33 pacientes com fibromialgia (FM) foram submetidas a 8 sessões semanais de Yoga (grupo YR, n=17) ou Yoga e massagem Tui Na (grupo YRT, n=16). Foram avaliados: questionário de impacto da FM (FIQ), dolorimetria, escalas visuais analógicas para a dor (EVA) e notas verbais para a dor antes da 1ª sessão e 5+1 semanas após a 8ª sessão. As notas verbais foram também aplicadas na 8ª sessão e as EVA antes e depois de cada atendimento. Ambos os grupos apresentaram reduções significativas nos resultados do FIQ após o tratamento e nas EVA em todas as sessões. As EVA e notas verbais mostraram que o grupo YR apresentou reduções significantes da dor no seguimento, mas não na sessão 8, enquanto o grupo YRT as apresentou já na sessão 8, porém não no seguimento. Portanto, o Yoga mostrou-se eficaz na redução dos sintomas da FM e a adição da massagem reforçou estes efeitos a curto prazo, porém impediu benefícios a longo prazo / 33 fibromyalgic (FM) patients were submited to 8 weekly sessions of Yoga (RY group, n=17) or Yoga plus Tui Na massage (RYT group, n=16). FM impact questionnaire (FIQ), algometry, pain visual analogic scales (VAS) and verbal scores for pain were assessed before session 1 and 5+1 weeks after session 8 (followup). Verbal scores were applied also in session 8 and VAS before and after each session. FIQ after treatment and VAS values in every session significantly decreased in both groups. VAS and verbal scores showed that RY group had significant decrease in pain in followup, but not yet in session 8, while RYT group pain decrease was significant in session 8, but not in followup. So, yogic training showed efficacy in FM decreasing symptoms and massage addition reinforced these effects during treatment, but it impeded long term benefits

A palavra DOR é definida como uma percepção consciente do indivíduo de impulsos nociceptivos modulados que originam uma experiência emocional e sensitiva desagradável, associada à lesão tecidual real ou potencial, ou descrita em termos de tal lesão. Considerando-se que a dor é um dos motivos mais comuns que levam um paciente a procurar por atendimento em consultório odontológico, este estudo teve como objetivo quantificar e qualificar a analgesia da musculatura mastigatória e da articulação temporomandibular proporcionada por medicamentos antiinflamatórios não esteroidais, associados ou não a outros agentes terapêuticos. O estudo clínico foi desenvolvido em pacientes que sofriam de algias crônicas na musculatura mastigatória, decorrentes de disfunções temporomandibulares. Foram selecionados, após anamnese e avaliação com a ferramenta RDC/TMD traduzido para a língua Portuguesa (PEREIRA JUNIOR, 2007), 18 voluntários para avaliar o efeito terapêutico (entendendo-se como efeito terapêutico o alívio da sintomatologia dolorosa e do restabelecimento da amplitude dos movimentos bordejantes mandibulares), dos três tratamentos coadjuvantes abaixo-relacionados, sendo dois medicamentos e um placebo para eliminar o efeito psicológico. Os tratamentos avaliados foram: um antiinflamatório não-esteroidal (AINES) Flanaren® (diclofenaco sódico), uma panacéia Sedilax® composta por AINES, miorrelaxante e analgésicos (diclofenaco sódico + carisoprodol + paracetamol + cafeína), ambos produzidos pelo laboratório Teuto® ; e um placebo, que consistia de pílulas preenchidas com 110 g de amido de milho, produzidas pela Faculdade de Ciências Farmacêuticas de Ribeirão Preto - USP. A administração de cada medicamento consistia de 1 unidade a cada 12 horas, durante um período de 10 dias, precedido e sucedido por avaliações de dor dos pacientes. Foi estabelecido um período de washout de 11 dias entre cada troca de tratamento. A avaliação dos tratamentos medicamentosos foi desenvolvida com diferentes ferramentas, como o McGill Pain Questionnaire (VAROLI; PEDRAZZI, 2006), para qualificar e quantificar dor não provocada, a escala visual analógica para dor à palpação, escala numérica para a quantificação da dor durante o tratamento, além de mensurações de amplitude de movimentos excursivos