Introduction: Currently used methods to collect self-reported information on pain status in population studies have remained unchanged over the past decades. Decreasing response rates and the necessity to collect more detailed information to advance on understanding declare the importance of updating these instruments. The aims of this thesis were to (1) explore different strategies to increase response rates and (2) assess whether population estimates of pain change when participants' pain management is considered for the pain assessment. Methods: A cross-sectional study was conducted in the general population in Grampian, Scotland. 4600 potential participants were randomly selected from the NHS community health index register and sent a self-completion questionnaire. Collected information included people's health status (SF-36), pain status (manikins, chronic pain grade), pain management and estimated pain status without pain treatments (enhanced pain status questionnaire). The newly developed pain management and enhanced pain status questionnaire were validated within a small sample of the questionnaire respondents who attended a subsequent interview. Results: The response rate was not significantly increased when single-sided questionnaires were sent to potential participants (OR=1.13, 95%CI=0.998, 1.28) or when an option to reply via the internet was provided (OR=1.06, 95%CI=0.94, 1.20). Population estimates of pain changed significantly with the use of the enhanced pain status questionnaire: the pain prevalence increased from 50.5% to 56.2% (difference=5.7%, 95% CI=2.2, 9.2). Likewise, respondents with pain estimated their pain to be significantly higher when they considered the effect of their treatments. Conclusions: Neither an option to reply via the internet nor single-sided questionnaires are effective methods to increase response rates to population studies. Conclusions: Neither an option to reply via the internet nor single-sided questionnaires are effective methods to increase response rates to population studies. The burden of pain is currently underestimated in population-based pain studies which do not include an assessment of pain management. As a result of the findings, pain management information should routinely be collected and considered in epidemiological studies assessing pain.

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Provoked vestibulodynia (PVD) is the most common condition leading to painful intercourse and is currently best understood within a biopsychosocial framework. Although the usefulness of non-medical treatment options for vulvar pain is recognized by many, there is limited research investigating the effectiveness of these treatments using a biopsychosocial approach to outcome measurement. Furthermore, there is little evidence to support the mechanisms by which these treatments lead to pain reduction. This study aimed to address these gaps by investigating two non-medical treatment options: individual cognitive-behavioural therapy (ICBT) and pelvic floor rehabilitation (PFR). Twenty women with PVD were randomly assigned to eight sessions of either ICBT or PFR. Participants were assessed at pre-treatment, post-treatment, and 6-month follow-up via gynecological examination, structured interviews and standardized questionnaires measuring pain, psychological, and sexual variables, quantitative sensory testing, and a pelvic floor muscle (PFM) evaluation. The primary outcome was change in intercourse pain intensity. Secondary outcomes included changes in other features of vestibular pain (e.g., frequency), cotton-swab test pain intensity, vestibular sensitivity, sexual functioning, PFM functioning, and pain cognitions. Changes in psychosexual and PFM functioning were investigated as predictors of treatment outcome. Results indicated no differences in the effectiveness of the treatment groups with respect to pain outcomes, with both groups demonstrating significant reductions in pain. Between-group differences were minimal in other areas, with some suggestion that participants in the ICBT group fared better with respect to sexual functioning, while participants in the PFR group demonstrated more improvements in PFM tone. Participants in both groups demonstrated meaningful improvements in pain cognitions, with the ICBT group demonstrating greater changes in rumination. The study was not able to detect significant predictors of treatment outcome. The results of the study suggest that both ICBT and PFR may lead to clinically meaningful improvements in pain, as well as in other areas of psychosexual functioning. Future treatment studies should consider incorporating general chronic pain clinical trial recommendations to allow for better comparison of outcomes with other studies. / Thesis (Ph.D, Psychology) -- Queen's University, 2013-11-19 18:16:18.353

