Bakgrund Reumatoid artrit (RA) och artros är komplexa tillstånd som kan vara svåra att diagnostisera och leda till långvarig smärta. Effektiv smärtlindring och hantering är avgörande för att förbättra livskvaliteten för personer med dessa sjukdomar. Primärvården spelar en central roll i hanteringen av kronisk smärta genom att erbjuda personcentrerad vård och integrera interdisciplinära metoder. Personers upplevelser av vården, inklusive kommunikation och tillgänglighet, är viktiga för att säkerställa effektiv smärtbehandling och välbefinnande. Personcentrerad vård, baserad på sjuksköterskans kärnkompetenser, är en grundläggande princip för att möta individuella behov och förbättra utfall för personer med reumatisk smärta. Syfte Syftet med litteraturöversikten var att belysa personer med reumatoid artrit och artros upplevelse av smärthantering inom primärvården. Metod En icke-systematisk litteraturöversikt där 11 vetenskapliga artiklar granskades. Artiklarna hämtades ur databaserna PubMed och CINAHL. Sökningarna baserades på noggrant utvalda sökord som lades ihop till sökblock. Vidare analyserades och kategoriserades artiklarna genom en integrerad analys baserad på Kristensson (2014). Resultat Dagliga utmaningar till följd av RA och artros identifierades, inklusive fysiska begränsningar, social isolering och psykologiska påfrestningar. Självhanteringsprogram och digitala verktyg visade sig kunna förbättra smärtbehandling och livskvalitet. Interaktionen med vårdpersonal betonade vikten av kommunikation, förståelse och patienttillfredsställelse. Tillgång till vård och socialt stöd ansågs avgörande för smärthantering. Slutligen, en personcentrerad vårdmodell och egenmaktstrategier visade positiva resultat för delaktighet och självhantering. Slutsats Personer med RA och artros får inte tillräckligt stöd och smärthantering i primärvården. Brist på information och personcentrerad vård leder till försämrad livskvalitet. Strukturerade interventioner, inklusive utbildning och fysisk aktivitet, visar sig vara viktiga för att förbättra hanteringen av smärtan och livskvaliteten för personerna. Ett holistiskt synsätt och personcentrerad behandling är avgörande för att uppnå god smärthantering och välbefinnande. / Background Rheumatoid arthritis (RA) and arthritis are complex conditions that can be difficult to diagnose and lead to long-term pain. Effective pain management is critical to improving quality of life for people with these diseases. Primary care plays a central role by offering person-centered care and integrating interdisciplinary methods. People's experiences of care are important to ensure effective pain management and well-being. Person-centred care is a fundamental principle for meeting individual needs and improving outcomes for people with rheumatic pain. Aim The aim of the literature review was to shed light on the experiences of individuals with RA and arthritis regarding pain management in primary care. Method A non-systematic literature review in which 11 scientific articles were reviewed. The articles were retrieved from the databases PubMed and CINAHL. The searches were based on carefully selected keywords that were combined into search blocks. Furthermore, the articles were analyzed and categorized through an integrated analysis based on Kristensson (2014). Results Daily challenges resulting from RA and arthritis were identified, including physical limitations, social isolation and psychological stress. Self-management programs and digital tools were shown to improve pain management and quality of life. Interaction with healthcare professionals emphasized the importance of communication, understanding and patient satisfaction. Access to care and social support was considered crucial for pain management. Finally, a person-centered care model and empowerment strategies showed positive results for participation and self-management. Conclusion People with RA and arthritis do not receive sufficient support and pain management in primary care. Lack of information and person-centred care leads to a reduced quality of life. Structured interventions, including education and physical activity, are shown to be important in improving pain management and quality of life for individuals. A holistic approach and person-centered treatment are essential to achieve good pain management and well-being.

Pain management is an important aspect of postpartum care, aiming to provide optimal comfort and well-being for women during the recovery period following childbirth. However, disparities in pain management persist, with specific populations experiencing inadequate pain management and unequal access to appropriate care. Studies show that women of color are less likely to receive pain medications, in comparison to their White counterparts, despite reporting higher postpartum pain scores. The analysis for this research is grounded in lack of quality care and socioeconomic factors. The thesis demonstrates the underlying issues in maternity care. Black women are the core group represented in this research because of an increase in maternal mortality, and morbidity rates. In this thesis, a systematic literature review was conducted to explore the racial/ethnic differences in post-partum pain experiences, assessment, and treatment.

