Bakgrund: Långvarig smärta är ett stort problem världen över. Egenvård är en viktig faktor för hanteringen av smärta för att uppnå livskvalitet. Syfte: Syftet var att undersöka patienters upplevelse av att leva med och hantera den långvariga smärtan i det dagliga livet. Metod: En allmän litteraturöversikt baserad på 15 kvalitativa artiklar, analyserade med en innehållsanalys med en manifest ansats. Resultat: Acceptans upplevdes vara det första steget mot hanteringen av smärta. Att leva med långvarig smärta upplevdes påverka både fysiska och psykiska aspekter. Genom att utöva egenvård upplevdes hanteringen av den långvariga smärtan underlätta. Patienterna upplevde ett behov av stöd från familj, vänner och hälso-och sjukvård. Diskussion: Upplevelsen av att leva med långvarig smärta i det dagliga livet varierade och det fanns både positiva och negativa erfarenheter. Slutsats: Hanteringen av smärta visade sig vara en pågående process. Om sjuksköterskan har kunskap och kompetens om hur patienterna upplever sitt långvariga tillstånd så kan det vara lättare att förstå och vägleda dessa patienter. Det ger en kunskap om hur patienterna kan uppleva smärt situationen och hanteringen av smärtan. / Background: Chronic pain is a major problem worldwide. Self-care is an important factor when it comes to managing pain to achieve quality of life. Aim: The purpose was to investigate patients' experience of living with and manage the chronic pain of daily life. Method: A general literature review based on 15 qualitative articles, analyzed with a qualitative content analysis with a manifest approach. Result: Acceptance was perceived to be the first step towards the management of pain. Living with long-term pain was felt to affect both physical and mental aspects. By practicing self-care, the management of the chronic pain was made easier. Patients experienced a need for support from family, friends and healthcare. Discussion: The experience of living with chronic pain in daily life varied and there were both positive and negative experiences. Conclusion: The management of pain proved to be an ongoing process. If the nurse has knowledge and skills about how patients experience their chronic condition, it may be easier to understand and guide these patients. It provides a knowledge of how patients can experience the pain situation and the management of pain. / <p>Examinationsdatum: 2019-12-04</p>

The main criteria for managing good postoperative care include the effective and appropriate choice of pain therapy. Experiencing pain is a purely individual feeling for each of us, so it is very important to have adequate and sufficient analgesia during this period. Modern management of post-operative pain therapy uses preparations of various pharmacological groups that potentiate and thereby more effectively reduce pain. By this mechanism, we can reduce the total dose of analgesics given, and more particularly, reduce the dose of opioids that have a higher risk of side effects. In this project i want to show how the analgesic catheter could be useful as alternative possibility in algorithm therapy of postoperative pain. Analgesic catheter enable continual local anesthetics administration, exactly 0,5% bupivacaine, which is operating in surgical wound. Main goal of the study is to find out and verify if analgesic catheter is method which provides continual analgesia strong enough to results in lower use of opioids. The research data will be determined by quantitative research using a questionnaire survey. Non standardized self-production questionnaire. will be given in a paper form to non-medical healthcare staff, who perform nursing activities The spectrum of patients is very specific; they are...