A dissertation presented to the Faculty of Health in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2001. / The aim of this study was to determine the relative effectiveness of the combination of spinal manipulative therapy (SMT) and non-steroidal anti-inflammatory drugs (NSAIDs) versus SMT with the administration of a placebo medication in the treatment of chronic mechanical thoracic facet syndrome. It was hypothesised that SMT and NSAIDs over a three week period would be more effective than SMT and placebo medication in terms of the objective and subjective clinical findings. The study design was that of a double blind randomized clinical trial. Sixty patients diagnosed with thoracic facet syndrome were randomly assigned to either the manipulation and NSAID group or the manipulation and placebo medication group. The age range of the patients was eighteen to fifty-nine years. Each patient in the NSAID group received 139mg of diclofenac free acid per day over five days. The placebo group received the same dosage of a similar appearance to that of diclofenac free acid over the same period. The placebo medication was in the form of lactose powders. Each group of thirty patients received six treatments of SMT over a three-week period. Group A received SMT and placebo medication while Group B received SMT and NSAIDs. The patients were assessed by means of obtaining subjective information consisting of three questionnaires; the McGill Short-Form Pain Questionnaire, the Numerical Pain Rating Scale -lOl and the Oswestry Pain Disability Index. Objective data was gathered from goniometer measurements. The objective data was collected before the / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Homoeopathy, Technikon Natal, 2001. / The purpose of this double-blinded study was to evaluate the relative efficacy of a homoeopathic pain complex (Arnica montana 30CH, Bellis perennis 30CH, Calendula officinalis 30CH, Hypericum perforaturn 30CH, Phosphorus 30CH, Staphysagria 30CH) and on allopathic analgesic (Stopayne\xAE) in the management of post-operative pain after haemorrhoidectomy; in terms of the patients' perception of the treatment. The hypothesis was to show that the homoeopathic pain complex would result in a similar response when compared to the allopathic analgesic without the dismay of adverse effects. Thirty patients with haemorrhoids were carefully screened by an appointed nurse and selected according to a selection criteria (3.3.1 and 3.3.2). Haemorrhoidectomies were performed by two surgeons on all participating patients. The selected patients were then divided into two groups (allopathic or homoeopathic) using a simple random sampling method. Data were collected at the King Edward VIII Hospital. IV Patients in group one received the allopathic analgesic i.e. Stopayne\xAE and patients in group two received the homoeopathic pain complex consisting ofArnica montana 30CH, Bellis perennis 30CH, Calendula officinalis 30CH, Hypericum perforaturn 30CH, Phosphorus 30CH and Staphysagria 30CH. These medications were administrated three times daily over a period of three days. Questionnaires (both in English and Zulu) were filled out by each patient over three consecutive days. Results were statistically analyzed using the Mann-Whitney U-test for the inter-group relationships and the Wilcoxon Signed Rank test for the intra-group relationships. It was found that both groups improved significantly by the thrid consultation compared to the first / M

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of MSc Physiotherapy Johannesburg, 2017 / Background Chronic pain is a health problem that occurs across cultures and across the globe. Treatment of chronic pain is challenging and there is often failure of recovery, with the need to look at different approaches to understanding chronic pain. It was recently found that people with chronic pain have both central and peripheral features. Therefore, there is a need to look at central mechanisms that may be contributing to the chronicity of pain. People with chronic pain disorders experience a disturbance in body schema. Laterality judgment performance is dependent on body schema and can therefore determine the central mechanisms affected in chronic pain patients. The aim of this systematic review is to determine whether there is a difference in laterality judgment between people with chronic pain and healthy individuals. Method A comprehensive search was done of the following databases: MEDLINE (Pubmed), CINAHL Plus, Cochrane Controlled Trials Registered, Physiotherapy Evidence Database (PEDro), Science Direct, SCOPUS, Clinical Key and Google Scholar. Combinations of the following