Class of 2007 Abstract / Objectives: This study evaluated the didactic pain management curriculum from 2003 to 2006 at the University of Arizona College of Pharmacy in comparison to a compilation of current published standards. Methods: The study design was a utilization-focused evaluation conducted by two doctor of pharmacy candidates. The eleven domains of cognitive and affective abilities used for analysis were compiled from the International Association for the Study of Pain (IASP) guidelines and from published expert-panel competencies in the American Journal of Pain Management (AJPM). These documents were chosen for comparison because they were created with the purpose of developing competent and proficient pharmacy clinicians. Results: The analysis revealed that the University of Arizona College of Pharmacy was unsuccessful in meeting the recommended standards for pain management competencies. Instruction in pain management was poorly integrated, incomplete, and sporadic throughout the coursework. Conclusions: Pain management was insufficiently addressed in coursework at the University of Arizona. Separating pain from other topics, integrating pain entirely into the therapeutics course, creating a course devoted to pain management, and/or fulfilling standards through a required clerkship may improve the current curriculum. The results of the assessment will be used to provide recommendations to improve the curriculum concerning pain management.

M.Tech.

M.Tech.

Pain can be a warning sign, but in surgery it is associated mainly with medical procedures. The aim of the research survey was to map out the pain rating scales that are used in practice in surgical patients, to determine the opinion of surgical nurses on these scales and patient experience. Furthermore, the paperwas aimed at the creation of a recommended procedure for evaluation of pain in surgical patients. In the empirical part of the thesis, quantitative and qualitative research was used. In the quantitative research, two questionnaires were created - for nurses (a non-standardized questionnaire) and for surgical patients (a combination of a non-standardized and standardized questionnaire). The focus group method with surgical patients and nurses was used as a qualitative method. The research survey shows that the most commonly used scale in practice is the visual analogue scale and verbal evaluation. Although these methods are widely used, our results suggest that they are not entirely sufficient. Respondents from the groups of nurses and patients wanted to add more accurate verbal description to the evaluation and increase the frequency of pain evaluation by a doctor and nurse. The most frequent symptoms of pain from the perspective of patients included: limited mobility and self-sufficiency, emotional lability, and verbal manifestations. And from the perspective of nurses: limited mobility, non-cooperation, limited self-sufficiency and verbal manifestations. Among the methods that are used most often by patientsto relieve painare medicinesprescribed by the doctor, relief positions, sleep and rest. More than 90% of patients are satisfied with the cooperation with the nurse and the doctor in the evaluation and treatment of pain. Based on the data analysis, a procedure for assessing pain in surgical patients has been proposed. Its clarity and usability were verified using the focus group method with surgical nurses and patients. Both the nurses and the patients assessed the recommended procedure quite positively. Possible pitfalls were perceived in the necessity of sufficient nurse-patient cooperation and enough time to implement the proposed assessment. The research survey was carried out in the territory of the South Bohemian region and is processed as part of thesolution of the GAJU team grant project - Use of Measuring Instruments in Nursing Practice (059/2018/S).

