Thesis (MBA)--Stellenbosch University, 2012. / Analgesics are the medication most-generally used by modern society. The pain management market has therefore experienced substantial growth over the last few years. This research report aims to provide a critical review of pain management in the pharmaceutical market in South Africa, in order to establish and evaluate the most significant growth factors. This research report provides an overview of the history of pain, the basic physiology of pain and pain classification systems. There are three categories of analgesics - opioid analgesics, non-opioid analgesics and adjuvant analgesics. These categories of analgesics have been analysed according to the most generally-used MIMS pharmacological classification system referring to the analgesic therapeutic classes. These are narcotic analgesics, analgesics and antipyretics, combination analgesics, others such as tramadol and musculo-skeletal agents which consist of NSAIDs and COX inhibitors. Growth over the last four years (from August 2009 to July 2012) will be determined by analysing data per molecule, per product and per manufacturer. Splits between branded and generic drugs will also be analysed. Top prescribers by healthcare professionals will be examined, analysing scripting data from ImpactRx, which covers 85% of the private market data nationally. There are currently approximately 41 analgesic molecules in the assessed pain market which has produced 738 analgesic products. The analgesic market (worldwide and in South Africa) has seen the launch of only a few new drugs. New molecules of the same drug class or family have been launched, but in effect they can be viewed as mere line extensions with claimed reduction in side effects, advanced delivery times or improved efficacy. Two new molecules have been launched in the South African market in the narcotic analgesic class, (oxycodone and hydromorphone), however these molecules have been available internationally for years. Accelerated growth of the pain management market has mainly been met by combination analgesics, which in essence are not new, but rather a combination of different active ingredients or new drug delivery systems. The impact of product withdrawals on market share is also evaluated. The development and acceptance of generics are highlighted as key contributing factors in the growth of the analgesic market. Important to note is that generics often compete in their own generic market share. This may be the reason why the generic market does not show a significant increase over branded products. Another significant trend evident in the increased acceptance of generics, is that manufacturers, in order to keep market share, may choose to produce their own generic medication after their branded products patent has expired. Pain is one of the main reasons why patients seek medical attention and it is the physician’s ethical responsibility to treat patients and provide them with effective pain relief medication. The WHO analgesic ladder as a guideline for treating pain has proven to be effective after 25 years in practice. It is forecasted that an increase in the narcotic analgesic class will be noted. Pain is heavily undertreated worldwide and in South Africa, Increased awareness, education, new advanced research and knowledge may help to address this dilemma.

Title: Efficiency of cold treatment of locomotive system dysfunctions Objectives: The theoretical part should provide an overview of effects of cold on the human organism. The practical part reports a pilot study in which local cryotherapy was applied to painful areas of dysfunctional locomotive system. Methods: After measuring local painfulness using an algometer, the Cryogen 2 device was used for local cryotherapeutic treatment; after the treatment, algometer was used again. Subjective state of the patient was monitored throughout the process. Cryotherapy was applied within normal individual physiotherapeutic treatment to patients of varying age, sex, and locomotive system dysfunctions. Results: We have shown that local cryotherapy, using the Cryogen 2 device, did decrease painfulness in measured areas. Although significant differences in pain perception were found between male and female patients, the efficiency of cryotherapy did not depend on sex. Some correlation was found between treatment efficiency and age. No evidence was found for establishing that repeated application decreases pain perception measured before the next treatment. The results are influenced by a smaller sample of patients and measurements, and by inhomogeneity of patients. Key words: pain treatment, cold, local cryotherapy,...

Yau, Ching Ying. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 180-194). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendixes includes Chinese.

