Background: Minor procedures in surgery and urology such as groin hernia and hydrocele repair, as well as prostate biopsies are very frequently done in routine practice. Complications and insufficient outcomes thus affecting many patients and the cumulative effect of this are of major importance in a population perspective. Aim: To explore complications and outcomes of surgical or diagnostic procedures and possible risk factors or predictors for adverse effects. Methods: By using both national quality and administrative registers, and by complementing registers with patient reported outcome measures, examine outcomes such as complications, persistent pain and recurrences. Also, in the case of hydro and spermatoceles, report incidence numbers. Further, by using a randomized trial, explore minimally invasive procedure such as sclerotheraphy compared to conventional surgery in respect to cure and adverse events. Results: When comparing with the open anterior mesh repair, endoscopic technique is advantageous in respect to the patient reported outcome of persistent pain. The drawback was an increased risk of postoperative complications and reoperation for recurrence. Incidence numbers for hydro and spematocele were 100/100000 men. Aspiration (± sclerotherapy) had a significantly lower rate of complications as compared to conventional surgery. In the interim analysis of the randomized trial, comparing sclerotherapy to Lord´s procedure for hydroceles, the cure rate was similar between treatments. Definite conclusions cannot be made due to the risk of type 2 errors, and the study will thus continue. In the case of trans-rectal prostate biopsy, the rates increased every year during the study time frame, up to an approximate risk of two per cent in 2012 for hospital readmission within 30 days, without an increased mortality within 30 days. Conclusions: The open anterior mesh procedure is still the preferred method for groin hernia repair in routine surgical practice. Hydro and spermatocele surgery is associated with high rates of complications, and the indication for repair should be scrutinized. The rates of infection after prostate biopsy is increasing and methods to reduce unnecessary biopsies as well as improved prophylaxis should be investigated.

Millions of people in the US currently suffer from chronic pain but available therapeutics do not provide effective chronic pain treatment. Opiate therapy is still the gold standard for chronic pain management with detrimental side effects, such as tolerance, addiction, constipation, and respiratory depression that limit their therapeutic potential. Opiates exert their positive and negative effects by activating the μ opioid receptor (MOR). Conversely, the κ opioid receptor (KOR) has been shown to modulate the tolerance and addiction produced by MOR agonists and is also involved in mood modulation (anxiety and depression). Therefore, blocking KOR activation results in positive effects against opiate side effects and stress-related depression. Dynorphin A (Dyn A) is the endogenous opioid peptide for the KOR. Structure-activity relationship (SAR) studies were carried out to develop a KOR selective antagonist based on the Dyn A structure. A minimum Dyn A pharmacophore with improved stability, no cell toxicity, and antagonist activity was discovered. Peptidomimetic enkephalin analogues previously developed in our group as MOR and δ opioid receptor (DOR) agonists have shown multifunctional activity, with MOR/DOR agonist and KOR antagonist activities. To our knowledge, this finding is first of its class for the opioid receptors. Novel design and synthesis of KOR selective ligands based on our multifunctional enkephalin analogues was done. Successful peptide synthesis resulted in analogues with high stability in rat plasma and no cell toxicity.

Opioider har blivit en vanligare behandlingsmetod för patienter med långvarig smärta som bidrar till att patienten upplever adekvat smärtlindring. Smärtlindringen kan dock leda till att patienter utsätts för opioidinducerade risker som leder till att patienten inte erhåller adekvat smärtlindring. Syftet med studien var att belysa patienters upplevelser av att behandlas med opioider vid långvarig smärta. Litteraturstudien utgår från en induktiv ansats och resultatet grundas på 14 vetenskapliga artiklar, varav sju artiklar är kvalitativa samt sju är kvantitativa. En innehållsanalys användes vilket resulterade i tre olika teman: Det professionella och sociala stödet, Inverkan på kropp och själ samt Vilja till att bemästra opioidbehandlingen. Resultatet visade både positiva och negativa upplevelser bland patienter med långvarig smärta som behandlas med opioider. Patienterna upplevde det professionella mötet som särskilt betydelsefullt då det ingav hopp och stöd. Patienter kunde däremot också uppleva förutfattade meningar samt negativa attityder vilket bidrog till bristfällig omvårdnad för patienterna. Studien föreslår att sjuksköterskor är i behov av utbildning och kunskap angående opioider och dess inverkan på kroppen för att bidra med god patientutbildning samt god omvårdnad. / Opioids have become a common method of treatment for patients with chronic pain that contribute to adequate pain relif. Pain relief can lead to patients being exposed to opioid-induced risks that causes inadequate pain relief for the patients. The aim of the study was to highlight patients experiences of being treated with opioids for chronic pain. The literature review is based on a inductive approach and the results are based on 14 scientific articles, including seven qualitative articles and seven quantitative articles. A content analysis of the article was used which resulted in three different themes: The professional and social support, Impact on the body and mind and Will to overcome opioid-therapy. The result showed both positive and negative experiences among patients with chronic pain treated with opioids. Patients experienced the professional meeting as particularly significant because it gave them hope and support. Patients could however also experience prejudice and negative attitudes which contributed to inadequate care for the patients. The study suggests that nurses are in need of education and knowledge about opioids and their impact on the body to contribute with good patient education and good nursing care.

