<p><p><strong>Syfte:</strong> Syftet med denna studie är att bland patienter med långvarig smärta, som är remitterade till en smärtmottagning, undersöka förväntningar avseende det första besöket, i vilken utsträckning patienterna anser att dessa uppfylldes samt att undersöka vilka förväntningar patienterna har på den fortsatta vården och kontakten med Smärtmottagningen. <strong>Metod:</strong> En empirisk studie med kvalitativ deduktiv ansats. Datainsamling skedde genom att tio personer intervjuades på Smärtmottagningen efter deras första besök. Materialet bearbetades med manifest innehållsanalys.<strong> Resultat:</strong> Patienter vid Smärtmottagningen hade i olika stor utsträckning förväntningar inför det första besöket och den fortsatta vården. Patienterna ansåg i varierande utsträckning att deras förväntningar på det första besöket hade uppfyllts, dock uttryckte alla patienter att minst någon förväntning uppfyllts. Gällande den fortsatta vården förväntade sig patienterna bland annat smärtlindring, stöd samt att upprätta en kontakt med Smärtmottagningen. <strong>Slutsats:</strong> Patienter vid en smärtmottagning har förväntningar på vården och att känna till dessa kan underlätta mötet med patienten för sjukvårdspersonalen. Föreliggande studie ger en inblick i tio patienters förväntningar och huruvida de blivit uppfyllda och tyder på att det är av värde att fråga patienter om deras förväntningar. Detta är något som smärtmottagningar kan överväga att implementera i vården.</p></p> / <p><p><strong>Aim:</strong> The aim of this study was to investigate expectations on the first appointment among patients with chronic pain referred to an outpatient pain clinic. The aim was also to investigate to which extent the expectations on the first appointment were fulfilled and to investigate the patients’ expectations on the continuing care and contact with the outpatient pain clinic.<strong> Method: </strong>An empirical study with qualitative design was used. The data was collected through interviews with ten patients after their first appointment at the clinic. Data was processed using manifest content analysis.<strong> Result:</strong> The patients had expectations in various extents prior to their first appointment and on the further care. The patients thought that their expectations were fulfilled to various extent, however all patients expressed that at least one expectation had been fulfilled. Regarding the continuing care the patients expected, among other things, to receive functioning pain treatment and support as well as to establish a contact with the outpatient pain clinic.<strong> Conclusion:</strong> Patients have expectations and awareness of these among the medical staff might facilitate the meeting between the medical staff and the patient. This study provides an insight in ten patients’ expectations and to which extent they have been fulfilled. The study also suggests that it would be of value to ask patients about their expectations, which outpatient pain clinics can consider implementing.</p></p>

Syfte: Syftet med denna studie är att bland patienter med långvarig smärta, som är remitterade till en smärtmottagning, undersöka förväntningar avseende det första besöket, i vilken utsträckning patienterna anser att dessa uppfylldes samt att undersöka vilka förväntningar patienterna har på den fortsatta vården och kontakten med Smärtmottagningen. Metod: En empirisk studie med kvalitativ deduktiv ansats. Datainsamling skedde genom att tio personer intervjuades på Smärtmottagningen efter deras första besök. Materialet bearbetades med manifest innehållsanalys. Resultat: Patienter vid Smärtmottagningen hade i olika stor utsträckning förväntningar inför det första besöket och den fortsatta vården. Patienterna ansåg i varierande utsträckning att deras förväntningar på det första besöket hade uppfyllts, dock uttryckte alla patienter att minst någon förväntning uppfyllts. Gällande den fortsatta vården förväntade sig patienterna bland annat smärtlindring, stöd samt att upprätta en kontakt med Smärtmottagningen. Slutsats: Patienter vid en smärtmottagning har förväntningar på vården och att känna till dessa kan underlätta mötet med patienten för sjukvårdspersonalen. Föreliggande studie ger en inblick i tio patienters förväntningar och huruvida de blivit uppfyllda och tyder på att det är av värde att fråga patienter om deras förväntningar. Detta är något som smärtmottagningar kan överväga att implementera i vården. / Aim: The aim of this study was to investigate expectations on the first appointment among patients with chronic pain referred to an outpatient pain clinic. The aim was also to investigate to which extent the expectations on the first appointment were fulfilled and to investigate the patients’ expectations on the continuing care and contact with the outpatient pain clinic. Method: An empirical study with qualitative design was used. The data was collected through interviews with ten patients after their first appointment at the clinic. Data was processed using manifest content analysis. Result: The patients had expectations in various extents prior to their first appointment and on the further care. The patients thought that their expectations were fulfilled to various extent, however all patients expressed that at least one expectation had been fulfilled. Regarding the continuing care the patients expected, among other things, to receive functioning pain treatment and support as well as to establish a contact with the outpatient pain clinic. Conclusion: Patients have expectations and awareness of these among the medical staff might facilitate the meeting between the medical staff and the patient. This study provides an insight in ten patients’ expectations and to which extent they have been fulfilled. The study also suggests that it would be of value to ask patients about their expectations, which outpatient pain clinics can consider implementing.

