses to optokinetic stimulation were inconclusive. Moderate levels of motion sickness did not affect memory performance, whereas decreased short term memory performance was seen in subjects reporting high levels of motion sickness. The autonomic responses and stress hormone secretion in response to low-force repetitive work and psychosocial stress in the chronic trapezius myalgia group were similar to those of the pain-free controls. However, muscle activity in the trapezius muscle was generally higher in the chronic trapezius myalgia group. There were indications of negative psychological states being related to a slower response and lower circadian variations of stress hormone secretion. With the present methods, it was possible to measure general stress responses but none of the measurements showed sufficient specificity to serve as predictors or indicators of motion sickness and chronic musculoskeletal pain, respectively. Summarizing, I cannot objectively measure how you feel; I still have to rely on your description of your condition.

Background: In recent years Acceptance and Commitment Therapy (ACT) has gained increasing status as a promising approach to treating chronic pain physical functioning and psychological well-being. The basic premise of ACT as applied to chronic pain is that while pain hurts, it is the struggle with pain that causes suffering. This approach aims to restore effective and adaptive functioning for an individual within a context of continuing pain so that the individual can live a more vital and meaningful life. There is a growing empirical support for the effectiveness of ACT however research has relied on self-reported quantitative outcomes, focused on addressing changes in pain intensity and the physical and psychological impact of chronic pain. There appears to be a gap in the literature on the exploration of the experience of attending an ACT programme for chronic pain from the patient’s perspective. Aim: This study sought to explore the experience of attending an ACT programme for chronic pain within an outpatient NHS hospital setting. Furthermore the study sought to explore the modulating factors influencing clients learning and understanding of the construct of acceptance from the perspective of the participants. Additionally, the experience of attending a group based ACT intervention was explored. Methodology: A qualitative methodology was chosen for the project. The study used a purposive sample of twelve participants, who had all attended the Luton & Dunstable Hospital ACT 8 week outpatient programme for chronic pain. The participants were interviewed through the use of a semi structured interviews, and the transcripts were transcribed and then analysed using Thematic Analysis. Identified themes were further organised using the tool of Thematic Network Analysis. Results: Three global themes emerged from the analysis of the data. The first global theme encompassed the participant’s pre-programme expectations and this theme highlighted the participant’s feelings of hope and hopelessness prior to attending the programme. The second global theme demonstrated the on-going process of living with chronic pain and highlighted the benefits and barriers to adopting and ACT based approach to chronic pain. Finally the third global theme addressed the experience of a group based intervention and included the positive and negative aspects of this experience for the participants. Clinical Implications & Conclusion: Based on the results of this study a number of clinical implications were highlighted in relation to the future development of ACT programmes for chronic pain. These included suggestions in relation to engaging participants in such programmes. Notably, timing issues, validation of physical symptoms, and consideration of the potential barriers to acceptance and understanding of the benefits of adopting and ACT group based pain management approach were discussed.

