Background/aim: Chronic low back pain (CLBP) is a variant of chronic pain and an overarching term for a diverse number of painful and benign conditions of the lower spine. Research has shown that CLBP challenges biomedical explanation and treatments and incurs passive coping strategies. Despite the enduring nature of CLBP there are few longitudinal studies. The aim of this investigation was to gain understandings of any consistencies and changes in the experiences of participants' experiences of living with CLBP. Design: A qualitative, longitudinal IP A research project that explored participants' pain experiences over two years (2005-2007). Methods: Semi-structured interviews were conducted with a purposeful sample of ten participants recruited from the waiting list of a chronic pain clinic. Each participant was interviewed prior to attendance and twice after treatment. The data were recorded and transcribed accounts were analysed using IPA. Results: The participants foreground the physicality of the pain. Further interpretive work showed that whilst participants emphasised the physicality of their condition they experienced embodied, multidimensional experiences characterised by loss. Most participants' continued to manage their pain within a biomedical model of understanding and behavioural focused coping strategies. In comparison, participants who experienced a period of painlessness due to medical interventions demonstrated a reappraisal of their situation and a trend towards adopting a wider, biopsychosocial understanding accompanied by changing coping strategies. Conclusion: The accounts revealed the relationship between the participants' painful body and self concept. For some participants, a respite from pain paralleled increasing psychosocial coping strategies and a future orientation that reflected changes in illness beliefs in the absence of a formal psychological intervention. In comparison, remaining participants continued to demonstrate a narrow repertoire of coping and loss orientation. Participants' responses to CLBP resonated with the grieving processes of bereaved individuals. Clinical implications are discussed with recommendations for future research.

The impact of pain intensity upon tasks of attention and memory was investigated, with the specific aim of evaluating differences in effortful versus automatic processing, implicit versus explicit memory, and right versus left hemisphere measures. All research participants in the study had been diagnosed with chronic pain conditions and each person completed memory and attention tasks, measures of intelligence, emotional functioning, and cognitive failures, and provided pain intensity ratings. Ratings regarding level of fatigue, quality of sleep, perceived control over pain, and perceived effect of pain on attention and memory were also obtained. With age, education, fatigue, and self-efficacy controlled, performance on the cognitive tasks was used to predict pain intensity through a series of hierarchical multiple regressions. Performance on the cognitive tasks was not able to account for a significant amount of the variance in pain intensity. Self-efficacy and fatigue were also noted as strong predictors of pain intensity among this sample. Implications are discussed in view of rehabilitation and neuropsychological assessment of persons with chronic pain, as well as clinical interventions with this population. / Graduate

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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Artrite à uma doenÃa inflamatÃria que afeta as articulaÃÃes sinoviais. Os sintomas mais comuns sÃo o aumento da sensibilidade à dor nas articulaÃÃes (hiperalgesia ou hipernocicepÃÃo) e edema. Uma alternativa para o tratamento da doenÃa à a inclusÃo de plantas medicinais. O Ãleo extraÃdo dos frutos do pequi (Caryocar coriaceum Wittm), tem ampla aplicabilidade na medicina popular. Ensaios prÃ-clÃnicos demonstraram propriedades terapÃuticas do Ãleo, tais como anti-inflamatÃria, gastroprotetora e cicatrizante. Com base neste contexto, o objetivo do presente estudo foi investigar a atividade antinociceptiva e anti-inflamatÃria do Ãleo de pequi (OPCC) na artrite induzida por zymosan em ratos. O estudo foi aprovado pela ComissÃo de Ãtica em Pesquisa Animal da Universidade Federal do Cearà (n 83/11). A artrite foi induzida por uma injeÃÃo intrarticular, no joelho direito, de zymosan (1mg/50ÂL) e foram avaliados a incapacitaÃÃo articular (hipernocicepÃÃo), edema articular, migraÃÃo de leucÃcitos, liberaÃÃo de citocinas e expressÃo de mediadores inflamatÃrios. Os animais foram prÃ-tratados, por via oral, com OPCC (100, 200 e 400mg/kg) ou veÃculo durante 7 dias consecutivos ou em dose Ãnica, 45 minutos, antes da induÃÃo de artrite. Dexametasona, indometacina ou dipirona foram utilizadas como controles positivos. A incapacitaÃÃo articular foi avaliada durante 4 horas apÃs a injeÃÃo de zymosan. Em seguida os animais foram eutanasiados, procedendo-se a lavagem da cavidade articular com EDTA em PBS para avaliaÃÃo de infiltraÃÃo de leucÃcitos, atividade de mieloperoxidase e dosagem de citocinas. O tecido sinovial