Chronic pain is a common and costly health condition for children. Previous studies have documented racial and gender disparities in pain care for adults, with women and racial minorities receiving poorer pain assessment and treatment. Providers contribute to these disparities when their pain-related decision-making systematically varies across patient demographic groups. Little is known about racial and gender disparities in children with chronic pain, or the extent to which providers contribute to these disparities. In a sample of 129 medical students (henceforth referred to as ‘providers’), Virtual Human (VH) methodology and a pain-related version of the Implicit Association Test (IAT) were used to assess the effects of patient race/gender and provider implicit racial/gender attitudes on providers’ pain assessment and treatment decisions for children with chronic pain. Findings indicated that, in the context of abdominal pain, providers rated Black patients as more distressed (mean difference [MD]=2.33, p<.01, SE=.71, 95% CI=.92, 3.73) and as experiencing more pain-related interference in daily activities (MD=3.14, p<.01, SE=.76, 95% CI=1.63, 4.64) compared to White patients. Providers were also more likely to recommended opioids for Black patients’ pain compared to White patients (MD=2.41, p<.01, SE=.58, 95% CI=1.05, 3.76). Female patients were also perceived to be more distressed by their pain (MD=2.14, p<.01, SE=.79, 95% CI=.58, 3.70), however they there were no differences in treatment recommendations based on patient gender (all ps>.05). The sample reported implicit attitudes that men and Black Americans were more pain-tolerant than their demographic counterparts; however, pain assessment and treatment decisions were not related to these implicit attitudes. This study represents a critical step in research on pain-related disparities in pediatric pain. Future studies are needed to further elucidate specific paths through which the pain experience and consequent treatment differ across racial and gender groups.<br>

Background: Juvenile idiopathic arthritis (JIA) refers to a group of auto-immune conditions involving joint inflammation that first appears before the age of 16. In the United States, about 294,000 children are affected. Although JIA can be widely attributed to genetic factors, the consensus is that environmental factors also play a role. Attempts to assess the role of environmental factors, though scarce, have focused on the role of infections, smoking exposure, and breastfeeding. Hygiene hypothesis, which suggests that adaptive immunological response improves with higher frequencies of pathogen exposure in early childhood, has been used to try to explain the risk of JIA. Common markers of microbe exposure in early life include sibling number, pet number, and maternal parity. Some prior studies conducted outside the U.S. suggests that increasing sibling number is protective against the risk of JIA. This study aimed to evaluate prior findings, using data from the U.S. Methods: The study used data from the 2017 Centers for Disease Control and Prevention National Survey for Child Health. The survey used a sample size of 21599 children to estimate the number of children in the U.S. Descriptive statistics was carried out, and logistic regression was used to determine the association between family number and the odds of developing JIA, while adjusting for sociodemographic variables. Family number was used as a proxy for sibling number. SAS v 9.4 was used for analysis. Results: Complete data on all the variables of interest were available for 17618 children, of which 67 had JIA. Although there was a marginal association between sibling number and JIA in the unadjusted model (OR [95% CI] 0.983-1.602) (P=0.068), in the adjusted model, there was no significant association between JIA and sibling number ([OR 95% CI] 0.8985-1.447) (P=0.29). There was a significant association between JIA and age, low birth weight, highest education level in the family, while sex had a marginal association. Conclusion: There was no association between family size and the development of JIA in this study. While some prior results have supported the observed significant effect of low birth weight, the disparity in results between this study and the Australian study could be due to the use of family number instead of sibling number. Further studies should assess the association of sibling number and developing JIA in the U.S.