Aim. The overall aims of this study were to develop a tailor-made educational intervention and to examine its effectiveness on short- and longer-term outcomes among Chinese patients with traumatic limb fractures who had undergone surgery. / Background. Fracture limb and undergoing surgery is the common problem after injury. It is the most common source of pain and anxiety and research continues to demonstrate a high prevalence of unrelieved pain in injured patients who have undergone surgery. Patient's belief in pain is the major barrier in pain management. Strategies directed to have appropriate educational interventions are urgently needed to improve patient outcomes for those suffering acute pain after surgery for traumatic limb fracture. / Conclusion. The C-BEI was effective in terms of reducing the pain barrier, providing post-operative pain relief, reducing anxiety, and improving sleep satisfaction in patients with fractured limbs during their first week of hospitalization after surgery. This study has generated evidence supporting the use of a C-BEI in acute pain management. / Method. The study was conducted in the orthopaedic wards of two regional hospitals in Hong Kong and comprised two phases. In phase one, qualitative interviews were conducted with twenty-six Chinese patients who had traumatic limb fractures and were undergoing surgery regarding their experiences of and beliefs about pain management. Ten orthopaedic nurses were also interviewed about their perceived pain management practices and the barriers that prevented better pain control among patients. The findings from these qualitative interviews were used to develop a cognitive behavioural approach educational intervention (C-BEI). C-BEI was used to enhance knowledge of pain, modify their beliefs about pain management and promote positive coping thoughts and behaviour. The C-BEI consisted of two sessions. The first was a 30-minute session comprised a combination of patient education and breathing relaxation exercise and conducted at T0 (1 day before surgery). A 30-minute reinforcement session was conducted at day 7 after surgery (T3). / Results. A total of 125 participants completed the study, with 62 in the experimental group and 63 in the control group. The participants were homogenous in terms of demographic data (P > 0.05) and baseline clinical characteristics (p > 0.05). The short-term outcomes (from T0 to T3) for the participants in the experimental group were a statistically significant with lower pain barrier (p = .003), lower level of pain (p = .003), lower level of anxiety (p < .001), and better sleep satisfaction (p = .001) than the control group. The experimental group had a significantly higher frequency of analgesic use at T2 (p < .001) and better self-efficacy in pain management at T3 (p = .011) than the control group. There were no statistically significant differences in the total length of stay in hospital, although the mean length of stay was shorter in the experimental group than in the control group (8.1 day VS 10.1 days). For longer-term effects, the C-BEI was effective at the post-operative stage in anxiety reduction ( p = .002) and sleep satisfaction improvement (p = .002). There were no statistically significant differences for the VAS pain level, GSE scores, physical health summary component (PCS) and mental health summary component (MCS) of the SF36 between two groups over three months, although the experimental group had better scores in the mental health dimension. Findings of the process evaluation showed that most participants perceived the C-BEI as effective in enhancing their knowledge on pain management and the use of analgesics, and helping them to cope with pain, the could sleep better and regain self-control. / The main study was conducted in phase II which consisted of outcomes and process evaluation. A quasi-experimental design of two groups' pre-test and post-test between subjects was employed for the outcomes evaluation. All participants in the experimental group received the C-BEI and usual care, whereas those in the control group received usual care only. The short-term outcomes were treated as primary outcomes and evaluated in terms of the participants' pain barrier score, pain level (Visual Analogue Pain Scale: VAS, anxiety level (State-Trait Anxiety Inventory:STAI), sleep satisfaction, self-efficacy in pain management (General Self Efficacy Scale: GSE), and frequency of analgesic use. All of which were measured at T0, T1 (day 2), T2 (day 4), and T3 (day 7) after surgery. The total length of stay in hospital of the two groups was also compared. Longer-term outcomes were further evaluated over three months at T4 (1 month) and T5 (3 months), and included the VAS pain level, STAI, sleep satisfaction, GSE and health-related quality of life (SF36).The intention-to-treat method was adopted. The process evaluation involved a qualitative study using telephone interviews. / Wong, Mi Ling, Eliza. / Adviser: Sally Chan. / Source: Dissertation Abstracts International, Volume: 71-01, Section: B, page: 0231. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 256-278). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese.

