The primary goal of this work is to validate the visual analog screening scale Emotion Thermometer (ET) in patients with chronic non-cancer lower back pain. In addition, the work aimed to verify the presumed relationships of clinically significant anxiety, its related concepts and depression with chronic pain and to explore which factors predict decrease in level of function and presence of psychiatric diagnosis according to MINI in patients with chronic pain. In the first chapter, the theoretical part of the thesis deals with the description of the ET tool and a systematic overview of validation and empirical studies. The second chapter focuses on mapping the relationships between stable affective components of ET (distress, anxiety, depression, anger) and chronic pain. The empirical part of the work has a quantitative design and is realized in the form of observational analytical cross-sectional study, in which two hundred and eighty-one patients hospitalized at the Department of Rehabilitation and Sports Medicine of the 2nd Faculty of Medicine at Charles University and at the University Hospital in Motol participated. Participants of the study underwent a clinical examination in the form of an interview and a questionnaire survey. 16 % of the participants met the MINI criteria for major...

Bakgrund Att leva med smärta leder till onödigt lidande och en av sjuksköterskans huvuduppgifter är att lindra detta lidande. Ofta är smärttillstånd komplexa och kan bero på flera orsaker. För att kunna uppnå god smärtlindring krävs det ibland därför olika typer och kombinationer av smärtlindring för att lindra smärta. Akupunktur är en omvårdnadsmetod som sjuksköterskan kan använda för att minska patientens smärta. Den teoretiska anknytningen till denna litteraturöversikt är Katie Erikssons omvårdnadsteori som beskriver tre typer av lidande: vårdlidande, sjukdomslidande och livslidande. Syfte Syftet var att belysa effekten av akupunktur som omvårdnadsmetod vid långvarig smärta med inriktning på patienters erfarenheter. Metod En litteraturöversikt med 16 inkluderade studier, publicerade mellan år 2010 och 2020. De använda databaserna är PubMed och CINAHL Complete. Insamlade data har bearbetats med integrerad analysmetod. Resultat Fyra områden framkom: smärtlindring, välbefinnande, patienters negativa erfarenheter och patienters förväntningar av akupunktur. I flera av artiklarna framkom det att akupunktur hade en smärtlindrande effekt. Den smärtlindrande effekten visades genom patienters smärtskattningar, fysiska tecken samt en minskad användning av analgetika. Patienterna upplevde även ett ökat välbefinnande genom en ökad känsla av autonomi, ökad livskvalitet och förbättrad psykisk hälsa. Patienternas upplevda negativa erfarenheter grundade sig i smärta eller rädsla vid nålinstick eller en utebliven effekt av behandlingen. Slutsats Akupunkturbehandling har en smärtlindrande effekt och kan minska patientens lidande på flera sätt. Majoriteten av deltagarna i de valda studierna upplevde att akupunkturbehandlingarna lindrade deras långvariga smärta. Oavsett smärtlindrande effekt så upplevde flera deltagare att akupunktur hade lett till ett ökat välbefinnande, vilket i sin tur kan minska lidande. / Background Living with pain leads to unnecessary suffering and one of the nurse's main tasks is to alleviate this suffering. Pain conditions are often complex and can be due to several causes. In order to achieve good pain relief, therefore, different types and combinations of pain relief are sometimes required to relieve pain. Acupuncture is a nursing method that the nurse can use to relieve the patient’s pain. The theoretical connection to this literature review is Katie Eriksson's nursing theory which describes three types of suffering: suffering related to care, suffering related to illness and suffering related to life. Aim The aim of this study was to describe the effect of acupuncture as a nursing method on chronic pain with focus on the patients' experiences. Method A literature review was conducted with 16 research articles, published between 2010 and 2020. The databases used were PubMed and CINAHL Complete. The collected data has been processed using an integrated analysis method. Results Four areas were found: pain relief, well-being, patients' negative experiences and patients' expectations of acupuncture. In several of the articles, it was found that acupuncture had a pain-relieving effect. The pain-relieving effect was shown through patients' pain measurement instruments, physical signs and a reduced use of analgesics. Patients also experienced increased well-being in the form of increased autonomy, increased quality of life and improved mental health. The patients' negative experiences were based on pain or fear of needle insertion or a lack of effect of the treatment. Conclusions Acupuncture treatment has a pain-relieving effect and can reduce patients suffering in several ways. The majority of the participants in the selected studies experienced that the acupuncture treatments relieved their long-term pain. Regardless of the pain-relieving effect several participants felt that acupuncture had led to increased well-being.

