M.Cur. (Intensive General Nursing) / From the professional ethical perspective the professional nurse is responsible for the treatment and nursing of a patient in acute pain by effectively handling pain in the first 48 hours post-operative following serious surgery. The professional nurse can treat patients optimally only if she has the necessary knowledge and skills with regard to the different methods of handling pain. By making effective handling of pain available to the patient, including the advantages and disadvantages, the professional nurse contributes to maintaining, promoting and restoring health. In this way she facilitates the patient in reaching his objective of obtaining wholeness and she obtains her objective of quality nursing. The aim of this study is to determine which method of handling pain, namely the intermittent bolus dose analgesics and patient controlled analgesics, offers the most advantages to the patient and the professional nurse. A quantitative, contextually descriptive research design was followed in which a survey method and a retrospective analysis of nursing and medical records were completed in order to determine the total amount of analgesic used and to investigate the haemodynamic stability while using analgesics. An analysis was done of the information collected by means of a structured pain control list. Results indicate that those patients using patient controlled analgesics use larger doses of analgesics and are haemodynamically more stable while using analgesics than those patients using the method of intermittent bolus dose analgesics. Following on the conclusion, nursing guidelines were established for nursing practice and recommendations were made for nursing practice, nursing education and further research.

M.Tech. (Chiropractic) / Myofascial Pain Syndrome, is a common source of frustration for both healthcare practitioners and patients. It is the second most common reason for patients visiting their health care practitioner and constitutes up to 85% of the reasons for visits to pain clinics (Han and Harrison, 1997). As muscle pain is the most common work-related injury (Hubbard, 1998), it costs billions of dollars in lost revenue every year due to lost productivity (Fricton, 1990). Hong (1994), states that dry needling has been extensively studied and has been shown to decrease or even abolish myofascial pain. However post dry needling soreness is a common side effect of dry needling. Stuart (2010), states that applying kinesio tape® to a musculoskeletal injury during rehabilitation could result in a quicker recovery by allowing the body to biomechanically heal itself. Garcia-Mura et al (2009), results suggest that kinesio tape® is a method highly appropriate in the treatment of myofascial trigger points by normalising muscular function, increasing lymphatic and vascular flow, diminishing pain and aid in the correction of possible articular malalignment. The aim of this study was to determine the effects that kinesio tape® has on the trapezius trigger point one post needling, to determine whether there is an increase in the therapeutic effect of dry needling and an increased recovery time of the myofascial trigger points, with regards to changes in pressure pain threshold, pain and cervical range of motion. Participants for this study were recruited either by an advertisement which was placed on the information board of the Chiropractic Day Clinic at the University of Johannesburg as well as advertisements placed in and around the University of Johannesburg at the Doornfontein Campus. Also, many participants were made aware of this study via word of mouth from candidates already involved in the study. Thirty participants were randomly assigned into one of two groups, each consisting of 15 participants. Group A received dry needling of the trapezius trigger point one followed by the application of kinesio tape® whereas group B received dry needing of trapezius trigger point one only. Participants were treated 5 times with objective and subjective measurements taken at the 1st, 3rd and 5th visits. Objective measurements consisted of readings taken with an algometer and cervical range of motion (CROM) device. The subjective measurements consisted of the Numerical Pain Rating Scale (NPRS) and the Vernon Mior Neck Disability Index. The results of the study showed clinically and statistical significant improvements for both groups in regards to alleviating pain subjectively (Numerical Pain Rating Scale and Vernon-Mior Neck Pain and Disability Index), increasing pressure pain threshold objectively (Algometer) and increasing range of motion objectively (Cervical Range of Motion device). However group A (dry needing and kinesio tape®) showed a greater improvement in both subjective and objective measurements. Based on the results of the study, it could be concluded that both dry needling on its own as well as applying kinesio tape® post dry needling can be effective in the treatment of myofascial trigger points in the upper trapezius muscle, however applying kinesio tape® post dry needling seemed to be more effective.

