Aim: The aim of this study was to explore the concurrent validity between Pain Limitation List (PLL) and Functional Disability Inventory (FDI), the association between PLL and age and FDI and age, the difference between gender in PLL and FDI and possible floor or roof effects in the two tests. Method: The study was a cross-sectional study and had a descriptive correlational and comparative design. 86 children with chronic pain participated in the study. Result: The study showed that PLL had a concurrent validity with FDI (r=-0,740), p<0,001). There was a weak correlation between FDI and age (r=0,249, p<0,021) but PLL did not have a correlation with age and there was no difference between gender in PLL or in FDI. Also, there was no floor or roof effect for the two tests but it seems that PLL is slightly more sensitive for children and adolescents with less pain-related disability. Conclusion: according to this study, PLL has a concurrent validity. But to be able to use PLL as a reliable instrument, more studies who explore reliability and other types of validity is needed. / Syfte: Syftet för denna studie var att undersöka samstämmig validitet mellan the Pain Limitation List (PLL) och the Functional Disability Inventory (FD), samvariationen mellan ålder och PLL och ålder och FDI, skillnad mellan kön för PLL och FDI samt eventuella takeller golveffekter för de två testen. Metod: Studien var en tvärsnittsstudie och hade en beskrivande korrelerande och jämförande design. 86 barn med långvarig smärta deltog i studien. Resultat: Studien visade att PLL har en samstämmig validitet med FDI (r= -0,740, p<0,001), att det var en svag samvariation mellan FDI och ålder (r=0,249, p<0,021), ingen samvariation mellan PLL och ålder samt att det inte förelåg någon skillnad mellan könen i FDI och i PLL. Det fanns heller ingen tak- eller golveffekt för de två testen men det verkar som att PLL är något mer känslig för barn och ungdomar med mindre smärtrelaterad aktivitetsbegränsning. Konklusion: Enligt denna studie har PLL samstämmig validitet. Men för att kunna använda PLL som ett pålitligt instrument behöver fler studier undersöka instrumentets reliabilitet och andra typer av validitet.

This study assessed the influence of massage therapy on the psychobiology of chronic pain patients. A pre- and posttest design measured the effects of a one-month treatment program Twenty outpatients and twenty inpatients of two chronic pain treatment programs, were administered several psychological and physiological tests before and after the study. Experimental subjects received massage therapy twice a week for one month in addition to their other therapies. Control subjects continued with their regular treatment modalities for one month. Results showed statistically significant differences (p < .05) on 5 of the 17 psychological variables and on the electromyograph levels. Analysis of Holmes-Rahe scores suggested that these differences were not attributable to the artifact effect of differential life stress.

Ce travail de thèse vise à étudier la dynamique psychique des sujets douloureux chroniques ainsi qu’à évaluer l’incidence d’une prise en charge hypnothérapeutique sur le fonctionnement psychique au sein de cette population. Cette recherche repose sur la mise en place d’une méthodologie incluant la passation du test de Rorschach, du test de l’arbre malade, et du test de MMPI-2, auprès d’une population de 36 sujets constitués en groupe clinique et témoin. Les résultats témoignent, chez les sujets douloureux chroniques, d’un fonctionnement psychique marqué par la présence d’un Moi ne parvenant pas à déployer une mobilisation défensive suffisamment efficiente pour restaurer un équilibre face à l’effraction somato-psychique que représente la douleur. Suite à la prise en charge hypnothérapeutique, les résultats révèlent des modifications au niveau de la dynamique psychique. Ils témoignent d’un renforcement de l’instance moïque permettant des remaniements au niveau de la sphère affective, de la qualité du rapport à la réalité ainsi qu’une restauration narcissique. La prise en charge engendre par ailleurs des ajustements au niveau de la consistance des limites de l’image du corps. L’incidence des modalités de fonctionnement psychique sur les effets de la prise en charge hypnothérapeutique semble fonction du niveau de psychopathologie présenté par les sujets. Les résultats obtenus traduisent les potentialités de l’hypnose en tant que technique psychothérapeutique. La prise en charge hypnothérapeutique semble exercer une incidence au niveau de l’image du corps et de l’instance moïque à même de contribuer à la restauration de l’équilibre psychique / This thesis work seeks to study the psychic dynamic of chronic pain subjects, as well as to assess the impact of a hypnotherapeutic treatment on the psychic functioning in this population. This research strategy relies on the following methodology: Rorschach test, ill tree test, MMPI-2 test, on a 36-subject population distributed in a clinical group and a witness group. On chronic pain subjects, results show a psychic functioning pronounced by the presence of an Ego that can not deploy sufficient protection to re-establish a balance following a somatopsychic break that the pain represents. Following a hypnotherapy, results show modifications of the psychic dynamic. They show a strengthening of the ego allowing a revision of the emotional sphere, as well as a better relation to reality and a narcissistic restoration. The treatment generates a better the perception of body image. The impact of psychic functioning from the effects of the hypnotherapy treatment seems to be related to the psychopathology level of the subjects. Results show that hypnosis can potentially be used as a psychotherapeutic technique. Hypnosis treatment seems to exercise an effect on the body image and the ego that may contribute to the restoration of the psychic balance