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Bakgrund: Ben- och fotsår förutses öka i världen då människor lever längre. Sårsmärta är vanligt förekommande hos patienter som har svårläkta ben- och fotsår och kan behandlas på olika sätt. Distriktssköterskor inom hemsjukvården har ett komplext ansvar för dessa patienter.  Syfte: Syftet med studien var att beskriva distriktssköterskors erfarenheter av smärtbehandling till patienter med svårläkta ben- och fotsår inom hemsjukvården. Metod: Tre hemsjukvårdsenheter med total 14 deltagare intervjuades. Intervjuarna har genomförts i en kommun i södra Sverige och analyserats enligt Graneheim och Lundmans innehållsanalys med manifest ansats.  Resultat: Resultatet presenteras i tre kategorier: Kompetens påverkar möjlighet till smärtbedömning i hemmet, Vikten av tillämpning av olika strategier för smärtbehandling i hemmet och Organisatoriska behov i hemsjukvården. Det framkom att distriktssköterskors kompetens påverkade bedömning av sårsmärta i hemmet. Distriktssköterskorna använde olika strategier för smärtbehandling vid ben- och fotsår. De påtalade även vikten av att ha rätt organisatoriska förutsättningar för att kunna bedriva en säker vård i patienternas hem. Slutsats: Vid smärtbedömning behövs bland annat användning av smärtskattningsinstrument. Distriktssköterskor behöver ha kunskap och möjlighet att använda olika behandlingsstrategier för smärtlindring. Det behövs även tydliga rutiner och gemensamma riktlinjer i arbetet med smärta vid svårläkta ben- och fotsår inom hemsjukvården. / Background: Leg and foot ulcers are expected to increase in the world as people live longer. Ulcer pain is common in patients who have difficult-to-heal leg and foot ulcers and can be treated in different ways. District nurses in home care service have a complex responsibility for these patients. Aim: The aim of the study was to describe district nurses' experiences of pain management for patients with difficult-to-heal leg and foot ulcers in home care service. Method: Three home care service units with a total of 14 participants were interviewed. The interviews were conducted in a municipality in southern Sweden and analyzed according to Graneheim and Lundman's content analysis with a manifest approach. Results: The results are presented in three categories: Competence affect the possibility of pain assessment at home, The importance of applying different strategies for pain management at home and Organizational needs in home care service. It was found that the competence of district nurses influenced the assessment of wound pain in patients' homes. The district nurses used different strategies for pain management of leg and foot ulcers. They also emphasized the importance of having the right organizational conditions to be able to provide safe care in patients' homes. Conclusion: When assessing pain, the use of pain assessment instruments is required, among other things. District nurses need to have the knowledge and ability to use different treatment strategies for pain relief. There is also a need of clear routines and common guidelines in the work with pain in difficult-to-heal leg and foot ulcers in home care service.

L’évaluation de la douleur chez le chat est souvent un défi en raison de leur nature discrète et les changements de comportement potentiels dans des situations inhabituelles et stressantes, telles que l'environnement vétérinaire. Différents outils d’évaluation de la douleur (c.-à.-d. des échelles de douleur) basés sur l'observation des comportements ont été proposés pour les chats; cependant, la majorité de ces outils manque de tests de validité, de fiabilité et/ou de généralisabilité. De plus, les échelles de douleur sont peu utilisées dans la pratique clinique. Des outils simples, pratiques et fiables tels que les échelles de grimace (instruments d'évaluation de la douleur basés sur l'expression faciale), ont le potentiel de changer ce scénario. Elles ont été développées pour plusieurs espèces, excluant le chat. L'objectif général de cette thèse était de développer un nouvel instrument basé sur l'expression faciale pour l'évaluation de la douleur aiguë chez les chats, la « Feline Grimace Scale » (FGS) et d'explorer ses applications et ses limitations. Nos hypothèses étaient que la FGS permettrait l’identification de la douleur chez les chats avec précision (dans différentes conditions telles que la douleur d’origine naturelle et postopératoire); elle serait valide et fiable (parmi différents évaluateurs); elle serait capable de détecter la réponse aux analgésiques; et finalement, elle pourrait être appliquée en temps réel dans le contexte clinique. La FGS a été développée et validée en utilisant une approche psychométrique pour détecter la douleur aiguë chez les chats. Cette échelle discriminait entre les chats en douleur de ceux qui ne le sont pas; détectait la réponse à différents analgésiques; et corrélait fortement avec un autre système de notation de la douleur. Une bonne fiabilité inter et intra-observateur a été démontrée, non seulement parmi les vétérinaires, mais