Många äldre lider av långvarig smärta och får inte alltid den hjälp de behöver. Ökad kunskap inom området behövs då antalet äldre kommer att öka. Att utvärdera och lindra smärta hos äldre utgör en viktig del av sjuksköterskans ansvarsområde. Genomförd studie syftar till att undersöka vilka kunskaper som finns om utvärdering och lindring av smärta riktad till äldre boende i kommunen. Genom litteraturöversikt av både kvalitativa och kvantitativa artiklar redovisas resultatet i fyra teman: sjuksköterskans utvärdering av smärta, vårdtagarens utvärdering av smärta, sjuksköterskans lindring av smärta och vårdtagarens lindring av smärta. Hur smärta blev utvärderad stämde inte alltid överens med vårdtagarens upplevelse av smärtan. Smärtlindring sker oftast med läkemedel men alternativa behandlingar blir allt vanligare. Ökat samarbete mellan olika yrkeskategorier kan leda till att äldre med långvarig smärta får den vård de har rätt till. Mer studier behövs för att kunna utveckla vården inom området smärta hos äldre. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

I bakgrunden förklaras vad begreppen smärta, kronisk smärta, lindra, smärtbedömning och smärtlindring innebär. I sjuksköterskans dagliga arbete är en uppgift att lindra kronisk smärta hos patienter. Idag lever många människor med denna typ av smärta, och dessa patienter förekommer överallt inom hälso- och sjukvården. Patienter med denna smärta visar inte hela tiden att de har ont eftersom de ofta har lärt sig att leva med den. Därför finns det stor risk att sjuksköterskor undervärderar patientens värk. Viktigt är att patientens smärtupplevelser lindras eftersom kronisk smärta kan ge besvärande konsekvenser.Syftet är att studera hur patienter med kronisk smärta upplever otillräcklig smärtlindring.Studien är en litteraturstudie där 8 artiklar med kvalitativ ansats har analyserats och granskats utifrån syftet.I resultatet framkommer patienternas egna upplevelser av kronisk smärta och hur det är att inte bli tillräckligt smärtlindrad. Resultatet presenteras i fyra huvudteman med tillhörande subteman. Huvudtemana är: att bemästra kronisk smärta, barriärer till smärtlindring, brister i mötet och emotionella reaktioner. I diskussionen belyses resultatet utifrån annan forskning. Patientens egna strategier och sjukvårdens behandlingar diskuteras. Vidare diskuteras patientens upplevelse av att inte bli betrodd, brister i mötet mellan patient och vårdpersonal och patientens tankar kring att inte bli tillräckligt informerad. Sjuksköterskan bör ge bättre information till patienten om dennes smärttillstånd, lyssna till de strategier patienten använder sig av och integrera dessa i omvårdnadsarbetet, samt vara medveten om de barriärer som finns som förhindrar fullgod smärtlindring. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-18T18:37:37Z No. of bitstreams: 1 RandolfodosSantosJunior_tese.pdf: 1610909 bytes, checksum: 28fc3685f524eb861999084083484f4a (MD5) / Made available in DSpace on 2018-10-18T18:37:37Z (GMT). No. of bitstreams: 1 RandolfodosSantosJunior_tese.pdf: 1610909 bytes, checksum: 28fc3685f524eb861999084083484f4a (MD5) Previous issue date: 2017-11-13 / The assessment and management of chronic pain are an important focus of attention, since these are pointed out as a major cause of disability and demand for health care.Objective: To evaluate the self-efficacy and indicators of anxiety and depression in patients diagnosed with chronic pain in two forms of treatment: a) structured program of Cognitive-Behavioral Therapy in group; B) control group who undergone the usual treatment of the institution.Materials and Methods: Adult patients of both genders at the beginning of care in the Pain Clinics. Those who met the inclusion criteria and agreed to participate in the study were randomized to allocation in the Experimental Group (EG) or Control Group (CG). All participants were evaluated in three moments: initial evaluation, reassessment and follow-up. They answered the following instruments: Questionnaire on clinical and