O desempenho no esporte de alto rendimento está associado a situações de desgastes físicos e psicológicos extremos tanto em treinamentos como em competições. A dor é um atributo constante na vida destes atletas e trata-se de uma experiência sensorial e emocional avaliada muitas vezes como negativa, associada a uma lesão real ou não que abrange aspectos fisiológicos, sociais e psíquicos. Assim, estudos com a intenção de dar significado a dor na percepção dos próprios atletas devem levar em conta a cultura do esporte e da modalidade, pois a cultura é um complexo de habilidades ou hábitos adquiridos pelo sujeito enquanto membro de um grupo social, fornecendo dados da identidade do ser atleta. Este estudo teve como objetivo analisar como as atletas olímpicas de Ginástica Rítmica experienciaram a dor e os seus significados em sua carreira esportiva. Para tanto foram investigadas as 18 atletas brasileiras que participaram dos Jogos Olímpicos de Verão em diferentes edições, sob a ótica dos Estudos Culturais, inspiração teórica para pensar produções culturais e as práticas sociais. A decisão por investigar esse grupo se estruturou por ser uma modalidade com grande dificuldade técnica, de profissionalização precoce e alto nível de desempenho, alcançados ainda na adolescência. A exigência excessiva e prematura do corpo, o envolvimento com as rotinas e o alto nível de dificuldade dos exercícios praticados predispõe as atletas a um maior risco de dor e sofrimento. O método utilizado foi a narrativa biográfica que proporcionou apreender por meio das memórias desse grupo de atletas a compreensão do significado da dor no esporte e na modalidade específica, apontando que esses significados são transmitidos através das gerações e relacionam-se com tradições e convenções grupais. As atletas criam sentidos para essas vivências através do discurso construído socialmente na modalidade; as experiências acumuladas dentro do grupo levam as participantes a uma expectativa do sofrimento; os vínculos estabelecidos geram a capacidade de simbolizar a dor; suportar o limite imposto pelo corpo faz parte da cultura da modalidade. Os sentidos que constituem o significado da dor permitiu compreender a essência dos conteúdos do que é e como se dá a experiência dolorosa de uma modalidade esportiva quando praticada em alto rendimento / High performance sports is associated with extreme physical and psychological wear in training and competition. Pain is a constant attribute in the lives of these athletes and it is a sensory and emotional experience often evaluated as negative, associated with a real physiological, social and psychic real or non-abreviant injury. Thus, studies with an intention of meaning and perception of the athletes themselves are taken into account the culture of the sport and the modality, because the culture is a complex of skills or habits acquired through a social factor. This study aimed to analyze how Olympic Rhythmic Gymnastics athletes experienced pain and their own meanings in their sports career. To that end, 18 Brazilian athletes participating in the Summer Olympics in different editions were investigated, from the perspective of Cultural Studies, theoretical inspiration to think about cultural productions and social practices. A decision to investigate this group was structured because it is a modality with great technical difficulty, of previous professionalization and a high level of performance, reached in adolescence. The excessive and premature requirement of the body, the involvement with routines and the high level of difficulty of the exercises practiced predispose as athletes to a greater risk of pain and suffering. The method used for the biographical narrative that allowed to apprehend through the medium of the memories of this group of athletes in the understanding of the meaning of pain without sport and in the specific modality, pointing out that these meanings are transmitted through sales and relate to group conventions and traditions. The athletes create meanings for these lives through the socially constructed discourse in the modality; the experiences as accumulated within the group they take as participants an expectation of suffering; the established bonds generate the capacity to symbolize pain; support more than the legal limit for the body is part of the sport culture. The senses that constitute the meaning of permible pain, namely the essence of the contents of what is like a painful experience of a sporting modality when practiced in high yield