aussi parmi les propriétaires de chats, les étudiants vétérinaires et les techniciens en santé animale. L’utilisation de la FGS en temps réel était aussi réalisable. D’autre part, nos résultats suggèrent que le genre de l'évaluateur influencerait l'évaluation de la douleur, car les évaluatrices attribuaient des scores plus élevés que les évaluateurs. La FGS est un outil valide, fiable et pratique pour l'utilisation potentielle en recherche ou en clinique; en temps réel ou par l’évaluation des images. Elle pourrait être aussi applicable dans une large gamme de conditions douloureuses et par des évaluateurs avec différents niveaux d'expertise, et potentiellement aussi à la maison (par les propriétaires de chats). Cela représente un progrès substantiel dans l’identification et la gestion de la douleur féline, vers les plus hautes exigences en matière de soins vétérinaires. / Pain assessment in cats is challenging due to a number of reasons, including their discrete nature and potential behavioral changes in unfamiliar and stressful situations, such as the veterinary environment. Different pain assessing instruments (i.e. pain scales) that rely on the observation of behaviors have been proposed for cats; however, the majority lack validity, reliability and/or generalizability testing. Additionally, the adherence to their use in clinical practice is low and warrants improvement. Simple, practical and reliable tools such as grimace scales (facial expression-based pain assessment instruments), have the potential of changing this scenario. They have been developed for several species, among which the cat was not included. The overall aim of this thesis was to develop a novel facial expression-based instrument for acute pain assessment in cats, the Feline Grimace Scale (FGS) and to explore its applications and limitations. Our hypotheses were that the FGS would be able to accurately identify pain in cats (in different conditions such as naturally-occurring or spontaneous and postoperative pain); it would be valid and reliable (among different raters); it would be able to detect the response to analgesics; and its application in real-time in the clinical context would be feasible. The FGS was developed and validated using a comprehensive psychometric approach to detect acute pain in cats. It has demonstrated a high discriminative ability between painful and non-painful cats; it is capable of detecting the response to different analgesic drugs and it is strongly correlated with another pain scoring system. Furthermore, it demonstrated good inter- and intra-rater reliability, not only among veterinarians, but also among cat owners, veterinary students and nurses (technicians). Real-time scoring using the FGS was proven feasible. On the other hand, our results suggested that the rater gender may influence pain assessment, as female raters assigned higher scores than males. The FGS is a valid, reliable and practical tool potentially for both research and clinical use in real-time or using image assessment; that may be applicable in a wide range of painful conditions, by raters with different degree of expertise, and potentially at home (by cat owners). This represents a substantial progress in feline pain management, towards the highest standards in veterinary care.

Background: Dipyrone (metamizole) is one of the most widely used non-opioid analgesics for the treatment of cancer pain. Aim: Because evidence-based recommendations are not yet available, a systematic review was conducted for the German Guideline Program in Oncology to provide recommendations for the use of dipyrone in cancer pain. Design: First, a systematic review for clinical trials assessing dipyrone in adult patients with cancer pain was conducted. Endpoints were pain intensity, opioid-sparing effects, safety, and quality of life. Data sources: The search was performed in MedLine, Embase (via Ovid), and the Cochrane Library (1948–2013) and additional hand search was conducted. Finally, recommendations were developed and agreed in a formal structured consensus process by 53 representatives of scientific medical societies and 49 experts. Results: Of 177 retrieved studies, 4 could be included (3 randomized controlled trials and 1 cohort study, n = 252 patients): dipyrone significantly decreased pain intensity compared to placebo, even if low doses (1.5–2 g/day) were used. Higher doses (3 × 2 g/day) were more effective than low doses (3 × 1 g/day), but equally effective as 60 mg oral morphine/day. Pain reduction of dipyrone and non-steroidal anti-inflammatory drugs did not differ significantly. Compared to placebo, non-steroidal anti-inflammatory drugs, and morphine, the incidence of adverse effects was not increased. Conclusion: Dipyrone can be recommended for the treatment of cancer pain as an alternative to other non-opioids either alone or in combination with opioids. It can be preferred over non-steroidal anti-inflammatory drugs due to the presumably favorable side effect profile in long-term use, but comparative studies are not available for long-term use.