sociodemographic data; Self-Efficacy Scale for Chronic Pain; Hospital Anxiety and Depression Scale; Numeric Pain Rating Scale; Inventory of Attitudes and Beliefs Facing Chronic Pain. The experimental group received, besides the habitual treatment provided by the institution, 10 sessions of Cognitive-Behavioral intervention in group. The control group received the usual treatment provided by the Pain Clinics. Results:A total of 114 adult patients undergoing chronic pain treatment participated in the first part of this study. Data pointed out high indicators of anxiety (53%) and depression (55%), in addition to low self-efficacy (63%). Low self-efficacy was associated with beliefs and dysfunctional attitudes towards pain and to higher indicators of anxiety and depression were observed. In the second part of the study, all participants were randomized into two groups: Experimental Group (EG) and Control Group (CG) . Fifty-seven patients participated in all the stages of this part of the study, 31 in EG and 26 in CG. Comparing the two groups according to the follow-up, the results showed that the experimental group had significantly higher self-efficacy scores (p <0.026) and. significantly lower anxiety scores (p < 0 , 01) and depression (p <0.023).Conclusion: In this study, the cognitive-behavioral therapy in group has improved important benefits for patients with chronic pain, playing on their beliefs and attitudes toward pain, anxiety management and reduction on depression indicators. / A avaliação e o manejo da dor crônica constituem importante foco de atenção, uma vez que são apontadas como uma das principais causas de incapacidade e de procura por cuidados de saúde. Objetivo: Avaliar autoeficácia e indicadores de ansiedade e depressão em pacientes com diagnóstico de dor crônica alocados em duas modalidades de tratamento: a) programa estruturado de Terapia Cognitivo Comportamental em grupo; b) grupo controle, que recebeu o tratamento habitual fornecido pela instituição. Materiais e Métodos: Participaram pacientes adultos de ambos os sexos, em início de atendimento na Clínica da Dor. Aqueles que atenderam aos critérios de inclusão e concordaram em participar do estudo foram randomizados para alocação no Grupo Experimental (GE) ou no Grupo Controle (GC). Todos os participantes foram avaliados em três momentos: avaliação inicial, reavaliação e seguimento. Responderam aos seguintes instrumentos: Questionário de dados clínicos e sociodemográficos; Escala de Autoeficácia para Dor Crônica; Escala Hospitalar de Ansiedade e Depressão; Escala Numérica de Dor; Inventário de Atitudes e Crenças Diante da Dor Crônica. O grupo experimental recebeu, além do tratamento habitual fornecido pela instituição, 10 sessões de intervenção Cognitivo Comportamental em grupo. O grupo controle recebeu o tratamento habitual, oferecido pela Clínica da Dor. Resultados: Participaram da primeira parte deste estudo 114 pacientes adultos em tratamento de dor crônica. Os dados apontaram indicadores elevados de ansiedade (53%) e depressão (55%), além de baixa autoeficácia (63%). Observou-se que a baixa autoeficácia está associada às crenças e atitudes disfuncionais diante da dor e a indicadores mais elevados de ansiedade e depressão. Na segunda parte do estudo, todos os participantes foram distribuídos por meio de randomização em dois grupos: Grupo Experimental (GE) e Grupo Controle (GC). Participaram de todas as etapas desta parte do estudo 57 participantes, sendo 31 no GE e 26 no GC. Comparando-se os dois grupos no que se refere ao seguimento, os resultados apontaram que o grupo experimental apresentou em relação ao grupo controle, escores significativamente maiores de autoeficácia (p < 0,026) e, significativamente,menores de ansiedade (p < 0,01) e depressão (p < 0,023). Conclusão: Neste estudo, a Terapia Cognitivo Comportamental em grupo promoveu benefícios importantes aos pacientes com dor crônica, atuando em suas crenças e atitudes diante da dor, manejo de ansiedade e redução nos indicadores de depressão.

