Bakgrund: Patienter med långvarig smärta är en stor grupp i samhället. Långvarig smärta avser en smärta som har varat i minst tre månader. Den innebär ett fysiskt, psykiskt och socialt lidande för patienterna. Mötet mellan patient och vårdpersonal påverkar patienternas förmåga att hantera sin smärta och vardag. Det är således relevant att ta reda på patienternas upplevelser av mötet med vårdpersonalen. Syfte: Syftet var att beskriva hur patienter med långvarig smärta upplever mötet med vårdpersonal. Metod: En litteraturöversikt med induktiv ansats. Litteratursökningen utfördes i CINAHL och MEDLINE. Tio artiklar med kvalitativ design som besvarade syftet valdes ut. Artiklarna analyserades enligt Fribergs femstegsmodell och sammanställdes till ett resultat. Resultat: Resultatet visade att patienterna med långvarig smärta upplevde mötet med vårdpersonalen både vårdande och bristande.  I resultatet framkom två kategorier vilka var Ett vårdande möte och Maktlöshet som beskrevs av respektive underkategorier. Slutsats: Patienterna med långvarig smärta behöver bli bemötta med förståelse och bli trodda. Ökad kunskap hos vårdpersonalen om långvarig smärta och patienternas upplevelse av mötet behövs för att patienterna ska uppleva ett vårdande möte. Ett vårdande möte kan leda till att deras hälsa förbättras och lidandet minskar. / Background: Patients with chronic pain are a large group of society. Chronic pain involves suffering to the patient. A meeting between patient and healthcare professionals affects the patient's ability to handle his pain and everyday life. It is thus relevant to ascertain the patient's experiences of the encounter with healthcare professionals.  Aim: The aim was to describe how patients with chronic pain experience the encounter with healthcare professionals. Method: A literature review with an inductive approach. Ten scientific articles with qualitative design were included. Result: The result showed that patients with chronic pain experienced the relationship in the healthcare both as caring and inadequate. In the result, two categories emerged which were  Caring encounter and  Powerlessness described by the respective subcategories. Conclusion: Patients with chronic pain need to be treated with understanding and being believed. Increased knowledge of healthcare professionals about chronic pain and the patient's experience of the healthcare relationship is necessary for the patient to experience a caring relationship. A caring relationship can lead to their improved health and diminished suffering.

Bakgrund:  Långvarig smärta är idag ett mångfacetterat folkhälsoproblem. Smärtupplevelsen är komplex och påverkar människan utifrån flera dimensioner. Det vardagliga livet påverkas vilket skapar problem på såväl individ- som samhällsnivå. Sjuksköterskans roll är betydelsefull angående bemötandet och för patientens fortsatta utveckling av smärtupplevelsen. Syfte: Att beskriva patienters erfarenheter av att leva med långvarig muskuloskeletal smärta.  Metod: Littereraturöversikt baserad på tio kvalitativa vetenskapliga artiklar framsökta i databaserna CINAHL Complete och PubMed. Artiklarnas resultat analyserades och granskades utifrån skriftliga sammanfattningar och teman framställdes med hjälp av färgkodning. Resultat: Centrala erfarenheter som framkom var att deltagarna upplevde sig känslomässigt involverade, vilket även visades påverka smärtupplevelsen. Inställningen till och hanteringen av smärtan, livet och framtiden påverkades av yttre faktorer och förmågan till acceptans. Analysen genererade fem teman: smärtans påverkan i vardagen, smärtans påverkan av självbilden, strategier, bemötandet från hälso- och sjukvården och balans mellan hopp och förtvivlan. Diskussion: Livet med långvarig smärta innebär ofta ett stort lidande för människan. Eriksson beskrivning av livslidande, vårdlidande och sjukdomslidande ligger till grund för resultatdiskussionen. Även betydelsen av acceptans, omvårdnaden och hoppet diskuteras i förhållande till relevant forskning och litteraturöversiktens resultat.