foi colhido para anÃlise imunohistoquimica de TNF-&#945; e COX-2. TambÃm foram avaliados o edema (diÃmetro transversal da articulaÃÃo) e o aumento da permeabilidade vascular pelo mÃtodo de extravasamento do Azul de Evans. O efeito antinociceptivo foi avaliado ainda atravÃs do teste de hiperalgesia mecÃnica plantar (Von Frey eletrÃnico) utilizando carraginia e PGE2. Os resultados demonstraram uma diminuiÃÃo significativa (p<0,05) da incapacitaÃÃo articular de todos os grupos tratados com OPCC durante 7 dias, no entanto com a dose Ãnica apenas as doses maiores foram eficazes. Em relaÃÃo à migraÃÃo de leucÃcitos para o lÃquido sinovial todos os grupos tratados com o OPCC (dose Ãnica e doses diÃrias) apresentaram significativa reduÃÃo (p<0,05) do nÃmero de leucÃcitos no lavado articular, acompanhada de uma diminuiÃÃo (p<0,05) na atividade da mieloperoxidase. Observou-se uma diminuiÃÃo (p<0,05) da liberaÃÃo de citocinas (TNF-&#945; e IL-1&#946;) no lÃquido sinovial, assim como expressÃo de TNF&#945; e COX-2 no tecido sinovial. O edema foi inibido (p<0,05) com o tratamento com OPCC em todas as doses administradas diariamente. AlÃm disso, os grupos tratados com 100 e 400mg/kg de OPCC apresentaram uma reduÃÃo significativa (p<0,05) da permeabilidade vascular. Os resultados mostraram ainda que a OPCC reduziu significativamente (p < 0,05) a hipernocicepÃÃo induzida pela carragenina e PGE2. Os dados sugerem que o OPCC exibe efeito anti-inflamatÃrio evidenciado pelo modelo de artrite induzida por zymosan em ratos, que pode ser associada com a inibiÃÃo da produÃÃo de citocinas prÃ-inflamatÃrias (TNF-&#945; e IL-1&#946;). Aparentemente essa aÃÃo pode estar envolvida com a inibiÃÃo da migraÃÃo de neutrÃfilos. Sugerimos ainda que o OPCC previne o desenvolvimento da hipernocicepÃÃo inflamatÃria mecÃnica evocada por carragenina e PGE2 (bloqueio direto da hipernocicepÃÃo) em ratos. / Arthritis is an inflammatory disease that affects synovial joints. The most common symptoms are increased sensitivity to joint pain (hyperalgesia or hypernociception) and edema. An alternative to treating the disease is the inclusion of medicinal plants. The oil extracted from the fruits of Pequi (Caryocar coriaceum Wittm) has wide applicability in popular medicine. Pre-clinical tests have demonstrated the therapeutic properties of the oil, such as anti-inflammatory, gastroprotective and healing. Based on this background, the objective of this study was to investigate the antinociceptive and anti-inflammatory oil Pequi (OPCC) in zymosan-induced arthritis in rats. The study was approved by the Ethics Committee on Animal Research of the Federal University of Cearà (n 83/11). Arthritis was induced by intraarticular injection in right knee of zymosan (1mg/50ÂL) and evaluated the articular incapacitation (hypernociception), joint swelling, leukocyte migration, cytokine release and expression of inflammatory mediators. The animals were pretreated orally with OPCC (100, 200 e 400mg/kg) or carrier for 7 consecutive days either as a single dose 45 minutes before the induction of arthritis. Dexamethasone, indomethacin or dipyrone were used as positive controls. The articular incapacitation was assessed 4 hours after injection of zymosan. Then the animals were euthanized, proceeding to wash the joint cavity EDTA in PBS for evaluation of leukocyte infiltration, myeloperoxidase activity and cytokine. The tissue synovial fluid was harvested for immunohistochemical analysis of TNF-&#945; and COX-2. We also evaluated edema (transverse diameter of the joint) and increased vascular permeability by the method of Evans blue extravasation. The antinociceptive effect was evaluated further by testing plant mechanical hyperalgesia (von Frey electronic). The results showed a significant decrease (p <0.05) joint of disability in all groups treated with OPCC for 7 days, but with only a single dose, higher doses were effective. Compared to the migration of leukocytes into the synovial fluid all groups treated with the OPCC (single dose and daily doses) showed a significant reduction p <0.05) in the number of leukocytes in the BAL joints, accompanied by a decrease (p <0.05) in myeloperoxidase activity. There was a decrease (p <0.05) cytokine release (TNF-&#945; and IL-1&#946;) in the synovial fluid as well as expression of TNF and COX-2 in synovial tissue. The edema was inhibited (p <0.05) treatment with all doses in OPCC. Moreover, the groups treated with 100 and 400mg/kg of OPCC showed a significant reduction (p <0.05) in vascular permeability. The results also showed that the OPCC significantly reduced (p <0.05) hypernociception and PGE2 induced by carrageenan. The data suggest that the OPCC exhibits anti-inflammatory effect evidenced by arthritis model in rats induced by zymosan, which can be associated with the inhibition of the production of proinflammatory cytokines (TNF-&#945; and IL-1&#946;). Apparently this action may be involved in the inhibition of neutrophil migration. We also suggest that the OPCC hypernociception prevents the development of carragenan-evoked inflammatory mechanical and PGE2 (direct blockade of hypernociception) in rats.