An alternative complementary approach was used to verify the antinociceptive effect of 4 CMMs aqueous extracts in a Drosophila adult model. Drosophila adults were subjected to CMM treatments and then placed on an in-house-designed heating device for noxious heat stimulation. Their behavioral outputs were quantified and expressed as heat avoidance index (AI) for revealing the degree of antinociceptive effect of CMMs. By comparing the AI value of non-CMM treated control group with CMM-treated groups at temperature challenge 32°C, it was found that an AI value of 0.2 was obtained for non-CMM-treated control group whereas CMMs-treated groups showed AI values ranged from 0.33 to 0.4. The increase of AI value in those CMM-treated groups means that Drosophila adults became more susceptible to noxious heat stimulation. This indicates that those identified CMMs by the larvae model possess strong and versatile antinoceiceptive activities in Drosophila adults. / In addition, reverse transcription PCR (RT PCR) analysis was performed to study the effects of CMMs on the mRNA expression of three nociceptive-related genes painless, nompC and CG4536. These three genes all belong to the Transient Receptor Potential (TRP) families and have been shown to be involved in heat response. The results indicate that the gene expression level for nompC was significantly down-regulated with fold changes ranging from 0.2 to 0.7 upon 2 hrs treatment of three aqueous CMM extracts Citrus aurantium, Angelica dahurica and Vitex trifolia. However, there is no significant difference in gene expression level for painless and CG4536. / In this study, it has been demonstrated that Drosophila are feasible to use for screening CMMs with antinociceptive activity. While the data of the relative gene expression level for those target genes observed in this study may also serve as biomarkers for providing more evidence to investigate drugs have antinociceptive effects. In the future, such information paves the way for further development in the study of antinociceptive drugs. / Nociception is the reception of signals in the central nervous system (CNS) triggered by specialized sensory receptors which received stimuli such as electrical, thermal, mechanical, or chemical and response to escape from danger. Similar to humans, the fruitfly Drosophila display evolutionarily conserved nociceptive response that makes it suitable for in vivo nociceptive study. In this study, Drosophila larvae were used as initial screening model to investigate the antinociceptive effect that was caused by 61 randomly selected Chinese Medicinal Materials (CMMs). Upon noxious heat stimulation, 73% of larvae in the control group produced a stereotypical rolling behavior within 1 s. Among those tested CMMs, the results indicated that 4 aqueous CMMs extracts from Citrus aurantium L. (family: Rutaceae), Angelica dahurica (Fish. ex Hoffm.) Benth. et Hook (family: Umbelliferae), Vitex trifolia L. var. simplicifolia Cham. (family: Verbenaceae) and Panax notoginseng (Burk.) F. H. Chen (family: Araliaceae) were found to have strong antinociceptive effect on Drosophila larvae since less than 40% of the larvae have produced stereotypical rolling behavior within 1 s upon noxious heat stimulation. / "September 2007." / Advisers: Ming Liang Song; Ho Yin Edwin Chan. / Source: Dissertation Abstracts International, Volume: 69-08, Section: B, page: 4768. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 134-139). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Objective: Chronic pain is a common condition worldwide that poses significant impact to society in terms of its health and economic costs. It has been found to be related to a number of emotional and cognitive factors that are amenable to psychological treatments. Traditional cognitive-behavioral therapy (CBT) for chronic pain has become the gold standard of psychological treatment with reported efficacy. However, recent meta-analyses have found its effect size to be only modest at most. Moreover, its specific mechanisms of action are not well elucidated. With recent advances in neuroscience on possible neurocognitive processes underlying chronic pain, alternative treatment models targeting these specific neurocognitive processes are worth exploring. The present study tested the effectiveness of the Four-step Mindfulness-based Therapy (FSMT) for chronic pain in a randomized-controlled trial. The FSMT was chosen because of its explicit emphasis on altering neurocognitive processes that appear to be highly relevant in treating chronic pain. Method: Ninety-nine chronic pain patients in a hospital cluster-based outpatient pain clinic were randomly allocated to either the FSMT treatment or wait-list control group. The FSMT was modified for use with chronic pain and incorporated mindfulness exercises, such as mindful breathing and mindful meditation. Treatment consisted of eight weekly two-hour group sessions conducted by a clinical psychologist experienced in the implementation of the FSMT protocol. Assessment took place at baseline and post-treatment for both the FSMT and wait-list control. For the FSMT, assessment also took place at mid-group and 3-month follow-up. Results: Findings showed that the FSMT produced superior outcomes in terms of activity interference (primary endpoint), pain unpleasantness, and depression when compared to the wait-list control group or over time. Improvements were also found in the process measures