Bakgrund  Långvarig smärta har en mångfacetterad grund och kan uttrycks på olika sätt. Den långvarigasmärtan har en stor prevalens i samhället och orsakar ofta lidande i flera dimensioner därhälso- och sjukvården arbetar för att förhindra dessa. Hälso- och sjukvården arbetar medmultimodal behandling i samarbete med patienterna för att hitta en acceptabel smärtnivå och en fungerande vardag. I samband med behandling får patienterna kontakt med vårdpersonalsom utför omvårdnad. För att utveckla omvårdnadsarbetet kan patienters upplevelser studeras. Syfte Syftet var att beskriva patienters upplevelser av omvårdnadens betydelse vid långvarigsmärta. Metod Designen var en icke-systematisk litteraturöversikt. I databaserna PubMed och CINAHL, sominnehar omvårdnadsvetenskaplig litteratur, söktes originalartiklar. Artiklarna avgränsades tillpublicering mellan åren 2010–2020 och skulle vara skrivna på engelska. Efter metodisktsökande, kvalitetsgranskning och analys med en integrerad analysmetod inkluderades 17artiklar av både kvalitativ och kvantitativ metod. Resultat Utifrån patienters upplevelser identifierades faktorer som beskrevs vara betydelsefulla delar iomvårdnaden. Tre kategorier skapades för att beskriva dessa faktorer: Partnerskap mellanvårdpersonal och patienter, struktur i omvårdnaden och patientens förväntningar påvårdpersonalen. Slutsats Resultatet tyder på att omvårdnad som utförs med ett uttalat holistiskt och personcentreratpartnerskap, där kunskap, kontinuitet och tillräckligt med tid finns tillgängligt, verkarupplevas som positivt och hjälpsamt av patienter med långvarig smärta. Kunskapen fråndenna litteraturöversikt kan ses som en sammanställning av information om patientersupplevelser av betydande delar i omvårdnaden som kan hjälpa sjuksköterskor i arbete mot enbättre omvårdnad och lindrandet av patienters lidande. / Background Chronic pain has a multifaceted basis and can be expressed in different ways. The chronicpain has a high prevalence in society and often causes suffering in several dimensions wherethe health service works to prevent these. The health service works with multimodal treatmentin collaboration with the patients to find an acceptable level of pain and a functioningeveryday life. In connection with treatment, patients get in touch with healthcare professionalswho perform nursing. To develop nursing, patients' experiences can be studied. Aim The purpose was to describe patients’ experiences of nursing care of importance for peoplewith chronic pain. Method The design was a non-systematic literature review. Original articles were searched indatabases with nursing science literature. The articles were limited to publication between theyears 2010-2020 and were to be written in English. After methodological search, qualityreview and analysis with an integrated analysis method, 17 articles of both qualitative andquantitative methods were included. Results Based on the patient's experiences, some factors were identified that were described asimportant parts of the care. Three categories were created to describe these factors:Partnerships between healthcare professionals and patients, the structure of care and thepatient’s expectations of healthcare professionals.  Conclusions The results indicate that nursing care provided with a pronounced holistic and person-centeredpartnership, where knowledge, continuity and sufficient time are available, seems to beperceived as positive and helpful by patients with chronic pain. The knowledge from thisliterature review can be seen as a compilation of information about patients 'experiences ofsignificant parts of nursing that can help nurses towards better nursing and the relief ofpatients' suffering.