Orientador: Claudia Herrera Tambeli / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-09T20:06:36Z (GMT). No. of bitstreams: 1 Clemente-Napimoga_JulianaTrindade_D.pdf: 878959 bytes, checksum: dc09cd918e21c2cf6868d31d1e6f9d55 (MD5) Previous issue date: 2006 / Resumo: Recentemente foi demonstrado que a ativação de receptores capa opióides localizados na ATM de ratos reduz o comportamento nociceptivo induzido pela injeção se formalina na ATM de ratos, especialmente nas fêmeas na fase diestro do ciclo estral. Sendo a fase diestro aquela que representa baixos níveis hormonais, estes resultados indicam que os hormônios gonadais diminuem a antinocicepção mediada pelos receptores capa na ATM. O objetivo deste trabalho foi investigar o possível mecanismo pelo qual os hormônios gonadais poderiam diminuir a antinocicepção mediada pelos receptores capa opióides através das seguintes hipóteses: (a) Os hormônios gonadais diminuem a antinocicepção mediada pelos receptores capa na ATM por diminuírem a expressão de receptores capa opióides no gânglio trigeminal; (b) O efeito periférico antinociceptivo dos agonistas dos receptores capa opióides é mediado pela ativação da via L-Arginina/NO/GMPc em machos e fêmeas; (c) Os hormônios gonadais diminuem a antinocicepção mediada pelos receptores capa na ATM por diminuírem a ativação da via L-Arginina/NO/GMPc. A análise pela técnica Western blot demonstrou que a expressão protéica dos receptores capa opióides é maior em fêmeas do que em machos, sugerindo que a testosterona induz acentuada diminuição na expressão dos receptores capa opióides. Nas fêmeas, a expressão dos receptores capa opióides foi significativamente maior nas fêmeas em diestro em relação às fêmeas em proestro, sugerindo que os hormônios gonadais femininos também diminuem a expressão dos receptores capa opióides. A co-administração do inibidor da NO-sintase, L-NMMA, ou do inibidor da guanilil ciclase sensível ao NO, ODQ, com o agonista do receptor capa opióide U50,488 bloqueou a antinocicepção mediada pelos receptores capa na ATM de machos e fêmeas, sugerindo que a antinocicepção induzida pelos receptores capa opióides é mediada pela ativação da via L-Arginina/NO/GMPc em ambos os sexos. No entanto, a co-administração de baixas doses de L-NMMA e ODQ com U50,488 significativamente diminuiu a antinocicepção mediada por receptores capa apenas nas fêmeas em diestro. Estes resultados indicam que a antinocicepção mediada pelos receptores capa opióides depende da ativação da via L-Arginina/NO/GMPc em machos e fêmeas. No entanto, o dimorfismo sexual na antinocicepção mediada pelos receptores capa opióides na ATM se deve, pelo menos em parte, pela diminuição da expressão dos receptores capa opióides no gânglio trigeminal pelos hormônios gonadais, especialmente a testosterona. Apesar do envolvimento da via L-Arginin/NO/GMPc na antinocicepção mediada pelo receptor capa na ATM em ambos os sexos, os hormônios gonadais não diminuem a atividade desta via diminuindo o efeito antinociceptivo mediado por receptores capa opióides na ATM / Abstract: We have previously demonstrated that activation of kappa opioid receptors located in the TMJ of rats suppresses formalin-induced TMJ nociception behavior especially in females of the diestrus phase of the estrous cycle. Since diestrus is a phase of low gonadal hormonal serum level, these findings indicate that gonadal hormones decrease kappa-mediated TMJ antinociception. The aim of this study was to investigate some of the mechanisms by which gonadal hormones might decrease kappa-mediated antinociception by testing the following hypothesis: (a) Gonadal hormones decrease kappa-mediated TMJ antinociception through a down regulation in the expression of kappa oipoid receptors in the trigeminal ganglia; (b) The peripheral antinociceptive effect of kappa opioid receptor agonists is mediate by the activation of the L-Arginine/NO/cGMP pathway in both males and females; (c) Gonadal hormones decrease kappa-mediated TMJ antinociception by diminishing the activity of the L-Arginine/NO/cGMP. Western blot analysis demonstrated that protein expression of KORs was significantly higher in females than in males, suggesting that testosterone induces a strong down-regulation in KOR expression. In females, KOR expression was significantly higher in those in diestrus than in proestrus suggesting that female gonadal hormones also down-regulate KOR expression in the trigeminal ganglia. Co-application of the NOS inhibitor L-NMMA or of the NO-sensitive guanylyl cyclase inhibitor ODQ with the kappa opioid receptor agonist U50,488 blocked kappa-mediated TMJ antinociception in males and females suggesting that antinociception induced by activation of peripheral kappa opioid receptors is mediated by the L-arginine/NO/cGMP pathway in both sexes. However, co-application of lower doses of L-NMMA and ODQ with U50,488 significantly diminished kappa -mediated TMJ antinociception only in diestrus females. These results indicate that kappa-mediated TMJ antinociception depends on activation of the L-Arginine/NO/cGMP pathway in both males and females. However, the sexual dimorphism in kappa-mediated TMJ antinociception is mediated, at least in part, by the down regulation in the expression of kappa-oipoid receptors in the trigeminal ganglia induced by gonadal hormones, especially testosterone. Despite the involvement of the L-Arginine/NO/cGMP pathway in kappa-mediated TMJ antinociception in both sexes, gonadal hormones do not diminish the activity of this pathway to decrease kappa-mediated TMJ antinociception / Doutorado / Fisiologia Oral / Doutor em Odontologia

