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.

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)

Chronic pain is common in western countries and entails considerable consequences for the afflicted individuals as well as for the society. Furthermore, chronic pain is complex including an advanced interplay between biological-, psychological- and social aspects. Treatment of chronic pain attempts to decrease pain intensity and increase physical-, psychological- and social functioning. However, the treatment of chronic pain is still not optimized. Different types of physical activity and exercise (PA&E) are commonly applied as non-pharmacological treatment strategies for chronic pain, but the most efficient type and dose of PA&E are unclear. In addition, adherence to prescribed PA&E is often troublesome, which further complicates the application of PA&E as treatment for chronic pain. The aim of this thesis is to increase the knowledge about PA&E as treatment for chronic pain regarding pain intensity, biochemical substances, adherence and attitudes. The findings of this thesis were that a long-term, home-based PA&E intervention comprising strength exercises as well as stretch exercises decreased pain intensity and increased function in women with chronic neck- and shoulder pain. Using microdialysis technique, differences in pain modulatory biochemical substances were found, before the intervention, in painful trapezius muscle compared to pain-free trapezius muscle. In addition, alterations in pain modulatory substances in painful trapezius muscle after the intervention were found, which possibly could imply peripheral physiological effects of PA&E. Furthermore, psychological factors could be associated to the effects of and adherence to the PA&E intervention. An intention to be physically active were expressed by patients with chronic pain, but a discordance between the intention and PA&E-behaviour were evident, even though the PA&E were experienced as valuable. In conclusion, this thesis strengthens the importance of PA&E as treatment for chronic pain. Especially, this thesis increases the knowledge about; possible peripheral pain inhibitory effects after long-term exercise; how psychological factors might affect the results of PA&E; and also about important behavioural aspects that might affect adherence to prescribed PA&E. This thesis highlights the need of more research on physiological pain inhibitory effects of long-term PA&E in chronic pain. Furthermore, improved methods for ensured adherence to prescribed PA&E are necessary in order to optimize the effect of PA&E as treatment for chronic pain.

The Behavioral Medicine Questionnare (BMQ) is a 44- item instrument administered via a computer CRT display or pencil and paper. The BMQ was designed to help primary care physicians treating spinal disorders to screen for emotional factors which warrant further psychological evaluation. The test is composed of three scales: Anxiety, Depression, and Somatization. Concurrent validity for each scale was determined through comparisons with subject (n = 133) scores on clinician judgement ratings, pain drawings, and the MMPI. The psychometric properties of the test were supported through statistical analysis. Significant correlations were found between the BMQ, MMPI, and clinician ratings, with the latter showing relationships of lesser strength. The only significant correlation to subject generated pain drawings was to the BMQ depression scale. Analysis indicated the need for seperate norms for males and females. Further research is needed to facilitate measurement and interpretation of the BMQ.

The purpose of the present study was to determine the extent of emotional alienation consistent with ecological and chronic pain patients and to assess differences on this dimension between these two patient populations. Ecological group included 100 ecological inpatients, chronic pain group, 30 spinal pain clinic patients. Tests administered were the Sixteen Personality Factor (16 PF) and the Minnesota Multiphasic Personality Inventory (MMPI) including Harris and Lingoes subscales. The ecological group was significantly higher on measures of alienation than the pain group or the standardization population. Results also indicated that the ecological group demonstrated more psychopathology. Emotional alienation appeared to be a consistent stressor in ecological and chronic pain patients. Treatment of these patients should include the reduction of this emotional correlate.

The disabling conditions of chronic low-back pain continue to cost patient, family, and society. The intricate mechanisms which perpetuate this medical condition often consist of both organic and functional factors. This study evaluated personality and psychosocial variables which may control individual responses to facet denervation, a treatment for chronic lumbar distress. The subjects were 47 chronic pain patients whose symptoms conformed to the facet syndrome. Patient responses to the Minnesota Multiphasic Personality Inventory (MMPI) and the Sixteen Personality Factor Questionnaire were reviewed in an effort to predict statistically symptomatic relief. Also, the patients' involvement in litigation and their accuracy in determining their pain level were studied as possible influencing variables. Results show the litigation factor and two scalesof the MMPI to be most useful in predicting patient response from facet denervation treatment.

Ankylosing Spondylitis (AS) and Chronic Pain Syndrome (CPS) can be treated in many different ways. I found a problem in the balance of healing modalities surrounding diagnosis and care of illness and disease. This struggle is not singular to AS and CPS, but universal to physical and mental concerns. Some effective treatments and therapies are not recognized as such or are just beginning to become so. The scope of my work reflects on the course of my life. It was heavily influenced by the way my medical care was managed from an early age and how it evolved over the years. Through my educational program, I examined the necessity to bridge the gap between treatment paradigms and to expand on a broader, more inclusive, healing rubric. This rubric includes a broader emphasis on skill-based and complementary and alternative medicines. The viability to incorporate holistic health therapies earlier in life is explored through my use of the Scholarly Personal Narrative (SPN) qualitative research method. I chose this methodology because scientific fact could be argued either way for one therapeutic approach over another. By incorporating lived experience through SPN the union and cohesion necessary in all healing modalities, and their positive aspects, can be seen. The truth becomes self-evident. The results of this examination showed awareness earlier in life toward alternative and holistic treatments being paramount. Parents and educators lack information concerning modern therapeutic approaches. It also showed each situation will vary, but choice in treatment for ailments and illness of all kinds is not only viable, but highly recommended and researched. Access issues such as health insurance remain obstacles with some treatments and therapies, while others are a matter of cost prohibition, such as nutrition therapies. The implications of my work indicate a need for earlier incorporation of holistic healing programs and skill based therapies alongside perpetuated medical models in early childhood development and education. In conclusion, awareness towards medical concerns and how we as a society treat them can be improved upon by systemically incorporating less harmful therapies earlier in life. Fostering relations between medical providers, care providers and educators for students' wellbeing should be the foreground of any educational policy. Educators and parents alike should be made aware of and take advantage of effective skill-based treatments before a physical or mental condition surfaces or medication only approaches are authoritatively recommended. Integrating programs that build strong mental resilience and focus on youth development and education can reduce the necessity for more invasive treatments or medications should an ailment or illness develop.

