Bakgrund   Långvarig smärta är ett folkhälsoproblem med en skadlig påverkan på människors hälsa, funktion och livskvalitet. Behandling av smärta innebär farmakologiska och icke-farmakologiska metoder. Dessa metoder används med fördel i kombination men detta görs inte i tillräckligt stor utsträckning. Den biopsykosociala synen på behandling flyttar fokus från den fysiska smärtlindringen till strategier som ökar individens funktionsförmåga och välbefinnande. Enligt Erikssons omvårdnadsteori är kunskap om lidande, det holistiska synsättet och den hela människan är av stor vikt för patientens upplevelse av gott bemötande i vården.   Syfte   Syftet var att belysa bemötandets betydelse för patienters smärtupplevelser vid långvarig smärta.  Metod  En icke-systematisk litteraturöversikt med 19 valda artiklar har utförts där en integrerad analysmetod använts. Artiklarnas kvalitet har bedömts med hjälp av Sophiahemmet högskolas matris.  Resultat  Resultatet i litteraturöversikten tydde på att patienter upplevde både positivt och negativt bemötande. Patienterna belyste vikten av ett empatiskt bemötande från hälso- och sjukvårdspersonalen, vikten av att bli sedda som hel människa, vikten av att få ta del av information och betydelsen av kompetent hälso- och sjukvårdspersonal. Resultatet kom även fram till vikten av att inte misstro patienternas smärtupplevelser. Ett negativt bemötande resulterade i känslor som frustration, ilska, besvikelse, rädsla och hopplöshet. Ett positivt bemötande korrelerade indirekt med ökad patientnöjdhet.   Slutsats  Resultatet i denna litteraturstudie tyder på att patienter har både negativa och positiva upplevelser av bemötandet i hälso-och sjukvården. Utifrån studiens resultat kan slutsats dras att det fanns en önskan om patientdelaktighet, mer kunnig personal. Patienterna önskade även att bli trodd i sin smärta och önskade en empatisk attityd från hälso- och sjukvårdspersonalen. Resultatet tyder även på att det fanns en korrelation mellan gott bemötande och ökad patientnöjdhet. / Background  Chronic pain is a public health issue with harmful effects on the health of people, their function and quality of life. Pain treatment involves pharmaceutical and non-pharmaceutical methods. These methods are most preferably used in combination but are not used enough. The bio-psychological view on treatment takes away focus from physical pain management to strategies that increase the individuals’ function and wellbeing. According to Eriksson's nursing theory, knowledge of suffering and the holistic approach to the whole being is of importance for the patient's experience of good treatment in care.  Aim  The aim was to enlighten the meaning of the encounter with the health-care professionals for patients with chronic pain and their pain experience.   Method  A non-systematic literature review with 19 selected articles has been performed where an integrated analysis method has been used. The quality of the articles has been assessed with the help of Sophiahemmet University's matrix.  Results  The result of this literature review indicated that patients experienced both positive and negative encounters. The patients highlighted the importance of an empathic encounter from the health-care staff, the importance of being seen as a whole being and the importance of receiving information and having competent health-care professionals. The result also showed the importance of not being distrusted in their pain experience. A negative encounter resulted in feelings such as frustration, anger, fear, hopelessness and disappointment. A positive encounter correlates indirectly with increased patient satisfaction.   Conclusions  The results of this literature study indicate that patients have both negative and positive experiences of the treatment in health care. Based on the results of the study, it can be concluded that there was a desire for patient participation and more knowledgeable staff. Patients described their desire to be believed in their pain and wished for an empathic attitude from health care staff of the patients. The results also implied that there was a correlation between a positive encounter with health professionals and patient satisfaction.

Neuropathic pain in a common problem encountered in palliative care. When neuropathic pain is diagnosed, appropriate treatment is important in limiting the severe psychosocial impairment that can ensue with undertreated pain. Proper evaluation of the patient to clarify the type of pain experienced is the first step to determine appropriate management. Tapentadol is an oral mu-opioid receptor agonist and a noradrenaline reuptake inhibitor developed by Ortho-McNeil Janssen Pharmaceuticals and approved by the Food and Drug Administration in November 2008 for the treatment of moderate-to-severe acute pain in adult patients and for chronic pain in August 2011 in an extended release form. Tapentadol has been studied for use in nociceptive pain but few studies have yet been done to assess its efficacy in the treatment of neuropathic pain.