of pain catastrophizing and pain acceptance. All treatment effects were maintained at follow-up. Further, the effects have been shown to be clinically significant and reliable above and beyond measurement errors. Mediational analyses revealed that pain catastrophizing and pain acceptance mediated the effects of FSMT on the outcomes of activity interference and depression; pain catastrophizing also mediated the effect of FSMT on the outcome of pain unpleasantness. Conclusions: The present study was the first to establish statistical and clinical evidence of the FSMT for chronic pain. It also revealed possible processes and mechanisms that might have brought about the changes in outcome, namely reduction in pain catastrophizing and improvement in pain acceptance. How the FSMT led to the outcome changes via these two processes was discussed and enriched by neurocognitive perspectives. Future studies should seek to further compare the FSMT with other active psychological treatments for chronic pain and collect neuroimaging data to further illustrate the neurocognitive processes involved. / Wong, Chi Ming. / "October 2009." / Adviser: Freedom Leung. / Source: Dissertation Abstracts International, Volume: 72-01, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 139-175). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Adequate pain assessment is a pre-requisite for appropriate pain management. If pain remains untreated in critically ill young children, it can have dramatic short- and long-term consequences on their health and development. Apart from humanitarian reasons, the assessment of pain has been recognised in some parts of the world as the fifth vital sign and thus should be part of standard practice of pain management. The evaluation of pain in preverbal children is, nevertheless, challenging for health professionals, as they cannot rely on self-report when making their assessment. Observational pain instruments have been developed to facilitate this task, but none of these existing instruments are appropriate for the postoperative critically ill young child. The aim of this research was to provide a clinically valid pain instrument for health professionals to use in practice for the evaluation of the pain and the effectiveness of pain treatment in critically ill young children. This thesis presents research that was conducted in three phases to (a) describe pain, (b) develop, and (c) test the pain instrument. Conceptualisation of pain and psychometric theory informed the conceptual framework for this study. An observational design was used in Phase One of the study to define pain behaviour in critically ill infants. Correlational design was used in Phase Two and Three to determine the association between the newly developed pain scale and other pain assessment instruments. Phase One of the study was conducted in the paediatric intensive care units of two tertiary referral hospitals. Eight hundred and three recorded segments were generated from recordings of five critically ill infants, aged between 0 and 9 months, who had undergone major surgery. / Results indicated significant physiological and behavioural changes in response to postoperative pain and when postoperative pain was exacerbated by painful procedures. Using the pain indicators observed in Phase One, in Phase Two the Multidimensional Assessment Pain Scale (MAPS) was developed and tested for reliability and validity in 43 postoperative preverbal children from the same settings. Internal consistency and interrater reliability were moderate and good, respectively. Concurrent and convergent validity was good. In Phase Three, the MAPS' response to analgesics and clinical utility was demonstrated in a convenience sample of 19 postoperative critically ill children aged between 0 and 3 1 months of age at a tertiary referral hospital in Western Australia. Development of a pain instrument is a complex and lengthy process. This study presents the preliminary psychometric properties that support the validity and clinical utility of the Multidimensional Assessment Pain Scale. The MAPS is a promising tool for assessing postoperative pain in critically ill young children, and its clinical validity will be strengthened with further testing and evaluation.

<p>Smärta påverkar livskvalitet negativt. Vid smärtbehandling uppstår ibland situationer då farmaka inte är tillräckligt för att smärtlindra. Då är sjuksköterskans roll betydelsefull eftersom valet av smärtbehandlingsmetod ofta kan påverkas av sjuksköterskan. Kunskap om komplementära behandlingsmetoder och förmåga att tänka holistiskt krävs av sjuksköterskan för att kunna ge en trygg och individanpassad behandling. Användning av avledning med komplementära metoder kan ge avslappning och följaktligen reducering av smärtintensitet. Syftet var att beskriva effekten av andning, massage, musik och riktad visualisering som komplementära smärtbehandlingsmetoder, vilka sjuksköterskan kunde använda sig utav. Den systematiska litteraturstudien består av 16 vetenskapliga artiklar som granskades och analyserades. Resultatet visade att de komplementära smärtbehandlingsmetoderna andning, massage, musik och riktad visualisering gav en betydande smärtlindring och de fungerade dessutom utmärkt som ett komplement till konventionell farmaka. Flera andra positiva effekter sågs såsom avslappning och förbättrad mobilitet, peristaltik och sömn samt minskad oro, hjärtrytm, andningsfrekvens och blodtryck. Förslag till fortsatt forskning kan vara att undersöka hur sjuksköterskans samtal med patient kan lindra smärta genom att på så sätt inge trygghet. Det vore också intressant att se ytterligare forskning om hur effektiv enbart smärtbehandlingsmetoden andning är.