keywords were used: ―laterality‖ ―body schema‖ ―motor imagery‖ and ―pain‖. The reference lists of all identified full text articles were searched for additional studies. Articles from inception up until December 2016 were considered for inclusion in this review. Outcome measures considered were reaction time (length of time taken to choose whether a pictured limb is right or left) and accuracy (correct number of responses). A total of 15 studies were included in this review. Methodological quality was assessed by two independent reviewers using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. Results from all the studies investigating similar conditions and using similar methodologies were analysed and pooled into statistical meta-analysis using Meta-Easy. The weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for the outcome measures, namely reaction time and accuracy. The random-effects model was used, due to the variation and small sample sizes in studies. Heterogeneity was assessed by the p-value and I2 value. Thereafter, studies were divided into sub-groups (according to condition/similar laterality tasks) and further iii analysed. Statistical measures used in both meta-analyses included the probability value, mean effect size, variance effect size and maximum likelihood. Where statistical pooling was not possible the findings are presented in a narrative form. Results Forest plots of reaction time of five studies regardless of condition in terms of reaction time showed a positive relationship between decreased reaction time and chronic pain. Accuracy of five studies regardless of condition did not show a clear direction of effect. Due to the high heterogeneity, interpretation of this meta-analysis should be done with caution. The sub-group analysis for accuracy in lower limb conditions versus healthy individuals showed a medium statistically significant effect size (0.59) with a significant 95% CI (0.11 to 1.07). Results for low back pain and cervical pain could not be pooled into a meta-analysis, as there were different methods of reporting the results in the studies. However, results from individual studies showed that laterality judgment impairments are present in the low back pain, complex regional pain syndrome 1 and the upper limb pain population. It was not been shown to be impaired in whiplash associated disorders. There is no consensus in the literature whether laterality is affected in chronic cervical pain. Conclusion Laterality judgment was shown to be impaired in CPRS 1, upper limb pain, carpal tunnel syndrome, and osteoarthritis of the knee and leg pain. Due to the lack of studies, low quality of evidence and differences in results between studies there are inconsistencies with regard to back pain and therefore no conclusions can be drawn from the literature. It was not been shown to be impaired in whiplash associated disorders and there is conflicting evidence in cervical pain. It is evident that the impairment of laterality judgment cannot be assumed amongst all chronic pain conditions. This systematic review can be used as a foundation for future research. Research studies can be designed to remediate laterality recognition in affected conditions and assess the effect hereof on levels of pain and functional abilities. This could solve the missing link in understanding chronic pain syndromes and its rehabilitation. Clinicians can also gain insight on incorporating techniques (e.g. graded motor imagery) to re-train the brain‘s neural plasticity, and to in turn decrease chronic pain. / MT2017

BACKGROUND Uterine evacuation (EVAC) and manual vacuum aspiration (MVA) are commonly performed minor gynaecological procedures, often being done on an out-patient basis. These procedures are associated with pain, but the severity and extent of the pain experienced, especially in the post-procedure period, is not well studied. OBJECTIVES The aim of this study was to determine whether patients who underwent EVAC and MVA procedures, experienced pain postoperatively; and if so, to quantify the degree of pain experienced. These patients were at Chris Hani Baragwanath Academic Hospital (CHBAH). The objectives of this study were to determine whether patients (having undergone EVAC and MVA) experienced pain postoperatively, and to also determine the intensity of the pain. Additionally, to ascertain whether patient age, gestational age or the duration of the procedure, had any impact on the pain experienced. METHOD A sample of 53 patients were selected, presenting for EVAC and MVA at CHBAH. There were 26 patients in the EVAC group and 27 in the MVA group. Information was collected from patient interviews and their hospital files and subsequently recorded on data sheets. Data collected on each data sheet