Objective: To identify correlates of quality of life (QoL) measured with the Quality of Life Scale (QOLS) in participants of a multidisciplinary day hospital treatment program for fibromyalgia (FM). Methods: In this cross-sectional, observational study, “real world” data from 480 FM patients including socio-demographics, pain variables and questionnaires such as the SF-36, Beck Depression Inventory (BDI), Multiphasic Pain Inventory (MPI), SCL-90-R and others were categorized according to the components (body structure and function, activities and participation, personal factors, environmental factors) of the International Classification of Functioning (ICF). For every ICF component, a linear regression analysis with QOLS as the dependent variable was computed. A final comprehensive model was calculated on the basis of the results of the five independent analyses. Results: The following variables could be identified as main correlates for QoL in FM, explaining 56% of the variance of the QOLS (subscale/questionnaire and standardized beta in parenthesis): depression (− 0.22), pain-related interference with everyday life (− 0.19), general activity (0.13), general health perception (0.11), punishing response from others (− 0.11), work status (− 0.10), vitality (− 0.11) and cognitive difficulties (− 0.12). Pain intensity or frequency was not an independent correlate. Conclusions: More than 50% of QoL variance could be explained by distinct self-reported variables with neither pain intensity nor pain frequency playing a major role. Therefore, FM treatment should not primarily concentrate on pain but should address multiple factors within multidisciplinary therapy.

Purpose: The purpose of this study was to determine whether levels of physical activity in people with chronic pain change after participating in a Chronic Pain Management Program (CPMP) at Groote Schuur Hospital (GSH). Methods: A pre-experimental pre-test, post-test study was conducted, consisting of 14 men and women suffering from chronic pain who were referred to a Chronic Pain Management Program (CPMP) from the Chronic Pain Management Clinic at GSH in Cape Town, South Africa. Subjective and objective measuring tools, including pedometry, were used to collect data and non-parametric analysis was conducted to analyse data. Results: 14 participants met the Inclusion criteria. Levels of physical activity changed markedly, but not significantly. Objectively-tested and self-reported physical activity levels changed significantly among participants who took part in a CPMP. Significant improvements in Pain Severity Scores and Pain Interference Scores occurred after the CPMP and there was convergent validity between self-reported and objectively-tested levels of physical activity in those suffering from chronic pain after the CPMP. Conclusion: The Chronic Pain Management Program at Groote Schuur Hospital in Cape Town has shown to improve function and physical activity of those patients living with chronic pain who take part in the CPMP, with function improving significantly, and physical activity nearly doubling in the group being tested who took part in the 5-week long program. The CPMP at GSH should be seen as the beginning of a greater movement towards increasing physical activity in the chronic pain sphere. Research in more public healthcare facilities is needed to increase knowledge around education, pacing and implementation strategies across South Africa.

Neuropathy is a nerve disorder found in HIV disease and diabetes mellitus that indicates damage in the peripheral nervous system. Burning, tingling, stabbing, shooting, and painful sensations in the hands and feet are common symptoms of this chronic disorder, and no treatments are available that repair the nerves. The approved pain treatments are few and only available for the diabetic neuropathy population. A mixed-methods study of archival data was performed to compare patients with painful neuropathy (PN) associated with 2 diseases: HIV (HIV-PN) and diabetes mellitus (DPN). This study examined the similarities and differences of the pain narratives and common pain questionnaires from 12 HIV-PN and 11 DPN subjects. An independent t test of the Visual Analog Scale, Numeric Rating Scale, Brief Pain Intensity subscale, and the Short Form McGill Pain questionnaire failed to reject the null hypothesis that HIV-PN and DPN have equal pain levels. The qualitative analysis revealed 8 shared themes in both groups, with footwear challenges reported as the primary theme. This finding supports the many shared themes between these groups, yet education addressing these themes is minimal. One contrasting theme, privacy, was detected in the HIV-PN group, correlating statistically with the Beck Depression Inventory findings of guilt feelings. The theme of exercise was unique for the DPN group. Both groups had paralinguistic and nonverbal elements discovered in the recordings demonstrating the need for future research to explore these components. Results of education and research themes of privacy in the HIV-PN group and pain communication strategies for both groups will increase understanding of etiology, intervention, and patterns of pain for those diagnosed with neuropathy.

