Recent advances in neuroimaging and electromagnetic measurement technology have permitted the exploration of structural and functional brain alterations associated with chronic pain. A number of cortical and subcortical brain regions have been found to be involved in the experience of chronic pain (Baliki et al., 2008; Jensen et al., 2010). Evidence suggests that living with chronic pain shapes the brain from both an architectural and a functional perspective, and that individuals living with chronic pain display altered brainwave activity even at rest. Quantitative EEG (qEEG) is a method of spectral analysis that utilizes a fast Fourier transform algorithm to convert analog EEG signals into digital signals, allowing for precise quantification and analysis of signals both at single electrode locations and across the scalp as a whole. An important advance that has been permitted by qEEG analysis is the development of lifespan normative databases against which individual qEEGs can be compared (Kaiser, 2006; Thatcher et al, 2000). Pilot data utilizing qEEG to examine brainwave patterns of individuals with chronic pain have revealed altered EEG activity at rest compared to age- and gender-matched healthy individuals (Burroughs, 2011). The current investigation extended the findings of the pilot study by utilizing qEEG to examine a larger sample of individuals with chronic pain. Individuals with chronic pain displayed significantly reduced slow wave activity in frontal, central, and temporal regions. Findings will be presented in terms of specific patterns of altered EEG activity seen in individuals with chronic pain.

Psychological factors have important implications for adjustment to chronic pain, which itself has a variety of emotional consequences. Mental imagery has historically been assumed to be closely connected to emotional responses, and some experimental and clinical evidence has supported this claim. Around two in five people with chronic pain spontaneously report having mind‟s-eye mental images of their pain, although this phenomenon has received only limited research attention. This study aimed to see whether, for people with chronic pain who report these images, evoking their pain images is different from describing their pain using only single descriptive words. It was hypothesised that evoking the images would result in a stronger negative emotional response, weaker positive emotional response and an increase in the perceived pain intensity. It was also hypothesised that, compared to baseline scores, emotional and pain intensity ratings would be higher under both experimental conditions. Thirty-six participants completed an experiment interview, which employed a repeated measures design. The dependent variables were visual analogue scale ratings of pain intensity and strength of emotional experience (fear, sadness, anger, disgust and happiness). Other measures completed assessed the nature of the imagery and level of overall psychological distress. The study found that evoking pain-related mental images resulted in a temporary increase in pain intensity, sadness, anger and disgust and a decrease in happiness. However, these emotional responses were no different from those experienced when participants described their pain in single words, although this verbal task did not result in the increase in pain intensity seen when images were evoked. These results suggest that for this group of people, pain imagery is no more closely connected to emotional responses than equivalent verbal representations. However, the fact that imagery evocation resulted in a temporary increase in pain intensity where the verbal condition did not perhaps suggests that this represents a qualitatively different kind of paying attention to pain. The next steps for this small but growing field of research are considered.

Systematic Review: Chronic pain and insomnia are highly comorbid, and evidence suggests a reciprocal relationship between these. CBT-I has been shown to improve sleep in those with chronic pain, therefore the potential of improved sleep leading to improvements in pain symptoms is a possibility. This led to the question: Does CBT-I improve pain symptoms in those with chronic pain and insomnia? A systematic review of the literature was conducted resulting in eight papers regarding six studies. Evidence was moderate that CBT-I improved sleep and pain related disability, but did not improve self reported pain levels. This discrepancy between improvements in pain related disability and no changes in self-reported pain levels led to the research question for the empirical element of the current thesis. Empirical Element of Thesis Objective: Chronic low back pain (CLBP) is a common form of chronic pain that affects a large population each year. Chronic pain and insomnia are highly comorbid conditions, yet knowledge about how patients perceive their interaction is limited. This qualitative study aims to inform our understanding of the patient experience with particular reference to beliefs and attributions surrounding pain, poor sleep and their interaction. Methods: 11 outpatients from a chronic pain clinic were recruited who suffered CLBP as their main symptom, and who had subsequently developed insomnia as a result. Data were analysed using Interpretative Phenomenological Analysis (IPA). Results: Qualitative analysis produced five super-ordinate themes: 1) the privacy of pain and solitude of sleep; 2) sleep/pain interaction; 3) night-time thinking; 4) adjustment and acceptance; and 5) self-management. Discussion: The first three themes combine to create the individual experience of CLBP: the visceral, emotional experience; the pre-existing and shifting beliefs; and the thought content. Once this is in place, the individual can reflect on what this means to them, and through acceptance, move through to adjustment. The individual accepts elements of their current experience, but where they see the opportunity to take control, these adjustments are translated into actions relating to self-management. These themes suggest CBT-I should be adapted to include pain specific beliefs to form a CBT for Insomnia and Chronic Pain (‘CBT-CPI’).