Globalt är smärta ett mycket stort problem och uppskattningsvis lever cirka 60 miljoner människor med långvarig smärta idag. Den långvariga smärtan kan vara svår att bemästra och patienter kan uppleva att traditionell medicinsk vård inte hjälper tillräckligt. Utöver traditionell medicinsk vård finns komplementära terapier som sjuksköterskan kan använda för att lindra patienters smärta. Syftet var att undersöka patienters upplevelser av användningen av komplementära terapier vid långvarig smärta. En litteraturstudie gjordes och den resulterade i åtta vetenskapliga artiklar som svarade till syftet. I resultatet framkom två kategorier: förbättring och ökad medvetenhet. Litteraturstudiens slutsats visade att patienter upplevde en lindring i den långvariga smärtan av de komplementära terapierna. Det framkom även att patienterna blev mer medvetna om sambandet mellan kroppen och smärtan, vilket gjorde att de kunde hantera den långvariga smärtan bättre. Sjuksköterskans kunskaper inom de komplementära terapierna som kan lindra långvarig smärta är dock fortfarande bristfälliga och mer forskning krävs, dels om patienters upplevelser av komplementära terapier och dels om de faktiska kostnaderna av att tillämpa dessa terapier. / Globally is the pain a huge problem and estimated live about 60 million people with chronic pain today. A long period of pain may be hard to cope with and patients can experience that conventional medicine are not efficient enough. Apart from conventional medicine there are complementary therapies of pain relief that the nurse may use to ease the patient's suffering. The purpose of this study was to investigate patients' experiences of the use of complementary therapies of long period of pain. A literary survey was performed which resulted in eight scientific articles corresponding to the purpose of the study. Two categories appeared among the result: recovery and increased body awareness. The conclusion of the literary survey showed that patients experienced relief from the prolonged pain of the complementary therapies. It also emerged that the patients became more aware of the connection between the body and the pain, which meant that they could handle the long-lasting pain better. However, the nurse's knowledge of complementary therapies of relieving pain is still deficient and more research partly about patients' experiences of complemantary therapies of pain and partly about the actual cost of applying these therapies are required.

