Bakgrund: Långvarig muskuloskeletal smärta är ett stort folkhälsoproblem. Förutom att smärtan ofta leder till en funktionsnedsättning kan den även ha en negativ inverkan på en persons liv på flera olika sätt. Frågan om hur kvinnor med långvarig muskeloskeletal smärta upplever att den påverkar deras identitet, är i fokus i denna undersökning. Syfte: Syftet med studien är att undersöka hur kvinnor med långvarig muskuloskeletal smärta upplever att den påverkar deras identitet. Metod: Detta är en intervjustudie med kvalitativ induktiv ansats. Tio kvinnliga deltagare intervjuades med en semistrukturell intervjuguide. En tematisk semantisk analys gjordes för att komma fram till resultaten. Resultat: Analysen resulterade i två huvudteman och 11 subteman: Huvudtema 1 "Hämmad från att vara den person man vill vara", och huvudtema 2 "Hanteringsstrategier för att bibehålla sin identitet och leva med sin smärta". Slutsats: Resultatet visade att kvinnorna i denna studie upplevde att smärtan hade en negativ inverkan på deras identitet, genom att hämma dem från att vara den person de ville vara. Det visade sig att kvinnornas identitet verkade vara starkt kopplad till deras fysiska funktion och möjlighet att delta i meningsfulla aktiviteter. / Background: Long-term musculoskeletal pain is a big public health issue. Aside from that pain often leads to a disability, it can also affect a person's life in different ways. In this study the focus was to investigate women's experience of how the pain might have affected their identity. Aim: To investigate how women with long-term musculoskeletal pain experince it affecting their identity. Method: This is a qualitative study where ten female participants were interviewed using a semi-structural interview guide. A thematic semantic analysis were used to extract the results. Results: The analysis resulted in two main themes including 11 subthemes: Main theme 1 "Inhibited from being the person one would like to be", and main theme 2 "Coping strategies for keeping their identity and live their life despite the pain". Conclusion: The results showed that the women in this study experienced that the pain had a negative impact on their identity, by limiting them from being the kind of person they wanted to be. It turned out that the women's identity seemed to be strongly linked to their physical function and the possibility to participate in meaningful activities.

The Minnesota Multiphasic Personality Inventory (MMPI) is the most frequently used psychological measure in the assessment of chronic pain. Since the introduction of the MMPI-2 in 1989 only two published studies have focused on cluster analysis of chronic pain patients. This study investigated MMPI-2 cluster solutions of chronic low-back pain patients. Data was collected from 2,051 chronic low-back pain patients from a multidisciplinary pain clinic in the southwestern United States. A hierarchical clustering procedure was performed on K-corrected T-scores of the MMPI-2 using the three validity and ten clinical scales. Four relatively homogeneous subgroups were identified for each sex with the MMPI-2. In general, these results replicated the findings of previous researchers using both the MMPI and MMPI-2.

The purpose of this study was to validate the Spanish version of the Dallas Pain Questionnaire (DPQ). Not only does the DPQ offer the potential of statistical and clinical diagnostic value but also is easily interpretable across cultural lines. No such instrument has presently been validated for the Mexican-American population. A total of 81 Spanish speaking subjects participated in this study. Of these subjects, 56 were classified as chronic pain patients by nature of their medical diagnosis and duration of pain. The 25 normal subjects were family members of the chronic pain patients and members of the Northern New Mexico Hispanic community chosen at random. Hypothesis one predicted that reliability would be obtained on Spanish speaking populations based on test-retest with correlation coefficients of the items. The second hypothesis predicted that the Spanish DPQ would have content validity or consistent internal structure on those items that measure the trait or behavior of interest based upon factor analysis approaches and internal consistency measures. Hypothesis three predicted that the Spanish version of the DPQ would significantly correlate with the English version of the DPQ on all four factors. All four hypotheses were supported. The Spanish DPQ showed reliability over time based on test-retest. The statistics revealed an internally reliable test, alpha coefficient analysis and factor analysis. The validity was supported by significant correlations with the English DPQ and discrimination between chronic and nonchronic pain patients. While all four hypotheses were upheld, interpretation of the present findings should be moderated by recognition of the limitations of the studies. Future studies should test larger samples to improve confidence in the psychometric properties of the instrument. Still notable limitations of the questionnaire are that the Spanish DPQ is a form that is more accurately viewed as a global measure.

