A collection of poems.

Yes / Medical cannabis is one of the most commonly reported therapeutic treatments sought for chronic pain. The wide acceptance and research in alternative medicine has put medical cannabis in the limelight, where researchers are widely examining the therapeutic benefits of medical cannabis and its association to treat chronic pain. The purpose of this scoping review is to provide an overview of the perspectives on CBD as an alternative treatment for chronic pain among health professionals and legal cannabis users.

Veterans experience chronic pain at a rate twice higher than civilians. Brain fog (BF), a phenomenon of mental cloudiness associated with functional challenges in cognition, is one of the least studied symptoms of chronic pain. Pain interference, a construct of chronic pain, can limit participation with activities. Both BF and pain interference can disrupt quality of life (QoL) in Veterans by limiting health and meaningful participation. The relationship between BF and pain interference on QoL has not been investigated. Thus, the objective of this study is twofold: 1) understand the experience and 2) explore the impacts and the possible mitigation of pain interference of BF on the QoL, in Veterans with pain symptoms and BF. First, a qualitative descriptive method was employed using content and matrix analyses, to describe the impacts of brain fog on QoL in Veterans with BF and pain symptoms. The content analysis revealed the triggers, impacts, management strategies, and suggestions for healthcare professionals. The matrix analysis showed that women described difficulty managing BF with competing roles (e.g., motherly duties). Next, we conducted a cross-sectional study Veterans, exploring whether the perceived level of pain interference in Veterans with BF and pain symptoms affected measures of QoL. Results indicated Veterans with BF and high pain interference showed more mental health symptoms (p=0.003), and less perceived level of confidence with abilities (0.036) and physical health (p=0.003), than Veterans with BF and low pain interference. Post-hoc tests revealed no significant differences across gender. Next, to explore how QoL constructs we related, we performed an exploratory correlational analysis, revealing significant correlations between perceived level of confidence with abilities and 1) mental health (r=-0.48), 2) physical health (r=-0.44), and 3) functional cognition (-0.44). This study contributes to the overall knowledge of BF, guiding recommendations for the development of an assessment and research priorities. / Thesis / Master of Science (MS) / ‘Brain fog,’ a symptom seen in chronic pain, is described as feelings of mental cloudiness. Veterans may experience brain fog and pain symptoms more often than civilians. We wanted to learn about the experience of brain fog and how it affects the lives of Veterans with pain symptoms. First, we used a qualitative study to explore their experiences. Veterans told us about the impacts, triggers, and management strategies related to brain fog. Then, to understand the impact of brain fog on Veteran’s quality of life, three related factors were used (health-related quality of life, functional cognition, and perceived confidence with abilities), evaluated in terms of how much pain symptoms interfered with functioning. Veterans with brain fog and high pain interference had more mental health symptoms, and poorer physical health and confidence with their abilities. Overall, this study will hopefully provide some insight into how to better support Veterans.

Background Chronic kidney disease (CKD) is a condition characterized by gradual loss of kidney function over time. Millions of adults have CKD and those who have diabetes, hypertension, and family history of kidney failure are at highest risk of its development. Patients may develop comorbidities, such as cardiovascular disease, anemia, mineral and bone disorders, and peripheral nervous system diseases. Those with kidney failure require dialysis or kidney transplantation, as well as medications, diet therapy, restriction of fluid intake, and lifestyle modifications. The cost for such treatment represents an enormous burden on healthcare systems worldwide, costing about 8% of the Medicare budget in the U.S. Literature review findings Chronic kidney disease is now described based on internationally accepted definitions and diagnosed, when structural or functional abnormalities of the kidneys persist for more than 3 months. End-stage kidney disease is the last stage of chronic kidney disease and is associated with a decreased quality of life and life expectancy. This comprehensive literature review focuses on the effectiveness of dietary therapy in delaying the progression of CKD to end stage kidney disease (ESKD). Current evidence provides guidelines to manage ESRD with the general population. However, despite this, many clinicians do not know how to use diet as part of clinical management. Proposed methods Given the broad spectrum of different dietary therapies to decelerate progression of CKD, many providers do not utilize this information in clinical practice. A workshop hosted by registered dieticians, summarizing the most up-to-date literature on the topic of dietary interventions to slow down CKD progression would be beneficial. The workshop will measure mid-level and high-level practitioner’s knowledge on dietary therapy for CKD and assess this post-workshop. The goal is to expand the knowledge of providers and equip them with the resources necessary to educate patients on healthy dietary modifications, in order to minimize progressive CKD. Conclusions Despite the availability of dialysis and recent advancements in post-transplant care, there is a benefit to lifestyle modification. There is promising evidence that a diet low in protein, potassium, or salt and following certain diets, such as the Mediterranean diet, is beneficial in the deceleration of CKD to end stage renal disease (ESRD). A diet containing processed foods, high protein, high salt, and high potassium content has been associated with an increased risk of transition from late-stage CKD to ESRD. It is possible that these dietary recommendations may apply to prevention of CKD or ESRD. The workshop will present the most up-to-date knowledge in the area of dietary therapies for CKD. A curriculum for mid- and advanced-level health care providers will provide them with the tools necessary to provide their patients with nutrition and lifestyle management.

