Pain management is a critical part of the care of the surgical patient. This study sought to investigate the impact of cultural and linguistic diversity on analgesic administration practices and opioid consumption during postoperative period. A retrospective medical record audit of 278 English-speaking and non-English speaking surgical patients was carried out at four hospitals in Sydney's South West. No differences were found in the type of analgesia prescribed, the mode of analgesia, or the commencement of oral analgesia between the two groups. However, non-English speaking patients consumed less analgesia during the initial postoperative period than their English speaking counterparts. The importance of this difference was further examined within the context of a range of factors known to influence analgesia consumption. A model including sociodemographic and clinical factors - mode of administration of analgesia, gender, and language spoken -predicted 37% of total opioid consumption. Although mode of administration was the most important factor, being of non-English speaking background also contributed substantially. Pain assessment, inclusive of gender and cultural nuances is recommended. The need for further research into pain interpretation in specific linguistic and cultural groups is highlighted / Master of Science (Hons) (Health)

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Breast cancer is one of the most common cancer diagnoses in women and is a significant cause of mortality and morbidity worldwide. Surgical treatment is indicated in most patients. Postmastectomy pain syndrome (PMPS) is a distinctive, persistent and debilitating neuropathic pain syndrome that develops after breast surgery. A review of the literature revealed no studies determining the prevalence of PMPS conducted in South Africa, specifically at the Chris Hani Baragwanath Academic Hospital (CHBAH). A detailed description of the prevalence of PMPS is needed to understand the problem in this patient group which may enable the development of a more effective pain management strategy.

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Traditionally analgesics have been the main stay of postoperative pain management. Taught non-pharmacological strategies have also been used. The possibility that patients may have a repertoire of self-generated strategies has tended to be overlooked. The aim of this study was to identify whether patients possess and utilise self-generated strategies for acute pain, and if so, to ascertain the effect of engaging patients in their postoperative pain management by supporting their strategies. To empower nurses to deliver effective pain management, and to promote evidence based practice, a second aim was to actively engage nursing staff in the process. A collaborative action research design based on critical theory was used to facilitate practitioner participation, enable practice development and generate a theoretical understanding of the issues. Three action research cycles were identified, each containing various methods and involving both patients and staff. The first cycle, entitled “telling the situation as it is”, described current practice from the ward staff’s perspective and identified 10 strategy themes through an outpatient survey. Cycle two focused upon “testing the proposed changes”. In contrast to many action research studies, a randomised controlled trial was undertaken to test the effect of incorporating patients’ self-generated strategies into postoperative pain management. The nursing staff were pivotal in both the decision to undertake the trial and in its management. The results indicated that identifying and supporting patients’ self-generated strategies significantly reduced postoperative anxiety, pain intensity and distress. Fewer experimental subjects required opiates, although non-steroidal anti-inflammatory consumption was increased in this group. Staff understanding and awareness of pain and their ability and confidence to manage pain increased. Certain staff also gained research skills. The third and final cycle, “creating change in practice: implementation and implications”, is being led by the nurses. The potential of action research to engage nurses in practice developments related to patient-centred care has been demonstrated.

Purpose: The purposes of this study were: (a) to describe the physical and mental health status of Afghan immigrant women in one Canadian city; (b) to construct an Afghan cultural model of pain (experience and management) using interview data and available literature; (c) to explore the experience of chronic pain and its management among Afghan immigrant women, both culturally and individually; and (d) to identify potential barriers to chronic pain management for both Afghan immigrant women and their health care providers. Methods: This study has two parts; questionnaires were used in Part 1, and semi-structured interviews supplemented by three short questionnaires were used in Part 2. Interpretive description methodology using thematic analysis and conceptual mapping was used for analysis of interviews in Part 2. Results: SF-36 responses (n = 9) in Part 1 suggested that the physical health status of the Afghan women was better than their mental health status. Health sciences literature and interviews with 6 Afghan immigrant women and 1 healthcare professional were used to construct cultural models of pain experience and pain management. Findings indicated that Afghan immigrant women who experienced and managed their chronic pain within their cultural model did so holistically across multiple factors: environmental, spiritual, biological, and psychological. However, each individual internalized their cultural model of pain in varying amounts. Barriers in healthcare access that prevented Afghan immigrant women from managing their pain well included: (a) different cultural perspectives between Afghan immigrant women and healthcare professionals regarding how pain is experienced and managed; and (b) communication difficulties between healthcare professionals and Afghan immigrant women. Significance of Findings: Cultural perspectives on pain experience and pain management influence treatment expectations and pain management. Differences in cultural perspectives are a barrier in healthcare access that prevents Afghan immigrant women from managing their pain well. Addressing the differences in perspective identified in this study will increase understanding for healthcare professionals as they work together with Afghan immigrant women patients, thereby improve communication and reduce barriers to pain management.