mandibulares. Foram colhidas também informações sobre possíveis efeitos colaterais indesejáveis relacionados aos tratamentos. O projeto foi submetido e aprovado pelo Comitê de Ética em Pesquisa envolvendo Seres Humanos da Faculdade de Odontologia de Ribeirão Preto da USP, Processo n.2006.1.558.58.0, Caae n.0022.0.138.000-06. Os resultados mostraram que a analgesia para a dor em repouso foi melhor com a utilização do Flanaren® e para a dor à palpação, igual para ambos os tratamentos. Os medicamentos Sedilax® e Flanaren® reduziram significantemente a dor após três dias de tratamento, enquanto o placebo, após oito dias. Não foram observadas melhoras na amplitude dos movimentos limítrofes da mandíbula. Também não foram observados efeitos colaterais significantes estatisticamente. Concluiu-se que o tratamento utilizando o diclofenaco sódico como adjuvante reduziu a dor em repouso; todos os tratamentos promoveram analgesia à dor à palpação, mas tanto o diclofenaco isolado como associado agiram no terceiro dia e o placebo, apenas no oitavo. Nenhum efeito colateral observado foi estatisticamente significante. / The word PAIN is defined as a conscious perception of modulated nociceptive input from an unpleasant emotional and sensitive experience, associated to a real or potential, or described in terms of such lesion. Considering that pain is one of main reasons which motivate patients to search for dental treatment, the aim of this study was quantify and qualify analgesia in masticatory muscles and temporomandibular joints by administration of non steroidal anti-inflammatory drugs, isolated or associated to other therapeutic agents. This clinical trial has been developed treating patients who had been suffering with chronic pain in masticatory muscles due to temporomandibular disorders. Eighteen volunteers were selected after anamnesis exam and assessment using RDC/TMD translated to Portuguese (PEREIRA JUNIOR, 2007), to evaluate the therapeutics effect (pain relief and maximum eccentric jaw movement recovery) of three adjuvant treatment: two medicines and one placebo, to eliminate psychological effects. Assessed treatments were: a non steroidal anti-inflammatory Flanaren® (sodium diclofenac), a panacea composed by an anti-inflammatory, muscle relaxant and analgesics (sodium diclofenac + carisoprodol + acetaminophen + caffeine), both produced by pharmaceutical laboratory Teuto® ; and a placebo, that were pills filled by 110 g of corn starch, produced by Faculty of Pharmaceutical Sciences of Ribeirão Preto USP. The dosage of all medicines was one pill every 12 hours, during 10 days, preceded and succeeded by patients` pain assessment. An 11 days washout period among each therapy has been established. The assessment of drug therapies were done using distinct instruments, as McGill Pain Questionnaire (VAROLI; PEDRAZZI, 2006), to qualify and quantify unprovoked pain; visual analogue scale for pain on palpation, numerical scale to quantify pain during treatment, and measurement of range of motion during maximum eccentric jaw movements. It has been obtained information about side effects related to treatments. The research project was submitted and approved by Ethics in Research Committee of Faculty of Dentistry of Ribeirão Preto USP, Lawsuit n.2006.1.558.0, CAAE n. 0022.0.138.000-06. Data analysis has shown that relief of unprovoked pain was better using Flanaren® , and reduction of pain on palpation was equal in all treatments. Both, diclofenac alone, also diclofenac associate to other drugs, reduced significantly pain after three days of treatment, while placebo, after eight days. It has not been observed increase of range of motion during maximum jaw excursive movements, neither statistically significant side-effect. It has been concluded that treatment using diclofenac as an adjuvant reduced unprovoked pain; all therapies relief pain on palpation, but it was observed on third day for diclofenac and diclofenac associated and on eighth day for placebo. There was not any statistically significant side effect.