Bakgrund: Smärta är en subjektiv upplevelse som är svår att sätta ord på. Det finns många personer i Sverige som lider av långvarig smärta och dessa är frekventa besökare hos sjukvården. Långvarig smärta är ett komplext tillstånd som kan vara svår att behandla. För att patienten ska få god vård bör dennes livsvärld beaktas. Syfte:Syftet var att belysa hur patienter med långvarig, icke-malign smärta upplever tillvaron. Metod: En litteraturstudie som har baserats på 13 vetenskapliga artiklar publicerade mellan åren 2007-2018. Artiklarna har hittats genom sökningar i databaserna CINAHL Complete, PubMed och SveMed+. Några av de sökord som använts var “chronic pain”, “patient” och “experience”. Litteraturstudien utgår från Callista Roy´s Adaptionsmodell. Resultat: Resultatet i denna litteraturstudie består av fyra huvudteman. Under “Mötet med vårdpersonalen” har det visat sig att många patienter kände att de blir misstrodda och inte tagna på allvar av vårdpersonalen. Det andra temat är “Smärtan påverkar livsvärlden” där patienterna uttryckte att hela livet förändrats och att de inte alltid känner igen sig själva .“Ibland räcker orden inte till”, det tredje temat, visade att patienterna upplevde smärta som något svårt att både skatta och förmedla. I “Behandling” som är det sista temat framkom det att många var oroliga för biverkningarna samt den höga beroenderisken som smärtstillande läkemedel kan ha. Diskussion: Resultatet diskuteras utifrån Callista Roys Adaptionsmodell och de fyra adaptiva lägena; fysiologiska funktioner, ömsesidigt beroendeläge självkoncept och rollfunktion. Sjuksköterskans roll och skyldigheter diskuteras även i samband med dessa lägen. / Background: Pain is a subjective feeling that is hard to put in to words. There are many people in Sweden that suffer from chronic pain and these are frequent users of the healthcare. Chronic pain is a complex condition that can be hard to treat. Aim: The aim was to illustrate how patients with chronic, nonmalignant pain experience their existence. Method: A literature review that is based on 13 peer reviewed articles that have been published between 2007-2018. The articles have been found in the following databases; CINAHL Complete, PubMed och SveMed+. Some of the keywords were “chronic pain”, “patient” and “expectations”. This literature review is based on Callista Roys Adaption Model. Results: The result in this literature review contains four main themes. In the first theme “The interaction with the healthcare professionals” showed that many patients felt disbelieved and not taken seriously. The second theme “The pain affected the patients’ quality of life“, the patients expressed that their whole life changed and that they cannot recognise themselves. “Sometimes the words are not enough”, the third theme, showed that patients experienced pain that is difficult to estimate and explain. Under “Treatment”, the last theme, many patients were worried about the side effects and the high risk of addiction that painkillers may have. Discussion: The result is discussed from Callista Roys Adaption Model and the four adaptive modes; physiological functions, interdependence, self-concept and role function. Nursing's roles and obligations are also discussed during these adaptive modes.

Bakgrund: Långvarig benign smärta är ett stort hälsoproblem i samhället. För att räknas som långvarig smärta ska smärtan ha varat i minst tre månader. Personer upplever långvarig smärta som fysiskt och psykiskt påfrestande. Sjuksköterskan har en viktig roll i bedömning, smärtskattning och behandling av smärtan. Det är således av betydelse att ta reda på personers upplevelse av långvarig smärta.   Syfte: Syftet med studien var att beskriva personers upplevelse av att leva med långvarig benign smärta.   Metod: En litteraturöversikt med induktiv ansats. Databaserna CINAHL och PsycINFO användes för att göra litteratursökningen. Syftet besvarades med tio artiklar som användes för att bygga upp resultatet. Fribergs femstegsmodell användes för att bearbeta och analysera resultatet i artiklarna.   Resultat: I resultatet framkom två huvudteman som var: Bemötande i vården och Påverkan på det dagliga livet. Båda huvudtemana hade tre subteman.   Slutsats: Personerna behöver bli betrodda och bekräftade i upplevelsen av sin smärta. En ökad kunskap i bemötandet av personer med långvarig smärta behövs för att mötet ska upplevas givande. Ett givande möte kan leda till minskad smärta eller upplevelse av god hälsa, trots smärtan. / Background: Chronic benign pain is a big worldwide health problem in the society. To be defined as chronic the pain must have lasted for at least three months. The chronic pain causes physical as well as psychic stress. The caregiver has a vital role in judging, pain scaling and treatment. It is thereby of importance to find out how people experience the chronic pain.   Aim: The purpose of the study was to describe people's experience of living with benign chronic pain   Method: A literature review with inductive approach. The databases CINAHL and PsycInfo was used to make the literature search. The aim was answered with 10 qualitative results articles. Fribergs fivestepsmodell was used to process and analyse the articles result.   Result: In the result two heads themes emerged: Treatment in healthcare and  Impact on daily life. Both head themes consisted of three subheadings.   Conclusion: There is a need to be believed and acknowledge in the experience of pain. An increased knowledge in treatment of people with chronic pain is needed for the meeting to be experienced as rewarding. A rewarding meeting can lead to reduced pain or experience of good health, despite pain.

