No / Chronic pain is currently under-diagnosed and under-treated, partly because doctors' training in pain management is often inadequate. This situation looks certain to become worse with the rapidly increasing elderly population unless there is a wider adoption of best pain management practice. This paper reviews current knowledge of the development of chronic pain and the multidisciplinary team approach to pain therapy. The individual topics covered include nociceptive and neuropathic pain, peripheral sensitization, central sensitization, the definition and diagnosis of chronic pain, the biopsychosocial model of pain and the multidisciplinary approach to pain management. This last section includes an example of the implementation of a multidisciplinary approach in Belgium and describes the various benefits it offers; for example, the early multidimensional diagnosis of chronic pain and rapid initiation of evidence-based therapy based on an individual treatment plan. The patient also receives continuity of care, while pain relief is accompanied by improvements in physical functioning, quality of life and emotional stress. Other benefits include decreases in catastrophizing, self-reported patient disability, and depression. Improved training in pain management is clearly needed, starting with the undergraduate medical curriculum, and this review is intended to encourage further study by those who manage patients with chronic pain.

No / The objective of this article was to evaluate the effectiveness of pharmacist-led medication review in chronic pain management. Six electronic databases (Medline, Embase, PsycInfo, CINHAL, CENTRAL, International Pharmaceutical Abstracts) reference lists of retrieved articles and relevant websites were searched for randomized controlled trials published in the English language involving adults with chronic pain. Studies were included if one of the intervention arms had received pharmacist-led medication review independently or as part of a multidisciplinary intervention. Risk of bias was assessed for all the included studies. The search strategy yielded 583 unique articles including 5 randomized controlled trials. Compared with control, meta-analysis showed that participants in the intervention group had: a 0.8-point reduction in pain intensity on a 0 to 10 numerical rating scale at 3 months [95% confidence interval (CI), -1.28 to -0.36] and a 0.7-point reduction (95% CI, -1.19 to -0.20) at 6 months; a 4.84 point (95% CI, -7.38 to -2.29) and -3.82 point (95% CI, -6.49 to -1.14) improvement in physical functioning on a 0- to 68-point function subscale of Western Ontario and McMaster Universities Osteoarthritis Index at 3 and 6 months, respectively; and a significant improvement in patient satisfaction equivalent to a "small to moderate effect." Pharmacist-led medication review reduces pain intensity and improves physical functioning and patient satisfaction. However, the clinical significance of these findings remain uncertain due to small effect size and nature of reported data within clinical trials that limits recommendation of wider clinical role of pharmacist in chronic pain management.

Ta min smärta på allvar; Att leva med långvarig smärta ur ett köns-och genusperspektiv  En litteraturstudie Bakgrund: Cirka 20–30% av världens befolkning lever med långvarig smärta. Könstillhörighet och genusaspekter, som tidigare studier har visat, påverkar människors välbefinnande och erfarenheter av smärta inom vården och samhället. Därför är det viktigt att undersöka vilken betydelse genus har vid långvarig smärta.  Syfte: Syftet med litteraturstudien är att beskriva vuxna patienters erfarenheter av att leva med långvarig smärta sett ur ett köns- och genusperspektiv.  Metod: Litteraturstudien inspirererades av Fribergs modell. Artikelsökning i databaserna Cinahl och Pubmed har gett resultat på nio empiriskt kvalitativa studier. Majoriteten av de sökningar som gjorts är fritextssökningar för att inkludera en större mängd artiklar. De utvalda studierna kvalitetsgranskades och graderades. Resultat: Analysen resulterade i tre kategorier; svårigheter i vardagen, smärtbehandling och bemötande inom sjukvården, med nio tillhörande underkategorier. Resultatet visade att den sensoriska upplevelsen av långvarig smärta inte skiljer sig mellan män och kvinnor. Däremot fanns skillnader kring erfarenheter i kontakt med sjukvården samt existerande samhällsnormer som påverkar hur patienten hanterar smärtsyndromet beroende på könsidentitet.   Konklusion: Samhällsnormerna ger påverkan på hur människor med långvarig smärta hanterade vardagen utifrån könsidentiteten och skapar svårigheter i det sociala livet.   Nyckelord: Genus, Kvinnor, Långvarig smärta, Män och Erfarenheter. / Abstract Take my pain seriously; Living with chronic pain from a sex- and gender perspectiveA literature review Background: Chronic pain affects around 20-30% of the world’s population and peoples’ lives long term. Peoples’ well-being has much to do with their contact and treatment in health care. Gender is, as earlier studies have shown, one of the variables that heavily contributes to how a person is perceived, by themselves and by society. It is therefore important to examine how aspects of gender impact those suffering from chronic pain.  Aim: The aim of this literature study was to describe adult patients’ experiences of living with chronic pain from a sex- and gender perspective.   Methods: The literature study was inspired by Friberg’s model. Article searches in the databases PubMed and Cinahl yielded nine qualitative studies. Majority of searches are free-text searches to include a wider amount of articles. The selected studies were quality reviewed and graded.  Results: The analysis resulted in three categories; Difficulties in daily life, pain management and treatment from the healthcare system, composed of nine subcategories. Results showed that the sensory sensation of long-term pain does not differ between men and women. There were differences regarding experiences in contact with healthcare and social norms that affect how the patient handles the pain syndrome relating to their gender identity. Conclusion: Societal norms affect how patients handle living with chronic pain based on their gender identity. Both male and female patients experience difficulties in their social life related to chronic pain. Keywords: Chronic pain, Experiences, Gender, Men & Women

