There is a great need for new analgesics. The current problem in treatment of severe pain is that side effects limit the effectiveness of therapy. Glycine receptors are important in modulation of nociception, suggesting a novel class of analgesics. Previous studies in rats show that intrathecal administration of glycine agonists and amino acids structurally similar to glycine have antinociceptive effects. The effects of isovaline, a unique, non-proteogenic glycine-like aminoacid, have not been studied. Isovaline is absorbed from the gut and transported across the blood-brain-barrier. We examined the hypothesis that isovaline produces antinociception in mice. Administration of strychnine, an antagonist at glycine receptors, into the cisterna magna or lumbar intrathecal space resulted in allodynia, localized to the somatotopic distribution of the trigeminal and lumbar nerves. These findings provided a basis for models of lumbar and trigeminal neuralgia. Racemic isovaline blocked strychnine induced allodynia in both models without apparent side effects. We next investigated the antinociceptive effects of glycine-like amino acids in formalin foot assay, a conventional rodent model of acute and chronic pain. Antinociceptive effects were demonstrated on intrathecal administration of glycine, beta-alanine, and isovaline. Intravenous isovaline produced significant antinociceptive effects in the formalin foot model. The toxicity of isovaline and related amino acids were determined. Exploratory behavior, gait, and responses to stimuli were used to assess sedation. The rotarod test was used to examine central nervous system (CNS) and neuromuscular toxicities of intravenous isovaline. Lumbar administration of glycine and beta-alanine caused scratching and/or lower body weakness. Isovaline at 7-times intrathecal ED50 produced lower body weakness in some animals. None of the amino acids produced sedation comparable to morphine. At 6-times ED50, beta-alanine produced weakness. Both glycine (ED50) and beta-alanine (3x ED50) but not isovaline produced local nerve irritation. Intracisternal injection of glycine did not reverse allodynia and resulted in death. Neither R nor S enantiomers of isovaline impaired performance on the rotarod test. Isovaline has significant antinociceptive properties. Given the absence of apparent CNS or motor toxicity, isovaline has potential as a clinical analgesic.

There is a great need for new analgesics. The current problem in treatment of severe pain is that side effects limit the effectiveness of therapy. Glycine receptors are important in modulation of nociception, suggesting a novel class of analgesics. Previous studies in rats show that intrathecal administration of glycine agonists and amino acids structurally similar to glycine have antinociceptive effects. The effects of isovaline, a unique, non-proteogenic glycine-like aminoacid, have not been studied. Isovaline is absorbed from the gut and transported across the blood-brain-barrier. We examined the hypothesis that isovaline produces antinociception in mice. Administration of strychnine, an antagonist at glycine receptors, into the cisterna magna or lumbar intrathecal space resulted in allodynia, localized to the somatotopic distribution of the trigeminal and lumbar nerves. These findings provided a basis for models of lumbar and trigeminal neuralgia. Racemic isovaline blocked strychnine induced allodynia in both models without apparent side effects. We next investigated the antinociceptive effects of glycine-like amino acids in formalin foot assay, a conventional rodent model of acute and chronic pain. Antinociceptive effects were demonstrated on intrathecal administration of glycine, beta-alanine, and isovaline. Intravenous isovaline produced significant antinociceptive effects in the formalin foot model. The toxicity of isovaline and related amino acids were determined. Exploratory behavior, gait, and responses to stimuli were used to assess sedation. The rotarod test was used to examine central nervous system (CNS) and neuromuscular toxicities of intravenous isovaline. Lumbar administration of glycine and beta-alanine caused scratching and/or lower body weakness. Isovaline at 7-times intrathecal ED50 produced lower body weakness in some animals. None of the amino acids produced sedation comparable to morphine. At 6-times ED50, beta-alanine produced weakness. Both glycine (ED50) and beta-alanine (3x ED50) but not isovaline produced local nerve irritation. Intracisternal injection of glycine did not reverse allodynia and resulted in death. Neither R nor S enantiomers of isovaline impaired performance on the rotarod test. Isovaline has significant antinociceptive properties. Given the absence of apparent CNS or motor toxicity, isovaline has potential as a clinical analgesic.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