INTRODUCTION: It is estimated that 100 million individuals suffer from chronic pain in the United States. Many of the options involved in chronic pain management have limited effectiveness come with risks of addiction, and/or have numerous side effects. The toll of chronic pain is even more substantial when complications with addiction arise. With an estimated 13.7% of adults having admitted to using pain relief medication for nonmedical purposes in the United States totaling a cost of approximately 55 billion dollars annually, the combined burden of chronic pain and addiction is considerable. To curb the sufferings created by chronic pain, it is essential to investigate its sources, the risks involved with current treatments, and alternative methods to alleviate chronic pain. PURPOSE: The objective of this study is to review the current literature on the topic of nonopioid therapies in the treatment of chronic pain, their ability to reduce opioid prescriptions, and assess their pros and cons. Three different forms of alternative treatments were chosen: 1) psychotherapeutic treatment Cognitive Behavioral Therapy, 2) Eastern Medicine Acupuncture, and 3) pharmacological class cannabinoids. RESULTS AND CONCLUSION: The current literature on alterative therapies show that cannabinoids had the most potential to decrease pain, followed by CBT, and acupuncture showing the least consistent efficacy. The literature on CBT elucidate a great potential to decrease the use of prescribed opioids without increasing pain while cannabinoids showed a synergistic effect with opioids. The combined results for acupuncture were not consistent, with only one of the studies showing potential to reduce the use of opioids, while the others showed no difference between real and sham acupuncture.

Complex regional pain syndrome (CRPS) is a chronic neuropathic pain disorder characterized by both central and peripheral symptoms that can be debilitating in children. CRPS treatment typically consists of intensive physical, occupational, and psychological therapy with evidence supporting the efficacy of this approach. Among these outcomes, some patients report significant improvements in pain while others report no change. Identifying baseline predictors of treatment resistance would refine our treatment approach and provide additional targets for intervention. The current study examined baseline brain structure via cortical thickness and gray matter volume (GMV) in 29 pediatric CRPS patients enrolled in an intensive pain rehabilitation program. All participants underwent MRI using a high-resolution T1-weighted sequence. Patients were categorized as pain treatment “responders” (n=19) or “non-responders” (n=10) based on change in reported pain levels from admission to follow up. Compared to treatment responders, non-responders demonstrated significantly less GMV in the bilateral nucleus accumbens p<0.05 and right: putamen p<0.01, pallidum p<0.05, and amygdala p<0.05. Furthermore, treatment non-responders exhibited significant cortical thickening in the left anterior insular cortex and medial frontal gyrus, and cortical thinning in the bilateral precentral gyrus and superior frontal gyrus; right: middle frontal gyrus, fusiform gyrus, inferior temporal gyrus, middle temporal gyrus, and anterior prefrontal cortex; and left: parahippocampal gyrus. Though we did see significant thinning of the primary motor cortex in treatment non-responders compared to responders, the majority of our findings were localized to regions associated with reward, motivation, learning, and emotion. We, therefore, postulate that treatment non-responders, when compared to responders, likely have an intrinsically reduced reward responsiveness, diminished motivation, and impaired learning, overall contributing to their negative treatment outcomes and chronification of pain. In conclusion, these baseline differences overall suggest these regional morphometric alterations may potentially serve as predictors of treatment response in pediatric CRPS. Furthermore, these areas may also indicate possible targets for future treatment.