A dor neuropática é uma síndrome dolorosa crônica, que ocorre muito frequentemente em pacientes com hanseníase, de difícil tratamento. Objetivou-se avaliar o efeito terapêutico da S(+)-cetamina na dor neuropática e qualidade de vida em portadores de hanseníase atendidos em ambulatórios em São Luís - MA. Estudo experimental tipo ensaio clínico, prospectivo, aleatório, duplamente cego, controlado por placebo, com 34 pacientes distribuídos aleatoriamente em um dois grupos, cetamina e placebo por três meses e randomizados por numeração sequenciada. A dor foi avaliada por meio de escala analógica visual (EAV) nas seis visitas quinzenais (1, 2, 3, 4, 5 e 6), e pelo inventário DN4, na visita 1 e 6, com distribuição da S(+)-cetamina e o analgésico de resgate e avaliado os efeitos adversos em cada visita. Realizou-se a coleta de 15mL de sangue para exames de segurança na visita 1 e 6 e para quantificação de citocinas plasmáticas IL-1, IL-6 e TNF&#945;, nas visitas 1, 2, 4 e 6. Foi também, avaliada a qualidade de vida por meio do questionário WHOQOL-Bref nas visitas 1 e 6. Os resultados demostraram predominância do sexo feminino, idade de 18 a 29 anos, pardos, solteiros, renda de 2 a 4 salários mínimos; e média de 7,782,21 anos de estudo. Na avaliação da dor pela EAV os dois grupos apresentaram uma redução dos escores médios de dor ao longo do tempo, e mostrou significância estatística p < 0,05. Entretanto não foi observada diferença estatística para os escores de dor entre os grupos e também, em relação ao uso do medicamento analgésico (codeína) de resgate. Houve redução significante nos escore de DN4 no grupo placebo em relação às avaliações iniciais e finais comparadas à cetamina, ainda os escores iniciais do DN4 foram significativamente menores no grupo placebo, nas avaliações de antes e depois do uso da S(+)-cetamina. Na avaliação da qualidade de vida nos domínios físico, psicológico, relações sociais e meio ambiente, não se observou diferença estatisticamente significante entre os grupos estudados. Os valores de IL-1, IL-6 e TNF-&#945;, em quatro coletas do soro dos grupos cetamina e placebo não mostraram diferença estatisticamente significante tanto na avaliação intragrupo ao longo das visitas, como entre os grupos. Em relação aos efeitos adversos, houve um predomínio estatisticamente significante no grupo cetamina especialmente para tontura, alteração visual e outros efeitos. Conclui-se que a S(+)-cetamina por via oral na dose utilizada em pacientes com hanseníase e dor neuropática não se mostrou superior ao placebo em relação ao efeito analgésico e no impacto na qualidade de vida. / Neuropathic pain is a chronic pain syndrome of difficult treatment, occurring frequently in patients with leprosy. The objective of this study was to evaluate the therapeutic effect of S(+)-ketamine on neuropathic pain and quality of life in patients with leprosy seen at an outpatient clinic in São Luís - Ma. Experimental study clinical trial, prospective, randomized, double-blind, placebo-controlled trial with 34 patients in a randomized two groups, ketamine and placebo for three months and randomized by sequential numbering. Pain was evaluated using a visual analogue scale (VAS) on six bimonthly visits (1, 2, 3, 4, 5 and 6), and using the DN4 questionnaire on visits 1 and 6, with distribution of S (+)-ketamine and rescue analgesic and adverse effects assessed at each visit. Blood (15ml) was drawn from patients for safety tests on visits 1 and 6, and on visits 1, 2, 4 and 6, to cytokines IL-1, IL-6 and TNF&#945;. Quality of life was also evaluated using WHOQOL-Bref on visits 1 and 6. Results showed most subjects female, age 18 and 29 years of age, pardo ethnicity, single, income between 2 and 4 minimum salaries, and a mean 7.782.21 years of education. In the assessment of pain by VAS both groups showed a reduction in mean pain scores over time, and showed statistical significance p <0.05. However there was no statistical difference in pain scores between groups and also in relation to the use of analgesic medication (codeine). There was significant reduction in DN4 score in the placebo group compared to the initial and final evaluations compared to ketamine, although the initial DN4 scores were significantly lower in the placebo group, the assessments before and after the use of S (+)-ketamine. In evaluating the quality of life in the physical, psychological, social relationships and environment, there was no statistically significant difference between groups. The amounts of IL-1, IL-6 and TNF-&#945; in serum of four collections of ketamine and placebo groups showed no statistically significant difference both in assessing intragroup along the visits as between groups. Regarding adverse effects, there was a statistically significant predominance in the ketamine group especially for dizziness, visual changes and other effects. We conclude that the S (+)-ketamine orally at the dose used in leprosy patients and neuropathic pain was not superior to placebo for the analgesic effect and impact on quality of life.

