Background Neuropathic pain (NP), defined as pain caused by a lesion or disease of the somatosensory system, affects 6.9 – 10 % of people worldwide. Pregabalin is currently recommended as a first line drug for NP in South Africa. Methods A cross-sectional retrospective descriptive medicines usage evaluation (MUE) of Pregabalin at Groote Schuur Chronic Pain clinic for the year 2017 was conducted. A MUE using a standardized data collection form was performed on 100 randomly selected folders. Data are summarized using descriptive statistics. Results The majority of cases were women (76) with a mean age of 55.9y (SD12.49). A diagnosis of NP was recorded in 58 folders and a “possible” diagnosis recorded in 7 folders. In 79 cases there was no mention of a tool/method used to diagnose NP. The most common condition diagnosed was chronic post-surgical pain with a neuropathic component (n=16), followed by NP (n=15). The most common initiating and current dose of Pregabalin was 75mg twice daily. In 56 patients, Pregabalin was prescribed in conjunction with a tricyclic antidepressant (TCA) or selective noradrenaline reuptake inhibitor (SNRI). Patient education was documented as having taken place in 76 of cases. Conclusions Based on this MUE we recommend the use of screening tools for the diagnosis of neuropathic pain, and a focus on the initiating dose of Pregabalin. The use of a standardized assessment document and the interdisciplinary team input at this clinic appears to optimize prescribing of Pregabalin in line with practice guidelines.

Protein stability is critical for the proper function of all proteins in the cell. Ubiquitin is a key post-translational modification that serves as a universal regulator of protein turnover and has emerged as a highly sought-after signal for biological inquiry and drug development. Yet the pervasive role of ubiquitin signaling has given rise to the fundamental challenge of selectively manipulating a widespread signal: current pharmacological and genetic tools that target the ubiquitin-proteasome system (UPS) broadly alter cellular proteostasis with confounding side effects. Ion channels are essential proteins that regulate fundamental cellular properties including; electrical activity, fluid homeostasis, muscle contraction, neuronal firing, gastric acidification, and gene expression. Enhanced or reduced ion channel expression represents a pathological signature for a myriad of disease states, from chronic pain to cardiac arrhythmias, epilepsy, and cystic fibrosis. Although ubiquitin represents a critical mediator of ion channel expression, the inability to precisely manipulate ubiquitin modifications in situ has limited mechanistic insight and opportunities for therapeutic intervention. To address this barrier, I developed a novel nanobody-based toolset to selectively – and bidirectionally – manipulate the ubiquitin status and functional expression of target ion channels for basic study and therapeutic rescue.

BACKGROUND: Chronic pain affects millions of Americans every day. Research shows that using different coping strategies (e.g. catastrophizing, coping self-statement and prayer) has differential impacts on pain outcomes. One of these coping mechanisms, prayer, has been examined less frequently than others perhaps because there is currently only one measure of prayer as a coping mechanism for pain, the Prayer/ Hope subscale of the Coping Strategies Questionnaire-Revised (CSQ-R). The latter, however, is an incomplete representation of prayer practices and hence the CSQ-R only offers a narrow measure of prayer. Recent research has characterized the CSQ-R as measuring prayer in a passive nature, which may be associated with poor pain outcomes. This measure does not include an active style of prayer. Furthermore, the evolution of research characterizing the petitionary content of prayer has resulted in substantive data revealing the contrasting dimensions of the prayer content with opposite reported outcomes. Thus, there is the need for a more comprehensive measure of prayer related to pain which clearly delineates the petitionary content of prayer. The current gap in the literature highlighted the beneficial nature of certain types of prayer for pain management and also the importance of the target to which the prayer is directed but noted that there exist no validated measures of pain-related prayer types. The aim of this study is to develop and validate a new measure of the use of prayer amongst people who experience pain, the Pain related PRAYERS (PPRAYERS) questionnaire. METHODS: An interim data analysis was performed of 42 adult participants with chronic pain who use prayer as a means to cope with their pain who completed a battery of questionnaires including the Brief Pain Inventory, PPRAYERS, Duke University Religion Index (DUREL), Coping Strategies Questionnaire-Revised (CSQ-R) and Pain Catastrophizing Scale (PCS).The population analyzed represented a fraction of an estimated target sample of 100 participants for this phase of the research. In order to assess the factor structure of PPRAYERS, two principal component analysis factor analyses were conducted on the Pain Related Prayer Questionnaire (PPRAYERS). In addition, bivariate correlations between the identified factors of PPRAYERS and other known pain-related psychosocial measures were examined to assess convergent and discriminant validity of the questionnaire. RESULTS: An interim, exploratory principal component analysis yielded six factors, active prayer, passive prayer, neutral prayer, along with three other factors that were atheoretical and accounted for 77% variance. However, based on our a priori theory (i.e. three types of prayer: active, passive and neutral) as well as minimal variance accounted for by the other three atheoretical factors, a follow up analysis of a three-factor model was performed and accounted for 58% variance. There was good convergent validity between the DUREL and the active prayer subscale of the PPRAYERS questionnaire. There was also good discriminant validity between the PCS and all subscales on the PPRAYERS questionnaire. CONCLUSION: According to these preliminary data, the PPRAYERS measure is comprised of three distinct factors: active, passive, and neutral prayer and is associated with pain and other pain-related factors. This study and the creation of PPRAYERS lays the foundation for additional studies evaluating the benefit of active, passive and neutral prayer in the treatment of chronic pain especially in patients open to religious, spiritual or meditative-based coping strategies. / 2023-12-02T00:00:00Z