Orientador: Celia Marisa Rizzatti Barbosa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-27T03:12:58Z (GMT). No. of bitstreams: 1 DeLaTorre_GiancarloCanales_M.pdf: 1869066 bytes, checksum: 85893ba40f18a6856da478ed26656c85 (MD5) Previous issue date: 2015 / Resumo: Disfunção temporomandibular (DTM) ou desordem craniomandibular são termos genéricos que abrangem um grupo amplo de problemas clínicos relacionados ao sistema estomatognático (SEG). A etiologia das DTM pode ser considerada multifatorial. Em função da similaridade com outras disfunções musculoesqueléticas, sobre as quais se desconhece o curso natural, terapias conservadoras estão indicadas como tratamento de primeira eleição. Dentre elas, cita-se a conscientização e a educação do paciente, as quais são intervenções rápidas, simples, sem riscos, e que podem obter sucesso sem custo adicional. Da mesma forma, os aparelhos interoclusais planos (AIP) são utilizados com frequência no controle da dor em portadores de DTM. Por tanto, o objetivo no presente trabalho foi avaliar o efeito da associação dessas duas terapias conservadoras (aconselhamento e aparelho interoclusal plano) sobre a dor crônica presente na dor miofascial. Ainda, buscou-se investigar o status psicológico e comprometimento psicossocial presentes nesta disfunção. Foram selecionadas 20 voluntárias com dor miofascial (RDC/TMD Ia e Ib), as quais foram submetidas a uma sessão de aconselhamento para DTM e uma semana após essa sessão AIP foram instalados. O efeito dos tratamentos foi avaliado através das variáveis: Escala Visual Analógica (EVA), para avaliar a dor subjetiva relatada pelas voluntárias, Algometria, para avaliar o limiar de dor à pressão dos músculos masseter superficial e temporal anterior de ambos lados da fase, e Eletromiografia (EMG) para avaliar a atividade elétrica nos mesmos músculos. As avaliações foram feitas no período inicial, e após a aplicação do tratamento (1 semana, 1, 3 e 6 meses). O status psicológico e comprometimento psicossocial (dor crônica, depressão e somatização), foram avaliados no período inicial e após 1 e 6 meses de tratamento. Para a análise estatística foi utilizado ANOVA para medidas repetidas para as variáveis EVA, Algometria e EMG, e o teste de correlação de Pearson para as variáveis EVA e EMG, para a variável RDC/TMD eixo II foram utilizadas, ANOVA para medidas repetidas e o teste post ¿ hoc de Bonferroni. Para todas as análises usou-se nível de significância de 5%. Foram encontradas diferenças significativas após o aconselhamento no EVA (p<0,0001), na Algometria para os músculos temporal e masseter esquerdo (p<0,05) e na EMG para os músculos temporal direito e masseter esquerdo (p<0,05) quando comparadas com o período inicial. Também houve diferença significativa para as avaliações de 1, 3 e 6 meses quando comparadas com o período inicial no EVA (p<0,005), na Algometria nas avaliações de 3 e 6 meses para todos os músculos (p<0,05) exceto para o temporal esquerdo na avaliação de 3 meses, e na EMG nas avaliações de 3 e 6 meses para os músculos temporal direito e masseter esquerdo (p<0,05). Para a variável RDC/TMD eixo II (dor crônica, depressão e somatização) houve diferença significativa nas avaliações de 1 e 6 meses quando comparadas com o período inicial (p<0,05). Assim, considera-se que a associação do aconselhamento e do aparelho estabilizador plano é eficaz no controle da dor crônica presente na dor miofascial, o que fortalece a indicação de terapias conservadoras como tratamento de primeira eleição para essas disfunções / Abstract: Temporomandibular disorders (TMD) or craniomandibular disorders are collective terms, which described a number group of clinical problems related with the stomatognathic system (SGS). The etiology of TMD can be described by multifactorial models, in which several factors are involved in the development of the disease. Due to its similarity to other musculoskeletal disorders, which natural course are also unknown, conservative therapies are indicated as the treatment of choice, such as auto massages, acupuncture, and pharmacological therapy. In a similar fashion, awareness and patient education (counselling) are considered a treatment for TMD and are used frequently, due to being a fast, simple, and conservative intervention with no risk that can achieved success with no extra cost. Similarly, oral appliances particularly stabilization appliance (SA) have been frequently used to control pain in patients with TMD, especially those of myogenic origin. This study aimed to compare changes in pain intensity (VAS), in the pressure pain threshold (PPT) and in eletromiographic activity (EMG) of masticatory muscles (anterior temporalis and masseter muscles) observed after counselling and association of counselling and stabilization splint in chronic pain patients with Miofascial pain; changes in the psychosocial factors were also investigated. Twenty volunteers with myogenic TMD (RDC/TMD groups Ia e Ib) diagnosis were enrolled in the study. At baseline, counselling patient was performed using a modified TMD manual (translated to Portuguese language) used at the University of Rochester (Rochester, NY, USA). Stabilization appliance were installed one week after since counselling was applied. Pain intensity and pain pressure threshold were evaluated at baseline, weekly for 1 month and at month 3 and 6; Electromyography was performed at baseline, week 1 and month 1, 3 and 6 and psychological measures were evaluated at baseline and month 1 and 6 after treatment. VAS, PPT and EMG values were analyzed by ANOVA for repeated measures, Pearson correlation test was used to analyzed VAS and EMG values; and psychological measures were analyzed by ANOVA for repeated measures, and Bonferroni (post-hoc), with 5% of significance. Significant differences were found after counselling for VAS (p<0,0001), in Algometry for left temporal and masseter muscles (p<0,05) and in EMG for left masseter muscles (p<0,05). Also significant differences were found in the 1st, 3rd and 6th month evaluations when compared with baseline values for VAS variable (p<0,05); in the 3rd and 6th month evaluation for all muscles in Algometry variable (p<0,05), except for left temporal muscle in the evaluation of 3rd month; and in the 3rd and 6th month evaluations for the right temporal and left masseter in the EMG variable (p<0,05). Psychological measurements (chronic pain, depression and somatization) presented significant difference (p<0,05) when compared all evaluations between them. In conclusion, the association of counselling and stabilization appliance showed to be effective in the management of pain in myogenic TMD patients, confirming that conservative therapies such as the ones used in this study should be the first option when treating miofascial pain patients / Mestrado / Protese Dental / Mestre em Clínica Odontológica

