A factor analysis was performed on eleven variables derived from scores on the McGill Pain Questionnaire, Oswestry Activity Rating Scale, graphic rating scales designed to assess the average pain intensity, frequency of leg pain, back pain, numbness and tingling in legs, and weakness in legs, as well as bothersomeness of back pain, leg pain, numbness and tingling in legs and weakness of legs. A composite Pain Index was created on the basis of three factors: leg pain, back pain, and overall pain complaints. Extraclassificatory variables, such as negative affect including depression and anxiety, cognitions regarding health status and expectation of recovery, bodily awareness/somatization and demographic variables such as smoking or non-smoking, compensation status, litigation status, use of narcotic and non-narcotic medication, use of alcohol, and time off of work were analyzed in combination and independently in relationship to the Pain Index.

O objetivo geral deste estudo foi avaliar a dor crônica advinda de diferentes tipos de cânceres. Os objetivos específicos foram descrever as características sociais dos participantes, caracterizar a dor percebida por meio de indicadores específicos e identificar os 10 descritores de dor crônica de maior e menor atribuição conforme a percepção da amostra. Participaram do estudo 45 mulheres com câncer de mama, 45 homens com câncer de próstata e 60 indivíduos de ambos os sexos com câncer de sistema digestivo. Para a mensuração da dor foram utilizados os 50 descritores de dor crônica que compõem a Escala Multidimensional de Avaliação de Dor (EMADOR), utilizando-se o método psicofísico de estimação de categorias. Os resultados da caracterização social das 3 amostras foram: a média de idade foi de 60 anos, 54% eram do gênero masculino, 58,7% casados, 65,3% pertencentes à religião católica e 50,6% tinham ensino fundamental completo. Na caracterização da dor foi evidenciado que, referente ao sítio primário do tumor, 30% estavam localizados na mama, 30% na próstata e 14,7% no estômago. O início da queixa dolorosa ocorreu em 40,7% dos participantes antes do diagnóstico da doença, 52,7% relataram somente 1 sítio de dor e 55,4% relataram que a mesma era intermitente. A intensidade da dor atribuída nas 3 amostras, considerando a média aritmética, demonstrou que os participantes com tumores de sistema digestivo reportaram os maiores escores (7,58 ± 2,59) e 26,6% desta amostra relataram escores acima de 8 para todos os descritores apresentados. Na avaliação dos descritores 10 descritores de maior atribuição foi observado que, 5 estavam presentes nas 3 amostras: -dolorosa?, -desconfortável?, -chata?, -desagradável? e o descritor -incômoda?, o qual foi o mais atribuído tanto pelos participantes com câncer de sistema digestivo quanto pelos participantes com câncer de próstata, demonstrando a similaridade da linguagem da dor nos diferentes grupos. Sobre a dimensão dos descritores de maior atribuição nas 3 amostras houve predomínio de descritores de dor crônica que caracterizaram a dimensão afetiva (50%), seguido pelos de dimensão cognitiva (26,6%) e pelos de dimensão sensitiva (23,3%). Concluímos que, mesmo sendo a dor oncológica um fenômeno considerado individual, multidimensional com comprometimento em diversos domínios da vida, a sua linguagem apresenta semelhança independente do sítio do tumor e do gênero e a dimensão afetiva da dor deve ser melhor explorada nas avaliações clínicas. / The aim general of this study was to evaluate chronic pain arising from different types of cancers. The specific objectives were to describe the social characteristics of the participants, to characterize the pain perceived by specific indicators and descriptors to identify the 10 major and minor award chronic cancer pain as perceived in the sample. The study included 45 women with breast cancer, 45 men with prostate cancer and 60 individuals of both sexes with cancers of the digestive system. For the measurement of pain were used 50 descriptors of chronic pain comprising the Multidimensional Pain Evaluation Scale (EMADOR), using the psychophysical method of category estimation. The results of the social characterization of the 3 samples were mean age was 60 years, 54% were male, 58.7% married, 65.3% belonging to the Catholic area and 50.6% had completed elementary education as schooling. The characterization of pain was evident that, for the primary tumor site 30% were located in the breast, prostate 30% and 14.7% in the stomach. The onset of pain complaint occurred in 40.7% of the participants before the diagnosis of disease, 52.7% reported only one site of pain and 55.4% reported that it was intermittent. Pain intensity given in three samples, considering the arithmetic mean, showed that participants with tumors of the digestive system report higher scores (7.58 ± 2.59) and 26.6% of this sample reported scores above average in 8 arithmetic mean of all the descriptors presented. In the evaluation of the descriptors was seen observed that among the 10 descriptors with higher scores, five were present in three samples: \"painful,\" \"uncomfortable\", \"boring,\" \"unpleasant,\" and the descriptor \"incommode? that was the longer assigned by both the participants with cancer of the digestive system and by the participants with prostate cancer, demonstrating the similarity of the language of pain in different groups. The dimension of descriptors with higher scores in three groups, there was a predominance of chronic pain descriptors that characterize the affective dimension (50%), followed by the cognitive dimension (26.6%) and size sensitive (23.3%). We conclude that even though cancer pain phenomenon considered an individual, multidimensional impairment in several areas of life, their language has similarities regardless of tumor site and gender, and affective dimension of pain should be further explored in the clinical ratings.