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Chronic pain continues to be a prevalent condition in the U.S. costing the healthcare system billions of dollars annually with little success in treatment modalities. The goal of this study was to review nociceptive processing in the context of sensory and motor disorders where chronic pain often appears as a common symptom. An activation likelihood estimate (ALE) meta-analysis was performed on brain coordinates from articles containing sensory disorders (spinal cord injury and amputation) with or without pain performing a movement execution and movement imagery task and motor disorders (Parkinson’s disease and dystonia) performing a movement execution task. Aberrations found in the cortical activity of sensorimotor regions of both sensory and motor disorders suggests these disorders should be studied and treated as a dysfunction of sensorimotor integration instead of solely sensory or motor. Alterations of sensorimotor integration could be the necessary trigger for reorganization of cortical maps that alters nociceptive processing. Furthermore, abnormal activity found in the brain regions of both sensory and motor disorders involved in the cognitive and attentional modulation of pain suggests a once voluntary response has transitioned to a conditioned response that perpetuates the experience of pain.

En av de vanligaste orsakerna till att patienter söker till primärvården är smärta. Långvarig smärta innebär ett stort lidande för de drabbade, det är ett tillstånd som kräver självhantering och planering. Egenvård skapar förutsättning att ta kontroll över sin egen situation och majoriteten av personer drabbade av långvarig smärta är villiga att använda sig av detta. E-hälsa innebär användning av informations- och kommunikationsteknik med syfte att främja hälsa. För patienter är internet och tekniska hjälpmedel en resurs med stor signifikans för möjligheten att kontakta hälso- och sjukvården samt kunna söka hälsoinformation på egen hand. Syftet med litteraturstudien är att undersöka och belysa hur e-hälsa kan ge stöd till egenvård för personer med långvarig smärta. Metoden är en litteraturstudie där 15 artiklar ingår, både kvantitativa, kvalitativa och mixed metod. I resultatet framkommer tre kategorier vilka är tillgång till strategier, självskattning och självövervakning samt kommunikation. Resultatet visar att E-hälsa kan stödja egenvården genom att göra vården och självhanteringsstrategier mer tillgängliga för patienterna, vilket leder till minskad smärta, ökad självständighet och nya vårdmöjligheter. / One of the most common causes of patients seeking primary care is pain. Chronic pain causes a lote of suffering for those affected, it is a condition that requires self-management and which requires planning. Self-care creates the conditions to control the situation and the majority of the persons affected by chronic pain are willing to use self-care. E-health means the use of information and communication technology with the aim to promote health. For patients, the Internet and technical aids is a resources of great significance for opportunities to contact health care and to seek health information on their own. The purpose of the literature study is to investigate and describe how e-health can support the self-care for people with chronic pain pain. The method is a literature study that includes 15 articles, both quantitative, qualitative and mixed method. The result reveals three categories, these are available strategies, self-assessment and self-monitoring and communication. The result shows that E-health can support self-care by making care and self-management strategies more accessible to patients, which leads to less pain, more independency and new care-opportunities.