Opioid therapy is widely used to treat veterans with chronic noncancer pain (CNCP) despite evidence indicating patient safety concerns with the treatment. Although there is a place for opioid therapy in chronic pain management, opioids are not recommended as the first line of treatment for CNCP because of the risk for accidental overdose and death. The purpose of this project was to examine alternative practices for managing CNCP through a systematic review of the literature guided by the conceptual model of the Joanna Briggs Institute method for systematic reviews (JBIM-SR). A critical appraisal of the literature was conducted, and data were extracted and analyzed to identify evidence-based alternatives to opioids for managing CNCP in veterans. Using Cochrane, CINAHL, Joanna Briggs, and PubMed databases for the search, 116 articles were initially identified and through exclusion of duplicates and those not consistent with the study purpose, the review was narrowed to 16 articles. A 2nd reviewer completed an identical search using the exclusion criteria and databases confirming the search results of the primary reviewer. The 16 peer-reviewed research studies published between 2006 and 2016 selected for the analysis were graded using the JBIM-SR grading chart. Educational programs were seen as positive for improving providers' use of alternative therapies for CNCP. Complementary and alternative therapies such as yoga, peer support, injection therapy, cognitive behavioral therapy and acceptance commitment therapy provided improvement in pain perceptions, and coping abilities. Results of this project can promote positive social change as the findings are shared with providers in the practice site and as Veterans receive safe alternatives to opioid therapy.

The prevalence of adults 65 years of age and older with significant pain is 25% to 50%, with many experiencing pain on a daily basis. The financial toll due to chronic pain is staggering; American's spend nearly $635 billion annually on health care. The purpose of this mixed methods study was to better understand the relationship between resilience, general health, and chronic pain in older adults. The quantitative question pertained to the relationship between resilience and both levels of chronic pain and general health in elderly chronic pain patients, and the qualitative question addressed participants' lived experiences of chronic pain. Resilience theory, which suggests that individual strengths enable people to rise above adversity, grounded the study. Participants were between ages 65 and 75 and were recruited from 3 pain centers and through the Survey Monkey participant pool; they included 55 older adults with chronic pain who responded to surveys (including Resilience scale, the Pain Impact Questionnaire-Revised (PIQ-R) Pain scale, and the Short Form 12 item (version 2) (SF-12v2) Health Survey, and 10 of them also participated in interviews. Regression analyses found no statistical relationships between resilience and either chronic pain or general health. Interview participants noted that to cope with pain they used personal strength, a positive outlook, religion, spirituality, pain management, physical activity, rest/sleep, managing their life, and religion and spirituality. Resilient behavior was inherent across various pain diagnoses, and participants appeared to place a great value in the social networks formed throughout life. These findings may help medical practitioners have a better understanding of the relationship between chronic pain and resilience in an aging, at-risk population.

Fibromyalgia (FM) is a musculoskeletal and neurological disorder that causes constant pain, cognitive problems with short term memory, and sleep disorders. There are more females diagnosed with FM than males, and research has therefore primarily been conducted with females. Because little is known about African American males with FM, biopsychosocial theory was used in this phenomenological study to examine how African American males with FM are affected biologically, psychologically, and socially. Eight African American males diagnosed with FM were recruited from Houston, Texas and were interviewed about their lived experiences with FM, including experiences with the healthcare system, and how they used the internet to seek information about FM. Individual interview transcripts, conduct open coding, and thematic analysis led to identification of the following themes: (a) lengthy multiple medical evaluations to receive a diagnosis and various symptoms; (b) physical challenges, physical limitations, emotional issues, and cognitive issues experienced with FM; (c) limited physical and emotional support from family and friends; (d) hopeful about work and plans; (e) trust and confidence in healthcare providers and medical information obtained by asking questions; (f) limited internet search and not involved in online FM forums. The study showed that African American males with FM may experience debilitating symptoms and may use faith-based beliefs as one way to cope with FM. These results may bring positive social changes by providing caretakers with a better understanding of how FM affects the quality of life of African American males with FM, and provide new data to assist healthcare providers in diagnosing, treating, and serving this population.