Denna tvärsnittsstudie syftade till att undersöka samförekomst av smärtrelaterad rädsla och social ångest i ett kliniskt sample med kronisk smärtproblematik. Syftet var också att beskriva och kontrastera samvariation av transdiagnostiska faktorer i eventuella subgrupper. Datan bestod av enkätsvar från 196 deltagare i Social ångest smärta-projektet som leds av Örebro universitet och Akademiska sjukhuset i Uppsala. En klusteranalys fick fram fyra subgrupper bland deltagarna. En subgrupp utmärkte sig för hög komorbiditet. Denna grupp visade höga nivåer av tänkbara transdiagnostiska faktorer som ångestkänslighet och negativ affekt, samt hög smärtkatastrofiering. Det diskuterades kring dessa faktorers roll som sårbarhets- och vidmakthållandeprocesser, utifrån aktuella teoretiska modeller. Studiens kliniska implikationer belyser behovet av hänsyn till dessa faktorers roll vid behandling och framtida forskning. / This cross-sectional study aimed to explore co-occurrence of pain-related fear and social anxiety in a clinical sample with chronic pain. The purpose was also to describe and contrast co-variation of transdiagnostic factors in potential subgroups. The data consisted of 196 answered questionnaires from the Social anxiety pain-project led by Örebro University and the Uppsala University Hospital. A cluster analysis produced four subgroups among the participants. One subgroup was salient for its high comorbidity. This group showed high levels of potential transdiagnostic factors such as anxiety sensitivity and negative affect, as well as high pain catastrophizing. These factors are discussed in terms of their role as vulnerability and maintaining factors, in the light of current theoretical models. The clinical implications of this study suggest taking the role of these factors into account in aspects of treatment and future research.