No / The purpose of this paper is to present the findings of one part of a larger study, funded by the National Institute for Health Research, which explored the management of pain in adult male prisoners in one large category B prison in England. In this paper, the authors focus on the attitudes and perceptions of prison staff towards pain management in prison. A qualitative design was utilised to explore the staff perceptions of pain and pain management in one adult male prison. Questionnaires were provided for all staff with prisoner contact, and a follow up focus group was undertaken to further explore questionnaire data. The questionnaire and focus group findings demonstrated that staff had a good awareness of pain and pain management in prison, with both physical and emotional pain identified. The frequency of approaches by prisoners to staff for pain relief was noted to be high, whilst awareness of how the prison environment could potentially exacerbate pain was discussed. The acquisition of analgesia by prisoners for secondary gain was identified as a challenge to both assessing levels of pain and providing pain relief in prison, illustrating the complexity of providing care within a custodial culture. The effect on staff of caring for prisoners found to be confrontational and deceitful was significant for participants, with feelings of anger and frustration reported. This study was undertaken in one adult male category B prison with a very high turnover of prisoners. Staff working in other types of prison, for example, higher security or those more stable with longer sentenced prisoners could provide alternative views, as may staff caring for younger offenders and women. The challenges to undertaking research in prison with staff who can understandably be reluctant to engage in reflection on their practice cannot be underestimated and impact significantly on available methodologies. This qualitative research is the first of its kind to offer the perspectives of both health care professionals and prison staff working with prisoners complaining of pain in an English prison. It provides the groundwork for further research and development.

This thesis describes patients in acute postoperative pain as well as patients with acute cancer-related pain in palliative care, and their experiences and perceptions of pain management in relation to HRQOL and the multidimensionality of pain. A combination of qualitative and quantitative methods was chosen. Data were collected using interviews and questionnaires; APS, SF:36 and a new developed questionnaire PC-PPQ measuring care related to pain management in palliative care. For assessing pain VAS and Pain-o-Meter were used. The study group consisted of 100 patients on their second postoperative day, and of 75 patients with cancer-related pain from two palliative care teams. The result showed that at the time of the interview 29 of the patients with postoperative pain reported a pain > 3 on VAS and 79 reported VAS > 3 as worst pain past 24 hours. The higher the intensity of pain the less satisfied the postoperative patients were with the nurses´ way of treating their pain. Thirty-three patients stated that they had received information regarding the importance of pain relief. Patients with postoperative pain as well as patients with cancer-related pain had been prescribed analgesics mostly a combination of Paracetamol, NSAID and opioid. Of the 75 patients with cancer-related pain and in palliative care 22 patients reported pain >3 on POM-VAS and 47 patients reported >3 on POM-VAS as worst pain past 24 hours. Twenty-eight patients reported an average pain > 3 on POM-VAS past 24 hours. Twenty-four patients used the words troublesome or tiring when describing their affective pain. Sensory pain was described as prickling or sore by 15 patients. The patients perceived their pain as “aching all over” and expressed a wish for pain relief as well as a fear for increased pain. HRQOL especially physical functioning decreased for patients with average pain > 3. Being cared for by a nurseled or a physician-led palliative care team indicated no statistically significant differences for patients´ HRQOL or pain intensities. The patients had experienced a statistically significant better care after being referred to a palliative care team, despite that pain control had not been optimized. Patients expressed a need for communication, planning and trust in order to improve pain management. Continuity of care and the opportunity to talk increase the patients feeling of security, as well as improved their perceived pain control. Structured ongoing discussion concerning pain management from an early stage of the disease or already preoperatively can provide an important intervention to meet the results of this thesis. Pain assessment covering the multidimensionality of pain, and pain treatment plans including both pharmacological and non-pharmacological treatment are further important interventions.

The need for nurses to become culturally competent is well documented in transcultural nursing literature. The subjective multidimensional nature of pain makes it imperative for nurses to use assessment methods that are culturally congruent. This study set out to explore the differences and similarities in conceptualization, experience, expression and management of pain between nurses and clients in the United Arab Emirates. The purpose of the study was to develop guidelines in the cultural pain assessment in the UAE context. The findings confirmed that nurses rely on biomedical approaches in assessment and relief of pain; clients were found to rely on the family for emotional support and on nurses for pharmacological interventions. Clients used sensory descriptors, and analogy when describing pain, nurses relied on the technical background and experience. Religious factors had a significant impact on clients' pain behavior. This study offers nurses new insights into cultural assessment of pain. / Health Studies / M. A. (Health Studies)

