Pain is a sensory experience associated with physical discomfort that is influenced by cognition and emotion and has been linked to an increased risk for aggression. The purpose of the current study was to examine the association between pain and aggression under controlled laboratory conditions using both experimental and non-experimental approaches. The aims of the study were two-fold. First, to manipulate perceived pain tolerance via faux feedback and then observe whether aggression differs as a function of this pain perception manipulation using a laboratory analogue of aggression. Second, to examine whether self-ratings of pain sensitivity and behavioral measures of pain are associated with self-reported or behavioral assessment of aggression. Eighty-three men and women were randomly assigned to one of three conditions: A high pain tolerance feedback group, a low pain tolerance feedback group, and a no pain tolerance feedback (control) group. Participants completed self-report ratings of pain and aggression, including the Life History of Aggression: Aggression subscale, the Buss Perry Aggression Questionnaire: Physical Aggression subscale, and the Pain Sensitivity Questionnaire. Participants then completed an algometer pressure pain task and immediately received high or low pain tolerance feedback (or no feedback) before engaging in an electric shock pain tolerance procedure and subsequently participating in a laboratory task of aggression against an increasingly provocative fictitious "opponent" during a competitive reaction-time task (i.e., the Taylor Aggression Paradigm; TAP). Aggression was operationalized both as the average shock and the number of "extreme" shocks administered to the opponent. The latter were ostensibly twice the opponent's pain threshold. Results indicated that, contrary to the main prediction, individuals who received high pain tolerance feedback tended to select lower mean shocks as provocation increased. Pain sensitivity was also positively related to TAP aggression. These results are consistent with the literature suggesting that low perceived pain tolerance is associated with aggression. However, pressure pain tolerance was positively associated with self-reported aggression, suggesting that the association between pain and aggression is complex, may involve multiple pathways, and is dependent on the method used to assess pain and aggression.

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Patients’ recovery after surgery is one of the most important health processes in planned hospital healthcare and has a direct impact on welfare and welfare systems. Therefore, what nurses do in the im­mediate postoperative period is of vital importance. This thesis addresses the question of understanding how nurses work in managing post-operative pain by exploring their daily nursing practices and experiences in responding to the patient in pain within a Thai cultural context. The project applied a qualitative methodology where the local culture and its day-to-day practices of pain management were studied by using observations, focus groups, in-depth interviews and a critical incident interview approach with nurses. Informants were recruited at a public hospital in Bangkok in a surgical ward. In all, 100 hours of observations, 39 interviews and 69 descriptions of critical incidents related to nurse’s pain management were gathered. The data analysis followed the principles of qualitative research. The findings showed that, although there is a clearly defined approach to pain management, the response system followed by the nurses to address patients’ pain is complex and includes much lead time between assessing patients’ pain and the nurses responding to the pain. Furthermore, nurses are caught in what is labeled a patient pa­radigm, where evidence of pain often is double- and triple-checked by scoring and recording signs that are then subject to confirmation by a third party. Underpinning this is a culture of pain management cultivated between the nurses that rests first and foremost on their own experiences and a working/professional culture where nurses offer each other practical help in urgent situations, but seldom discuss event-based strategies together. Nevertheless, when nurses described situations when they were successful in practicing pain management, they considered their own engagement and their availability of time, space and therapeutic options to be important. Keywords: Culture of nursing, Nursing in pain management, Pain assessment, Perception of pain, Pain management, Pain post-operative

