No description available.

No description available.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Anaesthesiology / Doctoral / Doctor of Philosophy

Complex Regional Pain Syndrome (CRPS) is an extremely debilitating condition, characterized by chronic pain with associated trophic changes. The 1st description of this condition dates back to 1864. The condition has been variously described over the years as “causalgia”, “Sudeck’s dystrophy” and “reflex sympathetic dystrophy”. In 1993 the International Association for the Study of Pain (IASP) introduced the term Complex Regional Pain Syndrome (CRPS) with diagnostic criteria that are currently used. CRPS was subdivided into type I and type II. CRPS type I is diagnosed when there is no obvious nerve injury, whereas CRPS type II refers to cases with nerve injury. It follows that the present diagnostic criteria depend solely on meticulous history and physical examination without any confirmation by specific gold standard tests. The pathophysiology of this pain syndrome is poorly understood; however there is growing evidence for an inflammatory or sympathetic cause. It is therefore not surprising that there is no uniform approach to its management. Therapy is often based on a multi-disciplinary team approach with use of non –pharmacological therapy (physiotherapy and occupational therapy), pharmacological therapy (analgesics, neuroleptics, bone metabolism drugs), and invasive therapy (stellate ganglion blocks and sympathectomy). This review acknowledges the humble beginnings of this condition, and provides an understanding for the evolution of its terminology. It objectively reviews the current IASP diagnostic criteria, challenging its efficacy and sensitivity. Despite its pathophysiology remaining an enigma, the latest pathophysiological advances are reviewed in the endeavour to better understand this condition and enhance treatment options. The role of surgical sympathectomy for this condition is reviewed, highlighting its importance and underappreciated success in the management of CRPS. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2012.

No description available.

The purpose of this research was to investigate the effect of parent education on maternal confidence and predictions of pain medication use in labor. The variables in this study were maternal age, parity, self-efficacy, prediction of pain medication usage, and parent education attendance. A convenience sample of 100 pregnant women enrolled in parent education classes at a major metropolitan tertiary care system was used. Data were collected through surveys administered by parent educators prior to the first class in the series and at the end of the last class. Instruments included the Childbirth Self-Efficacy Inventory and a questionnaire regarding maternal preference for pain control during tabor. The findings indicated that the parent education classes had a positive effect on the women's childbirth self-efficacy and outcome expectancy. Additionally, at the end of the classes a significant number of women reported they were less certain that they would have an epidural or use narcotic pain medication during labor. The findings, however, demonstrated no significant difference among the CBSEI scores of women with different preferences for pain control during labor.

Patienter med ett opioidmissbruk kan upplevas ha ett socialt avvikande beteendemönster som kan leda till en social stigmatisering. Att inom sjukvården se patienter som socialt avvikande kan leda till att de får en sämre vård och behandling än vad de har rätt till. Smärta är en subjektiv upplevelse, där patienten har en individuell uppfattning om sin smärta och kan därför inte jämföras med någon annans smärtupplevelse. Syftet med studien var att belysa sjuksköterskors attityder till smärtbehandling av patienter med opioidmissbruk. En systematisk litteraturstudie genomfördes bestående av 11 vetenskapliga artiklar. Resultatet mynnade ut i tre kategorier: Attityder gentemot patienter med opioidmissbruk, Attityder till den subjektiva smärtan och Attityder i samband med erfarenhet och bristande kunskap. Resultatet visade att sjuksköterskor har negativa attityder till patienter med opioidmissbruk. Trots att sjuksköterskorna var medvetna om att patienter med ett tidigare eller pågående opioidmissbruk, som upplevde smärta, behöver en högre dos av smärtlindring än patienter utan missbruksproblem, så upplevdes de ändå som de att ljög för att få en ökad dos opioider. Studien lyfte fram en bristande kunskap hos sjuksköterskor angående missbruk och beroende, vilket kunde leda till ett dömande av patienter med opioidmissbruk. Till vidare studier behövs det ytterligare forskning om hur patienter med opioidmissbruk upplever sjuksköterskornas attityder i det vårdande mötet. / Patients with an opioid addiction may be perceived to have a socially deviant behavior which may lead to social stigmatization. To see patients as socially deviant in healthcare can lead to that they receive worse care and treatment than what they are entitled to. Pain is a subjective experience, where the patient has an individual perception of his pain and can not be compared with another's experience of pain. The purpose of the study was to examine nurses' attitudes to pain treatment of patients with opioid addiction. A systematic literature review was conducted consisting of 11 scientific articles. The results culminated in three categories: Attitudes towards patients with opioid addiction, Attitudes to the subjective pain and attitudes associated with experience and lack of knowledge. The results showed that nurses have negative attitudes towards patients with opioid addiction. The nurses were aware that patients with a previous or current opioid addiction experienced pain needed a higher dose of pain medication, they were perceived nonetheless as they lied to get an increased dose of opioids. The study highlighted a lack of knowledge of nurses regarding addiction and dependence, which could lead to a judgment of patients with opioid addiction. For further studies there is a need to study how patients with opioid addiction experienced nurses' attitudes in the caring encounter.

This study was designed to determine the effectiveness of a clinical intervention program for reduction of pain and concomitant symptoms of anxiety, depression and hostility in individuals experiencing chronic pain. The program consisted of 36 weeks of supportive group therapy, education and sessions of progressive muscle relaxation induced hypnosis. Single subject research design was used to analyze the clinical effectiveness of treatment. Data was collected and compiled weekly. Serial position curves were generated for a Reported Pain Index, SCL-90-R Symptom Indices for Anxiety, Depression, Hostility and the SCL-90-R Global Severity Index. The three subjects were adults whose ages ranged from 39 to 65, with five or more years of chronic pain due to orthopedic or arthritic conditions. Qualitative analysis of the data indicated dramatic reductions in pain and secondary symptoms. Reductions in reported pain ranged from 17% to 31% with the mean pain reduction for the group of 20.6%. Reduction in the SCL-90-R Global Severity Index ranged from 13.1% to 49.4% with the mean reduction for the group of 36.1%. Reduction in depression ranged from 12.7% to 50% with the mean reduction for the group of 32.6%. Anxiety was reduced for two subjects with a slight increase of .02% for the third subject. Range of anxiety change was .02% increase to 59% reduction with a group mean reduction of 36.3%. Reduction in hostility ranged from 29.5% to 54.4% with a group mean reduction of 39.9%. Progressive muscle relaxation induced hypnosis contributed to further reduction of pain and secondary symptoms with reductions ranging from 4 to 49%. The results of this study show dramatic reductions in pain, depression, hostility and anxiety in chronic pain patients. These findings are not meant to be generalized to other populations, but may point the way for future research utilizing long-term therapeutic approaches and single subject research design.