People expenencmg chronic pain encounter increases m needs and endure the consequences of failure to satisfy needs. In much of the management of people with chronic pain, chronic pain is considered an abstract phenomenon with little attention given to the human experience. Numerous literature focus on a mechanistic reductionistic approach in management of chronic pain. Most literature is written by medical practitioners, nurses and psychologists from a health-care oriented methodology, whereas minimal research literature was contributed from a pastoral care and counselling perspective. This dissertation explores the needs and feelings of people with chronic pain to identify their needs at the various developmental stages of their pain experience, and within their relevant ecosystems, in order to develop a pastoral response. / Practical Theology / M. Th. (Practical Theology)

People expenencmg chronic pain encounter increases m needs and endure the consequences of failure to satisfy needs. In much of the management of people with chronic pain, chronic pain is considered an abstract phenomenon with little attention given to the human experience. Numerous literature focus on a mechanistic reductionistic approach in management of chronic pain. Most literature is written by medical practitioners, nurses and psychologists from a health-care oriented methodology, whereas minimal research literature was contributed from a pastoral care and counselling perspective. This dissertation explores the needs and feelings of people with chronic pain to identify their needs at the various developmental stages of their pain experience, and within their relevant ecosystems, in order to develop a pastoral response. / Philosophy, Practical and Systematic Theology / M. Th. (Practical Theology)

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Chronic pain sufferers are frequently misunderstood and stigmatised. The aim of this investigation was to provide a description of the lifewor1d of people with chronic low back pain, using the phenomenological method. Themes which emerged were that the persistent nature of chronic pain makes it particularly difficult to endure, arousing a profound fear of the future. It causes a disruption in the relationship between the person and the body, in which the person is forced to function within the constraints of pain. Sufferers are unable to fulfil social roles as expected and are forced to revise their goals and activities. The distress of their experience is mediated by the ability to make sense of their condition, finding meaning in the pain itself. The study highlights the value of the phenomenological method in health psychology. Recommendations are made which may be of benefit to people with chronic pain and their families. / Psychology / M. Sc. (Psychology)

Endometriosis is a pervasive, widespread disease that affects millions of women worldwide. The number of women affected by endometriosis is increasing at a staggering rate. Endometriosis impacts women in a variety of ways; it often gradually strips away their resistance to pain, their emotional strength, their concept of femininity and their ability to cope with challenges. This study aimed to provide a voice for women diagnosed with endometriosis. The study allowed the participants to share their experiences from diagnosis through to treatment and to explain the ways in which endometriosis influences their daily lives. In this research report the psychological impact of this disease is discussed, and factors that are not currently addressed by medical professionals treating women with endometriosis are highlighted. Social constructionism provided the theoretical framework for the study. One-on-one, in-depth interviews were conducted with five women who have been diagnosed with endometriosis by a gynaecologist through means of laparoscopic surgery. The method of analysis involved thematic network analysis. The participants’ narratives were converted into interview transcripts. These transcripts were analysed by the researchers and themes were identified. Themes that repeated were elaborated and were linked to available literature. The researcher hopes that this dissertation will contribute to existing knowledge regarding the psychological effects of endometriosis. It is hoped that it will help both the medical community and future and existing patients understand this disease and the effect that it has on the lives of women around the world, but particularly the lives of women in South Africa. / Psychology / M. Sc. (Psychology)