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M.Tech. / The purpose of this unblinded controlled study was to determine the effective of dry needling of the Vastus Medialis Oblique muscle when utilised in conjunction with conservative chiropractic management for Patellofemoral Pain Syndrome (PFPS). The subjects of the trial were treated at the Chiropractic Day Clinic at the University of Johannesburg. Thirty patients suffering from chronic Patellofemoral Pain Syndrome were chosen for the study and they were divided into two groups of fifteen. The first group received conservative chiropractic care which consisted of manipulation of the sacroiliac joint, mobilisation of the knee and patella joints and stretching and strengthening exercises consisting of Quadriceps standing self stretch and Quadriceps setting as the strengthening exercise. The second group received the above treatment but also underwent dry needling of the Vastus Medialis Oblique muscle. The objective data for this research was recorded using a lower limb isometric dynamometer and the subjective data was recorded with a pain scale. Both sets of data were recorded on the first, third and fifth treatments. The results of the trial showed that there was a significant increase in strength with a reduction in pain levels for both groups but there was no statistically significant difference when comparing the two groups. The dry needling group did however improve at a faster rate than the other group but it did even out after the five treatments. What was noteworthy is that the males of the study improved their strength by a much greater extent than the females which is uncommon for PFPS. The end result of this study is that overall, dry needling of the Vastus Medialis Oblique muscle is not highly beneficial in the long term management of PFPS but does have its benefits in the early stages of the treatment in order to relieve the acute pain and increase the Quadriceps muscle strength rapidly.

M.Tech.

Background: In 2011, 45% of the 6.1 million pregnancies in the United States were unintended. Of the unintended pregnancies, 50% were attributed to contraceptive failure or method non-adherence. Long-acting reversible contraceptives (LARCs) are birth control methods consisting of intrauterine devices (IUDs) and the birth control implants that are the most effective forms of reversible contraceptives. LARCs are 20 times more effective than other birth control methods; yet only 5.6% of women are choosing LARCs. Despite multiple pharmacological and non-pharmacological interventions prior to the procedure, 35% of women reported having moderate pain and 42% of women had severe pain associated during the IUD placement Purpose: The purpose of this quality improvement project was to identify health care providers’ knowledge and practice of pain management methods for IUD insertion in iparous women at a military medical treatment facility (MTF). Methods: This DNP quality improvement (QI) project used a quantitative descriptive methodology with a pretest-posttest design and educational intervention to identify the current practice and knowledge primary care providers have regarding appropriate pain management for iparous women when placing an IUD. Results: The providers’ responses reflect a self-efficacy represented by a knowledge increase in the areas of the limited benefit of premedication with either oral analgesics or cervical softening agents, placing an IUD based on the patient’s menstrual cycle, incorporating the use of a local analgesic, and the connection between counseling and patient satisfaction. Limited provider knowledge can be suggested by the varied responses regarding the topic of a CPG. Self-efficacy stayed stable for the areas of post-procedural NSAID use and having the time for counseling regarding expected pain during the procedure. Conclusion: Improving provider knowledge, skill, and counseling techniques can help decrease the expected and perceived pain for iparous women having an IUD placed leading to an increase of women having IUDs placed. An ultimate goal is to increase IUD use and retention, leading to decreased unintended pregnancy rates, lower maternal and newborn mortality, and improving patient satisfaction when having an IUD placed.