Typescript (photocopy) Includes bibliographical references (leaves: 260-304)

"December, 2003" / Bibliography: leaves 283-311. / xiv, 311 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, School of Medicine, Dept. of Psychology, 2005

<p><strong>Sammanfattning</strong></p><p>Fibromyalgi har betraktats ända framtill våra dagar som en ren psykosomatisk sjukdom som uppkom utan känd orsak. Sjukdomen innebar en ständig smärta och en oändlig trötthet/ utmattning. Det fanns ingen behandling för sjukdomen bara lindra symtomen. Syftet med denna litteraturstudie var att beskriva hur kvinnor med fibromyalgi upplevde sin livssituation. Metoden som användes var en litteraturstudie med beskrivande design. Artiklarna kvalitetsbedömdes, innehållet sammanställdes och resulterade i fyra kategorier. Resultatet som rörde dem fysiska aspekterna av livssituation visade att smärta, trötthet/utmattning och sömnlöshet var vanligt förekommande symtom i kvinnornas vardag som påverkade deras livskvalitet. Symtomen hindrade dem från att leva ett aktivt liv samt delta i sociala aktiviteter. De psykiska aspekterna inom livssituationen visade att kvinnorna med fibromyalgi gav uttryck för en längtan efter det liv de levt innan sjukdomen och den förlorade identiteten. De sociala aspekterna visade att kvinnorna med fibromyalgi hade en önska att få spendera mer tid tillsammans med familjen. Sjukdomen hade också en negativ inverkan på förhållande och separationer var inte ovanligt. Arbetet prioriterades högt och arbetslivet uppskattades som stimulerande. Bristen på synliga symtom vid sjukdomen  gjorde att kvinnorna blev ifrågasatta av personer i omgivningen och sjukvårdspersonal. Under de existentiella aspekterna föll de positiva sidorna med sjukdomen in. Kvinnorna började reflektera över alla måsten och plikter i livet samt lärde sig att prioritera på ett bättre sätt.</p><p> </p> / <p><strong>Abstract</strong></p><p><strong></strong><strong></strong>Fibromyalgia has considered until to day as a psychosomatic disease that emerged without any known cause.The main symptoms are constant pain and an abnormal feeling of fatigue or exhaustion. There are no treatment for the illness it just alleviated the symptoms. The aim of this study was the describe how women with fibromyalgi experienced their life-situation.The method used was a literature study with a descriptive design. The articles were quality-tested, the content put together/compiled and resulting in four categories as follows.The result involving the physical aspects of life-situation showed that pain, tiredness and sleeplessness was commonly occurring symptoms in women´s daily life which affected their quality of life.The symptoms prevented women from living an active life and actively taking part in social activites. The psychological aspects of life-situation showed that women with fibromyalgia expressed a longing for the life they lived before the illness and the lost identity. The social aspects showed that the women wished to spend more time with their families. The disease had negative effects on their relationships and separation was not unusual. Work was highly prioritised and estimated as stimulating. The deficiency on visible symptoms of the disease made that the women became questioned by persons in their environment and by health-personal. The positive sides of the disease was found in the existential aspects. The women started to reflect about their duties in life and learned how to prioritise on a better way.</p>