Résumé : Introduction : La prise en charge de la douleur aiguë pédiatrique persiste à être sous-optimale. Cette situation est souvent expliquée par la présence de barrières qui nuisent à l’application des connaissances. Depuis plus de 10 ans, un protocole standardisé (algorithme) basé sur une échelle d’auto-évaluation est utilisé au CIUSSS de l’Estrie-CHUS afin de traiter la douleur aiguë chez les enfants hospitalisés âgés entre 5 et 17 ans. Les infirmières pédiatriques ont demandé d’adapter cet algorithme afin de pouvoir l’utiliser chez les enfants plus jeunes. Pour ce faire, nous devions débuter par établir l’état des lieux de la gestion de la douleur pédiatrique. Puisqu’aucune échelle d’hétéro-évaluation de la douleur n’était utilisée au CIUSSS de l’Estrie-CHUS, l’échelle EVENDOL fut implantée. Objectifs : 1. Répertorier les scores de douleur avec l’échelle EVENDOL, les analgésiques prescrits et administrés pour les enfants âgés de 1 à 7 ans hospitalisés pour une condition douloureuse; 2. Évaluer la satisfaction et les changements de pratique des infirmières et infirmières auxiliaires suite à l’implantation de l’échelle EVENDOL. Méthodologie : 1. Une étude de cohorte fut réalisée. Tous les enfants âgés de 1 à 7 ans hospitalisés pour douleur aiguë furent inclus. Les scores de douleur ainsi que l’analgésie prescrite et reçue ont été relevés dans chacun des dossiers des enfants recrutés; 2. Les appréciations des infirmières furent consignées. Résultats : 1. Quarante patients ont participé à l’étude : 24 pour des soins chirurgicaux et 16 pour des soins médicaux. Un total de 260 scores de douleur fut relevé : la moyenne de douleur selon l’échelle EVENDOL fut de 2,3 (ÉT = 3,2) sur 15 (score maximal représentant une douleur sévère). Seulement 12 évaluations de douleur sur un total de 260 relevées furent cotées sévères (≥ 10/15); ces enfants avec douleur sévère ont reçu une analgésie proportionnelle à leur niveau de douleur. L’ensemble des patients a reçu une analgésie multimodale (deux analgésiques ou plus) dans une proportion de 95%. Plus de la moitié des prescriptions PRN (au besoin) ont été administrées sur un horaire régulier par les infirmières; 2. Les infirmières ont trouvé l’échelle simple d’utilisation à 93%. Le score global de satisfaction fut de 6,7/10. Conclusion : Les enfants ont reçu une analgésie multimodale de façon régulière et appropriée selon l’évaluation basée sur l’échelle EVENDOL. De plus, très peu de douleurs sévères furent notées. Nous suggérons que les infirmières ont donc transposé les principes de l’algorithme des 5-17 ans chez les enfants âgés de 1 à 7 ans. Ainsi, le projet subséquent de démontrer l’efficacité d’un algorithme chez les 1-7 ans fut jugé inopportun. L’application des connaissances peut être facilitée en contrant plusieurs barrières nuisant à une prise en charge optimale de la douleur en utilisant un algorithme. / Abstract : Background: Pediatric pain remains sub-optimally controlled. Many existing barriers that prevent knowledge translation (KT) are often mentioned as a reason for this situation. We used an algorithm based on an auto-evaluation scale in the CIUSSS of Estrie-CHUS for over 10 years for the 5 to 17 old hospitalized children. Pediatrics nurses ask to adapt this algorithm for using it with younger children. To do so, we had to dress an inventory of pediatric pain management. Because no hetero-evaluation scale was use in our pediatric ward, the EVENDOL scale had to be implemented. Objective: 1. Describe pain scores from the EVENDOL scale plus the prescribed and administrated analgesia from 1-7 years old hospitalized children with painful condition. 2. To evaluate the satisfaction and practice changes of nurses following the EVENDOL scale implementation. Methods: 1. This study used a cohort design. All children 1 to 7 years old admitted for painful medical or surgical conditions were evaluated using EVENDOL. Pain values and analgesia were noted for each patient by electronic and paper charting. 2. Satisfaction within the nursing staff were also evaluated. Results: 1. Forty children participate at this study: 24 were under surgical care and 16 under medical care. A total of 260 pain measurements were documented. The mean EVENDOL scores were 2.3 (SD 3.2) on 15 (maximal score that represent an intolerable pain). Only 12 of 260 pain assessments were in the severe pain category (≥ 10/15). These children with severe pain received an appropriate and timely analgesia. Overall 95% of this cohort received multimodal analgesia which are two or more types of pain medication. More than 50% of prescribed PRN medications were given on a regular basis. 2. Nurses’ ease of EVENDOL use was rated at 93%. Nurses’ global satisfaction score about the scale was 6.7/10. Conclusions: Children received a multimodal and a regular based analgesia combined to a valuable pain evaluation using the EVENDOL scale. Therefore, a low rate of severe pain was noted. We suggest that nurses spontaneously transposed the pre-existing 5 to 17 years old standardised analgesia protocol and used it in the 1-7-years-old group. Thereby, evaluating experimental group after algorithm implementation was irrelevant. KT can be facilitated to overcome several barriers to PPM by combined the use of an algorithm with several factors.