Os objetivos deste estudo foram mensurar a intensidade de dor durante o trabalho de parto com ou sem analgesia raqui-peri combinada através de métodos psicofísicos, quais sejam estimação de categorias (escala analógica visual-VAS) e de estimação de magnitude, verificar a estabilidade, validar a escala psicofísica de percepção da dor e caracterizar os descritores de dor durante o trabalho de parto. Os métodos psicofísicos utilizados foram estimação de magnitudes e emparelhamento intermodal. Quatro experimentos foram realizados: Experimento 1 - Tarefa de determinação de limiares de dor; Experimento 2 - estimação de magnitudes e estimação de categorias, Experimento 3 - estimação de magnitudes e comprimento de linhas e Experimento 4- validação da escala psicofísica. Participaram 68 parturientes (42 receberam analgesia e 26 sem analgesia), internadas no centro obstétrico do Hospital do interior do estado de São Paulo, idade entre 18 a 35 anos, com feto único, estado físico ASA I ou II e que estavam em trabalho de parto. As diferentes sensações de dor foram avaliadas a cada 60 minutos (após a rotina obstétrica), até a finalização do parto (parturientes que não receberam analgesia) ou até a realização da analgesia de parto indicada pela equipe médica. A analgesia de parto foi realizada por meio da técnica raqui-peri combinada. Quinze minutos após a instalação do cateter uma nova avaliação da dor foi realizada, quando o período de observação foi finalizado. O trabalho de parto com ou sem analgesia foi de responsabilidade da equipe médica, não tendo o pesquisador influenciado, a participante poderia ou não ter aceitado. Os resultados obtidos foram que cada participante apresentou um tempo próprio na determinação do seu limiar. Os aspectos fisiológicos e psicológicos evidenciam que a dor é uma experiência única e individual. Para comparação da intensidade da dor durante o trabalho de parto nos grupos com analgesia (após medicação) e sem analgesia, através do teste estatístico de Mann-Whitney, constatou-se que houve uma diferença significativa entre as intensidades de dor nos 2 grupos (p<0,001). A escala psicofísica da intensidade de dor antes da analgesia foi validada com o expoente de 0,63, depois da analgesia o expoente foi de 0,95 e sem analgesia o expoente foi de 0,91. O coeficiente de correlação de Kendall (W) aplicado a estimação de magnitude e comprimento de linha antes, depois e sem analgesia, mostrou W=0,46, W=0,90 e W=0,66 respectivamente, indicando correlação entre os dados. Os descritores de dor mais atribuídos pelas parturientes durante o trabalho de parto foram insuportável, desesperadora e terrível. / The aim of this study was to measure the pain intensity during labor with or without combined spinal-epidural analgesia utilizing psychophysical methods, whether they be category estimations (visual analogical scale VAS) , or magnitude estimations, to verify the stability, to validate the psychophysical scale of pain perception, and to characterize the pain descriptors during labor pain. The psychophysical methods utilized were magnitude estimations and cross-modal matching. A total of four experiments were performed: Experiment 1 Pain threshold determination task; Experiment 2 magnitude estimations and category estimations; Experiment 3 magnitude estimations and line lengths; and Experiment 4 psychophysical scale validation. The study was comprised of 68 parturients (42 received analgesia, and 26 without analgesia), admitted in the Obstetrics center of the Interior Hospital in the state of Sao Paulo, age ranging from 18 to 35, with a singleton fetus, physical state ASA I or II, and who were in labor.The diverse pain sensations were assessed every 60 minutes (after obstetric routine), until the the end of labor (parturients who did not receive analgesia) , or until the application of labor analgesia recommended by the medical team.The analgesia was applied by means of combined spinal epidural analgesia . Fifteen minutes after installing the catheter, a new pain assessment was carried out when the observation period was concluded. Labor with or without analgesia was the responsibility of the medical team, not undergoing influence from the researcher, and the participant could accept or decline. The results were that each participant presented personal timing in determining their threshold. The physiological and psychological aspects evidenced that pain is a unique and individual experience.For the comparison of pain intensity during childbirth labor in the groups with analgesia and the groups without analgesia (after measurement), utilizing the Mann-Whitney statistical test, a significant difference between the pain intensities for both groups (p<0,001) was found. The psychophysical scale for pain intensity before analgesia was validated with the exponent 0,63, after analgesia the exponent was 0,95, and without analgesia 0,91. Kendall`s correlation coefficient (W) was applied to the magnitude estimations and the line-lengths before, after and without analgesia , W=0,46, W=0,90, and W=0,66 resepctively, indicating correlation between the data. The parturients` most attributed pain descriptors during labor were: unbearable, despairing, and terrible.