The relief of pain is an essential element of nursing practice. Nursing has begun to successfully use art to assess and reduce pain among hospitalized children, surgical patients, and oncology patients. Structured art projects have been used to provide distraction from pain and patient drawings have allowed nurses to assess pain. This project employed grounded theory and thematic analysis to uncover significant concepts in the artists' statements. The Roy adaptation model and Saunders' total pain theory provided the project theoretical framework. The artistic statements and the art of chronic pain patients were examined using thematic analysis to identify recurrent themes. This project explored the insights to chronic pain in the adult patient as evidenced in the posted work. The project also considered how the content of the posted artistic statements informed individual nursing practice and facilitated the reduction of pain in the adult patient suffering from chronic pain. Emergent concepts were used to develop artistic nursing interventions. Suggested modification of nursing practice included drawing as a tool in pain assessment, exploring the meaning of color choices, encouraging mask making, providing distraction, and using art to identify spiritual distress. The proposed nursing actions will allow more effective communication of pain, provide meaningful distraction, intervene in spiritual distress, and encourage creation of an artistic product. Expected outcomes include more effective pain control, greater patient autonomy, and reduced healthcare costs. The application of this new knowledge and skill will make a difference in the lives of chronic pain patients and will therefore promote positive social change.

Pain is influenced by biological, social, emotional and cognitive factors. Emotions are not simply a consequence of pain but rather a fundamental part of the pain experience. In addition, the social context cannot be isolated when constructing the meaning of the child’s pain, and in understanding the influence of mother-child interactions on children’s physiology. This research consists of two studies, study one investigated the relationship between anxiety, depression and physical functioning in children and adolescents experiencing chronic pain. The participants were 73 childen and adolescents who were referred to either the Children’s Pain Management Clinic at the Royal Children’s Hospital or the Sydney Westmead Children’s Hospital aged between 7-18 years old. The results indicated that these young people were reporting anxiety and depression within the normal range with significant anxiety and depression levels both below prevalent rates found in the normal population. Furthermore, depression but not anxiety was associated with increasing leves of physical disablity in children and adolescents. This led to the investigation of the relationship between maternal emotions on children and adolescents’ anxiety, depression, somatic symptoms and physical functioing in children and adolescents experiencing chronic pain. Study two investigated the association of maternal and child emotions in children and adolescents with chronic pain. Participants included 62 mothers and 62 children and adolescents between the ages of 7-18 years (M=13). Mothers’ emotional distress (empathy, emotional involvement, and distress) was examined as a significant factor to be associated with children’s pain sensitive temperament and functional outcomes (anxiety, depression, somatisation, and physical functioning). Children’s perceptual sensitivity and avoidance of sensation, which are components of children’s pain sensitive temperament, were investigated in relation to children’s ability to regulate emotions. The association between maternal and child emotional regulation and children’s functional outcomes was also explored. Mothers completed questionnaires assessing children’s somatisation, their own difficulties with having a child with persisting pain and an empathy scale. Mothers also completed a semi-structured interview by Katz and Gottman (1991) the Meta-Emotion Interview which discusses mothers’ awareness of their own and their child’s emotions, mothers acceptance of their own and their child’s emotions, the regulation of their own and their child’s emotions and coaching of their child’s emotions. Children and adolescents completed quesionnaires measuring anxiety, depression, emotional involvement, somatisation and pain sensitive temperament. The results indicated low maternal emotional regulation was significantly associated with children's depression, anxiety and somatisation scores, whilst children’s emotional regulation was associated with children’s anxiety and depression, but not with somatisation scores. Maternal emotional distress was associated with children's pain sensitive temperament, emotional distress and reduced physical functioning. Furthermore, emotional regulation in children was associated with children's pain sensitive temperaments. It is proposed that young people with chronic pain may have a biological vulnerability to respond to stress and traumatic events as pain, and pain related symptoms. This biological sensitivity may be associated with children’s threshold of pain, whereby children’s perceptual sensitivity may be associated with reporting of somatic complaints. Thus, maternal emotions and social factors may be associated with children’s somatosensory processing and the chronic pain experience.

Purpose: The purposes of this study were: (a) to describe the physical and mental health status of Afghan immigrant women in one Canadian city; (b) to construct an Afghan cultural model of pain (experience and management) using interview data and available literature; (c) to explore the experience of chronic pain and its management among Afghan immigrant women, both culturally and individually; and (d) to identify potential barriers to chronic pain management for both Afghan immigrant women and their health care providers. Methods: This study has two parts; questionnaires were used in Part 1, and semi-structured interviews supplemented by three short questionnaires were used in Part 2. Interpretive description methodology using thematic analysis and conceptual mapping was used for analysis of interviews in Part 2. Results: SF-36 responses (n = 9) in Part 1 suggested that the physical health status of the Afghan women was better than their mental health status. Health sciences literature and interviews with 6 Afghan immigrant women and 1 healthcare professional were used to construct cultural models of pain experience and pain management. Findings indicated that Afghan immigrant women who experienced and managed their chronic pain within their cultural model did so holistically across multiple factors: environmental, spiritual, biological, and psychological. However, each individual internalized their cultural model of pain in varying amounts. Barriers in healthcare access that prevented Afghan immigrant women from managing their pain well included: (a) different cultural perspectives between Afghan immigrant women and healthcare professionals regarding how pain is experienced and managed; and (b) communication difficulties between healthcare professionals and Afghan immigrant women. Significance of Findings: Cultural perspectives on pain experience and pain management influence treatment expectations and pain management. Differences in cultural perspectives are a barrier in healthcare access that prevents Afghan immigrant women from managing their pain well. Addressing the differences in perspective identified in this study will increase understanding for healthcare professionals as they work together with Afghan immigrant women patients, thereby improve communication and reduce barriers to pain management.