Darbo tikslas: Įvertinti skausmo klinikų teikiamų paslaugų prieinamumą ir pasitenkinimą pacientų požiūriu. Tyrimo metodika: Tyrimas buvo atliktas Vilniaus, Kauno, Šiaulių ir Alytaus skausmo klinikose. Tyrimas vyko 2013 gegužės – 2013 gruodžio mėnesiais. Tyrimo metu atlikta anoniminė anketinė pacientų apklausa. Statistinei analizei tinkamos grįžo 363 anketos. Atsako dažnis 95,5 proc. Statistinė tyrimo duomenų analizė atlikta SPSS 17.0 programa ir Excel 2007 programa. Rezultatai: Didžioji dalis pacientų (73,3 proc.), norėdami pasiekti artimiausią skausmo kliniką užtrunka mažiau, nei vieną valandą. Vizito pas skausmo klinikų specialistus 44,6 proc. respondentų laukė 2-4 savaites, tačiau 15,4 proc. pacientų turėjo laukti ilgiau kaip mėnesį. Atvykus konsultuotis, beveik ketvirtadaliui (23,7 proc.) konsultacija vėlavo iki 30 minučių, o 7,7 proc. už durų laukė ilgiau nei pusvalandį. Pati dažniausia problema respondentams norint pasiekti skausmo klinikas buvo sveikatos būklė. Beveik pusė tyrimo dalyvių (48,8 proc.) liko labai patenkinti, o daugiau kaip trečdalis (39,1 proc.) – patenkinti skausmo klinikų paslaugomis. Nepatenkintų skausmo klinikų paslaugomis nebuvo. Visi tyrimo dalyviai teigiamai įvertino skausmo klinikų specialistų kompetenciją ir gydymo kokybę. Labiausiai patenkinti buvo gydytojo onkologo siųsti pacientai. Kuo trumpesnis laikas nuo registracijos iki vizito pas gydytoją, ar pas gydytoją patenkama paskirtu laiku, bei trumpiau laukiama eilėje prie kabineto, tuo... [toliau žr. visą tekstą] / Aim: To evaluate the pain clinics‘ provided services in terms of the accessibility and satisfaction in patients‘ opinion. Methods: The study was carried out in Vilnius, Kaunas, Siauliai and Alytus pain clinics. The study took place in May 2013 - December 2013. The study carried out an anonymous questionnaire survey of patients. For statistical analysis returned 363 suitable questionnaires. The response rate was 95.5 percent. Statistical data analysis was performed using SPSS 17.0 and Excel 2007 programs. Results: To reach the nearest pain clinic for the majority of patients (73.3 percent) takes less than one hour. For a visit to the pain clinic 44.6 percent of respondents waited for 2-4 weeks, but 15.4 percent of patients had to wait longer than a month. Upon arrival to consult, for almost a quarter (23.7 percent) of patients consultation was delayed for up to 30 minutes, and 7.7 percent of patients waited outside the door for more than half an hour. The most common problem for respondents to arrive to pain clinics was the state of health. Almost half of the survey participants (48.8 percent) were very pleased , and more than one-third (39.1 percent) were pleased with pain clinics‘ services. There was no discontentment with the services of pain clinics. All study participants positively evaluated the pain clinics‘ specialists‘ competence and quality of care. Most satisfied were patients sent by an oncologist. The shorter the time from registration to the doctor‘s visit, or... [to full text]

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-07-14T20:44:56Z No. of bitstreams: 1 TESE. Aline Palmeira. 2015.pdf: 1570086 bytes, checksum: da9d5e8fa41e091ee9d3f8fbc8ddcd3d (MD5) / Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-07-14T20:45:40Z (GMT) No. of bitstreams: 1 TESE. Aline Palmeira. 2015.pdf: 1570086 bytes, checksum: da9d5e8fa41e091ee9d3f8fbc8ddcd3d (MD5) / Made available in DSpace on 2015-07-14T20:45:40Z (GMT). No. of bitstreams: 1 TESE. Aline Palmeira. 