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Philosophiae Doctor - PhD / Pain is a complex biopsychosocial phenomenon that can have a profound impact on people's lives (Access Economics [AE], 2007). lts clinical relevance is well known - pain is suggestive of "actual or potential tissue damage" and plays a role in the diagnosis and clinical management of diseases and/or injury (International Association for the Study of Pain [IASP], 1986). It has both sensory and emotional aspects and is behaviourally expressed by how it is communicated by the sufferer and by its effect on the sufferer's behaviour (IASP, 1986; Linton, 2005; AE, 2007). Even though the experience of pain is associated with tissue damage or is described in terms of such damage, this association is variable so that "the size of an injury can be a poor guide as to how much an individual experiences pain" (AE, 2007). In fact, pain can exist without an objective evidence of tissue damage making pain the "ultimate subjective experience" (Odendaal, 2006). This phenomenon may relate to the fact that the interpretation of nociceptive signals as pain is influenced by a number of personal and environmental factors including past experience, integrity of the nervous system, beliefs and the situation in which tissue damage occurs (Eccleston, 2001; Turk, 2002a; Flor and Hermann, 2004; AE, 2007). As such, decisive and objective measurements are difficult to arrive at and pain is not always easily assessed by the healthcare provider. The translation of pain from acute to chronic however, means that pain and discomfort remains beyond the normal time of healing and by definition, persists either continuously or intermittently for 3 months or longer (Elliot et al., 1999). This changes the physiognomy of pain and the condition of chronic pain ensues. Chronic pain is an important but often neglected public health problem. It is disabling and associated with interference in normal activities of daily living (ADLs) such as work, home chores, family and sporting activities. Research shows that chronic pain is a key complaint that motivates many to seek health care (Crook et al., 1984, 1989; Sullivan et al., 1990; Smith et al., 1996; Mantyselka et al., 2001, 2002; Eriksen et al., 2004; AE, 2007) leading to high and ongoing consumption of treatments (AE, 2007). In fact, studies have shown that persons with chronic pain use health services up to five times more frequently than the rest of the population (Von Korff et al., 1990, 1991; Elliot et al., 1999; Eriksen et al., 2004). Side-effects of treatment are common with medication use including gastric problems such as ulcerations, nausea, constipation and mental slowing or confusion which can affect functioning. Chronic pam is also associated with mood and sleep disturbances such as depression or adjustment problems and trouble getting to sleep and/or frequent wakening during the night. For the sufferer, the effect of disuse of the aspect of the body in which pain is experienced is another manifestation of chronic pain. Muscles and joints become de-conditioned and pain sufferers may lose general body fitness (AE, 2007). Within the community, pain is a common cause of considerable suffering and disability affecting the general health and quality of life of individuals (Von Korff et al., 1990, 1992; Magni et al., 1990,1993; Walsh et al., 1992; Smith et al., 1996,2001; Verhaak et al., 1998; Elliot et al., 1999, 2002; Blyth et al., 2001; Reyes-Gibby et al., 2002; Lanteri-Minet et al., 2003). Significant amounts of working days are lost among the labour force impacting a profound economic and social toll on society (Bowsher et al., 1991; Elliot et al., 1999; Blyth et al., 2003; Igumbor et al.,2003). Simply put, "chronic pain is a human tragedy" (Odendaal, 2006). It is a serious and common problem that causes distress to patients and their caregivers, is a burden on health care professionals and health care resources and results in significant lost productivity. Chronic pain is therefore a problem of public health importance.

Indiana University-Purdue University Indianapolis (IUPUI) / Policy and natural shocks are exogenous factors, which may disrupt patients’ ability to access recommended health care. My dissertation investigates the effect of recent natural and policy shocks in health care provision on different patient outcomes. The first chapter studies the effect of the 2014 Ebola virus epidemic in West Africa on maternal health care utilization and infant health in Sierra Leone. The Epidemic resulted in the diversion of the limited health care resource away from other services to care for Ebola patients. It also led to maternal stress from fear of infection and community breakdown. The results show the outbreak led to significant decline in maternal health care utilization and infant birth weight. The second chapter examines whether physician practices that are vertically integrated with hospitals provide healthcare at higher costs than non-integrated practices in a Medicare patient population. The degree of integration is exogenously assigned to a patient following a geographical move. The study finds that switching to integrated practice increases health care utilization and spending. Although integration may increase quality of care, the increase in spending suggests the need for a continuing attention to policies and incentives that are associated with integration. Finally, the third chapter documents the impact of the recent changes in state medical and recreational cannabis access laws in the United States on health care utilization. The liberalization of access to cannabis may enable patients to substitute cannabis for another prescription and non-prescription health care services. The results show a significant decline in the utilization of emergency and outpatient services among patients with chronic pain for the states that legalized cannabis. The effect is mainly due to medical cannabis laws, whereas the effect of recreational cannabis is ambiguous. The three chapters, taken together, show that exogenous shocks, such as natural shocks and government policy, affect health care utilization and the health of individuals. Health policies should, therefore, target developing a resilient health care system that withstands natural shocks and promote policies that provide better treatment alternatives.

The purpose of this study was to qualitatively examine family relationships in families where one adult member was diagnosed with chronic illness resulting in chronic pain to determine why the crucible, or trial, of chronic illness triggered some families to strengthen while others weakened. The introduction of chronic illness instigates a process of change in family life, yet there is a paucity of research examining families in this situation, specifically when the chronic illness results in chronic pain. Utilizing grounded theory methodology and qualitative data analysis methods, dyadic interviews and periods of observation were conducted with six families across the United States. Questions were focused on family relationships and the impact of adult-onset chronic illness on relationships and family life. Open, axial, and selective coding were conducted during the process of data analysis, illuminating the important role family unity played in helping families remain strong. Findings detail the relationship between family strength and family unity. Adult-onset chronic illness provided a catalyst for families to establish and/or maintain family unity. Five families established or maintained family unity and reported positive changes in family strength, while one family failed to maintain or establish family unity and reported negative changes in family strength leading to separation and eventually divorce. This study has important implications for families facing adult-onset chronic illness and for practitioners serving this population.