BACKGROUND: Disparities in access to quality chronic pain treatment options disproportionately affect minorities. Although there is increasing evidence about the effectiveness of complementary and integrative medicine (CIM) to help in the treatment of pain, little is known about how low income minorities would benefit from having greater access to CIM. The Integrative Medical Group Visit (IMGV) model incorporates CIM in a medical group visit setting with the goal of increasing access to CIM. OBJECTIVE: The aims of this pilot study were to test 1) the feasibility of a Spanish language IMGV and 2) its effectiveness to reduce pain and improve function in Spanish speakers with chronic pain. METHODS: The study setting is the Family Medicine Clinic at Boston Medical Center. Adult Spanish speakers with chronic pain for at least 12 weeks were included; those pregnant, with psychosis, suicidal ideation or active substance abuse disorder were excluded. The intervention consisted of weekly, two-hour sessions for a total of 9 weeks. Main outcomes were pain level, pain interference, and physical and emotional function measured by the PROMIS 29 pre- and post-intervention, depression and stress, measured by PHQ-8 and PSS-10, respectively. Focus group participants discussed the feasibility of the intervention. Analyses involved t-tests to examine our outcome data, and qualitative thematic analysis for focus group data. RESULTS: This open study recruited 11 subjects, 10 women, average age of 51.9 years; 50% of participants attended more than four sessions. The outcomes showed a trend toward reduced depression, pain, fatigue, and anxiety. Qualitative themes of reduced pain, increased knowledge for healthier living, and improved access to pain treatment using an appropriately adapted intervention were found. CONCLUSIONS: It was feasible to implement the Latino IMGV model in the outpatient setting at BMC. Trends in reduction of pain and depression, as well as increased knowledge for healthier living and better access to CIM modalities were found. Future powered studies are needed to further implement this model.

The motor symptoms of Parkinson's disease (PD) have been linked to the emergence of exaggerated oscillatory activity in the 13 - 35 Hz beta range in recordings of the basal ganglia (BG) thalamocortical circuit of PD patients and animal models. PD patients and animal models also express dopamine-dependent cognitive impairments, implying effects of dopamine loss on the function of the anterior cingulate cortex (ACC). This thesis examines the electrophysiological behavior of the BG thalamocortical circuit in PD and dopamine-normal states during cognitive and motor activity. In vivo recordings in the BG of PD and dystonic patients were used to study the influence of dopamine during a test of executive function. Normal executive function was also investigated in the dopamine-healthy ACC of chronic pain patients. Both the BG and ACC exhibited lateralized electrophysiological responses to feedback valence. The BG also exhibited dopamine-sensitive event-related behavior. In additional experiments, chronically implanted recording electrodes in awake, behaving hemiparkinsonian rats were used to examine the transmission of synchronized oscillatory activity from the BG, through the ventral medial (VM) thalamus, to the ACC. Modulation of subthalamic nucleus, VM thalamus, and ACC activity during a simple cognitive/movement task was also investigated in hemiparkinsonian rats. Findings in the rat model suggest that ACC-mediated executive function is dopamine-sensitive and is reflected in the region's electrophysiology. These results may provide further insight into the significance of excessive oscillatory activity in PD and its influence on cognitive systems.

abstract: In rehabilitation settings, activity limitation can be a significant barrier to recovery. This study sought to examine the effects of state and trait level benefit finding, positive affect, and catastrophizing on activity limitation among individuals with a physician-confirmed diagnosis of either Osteoarthritis (OA), Fibromyalgia (FM), or a dual diagnosis of OA/FM. Participants (106 OA, 53 FM, and 101 OA/FM) who had no diagnosed autoimmune disorder, a pain rating above 20 on a 0-100 scale, and no involvement in litigation regarding their condition were recruited in the Phoenix metropolitan area for inclusion in the current study. After initial questionnaires were completed, participants were trained to complete daily diaries on a laptop computer and instructed to do so a half an hour before bed each night for 30 days. In each diary, participants rated their average daily pain, benefit finding, positive affect, catastrophizing, and activity limitation. A single item, "I thought about some of the good things that have come from living with my pain" was used to examine the broader construct of benefit finding. It was hypothesized that state and trait level benefit finding would have a direct relation with activity limitation and a partially mediated relationship, through positive affect. Multilevel modeling with SAS PROC MIXED revealed that benefit finding was not directly related to activity limitation. Increases in benefit finding were associated, however, with decreases in activity limitation through a significant mediated relationship with positive affect. Individuals who benefit find had a higher level of positive affect which was associated with decreased activity limitation. A suppression effect involving pain and benefit finding at the trait level was also found. Pain appeared to increase the predictive validity of the relation of benefit finding to activity limitation. These findings have important implications for rehabilitation psychologists and should embolden clinicians to encourage patients to increase positive affect by employing active approach-oriented coping strategies like benefit finding to reduce activity limitation. / Dissertation/Thesis / Ph.D. Psychology 2012