A prevalência de dor crônica entre pacientes com transtornos psiquiátricos é, possivelmente, no mínimo igual à da população geral; no entanto, são poucos os estudos na área. Objetivos: Avaliar a prevalência e as características da dor crônica em pacientes com esquizofrenia e comparar a qualidade de vida dos pacientes com e sem dor crônica. Método: Estudo transversal que envolveu uma amostra probabilística de 205 pacientes adultos, com diagnóstico de esquizofrenia (idade média 37 anos; 65% homens; média de anos de escolaridade 9 anos; 87% sem companheiro(a); 65% residiam com os pais; como ocupação principal, 25% eram trabalhadores dos serviços), atendidos em um ambulatório de hospital público do município de São Paulo, Brasil. Os pacientes foram entrevistados por meio de dois instrumentos caracterização da população e da dor e a Escala de Qualidade de Vida WHOQOL-bref. Resultados: A prevalência de dor em pacientes esquizofrênicos foi de 36,6% (75 pacientes). A dor foi mais presente no abdômen (30,7%), seguida da cabeça, face e boca (24%) e região lombar, sacra e cóccix (14,7%). Com relação à freqüência, 24% dos entrevistados referiram ter dor todos os dias, com duração entre 1 a 6 horas, 33,3% afirmaram ter dor de duas a três vezes por semana e 40% referiram dor em períodos mais espaçados, uma vez por semana e a cada quinze dias e somente 2,7% (n=2) uma vez por mês. O tempo médio de dor foi de 41 meses (DP=42,8). Dor moderada foi prevalente. Os escores de qualidade de vida foram baixos para os doentes do grupo sem dor (domínios físico 12,5; psicológico 11,9; social 7,4 e meio-ambiente 9,6) e com dor (domínios físico 11,4; psicológico 11,9; social 7,5 e meio-ambiente 10,6). Na comparação entre os grupos, o domínio físico apresentou diferença (p<0,001), o que indicou que pacientes esquizofrênicos com dor têm pior qualidade de vida por maior prejuízo funcional. Não houve diferença nos demais domínios (psicológico, relações sociais e meio-ambiente). Conclusão: O estudo é inédito em nosso meio e, em alguns aspectos, em âmbito internacional. A prevalência de dor crônica em pacientes esquizofrênicos foi semelhante à da população geral e o quadro álgico foi significativo em termos de tempo de duração, intensidade e freqüência dos episódios dolorosos. A qualidade de vida foi inferior à descrita em outros estudos, com pacientes esquizofrênicos, e a dor crônica piorou a qualidade de vida. Maior atenção à qualidade de vida de pacientes esquizofrênicos e ao controle da dor crônica deve ser observada / Background The prevalence of chronic pain among patients with psychiatric disturbance is possibly at least similar to the general population; however, there are too few studies in this field. Aims: to assess the chronic pain prevalence and its characteristics in schizophrenic patients, and to compare the quality of life of patients with and without chronic pain. Methods: Crossover study with a probabilistic sample of 205 adult outpatients with diagnosis of schizophrenia (mean age = 37 years, 65% men, mean scholarity = 9 years, 87% single, 65% living with parents, 25% had a job), treated in a governmental hospital of Sao Paulo city, Brazil. Patients were assessed by two instruments: characteristics of population/psychiatric disorder/pain and World Health Organization Quality of Life instrument (WHOQOL BREF). Results: Prevalence of pain in schizophrenic patients was 36,6%, (75 patients). Pain was more referred on abdomen (30.7%), followed by head/face/mouth (24%), and lumbar/sacral and coccyx regions (14.7%). Regarding frequency, 24% of the interviewees referred pain everyday with duration of 1 to 6 hours , 33.3% had pain two to three times a week, 40% referred pain with long intervals in between (once a week and each fortnight), and 2.7% (2 patients) once a month. Mean pain duration was 41 months (DP=42.8). Moderate pain was prevalent. Quality of life scores were low for patients without pain (domains 12,5; 11,9; 7,4;9,6) and with pain (domains 11,4; 11,9; 7,5; 10,6). In the comparison between groups, physical domain showed difference (P<0.001), which indicated that schizophrenic patients with pain have worse quality of life due to higher functional disability. There was no difference in other domains. Conclusion: This is a national original study, and in some aspects also original in the international scope. The prevalence of chronic pain in schizophrenic patients was similar to the general population and pain was significant in terms of duration, intensity and frequency. Quality of life was inferior to that described in other studies with schizophrenic patients and chronic pain worsened the quality of life. Higher attention to quality of life of schizophrenic patients and to the chronic pain control must be observed