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

The present study examined psychological factors associated with individual variation in children's adjustment following minor surgery, and focused specifically on the process of coping with postoperative pain. Sixty children and adolescents (7 to 16 yrs) were interviewed on the day following surgery. They provided ratings and descriptions of their postoperative pain experience, perceived capacity for pain control, spontaneous coping strategies, and emotional distress. Parents also provided information about their efforts (both historical and present) to facilitate their child's coping, their own emotional distress, and perceptions of their child's distress following surgery. Thirdly, nurses rated children's pain behaviours displayed on the ward. Finally, information about analgesic medications and physical complications following surgery was recorded from children's medical charts. Qualitative data concerning the process of coping with postoperative pain and specific parental influences on children's coping were presented within a conceptual model adapted from the adult stress and coping literature. The data were also analyzed for age/developmental differences between older children (10 to 16 yrs) and younger children (7 to 9 yrs). Finally the predictive role of demographic, child coping process, and parental influence variables, in accounting for variations in child coping outcome, was analyzed. Results indicated that children and adolescents experienced moderate to severe pain following minor surgery. They reportedly tried a number of different cognitive and behavioural methods to deal with postoperative pain. Also, parents took an active role in facilitating children's coping. Age group differences were revealed in children's descriptions of postoperative pain, their reported ways of coping with pain, and their perceptions of control over pain and recovery. Age effects were interpreted with caution, however, since age and sex were confounded in this sample. Children who reported the most pain and emotional distress following surgery also reported more catastrophizing cognitions, felt less in control of their recovery, and reported having tried a greater number of behavioral coping strategies to manage pain. These results emphasize the role of children's appraisal processes in predicting coping effectiveness, and demonstrate that more coping does not imply better outcome. Future research directions and potential clinical appplications that follow from these findings were discussed. / Arts, Faculty of / Psychology, Department of / Graduate

Pain behavior of neonates was compared across sleep/waking states and sex. From Gate-Control Theory (Melzack and Wall, 1982) it was hypothesized that pain behavior would vary depending on the ongoing functional state of the infant, in contrast with Specificity Theory (Mountcastle, 1980), from which one would expect neonatal pain expression to be solely a function of degree of tissue damage. The findings of facial action variation across sleep/waking state was interpreted as consistent with Gate-Control Theory. Awake alert infants responded with the most facial activity, which supported Brazelton's (1973) view that infants in this state are most receptive to environmental stimulation. Fundamental frequency of cry was not related to sleep/waking state. This suggested that findings from the cry literature on pain cry as a reflection of nervous system "stress", in unwell newborns, do not generalize directly to healthy infants under varying degrees of stress as a function of state. Sex differences were apparent in speed of response, with boys showing shorter time to cry and facial action following heel-lance. Issues raised by the study include the importance of using measurement techniques which are independent of pre-conceived categories of affective response, and the surprising degree of responsivity of the neonate to ongoing events. Exploratory analyses suggested obstetric factors were related to overall facial action. Caution was expressed in this interpretation due to the great complexity of the inter-relationships of medical, physiological and maternal variables which go far beyond the scope of this study. It was concluded that obstetric features such as mode of delivery should be considered in sample selection for neonatal pain studies, in contrast to current practise which has been to assume healthy newborns form an homogeneous population. It was clear from these findings that the issues are multifaceted, and the optimal way to proceed with research in the area of neonatal pain is with an interdisciplinary team format. / Graduate and Postdoctoral Studies / Graduate

Class of 2017 Abstract / Objectives: Specific Aim 1: Pharmacist will use pharmacological pain self-management strategies over non- pharmacological strategies. Specific Aim 2: Pharmacist pain self-management strategies will differ based on whether or not the pharmacist has chronic pain. Specific Aim 3: Pharmacist pain self-management strategies will differ across age. Specific Aim 4: Pharmacist pain self-management strategies will differ across gender. Methods: A survey was sent to all pharmacists with an email address registered with the State Board of Pharmacy in a single Southwestern state. The survey asked about characteristics of pain, strategies for managing pain, outcomes, and demographics. The primary outcome was severity of pain after treatment. Results: Responses were received from 417 pharmacists; 219 reported acute, 206 reported chronic pain, and 55 reported no pain. The chronic pain group was more likely to have a disability with poor/fair health status (P<0.006) and to report higher levels of pain before treatment (6.9 versus 5.8). Both groups reported similar relief from all strategies (76% versus 78% ; P equals 0.397), but the chronic pain group reported higher levels of pain after treatment (3.2 versus 2.0), less confidence in pain management, and less satisfaction (P less than 0.004). Conclusions: Age and gender did not affect the use of specific pain management strategies or the amount of pain relief received from all strategies used by participants with either acute or chronic pain. However, participants with chronic pain had higher levels of pain before and after treatment.