O desempenho no esporte de alto rendimento está associado a situações de desgastes físicos e psicológicos extremos tanto em treinamentos como em competições. A dor é um atributo constante na vida destes atletas e trata-se de uma experiência sensorial e emocional avaliada muitas vezes como negativa, associada a uma lesão real ou não que abrange aspectos fisiológicos, sociais e psíquicos. Assim, estudos com a intenção de dar significado a dor na percepção dos próprios atletas devem levar em conta a cultura do esporte e da modalidade, pois a cultura é um complexo de habilidades ou hábitos adquiridos pelo sujeito enquanto membro de um grupo social, fornecendo dados da identidade do ser atleta. Este estudo teve como objetivo analisar como as atletas olímpicas de Ginástica Rítmica experienciaram a dor e os seus significados em sua carreira esportiva. Para tanto foram investigadas as 18 atletas brasileiras que participaram dos Jogos Olímpicos de Verão em diferentes edições, sob a ótica dos Estudos Culturais, inspiração teórica para pensar produções culturais e as práticas sociais. A decisão por investigar esse grupo se estruturou por ser uma modalidade com grande dificuldade técnica, de profissionalização precoce e alto nível de desempenho, alcançados ainda na adolescência. A exigência excessiva e prematura do corpo, o envolvimento com as rotinas e o alto nível de dificuldade dos exercícios praticados predispõe as atletas a um maior risco de dor e sofrimento. O método utilizado foi a narrativa biográfica que proporcionou apreender por meio das memórias desse grupo de atletas a compreensão do significado da dor no esporte e na modalidade específica, apontando que esses significados são transmitidos através das gerações e relacionam-se com tradições e convenções grupais. As atletas criam sentidos para essas vivências através do discurso construído socialmente na modalidade; as experiências acumuladas dentro do grupo levam as participantes a uma expectativa do sofrimento; os vínculos estabelecidos geram a capacidade de simbolizar a dor; suportar o limite imposto pelo corpo faz parte da cultura da modalidade. Os sentidos que constituem o significado da dor permitiu compreender a essência dos conteúdos do que é e como se dá a experiência dolorosa de uma modalidade esportiva quando praticada em alto rendimento / High performance sports is associated with extreme physical and psychological wear in training and competition. Pain is a constant attribute in the lives of these athletes and it is a sensory and emotional experience often evaluated as negative, associated with a real physiological, social and psychic real or non-abreviant injury. Thus, studies with an intention of meaning and perception of the athletes themselves are taken into account the culture of the sport and the modality, because the culture is a complex of skills or habits acquired through a social factor. This study aimed to analyze how Olympic Rhythmic Gymnastics athletes experienced pain and their own meanings in their sports career. To that end, 18 Brazilian athletes participating in the Summer Olympics in different editions were investigated, from the perspective of Cultural Studies, theoretical inspiration to think about cultural productions and social practices. A decision to investigate this group was structured because it is a modality with great technical difficulty, of previous professionalization and a high level of performance, reached in adolescence. The excessive and premature requirement of the body, the involvement with routines and the high level of difficulty of the exercises practiced predispose as athletes to a greater risk of pain and suffering. The method used for the biographical narrative that allowed to apprehend through the medium of the memories of this group of athletes in the understanding of the meaning of pain without sport and in the specific modality, pointing out that these meanings are transmitted through sales and relate to group conventions and traditions. The athletes create meanings for these lives through the socially constructed discourse in the modality; the experiences as accumulated within the group they take as participants an expectation of suffering; the established bonds generate the capacity to symbolize pain; support more than the legal limit for the body is part of the sport culture. The senses that constitute the meaning of permible pain, namely the essence of the contents of what is like a painful experience of a sporting modality when practiced in high yield