Kronisk smärta drabbar många personer och kostar samhället stora summor pengar varje år. Det är inte bara den kroniska smärtans inskränkningar i den drabbades rörelseapparat, utan också dess påverkan på den psykiska hälsan. Syftet med detta arbete är att utreda på vilket sätt den psykiska hälsan påverkas hos personer med kronisk smärta. Metoden som använts är litteraturbaserade studier med kvalitativa artiklar och bygger på Granskär & Höglund–Nielsen (2008). Resultatet har baserats på nio stycken artiklar och en review som visar att personer med kronisk smärta ofta har någon form av psykisk påverkan orsakad av sin smärta. Det visar även att det finns en känsla av förändrad personlighet, en ökad isolering från andra människor samt en stor frustration över att inte veta exakt vad det är som orsakar smärtan. Även ovetskapen om hur smärtan kommer att utvecklas i framtiden har en negativ påverkan på den psykiska hälsan.Kronisk smärta förekommer i många av sjuksköterskans verksamhetsområden vilket gör ämnet angeläget att fortsätta utforska. / Chronic pain affects a lot of people and costs society a great amount of money each year. It’s not only the restriction of chronic pain as a disability but also the psychological impact. The aim of this study is to examine in how the mental status is effected by chronic pain. The method is a literature review based on Granskär & Höglund-Nielsen (2008). The result is based on nine articles and one review which showed that people with chronic pain often have some kind of psychological influence caused by the pain. It also shows a sense of changed personality and an increased isolation from other people. Not knowing what causes the pain and not knowing how it will develop in the future also has a negative impact on the mental health.Patients with chronic pain are common in the nursing profession which makes this topic a very important field to continue exploring.

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Recent evidence appears to indicate that neurons, responsible for our perception of the world around us, are not only electrically excitable, but may have mechanical triggers as well. This is well supported through the growing number of observations of focused ultrasound (FUS) perturbations of the neurons located in our central nervous system (CNS). However, while the CNS is largely responsible for turning electrical signals from the periphery into thoughts and understanding, less is known about the effect of which FUS has upon the peripheral signals themselves: our peripheral nervous system (PNS). Given the non-invasive nature of FUS - were it be discovered to influence neuronal signaling, FUS would become a powerful tool for therapy and medicine, especially in conditions involving pain. Thus, we ponder the question, "How can FUS modulate nerve activity and furthermore, what are the interactions on pain signaling?" In this dissertation, a road-map is described for translating insights acquired through pre-clinical study of ultrasound PNS stimulation to clinical investigation on neuropathic pain modulation in humans. More specifically, methods and tools to study excitation of the sciatic nerve bundle and the dorsal root ganglia (DRG) were built and optimized in rodent models. In turn, these methods and findings enabled investigation into pain signaling and translation to human studies. Finally, FUS was shown to mitigate pain sensations in human patients with neuropathic pain. First, using a newly developed in vivo nerve displacement imaging technique, mechanical deformations of the nerve from FUS stimulation were noninvasively mapped in a two-dimensional plane centered at the sciatic nerve. Nerve displacements were positively correlated with downstream compound muscle activation from FUS sciatic nerve stimulation. Furthermore, by focusing ultrasound waves to the DRGs directly in an ex vivo preparation, additional parameters were identified to modulate spike transmission, effectively regulating high frequency signaling. Next, we investigated the feasibility translating FUS nerve stimulation to clinical studies. We first looked at effects on upstream cortical activity and pain signaling from somatosensory stimuli using high-frequency functional ultrasound (fUS) imaging. FUS was shown to both stimulate somatosensation and suppress pain signaling in the cortex. Secondly, nerve displacement imaging was scaled-up for human investigation, essential for in-procedure localization and stimulation of the targeted nerve bundle. Using a combination of imaging and therapeutic excitation, simultaneous nerve targeting, stimulation, and monitoring was established at pressures required for stimulation. Lastly, clinical feasibility was investigated using previously optimized FUS pulse schemes and scaled-up neuromodulation technologies. Specifically, we applied simultaneous FUS to the median nerve and thermal stimulation to the corresponding dermatome in healthy human subjects. Furthermore, patients with robust and repeatable mechanically-assessed neuropathic pain were similarly stimulated with FUS to assess pain suppression. Based on the findings presented herein, noninvasive FUS peripheral stimulation has the potential for radically shifting the traditional pharmaceutical paradigms in chronic and acute pain treatment by altering signals before being processed in the spinal cord and ultimately the brain. The studies outlined herein serve to elucidate mechanisms of FUS in the PNS, as well as provide the starting foundations for further development of FUS as an effective pain treatment.