There is a great need for new analgesics. The current problem in treatment of severe pain is that side effects limit the effectiveness of therapy. Glycine receptors are important in modulation of nociception, suggesting a novel class of analgesics. Previous studies in rats show that intrathecal administration of glycine agonists and amino acids structurally similar to glycine have antinociceptive effects. The effects of isovaline, a unique, non-proteogenic glycine-like aminoacid, have not been studied. Isovaline is absorbed from the gut and transported across the blood-brain-barrier. We examined the hypothesis that isovaline produces antinociception in mice. Administration of strychnine, an antagonist at glycine receptors, into the cisterna magna or lumbar intrathecal space resulted in allodynia, localized to the somatotopic distribution of the trigeminal and lumbar nerves. These findings provided a basis for models of lumbar and trigeminal neuralgia. Racemic isovaline blocked strychnine induced allodynia in both models without apparent side effects. We next investigated the antinociceptive effects of glycine-like amino acids in formalin foot assay, a conventional rodent model of acute and chronic pain. Antinociceptive effects were demonstrated on intrathecal administration of glycine, beta-alanine, and isovaline. Intravenous isovaline produced significant antinociceptive effects in the formalin foot model. The toxicity of isovaline and related amino acids were determined. Exploratory behavior, gait, and responses to stimuli were used to assess sedation. The rotarod test was used to examine central nervous system (CNS) and neuromuscular toxicities of intravenous isovaline. Lumbar administration of glycine and beta-alanine caused scratching and/or lower body weakness. Isovaline at 7-times intrathecal ED50 produced lower body weakness in some animals. None of the amino acids produced sedation comparable to morphine. At 6-times ED50, beta-alanine produced weakness. Both glycine (ED50) and beta-alanine (3x ED50) but not isovaline produced local nerve irritation. Intracisternal injection of glycine did not reverse allodynia and resulted in death. Neither R nor S enantiomers of isovaline impaired performance on the rotarod test. Isovaline has significant antinociceptive properties. Given the absence of apparent CNS or motor toxicity, isovaline has potential as a clinical analgesic. / Medicine, Faculty of / Anesthesiology, Pharmacology and Therapeutics, Department of / Graduate

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2014 / Discrepancies exist between how pain is assessed in ICU patients able and unable to self report. There are pain assessment scales and guidelines that have been developed over the years for pain assessment. However, little is known regarding ICU nurses’ knowledge and current practices in the provision of pain management in the critically ill. The purpose of this study was to investigate intensive care nurses’ knowledge and practices related to pain assessment for critically ill patients. A quantitative non-experimental, descriptive cross-sectional design was used to achieve the objectives. ICU nurse participants (n=79) were drawn from the five (5) adult ICUs in a public tertiary hospital. Data were collected using a self-administered questionnaire by Rose et al. 2011. Descriptive and inferential statistics were used to analyze the data.

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 4 uppsatser.

Lower back pain (LBP) is a medical condition that will affect most of us at some point in our lives. Several medical causes have been identified for LBP, yet the large majority of LBP patients do not receive a specific diagnosis. These patients use up a large majority of health care resources, and accumulate billions of dollars in medical costs in countries throughout the globe. In recent years, an increasing focus has been placed on the idea that aquatic therapy may be an effective therapy for LBP patients. Exercise therapy has already proven itself as an effective means for treating LBP. Thus, combined with the unique properties of water, experts believe that aquatic therapy is the future of LBP treatment. This thesis aims to explore the efficacy of aquatic therapy as a treatment for LBP. Through the analysis of controlled peer-reviewed studies, scholarly information databases, and historical data on LBP treatment, this thesis evaluates the relationship between aquatic therapy and LBP in its entirety. Scientific properties of water have shown its many uses in rehabilitative therapy treatments. Water, in theory, is able to manipulate the exercise environment to allow for more substantial progress to be made. In studies where aquatic therapy was tested versus no treatment, aquatic therapy proved to be a more efficient and effective option. Still, when placed against other therapies, aquatic therapy did not always prove more effective. While the analyzed studies support the idea that aquatic therapy is an effective treatment for LBP, further research is needed to determine how aquatic therapy holds up against other forms of treatment.