2015.pdf: 1570086 bytes, checksum: da9d5e8fa41e091ee9d3f8fbc8ddcd3d (MD5) / A dor crônica é considerada um problema de saúde pública pelas inúmeras repercussões que traz para a vida de quem adoece e por seus impactos na sociedade. Os avanços no seu estudo têm confirmado que a dor é um fenômeno de interface entre a biologia e a cultura, configurando-se como um desafio para as ciências médicas, assim como para os estudos em ciências humanas. As pesquisas nesse campo apontam para a multiplicidade de enfoques possíveis no estudo da dor e investigações, cujo foco está naqueles que adoecem, têm favorecido a compreensão desse fenômeno no que diz respeito às inúmeras repercussões que a dor possui para aqueles que adoecem e seu grupo social, assim como chamam atenção para a presença da deslegitimação da dor sentida, para a invisibilidade desse adoecimento e para a dificuldade na construção de sentidos e significados para a dor, para além dos propostos pela Medicina. No Brasil, poucos estudos na perspectiva das Ciências Sociais em Saúde têm sido realizados com o foco nas pessoas que adoeceram por dor crônica e, diante da importância de compreender o que acontece com essas pessoas no contexto da assistência em saúde, buscou-se analisar nesta tese a experiência de dor crônica, ao longo de um determinado período, de pessoas que iniciavam o seu acompanhamento em um serviço especializado no tratamento da dor. A perspectiva longitudinal apresentou-se como importante neste trabalho, ao se considerar os avanços que estudos desse tipo têm proporcionado nas Ciências Sociais e por possibilitar o acompanhamento da organização da experiência de enfermidade a partir da interação com o serviço em questão. Foram realizadas entrevistas narrativas com 11 pessoas que iniciavam o seu tratamento para dor no serviço especializado e um ano após esse acompanhamento. Entre a realização das entrevistas desses dois momentos, foi realizada observação participante e utilizado o registro no diário de campo. A interpretação das narrativas foi baseada na Teoria da Interpretação de Paul Ricoeur, estabelecendo-se uma relação com o texto produzido a partir dos conceitos de distanciação, apropriação, explicação e compreensão. O diário de campo contribuiu com informações que não estivessem presentes nas narrativas, assim como com eventos que ocorreram na situação de interação do participante com a Instituição. Diante da análise dos dados, foram organizados três artigos empíricos, com objetivos distintos, porém complementares. O primeiro artigo teve o objetivo de compreender, transversalmente, a experiência de enfermidade dos participantes que iniciavam o seu acompanhamento no serviço especializado. Entre os principais resultados têm-se a importância da significação da dor na vida de quem adoeceu e o reconhecimento do sofrimento advindo dessa vida com dor, seja pelas mudanças que ela causa (que fazem refletir acerca do valor da vida com dor), seja pela presença da deslegitimação constante do vivido, nas diversas esferas sociais. O segundo artigo teve como objetivo aprofundar a discussão sobre a experiência de enfermidade e sua relação com as expectativas das pessoas frente ao novo tratamento que seria iniciado, ainda em uma abordagem transversal. Os principais achados relacionam-se à importância da relação entre a experiência de dor e a organização das expectativas; ao destaque que a diminuição da intensidade da dor tem, mas que organiza-se em torno da expectativa de cura ou de alívio do sofrimento trazido pela dor; e às diferenças entre o que os participantes esperam encontrar em uma clínica de dor e o que a literatura aponta como possíveis objetivos das clínicas de dor. O último artigo refere-se à experiência de enfermidade dos participantes, na abordagem longitudinal, tendo, como um elemento importante da análise, a interação com o Serviço. Os resultados apontam para a mudança em diversos aspectos na experiência de dor dos participantes, a partir da interação com o Serviço e para a possibilidade de permanência ou desvinculação do tratamento a partir da experiência de dor e da interação ocorrida durante o período analisado. Novos estudos que se dediquem a essa temática, nas Ciências Sociais, tornam-se necessários, tendo em vista as possibilidades de análise por meio do conceito de experiência de enfermidade, pelo reconhecimento das repercussões, do sofrimento e da incomunicabilidade da dor na vida de quem adoeceu, e pelos impactos que um tratamento específico, em uma clínica de dor podem ter para quem tem dor crônica.