Recém-nascidos enfermos experienciam a dor rotineiramente associada a procedimentos invasivos dentro da Unidade de Terapia Intensiva Neonatal. A avaliação da dor tem como objetivo fornecer dados para determinar ações que aliviem a dor do neonato. A Neonatal Infant Pain Scale é uma escala de avaliação da dor para recém-nascidos validada no Canadá e utilizada no Brasil, porém não há um estudo de adaptação transcultural e validação para o país. Este estudo teve o objetivo de realizar a adaptação transcultural e validação clínica do instrumento Neonatal Infant Pain Scale para uso no Brasil. Utilizou-se os passos propostos por Beaton para adaptação transcultural de instrumentos de medida em saúde, envolvendo as etapas de tradução inicial, síntese entre os tradutores, retrotradução, revisão por comitê de especialistas e testagem da versão pré-final a fim de garantir equivalência entre o instrumento original e a tradução. O instrumento final adaptado foi submetido à validação clínica para avaliação da manutenção das propriedades psicométricas de validade, confiabilidade e consistência interna. A amostra consistiu de 60 recém-nascidos a termo e saudáveis submetidos a um procedimento doloroso que foi filmado e avaliado por seis enfermeiros posteriormente, sendo que cada vídeo foi avaliado por dois enfermeiros (confiabilidade interobservador) e reavaliado por um deles (confiabilidade intraobservador). Para os dados da validação clínica, foram realizados os testes estatísticos t de Student, coeficiente kappa ajustado por PABAK, método de Bland-Altman e coeficiente alfa de Cronbach. O estudo foi realizado na unidade de neonatologia de um hospital universitário de Porto Alegre, RS, entre setembro de 2011 e setembro de 2012. Os princípios éticos foram respeitados e foi consentida permissão do hospital detentor dos direitos sobre a escala e do seu autor para o estudo. Após a tradução e elaboração da versão pré-final, sua clareza foi avaliada por 32 profissionais da saúde através de uma escala likert, resultando em um nível de clareza superior a 87,5%. A versão adaptada para o Brasil, agora chamada Escala de Dor no Recém-Nascido (NIPS - Brasil), demonstrou muito boa confiabilidade inter e intraobservador, com PABAK de 0,93 na concordância em relação ao escore total, sendo que no gráfico de Bland-Altman a concordância inter e intraobservadores ficou acima de 95% e 90%, respectivamente. A consistência interna foi considerada boa, com alfa de Cronbach de 0,762. Considera-se a adaptação transcultural da Neonatal Infant Pain Scale para o português falado no Brasil estabelecida e validada para uso em recém-nascidos a termo do Brasil submetidos a dor aguda. / Newborns in neonatal intensive care units routinely experience pain associated with invasive procedures. Pain assessment should provide data to define actions to alleviate neonatal pain. The Neonatal Infant Pain Scale is a pain assessment instrument for newborns validated in Canada and used in Brazil, although no cross-cultural adaptation and validation study had been previously performed for use in this country. In this study, the Neonatal Infant Pain Scale was adapted cross-culturally and validated clinically for use in Brazil. The steps recommended by Beaton for the cross-cultural adaptation of health measurement instruments were followed, including initial translations, synthesis of translations, back translations, review by an expert committee and testing of the pre-final version to ensure the equivalence between the original instrument and the translated version. The final adapted instrument was submitted to clinical validation to evaluate the retention of psychometric properties, validity, reliability and internal consistency. The study included 60 healthy term newborns that underwent painful procedures, which were video recorded and later evaluated by six nurses. Each recording was evaluated by two nurses (inter-rater reliability) and re-evaluated by one of them (intra-rater reliability). Clinical validation data were analyzed using the Student t test, the prevalence-adjusted bias-adjusted kappa (PABAK) coefficient, Bland-Altman plots and the Cronbach’s alpha coefficient. The study was conducted in the neonatology unit of a university hospital in Porto Alegre, Brazil, from September 2011 to September 2012. Ethical principles were followed, and the permission to use the scale was granted by its coauthor and the hospital that holds its rights. After