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2014-10-08T19:14:45Z No. of bitstreams: 2 Dissertação - Patrícia Pereira de Vasconcelos - 2012.pdf: 1578862 bytes, checksum: 94377135b580d72c62777755a8cc3ef2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2014-10-09T11:24:30Z (GMT) No. of bitstreams: 2 Dissertação - Patrícia Pereira de Vasconcelos - 2012.pdf: 1578862 bytes, checksum: 94377135b580d72c62777755a8cc3ef2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-10-09T11:24:30Z (GMT). No. of bitstreams: 2 Dissertação - Patrícia Pereira de Vasconcelos - 2012.pdf: 1578862 bytes, checksum: 94377135b580d72c62777755a8cc3ef2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2012-05-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Chronic pain is an unpleasant experience that reaches much of the world's population; however, population studies with the elderly are rare. The aim of this study was to assess chronic pain and self-rated health among community elders. Study population-based cross-sectional, in Goiania, Goias, December/2009 between April 2010 and. For this cut, we excluded those who reached  13 on the MEEM scores, and needed help for the answers. The random sample consisted of 872 participants. Chronic pain was considered as existing for six months or more. Pain intensity was measured by using a numeric scale (0-10: zero=no pain, 1,2,3,4=mild, 5.6=moderate, and strong=7,8,9, and 10=worst pain possible) the location investigated through body diagrams, and self-rated health assessed by the scale of verbal descriptors ("very good", "good," "regular," "bad," "worst"). The project was approved by the CEP/UFG (Protocol 050/2009) and seniors signed the Informed Consent. The data were analyzed using Stata version 8.0 and operated by means of absolute and relative frequency and Confidence Interval (95%). Of the 872 elderly, 460 (52.7%: 95% CI: 49.4% -56.1%) reported chronic pain. By age, the prevalence was 52.4, 53.1 and 53.0%, respectively, among young elderly (60-69 years), elderly (70-79 years) and very elderly (80 or +). Women obtained higher prevalence of chronic pain (60.4%) than men (40.1%), prevailing among the young elderly (57.6/43.4%), elderly (62.8/38.6%) and very elderly (64.5/33.9%). The elderly with chronic pain, 49.8% were young elderly, 33.0% and 17.2% very elderly seniors. The increased representation of women was (71.3%), and 48.8% were young elderly, 32.9% and 18.3% elderly, very elderly. The marriage prevailed among young elderly (46.0%) and elderly (54.1%) and widowed (55.7%), among the very elderly. Income  minimum wage prevailed among the 3 elderly age groups (32.1; 56.4; 50.7%) and education "primary" among young elderly (48.0%), elderly (45.7%) and very elderly (53.9%). The sites of pain were prevalent: MMII (34,5%) and lumbar (29,5%) and 12.6% of seniors reported "worst possible pain," 42.0% "severe pain", 26.0% "moderate" and 19, 4%, "mild". The young elderly (45.2) and seniors (41.3%) reported more pain "strong" and the very old, "severe pain" (33.3%) and "worst pain" (20.3%). Women reported pain "strong" and "worst possible pain" (45.8; 14.1%) more often than men, who reported more pain "mild" and "moderate" (27.1; 32.2 %.) When health was perceived as "very good", "moderate pain" (41.7%) and "mild" (33.3%) prevailed. Those who perceived their health as "good" over reported "mild pain" (33.9%) and when his health was "fair", "bad" and "very bad", the highest frequency of reported pain was "strong" (46.0%), "strong" (56.5%) and "worst possible pain" (60.0%), respectively. The prevalence estimates found are similar to other national studies. Most elderly people suffer from chronic pain of high intensity, which affects the lower limbs and lower back. Population-based studies help us to identify penetration points for planning and implementing strategies that print improving health care in this population. / A dor crônica é uma experiência desagradável que atinge grande parte da população mundial, contudo, estudos populacionais com idosos são raros. O objetivo desse estudo foi analisar a dor crônica e a autopercepção de saúde entre idosos da comunidade. Estudo de base populacional, transversal, em Goiânia, Goiás, entre dezembro/2009 e abril/2010. Para este recorte, foram excluídos aqueles que alcançaram escores 13 no MEEM; e precisaram de ajuda para as respostas. A amostra probabilística constituiu-se de 872 participantes. Dor crônica foi considerada como existente há seis meses ou mais. A intensidade de dor foi medida por meio de escala numérica (0-10: zero=sem dor; 1,2,3,4=leve; 5,6=moderada e 7,8,9=forte; e 10=pior dor possível); a localização investigada por meio de diagramas corporais; e a autopercepção de saúde avaliada por