Pain in sport serves the adaptive functions of signalling impending or actual injury and signalling the achievement of optimum workload to produce a conditioning effect. It is important to be able to distinguish what pain is signalling in order to respond to it effectively. The different functions of pain present a challenge for athletes wanting to improve their skill and conditioning level in the most efficient manner without becoming injured. However, this challenge could prove dangerous to children who have only a partial understanding of the value of pain, or who believe that they must endure great amounts of pain in order to become successful in sport. Previous research with general populations has demonstrated that children have a naive understanding of pain causation and do not understand the value of pain. In addition, previous research demonstrated that social factors such as peer and parental pressure may lead to situations where child athletes suffer preventable injuries because they ignore the warning signals of pain. Because coaches and parents are often responsible for deciding what to do when children present with pain, it is important for these adults to be aware of the cognitive limitations of children regarding the causes and meaning of pain. To date, there is no research which examines what athletes know about sport-related pain. Participants for this research project were 68 gymnasts aged 6 to 13 years. Several questions were asked in this study: (a) can gymnasts of various ages distinguish different types of sport-related pain?; (b) do gymnasts respond differently to different types of sport-related pain?; (c) what reasons do gymnasts give for continuing or discontinuing gymnastics when they have pain?; (d) do gymnasts understand the concept of pain causality?; (e) do gymnasts understand the value of pain?; (0 do gymnasts use pain for secondary gain? These questions were investigated in the context of an interview designed for this study. Two subtests from the Stanford-Binet Intelligence Scale and tests of cognitive developmental level based on Piagetian theory were also administered. The effects of age, gender, level of cognitive development, experience with sport, and experience with pain and injury were examined for their influence on responses to the above questions. Results revealed age differences in the gymnasts' ability to distinguish types of pain such that older gymnasts identified more pain types. However, even the youngest participants were able to discuss more than one type of pain. There were age differences in gymnasts' understanding of pain causality. Contrary to previous research demonstrating children to be unable to identify a physiological cause of pain, 32% of the gymnasts aged 9 to 13 were able to describe the role of the brain and/or nerves in pain causality. Also contrary to previous research with general populations, the gymnasts were able to discuss the value of pain, especially as a signal of hard work and as a warning to stop what they are doing. Forty percent of participants reported using pain (sport-related and/or non sport-related) for secondary gain. Not a single gymnast reported using pain as an excuse for a poor performance. Six of them did, however, report pretending to be in pain to avoid something in the gym that caused them fear. Further demonstrating an appreciation of different types of pain, results showed the gymnasts to respond differently to various pain types. These young athletes demonstrated an awareness of the need to stop their sport in some cases and to continue gymnastics in other cases, depending upon the type of pain. When continuing gymnastics despite pain, participants usually justified their decision by saying that the pain was not harmful to them. When describing why they discontinued gymnastics because of pain, participants often stated that the pain or injury may worsen. Few participants stated a concern for their future functioning. No participant described pressure from coaches, parents or peers to continue gymnastics while experiencing pain. Results are discussed in a variety of contexts: (a) comparison of these results to those of similar research done with general populations of children; (b) implications for training practices, coach and athlete education. and sport policy in general; (c) support for a theory of cognition that encompasses both nativist and constructivist components; and (d) directions for future research.