Chronic pain may be defined as pain which persists in a patient for a prolonged period of time. Although this period of time may range from 3-12 months, it is most commonly described as pain which extends beyond the time required for healing. Chronic pain may also be classified into two different categories depending on the cause. The first category is nociceptive, which is chronic pain caused by activation of nociceptors. This may be due to several factors such as trauma or temperature. The second category is neuropathic chronic pain. These are chronic pains which are not necessarily caused by trauma, but more likely due to the malfunction of the nervous system. For this study, our aim is to develop a patient-controlled, externally actuated hydrogel system which is capable of ‘ON-OFF’ drug release. The model drug which was incorporated into the SAPD was a Non- Steroidal Anti-Inflammatory Drugs (NSAID), and thus our drug release system would be beneficial primarily for nociceptive chronic pain. This subcutaneously implanted SAPD is produced with an electroactive polymer which allows drug release in the presence of electrical stimulation. This would result in direct availability of drug at the site of actuation with reduced side-effects and increased drug bio-availability. The SAPD was formed by crosslinking polyvinyl alcohol (PVA) with diethyl acetamidomalate (DAA). The result was a hydrogel which was capable of swelling while remaining insoluble when placed in various solvents. After the hydrogel was synthesized, indomethacin was incorporated as the model drug. Indomethacin exhibited superior Drug Entrapment Efficiency (DEE) (±70-90%) and responsive release in the presence of an electrical stimulus. Finally, polyaniline (PANi) was used as the electroactive polymer in order to enhance the conductivity and allow sufficient release of the drug. Optimization of the SAPD was undertaken with a 3-factor Box-Behnken Design which measured the rate of erosion, drug release and DEE. The optimized SAPD was synthesized using PVA (0.8g) crosslinked with DAA (0.0689g) and a concentration of 1.3418%w/w PANi. Indomethacin was used and the DEE achieved was 76.32±10.46% (target 80.5381%). The drug release profile was 1.622%±0.1857% (target 1.7%) per release cycle and erosion rate was 5.73±1.26% (target 6.3201%) when actuated with a potential difference of 1V for a duration of 1 minute. Chemometric modelling performed on the SAPD showed that drug release may be attributed to erosion of the SAPD in the presence of an electrical stimulus. The polymeric strands usually rest as a coiled state within the SAPD. This coiled state may be the reason the hydrogel remained intact in the absence of electrical stimulation. However, external electrical fields may adduct to form a coil rather than an extended chain resulting in the formation of a globular aniline-vinyl complex. This formation thus leads to a weakened form of the hydrogel structure, resulting in breakdown and ultimately erosion. This erosive phenomenon ceased once the electrical stimulation was removed. The end result of this hydrogel erosion is the liberation of the entrapped indomethacin. In vivo animal studies on the SAPD indicated an ‘ON-OFF’ drug release profile. The drug release was consistent and drug quantity of ±0.15mg per release cycle in the Sprague-Dawley rat model. The SAPD was implanted subcutaneously under the left flank and an electrical stimulation was triggered with the use of a 2-in-1 galvano/potentiostat in order to ensure the electrical stimulus was constant. The potential difference used was 1V over a period of 1 minute. The rats were assessed for signs of illness or swelling after the implantation procedure to determine the biocompatibility of the SAPD. The rats were monitored for 10 days and weighed daily. Results have shown that the rats did not experience any considerable swelling and the weights of each rat were steady, thus indicating biocompatibility of the SAPD. Histopatholgical samples indicated mild inflammation around the site of implantation 10 days after implantation. This may have been due to minor surgery at site of implantation. The biocompatibility of the SAPD was generally good and there were no signs of tumour or long term tissue inflammation. Future application of the SAPD may include an external actuation device to be worn as a watch which allows actuation of the SAPD when required by the patient.

Thesis advisor: Callista Roy / Assessing pain in nonverbal children with intellectual disability (ID) is challenging. These children are at risk for having pain from complex medical conditions and treatments for these conditions (Breau, Camfield, McGrath, Finley, 2004). Compounding this, their pain cues are often misunderstood, given that they are nonverbal and limited by their physical abilities. Although, pain assessment tools for this population exist, there is a need for tools appropriate for a range of exhibited pain expressions. The general purpose of this study was to examine the words that parents of children with ID use to describe their child's pain responses in order to improve pain recognition and management. Specifically, the aims were to: 1) Identify common pain responses; 2) Examine the relationship between type of pain response and demographic characteristics; 3) Compare common pain responses to cues in the literature. A non-directed summative content analysis identified patterns in 335 parent described pain responses of 50 nonverbal children with ID ages 6-18 years. The relationships between type of pain response and selected demographic factors were examined. Then pain responses were compared to items of pain tools for this population. Seven distinct categories of pain expression were identified in the content analysis. The greatest percentage of pain cues were within the categories of vocalization (39.4%), social behavior (21.8%) and facial expressions (16%). Four categories: vocalization, social behavior, muscle tone and activity level included opposite responses to pain. Significant relationships between type of parent described pain expression and 1) pain severity; 2) causes of ID and; 3) the gender of the child found that type of pain expression changes with severity; that patients with seizure disorders expressed pain with vocal pain expression; and that females expressed pain with more social pain expression while males expressed with more vocalizations. The results support published evidence that parents can articulate their child's pain responses. The study also provides evidence of: 1) opposite pain responses within general categories of pain; 2) a significant relationship between type of pain responses and severity of pain, cause of ID and child gender and; 3) the comprehensiveness of pain assessment tools vary greatly. / Thesis (PhD) — Boston College, 2010. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

A Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirement for the degree of Master of Science in Physiotherapy Johannesburg, 2017 / Background: The cognitive elements of fear avoidance and pain catastrophising in individuals suffering from chronic pain, including chronic low back pain and chronic musculoskeletal conditions, have been found to be significant impediments to recovery. However, little is known about the influence of fear avoidance and pain catastrophising on chronic non-specific neck pain, especially in the context of a South African population. The purpose of this study was to determine the prevalence of fear avoidance and pain catastrophising in patients suffering from chronic neck pain of three or more months’ duration who were attending physiotherapy in private clinics in Johannesburg, South Africa. The objectives of this study were to establish the prevalence of fear avoidance, the prevalence of pain catastrophising, and to establish the association between demographic variables and fear avoidance and pain catastrophising respectively. Methods: In order to fulfil the objectives, a cross-sectional design was used on the basis of the validated Tampa Scale for Kinesiophobia-11 (TSK-11) and the Pain Catastrophising Scale (PCS) questionnaires to determine the prevalence of fear avoidance and pain catastrophising respectively in patients suffering with chronic neck pain. The patients were sampled sequentially from randomly selected private practices in Johannesburg, South Africa, with the particular focus being on musculoskeletal conditions. The demographic data included gender, age, pain intensity, marital status, highest level of education attained, employment status, duration of neck pain, and whether or not the participant had had to reduce his/her work load as a result of the pain experienced. These factors were tested in terms of their association between fear avoidance and pain catastrophising respectively, and of the association between fear avoidance and pain catastrophising itself. A total of 106 participants were interviewed. The data from the questionnaires and the demographic questionnaires were analysed using Statistica, version 12. The results were considered significant when p-values of 0.05 were attained. Results: A total of 106 participants with a mean age of 48.7 years (SD=14.8; range 20-80 years) were drawn sequentially from a randomly selected total of 25 private practices. Female participants constituted 81.1% (n=86) of the total participants and 76.4% had some form of tertiary education. The majority (76.4%) were working and most (79.2%) had not reduced their work load as a result of their pain. Many participants were in a relationship (67.9%) and the pain intensity showed a mean of 4.4 on the VAS (SD=2.2; range 0.3-8.7), with the median pain duration being 96 months (8 years) (IQR=30-180 months) (2.5-15 years); range 3-756 months (0.25-63 years)). The TSK-11–Total showed a mean score of 22.9 and 25.5% of the participants (n=106) presented with significant fear avoidance measured on theTSK-11-Total scale. The prevalence was based on a cut-off equivalent to the midpoint scale. The median score for the PCS-Total was 12. The prevalence of clinically relevant scores for the PCS-Total was 15.1% (n=106) of the population studied, based on a cut-off score of =30. There was a significant, positive correlation between the TSK-Total and the PCS-Total and its subscales; and between the TSK-SF and the PCS-Total and its subscales. Significant association was found between the highest level of education and the TSK-11-Total score. The mean TSK-11 score for those with secondary education (26.0 ± 3.4) was higher than that for patients with a tertiary education (21.9 ± 1.5), indicating that those with a secondary education were more likely to be fear avoidant than those with a tertiary education. There was a significant, positive correlation between pain intensity and the TSK-Total score, and a significant positive correlation between pain intensity and the PCS-Total score. No significant association was found for fear avoidance and pain catastrophising in respect of any of the other demographic variables. Conclusion: This prevalence study established that of the sample of adults attending physiotherapy for chronic non-specific neck pain, 25.5% suffer from fear avoidance and 15.1% suffer from pain catastrophising. An association was found between the total scores for fear avoidance and pain catastrophising. Furthermore, an association was also found between fear avoidance and its subscale, somatic focus, and between pain catastrophising and all its subscales, namely rumination, magnification and helplessness. Yet another positive association was found between secondary education and fear avoidance, and a positive correlation between pain intensity and both fear avoidance and pain catastrophising respectively. / MT2018

Introduction Various authors have proposed that there may be altered hip rotation range of motion (ROM) in patients with low back pain (LBP). However, limited studies have been conducted to investigate the association between hip rotation ROM and LBP specifically in distance runners. The aim of this study was to determine whether there is an association between hip rotation ROM and non-specific LBP in distance runners. Methods A cross-sectional design was used to look at the relationship between hip rotation ROM and LBP. Thirty five runners with LBP (24 males, 11 females) and 51 runners without LBP (29 males, 22 females) participated in the study. A questionnaire was used to divide participants into LBP and no LBP groups and to evaluate certain factors specific to LBP. Passive rotation ROM was measured in prone position using a hand-held inclinometer. Results Results showed no statistically significant difference (p>0.05) in hip rotation ROM between the two groups. Furthermore, no statistically significant difference (p>0.05) was found for factors specific to running, between the two groups. Conclusion Although no association was found between hip rotation ROM and LBP in distance runners, further research is needed into other possible causative factors of LBP in distance runners. Keywords Low back pain, hip biomechanics, hip mobility, hip rotation, sports and running Operational definitions  Low back pain (LBP): pain and discomfort located below the costal margins and above the gluteal folds, with or without associated leg pain (Van Tulder et al 2006).  Non-specific LBP: pain not attributable to a clearly recognisable pathology (Koes et al 2006).  Healthy distance runner: a runner who has had no LBP symptoms within the last 6 months.  Time trial: an unofficial road running race in which participants are timed individually over a set distance, in this case, 4km.