Background: Palpation is an examination technique used to diagnose and treat myofascial pain syndrome (MPS) and fibromyalgia (FM). Currently, there is no validated technique for classifying the results. A valid and reliable pressure pain threshold scale (PPTS) may provide a means for clinicians to grade, document, and report findings. The purpose of this dissertation was to validate a PPTS in patients diagnosed with MPS and FM. Design and Methods: An observational study. Participants who met the inclusion criteria were placed into three equal groups: MPS, FM, and control. All participants underwent one, two-part testing sessions using the American College of Rheumatology criteria. Part-I consisted of palpation with a digital pressure sensor and part-II utilized an algometer. For each tender point (18-total), the participants graded their level of discomfort using the visual analog scale (VAS) and manual tender point rating survey (MTPS) and the examiner graded their response using the PPTS (e.g. ordinal scale with increasing severity from 0-4). Analysis: Intrarater reliability was calculated using the intraclass correlation coefficient model 3, k. Concurrent validity between the PPTS, VAS, and MTPS was calculated using the spearman rank correlation coefficient. A receiver operating characteristic curve was used to determine the minimal cut-off value between groups. Results: Eighty-four participants were included in the analysis. The PPTS had good intrarater reliability (ICC ≥.88). A moderate to excellent relationship was found between the PPTS and VAS for all groups with the algometer and digital pressure sensor (rho ≥.61). A moderate to excellent relationship was found between the PPTS and MTPS for all groups with the algometer (rho≥.68) and for the MPS and control group with the digital pressure sensor (rho ≥.71). There was a little to moderate relationship (rho=.01-.50) between the PPTS and MTPS for the FM group with the digital pressure sensor. A cut-off value of 2 on the PPTS differentiated participants with MPS and FM from controls. Discussion: The results provide preliminary evidence validating the PPTS for patients with MPS and FM. Future research should determine interrater reliability, diagnostic accuracy, and efficacy of the PPTS with other chronic pain and orthopedic conditions.

Indiana University-Purdue University Indianapolis (IUPUI) / Compared to White and high socioeconomic (SES) patients, Black and low SES patients are less likely to receive adequate pain care, including receiving fewer analgesic medications. Providers may, inadvertently or not, contribute to these disparities in pain care via biased decision-making. Prior work suggests there is a complex relationship in which race and SES uniquely and interactively affect providers’ clinical decisions, but few studies have examined the influence of patient race and SES simultaneously on providers’ pain-related decisions. Furthermore, previous studies suggest that providers’ attitudes about race and SES influence their clinical decisions. The present study examined the influence of patient race and SES and providers’ implicit and explicit attitudes about race and SES on providers' pain-related decisions. Four hundred and seven medical residents and fellows made pain assessment (interference and distress) and treatment (opioids, opioid contracts, and workplace accommodations) decisions for 12 computer-simulated patients with chronic back pain that varied by race (Black/White) and SES (low/high). Subjects completed Implicit Association Tests to assess implicit attitudes and feeling thermometers to assess explicit attitudes about race and SES. Repeated measures ANOVAs indicated that patient race and/or SES had main effects on all pain-related decisions and had interaction effects on providers’ ratings for interference, distress, and workplace accommodations. Providers’ implicit attitudes about race and explicit attitudes about race and SES predicted their pain-related decisions, but these effects were not consistent across all decisions. The current study highlights the need to examine the effects of patient race and SES together, along with providers’ implicit and explicit attitudes, in the context of pain care. Results inform future work that can lead to the development of evidence-based interventions to reduce disparities in pain care.

Nociception is the sensory nervous system that detects harmful stimuli including excessive heat, cold, toxic chemicals, and noxious mechanical stimulations. Transient receptor potential (TRP) channels are a group of evolutionarily conserved ion channels consisting of 4 subunits, each with 6 transmembrane spans, and detect a variety of external and internal nociceptive stimuli. Due to their critical roles in nociception, it is essential to understand the mechanisms that regulate TRP channels and subsequent nociception. Here, I investigated two distinct types of regulation of Drosophila transient receptor potential cation channel A1 (TrpA1): regulation via the expression of different TrpA1 isoforms, and via its binding with associated proteins. I found that one of the TrpA1 isoforms, TrpA1(E), inhibits the thermal responses of other TrpA1 isoforms in vitro. I also identified potential TrpA1 binding partners through Co- immunoprecipitation (Co-IP) and mass spectrometry analysis. These binding partners need further validation and characterization through biochemical, cellular, and behavioral assays to illustrate their roles in nociception, and may serve as potential drug targets for chronic pain.

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