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Activation of nociceptors causes them to secrete neuropeptides, such as substance P (SP) and calcitonin-gene related peptide (CGRP). By reacting with receptors on blood vessels these peptides contribute to inflammation by evoking vasodilation and increasing vascular permeability that allows proteins and fluid to leave the blood vessels (plasma extravasation, PE). These substances can also lead to the sensitization of nociceptors and the resulting positive feedback thereby prolongs inflammation and pain. Thus, blocking the release of neuropeptides may have important therapeutic value in pain conditions where neuropeptides have been implicated. Therefore, the aim of this study was to define the time course of changes in vascular permeability and to test the ability of novel agents to modulate this response. PE and vasodilation was evoked by stimulating the saphenous nerve or by injecting the chemical irritant capsaicin into the rat hindpaw. Changes in blood flow were evaluated with a laser Doppler and digitized image analysis was used to measure changes in reflectance of the skin due to accumulation of extravasated (EB) dye. Analysis of the change in pixel intensity in the digitized images revealed that the magnitude of PE was dependent on the stimulus pulse number. Moreover, the time course of enhanced vascular permeability produced by electrical stimulation was a transient event compared to a much longer response with capsaicin. It was also demonstrated that sumatriptan, (a 5-HT1B/D receptor agonist) and botulinum neurotoxin type-A were effective treatments for capsaicin and saphenous nerve induced vasodilation and PE. Neither drug interfered with activation of the SP or CGRP receptor, which may suggest that both drugs work by inhibiting neuropeptide release. Therefore, this study has described the time course of vascular permeability evoked by two different stimuli and has demonstrated the ability of two novel agents to attenuate these responses.

The oldest procedure for pain relief has been music. There is abundant behavioural evidence to support music’s pain relieving properties, however, studies to date have yet to investigate music-induced analgesia via imaging. Our first imaging study used thermal stimulation just below pain threshold in combination with various music stimuli, to determine whether music can affect neural activity in response to heat stimuli within brainstem and spinal cord regions. Differential responses to music stimuli were found within regions known for descending modulation, and familiar classical music had a unique effect on neural activity in these regions compared to unpleasant music, reverse music, and no music. This study confirmed that the emotional valence of music affects neural activity in the brainstem and spinal cord. The second study used a well-defined pain paradigm applied with or without favorite music to study the neural activity responses in the brain, brainstem, and spinal cord using imaging. Subjective pain ratings were significantly lower when painful stimuli were administered with music than without music. The pain condition alone elicited neural activity in brain regions consistently activated during similar pain studies. Brain regions associated with pleasurable music listening were activated including limbic, frontal, and auditory regions when comparing music to non-music pain conditions. In addition, neural regions showed activity responses indicative of descending modulation when contrasting the two conditions. These regions include the spinothalamic tract, dorsolateral prefrontal cortex (DLPFC), periaqueductal grey (PAG), rostral ventromedial medulla (RVM), and the dorsal gray matter of the spinal cord. The data suggest that music seems to engage mesolimbic and mesocortical brain regions to activate the descending pain modulation pathway. Lower subjective pain ratings corresponded to a greater suppression in the dorsal gray matter when listening to music. This is the first imaging study to characterize the neural response of pain and how it is mitigated by music listening, and brain and spinal fMRI are appropriate means to study pain processing and its modulation in the central nervous system. / Thesis (Master, Neuroscience Studies) -- Queen's University, 2013-06-18 11:33:32.818