Orientador: Guilherme Antonio Moreira de Barros / Resumo: Segundo a Associação Internacional para o Estudo da Dor (IASP), a dor crônica pós-operatória (DCP) é aquela presente por mais de três meses após a realização de um procedimento cirúrgico. As cirurgias ortopédicas para o tratamento de doenças degenerativas relacionadas ao avanço da idade têm crescido nas últimas décadas, expondo esses indivíduos ao risco de desenvolver a DCP. O objetivo desse estudo foi avaliar a incidência de DCP em pacientes submetidos as cirurgias ortopédicas como a artroplastia total de joelho e quadril, fixação de fratura de fêmur e cirurgias na coluna vertebral. Os fatores de associação para o aparecimento da DCP, assim como sua ocorrência foram estudados. Foram aplicados questionários validados disponíveis na literatura, assim como protocolo de pesquisa desenvolvido pelos pesquisadores. Buscou-se contemplar questões sobre a presença, localização, tipo e intensidade da dor, presença de dor neuropática, identificação de labilidade emocional e catastrofização da dor, uso de medicação para o controle da dor, dentre outros. As entrevistas dos participantes ocorreram em duas etapas, no pré-operatório e pós-operatório, esse último com o seguinte cronograma: 30 dias, três, seis e doze meses após a realização da cirurgia. Os pacientes incluídos no decorrer da pesquisa foram acompanhados durante um ano após a realização da cirurgia, sendo assim, o estudo levou dois anos para ser concluído. Essa pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da instituição... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: According to the International Association for the Study of Pain (IASP), chronic postoperative pain (DCP) is that present for more than three months after the performance of a surgical procedure. Orthopedic surgeries for the treatment of degenerative diseases related to advancing age have grown in recent decades, exposing these individuals to the risk of developing PCD. The aim of this study was to evaluate the incidence of PCD in patients undergoing orthopedic surgeries such as total knee and hip arthroplasty, fixation of the femur fracture and surgeries in the spine. The association factors for the onset of DCP, as well as its occurrence, have been studied. Methods: Validated questionnaires available in the literature were applied, as well as a research protocol developed by the researchers. We sought to contemplate questions about the presence, location, type and intensity of pain, presence of neuropathic pain, identification of emotional lability and pain catastrophization, use of medication for pain control, among others. The participants' interviews took place in two stages, in the preoperative and postoperative periods, the latter with the following schedule: 30 days, three, six and twelve months after the surgery. The patients included in the research were followed up for one year after the surgery, so the study took two years to complete. This research was approved by the institution's Research Ethics Committee. Results: After invitation, analysis of inclusion and ex... (Complete abstract click electronic access below) / Doutor

Sammanfattning Bakgrund  Långvarig smärta hos barn och ungdomar är vanligt förekommande och flickor är mer drabbade än pojkar. Smärtan påverkar den drabbade i stor utsträckning vilket ofta visar sig i det sociala livet, vid dagliga aktiviteter och under skolgången. Syfte  Syftet med denna studie var att utforska flickor med långvarig smärtas upplevelser och erfarenheter av fysioterapeutisk behandling.  Metod En kvalitativ studie genomfördes med data baserat på semistrukturerade intervjuer. Bekvämlighetsurval användes för att rekrytera informanter. Data analyserades genom en kvalitativ innehållsanalys med abduktiv ansats.   Resultat Under intervjuerna framgick det att den långvariga smärtan bidrog till både fysiska och psykologiska begränsningar. Det som framförallt upplevdes som positivt med den fysioterapeutiska behandlingen var att känna sig delaktig och att kunna påverka utfallet, samtidigt som restriktioner från fysioterapeuten upplevdes begränsande. Behandlingen bidrog bland annat till en positivare inställning, en ökad aktivitetsnivå och ett förbättrat psykiskt välmående. Alla informanter var positivt inställda till att ha träffat en fysioterapeut även om vissa fått begränsade resultat av behandlingen. Det framkom att det var viktigt att fysioterapeuten visade intresse och kommunicerade med ungdomen i första hand.  Slutsats  Flickor som lever med långvarig smärta hade erfarenheter av både fysiska och psykologiska begränsningar. De positiva effekterna av den fysioterapeutiska behandlingen beskrevs som en ökad aktivitetsnivå och delaktighet i det sociala livet. Trots att behandlingen inte alltid givit den effekt som informanten eller dess anhöriga förväntat sig, hade fysioterapeutens bemötande och engagemang gjort ett stort avtryck hos informanten. / Abstract  Background  Chronic pain in children and adolescents is common and girls are more affected than boys. The pain effects the affected person widely which is often showed in the social life, in daily activities and in school. Aim  The aim of this study was to explore experiences of physiotherapeutic treatment among girls with chronic pain. Methods A qualitative study was made, and data were collected through semi structured interviews. Convenience sample was used to recruit informants. Data were analysed using a qualitative content analysis with an abductive approach.   Results Chronic pain in young girls caused both physical and psychological limitations. Positive experiences of the physiotherapeutic treatment included to feel involved in one’s own treatment and to be able to influence the outcome, while getting restrictions from the physiotherapist seemed limiting. The treatment contributed to a more positive attitude, an increased level of physical activity and an improved mental well-being. The informants had a positive attitude towards meeting a physiotherapist, even though some of them had seen limited results of the treatment. It was important that the physiotherapist showed an interest and communicated with the adolescent in the first place.  Conclusion Girls who live with chronic pain had experiences of both physical and psychological limitations. The positive effects of the physiotherapeutic treatment were described as an increased activity level and participation in social life. Even though some of the girls had seen limited results of the treatment, the physiotherapist’s commitment made a great impression on the informants.