Despite the increasing acceptance of biopsychosocial models of pain and multidisciplinary treatments for pain, relatively little is known about the specific psychological variables and social processes related to postoperative pain in children, especially in an outpatient setting. The present study examined demographic, medical, and psychological predictors of children's pain and parents' administration of pain medication. Two hundred and thirty-six families with children aged 2 to 12 undergoing day surgery participated in the study. This included a subset of 100 children aged 6 to 12, who were asked to complete self-report measures of anxiety, expected pain, coping style, and pain. Parents of all children completed measures of expected pain, expected benefit from medication, perspective taking, and negative attitudes towards analgesics. Parents and school-aged children completed pain diaries on the day of surgery and two days following surgery. The prevalence of clinically significant pain was somewhat lower than in previous studies, but both pain and undertreatment (parents who gave less than the recommended amount of pain medication) remained common. Predictors of pain were examined by multiple regression, using data from the subset of 100 children aged 6 to 12. More intense pain was related to more invasive surgery, a constellation of analgesic-related variables (more doses of analgesia given, the use of a regional block, the use of local infiltration), high anxiety, high expectations of pain, and a tendency to cope with pain by acting out and catastrophizing. Predictors of dosing were examined by multiple regression, using data from the entire sample of 236 children. Parents gave more medication when their children had invasive surgery and high levels of pain, when they expected a lot of pain, and when they were relatively unconcerned about the negative effects of pain medication. In each case, the psychological variables, entered as a block, were significant predictors of pain even after controlling for demographic and medical variables. Health care providers should be aware of psychological factors predicting pain, as they may help to identify families that are at "high risk" for pain and undermedication. In addition, the variables identified in this study are appropriate targets for further research on psychological factors that cause, mediate or contribute to pain processes, and as such may contribute to the development of theoretical models of pain and pain management. / Arts, Faculty of / Psychology, Department of / Graduate

The financial cost for health care and lost productivity due to chronic pain has been estimated at over $70 billion per year. Researchers have attempted to discover the psychosocial and personality factors that discriminate between people who learn to cope well with chronic pain and those who have difficulty adjusting. The purpose of the present study was to examine the effects of perceived locus of control and dispositional optimism on chronic pain treatment outcomes. Subjects reported significantly lower post-treatment pain levels as compared with pre-treatment levels (M = 0.66, SD = 1.58), t(45) = 2.85, p = .007 (two-tailed), but decreased pain was not associated with scores on the internality dimension of the Pain Locus of Control Scale (PLOC) or on the Life Orientation Test-Revised (LOT-R) (a measure of dispositional optimism). Overall, participants' increased coping ability was associated with scores on the LOT-R, but not with scores on the internality dimension of the PLOC. Subjects with the lowest pre-treatment scores on the LOT-R demonstrated significantly greater increases in post-treatment coping ability than those with the highest scores (F(2,40) = 3.93, p < .03). Participants with the highest pre-treatment scores on both the PLOC internality dimension and the LOT-R demonstrated greater post-treatment coping ability (F(2,32) = 4.65, p < .02), but not less post-treatment pain than other subjects. Participants' post-treatment LOT-R scores were significantly higher than their pre-treatment scores (M = 2.09, SD = 3.96), t(46) = 3.61, p = .001 (two-tailed), but post-treatment PLOC internality scores were not significantly higher than pre-treatment scores. Implications of these results are discussed.

The present study explored whether use of Spanish language sayings, or dichos, improved group climate within multi-ethnic chronic pain groups. Use of this form of figurative language fits within psychological theory identifying use of metaphor as a means of promoting change and creating new meaning. Further, metaphor use is consistent with the broader aims of experiential therapy. Group climate was measured by group members' self reports using the Group Climate Questionnaire-Short Form. A pilot study involving Latino Americans in medical and non-medical contexts aided in categorizing dichos as high versus low-relevance. It was anticipated that clients would rate high-relevance sessions as involving greater engagement, and less conflict and avoidance than low-relevance groups. Participants were recruited from four multidisciplinary pain management clinics offering similar programs. Once every four to six weeks, group leaders were provided with a list of either high or low-relevance dichos, and were blind to the existence of dichos categories. Three hierarchical regression analyses were employed to determine whether dichos relevance, characterized as low, mixed or highly relevant, contributed to variance in group conflict, avoidance and engagement. Dichos familiarity was the last variable entered into the regression equation, with gender, ethnicity and acculturation score entered in sequential fashion. Consistent with predictions, low-relevance groups yielded higher conflict scores than all groups combined. Also, high-relevance groups predicted lower avoidance when compared to all groups. In contrast to hypotheses, high-relevance groups predicted lower ratings of group engagement when compared to all groups. Post-hoc analysis indicated the mixed-relevance groups yielded significantly higher engagement scores than the low and high-relevance groups. Implications of these findings are discussed in relation to impact on approaches to group therapy with Latino American clients, and within the chronic pain population. Limitations of the study and recommendations for future research are offered.