included: patient age, gestation, procedure (EVAC or MVA), reason for procedure, length/duration of procedure and analgesia received prior to and during the procedure. Pain was assessed at intervals of 10 minutes, 40 minutes, 2 hours and 3 hours post-procedure. This was achieved using a ratio, which was determined from a visual analogue scale (VAS). Patients who had pain greater than 3/10 on the VAS score, received rescue analgesia in the form of diclofenac, 1mg/kg diluted in 250 ml of Ringer‘s lactate, over 30 minutes intravenously. RESULTS Patients in the MVA group experienced significantly more pain immediately postoperatively than the patients in the EVAC group. However, there were no significant differences found in pain experienced between the two groups at 40 minutes and thereafter. CONCLUSION Patients undergoing EVAC do experience pain, but if multimodal analgesia is provided, the pain experienced is not significant. Patients undergoing MVA experience significant pain post-procedure. It is recommended that improved analgesia protocols should be instituted.

by Man Hon Ming. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1990. / Bibliography: leaves 91-111. / ABSTRACT --- p.I / ACKNOWLEDGEMENT --- p.V / TABLE OF CONTENTS --- p.VI / LIST OF TABLES --- p.X / LIST OF ILLUSTRATIONS --- p.XII / Chapter CHAPTER 1 - --- INTRODUCTION --- p.1 / Chapter CHAPTER 2 - --- LITERATURE REVIEW --- p.5 / Chapter 2.1. --- "Low back pain and ""Facet joint syndrome""" --- p.5 / Chapter 2.1.1. --- Cost of low back pain --- p.5 / Chapter 2.1.2. --- Low back pain in industry --- p.5 / Chapter 2.1.3. --- Differential diagnosis of low back pain --- p.6 / Chapter 2.1. --- Lumbar facet joint syndrome --- p.8 / Chapter 2.2.1. --- Historical review --- p.8 / Chapter 2.2.2. --- Anatomy of the lumbar facet joint --- p.10 / Chapter 2.2.3. --- Functions of facet joint --- p.11 / Chapter 2.2.4. --- Pathophysiology and pathology of facet syndrome --- p.13 / Chapter 2.2.5. --- Diagnosis of facet syndrome --- p.16 / Chapter 2.2.6. --- Treatment of facet syndrome --- p.18 / Chapter 2.2.7. --- Prognosis of facet syndrome --- p.22 / Chapter 2.3. --- Articular cartilage of lumbar facet joint --- p.23 / Chapter 2.3.1. --- Function of articular cartilage --- p.24 / Chapter 2.3.2. --- Physical and mechanical properties of articular cartilage --- p.25 / Chapter 2.3.3. --- "Morphology of normal, aging and degenerated lumbar facet joint" --- p.26 / Chapter 2.3.4. --- The frequency and distribution of osteoarthritis in lumbar facet joint cartilage --- p.30 / Chapter 2.3.5. --- "Biochemistry of normal, aging and degenerated articular cartilage" --- p.32 / Chapter CHAPTER 3 - --- MATERIALS AND METHODS --- p.36 / Chapter 3.1. --- Clinical study --- p.36 / Chapter 3.1.1. --- Patients selection --- p.36 / Chapter 3.1.2. --- Initial assessment --- p.37 / Chapter 3.1.3. --- Reassessment --- p.37 / Chapter 3.1.4. --- Interpretation of the forms for the registration of related symptoms and signs --- p.38 / Chapter 3.1.5. --- Specific scoring system --- p.39 / Chapter 3.1.6. --- Methods of treatment --- p.41 / Chapter 3.1.7. --- Statistical method --- p.41 / Chapter 3.2. --- Cadaveric study of human lumbar facet joint cartilage --- p.43 / Chapter 3.2.1. --- Cadavers --- p.43 / Chapter 3.2.2. --- Procedures of dissection of the lumbar facet joint and articular cartilage --- p.44 / Chapter 3.2.3. --- "Development of ""indices"" for the observation and statistics of the articular cartilage in facet joints" --- p.44 / Chapter 3.2.4. --- Biochemical study of normal and degenerated cartilage --- p.50 / Chapter 3.2.5. --- Statistical methods --- p.54 / Chapter CHAPTER 4 - --- RESULTS / Chapter 4.1. --- Clinical study --- p.56 / Chapter 4.1.1. --- General results of the patients --- p.56 / Chapter 4.1.2. --- "Influence of various variables in predicting the ""Severity score""" --- p.62 / Chapter 4.2. --- Cadaveric study of human lumbar facet joint cartilage --- p.65 / Chapter 4.2.1. --- Sex and age --- p.65 / Chapter 4.2.2. --- The correlation between gross and histological appearance --- p.66 / Chapter 4.2.3. --- Ostoearthritic changes in the lumbar facet joints cartilage related to other factors --- p.67 / Chapter 4.2.4. --- """GMI"" and water content of the cartilage" --- p.69 / Chapter 4.2.5. --- """GMI"" and proteoglycan content of the cartilage" --- p.69 / Chapter CHAPTER 5 - --- DISCUSSION --- p.71 / Chapter APPENDIX 1 - --- Low back pain in Chinese industrial population --- p.79 / Chapter APPENDIX 2 - --- Standardized back clinic assessment sheets --- p.81 / Chapter APPENDIX 3 - --- Enzymatic method for the comparison of extraction of uronic acid from standard chondroitin 6-sulfate --- p.83 / Chapter APPENDIX 4 - --- Stability of standard chondroitin 6-sulfate in various conditions --- p.86 / Chapter APPENDIX 5 - --- "Original data of ""Gross Linear Index"" and ""Histological Linear Index""" --- p.88 / Chapter APPENDIX 6 - --- Original data of water content of various gradings --- p.89 / Chapter APPENDIX 7 - --- Original data of uronic acid content of various gradings --- p.90 / REFERENCES --- p.91