Chronic low back pain (CLBP) is defined as pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without sciatica, that lasts for at least twelve weeks.1 It is the leading cause of disability and loss of productivity in the United States.2 There is conflicting evidence on what is the most effective nonpharmacological treatment for CLBP. Many studies have shown that any general exercise routine is effective for improving symptoms, but the literature provides conflicting evidence about what specific type of exercise is best.3 A few studies have demonstrated decreased pain and disability with supervised directional preference exercise routines compared to non-directional preference routines. The objective of this study was to determine the effectiveness of a home directional preference exercise/stretch program for reducing disability in mechanical CLBP in patients in a residency clinic and to expand on the limited evidence of directional preference exercise effectiveness. Unlike other directional preference interventional studies, this program’s simplicity and convenience of performing at home potentially could increase patient compliance and therefore effectiveness. Patients were screened at a routine clinic visit and considered eligible if they had a known diagnosis of CLBP. They were excluded if they were in an acute exacerbation. Participating patients were categorized on directional range of motion preference based on their physical exam, either flexion or extension, whichever improved their pain. They were given a simple routine with instructions and pictures consisting of three exercises and stretches that emphasized their specific directional preference. Subjects performed three sets of each routine two to three days per week. Degree of disability score was measured at initial visit by completing the gold standard disability index questionnaire, the Oswestry Disability Index (ODI). Degree of disability was reassessed with ODI at a follow-up assessment four to eight weeks later with five follow-up questions regarding compliance and acute exacerbation. Patients were excluded if they were in an acute exacerbation. Pre-interventional disability scores were then compared to post-interventional disability scores. Twelve total patients enrolled in the program. Seven were lost to follow up. Five completed the study at the proper follow up interval; however, one was in an acute exacerbation so was excluded. Of the four patients included, two had extension and two had flexion preference. Three out of four patients had decreased disability scores at follow up. Total post-intervention score on ODI improved by an average of 10 points compared to pre-intervention score for the patients who improved. The most improved post-interventional ODI score category was walking and changing degree of pain. Seventy-five percent of the patients who completed the study had an improvement in their CLBP disability score. However, due to a small sample size and study power, the results are not statistically significant. Therefore, a conclusion cannot be appropriately drawn about the effectiveness of performing a home directional preference exercise/stretch program for reducing disability in mechanical CLBP in patients at a residency clinic. Nevertheless, the results are promising and deserve further investigation with a larger sample size.

Background: Rural Tennessee, especially rural East Tennessee has seen a dramatic increase in rates of controlled drug prescriptions and controlled drug overdose deaths in recent years. However, little is known about the individual decisions to prescribe or continue prescriptions with relation to addiction concerns. Objectives: The purpose of this study was to learn more about what factors lead to physicians’ prescribing control drugs for non-cancer pain through the use of focus groups. Methods: A qualitative study, using focus groups, in five family medicine clinics in East Tennessee and Southwest Virginia. The investigators used a semi-structured interview guide designed to facilitate group discussions about prescription drug abuse and misuse. Results: There were four main themes identified by the focus groups: (1) prescribers’ changing prescribing patterns over time; (2) factors that influence controlled drug prescribing; (3) use and barriers to using state prescription drug monitoring programs (PDMPs); (4) prescribing controlled drugs to women of childbearing age. Each theme had several subthemes. Conclusions: The balance between treating the patient's symptoms and causing potential harm is a challenge. The patient's pain cannot be ignored, but the potential harm of opioid therapy is not taken lightly. As the public health concern of prescription drug abuse in rural Appalachia continues to spread, prescribers are aware of their connection to the problem, and ultimately the solution.

Abstrakt Bakgrund: Ryggsmärta ett subjektivt och multidimensionellt problem som påverkar många personers vardag. Kronisk ryggsmärta är ofta ett livslångt tillstånd med stor personlig betydelse som personen måste lära sig leva med. Ryggsmärtan måste därmed förstås respekteras av sjuksköterskan. Syfte: Syftet med litteraturstudien var att beskriva vuxna personers erfarenheter av att leva med kronisk ryggsmärta.  Metod: En litteraturstudie baserad på åtta kvalitativa intervjustudier. Datainsamling av inkluderade artiklar utfördes i databaserna CINAHL och PubMed. Analys gjordes enligt Fribergs femstegsmall. Resultat: Analysen resulterade i fyra kategorier: ”Ryggsmärtan påverkar fysiskt”, ”Känslorna och självuppfattningen påverkas”, ” Sociala livet förändras” och ” Hitta balans i tillvaron”. Konklusion: Kronisk ryggsmärta påverkade flera aspekter av personers liv och gav liknande men unika erfarenheter. Personer med ryggsmärta påverkades inte bara av ryggsmärtan utan av andra personers förhållningssätt och omgivande faktorer. Sjuksköterskan kan använda erfarenheterna och kunskap om personernas beteenden för att främja anpassning och hälsa samt möjliggöra bättre bemötande, förståelse och personcentrerad omvårdnad. / Abstract Background: Back pain is a subjective and multidimensional problem that affect many people’s everyday lives. Chronic back pain is often a lifelong condition with great personal significance that the person must learn to live with. Therefore, back pain must be understood and respected by the nurse. Aim: The aim of the literature study was to describe adults’ experiences of living with chronic back pain. Methods: A literature study based on eight qualitative interview studies. Data collection of included articles was performed in the CINAHL and PubMed databases. Analysis was done according to Friberg’s five-step model. Results: The analysis resulted in four categories: “Back pain affects physically”, “Emotions and self-perception are affected”, “The social life changes” and “Finding balance in in life”. Conclusion: Chronic back pain affected several aspects of people’s lives and gave similar but unique experiences. People with back pain were not only affected by their back pain but also other people’s attitudes and surrounding factors. Nurses can use the experiences and knowledge of the people’s behaviour to promote adaption and health as well as enable better approach, understanding and person-centred care.