Bakgrund I Sverige lider uppskattningsvis 20 % av befolkningen av långvarig smärta som kan skattas måttlig till svår. Smärta är en subjektiv upplevelse som kan definieras som sensoriskt och känslomässigt obehag. Syfte Syftet med denna litteraturstudie var att beskriva hur patienter upplever att långvarig smärta påverkar deras liv samt att beskriva de ingående studiernas datainsamlingsmetod. Metod Tolv kvalitativa artiklar som berörde patienters upplevelser av att leva med långvarig smärta inkluderades efter sökningar i databaserna PubMed och Cinahl och sammanställdes i en deskriptiv litteraturstudie. Huvudresultat Patienterna upplevde att långvarig smärta påverkade alla aspekter av deras liv. De beskrev smärtans oförutsägbarhet och hur kroppen kändes förändrad, icke tillförlitlig och icke funktionell. Många beskrev hur de påverkades både psykiskt och socialt samt att de drabbats av nedstämdhet, depressioner och minskad livskvalitet. Patienterna beskrev att det kunde vara svårt att acceptera smärtan som en del av livet, då acceptans först sågs som ett nederlag. Med tiden lärde sig många av patienterna att både hantera och acceptera smärtan, de omvärderade sin vardag och lärde sig att se livet ur andra perspektiv. Slutsats Att leva med långvarig smärta innebar att vardagen begränsades och hela livet påverkades, detta födde rädsla och oro som kunde leda till nedstämdhet och depression. Många patienter hade svårt att acceptera smärtan som en del av livet och behövde stöd i att lära sig hantera den. Därför behövs det mer forskning kring hur sjukvården ska kunna assistera patienterna i detta. / Background Twenty percent of the Swedish population is suffering from chronic pain that can be rated as medium to severe. Pain is a subjective experience that can be defined as a sensory or emotional discomfort.     Aim The aim of this literature review was to describe how patients experience that chronic pain are effecting their lives and to describe the data collection of the included studies.  Method Twelve articles with a qualitative design concerning patient experiences of living with chronic pain was included through searches of databases PubMed and Cinahl and compiled in a descriptive literature review. Main Results The patients experienced that chronic pain affected all aspects of their lives. They described the unpredictability of the pain and how the body felt changed, non-reliable and non-functional. Many patients described how they were affected both psychologically and socially. They were also suffering from low mood, depression and loss of quality of live. The patients described difficulties with accepting the pain as a part of life, acceptance was seen as a defeat at first. With time, many patients learned how to manage and accept the pain. They revalued their everyday life and learned to look at life in different perspectives.    Conclusion Living with chronic pain meant a restricted everyday life and there was a general impact on life. This lead to fear and anxiety that could lead to low mood and depression. A lot of patients found it difficult to accept the pain as a part of life and were in need of support with pain management. There is a need of more research concerning how the healthcare can aid patients in this matter.

Bakgrund: Smärta är en multidimensionell och subjektiv upplevelse som kan drabba alla människor. Smärta är den vanligaste orsaken till uppsökande av sjukvård samt orsakande av funktionsnedsättningar och oförmåga att arbeta. Personer med långvarig smärta måste självständigt utföra en stor del av sin behandling och omvårdnad i form av egenvård. Det ingår i sjuksköterskans uppdrag att uppmuntra och stödja patienter till att utföra egenvård, dock finns ingen entydig definition av begreppet egenvård. Syfte: Att redogöra för hur personer med långvarig smärtproblematik beskriver egenvård. Metod: En litteraturöversikt baserad på tio vetenskapliga artiklar med kvalitativa och kvantitativa ansatser. Artiklarna togs fram via sökningar i databaserna CINAHL Complete och MEDLINE, och var publicerade mellan åren 2005-2015. Artiklarna har analyserats enligt Fribergs analysmetod. Resultat: Resultatet i litteraturöversikten presenterade att personer med långvarig smärta beskrev egenvård som multidimensionell. Egenvård ansågs bestå av personliga förmågor samt mentala och praktiska strategier. Personer med långvarig smärta ansåg även att utbildning och stöd ifrån hälso- och sjukvården var viktigt för utförandet av egenvård. Diskussion: Resultatet har diskuterats utifrån Dorothea Orems omvårdnadsteori om egenvårdsbalans samt vetenskapliga publiceringar. Egenvårdens innebörd för personer med långvarig smärta har jämförts med de olika definitioner av egenvård som tillämpas inom hälso- och sjukvården. Vidare har egenvårdsdefinitionernas betydelse för hälso- och sjukvårdens egenvårdsstödjande insatser diskuterats. / Background: Pain is a multidimensional and subjective experience that can affect anyone. Pain is the most common reason to seek medical care and is the main cause to disability and inability to work. People with chronic pain need to independently manage a large part of their treatment and care in the form of self-management. One part of the nursing role is to encourage and support patients to perform self-management, however there is no clear definition of the term self-management. Aim: To illustrate how people with chronic pain describes self-management. Method: The literature review was based on ten scientific articles, with qualitative and quantitative approaches. The articles were found through searches in the databases CINAHL Complete and MEDLINE, with publication between the years 2005-2015. The articles were analyzed using Fribergs method of analysis. Results: The literature review showed that people with chronic pain described that self-management was multidimensional. Self-management was considered to involve both personal abilities, mental and practical strategies. People with chronic pain also believed that education and support from healthcare was essential for self-management. Discussion: The result has been discussed against Dorothea Orems nursing theory about self-care and relevant scientific publications. The ​​meaning of self-management for people with chronic pain has been compared with various definitions of self-management that are applied in healthcare. Furthermore the definitions of self-management were put in relation to how the healthcare provide supporting self-management interventions.