Background & Purpose: Chronic pain is a prevalent chronic condition for which the best management options rarely provide complete relief. Individuals with chronic pain with neuropathic characteristics (NC) report more severe pain and experience less relief from interventions. Little is known about current self-management practices. The purpose of this dissertation was to inform self-management of chronic pain with and without NC at the individual, health system, and policy levels using the Innovative Care for Chronic Conditions Framework. Methods: The study included a systematic search and review and cross-sectional survey. The review evaluated the evidence for chronic pain self-management interventions and explored the role of health care providers in supporting self-management. The survey was mailed to 8,000 randomly selected Canadians in November 2011, and non-respondents were followed-up in May 2012. Screening questions were included for both chronic pain and NC. The questionnaire captured pain descriptions, self-management strategies, and self-management barriers, and facilitators. Results: Findings of the review suggested that self-management interventions are effective in improving pain and health outcomes. Health care professionals provided self-management advice and referred individuals to self-management interventions. The questionnaire was completed by 1,520 Canadians. Those with chronic pain (n=710) identified primary care physicians as the most helpful pain management professional. Overall, use of non-pharmaceutical medical self-management strategies was low. While use positive emotional self-management strategies was high, individuals with NC were more likely to use negative emotional self-management strategies compared to those without NC. Multiple self-management barriers and facilitators were identified, however those with NC were more likely than those without NC to experience low self-efficacy, depression and severe pain which may impair the ability to self-management. Conclusions: Health care professionals have the opportunity to improve chronic pain outcomes by providing self-management advice, referring to self-management interventions, and addressing self-management barriers and facilitators. Individuals with NC may require additional health services to address their greater self-management challenges, and further research is needed to identify non-pharmaceutical interventions effective in relieving chronic pain with NC. Public policy is needed to facilitate health systems in providing long-term self-management support for individuals with chronic pain. / Thesis (Ph.D, Nursing) -- Queen's University, 2013-09-25 12:57:58.59

Methods: Three research methodologies were used including a comprehensive literature review, a descriptive study and a qualitative study.  A revised root cause analysis framework (consisting of four major steps) adapted and created by the researcher was also applied as an analytical framework to the whole research programme to facilitate the achievement of the aim and objectives. Results: Antidepressants were the most commonly prescribed drugs followed by a combination of paracetamol and weak opioids.  Drug-drug interactions between antidepressants and opioids were the most common potential MRPs.  Analgesic prescribing was independently associated with cause of pain and health-related quality of life.  Pain level, cause of pain and health-related quality of  life were independent significant factors for adjuvant prescribing.  The poorer the health-related quality of life was, the greater the number of analgesics and adjuvant drugs that were prescribed.  A  model of pain medication taking behaviours was developed, and relationships between MRPs, pain medication taking behaviours and considerations of patients’ perspectives on pain and pain medication taking were identified.  Patient factors were the main root causes of complex MRPs.   A set of recommendations (for both GPs and pharmacists) and evidence-derived questions for primary care pharmacists were proposed to help reduce and prevent MRPs. Conclusion: An intervention based on the findings of this study, and related to the pharmacist’s roles and responsibility could ultimately help to improve pharmaceutical care services for people with chronic pain in primary care.

A dissertation presented in partial fulfilment of the requirements for the Masters Degree in Technology: Chiropractic, Technikon Natal, 1997. / The purpose of this investigation was to compare the effectiveness of chiropractic manipulation alone to the use of chiropractic manipulation together with therapeutic exercise in the management of chronic mechanical cervical spine conditions. Measurements in terms of objective and subjective clinical findings, were to be used to substantiate or refute the use of auxiliary therapeutic exercise in these conditions. It was hypothesised that therapeutic exercise would be a valuable adjunct to the chiropractic management of chronic mechanical cervical spine conditions in terms of objective (flexibility) and subjective (pain and disability) clinical findings. Thirty consecutive subjects suffering from chronic neck pain were obtained from local advertising (radio and newspapers) and randomly placed into two groups for comparison. The 0. age group of subjects accepted ranged from 16 to 60 and included both sexes from any race, who had suffered from neck pain for six weeks or longer. Subjects were assessed to determine whether there were any contra-indications to manipulation or exercise. Treatment commenced for a month with both groups receiving spinal manipulative therapy and one group doing daily therapeutic exercises. The eROM goniometer, McGill Pain Questionnaire, Numerical Pain Rating Scale - 101 Questionnaire and the CMee Neck Disability Index were / M