Although many theorists have speculated that chronic pain may be linked to some sort of central neuropsychological integration deficit, a review of the current literature reveals no empirical support for this theory. This study attempts to assess the severity, if any, of neuropsychological deficits in chronic pain subjects by using a neuropsychological screen developed at the University of North Texas. Also, presented are studies of correlations between the UNT Neuropsych-screen and the MMPI. the Dallas Pain Questionnaire (DPQ), the Dallas Pain Drawing CDPD), and time since injury in order to assess any possible relationships. The subjects in this study consist of 100 volunteers. Of these subjects, 74 were patients of the Spinal and Chronic Pain Center at Medical Arts Hospital in Dallas, Texas and represented the clinical population. The remaining 26 subjects were staff volunteers from the hospital . The results of the study indicate significant differences between chronic pain subjects and non-pain subjects across many areas of neuropsychological functioning, as well as other significant correlations among many of the variables. The implications of this study are elaborated upon, in the discussion section, in detail along with limitations and future research directions.

This investigation evaluated the efficacy of relaxation training and cognitive therapy separately and in combination in enhancing the coping skills of patients during epidural steroid injections. Subjects consisted of 80 back pain patients. They were randomly assigned to four groups to receive either relaxation training, cognitive therapy, relaxation and cognitive therapy, or attention control treatment. All subjects were provided preparatory information describing the procedure for the epidural injection and typical physical sensations experienced by patients undergoing the procedure. Relaxation training consisted of Jacobsonian progressive relaxation instructions which were modelled by the trainer. Cognitive therapy consisted of instructions and a work sheet designed to assist subjects in designing positive (rational) self statements concerning the injection procedure. Attention control procedures involved instructions and written exercises of equal duration to the relaxation and cognitive treatments but containing no instructions for the control of anxiety and pain. The three experimental groups exhibited significantly fewer "ae1f-distress" verbalizations during the injection. On other dependent measures, namely, the remaining catagories of pain verbalizations, gross body movements, heart rate, and independent ratings of anxiety there were no significant differences among experimental and control groups. Results are discussed in terms of spontaneous use of coping skills, habituation, individual differences in predisposition to specific coping strategies, and possible cultural/class/educational correlates of specific coping strategies. Improvements in methodology and directions for future research are recommended.

The present study explored whether use of Spanish language sayings, or dichos, improved group climate within multi-ethnic chronic pain groups. Use of this form of figurative language fits within psychological theory identifying use of metaphor as a means of promoting change and creating new meaning. Further, metaphor use is consistent with the broader aims of experiential therapy. Group climate was measured by group members' self reports using the Group Climate Questionnaire-Short Form. A pilot study involving Latino Americans in medical and non-medical contexts aided in categorizing dichos as high versus low-relevance. It was anticipated that clients would rate high-relevance sessions as involving greater engagement, and less conflict and avoidance than low-relevance groups. Participants were recruited from four multidisciplinary pain management clinics offering similar programs. Once every four to six weeks, group leaders were provided with a list of either high or low-relevance dichos, and were blind to the existence of dichos categories. Three hierarchical regression analyses were employed to determine whether dichos relevance, characterized as low, mixed or highly relevant, contributed to variance in group conflict, avoidance and engagement. Dichos familiarity was the last variable entered into the regression equation, with gender, ethnicity and acculturation score entered in sequential fashion. Consistent with predictions, low-relevance groups yielded higher conflict scores than all groups combined. Also, high-relevance groups predicted lower avoidance when compared to all groups. In contrast to hypotheses, high-relevance groups predicted lower ratings of group engagement when compared to all groups. Post-hoc analysis indicated the mixed-relevance groups yielded significantly higher engagement scores than the low and high-relevance groups. Implications of these findings are discussed in relation to impact on approaches to group therapy with Latino American clients, and within the chronic pain population. Limitations of the study and recommendations for future research are offered.