D.Phil. / Chronic pain is a devastating problem and one of the leading causes of disability internationally with an estimated 25-30% of people in industrialised nations suffering from it. Various approaches are available for the treatment of chronic pain with exercise therapy is often the last resort, after all else has failed. The present study was motivated by the growing prevalence of chronic pain patients and the recent progress in pain science. This study made use of a quasi-experimental design where randomization was a function of participant convenience. It made use of a Pre-Test Post-Test battery consisting both of self-report questionnaires and of a physical assessment evaluating components of chronic pain patients’ experience prior to and following a combined therapeutic intervention programme of 12 sessions. Follow- up was at 12 months. The objectives were to integrate patient reconceptualization of pain by means of an active approach combining pain education and exercise therapy, and to determine the effect of a change in pain cognition on the outcome compared to a control group receiving exercise therapy only. A heterogeneous group of chronic pain patients were randomized into 2 groups who both received exercise therapy twice per week: the experimental group (80) received exercise therapy and a specific 3 hour pain education session with the active control group (74) only receiving exercise therapy. There were no differences in pain related or demographic characteristics between groups at baseline. Both groups had a significant reduction in pain perception after 12 exercise therapy sessions (P<0.05). After a follow up period of 12 months the experimental group sustained the same level of pain reduction (P<0.05). The control group maintained only some the acquired reduction in pain perception. In the experimental group an increased participation in physical activity was also found 12 months after the intervention. Exercise therapy significantly reduces the perception of pain in chronic pain patients after 12 therapy sessions, but the combination of pain education and exercise therapy better maintain these effects after a year. Key Words: chronic pain, exercise, pain education.

Charles University in Prague Faculty of Pharmacy in Hradec Králové Department of Pharmacology & Toxicology Student: Stela Pavlíčková Supervisor: PharmDr. Ludmila Melicharová Title of diploma thesis: Pain therapy with focus on pacients with oncological disease Pain therapy is a part of the oncological illnesses complex treatment. This therapy doesn't solve the cause of cancer, but significantly increase patient's quality of life during oncological treatment, even in the terminal stage. The main target of this work is to give basic information about pain treatment, focusing on the oncological pain, and elaborate a review of pharmacological groups and individual substances most used in oncological pain treatment. Basic pillar of the cancer pain treatment is pharmacotherapy, which goes out of the WHO three-grade analgesic ladder. Basic therapy is made of nonopioid analgesics. In case that they aren't enough, we can add weak opioids, which can be replaced by strong opioids afterwards. Analgesics are usually used repeatedly and often in combinations. Dosage interval depends on pharmacological properties, dosage form and patient condition. Well controlled pain phases are usually interrupted by very strong, cruel pain episodes, which are called break-through pain. Very strong pain, fully or partially...

The aim of this thesis is to investigate the prevalence and management of bladder pain syndrome (BPS) amongst women with chronic pelvic pain (CPP) through a series of systematic reviews, a structured survey and primary study. It has been acknowledged that the diagnosis and management of BPS is a contentious subject. The mean prevalence of BPS in women with CPP is 61%. I initially carried out a patient and clinician survey to understand how BPS was being managed in the UK. I found wide variation in diagnostic methods and treatments of BPS used by clinicians and experienced by patients with no obvious consensus. Since we know the predominant complaint in these patients is pain (bladder or pelvic) I used patients with pelvic pain as my cohort. Cystoscopy is no longer used as a diagnostic test for BPS. It is possible to diagnose BPS through a consensus expert panel using symptom-based criteria. This method of deriving a reference standard is demonstrated in the primary study, since no gold standard diagnostic test exists for BPS. A case-control feasibility study was undertaken to investigate the accuracy of a group of urinary symptoms to diagnose BPS. While, neither index test of bladder filling pain or bladder wall tenderness can sensitively diagnose BPS alone, the symptoms of bladder filling pain, urinary frequency, pain on urination and pain on full bladder are a good predictor of the condition. A systematic review assessing the reporting outcomes identified five measures that should be included in studies; pain, urinary symptoms, general 8 wellbeing, quality of life and bladder capacity. Of the 19 treatments used for BPS, the level and strength of evidence ratings overestimated quality compared to the GRADE ratings. BPS can be diagnosed symptomatically but there is variable reporting of outcome measures and poor evidence for treatment effectiveness.