Still House is a poetry manuscript that explores the relationship between traditional gender roles and traditional poetic forms. The poems in this collections seek to revise the role of the homemaker and interrogate whether it is okay to take comfort and pleasure in tasks that are often labeled as feminine (i.e. cooking, baking, decorating, organizing, shopping, choosing outfits) while rejecting other parts of the homemaker archetype, such as subservience to and dependence upon men. Limited gender roles, patriarchy, sexist comments, capitalism, toxic masculinity, the cis-hetero-white-male gaze, trauma, physical pain, illness—these all can make it feel like we are not fully in control and ownership of our bodies, like something is encroaching. The poems in Still House are invested in using the poetics of embodiment (a poetics centered around telling stories about the body through immersive sensory details) to reclaim the body from trauma, patriarchy, and chronic pain and illness.

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...

Magister Scientiae Dentium - MSc(Dent) / The objective of the study was to compare pain and functional limitation of temporomandibular myalgia patients, before and after low-level-laser treatment (LLLT).This was a prospective, randomized, placebo-controlled, triple-blinded clinical study. Patients diagnosed with temporomandibular myalgia according to the DC/TMD protocol were recruited from the TMD clinic of the Mitchell’s Plain Oral Health Centre. Treatment was performed using diode laser (Sirolaser, Dentsply Sirona). The 3 regions of the masseter and temporalis muscles were treated bilaterally with a dose of 8J/cm2 per region. Pain and function were assessed using pain-free opening, numeric rating scales (NRS), Characteristic Pain Intensity Scores (CPIS), Interference Score (IS), and Jaw Functional Limitation Scale (JFLS) at the first and last LLLT and at 4-week recall (intervals 1, 2, 3). Statistical analysis was done by means of explorative categorical principal and multivariate interdependent analysis.

Bakgrund Långvarig smärta är ett utbrett problem med konsekvenser på både individ- och samhällsnivå. Personer med långvariga smärttillstånd är ofta fysiskt inaktiva till följd av smärta, trots att fysisk aktivitet har kända positiva effekter på både smärta och den övriga hälsan. Fysisk aktivitet kan utföras i form av egenvård, bland annat som en del i omvårdnaden. För att motverka konsekvenserna av fysisk inaktivitet och för att främja en god hälsa, behövs fler studier om personers upplevelser av fysisk aktivitet vid långvarig smärta. Syfte Syftet var att belysa personers upplevelser av fysisk aktivitet vid långvarig smärta. Metod Denna icke-systematiska litteraturöversikt baserades på 15 vetenskapliga artiklar med kvalitativ design, vilka inhämtades från databaserna PubMed och CINAHL. Därefter granskades artiklarna avseende kvalitet utifrån Sophiahemmet Högskolas granskningsmall och artiklarnas innehåll analyserades utifrån en metod beskriven av Friberg, varpå tre huvudkategorier utformades. Resultat I resultatet beskrevs en variation av upplevelser av fysisk aktivitet. Dessa var bland annat ökad smärta alternativt en positiv inverkan på smärtan, smärthanteringen och den allmänna hälsan, såväl fysiskt som psykosocialt. Upplägget av fysisk aktivitet upplevdes även ha påverkan på utförandet av det och genomgående beskrevs vikten av motivation och stöd, samt betydelsen av att ha personens situation och sammanhang i åtanke. Slutsats Varierade upplevelser av fysisk aktivitet vid långvarig smärta beskrevs, där motivation, stöd från andra samt information och kunskap upplevdes vara några av de viktigaste aspekterna i att få den fysiska aktiviteten att fungera. Resultatet visade sammanfattningsvis på att personcentrering och individanpassning i omvårdnaden utgjorde grunden för ett lyckat utförande och vidmakthållande av den fysiska aktiviteten. / Background Chronic pain is a widespread problem, with consequences on both an individual and societal level. People with chronic pain conditions are often physically inactive due to pain, even though physical activity has known positive effects on both pain, and health in general. Physical activity can be performed in the form of self-care, as a part of nursing care. To counteract the consequences of physical inactivity, and to promote good health, more studies about people’s experiences of physical activity when living with chronic pain are required. Aim The aim was to illustrate people’s experiences of physical activity when living with chronic pain.                                             Method This non-systematic literature review was based on 15 scientific articles with a qualitative design, which were obtained from the databases PubMed and CINAHL. The quality of the articles was reviewed using the assessment basis by Sophiahemmet University, and each article was analyzed by a method for content analysis described by Friberg, whereupon three main categories were formulated. Results A variation of experiences of physical activity was described. Some of these were increased pain or positive effects on pain, pain management, and health in general, both physically and psychosocially. People also experienced that the arrangement of physical activity affected their performance. The importance of motivation and support, as well as having the individual’s situation and context in mind, was also constantly described. Conclusions Varying experiences of physical activity when living with chronic pain were described, where motivation, support from others, information, and knowledge were perceived to be some of the most important aspects in making the physical activity function. As a summary, the results showed that person-centered care, and individual adaptation in nursing-care, formed the basis of successful performance and maintenance of physical activity.