This thesis is an investigation of the objective assessment of pain through the use of pressure algometers and rumination tags and the effects of pain management therapy for experimentally-induced mastitis on behaviour and physiological measures in dairy cattle. Twenty-four lactating Holstein cows were enrolled in a lipopolysaccharide (LPS) endotoxin challenge study, where one mammary quarter was infused with 25 µg of Escherichia coli (E. coli) LPS endotoxin. Subsequently, a subcutaneous injection of either a non-steroidal anti-inflammatory drug (NSAID) (meloxicam; n=12) or placebo (n=12) was randomly allocated and administered using double-blind methods. Several behavioural, physiological and performance parameters were monitored throughout the study period. Beneficial effects of meloxicam administration on pain sensitivity, edema scores and dry matter intake were shown. For a subset of animals receiving placebo treatment, the algometer and rumination tags accurately detected changes in both pain sensitivity and rumination time after endotoxin challenge. / Canadian Bovine Mastitis Research Network and Boehringer-Ingelheim, Canada

Title page, table of contents and abstract only. The complete thesis in print form is available from the University of Adelaide Library. / While opioids are the most effective and widely used class of drug for the management of moderate to severe pain, their use may be limited by adverse effects that are unpleasant and potentially dangerous. Research is increasingly directed towards strategies to improve the use of opioids in pain management, investigating methods by which the analgesia afforded by an opioid may be enhanced, while minimising adverse effects. One approach that has produced promising findings in animal studies and some clinical reports is the combination of an opioid agonist and "ultra-low" (nanomole) doses of an opioid antagonist. A recent animal study reported that antinociception may be significantly enhanced with the combination of the partial opioid agonist/antagonist buprenorphine and ultra-low doses of the antagonist naloxone. The central aim of the studies described herein was to investigate the effect of this drug combination on response to experimental nociceptive stimuli and the incidence and severity of adverse effects among healthy volunteers. The first study established normative responses to two commonly used nociceptive tests, the cold pressor and electrical stimulation tests, in 100 healthy volunteers. The effect of buprenorphine on nociceptive test performance had not previously been determined, therefore a dose-ranging study of buprenorphine was conducted to establish a doseresponse relationship. The subsequent two studies investigated the effect of a range of buprenorphine:naloxone IV dose ratios (5:1, 10:1, 12.5:1, 15:1, 20:1 and 25:1) on nociception and adverse effects among healthy volunteers. These studies are the first to investigate the combination of buprenorphine and ultra-low dose antagonist in humans, and the first to assess the agonist:antagonist combination in an experimental model of human nociception. Antinociception was significantly enhanced with the combination of buprenorphine and naloxone in the 12.5:1 and 15:1 ratios. Moreover, this enhanced antinociception occurred without a simultaneous increase in adverse effects and indeed with a reduction in the severity of some effects. An agent that produces greater analgesia and reduces adverse effects has the potential to overcome some of the barriers that limit the use of opioids in pain management. The current findings indicate that further investigation of this drug combination is warranted. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1177227 / Thesis (Ph.D.) -- University of Adelaide, Dept. of Clinical and Experimental Pharmacology, 2005

Chronic pain poses a major concern to modern medicine and is frequently undertreated, causing suffering and disability. Transdermal delivery is the pivot to which analgesic research in drug delivery has centralized especially with the confines of needle phobias and associated pain related to traditional injections, and the existing limitations associated with oral drug delivery. Highlighted within this thesis is the possibility of further developing transdermal drug delivery for chronic pain treatment using an Electro-Modulated Hydrogel- Microneedle array (EMHM) prototype device for the delivery of analgesic medication