<p>Chronic pain is a distressing, prevalent, and expensive condition that is not well understood and difficult to treat. Spinal cord stimulation (SCS) has emerged as a viable means of managing chronic pain when conventional therapies are ineffective, but the efficacy of SCS has improved little since its inception. The mechanisms underlying SCS, in particular the neuronal responses to SCS, are not well understood, and prior efforts to optimize SCS have focused on electrode design and spatial selectivity without considering how the temporal aspects of SCS (stimulation frequency, pattern) may affect neuronal responses to stimulation. The lack of a biophysical basis in prior attempts to optimize therapy may have contributed to the plateau in the clinical efficacy of SCS over time. This dissertation combines computational modeling and in vivo electrophysiological approaches to investigate the effects of SCS on sensory neuron activity in the dorsal horn and uses the insights gained from these experiments to design novel temporal patterns for SCS that may be more effective than conventional therapy.</p><p>To study the mechanisms underlying SCS, we constructed a biophysically-based network model of the dorsal horn circuit consisting of interconnected dorsal horn interneurons and a wide dynamic range (WDR) projection neuron and representations of both local and surround receptive field inhibition. We validated the network model by reproducing cellular and network responses relevant to pain processing including wind-up, A-fiber mediated inhibition, and surround receptive field inhibition. To quantify experimentally the responses of spinal sensory projection neurons to SCS, we recorded the responses of antidromically identified sensory neurons in the lumbar spinal cord during 1-150 Hz SCS in both healthy rats and neuropathic rats following chronic constriction injury (CCI). In a subset of rats, we additionally assessed the impact of GABAergic inhibition on spinal neuron responses to SCS by conducting SCS experiments following the intrathecal administration of bicuculline, a GABAA receptor antagonist, and CGP 35348, a GABAB receptor antagonist. Finally, we used the computational model to design non-regular temporal patterns capable of inhibiting sensory neuron activity more effectively than conventional SCS and at lower equivalent stimulation frequencies than clinical standard 50 Hz SCS, and we experimentally validated model predictions of the improved efficacy of select patterns against conventional SCS.</p><p>Computational modeling revealed that the response of spinal sensory neurons to SCS depends on the SCS frequency; SCS frequencies of 30-100 Hz maximally inhibited the model WDR neuron consistent with clinical reports, while frequencies under 30 Hz and over 100 Hz excited the model WDR neuron. SCS-mediated inhibition was also dependent on GABAergic inhibition in the spinal cord: reducing the influence GABAergic interneurons by weakening their inputs or their connections to the model WDR neuron reduced the range of optimal SCS frequencies and changed the frequency at which SCS had a maximal effect. Experimentally, we observed that the relationship between SCS frequency and projection neuron activity predicted by the Gate Control circuit described a subset of observed SCS-frequency dependent responses but was insufficient to account for the heterogeneous responses measured experimentally. In addition, intrathecal administration of bicuculline, a GABAA receptor antagonist, increased spontaneous and evoked activity in projection neurons, enhanced excitatory responses to SCS, and reduced inhibitory responses to SCS, consistent with model predictions. Finally, computational modeling of dual frequency SCS, implemented by delivering two distinct frequencies simultaneously to distinct fiber populations, revealed frequency pairs that were more effective at inhibiting sensory neuron activity than equivalent conventional SCS and at lower average frequencies than clinically employed 50 Hz SCS. Experimental assessments of the effect of dual frequency SCS on spinal sensory neurons confirmed model predictions of greater efficacy at lower equivalent stimulation frequencies and suggest the use of non-regular temporal patterns as a novel approach to optimizing SCS. The outcomes of this dissertation are an improved understanding of the mechanisms underlying SCS, computational and experimental tools with which to continue the development and improvement of SCS. The insights and knowledge gained from the work described in this dissertation may result in translational applications that significantly improve the therapeutic outcomes of SCS and the quality of life of individuals affected by chronic pain.</p> / Dissertation

It is believed by many researchers that little attention has been given to patients' perceptions of the impact of chronic pain on their lives. In recognition of this need, G. Frank Lawlis, C. Edward McCoy, and David K. Selby developed the Dallas Pain Questionnaire (DPQ) to assess the amount of chronic pain that affects four aspects (daily activities, work-leisure activities, anxiety-depression, and social interest) of the patients' lives. The present study, conducted to validate the DPQ's statistical properties, first reviews the literature addressing the various theories and varieties of pain, its opiates, and the two current approaches to quantify pain. This study included a total of 143 subjects. Clinical subjects were 104 inpatients in the Spinal and Chronic Pain Center at Medical Arts Hospital and 15 chronic pain outpatients released to work. Normal subjects consisted of staffing personnel (n = 13) and flight assistance employees (U = 11)- Both clinical and normal groups completed the DPQ. The Minnesota Multiphasic Personality Inventory (MMPI) was administered only to the clinical population. Results suggest that the DPQ is both externally reliable (stability reliability coefficient of .970) as well as an internally consistent instrument. Two factors emerged from factor structure analysis. Factor one (63.2% of variance) represents functional activities. Factor two (8.3% of variance) represents emotional capacities. A correlation analysis suggests the concurrent validity of the psychological and functional factors of the DPQ. A t-test demonstrated that chronic pain patients have significantly higher DPQ's scores than normals. Because these findings support its psychometric properties, the DPQ appears to have utility for clinical and research purposes. The findings, limitations, and implications of this study are detailed, as are suggestions for future research.