Syfte: Att utifrån litteratur beskriva hur sjuksköterskor kan identifiera smärta hos äldre personer med demenssjukdom, samt att undersöka vilka mätinstrument som finns att tillgå för att beskriva smärta. Metod: Litteraturstudien var av deskriptiv design. Litteratursökningen gjordes i databaserna PubMed och Cinahl. Resultat: Resultatet baserades på 14 vetenskapliga artiklar som visar att det finns många uttryck för smärta som sjuksköterskan kan använda sig av för att identifiera smärta hos äldre personer med demenssjukdom. Resultatet visade att det är mycket svårare att identifiera smärta vid omvårdnad av äldre demenssjuka, då de inte kan kommunicera som kognitivt intakta personer. Därför är det viktigt att sjuksköterskan känner patienten för att kunna notera avvikelser i beteendet och kroppsspråket, vilket kan tyda på smärta. Resultatet visade även att det finns en mängd olika mätinstrument för att skatta smärta hos äldre med demenssjukdom. Smärtskattningsinstrumenten delas in i självskattningsskalor och observationsskalor. Slutsats: Identifieringen av smärta hos denna patientgrupp kräver att sjuksköterskan är lyhörd, innehar kunskap och erfarenhet samt tar sig tid för bedömningen. Vid smärtskattning är observationsskalor att föredra då demenssjuka individer har svårare att självskatta sin smärta. / Aim: To describe from literature how nurses can identify pain in older people with dementia and to examine the instruments available to describe the pain. Method: The literature study was descriptive design. The literature search was done in PubMed and Cinahl databases. Results: The result was based on 14 scientific articles that show that there are many expressions of pain that nurses can use to identify pain in older people with dementia. The results showed that it is very difficult to identify pain in care of older persons with dementia, because they can not communicate as cognitively intact persons. It is therefore important that the nurse knows the patient to record deviations in behavior and body language, which may indicate pain. The results also showed that there are a variety of different sensors to estimate the pain in the elderly with dementia. Pain measurement instruments are divided into self-rating scales and observation scales. Conclusion: The identification of pain in this population requires that the nurse is attentive, have knowledge and experience and take the time for assessment. The pain assessment is observation scales to prefer demented individuals are less able to self-rate their pain.

Pain is common among women undergoing first trimester surgical abortions. At the postoperative unit, department of gynaecology, University Hospital, Uppsala, the goal is that 80 % of the women should rate pain as £ 3 on a numeric rating scale (NRS), when leaving the unit. The aim of the study was to investigate how rating was performed at the unit and to investigate patient’s perceptions of pain after having undergone first trimester surgical abortion. 20 patients (74%) participated in the study. Ninety percent of the patients rated their pain as NRS £ 3 when leaving the unit. Seven patients (35 %) rated their pain as NRS &gt; 3 directly after operation, and 2 (10 %) patients NRS &gt; 3 when leaving the unit. There were no correlations between patient’s age and ratings of pain. There was no difference in rating of pain between patients with prior vaginal delivery and patients who had no prior vaginal delivery. There were no correlations between ratings of pain and gestational age. Conclusion: It is important that patients undergoing first trimester surgical abortions receive adequate pain treatment. The unit’s goal for postoperative pain treatment is achived, 90 % of the patients rated their pain as NRS £ 3 when leaving the unit.