Bakgrund: Kronisk smärta är vanligt förekommande och ses som ett folkhälsoproblem. Typiskt för kronisk smärta är att smärtupplevelsen bortsett från själva smärtan, präglas av psykiska och sociala besvär. Orsakerna till smärtan kan vara många och behandlingen kan vara komplex. Sjuksköterskan har en stor roll i vårdandet av patienterna. Syfte: Att beskriva patienters upplevelser av att leva med kronisk smärta. Metod: Kvalitativ metod där 10 vetenskapliga artiklar lästes och analyserades. Resultat: 6 teman identifierades; begränsad livskvalité, begränsad möjlighet till ett socialt liv, ett förändrat synsätt på livet, annorlunda vardagar, viljan att hantera kronisk smärta och bli sedd och tagen på allvar i det vårdande mötet. Diskussion: Kronisk smärta måste framför allt ses som ett lidande och en livsomställning för den drabbade och de anhöriga. Patienter måste lära känna sig själva på nytt och acceptera smärtan, vilket är en process. Olika tillvägagångssätt används som strategier för att hantera smärtan och bemötandet från sjuksköterskan anses extremt viktigt. Konklusion: Det är viktigt att patienten bli tagen på allvar för minskat lidande och ökad livskvalité. Det är viktigt att sjuksköterskan beaktar patientens livsvärld. / Background: Chronic pain is common and seen as a public health problem. Typical of chronic pain is that the pain experience, apart from the pain itself, is characterized by mental and social problems. The causes of pain can be many, and the treatment complex. The nurse has a major role in the care of patients. Purpose: To describe patients' experiences of living with chronic pain. Method: Qualitative method where 10 articles were read and analyzed. Results: 6 themes were identified; limited quality of life, limited opportunity for a social life, a changed view of life, different weekdays, the desire to deal with chronic pain and be seen and respected in the healthcare. Discussion: Above all chronic pain must be seen as a suffering and a life adjustment for the patients and the relatives. Patients need to better understand themselves and accept the pain, a process which is required. Different approaches are used as a strategy to manage the pain and the treatment from the nurse is considered extremely important. Conclusion: It is important that the patient is taken seriously to reduce the suffering and increase the quality of life. It is important that the nurse considers the patient's personal life.

Aim: Study the psychometric properties of the Swedish version of the Injustice Experience Questionnaire (IEQ-S) among patients with chronic pain referred to Swedish specialist care. Method: This study was part of a feasibility study for a cohort exploring patients with chronic, non-malignant pain. Sixty-five participants, referred to Pain Center at Uppsala University hospital, with a pain duration over three months at the time of referral, were consecutively sampled. The participants completed the IEQ-S to prepare for their clinical visit and again within six weeks to examine the stability reliability. The Work Ability Index was completed for a concurrent criterion validity analysis. Results: The correlation coefficient between the IEQ-S and WAI (n = 57) was rS = - 0.47, p = &lt; 0.01. The internal consistency reliability for the full IEQ-S was Cronbach’s alpha = 0.94 (n = 64). The stability reliability was calculated using an Intraclass Correlation Coefficient = 0.80 (n = 55), with a 95 % confidence interval ranging between 0.69-0.88. The median total score for IEQ-S measured at admission = 27.0 (n = 64), 25th percentile = 15.3, 75th percentile = 37.8, range = 3-48 points. The mean = 26.2, standard deviation = 13.3. Thirty out of 64 participants (46.9 %) had a total score &gt; 30. Conclusion: This study has contributed with new information about the psychometric properties of the IEQ-S, for patients with chronic pain referred to specialist care in Sweden. The internal consistency of the IEQ-S was high (1), and the stability reliability satisfactory (3). There was a moderate (4), negative, significant relationship between IEQ-S and WAI, high levels of perceived injustice were associated with low work ability in this study. The results support the use of the IEQ-S as an adjunct tool to assess patients with chronic pain referred to specialist care in Sweden, however further research is desirable. This study has also given an insight into how injustice is perceived among patients with chronic pain, however this should be studied in a larger sample.