escala de descritores verbais (“muito boa”, “boa”, “regular”, “ruim”, “muito ruim”). O projeto foi aprovado pelo CEP/UFG (Protocolo 050/2009) e os idosos assinaram o TCLE. Os dados foram analisados pelo programa Stata versão 8.0 e explorados por meio de frequência absoluta e relativa e Intervalo de Confiança (95%). Dos 872 idosos, 460 (52,7%: IC 95%: 49,4%-56,1%) referiram dor crônica. Por faixa etária, a prevalência foi de 52,4%; 53,1% e 53,0%, respectivamente, entre jovens idosos (60-69 anos); idosos (70-79 anos); e muito idosos (80 anos ou+). As mulheres alcançaram maior prevalência de dor crônica (60,4%) que os homens (40,1%), prevalecendo entre os jovens idosos (57,6%/43,4%); idosos (62,8%/38,6%) e muito idosos (64,5%/33,9%). Dos idosos com dor crônica, 49,8% eram jovens idosos, 33,0% idosos e 17,2% muito idosos. A maior representação foi pelas mulheres (71,3%), sendo que 48,8% eram jovens idosas, 32,9%, idosas e 18,3%, muito idosas. Os casados prevaleceram entre jovens idosos (46,0%) e idosos (54,1%); e os viúvos (55,7%), entre os muito idosos. A renda  um salário mínimo prevaleceu entre idosos das 3 faixas etárias (32,1%; 56,4%; 50,7%) e escolaridade “primário” entre jovens idosos (48,0%), idosos (45,7%) e muito idosos (53,9%). Os locais de dor prevalentes foram: MMII (34,5%) e região lombar (29,5%); e 12,6% dos idosos referiu “pior dor possível”, 42,0% “dor forte”; 26,0% “moderada” e 19,4%, “leve”. Os jovens idosos (45,2%) e idosos (41,3%) relataram mais dor “forte”; e os muito idosos, “dor forte” (33,3%) e “pior dor” (20,3%). As mulheres relataram dor “forte” e “pior dor possível” (45,8%; 14,1%) com maior frequência que os homens; que relataram mais dor “leve” e “moderada” (27,1%; 32,2%). Quando a saúde foi percebida como “muito boa”, “dor moderada” (41,7%) e “leve” (33,3%) prevaleceram. Aqueles que perceberam sua saúde como “boa” relataram mais “dor leve” (33,9%) e quando a saúde foi “regular”, “ruim” e “muito ruim”, a maior frequência de relatos foi de dor “forte” (46,0%), “forte” (56,5%) e “pior dor possível” (60,0%), respectivamente. As estimativas de prevalência encontradas são semelhantes a outros estudos nacionais. A maioria dos idosos sofre dor crônica, de elevada intensidade, que afeta os MMII e a região lombar, especialmente das mulheres. Estudos de base populacional permitem identificar pontos de penetração para planejamento e implementação de estratégias que imprimam melhoria no cuidado à saúde dessa população.

A Dor Crônica por Afecções Musculoesqueléticas (DCAME) é uma doença que, além de atingir o sistema osteomuscular, principalmente de mulheres da faixa etária entre 45 a 64 anos, frequentemente acarreta desordens psicológicas, sociais e espirituais e é influenciada por elas, podendo ainda desenvolver grande carga de desgosto para os doentes quando não diagnosticada e tratada adequadamente. Assim, dentre os aspectos citados, destaca-se o Bem-Estar Espiritual (BEE) como uma expressão da espiritualidade prática que, embora recentemente abordada em estudos científicos foi, desde o início da humanidade, apontada como uma dimensão importante no processo saúde-doença, por possibilitar, além de outros benefícios, o restabelecimento mais rápido da saúde. Foi neste contexto que se tornou necessário compreender e refletir sobre os significados do BEE que permearam a vivência de mulheres portadoras de DCAME e as formas pelas quais o BEE foi manifestado por esta população, para facilitar o esclarecimento tanto das causas da dor atribuídas por elas quanto das formas de manejo e dos impactos ocasionados pela dor. Desta forma, este estudo, que foi realizado na Clínica de Dor do Hospital das Clínicas de Ribeirão Preto (CDHCRP) e conduzido de acordo com as normatizações da Comissão Nacional de Ética em Pesquisa (CONEP), utilizou-se de abordagem qualitativa. Neste trabalho, após seleção por amostragem por conveniência, 11 sujeitos foram selecionados e entrevistados individualmente numa sala reservada a este fim, sendo um guia à entrevista um roteiro norteador de entrevista semiestruturada com questões fechadas para identificação e delineamento sociodemográfico e questões abertas para a apreensão dos significados de BEE bem como dos conhecimentos acerca das causas, dos impactos e das formas de alívio da dor. Os dados coletados foram gravados em um aparelho de MP3 e transcritos na íntegra para o início da análise dos dados que foi feita por meio da Análise Temática (AT), uma das técnicas da Análise de Conteúdo (AC) e possibilitaram o surgimento de quatro temas: Significados e Manifestações do BEE; Modelos explicativos para a dor; Formas de manejo da doença e Impactos da dor crônica. A partir destes temas, algumas interpretações acerca do BEE puderam ser destacadas. Relatado