The assessment of pain in children has been an enduring theme in the research literature over many decades, with particular focus on how pain can be adequately measured and the extent of under-measurement of pain (American Academy of Pediatrics 2001; Coyne, 2006; McCaffery & Beebe 1989; Subhashini et al., 2009). Definitions of pain, and hence development of pain measurement tools, are often criticised for not addressing the influence of culture and ethnicity on pain (Bates et al., 1993; McCaffery & Beebe 1989; Zinke, 2007), in children, the perception and expression of pain is also affected by cognitive development (Hallström and Elander, 2004). Whilst there has been an increase in the number of children living in the United Kingdom (UK) who do not speak English as their first language, it has been acknowledged that the measurement and management of pain by health service professionals relies predominantly on their experience with English speaking children (RCN, 2009). This study aimed primarily to examine how primary school age children in key stage 1 who speak English as a primary or additional language experience, express, and explain pain. This aim was addressed through three research questions: (1) how do primary school age children in key stage 1 talk about pain? (2) What are the similarities and differences in the language used to talk about pain by children with English as a primary and additional language? (3) Are there differences in the perceptions of pain by children of different age, gender, language background, and country of birth? A second aim was to examine whether language would affect actions taken by final year child health students and nurses working in Minor Injuries Units to manage pain in primary school age children. Study objectives were addressed using a two phase mixed methods design. The first aim was addressed using six focus group interviews with groups of primary school children (aged 4-7) (Phase 1). Two methods were used in the interviews: use of drawings from the Pediatric Pain Inventory (Lollar et al., 1982) to capture the language used by children to describe pain and observation of the children’s placing of pain drawings on red/amber/green paper to denote perceived severity of pain. Following data collection, the vocabulary of each child was assessed using a standardised lexical test (British Picture Vocabulary Score version II - BPVS II) (Dunn et al., 1997). To address the second aim, a factorial survey was conducted (Phase 2) with nurses working in Minor Injuries Units and child health nursing students to determine whether language has an impact on decisions made about the management of children in pain following a minor injury. Phase 1 findings demonstrated that children from English as an Additional Language (EAL) backgrounds used less elaborate language when talking about pain but tended to talk about the pictures prior to deciding where they should be placed. The children’s placement of pain drawings varied according to language background, gender, and age. The calculated language age of English lexical comprehension (BPVS II score) of monolingual children (M=69.85, SD=19.27) was significantly higher than EAL children (M=47.93, SD=14.32; t (32) = 3.60, p =0.001, two-tailed). However, when these differences were explored in terms of year group, the differences remain significant with foundation and year 2 but not with year 1. For the EAL children, there were also significant relationships between BPVS II score and length of stay in the UK (spearman’s rho 0.749, p = 0.33). The Phase 1 findings were used to construct vignettes, describing hypothetical care situations, for Phase 2. Multinomial logistic regression was used to analyse the impact of a child’s age, gender, language, parent’s language, injury mechanism, and reaction to pain on the way in which the child’s pain would be assessed and whether parents or an interpreter would be invited to assist in pain assessment. Findings demonstrated that observing the child’s behaviour is the most significant assessment process that is used to assess EAL children, rather than the Visual Analogue Scale (VAS), which was used with non-EAL children. This is significant as VAS is the mostly widely used tool to assess pain in health care settings. However, VAS is only effective if it can be understood by the child. Further, MIU nurses and child health students were more likely to involve parents who speak English well than those who speak English poorly but would ask for an interpreter if their involvement was necessary. In order for the respondents to explain their decisions, they were asked an open ended question for each vignette. They reported that language and age of children are the most common difficulties they faced during assessment of pain. Therefore, they suggested some solutions, like using an age appropriate tools for assessing younger children. Respondents also identified that using an interpreter is a time consuming process, which might delay the management of pain. In light of the growing numbers of EAL children in the UK; this research has application in a number of contexts. The variation in language would apply if children were reporting their own pain. However, the findings emphasise the need for sufficient time to be allocated to pain assessment to allow an individualised approach. Study findings suggest several factors that may be important in assessing pain in EAL children; these should be explored further in the context of clinicians’ assessment of pain. The implications of the study impact on policy, practice, education, and future research.