Dissertation submitted in the partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Technikon Natal, 1996. / There have been few substantiated studies done to investigate the efficacy of spinal manipulative therapy for cervical syndromes [Vernon et.al. (1990: 13), Sloop et.al. (1982: 532) and Cassidy 1\ et. al. (1992: 495)]. Therefore, more conclusive evidence is needed to verify the success of manipulation, especially in terms of chiropractic treatment methods. The purpose of this investigation was to evaluate cervical spine manipulation and combined cervical and thoracic spine manipulation, according to subjective and objective clinical findings, in order to determine the efficacy of each approach in the management of mechanical neck pain. It was hypothesized that cervical spine manipulation, and combined cervical and thoracic spine manipulation would both be effective in the treatment of mechanical neck pain. However, it was proposed that combined cervical and thoracic spine manipulation would be more effective than just cervical spine manipulation, in terms of subjective and objective clinical findings. This study consisted of a controlled trial of a sample population diagnosed with joint dysfunction (cervical and thoracic facet syndrome) . Thirty subjects were randomly divided into two groups: the control group and the experimental group. The control group was treated with cervical adjustments only and the experimental group received combined cervical and thoracic adjusfments. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic,Technikon Natal, 1999. / Pain arising from myofascial trigger points is common and is often so disabling that the need for fast effective treatment is urgent. Of the many documented treatments for trigger points, there is little evidence to support one treatment over another. It is thus the purpose of this study to determine the relative effectiveness of stretch and ice to stretch and spray in the treatment of myofascial trigger points found in the upper trapezius muscle. This comparative clinical study involved the participation of thirty patients presenting with myofascial trigger points of the upper trapezius muscle. By means of consecutive sampling, patients complaining of neck pain, and/or headaches, and/or shoulder pain or a combination thereof, and who were between the ages of sixteen and sixty-five, underwent a screening processes to determine if they had active myofascial trigger points in the upper trapezius. Those that were eligible for the study were randomly assigned to either the stretch and ice group or the stretch and spray group. The subjective primary data consisted of three pain questionnaires, namely the Short Form McGill Pain Questionnaire, CMCC Neck Disability Index, and Numerical Rating Scale-101. The objective data was supplied by readings taken from an algometer. The patients underwent three consultations in the first week, two consultations in the second week and a final consultation one-month after the fifth treatment. All the primary data was collected at four occasions. These were at the first, third, fifth and one month follow-up consultations. Intra-group analysis using the Wilcoxon Sign-Rank Test determined if each group improved significantly with respect to the data collected. The Mann-Whitney U test was used to determine which group was statistically better than the other. The results, including the standard deviation, standard error, mean and power / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2006. / Graston Technique Instrument-assisted Soft Tissue Mobilization (GTISTM), is a relatively new form of myofascial pain syndrome (MPS) treatment, that is thought to be an advanced form of soft tissue mobilization. The stainless steel instruments that are used are specifically designed for various parts of the body and are used to detect and release scar tissue, adhesions and fascial restrictions (Carey-Loghmani, 2003:7). It is speculated that the Graston Technique instruments may be superior to other instruments due to the uniqueness of the instrument design, instrument material (stainless steel), delivery method and technique process. The instruments have been designed to adapt to the various curves of the body allowing the clinician to detect and treat soft tissue dysfunctions in an accurate and specific manner (Carey-Loghmani, 2003;2). Other soft tissue therapeutic techniques make use of specifically designed aluminium instruments have shown to be successful in the treatment of tendonitis (Davidson et aI., 1997).Thus it was the aim of this study to determine if there was a significant clinical difference between the Graston Technique instruments and instruments of the exact design but of a constitutionally different material (i.e. aluminium). This was achieved by varying the instrument material, while maintaining all the other features of the instrument, as well as the treatment protocol in the management of myofascial trigger points (MTrPs) of the trapezius and the levator scapula muscles. III This pilot study was a comparative clinical trial conducted on a quasiexperimental basis, aimed at establishing the influence of component materials of the Graston Technique instruments in the treatment of MPS in terms of clinical outcomes. The sample size consisted of sixty patients selected from the Durban Metropolitan Area. Patients between the ages of 18 and 55 and diagnosed / M