como um aspecto humano de difícil definição, o BEE pôde ser manifestado de diferentes maneiras. As formas apresentadas foram o bom relacionamento consigo mesmo, com o outro e com Deus, o desenvolvimento de esperança, da confiança, da fé em si e no tratamento que realizaram, o conforto físico, a ocupação, o lazer, o aprendizado e a empatia no contato com o outro. Neste trabalho, algumas causas manifestadas foram as de origem psicossocial, as sobrecargas físicas e comportamentos que perpetuam o problema, além da dor como resposta a um pecado. Destacadas algumas causas, o trabalho apontou para a utilização das preces como coadjuvante do tratamento médico convencional por todas as entrevistadas e da técnica Reiki. Tendo em vista o exposto, a DCAME mesmo impactando de forma negativa na vida das entrevistadas, desenvolvendo inclusive o medo da perda da autonomia e independência, possibilitou a modificação de suas visões de mundo, sendo fonte de descoberta de valores humanos tais como a coragem, a resiliência, a valorização da vida bem como da empatia pelo sofrimento alheio. Em suma, este estudo destacou a importância da DCAME enquanto doença multidimensional que leva o indivíduo a experimentar necessidades espirituais importantes, sendo o incentivo a busca da integralidade no contexto hospitalar para o correto manejo do problema mais do que uma emergência para a saúde pública. / Chronic Musculoskeletal Pain (CMP) is a disease that, in addition to achieving the musculoskeletal system, especially the women aged 45 to 64 years, often entails psychological, social and spiritual disorders and is influenced by them and may develop big load of grief for patients when not diagnosed and treated properly. Thus, among the aspects mentioned, Spiritual Well-Being (SWB) as an expression of practical spirituality which, although recently has been addressed in scientific studies, since the beginning of mankind, considered as an important dimension in the health-disease process, by allowing, among other benefits, the most rapid restoration of health. In this context, it has become necessary to understand and reflect on the meanings of SWB that permeated the experience of women with CMP and the ways in which the SWB was expressed by this population, both to facilitate the clarification of the causes of pain attributed by them as forms of management and the impacts caused by pain. Thus, this study, which was conducted at the Pain Clinic of the University Hospital of Ribeirão Preto (PCUHRP) and conducted according to the regulations of the National Committee of Ethics in Research (NCER), used a qualitative approach. In this work, after being selected by convenience sampling, 11 subjects were selected and individually interviewed in a room reserved for this purpose, with a guide to interview a guiding semi- structured interview with closed questions and to identify sociodemographic and open design issues for the seizure of SWB meanings and knowledge about the causes, impacts and forms of pain relief. Data were recorded on an MP3 player and transcribed to the top of the data analysis that was done by means of the Thematic Analysis (TA), one of the techniques of Content Analysis (CA) and made possible the emergence of four themes: Meanings and Manifestations of SWB; Explanatory models for pain; Forms of disease management and Impacts of chronic pain. From these themes, some interpretations of the SWB could be highlighted. Reported as a human aspect difficult to define, SWB could be manifested in different ways. The forms submitted were good relationship with oneself, with others and with God, the development of hope, trust, and faith in themselves and who performed the treatment, physical comfort, occupation, leisure, learning and empathy contact with each other. In this work, some causes were expressed psychosocial origin, physical burdens and behaviors that perpetuate the problem, in addition to pain in response to a sin. Highlighted some causes, the paper points out the use of prayer as an adjunct to conventional medical treatment for all interviewees and Reiki technique. In view of the above, the same CMP negatively impacting on the lives of the interviewees, including developing the fear of loss of autonomy and independence, enabled the modification of their worldviews, a source of discovery of human values such as courage, resilience, valuing life and empathy for others\' suffering. In summary, this study highlighted the importance of CMP as multidimensional disease that causes the individual to experience significant spiritual needs, and encouraging the pursuit of comprehensive health care in the hospital setting to the correct handling of the problem more than a public health emergency.