The current literature highlights the significant role of psychological factors including cognitive (pain related thoughts and beliefs) and acceptance components (pain willingness, activity engagement, psychological inflexibility) in the management of chronic pain. The research is however in the preliminary stages in terms of investigating the specific relationships that exist between these psychological processes in their ability to predict adjustment to pain. This study aims to extend the current findings by investigating the relationships between several cognitive and acceptance components in their ability to predict emotional and physical adjustment in the context of chronic pain. The hypotheses that cognitive and acceptance components mediate the relationship between pain severity and pain adjustment, and also that acceptance mediates the relationship between cognitive components and pain adjustment will be tested. Method The study employed a cross-sectional survey-based design, including 214 chronic pain patients recruited from an NHS pain clinic. Participants completed a series of self-report questionnaires measuring pain severity, fear of movement beliefs, pain self-efficacy beliefs, pain catstrophising, acceptance and psychological flexibility, pain disability, and depression and anxiety. Structural Equation Modeling was used in order to conduct path analyses, investigating the complex relationships between these variables in predicting physical and emotional adjustment to chronic pain. Results The results from a Confirmatory Factor Analysis indicated that a three factor model comprising pain, cognitive and acceptance components as separate latent variables had a poor fit and therefore could not be used in further analysis. The results of path analyses showed that pain self-efficacy was the only variable to have a strong mediating influence between pain and physical adjustment. Findings also supported a nested path model demonstrating that acceptance, catastrophising and self-efficacy were mediators between pain and emotional adjustment, and that acceptance was also a mediator for pain catastrophising and a partial mediator for pain self-efficacy in their relationship with emotional adjustment. Conclusions The importance of pain self-efficacy specifically in predicting physical adjustment to pain is highlighted. A more complex model however is required to explain emotional adjustment, with acceptance playing a more prominent role in comparison with other variables. The findings also provide support for both Cognitive and Acceptance-based interventions in improving adjustment to living with chronic pain. Given the preliminary nature of these findings, further research employing similar statistical methods are required to provide further support.

Bakgrund: Långvarig smärta definieras som smärta som inte har gått över på 3-6 månader. Smärta är en individuell upplevelse som inte kan mätas objektivt, utan den som upplever vet själv hur intensiv den är och smärtans duration. Syfte: Syftet med denna litteraturstudie var att beskriva patienters upplevelser av att leva med långvariga smärta ur ett psykosocialt perspektiv. Syftet var också att beskriva vilka datainsamlingsmetoder de vetenskapliga artiklarna har använt sig av. Metod: Föreliggande litteraturstudie har en deskriptiv design. Föreliggande litteraturstudies resultat baseras på 12 kvalitativa vetenskapliga artiklar som har sökts fram genom databaserna CINAHL och PubMed. Huvudresultat: Sammanställningen av de inkluderade artiklarna visade på upplevelser av känslomässig påverkan på patienternas liv som ett kraftigt lidande och negativa tankar inför framtiden. Smärta upplevdes också ge sociala begränsningar i arbetslivet, förlust av identitet samt sociala relationer. Patienterna upplevde ett negativt bemötande från sjukvårdspersonalen. Slutsats: Upplevelser av smärta påverkade patienterna psykiskt och socialt. Smärta har resulterat till känslomässig påverkan och lett till sociala begränsningar i både arbetslivet och relationen till familj, vänner och barn. Upplevelsen av sjukvårdspersonalens bemötande upplevdes negativt av patienterna, där smärtan inte togs på allvar. Detta i sin tur påverkade de att få någon behandling eller mediciner. Författaren till föreliggande litteraturstudie menar att utifrån föreliggande litteraturstudies resultat finns brister hos sjukvårdpersonalen, detta i sin tur kan vara till hjälp att öka sjukvårdens kunskaper om dessa patienters upplevelser av långvarig smärta samt att kunna bemöta de på ett värdigt och respektfullt sätt. Det är viktigt att tro på patienters smärta och kunna sträcka de hjälpande hand. / Background: Chronic pain is defined as pain that has not gone over 3-6 months. Pain is an individual experience that cannot be objectively measured, but that experience knows how intense it is, and pain duration. Aim: The aim of this literature review was to describe patient's experiences of living with chronic pain from a psychosocial perspective. The aim was also to describe the data collection methods of scientific articles have used. Method: This literature review has a descriptive design. This literature review study's results are based on 12 scientific articles that have been found through the database CINAHL and PubMed. Result: The compilation of the included articles led to perceptions of emotional impact on patients' lives as a major suffering and negative thoughts about the future. Pain was felt also that the social constraints of working life, loss of identity and social relationships. Patients experienced a negative attitude of medical staff. Conclusion: Experiences of pain affect patients psychologically and socially. Pain has led to the emotional impact and led to social constraints in both working life and relationship to family, friends and children. Experience of healthcare professionals experienced negative treatment of patients where the pain is not taken seriously. This in turn affected the receive any treatment or medication. The author of this literature review means that based on present literature studies results are deficiencies in health care, this in turn may help to increase medical knowledge of these patients experience chronic pain as well as to cope with the in a dignified and respectful manner, believing the pain and to extend helping hand to patients

No description available.