Relapse prevention after pain management is a neglected area and Internet-based interventions have the potential to partly fill this gap. A challenge in designing effective relapse prevention program is how to motivate patients to persist throughout the full length of treatment. Following a regular pain management program, 29 participants underwent a 20 week long Internet–based relapse prevention program based on acceptance-oriented CBT. Qualitative analyses showed changes in attitudes towards their pain and body during the course of treatment. Degree of personal commitment in treatment goals seemed to affect gains relating to new perspective on self and future. Therapeutic strategies of defusion and mindfulness seemed to ease perspective changes and persistence to comply. Values interventions are hypothesized to be a plausible therapeutic strategy to engage participants in continuous behavior change. Further studies on non-compliers and drop-outs could enhance understanding of interventions necessary to maintaining motivation. When and how to give therapist support during Internet-based treatment for chronic pain is another area in need of further studies.

Bakgrund: Långvarig smärta är en av de främsta orsakerna till varaktigt lidande och funktionsnedsättning både i Sverige och globalt. Dagens behandlingsmetoder anses i många fall bristfälliga. I ett allt mer högteknologiskt samhälle utvecklas elektroniska hjälpmedel som stöd till personer med olika sjukdomstillstånd. Tidigare studier visar att internetbaserade interventioner främjar hälsa, lindrar lidande och ökar egenmakten, dock är området fortfarande under snabb utvecklig. Syfte: Att beskriva effekterna av internetbaserade interventioner riktade mot långvarig smärta. Metod: Begränsad systematisk litteraturöversikt med elva kvantitativa artiklar.  Resultat: Fem av artiklarna använde KBT, tre artiklar använde ACT och tre artiklar använde självhanteringsmetoder. Fyra effekter av interventionerna framkom; smärtreducering, smärthantering, livskvalitet och psykisk hälsa. Smärthantering förbättrades signifikant, resterande förbättrades, dock ej signifikant. Effekterna är förbättrade till signifikant förbättrade vid uppföljningar efter avslutad behandling. Slutsats: Att införa internetbaserade interventioner som tillägg till klinisk omvårdnad kan innebära hälsovinster för enskild person samt för samhället. Dock ses svårigheter att implementera den här typen av intervention på en större befolkning då faktorer som tillgänglighet och könsfördelning påverkar negativt. Fortsatt forskning: Jämnare könsfördelning i studier, större geografisk utbredning samt långtidsuppföljningar bör ligga i fokus för framtida forskning. / Background: Chronic pain is one of the primary causes to abiding suffering and disabilities in Sweden and globally. Today’s treatment methods are somewhat considered lacking. In a high technology society, as the one we are living in today, the developing of electronic aids for persons with different disease states increases. Internet-based interventions is considered a part of the future in health care. Aim: The aim of this study was to describe the effects of Internet-based interventions designed for people with chronic pain. Method: A rapid systematic review with eleven quantitative studies. Result: Five studies used CBT, three studies used ACT and three is denominated as self-management. Four effects became clear; mental health, pain management, pain reducing, and quality of life. Pain management showed significant improvement, the other three effects showed improvement, although no significant improvement. At follow-up after post intervention the effects improved, some with significance. Conclusion: To implement internet-based interventions as an addition to clinical care could mean health benefits for the community as well as the individual person. However, this intervention type is not accessible on a larger population. Further Research: There should be focus on gender equality, broader geographic areas and longer follow-ups in future research.

Zhu, Fang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 171-185). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese.