Older adults (65+) are one of the fastest growing segments of the population in the United States. Chronic pain is common among this population, and chronic low back pain (CLBP) in particular is the number one pain complaint among older adults. In addition to larger societal and fiscal costs, CLBP is associated with a host of personal negative consequences such as physical disability, poor psychosocial functioning, and decreased quality of life. Despite being a leading health problem in older adulthood, little is known about how older adults actually experience this type of pain. Thus, the purpose of this dissertation was to understand older adults’ lived experience of CLBP. To improve understanding of CLBP in this understudied population, a qualitative study using a phenomenological method was conducted. Phenomenology, rooted in existential philosophy, is the study of the nature and meanings of phenomena, in which experiences related to the phenomena are the main source of insight. van Manen’s Phenomenology of Practice method specifically guided the investigation with regard to study conception, data collection, and data analysis. Participants were 21 older pain clinic patients living with CLBP who engaged in one-on-one in-depth interviews. Findings suggest that CLBP is an all-encompassing presence in participants’ lives. Seven main themes include: (1) Living a life full of pain; (2) Pain affects everything; (3) With others but a lone in my pain; (4) With pain comes sorrow; (5) Aging painfully; (6) Managing the incurable; (7) You just have to keep going. Implications for social work practice, research, and policy are discussed. By building a deeper understanding of older adult’s experiences and personal meaning of CLBP, social workers may be more able to provide meaningful and effective psychosocial services in the context of interdisciplinary CLBP management.

Background Neuropathic pain (NP), defined as pain caused by a lesion or disease of the somatosensory system, affects 6.9 – 10 % of people worldwide. Pregabalin is currently recommended as a first line drug for NP in South Africa. Methods A cross-sectional retrospective descriptive medicines usage evaluation (MUE) of Pregabalin at Groote Schuur Chronic Pain clinic for the year 2017 was conducted. A MUE using a standardized data collection form was performed on 100 randomly selected folders. Data are summarized using descriptive statistics. Results The majority of cases were women (76) with a mean age of 55.9y (SD12.49). A diagnosis of NP was recorded in 58 folders and a “possible” diagnosis recorded in 7 folders. In 79 cases there was no mention of a tool/method used to diagnose NP. The most common condition diagnosed was chronic post-surgical pain with a neuropathic component (n=16), followed by NP (n=15). The most common initiating and current dose of Pregabalin was 75mg twice daily. In 56 patients, Pregabalin was prescribed in conjunction with a tricyclic antidepressant (TCA) or selective noradrenaline reuptake inhibitor (SNRI). Patient education was documented as having taken place in 76 of cases. Conclusions Based on this MUE we recommend the use of screening tools for the diagnosis of neuropathic pain, and a focus on the initiating dose of Pregabalin. The use of a standardized assessment document and the interdisciplinary team input at this clinic appears to optimize prescribing of Pregabalin in line with practice guidelines.

Chronic pain is common and a burden for both the individual and society. In chronic pain, the pain has lost its function as a warning system and instead has become a disease in itself. Neurobiologically, several areas of the brain are involved, but to gain a broader understanding of the long-term pain, the biopsychosocial model is the best starting point. In line with thisand many scientific studies since the late 90's, psychological factors have proven to be an important factor in the development and maintenance of chronic pain. Interdisciplinary multimodal rehabilitation programs (IMMRP) are the treatment currently given to patients with long-term pain in the specialized pain rehabilitation. When the IMMRP has been reviewed, patients have shown improvement over time, but it is not possible to say whether it is the IMMRP or which parts of the IMMRP that explain the improvement (1). In this licentiate thesis, I have studied the importance of psychological factors in the rehabilitation of patients with chronic pain. This has been done in three studies reported in three published articles. All the studies have been close to the clinic and have been performed on patients in the specialized pain rehabilitation care in Sweden. The first article studied the effect of the multimodal investigation (MMI). More specifically, it was investigated whether alliance building and feelings of validation in patients with chronic pain affected their acceptance of pain, pain management, catastrophic thoughts, and depression. This was performed in a "single case" study on six patients in MMI. The results showed that despite good alliance and sense of validation, acceptance increased only in one patient and no improvement was seen in pain management, catastrophizing, and depression. In study two, subgroups of patients with chronic pain were studied. The subgroup analysis showed that patients referred for IMMRP could be divided into groups with different profiles regarding emotional problems and pain avoidance. These profiles were important for how the patients relatedto their pain and the results of IMMRP. The results of the study can increase the understanding of which patients should be selected for IMMRP and how the treatment can be adapted to the patients' needs. In study three, opioid treatment in patients with long-term pain who were referred to IMMRP was studied. The result showed that opioid prescribing was common and 55% of the participants received at least one prescription for opioids during the two years after the first assessment. It also turns out that there was a connection between individual patient characteristics (especially pain and depressive symptoms) and opioid prescription. Understanding how individual patient characteristics relate to prescribing patterns and long-term opioid use is an important prerequisite for managing opioid prescribing and the basics for preventing overuse. Overall, this licentiate thesis shows that MMU has no therapeutic effect on patients with long-term pain. It also shows that patients with chronic pain are a heterogeneous group that can be divided into subgroups based on psychological characteristics. The subgroups, in turn, had different ways of managing their pain and absorbing the treatment offered. In addition, it emerged that opioid prescribing was common among patients with long-term pain and that there was a link between opioids and patient characteristics.