<p> </p><p>Bakgrund:Smärta är en naturlig upplevelse vilken alla människor kommer i kontakt med och känner någon gång i livet. Smärta benämns kronisk om personen haft smärtan mer än sex månader i följd. Betydelsefullt för personer med kronisk smärta är att sjuksköterskan kan hantera smärtproblematik. Syfte: Syftet var att beskriva personers upplevelser av att leva med kronisk smärta. Metod: En allmän litteraturstudie har legat till grund för arbetet. Nio vetenskapliga artiklar har analyserats genom en kvalitativ och kvantitativ innehållsanalys. Resultat: Accepterande av kronisk smärta var ett påtagligt problem för dessa personer. En del påverkades så djupt av sin smärta att de hamnade i depression. Familjen har stort inflytande för personen med kronisk smärta. Egenvården är en viktig del för personer med kronisk smärta. Diskussion: Accepterande av smärta byggde i hög grad på hur smärtstillad personen upplevde sig vara. Sjukdom kan upplevas positivt trots att den är kronisk enligt Dorothea Orem. Slutsats: Studiens betydelse för sjuksköterskor är att kunna bemöta och ge en bättre omvårdnad till personer som lider av kronisk smärta. Med djupare kunskaper om hur personer med kronisk smärta upplever sjuksköterskans bemötande kan detta leda till bättre omvårdnad och patientkontakt.</p><p> </p> / <p> </p><p>Background: Pain is a natural experience which all people come into contact with and feels at some point in their lives. Chronic pain is when the person had pain for more than six consecutive months. It is significant for a person with chronic pain that a nurse can deal with pain problems. Aim: The aim was to describe people's experiences of living with chronic pain. Method: A general literature study has been the basis for the work. Nine scientific articles have been analyzed trough qualitative and quantitative content analysis. Results: Acceptance of chronic pain was a substantial problem for these people. Some were affected so deeply by their pain that they went into depression. The family has great influence on people with chronic pain. Self-care is an important part of people with chronic pain. Discussion: Acceptance of pain was based largely on how people experienced the pain. Illness may be viewed positively, although it is chronic according to Dorothea Orem. Conclusion: The study is important for nurses in order to respond and provide better care to people suffering from chronic pain. With a deeper understanding of how people with chronic pain perceive the nurse's response, this can lead to better care and patient contact.</p><p> </p>

<p><p><strong>Syfte:</strong> Syftet med denna studie är att bland patienter med långvarig smärta, som är remitterade till en smärtmottagning, undersöka förväntningar avseende det första besöket, i vilken utsträckning patienterna anser att dessa uppfylldes samt att undersöka vilka förväntningar patienterna har på den fortsatta vården och kontakten med Smärtmottagningen. <strong>Metod:</strong> En empirisk studie med kvalitativ deduktiv ansats. Datainsamling skedde genom att tio personer intervjuades på Smärtmottagningen efter deras första besök. Materialet bearbetades med manifest innehållsanalys.<strong> Resultat:</strong> Patienter vid Smärtmottagningen hade i olika stor utsträckning förväntningar inför det första besöket och den fortsatta vården. Patienterna ansåg i varierande utsträckning att deras förväntningar på det första besöket hade uppfyllts, dock uttryckte alla patienter att minst någon förväntning uppfyllts. Gällande den fortsatta vården förväntade sig patienterna bland annat smärtlindring, stöd samt att upprätta en kontakt med Smärtmottagningen. <strong>Slutsats:</strong> Patienter vid en smärtmottagning har förväntningar på vården och att känna till dessa kan underlätta mötet med patienten för sjukvårdspersonalen. Föreliggande studie ger en inblick i tio patienters förväntningar och huruvida de blivit uppfyllda och tyder på att det är av värde att fråga patienter om deras förväntningar. Detta är något som smärtmottagningar kan överväga att implementera i vården.</p></p> / <p><p><strong>Aim:</strong> The aim of this study was to investigate expectations on the first appointment among patients with chronic pain referred to an outpatient pain clinic. The aim was also to investigate to which extent the expectations on the first appointment were fulfilled and to investigate the patients’ expectations on the continuing care and contact with the outpatient pain clinic.<strong> Method: </strong>An empirical study with qualitative design was used. The data was collected through interviews with ten patients after their first appointment at the clinic. Data was processed using manifest content analysis.<strong> Result:</strong> The patients had expectations in various extents prior to their first appointment and on the further care. The patients thought that their expectations were fulfilled to various extent, however all patients expressed that at least one expectation had been fulfilled. Regarding the continuing care the patients expected, among other things, to receive functioning pain treatment and support as well as to establish a contact with the outpatient pain clinic.<strong> Conclusion:</strong> Patients have expectations and awareness of these among the medical staff might facilitate the meeting between the medical staff and the patient. This study provides an insight in ten patients’ expectations and to which extent they have been fulfilled. The study also suggests that it would be of value to ask patients about their expectations, which outpatient pain clinics can consider implementing.</p></p>