published_or_final_version / Anaesthesiology / Doctoral / Doctor of Philosophy

The studies in this dissertation asses age differences in the experience of pain in humans and animals and the appropriateness of pain assessment tools across the adult life-span. Chapter I reviews age differences in experimental, acute and chronic pain in humans. Chapter 2 reviews age differences in the outcome of psychological treatments for chronic pain. It is concluded do there are age differences in each type of pain and that the elderly appear to benefit from psychological treatments as much as younger groups. Several experiments were conducted to examine the concepts that the elderly believe that pain is an inevitable part of aging and are not distressed by it, and that they experience less interim pain than younger patients. However, Chapter 3 presents two studies which find no age differences in pain beliefs. Furthermore, the studies described in Chapters 4 and 5 suggest that there may be age differences in the perceived qualities of chronic pain, measured with the short and full form of the McGill Pain Questionnaire (MPQ), but no age differences in pain intensity measured with single-item scales The data from Chapters 3, 4 and 5 suggest that the affective and cognitive components of chronic pain do not differ among age groups. Analysis of the psychometric properties of the pain measures suggests that verbal descriptor scales of pain intensity and both forms of the MPQ may be appropriate for use across the adult life-span. However, visual analog scales may not be appropriate for use with the elderly. To further elucidate the effects of aging on pain, Chapter 6 reviews age differences in nociceptive responsivity and pain behaviours in the rat. This review suggests that reflexive responses to nociceptive stimuli may not be age dependent although sensitivity on tests of more highly organized behaviours may decrease with age. Chapter 7 presents studies of age differences in the formalin test, a model of tonic pain, which suggest a curvilinear relationship be

The present study examined the nature of and relationship between attributions, just world beliefs (JWB) and adjustment in a sample of 62 community pain sufferers. This was exploratory because it accounted for shortcomings of these concepts, meaning they have not been investigated like this in pain. Specifically, it accounted for the scarcity of research distinguishing between cause, responsibility and blame; allowing the self-definition of responsibility, blame and adjustment; examining changes in attributions and adjustment, and considering just world beliefs. The importance of investigating these issues in pain was detailed. The research was conducted in two phases. The first, brief phase piloted a measure to account for these shortcomings. The second phase used the piloted measure to investigate the shortcomings in a series of five aims. Descriptive analyses indicated that most participants made causal attributions for their pain, with around half attributing responsibility and blame. Although similar in the types of attributions made, cause was distinguished from responsibility and blame, which were indistinguishable from each other. Attributions did not change. Additionally, JWB were weakly correlated with pain intensity, and analyses of variance techniques found JWB to interact with pain duration, such that those with 1 month-2.5 years' duration had stronger JWB than those in the 3-9 years' duration. JWB did not interact with attributions or adjustment, but chi-square analyses found attributions interacted with adjustment, such that attributions to the self were adaptive, while attributions to others resulted in poor adjustment to pain. Stepwise multiple regression analyses suggested that these latter attributions predicted pain intensity, as did pain treatments. Additionally, individual differences in attributions, adjustment and pain intensity emerged in chi-square analyses, although none were found on JWB. Full interpretations were made of these findings, and their implications for future research discussed.

Since the late 19th century, scientists and clinicians have generated an astonishing array of meters, scales, experimental designs, and questionnaires to quantify pain with more precision, accuracy, and objectivity. In this thesis, I follow the development and implementation of pain-measuring technologies in the United States until the mid-1970s. Focussing on how these technologies work, I analyse the relationship between practices of objectification; the social, material and technical resources on which these practices depend; and changing conceptions of pain, subjectivity and objectivity. / Surprisingly, as efforts to objectify pain were intensified, pain was increasingly conceptualised as a subjective experience, that is, as a phenomenon inextricably tied to the unique emotional, psychological, and social condition of the experiencing self. I argue that this transformation was not solely due to the development of new theoretical models of pain, but also, importantly, enabled by the implementation of new technologies that could measure pain as an individual and psychological phenomenon. I also argue that the successful implementation of these technologies depended on the availability of specific social, material, and technical resources, and examine the social settings in which these resources were made available. / The main motivation for the direct investment of new resources towards pain-measuring technologies was a desire to make analgesic drug testing more objective. Beginning in the late 1930s, professional, industrial and public health interests in drug addiction, opiate pharmacology, new drug development and therapeutic testing converged on the goal of better pain-measurement. By the 1950s, the organisation and funding of analgesic testing made it possible to implement and validate the analgesic clinical trial, a technology that determined analgesic efficacy by measuring collective pain and its relief. The validity of the clinical was based on procedural and statistical control of data collection and analysis, rather than on the standardisation of individual experiences and evaluations of pain. It became possible to think of pain relief as an inevitably idiosyncratic experience, open to multiple sources of psychological variation, and yet still measure it consistently and objectively on a collective level. / Keywords. pain; measurement; objectivity; subjectivity, clinical trials; analgesics: psychophysics; psychosomatics; history of medicine; history of science.