This research was executed as three separate studies. Study 1 focused on the perception of pain and the semantic aspects of pain. Study 2 focused on the measurement of acute pain and mood states. Study 3 focused on the psychological treatment of cancer pain. In Study 1 a group of 66 Setswana-speaking adults were required to describe what they saw, what happened, and what would be the outcome with respect to three visually presented pain scenes using The Pain Apperception Test (PAT) A qualitative analysis of their responses shows that pain is experienced as an all encompassing experience affecting all aspects of their lives, such as the physical, emotional, social, and economic. This was found to be true, irrespective of gender and age with the exception of economic issues. A qualitative analysis of their responses to the Pain Eliciting Incidents Questionnaire (PEIQ) reveals that the Setswana pain descriptors are classifiable according to the three dimensions of pain namely, the sensory-discriminative, affective-motivational, and cognitive-evaluative. Sludy 2 applied the Profile of Mood States (POMS) preoperatively to a group of 58 female laparotomy (gynaecological) patients. These patients were also tested post-operatively with the Visual Analogue Scale (VAS) and the Wisconsin Brief Pain Questionnaire (WBPQ) as pain measures. The pain measures were taken at no medication and at the peak of medication. Factor analysis could not confirm the validity of the six POMS scales. These scales also did not show correlations with post-operative pain. Correlations between the pain measures showed acceptable reliability and validity of the VAS and the WBPQ. In Study 3 three groups of 15 cancer patients each, suffering from chronic pain, were treated over a period of two weeks with either cognitive behavioural therapy plus medication, reassurance therapy plus medication, or medication only. Comparison of before and after treatment pain measures showed that both cognitive behavioural therapy and reassurance therapy had a beneficial effect. Follow-up results three months later showed that the beneficial effect of reassurance therapy did not persist. Patients treated with cognitive behavioral therapy still showed the beneficial effects thereof. / Psychology / D. Litt. et Phil. (Psychology)

This research was executed as three separate studies. Study 1 focused on the perception of pain and the semantic aspects of pain. Study 2 focused on the measurement of acute pain and mood states. Study 3 focused on the psychological treatment of cancer pain. In Study 1 a group of 66 Setswana-speaking adults were required to describe what they saw, what happened, and what would be the outcome with respect to three visually presented pain scenes using The Pain Apperception Test (PAT) A qualitative analysis of their responses shows that pain is experienced as an all encompassing experience affecting all aspects of their lives, such as the physical, emotional, social, and economic. This was found to be true, irrespective of gender and age with the exception of economic issues. A qualitative analysis of their responses to the Pain Eliciting Incidents Questionnaire (PEIQ) reveals that the Setswana pain descriptors are classifiable according to the three dimensions of pain namely, the sensory-discriminative, affective-motivational, and cognitive-evaluative. Sludy 2 applied the Profile of Mood States (POMS) preoperatively to a group of 58 female laparotomy (gynaecological) patients. These patients were also tested post-operatively with the Visual Analogue Scale (VAS) and the Wisconsin Brief Pain Questionnaire (WBPQ) as pain measures. The pain measures were taken at no medication and at the peak of medication. Factor analysis could not confirm the validity of the six POMS scales. These scales also did not show correlations with post-operative pain. Correlations between the pain measures showed acceptable reliability and validity of the VAS and the WBPQ. In Study 3 three groups of 15 cancer patients each, suffering from chronic pain, were treated over a period of two weeks with either cognitive behavioural therapy plus medication, reassurance therapy plus medication, or medication only. Comparison of before and after treatment pain measures showed that both cognitive behavioural therapy and reassurance therapy had a beneficial effect. Follow-up results three months later showed that the beneficial effect of reassurance therapy did not persist. Patients treated with cognitive behavioral therapy still showed the beneficial effects thereof. / Psychology / D. Litt. et Phil. (Psychology)