Lau Suk-chu. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 85-94). / Abstracts in English and Chinese. / Abstract --- p.i / 論文摘要 --- p.iii / Acknowledgements --- p.v / Table of Contents --- p.vi / List of Tables --- p.ix / List of Figures --- p.x / Table of Abbreviations --- p.xi / CHAPTERS / Chapter 1. --- Introduction --- p.1 / Chapter 2. --- Literature Review --- p.3 / Chapter 2.1 --- The Importance of Postoperative Pain Management --- p.3 / Chapter 2.1.1 --- Humanitarian --- p.3 / Chapter 2.1.2 --- Under-management of Postoperative Pain Relief --- p.3 / Chapter 2.1.3 --- Pain Relief- A Key Strategy for Better Surgical Outcomes --- p.5 / Chapter 2.2 --- Postoperative Pain Relief and Clinical Outcomes --- p.7 / Chapter 2.3 --- Postoperative Pain Relief and QoR --- p.8 / Chapter 2.4 --- A New Concept of Service Expected for Better Surgical Pain Relief --- p.9 / Chapter 2.4.1 --- Recognition of the New Concept of Service - APS --- p.10 / Chapter 2.4.2 --- Role of an APS --- p.11 / Chapter 2.4.3 --- Organization of APS --- p.12 / Chapter 2.4.3.1 --- The Anesthesiologist-based APS --- p.12 / Chapter 2.4.3.2 --- The Nurse-based APS --- p.13 / Chapter 2.4.3.3 --- The Multidisciplinary APS --- p.14 / Chapter 2.4.4 --- Postoperative Pain Management Service in Hong Kong --- p.15 / Chapter 2.4.4.1 --- Review of postoperative pain management service in Hong Kong --- p.15 / Chapter 2.4.4.2 --- Recommending APS in Hong Kong --- p.15 / Chapter 2.4.4.3 --- The recognition of APS in Hong Kong --- p.15 / Chapter 2.4.4.4 --- The development of APS in Hong Kong --- p.16 / Chapter 2.4.4.5 --- The compliance of APS teams in Hong Kong with the recommendations made by Hospital Authority --- p.17 / Chapter 2.4.5 --- Summary of Background of APS --- p.19 / Chapter 3. --- Economic Evaluation of Acute Pain Service Programs: A Systematic Review --- p.20 / Chapter 3.1 --- Abstract --- p.20 / Chapter 3.2 --- Introduction --- p.21 / Chapter 3.3 --- Methods --- p.22 / Chapter 3.3.1 --- Study Selection Criteria --- p.22 / Chapter 3.3.2 --- Search Strategy --- p.23 / Chapter 3.3.3 --- Data Analysis --- p.23 / Chapter 3.4 --- Results --- p.24 / Chapter 3.5 --- Discussion --- p.27 / Chapter 3.6 --- Conclusion --- p.30 / Chapter 4. --- Methodology of the RCT Study --- p.41 / Chapter 4.1 --- Setting --- p.41 / Chapter 4.2 --- Eligibility Criteria for Participants --- p.42 / Chapter 4.3 --- Obtaining Informed Consent --- p.42 / Chapter 4.4 --- Study Intervention --- p.43 / Chapter 4.4.1 --- Randomization --- p.43 / Chapter 4.4.1.1 --- Randomization: Generation and Concealment --- p.43 / Chapter 4.4.1.2 --- Randomization: Implementation --- p.43 / Chapter 4.4.1.3 --- Study Intervention: APS (Intervention group) and CWPS (Control) --- p.44 / Chapter 4.5 --- Data Collection and Outcome Measures --- p.44 / Chapter 4.5.1 --- Primary Outcomes --- p.44 / Chapter 4.5.1.1 --- Data Obtained at 72 hours After Surgery --- p.44 / Chapter 4.5.1.2 --- "Data Obtained at 24, 48 and 72 hours After Surgery" --- p.46 / Chapter 4.5.2 --- Secondary Outcomes --- p.47 / Chapter 4.6 --- Sample Size --- p.47 / Chapter 4.7 --- Data Analysis --- p.48 / Chapter 4.7.1 --- Comparability Between APS and CWPS Groups --- p.48 / Chapter 4.7.2 --- Comparing Costs and Effects of Interventions --- p.48 / Chapter 5. --- Results and Analysis --- p.51 / Chapter 5.1 --- Flow of Participation --- p.51 / Chapter 5.1.1 --- Enrollment of Participation --- p.51 / Chapter 5.1.2 --- Allocation of Treatment --- p.51 / Chapter 5.1.3 --- Follow-up --- p.53 / Chapter 5.2 --- Results of Data Analysis --- p.53 / Chapter 5.2.1 --- Patient Demographics --- p.53 / Chapter 5.2.2 --- Costs of Interventions --- p.55 / Chapter 5.2.3 --- Patient Satisfaction --- p.55 / Chapter 5.2.4 --- QoR --- p.61 / Chapter 5.2.5 --- Average Pain Severity Ratings --- p.62 / Chapter 5.2.6 --- Pain at Rest Severity --- p.63 / Chapter 5.2.7 --- Pain on Movement --- p.64 / Chapter 5.2.8 --- Average Pain Interference with Daily Activities --- p.65 / Chapter 5.2.9 --- Effectiveness of Pain Relief --- p.66 / Chapter 5.2.9.1 --- Side Effects of Pain Medications --- p.66 / Chapter 5.2.9.2 --- Summary of results --- p.67 / Chapter 6. --- Discussion and Conclusion --- p.68 / Appendix A: Data Collection Form --- p.71 / Appendix B: Conference Abstract --- p.81 / Appendix C: Conference Abstract --- p.83 / REFERENCES --- p.85

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