translation and preparation of the pre-final version, 32 healthcare workers used a Likert-like scale to assess clarity, which was greater than 87.5%. The version adapted for use in Brazil, now called Escala de Dor no Recém-Nascido (NIPS Brazil) had good inter- and intra-rater reliability, PABAK was 0.93 for the agreement with total score, and inter- and intra-rater agreements were greater than 95% and 90% according to the Bland-Altman plots. Internal consistency was good, with a Cronbach’s alpha of 0.762. This study adapted the Neonatal Infant Pain Scale cross-culturally to Brazilian Portuguese and clinically validated it for use with Brazilian term newborns that experience acute pain. / Recién nacidos enfermos experimentan el dolor rutineramente asociado a procedimientos invasivos dentro de la Unidad de Terapia Intensiva Neonatal. La evaluación del dolor tiene como objetivo proveer datos para determinar acciones que alivien el dolor del neonato. La Neonatal Infant Pain Scale es una escala de evaluación del dolor para recién nacidos validada en Canadá y utilizada en Brasil, pero no hay un estudio de adaptación transcultural y validación para el país. Este estudio tuvo el objetivo de realizar la adaptación transcultural y validación clínica del instrumento Neonatal Infant Pain Scale para uso en Brasil. Se utilizaron los pasos propuestos por Beaton para adaptación transcultural de instrumentos de medida en salud, involucrando las etapas de traducción inicial, síntesis entre los traductores, retrotraducción, revisión por comité de especialistas y testaje de la versión pre-final a fin de garantizar equivalencia entre el instrumento original y la traducción. El instrumento final adaptado fue sometido a la validación clínica para evaluación del mantenimiento de las propiedades psicométricas de validad, confiabilidad y consistencia interna. La muestra consistió de 60 recién nacidos a término y saludables sometidos a un procedimiento doloroso que fue filmado y evaluado por seis enfermeros posteriormente, siendo que cada vídeo fue evaluado por dos enfermeros (confiabilidad interobservador) y reevaluado por uno de ellos (confiabilidad intraobservador). Para los datos de la validación clínica, fueron realizados los testes estadísticos t-student, coeficiente kappa ajustado por PABAK, método de Bland-Altman y coeficiente alfa de Cronbach. El estudio fue realizado en la unidad de neonatología de un hospital universitario de Porto Alegre, RS, entre septiembre de 2011 y septiembre de 2012. Los principios éticos fueron respetados y fue consentido permiso del hospital detentor de los derechos sobre la escala y de su coautor para el estudio. Después de la traducción y elaboración de la versión pre-final, su claridad fue evaluada por 32 profesionales de la salud a través de una escala likert, resultando en un nivel de claridad superior a 87,5%. La versión adaptada para el Brasil, ahora llamada Escala de Dor no Recém-Nascido (Escala de Dolor en el Recién Nacido) (NIPS - Brasil), demostró muy buena confiabilidad inter e intraobservador, con PABAK de 0,93 en la concordancia en relación al escore total, siendo que en el gráfico de Bland- Altman la concordancia inter e intraobservadores quedó arriba de 95% y 90%, respectivamente. La consistencia interna fue considerada buena, con alfa de Cronbach de 0,762. Se considera la adaptación transcultural de la Neonatal Infant Pain Scale para el portugués hablado en Brasil establecida y validada para uso en recién nacidos a término de Brasil sometidos a dolor agudo.

<p>Uvod: Radikulopatija je obično praćena bolovima i drugim senzornim i motornim poremećajima, uz smanjenje kvaliteta života u različitom obimu. Algometrija kao visokosenzitivna metoda pruža objektivan uvid u stepen bola, dok se upotrebom upitnika na jednostavan način mogu proceniti karakteristike bola i biopsihosocijalni status pacijenta. Cilj: Istraživanje je sprovedeno kako bi se izmerili prag bola i prag tolerancije na bol kod pacijenata sa cervikalnom i lumbalnom radikulopatijom i utvrdila moguća povezanost bola sa biopsihosocijalnim faktorima. Materijal i metode: Studijom je pre započinjanja i posle zavr&scaron;avanja terapijskog ciklusa ispitano 60 pacijenata sa dijagnostikovanom cervikalnom radikulopatijom (30 mu&scaron;karaca i 30 žena) i 60 pacijenata sa dijagnostikovanom lumbalnom radikulopatijom (30 mu&scaron;karaca i 30 žena). Svi pacijenti su bili hospitalno lečeni u okviru Klinike za