Background: Pain related to cancer is the biggest problem for patients with this diagnosis. Every year, many suffering cancer patients die without adequate pain relief. Although, there are international guidelines from the World Health Organization (WHO) for pain relief in cancer-related pain, they are not followed in all countries, leading to global inequality. Aim: The aim of the study was to shed light on patients' experiences of cancer-related pain and its pain-relief from a global perspective. Method: A general literature study was conducted using content analysis of 12 scientific articles including both qualitative and quantitative research methodology. Results: During the content analysis, four main categories emerged: “Quality of life”, “Caregiver - Patient”, “Knowledge” and “Socio-economic factors”. Among the factors that affect pain-relief, access to medicines, information, knowledge, fear of side effects and addiction, patients' cultural and religious background have the greatest impact. Conclusion: A large difference in access to medicines and care is demonstrated around the world, which makes a difference in patients' experiences. There is a need for guidelines on pain-relief in cancer-related pain and continuous information about them at a local level. In addition, all countries are required to adhere to and follow international guidelines to improve cancer-related pain-relief, which can reduce inequality in care and suffering around the world. / Bakgrund: Smärta relaterad till cancer är det största problemet för patienter med denna diagnos. Varje år dör många lidande cancerpatienter utan en adekvat smärtlindring. Trots att det finnsmediinternationella riktlinjer från World Health Organisation (WHO) för smärtlindring vid cancerrelaterad smärta följs inte de i alla länder vilket leder till den globalaojämlikheten. Syfte: Syftet med studien var att belysa patientersupplevelser av cancerrelaterad smärta och dess smärtlindring ur det globala perspektivet. Metod: En allmän litteraturstudie genomfördes med hjälp av innehållsanalys av 12 vetenskapliga artiklarinnefattande bådekvalitativ ochkvantitativ forskningsmetodik. Resultat: Under innehållsanalys framkom det fyra huvudkategorier: “Livskvalitet”, “Vårdgivare -Patient”, “Kunskap” och “Socioekonomiska faktorer”. Bland faktorer som påverkar smärtlindring hartillgång till läkemedel, information, kunskap, rädsla för biverkningar och beroende, patienters kulturella samt religiösa bakgrundden största inverkan. Slutsats: Stor skillnad på tillgång till läkemedel och vård påvisas runt om i världenvilket ger skillnad på patienters upplevelser. Det föreligger behov av riktlinjer om smärtlindring vid cancerrelaterad smärta och kontinuerlig information om dem på lokal nivå. Dessutom krävs det att alla länder ska förhålla sig och följa de internationella riktlinjerna för att förbättra cancerrelaterad smärtlindring vilket kan minska ojämlikhet i vården och lidandet runt om i världen.

Indiana University-Purdue University Indianapolis (IUPUI) / Pharmacogenetic testing has the potential to improve pain management through addressing wide interindividual variations in responses to pharmacogenetically actionable opioids, ultimately decreasing costly adverse drug effects and improving responses to these medications. A recent review of pharmacogenomics in the nursing literature highlighted the need for nurses to more fully embrace the burgeoning field of pharmacogenomics in nursing research, clinical practice, and education. Despite the promise of pharmacogenetic testing, significant challenges exist for evaluating outcomes related to its implementation, including oversimplification of medication exposure, the complexity of patients' clinical profiles, and the characteristics of healthcare contexts in which medications are prescribed. A better understanding of these challenges could enhance the assessment and documentation of the benefits of pharmacogenetic testing in guiding opioid therapies. This dissertation is intended to address the challenges of evaluating outcomes of pharmacogenetic testing implementation and the need for nurses to lead pharmacogenomic-related research. The dissertation purpose was to advance the sciences of nursing, pain management, and pharmacogenomics through the development of a typology of common patterns of medication exposure to known pharmacogenetically actionable opioids (codeine &amp; tramadol). A qualitative, person-oriented approach was used to retrospectively analyze six months of electronic health record and pharmacogenotype data in 30 underserved adult patients. An overarching typology with eight groups of patients that had one of five opioid prescription patterns (singular, episodic, switching, sustained, or multiplex) and one of three types of medical emphasis of care (pain, comorbidities, or both) were identified. This typology consisted of a description of multiple common patterns that compare and contrast salient factors of exposure and the emphasis of why individuals were seeking care. Furthermore, in an aggregate descriptive analysis evaluating key clinical profile factors, these patients had complex medical histories, extensive healthcare utilization, and experienced significant polypharmacy. These findings can aid in addressing challenges related to the implementation of pharmacogenetic testing in clinical practice and point to ways in which nurses can take the lead in pharmacogenomics research. Findings also provide a foundation for future studies aimed at developing medication exposure measures to capture its dynamic nature and identifying and tailoring interventions in this population.