Bakgrund: Barns smärta är komplex och för att uppnå en adekvat smärtbehandling krävs erfarenhet. Det är viktigt att behandla smärta då det är ett hot mot barnets hälsa och underbehandlad smärta kan medföra svåra komplikationer. Smärta är en subjektiv upplevelse och för att uppnå en positiv smärtbehandling måste barnet tillfrågas om sin smärta. Syfte: Syftet var att belysa barns upplevelser av smärtbehandling och smärthantering vid vårdinrättningar Metod: En allmän litteraturstudie med en strukturerad sökmetod där nio artiklar granskades med hjälp av innehållsanalysens fem steg. Resultat: Presenteras i fyra kategorier: att vara delaktig och få information är betydelsefullt, lyckad farmakologisk smärtlindring bidrar till positiva upplevelser, vikten av distraktion, att få stöd och känna trygghet är centralt med underkategorierna; från föräldrarna, vid sjuksköterskans omvårdnad. Konklusion: Barn upplever att trygghet är en central del av smärtbehandlingen som skapas med hjälp av adekvat information, delaktighet, distraktion och genom föräldrarnas närvaro. För att uppnå positiva upplevelser av smärtbehandlingen behöver sjuksköterskan administrera snabb och adekvat farmakologisk behandling i kombination med distraktion anpassat efter varje enskilt barn. Behandling av smärta kräver ständig utveckling samt uppdatering av riktlinjer där barnens subjektiva upplevelse av smärta bör vara central för en lyckad utveckling av smärtbehandling. / Background: Children's pain is complex and in order to achieve adequate pain management experience is required. It is important to treat pain as it is a threat to the child's health and untreated pain can lead to severe complications. Pain is a subjective experience and in order to achieve a positive pain management, the child must be asked about the pain. Aim: The aim was to describe children's experiences of pain management and pain treatment at care facilities. Method: A general literature study with a structured search method in which nine articles were examined using the five steps of content analysis. Results: Presented in four categories: being involved and receive information is important, successful pharmacological pain treatment contributes to positive experiences, the importance of distraction, to obtain support and feeling safe is central with the subcategories: from the parents, caring from the nurse. Conclusion: Children experience that security is a central part of the pain treatment which is created with the help of information, participation, distraction and through the presence of the parents. To achieve positive experiences of pain management the nurses need to administrate fast and adequate pharmacological treatment combined with distraction adapted to each individual child. Treatment of pain requires constant development and updating of guidelines where children's subjective experience of pain should be central to the successful development of pain treatment.

Bakgrund: Opioider är en viktig del inom behandling av postoperativ smärta. Det är viktigt att patienten erhåller adekvat information om opioder för att bespara patienten lidande och för att minimera riskabelt bruk. Syfte: Syftet var att beskriva patienters erfarenheter av att behandlas med opioider för postoperativ smärta. Metod: Studien utfördes som en allmän litteraturstudie med induktiv ansats. Litteraturstudien består av 17 vetenskapliga artiklar. Resultat: Resultatet genererade tre kategorier. Patienters fysiska erfarenheter innefattar patienters somatiska erfarenheter, hur de upplevde opioiders effekter och bieffekter. Patienters känslomässiga erfarenheter rymmer känslor som patienterna upplevde i samband med opioidbehandling och förutfattade meningar. Patienters erfarenheter av information omfattar vilken utbildning patienter hade erhållit av sjuksköterskan och vilka kunskapsbehov som upplevdes. Konklusion: Det var vanligt att patienterna upplevde biverkningar och uttryckte en oro över att uppleva biverkningar och att utveckla beroende. Patienterna hade även negativa föreställningar om opioider, vilket kunde resultera i att patienterna självmant reducerade sina doser eller slutade helt med sin behandling utan att rådfråga läkare. Bristfällig information om opioider resulterade i inadekvat smärtlindring. Sjuksköterskan är i behov av mer kunskap kring postoperativ opioidbehandling för att på så sätt kunna minska patienters oro, optimera smärthanteringen och minimera riskabelt handhavande av opioider. / Background: Opioids are an important part in the treatment of postoperative pain. It is important that patients receive adequate information regarding opioids to spare suffering and to minimize potentially dangerous use. Aim: The aim was to describe patients’ experiences of being treated with opioids for postoperative pain. Method: The method used was a literature review with an inductive approach, which consist of 17 scientific articles. Result: The result generated three categories. Patients’ physical experiences includes patients’ somatic experiences, how they experienced the opioids’ effects and side-effects. Patients’ emotional experiences contains emotions that patients experienced when being treated with opioids, as well as preconceptions. Patients’ experiences of information includes what education patients had received from the nurse and what knowledge they perceived to be lacking. Conclusion: It was common that patients experienced opioid-related side effects. Patients expressed fear of side effects and to become addicted. Patients’ negative views of opioids could result in poor prescription compliance. Either by reducing their dosages or quitting completely, without consulting a physician. Patients received inadequate information regarding opioids that resulted in insufficient pain treatment. The nurse is in need of more knowledge regarding postoperative opioid treatment, in order to reduce patients’ worry, optimise pain management and minimize unsafe use, storage and disposal of opioids.