This Thesis reports a full scale study of cognition and mood in Chronic Fatigue Syndrome (CFS) longitudinally during recovery. Previous studies fail to cover the scope of this study and/or fail to define adequately the syndrome for subject selection. 47 CFS patients were compared with 41 normal and 26 Crohns/colitis controls in a longitudinal study of cognitive performance and depression/anxiety scores. CFS patients performed significantly worse than controls on many of the cognitive tests at first testing. Small but significant differences between CFS and normal controls were found on memory tests (Logical Memory, Word Recognition and, more significantly, Rey Complex Figure) but Crohns/colitis patients scored similarly to CFS, suggesting that this might relate to a general problem such as attention. Much larger and more significant differences between CFS and both control groups were found on tests involving a psychornotor component (e. g. Reaction Time, Finger Tapping and Digit Symbol). CFS patients' performance improved over time (above practise) on word recognition, Stroop (colours), Reaction Time (Movement) and Digit Symbol. CFS patients were significantly more depressed/anxious than the control groups and scored higher on Middlesex Health Questionnaire (Psychiatric). Depression/anxiety did not diminish significantly by second testing. Differences on depression scores accounted for some of the differences in cognitive test performance, in particular Word Fluency and Stroop; however, significant differences remained after ANCOVA removed depression: significant differences remained on Logical Memory, Word Recognition, Digit Symbol, Finger Tapping and Reaction Time. It was concluded that CFS patients were slowed on psychornotor tasks and that this was only partly accountable by depression as suggested by depressed score. CFS patients performed slightly worse on some other tests possibly dependant upon the task demand. Digit Symbol, Reaction Time, and Finger Tapping seemed to be most sensitive to CFS. Brain damage was not necessarily indicated by the results: differences in psychornotor performance could be caused by difficulties in the transmission of instructions to the muscle or slowness in the nerves and muscles themselves. CFS patients' performance significantly improved on a number of tests over time, and did not significantly deteriorate on any test; therefore, the trend of CFS patients' test performance overall was to get better not worse over time.

Chronic pain is a condition that impacts millions of men and women around the globe. It is a compelling disease that particularly impacts quality of life (QOL) for many veterans with undertreated or untreated pain. The focus of this systematic literature review was the appraisal of articles and clinical practice guidelines to better understand best-practice nonpharmacological strategies for management of chronic pain. Key words used in the literature search included chronic pain and veterans, complementary alternative medicine (yoga, tai chi, music therapy, acupuncture, and massage), and cognitive behavioral therapy (CBT). The articles included in the review were limited to those pertaining to adults over the age of 18 with non-cancer musculoskeletal chronic pain. The review excluded articles pertaining to patients reporting headache, cancer-related pain, fibromyalgia, mental health problems, or gynecological pain. Polit and Beck's levels of evidence were used to appraise each article. The Stetler model was used as the change model for this project. Thirty-six articles met the criteria and were included. Nine clinical practice guidelines were appraised. Four articles were pilot studies, 3 met the criteria for Evidence Levels V-VII, 3 met the criteria for Levels III-IV, 8 were Level II, and 18 were systematic reviews of randomized controlled trials (Level I). The analysis of evidence supported the use of yoga, CBT, acupuncture, and massage therapy as best-practice methods of personalized nonpharmacological pain management. This project is important for those who care for veterans and other adult chronic pain patients. Application of the findings may lead to changes in chronic pain management that will enhance social change and improve QOL for veterans and others living with untreated or undertreated chronic pain.