Introduktion: Långvarig smärta påverkar uppemot 30% av världens befolkning och tar upp stora resurser inom hälso- och sjukvården. Långvarig smärta påverkar individen på flera nivåer där biopsykosociala interventioner har visat sig vara mest effektiva vid behandling. Det finns dock brist på insatser som kan användas i primärvården.  Syfte: Att utforska hur personer med långvarig smärta har upplevt rehabiliteringsprocessen i ett gruppträningskoncept i primärvård som kombinerar både psykologiska och fysioterapeutiska metoder.  Metod: Semistrukturerade intervjuer gjordes med elva deltagare (kvinnor 51-68 år) som deltagit i gruppträningen de senaste sex månaderna relaterat till långvarig smärta med eller utan samsjuklighet. Urvalet var strategiskt och analys gjordes med grundad teori enligt Charmaz.  Resultat: Analysen genererade en teoretisk modell och fem kategorier. Huvudkategorin – lära sig nya sätt att leva med smärta – en förändringsprocess i trygg miljö, illustrera genom tre olika sammanhang som har haft betydelse för deltagarnas rehabiliteringsprocess, 1) ett inre cirkulärt sammanhang, 2) vårdmiljön och 3) friskvården och sociokulturella sammanhanget.  Slutsats: Studien tillhandahåller en ökad förståelse för hur en rehabiliteringsprocess upplevs av personer med långvarig smärta som deltagit i ett gruppträningskoncept i primärvården. Studien belyser vårdens roll i att stödja och inge trygghet för att främja en förändringsprocessen. Studien uppmärksammar även hur psykosociala faktorer kan hindra personer med långvarig smärta från att upprätthålla motivation till att träna och ta sig ut till friskvården på egen hand. Framtida studier behövs som studerar gruppträningen i relation till andra behandlingsinterventioner. / Introduction: Chronic pain affects up to 30% of the world’s population and takes up large resources in healthcare. Chronic pain affects the individual on several levels where biopsychosocial interventions have been shown to be most effective in treatment. However, there is a lack of interventions that can be used in primary healthcare.  Aim: To explore how people with chronic pain have experienced the rehabilitation process in a group training concept in primary healthcare that combines both psychological and physiotherapeutic methods.  Method: Semi-structured interviews were conducted with eleven participants (women 51-68 years) who had participated in the group training related to chronic pain with or without comorbidity. The selection was strategic and analysis was done with grounded theory according to Charmaz.  Results: The analysis generated a theoretical model and five categories. The core category – learning new ways of livning with pain – a change process in safe environment, is illustrated through three different contexts that have been important for the participants’ rehabilitation process, 1) an inner circular context, 2) the health care context and 3) the wellness and socio-cultural context.  Conclusion: The study provides an increased understanding of how a rehabilitation process is experienced by people with chronic pain. It highlights the role of health care in supporting a change process and it draws attention to how psychosocial factors can prevent people with chronic pain from maintaining motivation to exercise and get out to wellness training. Future studies are needed that examine the group training in relation to other treatment interventions.

Acutely manifesting radicular pain syndromes associated with degenerations of the lower spine are frequent ailments with a high rate of recurrence. Part of the conservative management are periradicular infiltrations of analgesics and steroids. The purpose of this study is to evaluate the dependence of the clinical efficacy of CT-guided periradicular injections on the pattern of contrast distribution and to identify the best distribution pattern that is associated with the most effective pain relief. Using a prospective study design, 161 patients were included in this study, ensuring ethical standards. Statistical analysis was performed, with the level of statistical significance set at p = 0.05. A total of 37.9% of patients experienced significant but not long-lasting (four weeks on average) complete pain relief. A total of 44.1% of patients experienced prolonged, subjectively satisfying pain relief of more than four weeks to three months. A total of 18% of patients had complete and sustained relief for more than six months. A significant correlation exists between circumferential, large area contrast distribution including the zone of action between the disc and affected nerve root contrast distribution pattern with excellent pain relief. Our results support the value of CT-guided contrast injection for achieving a good efficacy, and, if necessary, indicative repositioning of the needle to ensure a circumferential distribution pattern of corticosteroids for the sufficient treatment of radicular pain in degenerative spine disease.