Faculty of Medicine School of Physiotherapy 82-29610 Tel: 011 452 3175 / Physiotherapists commonly assess head and shoulder posture and correct poor posture on the grounds that there is an association between the patients’ cervical symptoms and their posture. The aims of this study were firstly to compare the sagittal head and shoulder posture and demographic variables of patients with chronic cervical pain to those of “healthy” volunteers. Secondly, to investigate the relationship between the frequency and severity of pain and the sagittal head and shoulder posture of patients with chronic cervical pain. Lateral view photographs were taken of nineteen patients (experimental group) and eighteen “healthy” volunteers (control group) in a supported sitting position. The following five static postural positions were assessed: (1) neutral or natural head and shoulder posture (2) maximum head protraction (3) maximum head retraction (4) maximum shoulder protraction and (5) maximum shoulder retraction. The active range of anteroposterior glide (total excursion) of the participants’ head and shoulders was also assessed. The participants completed a questionnaire that included their demographic variables, medical history and leisure time activities. Differences in head and shoulder posture were observed between the two groups. Some of these differences supported postural relationships that have been described in the literature. The experimental group had a more forward head resting position than the control group. The range of motion (total excursion) of the head and shoulders of the experimental group was less than the control group. In contrast to clinical assumptions that have been described in the literature, a forward resting head posture was not related to a protracted shoulder position or to upper cervical spine extension when measured in the sagittal plane. A relationship was observed between the frequency and severity of pain in certain body regions and selected postural measurements in the experimental group. It is suspected that most of the findings might be the result of poor cervical and scapular muscle control caused by chronic pain. This emphasises the need to assess the influence of tissue and joint extensibility and muscle control on head and shoulder posture. Analysis of the questionnaires demonstrated that the experimental group’s ability to carry out activities of daily living was significantly affected by pain (p=0,001). There was no significant difference in the number of hours worked per week between the experimental and control groups (p=1,000). There was a tendency (p=0,118) for the control group to devote a greater number of hours to “active” leisure time activities. The control group might have been less symptomatic as a result thereof. This highlights the necessity to further investigate the effect of exercise on postural correction and prevention of cervical symptoms.

I have investigated the effects o f both systemic and intracerebroventricular administration o f non-steroidal anti-inflammatory drugs (NSAIDs), o f varying therapeutic potency, on i) nociception during tail ischaemia and ii) hyperalgesia to a noxious thermal stimulus, evident during reperfusion of the receptive field on the tail, in conscious Sprague-Dawley rats. NSAIDs were found to attenuate the hyperalgesia evident during reperfiision o f the tail, whilst having no effect on the escape latency to a noxious ischaemic stimulus or on the tail flick latency in the absence of tail ischaemia. The intracerebroventricular doses required to attenuate reperfiision hyperalgesia were 2-3 orders o f magnitude less than those required by systemic administration for the same drugs. Using mechanical search stimuli, I located neurones in the dorsal horn of the spinal cord of rats with receptive fields in the tail. Neuronal responses to noxious and innocuous mechanical stimulation, as well as to noxious thermal stimulation before ischaemia and during reperfusion after ischaemia, were assessed. Of the population of neurones I examined, only a minority responded to thermal stimulation before ischaemia, and during reperfiision the neurones became more sensitive to mechanical stimuli, but not to noxious thermal stimuli. Furthermore, the neurones exhibited a decreased sensitivity to mechanical stimulation during ischaemia. Application of NSAIDs to the spinal cord did not alter the response properties of the neurones during receptive field ischaemia, but decreased receptive field size and reduced spontaneous and evoked activity during reperfusion of the tail. I have shown that the neurochemical mechanisms underlying nociception during ischaemia and reperfusion of the rat tail are different. While prostaglandins appear to pla] .0 role in mediating nociception during ischaemia, they are mediators of the hyperalgesia and neuronal hypersensitivity evident during receptive field reperfusion.