BACKGROUND: Nursing care is the nurse's area of expertise, which in a neonatal care ward includes individualized, highly qualified care. Globally, nearly 30 million children are born each year who are in need of specialist care in a neonatal unit. During the care period, children can be exposed to up to 14 invasive procedures per day that can cause different types of pain. Therefore, it is very important that children are adequately managed for pain. The role of nurse in the neonatal care unit includes monitoring the newborn and administering appropriate treatment to prevent the development of disease or further deterioration. In addition to the specialized somatic care, the nurse has a key role in communication with the guardians related to the family-centered nursing. AIM: The purpose was to investigate nurse's experiences of pain management of newborns in the neonatal care unit. METHOD: A general literature study with a qualitative approach carried out with the help of thematic content analysis. RESULTS: The results and findings of the articles are presented in two main themes: Professional ability and Organizational factors and six sub-themes. CONCLUSION: Adequate pain management and family-centered care are crucial for the survival, recovery and continued health of newborns. More research is needed to implement routines at both local and global level and train nurses in pain assessment and pain relief. / BAKGRUND: Omvårdnad är sjuksköterskans kompetensområde, som på en neonatalvårdsavdelning innefattar individualiserad, högkvalificerad vård. Globalt föds närmare 30 miljoner barn per år som är i behov av specialistvård på en neonatalavdelning. Under vårdtiden kan barnen utsättas för upp till 14 invasiva ingrepp per dag som kan orsaka olika typer av smärta. Därför är det av stor vikt att barnen smärthanteras på ett adekvat vis. Rollen som sjuksköterska på neonatalvårdsavdelning inkluderar övervakning av det nyfödda barnet samt administrering av lämplig behandling för att förhindra utveckling av sjukdom eller ytterligare försämring. Utöver den specialiserade somatiska vården har sjuksköterskan en nyckelroll i kommunikationen med vårdnadshavarna relaterat till den familjecentrerade omvårdnaden. SYFTE: Syftet var att undersöka sjuksköterskors erfarenheter kring smärthantering av nyfödda barn inom neonatalvården. METOD: En allmän litteraturstudie med kvalitativ ansats utförd med hjälp av tematisk innehållsanalys. RESULTAT: Artiklarnas resultat och fynd presenteras inom två huvudteman: Professionell förmåga och Organisatoriska faktorer och sex subteman. SLUTSATS: Adekvat smärthantering och familjecentrerad omvårdnad är avgörande för de nyfödda barnens överlevnad, återhämtning och fortsatta hälsa. Mer forskning behövs för att på både lokal och global nivå implementera rutiner och utbilda sjuksköterskor i smärtbedömning och smärtlindring.

Indiana University-Purdue University Indianapolis (IUPUI) / Voltage-gated sodium channels (VGSCs) are transmembrane proteins responsible for the initiation of action potentials in excitable tissues by selectively allowing Na+ to flow through the cell membrane. VGSC subtype Nav1.7 is highly expressed in nociceptive (pain-sensing) neurons. It has recently been shown that individuals lacking the Nav1.7 subtype do not experience pain but otherwise function normally. In addition, dysfunction of Nav1.7 caused by point mutations in the channel is involved in two inherited pain disorders, primary erythromelalgia (PE) and paroxysmal extreme pain disorder (PEPD). This indicates Nav1.7 is a very important component in nociception. The aims of this dissertation were to 1) investigate if the antipsychotic drug, trifluoperazine (TFP), could modulate Nav1.7 current; 2) examine changes in Nav1.7 properties produced by the PE mutation N395K including sensitivity to the local anesthetic (LA), lidocaine; and 3) determine how different inactivated conformations of Nav1.7 affect lidocaine inhibition on the channel using PEPD mutations (I1461T and T1464I) that alter transitions between the different inactivated configurations of Nav1.7. Standard whole-cell electrophysiology was used to determine electrophysiological and pharmacological changes in WT and mutant sodium currents. Results from this dissertation demonstrate 1) TFP inhibits Nav1.7 channels through the LA interaction site; 2) the N395K mutation alters electrophysiological properties of Nav1.7 and decreases channel sensitivity to the local anesthetic lidocaine; and 3) lidocaine stabilizes Nav1.7 in a configuration that decreases transition to the slow inactivated state of the channel. Overall, this dissertation answers important questions regarding the pharmacology of Nav1.7 and provides insight into the changes in Nav1.7 channel properties caused by point mutations that may contribute to abnormal pain sensations. The results of this dissertation on the function and pharmacology of the Nav1.7 channel are crucial to the understanding of pain pathophysiology and will provide insight for the advancement of pain management therapies.

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