Thesis (M.Pharm) -- University of Limpopo, 2013 / Introduction: Many patients with chronic illnesses including asthma, hypertension, diabetes mellitus and HIV/AIDS, have difficulties adhering to their recommended regimens. This may result in sub-optimal management and control of the illness. What a patient understands about a specific regimen, including the reason for taking each medication and the intricacies of dosing schedules and administration requirements, can have a profound influence on adherence. Monitoring the effectiveness and safety of the treatment administered helps to decide whether this should be continued, changed or stopped. Any drug may produce unwanted or unexpected adverse reactions. The choice of drugs depends on many factors, such as the pattern of diseases, the treatment facilities, the training and experience of the available personnel, the financial resources available and demographic or environmental factors. The level of adherence to medication among with hypertension and diabetes mellitus or anti-retroviral therapy has not been studied in Limpopo province Aim: The aim of the study was to determine the adherence patterns and the factors contributing to the adherence to treatment by diabetic, hypertensive and HIV/AIDS patients at Mokopane Hospital. Methodology: This was a cross-sectional, descriptive study conducted through use of a questionnaire administered as an exit interview at the pharmacy after the patients had consulted the doctor and received their medication from the pharmacy. Results: The data was collected over a period of two months, where every patient was seen only once using their hospital numbers to avoid repetition. The study included a total of 307 participants, 201 (60%) were patients on ARVs, 48 (16%) were on anti-hypertensive, 35 (11%) on anti-diabetic, and 23 (8%) on both anti-hypertensive and anti-diabetics. The respondents were predominantly female (n = 234; 76%) while 73 (24%) male. Similarly of the 201 participants on ARVs treatment, 153 (76%) were females and 48 (24%) were males; among those on anti-hypertensives only 11 (22%) were males. For the diabetics 6 (17%) were males and 29 (83%) were females. Of participants with both hypertension and diabetes 9 (39.1%) were males and 14 (60.9%) were females. Seventy-nine percent (79%) of respondents on ART, 69% of those on anti-hypertensive, 72% of those on anti-diabetics, and 66% of those on both anti-diabetics and anti-hypertensives were adherent to their treatment. The younger patients (21 to 40 years) were less likely to have forgotten to take their treatment in the last one month (21% of respondents) than the older patients (41 to 87 years), 34% of whom forgot to take medication in the month prior to the study. Most respondents 250 (81%) reportedly used an alarm system/timer as reminder to take their medication. Most of them reported that they received information regarding their condition and medication, though some were not sure of the side effects or indications for the medications. Adherence was attributed to faith in the healthcare worker, fear of complications of the condition, and a desire to control the condition. Non-adherence was seen as an active decision, partly based on misunderstandings of the condition and general disapproval of medication which was only taken in order to facilitate daily life or minimize adverse effects. Conclusion: The levels of non-adherence (21% to 34%) among the patients on chronic medication are not acceptable. Elderly patients were more likely to be non-adherent to their treatment compared to the younger patients. Some information gaps were identified regarding their conditions and indications for medications. It is therefore important for the health professional to provide patients with full information about the indications, efficacy, and side effects of the medication given to them. Ways should be found to support elderly patients who are on chronic medications; for instance through directly observed therapy and/or using treatment supporters.

Thesis (M.A. (Clinical Psychology)) -- UNiversity of Limpopo, 2014 / A number of studies have revealed that chronic diseases are common in all communities. This study explored the views of indigenous healers regarding the causes and treatment of chronic diseases in Ga-Dikgale community. A qualitative approach was followed and participants were selected through snowball sampling. Seven participants (2 males and 5 females) who are indigenous healers were recruited for the study. Data was collected using in-depth semi-structured one-to-one interviews and analysed using content analysis. The results of the study are presented in terms of the following themes: a). Participants’ views regarding the types of chronic diseases: despite the divergent views held by indigenous healers regarding chronic diseases, they all perceive these debilitating conditions as incurable. b). Participants’ own explanations of the causes of chronic diseases: it appeared the causes of chronic diseases were attributed to both cultural beliefs and modern medical science. c). Participants’ experiences and subjective notions on the treatment methods for chronic diseases: it was found that Western medicine is considered the most viable option to treat chronic diseases instead of indigenous medicine. d). Participants’ descriptions of the most common diseases that they treat: indigenous healers treat non-chronic conditions instead of chronic diseases. e). Participants’ own perceptions of their roles in the community: it appeared indigenous healers felt they received support from their community as they were consulted mostly for non-chronic conditions; and f). Participants’ recommendations on how people with chronic diseases should be managed: indigenous healers recommend that people should seek medical intervention for treatment of chronic diseases. The study further revealed that indigenous healers in this community are not always the first line of treatment for chronic conditions. Instead, it was found that indigenous healers tend to advice patients with chronic diseases to seek medical intervention rather than traditional healing. The study is concluded by recommending further investigation on chronic diseases, including the possibilities of integrating indigenous healing and Western-oriented health care systems.