Thesis (Ph. D.)--University of Sydney, 2009. / Title from title screen (viewed Nov. 26, 2009) Includes tables and questionnaires. Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy to the Kolling Institute of Medical Research, Faculty of Medicine. Degree awarded 2009; thesis submitted 2008. Includes bibliography. Also available in print form.

The relief of pain is an essential element of nursing practice. Nursing has begun to successfully use art to assess and reduce pain among hospitalized children, surgical patients, and oncology patients. Structured art projects have been used to provide distraction from pain and patient drawings have allowed nurses to assess pain. This project employed grounded theory and thematic analysis to uncover significant concepts in the artists' statements. The Roy adaptation model and Saunders' total pain theory provided the project theoretical framework. The artistic statements and the art of chronic pain patients were examined using thematic analysis to identify recurrent themes. This project explored the insights to chronic pain in the adult patient as evidenced in the posted work. The project also considered how the content of the posted artistic statements informed individual nursing practice and facilitated the reduction of pain in the adult patient suffering from chronic pain. Emergent concepts were used to develop artistic nursing interventions. Suggested modification of nursing practice included drawing as a tool in pain assessment, exploring the meaning of color choices, encouraging mask making, providing distraction, and using art to identify spiritual distress. The proposed nursing actions will allow more effective communication of pain, provide meaningful distraction, intervene in spiritual distress, and encourage creation of an artistic product. Expected outcomes include more effective pain control, greater patient autonomy, and reduced healthcare costs. The application of this new knowledge and skill will make a difference in the lives of chronic pain patients and will therefore promote positive social change.

Chronic pain is estimated to affect approximately 29% of the Canadian population and causes far-reaching lifestyle changes and difficulties that have personal, social, and economic impact. Managing pain is a complex task that recently has been recognized as requiring a multidisciplinary approach. Significant amounts of research have been conducted to understand the biological and cognitive bases of pain; and yet, spiritual aspects of chronic pain have received less attention. Despite this, spirituality remains an important coping strategy as reported by individuals managing chronic health conditions. Some interventions in use today have spiritual roots; however, western medical treatments of pain often do not recognize or utilize spirituality on a regular basis. Utilizing one such intervention, namely mindfulness meditation (MM), this study attempted to understand the role that MM plays in the management of chronic pain and the development of spirituality. This study measured self-reported pain, anxiety, depression, and spirituality in individuals engaged in an 8-week group process in which individuals were provided chronic pain related psycho-education either with MM or without. A repeated measures model was utilized to measure changes that occurred in reported pain experiences (using the McGill Pain Questionnaire) and in spirituality (using the Spiritual Assessment Scale ) to determine if changes could be associated with the teaching of MM. Differences in Affective pain ratings were observed and correlations between pain ratings and spirituality discussed. Reasons for the lack of significant findings, including sample size, power, and measures are discussed.

Chronic pain is estimated to affect approximately 29% of the Canadian population and causes far-reaching lifestyle changes and difficulties that have personal, social, and economic impact. Managing pain is a complex task that recently has been recognized as requiring a multidisciplinary approach. Significant amounts of research have been conducted to understand the biological and cognitive bases of pain; and yet, spiritual aspects of chronic pain have received less attention. Despite this, spirituality remains an important coping strategy as reported by individuals managing chronic health conditions. Some interventions in use today have spiritual roots; however, western medical treatments of pain often do not recognize or utilize spirituality on a regular basis. Utilizing one such intervention, namely mindfulness meditation (MM), this study attempted to understand the role that MM plays in the management of chronic pain and the development of spirituality. This study measured self-reported pain, anxiety, depression, and spirituality in individuals engaged in an 8-week group process in which individuals were provided chronic pain related psycho-education either with MM or without. A repeated measures model was utilized to measure changes that occurred in reported pain experiences (using the McGill Pain Questionnaire) and in spirituality (using the Spiritual Assessment Scale ) to determine if changes could be associated with the teaching of MM. Differences in Affective pain ratings were observed and correlations between pain ratings and spirituality discussed. Reasons for the lack of significant findings, including sample size, power, and measures are discussed.