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg 2017. / Neck pain is one of the most common debilitating musculoskeletal complaints seen in physiotherapy practice. It is often associated with headache, upper back and shoulder/arm pain (cervico-brachial pain) and such patients are more disabled than patients with neck pain only. Cervico-brachial pain syndrome is an upper quarter pain syndrome in which neural tissue sensitivity to mechanical stimulus is thought to play a role. Neuropathic pain is a problem associated with and prevalent in neck and arm pain. Psychosocial factors, such as fear-avoidance beliefs and catastrophising, have been shown to play an important role in treatment outcomes. Neural mobilisation (NM) is often used to influence the neural structures in conditions with signs of neural involvement or neural mechano-sensitivity. It seems reasonable to use neural mobilisation in cervico-brachial pain as neural structures play an important role in this condition The optimal treatment intervention for cervico-brachial pain is yet to be established. The prevalence of cervico-brachial pain in a South African population is also unknown. Aims of the study The aims of the study were to: i. To establish the prevalence of cervico-brachial pain in patients being seen in physiotherapy practices in Pretoria, South Africa. ii. To establish the effect of neural mobilisation on the pain, function and quality of life of patients with acute and sub-acute cervico-brachial pain. iii. To establish the influence of high catastrophising scores and neuropathic pain on treatment outcomes. iv. To establish the effect of demographic factors on the pain, function and quality of life of patients with cervico-brachial pain. Methods Research Question 1. A retrospective survey of physiotherapy patient records dated 1 January 2011 to 31 December 2011 was conducted. The prevalence of patients with neck pain in relation to other musculoskeletal complaints was calculated and expressed as a percentage. Symptoms recorded included the following; headache, dizziness, pins and needles, feeling of weakness, other sensations, more than one symptom and pain in other area/s. Based on body charts, areas of pain were coded as neck pain only, pain in the shoulder, shoulder and upper arm, shoulder to elbow, lower arm, hand, neck and arm up to wrist, neck and arm including hand. Research Questions 2, 3 and 4 A single blind randomised clinical trial was conducted to establish the effect of neural mobilisation on cervico-brachial pain. The intervention group (IG) received cervical and thoracic mobilisation exercises, advice and NM. The usual care (UC) had the same treatment without NM. Outcomes were assessed at 3 weeks, 6 weeks, 6 months and 12 months. The Numerical Pain Rating Scale was used to determine the effect of NM on pain. The Patient Specific Functional Scale was used to determine the effect of NM on function and the EuroQual5 instrument was used to establish the effect of NM on the quality of life. At 6 weeks the Global Rating of Change was administered to measure patient’s perception of recovery. The Neuropathic Diagnostic Questionnaire (DN4) was used to classify patients with neuropathic pain and the Pain Catastrophising Scale to identify catastrophisers. Results and Discussion Prevalence of neck and radiating arm pain in physiotherapy private practice, Pretoria South Africa The prevalence of neck pain in private physiotherapy practices in Pretoria, SA is high (46.4% of the total musculoskeletal complaints) with radiating arm pain (52.2% of neck pain population) and pain in other areas (22.6% of neck pain population) being commonly associated with neck pain. Furthermore, other symptoms such as headache (25.4% of the neck pain population) and paraesthesia (11.2%) are also frequently present. Neck pain is multi-faceted and this has implications for its management. Future studies with a bigger, representative population sample are needed to establish the prevalence of neck pain in SA. The effect of neural mobilisation on cervico-brachial pain All patients improved significantly in terms of pain, function and quality of life over the 12-month period. However, the IG had significantly less pain than the UC group at 6 months (p=0.03 95% CI 0.96 - 2.03) and this difference was more pronounced in patients with neuropathic pain (IG 2.91 95%CI 1.74 - 4.08 and CG 5.5 95% CI 3.45 - 7.55 p=0.01). There were no significant differences between groups in terms of function or quality of life. Patients with neuropathic pain had significantly more pain at 6 months (positive neuropathic pain 3.71 95%CI 2.57 – 4.84; negative neuropathic pain 1.44 95% CI 0.93 – 1.96 p=0.0001) and 12 months (positive neuropathic pain 3.23 95% CI 1.74 – 4.71; negative neuropathic pain 1.38 95% CI 0.88 – 1.91 p=0.01) compared to those without neuropathic pain. At 12 months function was also negatively affected by the presence of neuropathic pain (positive neuropathic pain 23.91 95%CI 20.96 – 26.86; negative neuropathic pain 27.15 95% CI 25.95 – 28.36 p=0.04). It did not have an effect on quality of life. Catastrophisers had more pain at 6 months (catastrophisers 4.25 95% CI -1.90 – 10.40; non-catastrophisers 1.70 95% CI 1.22 – 2.17 p=0.02) and 12 months (catastrophisers 3.56 95% CI 1.10 – 6.02) compared to non-catastrophisers (1.47 95% CI 0.96 – 1.99 p=0.02). There was no difference in their function at any time, however at baseline they reported a lower quality of life (Catastrophisers 61.96 95% CI 52.04 – 71.87; non-catastrophisers 75.79 95% CI 71.91 – 79.66 p=0.002). Conclusion The addition of NM to cervical and thoracic mobilisation, exercises and advice to stay active, in the management of cervico-brachial pain, resulted in less pain at 6-month follow-up. For patients with neuropathic pain the positive effect was more pronounced. Adding NM as an adjunct to usual care is effective to improve pain for patients with cervico-brachial pain especially for those with a neuropathic pain component. The presence of neuropathic pain and catastrophising resulted in poor pain-related outcomes. / MT2017