medicinsku rehabilitaciju, Kliničkog centra Vojvodine u Novom Sadu, a terapijski ciklus je u proseku trajao 14-21 dan. U istraživanju su kori&scaron;ćenitest za detekciju bola (Pain Detect Test), kratki upitnik o bolu (Brief Pain Inventory), indeks onesposobljenosti zbog bolova u vratu (Neck Disability Index), Kvebekova skala onesposobljenosti kod lumbalnog sindroma (Quebec Back Pain Disability Scale), bolnička skala za anksioznost i depresiju (Hospital Anxiety and Depression Scale), upitnik za procenu prisustva straha od fizičke aktivnosti/posla i njihovog izbegavanja (The Fear-Avoidance Beliefs Questionnaire)&nbsp; i skala katastrofizma bola (Pain Catastrophizing Scale). Rezultati: Nije uočena statistički značajna razlika algometrijskih vrednosti između pacijenata sa cervikalnom radikulopatijom i pacijenata sa lumbalnom radikulopatijom. Ustanovljeno je da osobe ženskog pola imaju niži prag bola i nižu toleranciju na bol od osoba mu&scaron;kog pola. Poređenjem algometrijskih vrednosti pre započinjanja i posle zavr&scaron;avanja terapijskog ciklusa zapaža se da je program rehabilitacije povoljno uticao na pacijente sa lumbalnom radikulopatijom, dok je kod pacijenata sa cervikalnom radikulopatijom do&scaron;lo do pogor&scaron;anja tegoba. Prisutna je negativna korelacija između vrednosti izmerenih algometrom i skorova za anksioznost, depresiju i strah od fizičke aktivnost i posla, &scaron;to znači da biopsihosocijalni faktori u velikoj meri utiču na bolnost. Zaključci: Kvantifikovanje i mapiranje bola uz pomoć algometra i utvrđivanje biopsihosocijalnog statusa putem upitnika će omogućiti primenu adekvatne terapije kod pacijenata, koja je zasnovana na individualnom pristupu. Istovremeno bi primenjenom metodologijom bila postignuta bolja verifikacija rezultata rehabilitacionog programa.</p> / <p>Introduction: Radiculopathy is usually accompained by pain and other sensory and motor disorders, with reducing the quality of life in different extent. Algometry as a highly sensitive method provides objective insight into the degree of pain, while the use of questionnaires in a simple way can estimate the characteristics of pain and the patient&#39;s biopsychosocial status. Objective: The study was conducted in order to measure the pressure pain threshold and pressure pain tolerance threshold in patients with cervical and lumbar radiculopathy and found a possible association of pain with the biopsychosocial factors. Materials and methods: The study examined 60 patients with cervical radiculopathy (30 men and 30 women) and 60 patients with lumbar radiculopathy (30 men and 30 women) before starting and after finishing treatment cycle. All patients were hospitalized in the Clinic for Medical Rehabilitation, Clinical Center of Vojvodina in Novi Sad, and a treatment cycle lasted an average of 14-21 days. Research was conducted using Pain Detect Test, Brief Pain Inventory, Neck Disability Index, Quebec Back Pain Disability Scale, Hospital Anxiety and Depression Scale, The Fear-Avoidance Beliefs Questionnaire and Pain Catastrophizing Scale. Results: There was no statisticallly significant difference in algometric values between patients with cervical radiculopathy and patients with lumbar radiculopathy. It was found that females have a lower pressure pain threshold and lower tolerance to pain than males. Comparing algometric values before starting and after finishing treatment cycle can be noted that the program of rehabilitation favorable influence on patients with lumbar radiculopathy, while in patients with cervical radiculopathy occured deterioration in subjective symptoms. There is a negative correlation between values measured by algometer and scores for anxiety, depression and fear of physical activity and work, which means that biopsychosocial factors greatly affect the pain. Conclusions: Quantification and mapping the pain by algometer and determination of biopsychosocial status through questionnaires will provide the implementation of appropriate therapy for patients, which is based on individual approach. At the same time, the applied methodology would be achieved better verification of the results in rehabilitation program.</p>