The purpose of the present study was to investigate cognitive functioning in a group of 30 chronic pain patients (CPG) as compared to a group of 39 acute pain patients (APG). In order to assess cognitive performance, certain subtests were selected from the McCarron-Dial System (MDS) of Neuropsychological Evaluation. Specifically, a measure of haptic discrimination was used along with the Bender Visual Motor Gestalt Test. As such, completion of these subtests required a cortically mediated, central nervous system processing of sensory information. This particular method of assessment was chosen because it provided a nonverbal measure of higher-order cognitive performance. Additionally, the haptic measure provided separate scores for right and left hemispheric functioning. Data analysis revealed significantly poorer Bender performance among CPG members (t(69) = -5.09, E - •0004, two tailed). Further data analysis revealed that the CPG performed significantly poorer on certain of the haptic discrimination subtests. Specifically, both texture and configuration scores for the right hemisphere were significantly lower among CPG members (texture, p = -042 and configuration, p = .002). Subsequent analyses were conducted to determine predictive relationships between important variables. These data are discussed in terms of their clinical significance and importance for future research.

The current study examined the ability of pain-related catastrophizing to predict outcomes following non-surgical and surgical intervention for temporomandibular disorders (TMDs). The interpersonal context of pain-related catastrophizing, referred to as the communal coping model, was also examined to determine if patient perceptions of punishing and solicitous responses from significant others would moderate or mediate relations between pain catastrophizing and outcomes. The role of pain duration as a moderator of the relation between pain-related catastrophizing and perceived significant other responding was also examined. A total of 94 patients were identified for which 65 had follow-up outcomes that could be examined. Patient follow-up data were obtained at approximately two to three weeks, two to three months, and six months post-intervention. Results showed that pain-related catastrophizing was predictive of greater pain severity at all three follow-up time points after controlling for baseline levels of pain severity, depressive symptoms, sleep disturbance, and pain duration. Pain-related catastrophizing was predictive of poorer range of motion (ROM) at the initial follow-up after controlling for baseline levels of ROM, gender, and form of intervention. Pain-related catastrophizing was not associated with ROM at the second and third post-intervention follow-ups. There was no interaction between pain-related catastrophizing and perceptions of either solicitous or punishing responses in predicting post-intervention pain severity or ROM and any time point. Perceptions of significant other responses also did not mediate the relation between pain-related catastrophizing and post-intervention outcomes at any time point. Additionally, the interaction between pain duration and pain-related catastrophizing in the prediction of post-intervention pain severity or ROM was not significant at any follow-up time point. The findings indicate that pain related catastrophizing is an important predictor of pain severity following non-surgical and surgical interventions for TMDs both initially and in the long-term. Pain-related catastrophizing is related to ROM outcomes only in the short term. Perceptions of punishing and solicitous responses from significant others do not appear to play a role in these associations. The results suggest that patients with high levels of pre-intervention catastrophizing may benefit from adjunctive cognitive-behavioral intervention to attenuate post-intervention pain severity.

This diploma thesis summarizes recent knowledge about body scheme, spatial orientation and their change in context of chronic pain. The purpose of this work is to find out if chronic pain negatively affects the body scheme and spatial orientation. The thesis includes a comparative analysis of experimental measurements between the patients with Failed Back Surgery Syndrome and healthy control group. The analysis compares tasks based on spatial orientation and body scheme tests. Results show the patients' group having lower results in body scheme related tests, showing a noticeable disparity compared to the control group's test scores. These results were further supported by portion of spatial orientation based tasks, where patients' group again performed at significantly lower level than the control group. In conclusion, our thesis, along with other academic works, states that there is a correlation between chronic pain, disrupted body scheme and spatial orientation. However, at the present time it could not be determined whether the pain precedes the effect of disrupted body scheme or vice versa. Powered by TCPDF (www.tcpdf.org)

Aim: The aim of this thesis is both evaluate a somatognosis quality and consider rate of personality dimensions in patients with FBSS. Methods: 30 patients with FBSS and 25 probands of healthy control group were examinated in laboratory of spatial cognition called Blue Velvet Arena. They underwent spatial navigation task and body scheme tests. We made comparative analysis of these measurements between groups. We evaluated personality dimensions in patients group, by using NEO personality inventory and Petrie test. Finally we consider relationships of these variables and another related factors. Results: Signicant difference between patient's group and control group was found both in spatial navigation task and body scheme tests. In spatial navigation task control group had lower results compared to the patient's group. In body scheme tests was found reverse results. We found high correlation of body scheme with age, pain duration and activity level. There was high percentage of underestimating probands and probands with high score of conscientiousness. Error rate (judgement out of tolerance zone) was higher in patient's group compared to the control group. Conclusions: Our results states that patients with FBSS have lower quality of somatognosis in light of body scheme. We hypothesise, that body...