Made available in DSpace on 2016-04-28T20:38:32Z (GMT). No. of bitstreams: 1 Rosane Raffaini Palma.pdf: 822317 bytes, checksum: 7c6909cc60e18d23eb5eee218cc33e88 (MD5) Previous issue date: 2012-10-17 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / A new approach to the study of the processes and perceptions of life experiences is being taken by psychologists, with emphasis on the understanding of the healthy aspect of human beings, the resilience. Seeing the family as a dynamic system, the present study adopted the theoretical framework of systems thinking, in order to identify and understand the care provided by health teams with respect to the use of the concept of resilience with patients and their families when dealing with a disease. A focus group was used as qualitative research method, considering that the energy generated by the group would result in deeper and more diverse answers. A multidisciplinary health care team participated in the study, and was invited to discuss a fictional case, addressing complaints of chronic pain. The answers of the participants were analyzed based on the studies of family resilience, according to Walsh. The team showed interest in addressing the needs of the fictional patient by using the concept of resilience, and more than that, was willing to put themselves in the place of the family. The group took into account the extraction of meaning from the family adversities and the connection between the patient and her relatives, considering the possible emotion instability resulting from the recent loss, and the physical distance between the patient and her relatives. They also focused attention on aspects such as overcoming adversities, flexibility, clarity of information, social and financial resources, open emotional expression and collaborative resolution of the problems of the patient, but with less emphasis, considering a perspective of work related to the care unit. No suggestions were made by the group with regards to religious or spiritual practices to cope with the complaint / Um novo enfoque vem sendo adotado pela psicologia, ao estudar processos e percepções das experiências da vida, com ênfase na compreensão do aspecto saudável do ser humano, que é a resiliência. Por considerar a família um sistema em movimento, o presente estudo adotou o referencial teórico do pensamento sistêmico, com o objetivo de identificar e compreender os cuidados que as equipes de saúde prestam em relação à utilização de práticas ligadas à resiliência para o paciente e sua família, ao lidar com uma doença. O grupo focal foi utilizado como método de pesquisa qualitativa, considerando que a energia gerada pelo grupo cria profundidade e diversidade de respostas. Uma equipe multiprofissional de saúde participou do estudo, à qual foi proposta a discussão de um caso clínico fictício, abordando queixa de dor crônica. As respostas dos participantes foram analisadas por meio dos estudos sobre resiliência familiar segundo Walsh. Para dar acolhimento às necessidades da paciente fictícia ligadas à resiliência, a equipe mostrou-se interessada e, mais do que isso, disposta a ocupar um lugar que originalmente caberia à família. O grupo levou em conta a extração de significado na adversidade familiar e a conexão entre a paciente e seus familiares, considerando a possível fragilidade emocional decorrente de sua viuvez recente e a distância física entre a paciente e os familiares. Mostrou ainda atenção à superação da adversidade, flexibilidade, clareza nas informações, recursos sociais e financeiros, expressão emocional aberta e resolução colaborativa dos problemas da paciente, porém, com menos ênfase, considerando uma perspectiva de trabalho ligada à unidade de cuidado. Não foram identificadas sugestões pela equipe participante quanto às práticas ligadas à religiosidade ou espiritualidade no enfrentamento da queixa

A partir d’une pratique clinique auprès de patients douloureux chroniques dans un centre de la douleur il s’agira de mettre en évidence le rôle joué par des expériences précoces de douleur et leur éventuelle participation au processus de chronicisation de douleurs actuelles pour une catégorie de ces patients. Plus précisément il nous faudra examiner de quelle manière les relations premières de ces sujets avec leurs objets de soin pourraient s’être nouées en partie autour de la perception de douleur. Nous voulons montrer que cette population de patients s’est probablement trouvée très tôt confrontée de différentes manières à des vécus de douleur Pour ce faire nous nous proposons de faire appel de façon préférentielle à un ensemble de travaux et de réflexions développés ces dernières années dans les deux champs que sont d’une part les neurosciences et d’autre part la psychanalyse. Nous terminons par un retour à travers une monographie clinique sur les implications thérapeutiques que peut avoir la prise en compte d’un tel regard sur les avatars de la construction psychique du sujet et ces relations à des expériences ultérieures de douleur. / The subject of this thesis is to show the particular role played by early pain experiences and their possible link to present pain chronicising process for a part of these patients. More precisely, we will review how the first relationships of these subjects to their caregivers could have been partly tied up with pain perception.We want to show how this patients population has been probably very early confronted to pain experiences in different ways.To do so, we will bring up preferentially a set of work and reflection developed throughout these years in both psychoanalysis and neurosciences fields.We end up this work by a return through a clinical monography on therapeutic implications that such an approach can have on the subject psychic construction misadventures and his relationships to further pain experiences.