Chronic pain is usually defined as pain of more than three months duration. The prevalence of chronic pain among the general population in Sweden is 18%. Compared with the general population, these patients report lower life satisfaction, decreased activity in daily life and higher levels of depression with decreased work ability, and increased sick leave. Research indicates that multimodal rehabilitation (MMR) programmes, including cognitive behavioural approaches for patients disabled by chronic pain, are effective for return to work. The primary aim of this thesis was to assess outcomes by a long-term follow-up of patients with chronic musculoskeletal pain. Furthermore, the aim was to evaluate two different rehabilitation strategies regarding impact on pain intensity, activity, depression, life satisfactions, and sick leave. Two groups, comprising 255 (between the years 1999-2002) and 296 (between 2007-2008) patients respectively, from the Pain Rehabilitation Clinic at Umeå University Hospital, Sweden, were all assessed by interdisciplinary teams. They completed questionnaires regarding pain intensity, disability, life satisfaction, anxiety and depression, and sick leave, before intervention, immediately after intervention (only the first group; n=255), and at one-year follow-up, after participating in a MMR programme in a specialist clinic, or after receiving a rehabilitation plan (RP) with follow-up in primary care. Allocation to either of the two groups was based on the initial interdisciplinary team assessment. Furthermore, a five-year follow-up of 158 patients with whiplash injury was conducted. Pain intensity decreased and life satisfaction increased significantly regarding somatic health in both groups, at follow-up. In addition, depression improved and disability decreased to a higher extent after participating in the MMR programme as compared to RP and subsequent follow-up in primary care. Patients’ positive beliefs about recovery, and positive expectations about work correlated with favourable rehabilitation outcomes. Sick leave at one year follow-up decreased in both groups. Regarding whiplash injury, patients who reported moderate or severe disability also reported significantly higher pain intensity, depression and post-traumatic stress scores and lower perception of general health compared with patients who reported mild or no disability. In conclusion, MMR programmes seem to be beneficial by decreasing pain intensity, depression, disability and sick leave among patients with chronic musculoskeletal pain. Furthermore, patients’ positive beliefs correlate with more favourable long-term outcomes. An interdisciplinary team assessment based on a biopsychosocial approach may be of value for selection of rehabilitation strategy.

This dissertation introduces a new problem in the delivery of healthcare, which could result in lower cost and a higher quality of medical care as compared to the current healthcare practice. In particular, a framework is developed for sedation and cardiopulmonary management for patients in the intensive care unit. A method is introduced to automatically detect pain and agitation in nonverbal patients, specifically in sedated patients in the intensive care unit, using their facial expressions. Furthermore, deterministic as well as probabilistic expert systems are developed to suggest the appropriate drug dose based on patient sedation level. This framework can be used to automatically control the level of sedation in the intensive care unit patients via a closed-loop control system. Specifically, video and other physiological variables of a patient can be constantly monitored by a computer and used as a feedback signal in a closed-loop control architecture. In addition, the expert system selects the appropriate drug dose based on the patient's sedation level. In clinical intensive care unit practice sedative/analgesic agents are titrated to achieve a specific level of sedation. The level of sedation is currently based on clinical scoring systems. In general, the goal of the clinician is to find the drug dose that maintains the patient at a sedation score corresponding to a moderately sedated state. This is typically done empirically, administering a drug dose that usually is in the effective range for most patients, observing the patient's response, and then adjusting the dose accordingly. However, the response of patients to any drug dose is a reflection of the pharmacokinetic and pharmacodynamic properties of the drug and the specific patient. In this research, we use pharmacokinetic and pharmacodynamic modeling to find an optimal drug dosing control policy to drive the patient to a desired sedation score.