OBJETIVOS Este estudo tem dois objetivos: 1) verificar a freqüência de depressão em pacientes femininas com fibromialgia; 2) comparar as pacientes com fibromialgia com ou sem depressão para verificar se diferem no uso de seus mecanismos de defesa e qualidade de vida. MÉTODOS Oitenta e seis pacientes femininas com fibromialgia foram avaliadas psiquiatricamente. O diagnóstico psiquiátrico foi feito por meio de entrevistas clínicas e confirmado pelo MINI (Mini International Neuropsychiatric Interview), uma entrevista psiquiátrica estruturada. O uso dos mecanismos de defesa foi avaliado pelo DSQ-40 (Defense Style Questionnaire), um questionário autoaplicável com 40 questões. A qualidade de vida foi avaliada pelo WHOQOL – Bref (World Health Organization Quality of Life Instrument – Short Version), também auto-aplicável, composto por 26 questões, dividido em quatro domínios: físico, psicológico, relações sociais e ambiental. A gravidade da depressão foi verificada pelo BDI (Beck Depression Inventory), um teste com 21 itens de múltipla escolha. Todos os instrumentos utilizados já se encontram validados para o português brasileiro. RESULTADOS Sessenta e duas pacientes (72,1%) tinham depressão atual (Depressão Maior ou Distimia), com qualidade de vida pior do que aquelas sem depressão (p<0,008). Quanto mais grave foi a depressão, avaliada pelo BDI, pior foi avaliada a qualidade de vida em todos os domínios (p<0,001). As pacientes com depressão usaram mais mecanismos de defesa imaturos, menos mecanismos maduros (p<0,001) e eram mais jovens, quando comparadas com aquelas sem depressão (46,06 anos, DP ± 10,03 vs. 52,29 ± 11,23, t= 2,09, p= 0,039). Entretanto, na regressão logística controlada para a idade, todos os domínios da qualidade de vida e os escores de defesas maduras e imaturas permaneceram associados à presença de depressão. CONCLUSÕES Neste estudo, a alta freqüência de depressão em pacientes com fibromialgia corrobora os dados da literatura científica internacional, em seus limites superiores. A presença de depressão está associada a pior qualidade de vida e maior uso de mecanismos de defesa mal-adaptativos. Esses resultados sugerem que a depressão, quando presente, deve ser tratada vigorosamente para melhorar a qualidade de vida dos pacientes com fibromialgia. / OBJECTIVE This study has two aims: 1) to verify how frequent depression among female patients with fibromyalgia is; 2) to compare the female patients with fibromyalgia with and without depression in order to verify whether their defense mechanisms and quality of life differ. METHODS Eighty-six female patients with fibromyalgia were assessed. The psychiatric diagnosis was conducted through clinical interviews and confirmed by MINI (Mini International Neuropsychiatric Interview), a structured psychiatric interview. The use of defense mechanisms was evaluated through the self-applied means DSQ- 40 (Defense Style Questionnaire). Quality of life was evaluated by WHOQOL – Brief (World Health Organization Quality of Life Instrument – Short Version), also self-applied, composed by 26 questions, divided in four domains: physical, psychological, social relations and environment. The level of depression was attained through BDI (Beck Depression Inventory), a 21-multiple choice test. All instruments employed have been previously validated to Brazilian Portuguese. RESULTS Sixty-two patients (72.1%) presented current depression (Major Depression or Dysthymia). The quality of life of these patients was worse than of the patients without current depression (p<0.008). The graver the depression, which was evaluated by BDI, the worse the quality of life was in all domains (p<0.001). The depressed patients employed more immature defense mechanisms and a lesser number of mature mechanisms (p<0.001), and they were younger when compared to the ones who were not depressed (46.06 years old, DP ± 10.03 vs. 52.29 ± 11.23, t = 2.09, p = 0.039). The controlled logistic regression for age was used in this study and all domains of the quality of life and the scores of mature and immature defenses remained associated to the presence of depression. CONCLUSIONS In this study, the high occurrence of depression in patients with fibromyalgia corroborates the data available in international scientific literature, though, in its higher limits. The presence of depression is associated to a worse quality of life and to a greater use of defense mechanisms which are maladapted. These results suggest that depression should be treated vigorously in order to improve the quality of life of patients with fibromyalgia.