Background Epidural fibrosis (EF) is defined as nonphysiological scar formation, usually at the site of neurosurgical access into the spinal canal, in intimate vicinity to and around the origin of the radicular sheath. From the very onset, EF behaves as a reparative inflammation causing, as a rule, symptoms of characteristic nature and clinical course (pain). Treatment of epidural fibrosis causing failed back surgery syndrome (FBSS) by neuromadulation technique is very expensive. Finding of suitable parameters for the indication of treatment is therefore very important. Aims The study is based on evidence of the importance of epidural fibrosis for the development of chronic pain. Research is also focused on the comparison of the range fibrosis and the effect of stimulation (spinal cord stimulation - SCS). The goal is to find a suitable selection factor for the indication of neuromodulation. Methods I. A double-blind prospective study was conducted to investigate a cohort of 200 patients requiring surgical treatment for intervertebral disc hernia (hernia disci intervertebralis). The patients were randomly and blindly divided into 2 groups, one on peroperatively applied local doses of a mixture containing corticosteroids, the other without such medication. All the requirements of a double-blind...

Bakgrund: Långvarig smärta antas drabba var femte person i Sverige och bland dem är rörelserädsla vanligt. Rörelserädsla är komplext och kan påverka en person biomedicinskt, psykologiskt och socialt, varför fysioterapeuten bör använda ett beteendemedicinskt arbetssätt. Forskning har visat att fysioterapeuter har svårt att identifiera psykosociala faktorer kopplade till rörelserädsla. Syfte: Att studera hur fysioterapeuter beskriver sitt arbete med patienter med rörelserädsla relaterat till långvarig smärta. Metod: En kvalitativ intervjustudie genomfördes. Sju fysioterapeuter från olika typer av verksamheter rekryterades genom ett ändamålsenligt bekvämlighetsurval. Data analyserades manifest med en induktiv ansats. Resultat: Analysen resulterade i fem kategorier med tre till fem underkategorier vardera: “Uppfattning om utmärkande drag och beteenden hos patienter med rörelserädsla”, “Grundförutsättningar för ett framgångsrikt arbete”, “Identifiera och skapa förståelse för patientens rörelserädsla”, “Strategier för att förändra tankar och känslor i samband med rörelse” och “Omständigheter som kan göra arbetet utmanande eller svårt”. Slutsats: Ett biopsykosocialt och beteendemedicinskt arbetssätt beskrevs användas vid arbetet med dessa patienter. Arbetet beskrevs som komplext och utmanande för en fysioterapeut att hantera ensam. Teamarbete, tydliga målsättningar och en god relation mellan parterna uttrycktes vara viktigt för att lyckas. / Background: Chronic pain is assumed to affect every fifth person in Sweden and fear of movement is common. Fear of movement is complex and affects a person biomedically, psychologically and socially, why physiotherapist's should use a behavioral medicine approach. Research has shown that physiotherapist's have difficulty identifying psychosocial factors involved in fear of movement. Aim: To study how physiotherapist's describe their work with patients with fear of movement related to chronic pain. Method: A qualitative interview study was conducted. Seven physiotherapist's were recruited through a purposive convenience sample. Data was analyzed manifestly with an inductive approach. Result: The analysis resulted in five main categories: “Perception of distinguishing features and behaviors in patients with fear of movement”, “Essential prerequisites for successful work”, “Identify and create understanding of the patient's fear of movement”, “Strategies for changing thoughts and emotions related to movement” and “Circumstances that can make the work challenging or difficult”. Conclusion: A biopsychosocial and behavioral medicine approach was described to be used when working with these patients. The work was described as challenging for physiotherapist's to handle alone. Teamwork, clear goal setting and a good patient-therapist relationship were expressed to be important.