Intravenous line placement is one of the most common procedures performed on children presenting to the Emergency Department. Anxiety about needles is widespread, and many children experience high levels of fear and/or pain with their IV line placements. Hypnosis is a behavioral intervention that shows significant promise for alleviating procedure-related pain and anxiety in children. Twenty-five developmentally normal, English-speaking children between the ages of five and fifteen who required IV line placement in the Pediatric Emergency Department at Yale-New Haven Childrens Hospital were randomized to receive either the standard of care or standard of care plus a brief hypnotic intervention. The groups were similar with regard to baseline demographic and socioeconomic status, previous experience with medical care, and presence or absence of chronic medical conditions. Childrens pre-procedural anxiety ratings on a 10cm visual analog scale (VAS) and expected procedural pain ratings by 10-point oucher and 10cm VAS were not significantly different between the groups. Children randomized to the hypnosis group reported less anxiety during the procedure (mean 5.0 vs 3.1, median 7.2 vs 2.2, p = 0.28) than children randomized to the standard of care group. Cases also had a decrease in anxiety from expected to actual of 1.6 on a 10cm scale, while those randomized to the control group had an increase from expected to actual anxiety of 1.1 (p=0.01). A smaller trend towards decreased pain in the hypnosis group was also present. As measured by VAS, cases had lower mean pain scores (3.4 vs 4.3) than controls. In a comparison of anticipated and actual pain scores between groups, the hypnosis group had a mean decrease of 0.8 on a 10cm VAS , while the control group had a mean increase of 0.5 (p=0.14). Recruitment of subjects is ongoing, but preliminary results suggest that hypnosis is effective for alleviating needle-related anxiety in children undergoing IV line placement and may be helpful for alleviating the pain of IV line placement as well.

Diss. (sammanfattning) Linköping : Univ., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Bakgrund: Palliativ vård syftar bland annat till att lindra lidande och symtom som smärta och ångest. För att kunna bedöma, utvärdera samt lindra symtomen behövs smärtskattningsinstument användas. Att lindra dessa symtom främjar livskvaliteten hos patienter i en palliativ fas. Genom det Svenska palliativregistret finns möjlighet att sammanställa och utvärdera information som kan främja forskning och därmed bidra till ett minskat lidande. Syfte: Syftet är att undersöka förekomst av smärta och smärtlindring i livets slutskede samt se i vilken utsträckning validerade instrument används. Syftet är också att undersöka om det finns någon skillnad mellan smärta och olika bakgrundsvariabler. Metod: Denna studie är en deskriptiv studie av kvantitativ design och är utformad med hjälp av retrospektiv registerdata. Datan insamlades genom det Svenska palliativregistrets dödsfallsenkät. 1435 patienter inkluderades som hade vårdats på olika palliativa vårdformer inom Uppsala och Enköping.   Resultat: Resultatet visar att smärtskattningsinstrument används i en bristande utsträckning inom den palliativa vården, då endast 56 % utav de som hade smärta också smärtskattades. När det gäller smärtlindring så blev 69 % utav patienterna helt och 30 % delvis smärtlindrade. Vid analysen utav samband mellan smärtlindring och vissa dödsplatser så visade resultatet att det fanns en signifikant skillnad. Samma resultat framkom även gällande analysen utav samband mellan vissa grundsjukdomar och upplevelsen utav smärta. Upplevelsen utav smärta samtidigt som upplevd ångest visade sig ha ett samband. Slutsats: Detta område är relativt outforskat, vilket gör att mer forskning behövs. Resultatet från denna studie kan användas som ett underlag för framtida forskning. / Background: Palliative care is intended to alleviate suffering such as pain and anxiety. By using pain measurements instruments these symptoms can be assessed, evaluated and alleviated. The patients life quality is promoted by alleviating these symptoms. Through the Swedish Register of palliative care there is a possibility to compile and evaluate information that can promote research and thereby contribute to a reduced suffering. Aim: The aim is to investigate the presence of pain and pain treatment in end of life care and also to learn in which extent validated pain measurements instruments are used. The aim is also to investigate whether there is a difference between pain and different background variables. Method: This is a descriptive study of a quantitative design and is shaped with retrospective registry data. The data was collected through the Swedish register of palliative cares’ death questionnaire. 1435 patients were included who had been cared in different forms of palliative care in Uppsala and Enköping. Result: The result shows that pain measurement instruments are used in a lacking extent in palliative care, where 56 % of those who experienced pain were pain estimated. When it comes to pain estimation this study shows that 69 % of the patients were completely relieved of their pain and 30 % were partly relieved. The analysis of the connection between pain treatment and some death places showed that there is a significant difference. The same result also appeared in the analyze of the connection between some background diseases and the experience of pain. The experience of pain was shown to have a connection with the experience of anxiety. Conclusion: This area is relatively unexplored, which means more research is required. The results of this study could be used as a basis for future research.