Chronic pain is a widespread problem, especially in the older population, and can affect various aspects of daily living. At a time when it has been acknowledged that the population is increasingly ageing, research regarding the effects of chronic pain on the daily living of older adults is essential. Furthermore, the development of innovative technology is changing the way that much research is being conducted, and can lead to the retrieval of novel information, using a fresh approach. The adoption of this technology in the field of chronic pain research has the potential to examine various aspects of the daily living of older adults living with chronic pain using a different approach to previous research. This study is underpinned by a Critical Realist ontology and Hermeneutic epistemology and follows a Generic Qualitative Research methodology (Caelli, et al., 2003). The aim of the study was not to generalise the findings but to gather a deep theoretical description of the outcomes and offer an explanation of these findings based on an analysis of the multiple research methods used within the study. This study had two main aims and was split into two sections according to the aims. Firstly, Part A of this study aimed to explore a range of day-to-day patterns and experiences of functioning in older adults suffering from chronic pain. Part B aimed to explore the usability, acceptance and experience of the technology used to measure functioning as part of the first aim of this study. Part B also aimed to look at the practicalities the participants were faced with when using the technology. A mixed methods design was used for Part A in which 15 older adults (65+) living with chronic pain (pain >3 months) took part in an in-depth study lasting seven days. As well as the 15 core participants that took part in the study, two older adults (65+) without chronic pain and two younger adults (<65) with chronic pain took part in the study in order to provide some insight into the effects of either pain, or age, on functioning. Part A used four data collection techniques to gather data upon the daily functioning of older adults with chronic pain; the Daily Reconstruction Method diary (Kahneman, Krueger, Schkade, Schwarz, Stone, 2004), the Sensecam (also known as the Vicon Revue, Vicon©), the LifeShirt (Vivometrics Inc) and a semi-structured interview. However, although the LifeShirt was validated, as part of this PhD, and used throughout the study, the gathered data was not analysed due to multiple problems with the data. The Daily Reconstruction Method, Sensecam and the semi-structured interview were each analysed separately before the results of the Daily Reconstruction Method and Sensecam were integrated into the themes derived from the semi-structured interviews. The integrated results led to the development of two themes, each with sub-themes; ‘effect on daily living’ and ‘managing pain and functioning’. The themes from Part A highlighted the way in which pain affected functioning and the modifications to daily functioning as a result of chronic pain. The way in which individuals perceived the management of their own pain and functioning, as well as strategies and assistive devices to manage pain and functioning were also discussed. This study has furthered current knowledge due to the idiographic nature of the study, as well as multiple, novel, data collection tools used, adding additional details to how tasks have been modified, reduced, or terminated. Part B of this study used the Unified Theory of Acceptance and Use of Technology (UTAUT, Venkatesh, et al., 2003), the Flow-State Scale (Jackson & Marsh, 1996) and semi-structured interviews to explore participants’ use of both the Sensecam and LifeShirt. The questionnaires and interviews were carried out with all of the individuals that carried out Part A of this research. From the semi-structured interviews two main themes were reported, each with sub-themes; ‘expectations and experiences’ and ‘awareness of equipment’. Two concepts developed from the themes within Part B that were specific to the participants’ experiences of wearing wearable technology in this study, as opposed to ‘typical’ non-wearable technology; specifically, the importance of design and the importance of others. Both of these overarching concepts affected the expectations of the technology, the experiences of using the technology, as well as the awareness of the technology during use. Furthermore, both concepts will remain and are long-lasting, despite the development of the technology in this field, but there are specific details that are contemporary and are specific to either the Sensecam or the LifeShirt as used in this study.