</p> / <p>Pain affects quality of life. In some pain treatment situations drugs is not enough to ease pain. The nurse has an important role when it comes to pain treatment since the choice of method may be affected by the nurse. Knowledge about complementary therapies and ability to think holistically is required by the nurse in order to provide a secure and personalized treatment. The use of distraction with complementary methods can give relaxation and consequently reduction of pain intensity. The aim was to describe the effect of breathing, massage, music and guided imagery as complementary pain treatment methods, for the nurse to use. The systematic literature review consists of 16 research articles that were examined and analyzed. The results showed that the complementary pain treatments breathing, massage, music and guided imagery gave a significant pain relief and worked, in addition, excellent as a complement to conventional drugs. Several other positive effects were seen such as relaxation and improved mobility, peristalsis and sleep and reduced heart beat, respiratory rate and blood pressure. Proposals for further research may be to examine how nurse’s dialogue with patient can alleviate pain through to evoke safety. It would also be interesting to see further research on how effective the pain treatment method respiration is on its own.</p>

Smärta påverkar livskvalitet negativt. Vid smärtbehandling uppstår ibland situationer då farmaka inte är tillräckligt för att smärtlindra. Då är sjuksköterskans roll betydelsefull eftersom valet av smärtbehandlingsmetod ofta kan påverkas av sjuksköterskan. Kunskap om komplementära behandlingsmetoder och förmåga att tänka holistiskt krävs av sjuksköterskan för att kunna ge en trygg och individanpassad behandling. Användning av avledning med komplementära metoder kan ge avslappning och följaktligen reducering av smärtintensitet. Syftet var att beskriva effekten av andning, massage, musik och riktad visualisering som komplementära smärtbehandlingsmetoder, vilka sjuksköterskan kunde använda sig utav. Den systematiska litteraturstudien består av 16 vetenskapliga artiklar som granskades och analyserades. Resultatet visade att de komplementära smärtbehandlingsmetoderna andning, massage, musik och riktad visualisering gav en betydande smärtlindring och de fungerade dessutom utmärkt som ett komplement till konventionell farmaka. Flera andra positiva effekter sågs såsom avslappning och förbättrad mobilitet, peristaltik och sömn samt minskad oro, hjärtrytm, andningsfrekvens och blodtryck. Förslag till fortsatt forskning kan vara att undersöka hur sjuksköterskans samtal med patient kan lindra smärta genom att på så sätt inge trygghet. Det vore också intressant att se ytterligare forskning om hur effektiv enbart smärtbehandlingsmetoden andning är. / Pain affects quality of life. In some pain treatment situations drugs is not enough to ease pain. The nurse has an important role when it comes to pain treatment since the choice of method may be affected by the nurse. Knowledge about complementary therapies and ability to think holistically is required by the nurse in order to provide a secure and personalized treatment. The use of distraction with complementary methods can give relaxation and consequently reduction of pain intensity. The aim was to describe the effect of breathing, massage, music and guided imagery as complementary pain treatment methods, for the nurse to use. The systematic literature review consists of 16 research articles that were examined and analyzed. The results showed that the complementary pain treatments breathing, massage, music and guided imagery gave a significant pain relief and worked, in addition, excellent as a complement to conventional drugs. Several other positive effects were seen such as relaxation and improved mobility, peristalsis and sleep and reduced heart beat, respiratory rate and blood pressure. Proposals for further research may be to examine how nurse’s dialogue with patient can alleviate pain through to evoke safety. It would also be interesting to see further research on how effective the pain treatment method respiration is on its own.

Due to technologic breakthroughs, neonatal intensive care units (NICU) are caring for sicker and tinier clients. However, personal beliefs and attitudes about neonatal pain have not kept up with the times. The purpose of this study was to explore knowledge and attitudes of NICU RNs regarding the assessment and management of neonatal pain. The theoretical framework for this study was Travelbee's Human-to-Human Relationship Theory. The sample was drawn from a mailing list obtained from the Central Indiana chapter of the National Association of Neonatal Nurses. Thirty nurses completed the study's tool, Use of Drugs for Pain and Agitation Survey of NICU's Questionnaire. Statistical analysis included frequencies and percentages. Results revealed that there was consistent agreement among nurses regarding the belief that neonates do feel pain and that pain assessment and management is different for neonates as compared to adults. Implications are discussed in relation to improvement in nursing practice and to nursing education. / School of Nursing