Thesis (Ph. D.)--University of Washington, 1984. / Vita. Bibliography: leaves [124]-128.

Doctor of Philosophy / Despite the demonstrated efficacy of cognitive-behavioural therapy for chronic pain, recent research has attempted to identify predictors of treatment outcome in order to improve the effectiveness of such treatments. This research has indicated that variables such as the nature of the onset of the pain and psychopathology are associated with poor adjustment to chronic pain. Accordingly, these variables might also be predictive of poor response to treatment. Individuals who experience a sudden onset of pain following an injury or accident, particularly when the instigating event is experienced as psychologically traumatic, may present for treatment with high levels of distress, including symptoms consistent with a posttraumatic stress response. The impact of this type of onset of pain and posttraumatic stress symptoms on adjustment to chronic pain and treatment outcome is the focus of this thesis. Three studies were conducted to clarify and extend earlier research findings in this area. Using 536 patients referred for treatment in a tertiary referral pain management centre, the first study examined the psychometric properties of a widely used self-report measure of posttraumatic stress symptoms (the PTSD Checklist, or PCL), modified for use in a chronic pain sample. This study provided preliminary support for the suitability of the PCL as a self-report measure of Posttraumatic Stress Disorder (PTSD) symptoms in chronic pain patients. However, the study also highlighted a number of issues with the use of self-report measures of posttraumatic stress symptoms in chronic pain patient samples. In particular, PCL items enquiring about symptoms which are a common aspect of the chronic pain experience (e.g. irritability, sleep problems) appeared to contribute to high mean scores on the PCL Avoidance and Arousal subscales. Furthermore, application of diagnostic cut-off scores and an algorithm recommended for the PCL in other trauma groups suggested that a much larger proportion of the sample was identified as potentially meeting diagnostic criteria for PTSD than would have been expected from previous research. The second study utilised the modified PCL to investigate the impact of different types of onset of pain (e.g. traumatic onset) and posttraumatic stress symptoms on adjustment to chronic pain in a sample of 196 chronic pain patients referred to the same centre. For patients who experienced the onset of pain related to a specific event, two independent experts in the field of PTSD determined whether these events satisfied the definition of a traumatic event according to DSM-IV diagnostic criteria. Adjustment was assessed through a number of validated measures of mood, disability, pain experience, and pain-related cognitions. Contrary to expectations, comparisons between patients who had experienced different types of onset of pain revealed few significant differences between them. That is, analyses comparing patients presenting with accident-related pain, or pain related to other specific events, to patients who had experienced spontaneous or insidious onset of pain revealed no significant differences between the groups on measures of pain severity, pain-related disability, and symptoms of affective distress after adjustment for age, pain duration, and compensation status. Similarly, comparisons between patients who had experienced a potentially traumatic onset of pain with those who had experienced a non-traumatic or spontaneous or insidious onset of pain also revealed no significant differences on the aforementioned variables. In contrast, compensation status, age, and a number of cognitive variables were significant predictors of pain severity, pain-related disability, and depression. The final study investigated the impact of type of pain onset and posttraumatic stress symptoms on response to a multidisciplinary cognitive-behavioural pain management program. Unlike the previous study, this treatment outcome study revealed a number of differences between onset groups. Most notably, patients who had experienced an insidious or spontaneous onset of pain reported greater improvements in pain severity and maintained these improvements more effectively over a one month period than patients who had experienced pain in the context of an accident or other specific incident. There was also limited evidence that improvements in depression favoured patients who had experienced an insidious or spontaneous and non-traumatic onset of pain. Consistent with this, posttraumatic stress symptoms were a significant predictor of treatment outcome, with higher levels of symptoms being associated with smaller improvements in pain-related disability and distress. Notably, this study also revealed that certain cognitive variables (i.e. catastrophising, self-efficacy, and fear-avoidance beliefs) were also significant predictors of treatment outcome, consistent with previous findings in the pain literature. This provided some perspective on the relative roles of both PTSD symptoms and cognitive variables in adjustment to persisting pain and treatment response. These findings were all consistent with expectations and with previous research. Implications for future research and for the assessment and treatment of chronic pain patients who present with posttraumatic stress symptoms are discussed.