CONTEXT: Recent studies have considered the role of inflammation in the development of both cardiovascular disease (CVD) and musculoskeletal conditions, such as rheumatoid arthritis. Studies suggest that inflammation plays a significant role in the development of cardiovascular disease. In conditions of chronic pain, as with rheumatoid arthritis, inflammation has also been noted through elevated levels of inflammatory markers. There are currently no studies that examine the possible connection between inflammatory markers related to increased risk of cardiovascular disease and nonspecific chronic musculoskeletal pain (NCMP). OBJECTIVE: The purpose of this study was to determine whether urinary levels of microalbumin (MA) and F2-isoprostanes (F2-isoPs), inflammatory biomarkers associated with increased CVD risk, are elevated in persons with NCMP compared to nonpain case controls. NCMP refers to pain present for more than 3 days per week and for more than 12 weeks. This type of pain is not due to injury but is associated with interference of normal function. DESIGN: Nonrandomized observational study. METHODS: A cross-sectional study with 120 participants (60 pain subjects, 60 nonpain case-controls). A single first-morning void urine sample was collected from each subject. Urine specific gravity and total volume were measured and then a sample was sent to a lab for analysis of MA and F2-isoPs. Inflammatory biomarker levels in the pain and nonpain groups were compared. RESULTS: There were no significant differences in F2-isoPs levels between the chronic pain group (0.65ng/mg ± 0.05) and the nonpain group (0.80ng/mg ± 0.07) (95% CI (-0.32, 0.03)). However, MA levels were significantly higher in the chronic pain group (2.41mg/g ± 0.24) compared to the nonpain group (1.88mg/g ± 0.14) (95% CI (0.34, 1.68)). MACR levels were also significantly higher in the chronic pain group (2.07mg/g ± 0.31) compared to the nonpain group (1.14mg/g ± 0.14) (95% CI (0.32, 1.64)). CONCLUSION: These findings suggest a possible link between at least one inflammatory marker (microalbumin) and NCMP. This in turn allows for a limited but reasonable inference that NCMP may be a risk factor for cardiovascular disease, mediated through the MA inflammatory biomarker. Further research is needed to more fully understand the possible connection between NCMP and CVD.

A central component of many psychological interventions is breathing training. Breathing training protocols based on a mindfulness or a cognitive behavioral therapy (CBT) have demonstrated value in the management of psychological and medical ailments. Yet, despite the wealth of literature examining each approach, little direct comparison exists. An additional concern is the proliferation of smart phone health (mHealth) applications (apps) providing breathing training with little empirical evidence to support their clinical use. A possible explanation for the interest in breathing and mHealth apps is the growing body of literature indicating breathing training provides wide ranging health benefits through improved stasis of the autonomic nervous system (ANS). As ANS dysregulation underlies many chronic health conditions such as persistent temporomandibular disorders (TMDs), there is a need for empirical research to identify the most effective modality of breathing training and validate the clinical efficacy of breathing based mHealth apps. Study One compared the effectiveness of a mindfulness breathing meditation (MB) and a CBT based protocol teaching diaphragmatic breathing (DB) to improve biomarkers of ANS stasis. An attention control approach based on the Nolen-Hoeksema task (C) was included as a comparison group. Ninety participants were randomly assigned to either the MB, DB, or C condition. Within each condition, 30 participants were provided skills training with practice time and completed a behavioral self-regulation task. Participants in the DB condition approach had significantly lower breathing rates than those in the MB and C conditions (p < .001). DB condition participants experienced improvements on high-frequency heart rate variability (p < .05) and the standard deviation in NN intervals (p < .001), which served as indicators for ANS stasis. No differences were found between conditions on the behavioral self-regulation task (p’s > .05). Given these results, the DB training protocol was converted into a mHealth app to facilitate a clinical trial with patients suffering persistent TMDs. Study Two examined the additive benefits of including the mHealth app with standard dental care (SDC+) versus standard dental care alone (SDC). Nineteen patients seeking care for persistent TMDs were recruited. All participants were asked to track daily ratings of pain (VAS), relaxation (RR), and complete weekly assessments on several comorbid psycho-social factors. Within the SDC+ condition participants were asked to track the proximate effects of each breathing practice on VAS and RR ratings. Given a high drop-out rate (nine participants) and low overall sample size (N = 10), results are exploratory at best. Within the SDC+ condition, results indicated reliable improvements in average VAS and RR ratings from before and after SDC+ participants used the mHealth app (p’s < .05). Within a one session training paradigm, results supported the use of a DB based intervention above the use of a MB or C intervention. Future research should consider the effects of having multiple training sessions. Study Two results were complicated by a limited sample size and failed to provide a clear picture of whether the conjunctive treatment in the SDC+ condition provided additional symptom relief above traditional dental care alone. Although exploratory results indicated the mHealth app provided temporary improvements in pain and feelings of relaxation, a well powered trial is needed to clarify whether the finding represents an enduring treatment effect.