As atitudes e crenças sobre a dor lombar crônica inespecífica (DLCI) dos profissionais de saúde estão associadas com as de seus pacientes, assim como com os resultados do tratamento. Por sua relevância, alguns estudos já foram realizados com o intuito de identificar as atitudes e crenças ligadas à orientação de tratamento que os médicos adotam no manejo da DLCI, bem como investigar a associação entre suas características demográficas e profissionais e suas atitudes e crenças. No entanto, no Brasil encontramos apenas uma pesquisa sobre esse tema, com fisioterapeutas que atuavam em hospitais e clínicas particulares. Os objetivos desta dissertação foram: 1) revisar os documentos que abordam o manejo da DLCI localizados na Biblioteca Virtual em Saúde do Ministério da Saúde; 2) descrever atitudes e crenças relacionadas à orientação de tratamento dos médicos de Unidades Básicas de Saúde (UBS) conveniadas a Prefeitura de Porto Alegre (PREFPOA) e identificar a associação entre suas características demográficas e profissionais e as suas atitudes e crenças relacionadas à orientação de tratamento da dor lombar crônica inespecífica. Esta dissertação foi composta por dois artigos, sendo que cada artigo inclui um dos objetivos citados. Para atingir o objetivo 1, realizamos uma revisão de documentos na língua portuguesa sobre o manejo da dor lombar publicados na Biblioteca Virtual em Saúde do Ministério da Saúde. Para atingir o objetivo 2, todos os médicos de UBS da PREFPOA foram convidados para participar do estudo. Como critérios de inclusão, foi determinado que para participar da pesquisa o médico deveria atender pelo menos um paciente com DLCI por semana e estar trabalhando na atenção básica há pelo menos seis meses. Para coleta de dados, utilizamos um questionário demográfico e profissional e o Pain Attitudes and Beliefs Scale for Physiotherapists, para avaliar as atitudes e crenças, sendo composto por duas orientações de tratamento: biomédica e comportamental. Os resultados do artigo 1 indicam que não há um documento na língua portuguesa que oriente os profissionais a utilizarem a orientação biopsicossocial no manejo de pacientes com DLCI. Os resultados do artigo 2, em que participaram do estudo 110 médicos, com idade média de 47,18(±9,52) anos, indicam uma média de 27,75(±6,89) na orientação biomédica e de 22,76(±4,44) na orientação comportamental, sendo que os médicos consideraram o papel do estresse e de questões psicossociais no manejo da DLCI, mas também relacionaram a dor à presença de lesão tecidual. Tanto na orientação biomédica quanto na comportamental as diferenças entre os grupos foram pequenas, considerando as variáveis demográficas e profissionais. Conclui-se que existe uma carência de documentos na língua portuguesa para guiar os profissionais a utilizarem a orientação biopsicossocial no manejo da DLCI, os médicos de UBS da PREFPOA apresentaram atitudes e crenças ligadas tanto à orientação biomédica quanto comportamental e nenhuma característica analisada estava associada às atitudes e crenças dos médicos. / Attitudes and beliefs about chronic nonspecific low back pain of health professionals are associated with their patients, as well as the results of treatment. For its relevance, some studies have been conducted in order to identify the attitudes and beliefs related to orientation treatment that physicians adopt in the management of chronic nonspecific low back pain and investigate the association between their demographic and professional characteristics and their attitudes and beliefs. However, in Brazil we found only research on this subject, with physiotherapists who worked in hospitals and private clinics. The objectives of this dissertation were: 1) to review the documents that address the management of chronic nonspecific low back pain located in the Virtual Health Library of the Ministry of Health; 2) describe attitudes and beliefs related to the orientation treatment of the Basic Units of Health linked the Porto Alegre Prefecture and identify the association between their demographic and professional characteristics and their attitudes and beliefs related to orientation treatment of chronic non-specific low back pain. This dissertation was composed of two articles, wherein each article includes one of said goals. To article the goal 1, we conducted a review of documents in Portuguese on the management of low back pain published in the Virtual Library of Health Ministry of Health. To article the goal 2, Porto Alegre Prefecture’ Basic Units of Health’ all physicians were invited to participate in the study. As inclusion criteria, it was determined that to participate in the survey the physician should meet at least one patient with chronic nonspecific low back pain a week and be working in primary care for at least six months. To collect data, use demographic and professional questionnaire and Pain Attitudes and Beliefs Scale for Physiotherapists, to assess attitudes and beliefs, being composed of two treatment guidelines: biomedical and behavioral. The results of Article 1 indicate that there is a document in the Portuguese language to guide professionals to use the biopsychosocial orientation in the management of patients with chronic nonspecific low back pain. The results of Article 2, in the study 110 physicians with an average age of 47.18 (± 9.52) years, indicate an average of 27.75 (± 6.89) in biomedical orientation and 22.76 (±4.44) in the behavioral orientation, and the physicians considered the role of stress and psychosocial issues in the management of chronic nonspecific low back pain, but also related pain to the presence of tissue injury. Any biomedical orientation as the behavioral differences between groups were small, considering demographic variables and professionals. It is concluded that there is a lack of documents in Portuguese to guide professionals to use the biopsychosocial guidance in the management of chronic nonspecific low back pain, Porto Alegre Prefecture’ Basic Units of Health’ physicians of presented attitudes and beliefs related to both biomedical and behavioral guidance and no analyzed characteristic was associated with attitudes and beliefs of physicians.