Thesis (MScPhysio (Physiotherapy))--Stellenbosch University, 2008. / The prevalence of low back pain (LBP) in United Arab Emirates (UAE) is estimated to be about 57% in males and 64% in females. Low back pain is commonly treated by primary care physicians and physiotherapists in the UAE. are increasingly used for clinical assessment, to demonstrate and reflect on the effectiveness of an intervention. Oswestry Disability Index (ODI) is Self-reported outcome measure that widely used and recommended for LBP. ODI Arabic version was developed and validated in women population. To date no UAE Arabic version of the ODI exists which has been cross-culturally adapted, validated and published in the peer-reviewed literature. . Objective The objectives are, to cross-culturally adapt the Arabic version of the ODI developed in Tunisia to devise a pre-final ODI-UAE Arabic version; to pre-test the pre-final ODI-UAE Arabic version in a target group of patients to devise the final ODI-UAE Arabic version; and to determine the reliability and construct validity of the final ODI-UAE Arabic version. Study design Culture adaptation, reliability and validity testing. Methodology The cross culture adaptation of the ODI Arabic version developed in Tunisia was performed in accordance with the published guidelines. For reliability 108 clients of UAE nationals with LBP were consecutively selected and completed the final ODI-UAE Arabic version, at baseline and 48 hours, and test–retest reliability and internal consistency were calculated. For validity 108 completed the final ODI-UAE Arabic version, VAS, and the Squat test at baseline and 4 weeks follow up; construct validity, items frequency response, response to change and floor and ceiling were evaluated. Results The ODI-UAE (9 questions) had high level of test–retest with ICC of 0.99; the mean at baseline and 48 hours was (0.68); Cronbach's alpha was 0.99. Strong positive correlation with VAS r =>0.70 (p = <0.01), and moderate inverse correlation between ODI and Squat r =>0.65 (p = <0.01).The results of the maximum frequency response were less than 80% for the entire 9 question. The effect size and the SRM of ODI-UAE, VAS and Squat test at baseline and 4 weeks were identical comparable the effect size, were 1.66, 1.85, and 1.59 respectively. ODI-UAE demonstrated absence of floor and ceiling effect; less than 15% of the respondents achieved the lowest or highest possible score respectively (0 -11.5) or (87-100%). Conclusion The ODI-UAE Arabic version is an easy to understand, reliable and valid condition-specific outcome measure for the measurement of the limitation of functional ability cause by LBP in the United Arab Emirates national population.

Pain requiring treatment is experienced by many cancer patients at the end of life. When these patients stay at home, family caregivers are often directly implicated in pain management. There are few studies that examine the process that these family caregivers engage in when they take on the responsibility of pain management. This means we need information on whether or not these family caregivers are prepared for management to ensure proper support and optimal pain control. / The purpose of this qualitative study was to study the process used by family caregivers at home to manage the pain of palliative cancer patients using a grounded theory approach. A total of 24 family caregivers with differing relationships to the patient and differing lengths of caregiver experience participated. Family caregivers were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews, field notes, and memos. Data analysis used Strauss & Corbin's (1998) suggestions for substantive coding: open, axial, and selective coding. / The results lead to the proposition of an explanatory theory titled "the puzzle of pain management," which include: 1) a frame of the process of "drawing on past experiences"; 2) puzzle pieces representing the process "strategizing a game plan" which include the sub-processes of "accepting responsibility," "seeking information," and "establishing a pain management relationship"; 3) puzzle pieces representing the process of "striving to respond to pain" which include the sub-processes of "determining the characteristics of pain," "implementing a strategy for pain relief," and "verifying if pain relief strategies were successful; and 4) "gauging the best fit," a decision-making process that joins the two pieces of the puzzle. / The realization that family caregivers assemble a puzzle of processes indicates that there are factors that nurses must be aware of before creating, teaching, and implementing interventions for pain management. Furthermore, the results provide information to create and subsequently administer interventions based on caregivers' existing knowledge, identified needs for information and support, and current pain management regimens. The puzzle of pain management must be validated by further studies using this theory, in part, to help create interventions that will allow us to know how useful the theory is in practice. / Keywords: family caregivers, carers, pain management, palliative care, cancer pain, home care, grounded theory