Thesis (MPsych(Clin))--University of South Australia, 1998

Thesis (Ph. D.)--West Virginia University, 2004. / Title from document title page. Document formatted into pages; contains vi, 58 p. : ill. Includes abstract. Includes bibliographical references (p. 23-32).

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of MSc Physiotherapy Johannesburg, 2017 / Background Chronic pain is a health problem that occurs across cultures and across the globe. Treatment of chronic pain is challenging and there is often failure of recovery, with the need to look at different approaches to understanding chronic pain. It was recently found that people with chronic pain have both central and peripheral features. Therefore, there is a need to look at central mechanisms that may be contributing to the chronicity of pain. People with chronic pain disorders experience a disturbance in body schema. Laterality judgment performance is dependent on body schema and can therefore determine the central mechanisms affected in chronic pain patients. The aim of this systematic review is to determine whether there is a difference in laterality judgment between people with chronic pain and healthy individuals. Method A comprehensive search was done of the following databases: MEDLINE (Pubmed), CINAHL Plus, Cochrane Controlled Trials Registered, Physiotherapy Evidence Database (PEDro), Science Direct, SCOPUS, Clinical Key and Google Scholar. Combinations of the following keywords were used: ―laterality‖ ―body schema‖ ―motor imagery‖ and ―pain‖. The reference lists of all identified full text articles were searched for additional studies. Articles from inception up until December 2016 were considered for inclusion in this review. Outcome measures considered were reaction time (length of time taken to choose whether a pictured limb is right or left) and accuracy (correct number of responses). A total of 15 studies were included in this review. Methodological quality was assessed by two independent reviewers using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. Results from all the studies investigating similar conditions and using similar methodologies were analysed and pooled into statistical meta-analysis using Meta-Easy. The weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for the outcome measures, namely reaction time and accuracy. The random-effects model was used, due to the variation and small sample sizes in studies. Heterogeneity was assessed by the p-value and I2 value. Thereafter, studies were divided into sub-groups (according to condition/similar laterality tasks) and further iii analysed. Statistical measures used in both meta-analyses included the probability value, mean effect size, variance effect size and maximum likelihood. Where statistical pooling was not possible the findings are presented in a narrative form. Results Forest plots of reaction time of five studies regardless of condition in terms of reaction time showed a positive relationship between decreased reaction time and chronic pain. Accuracy of five studies regardless of condition did not show a clear direction of effect. Due to the high heterogeneity, interpretation of this meta-analysis should be done with caution. The sub-group analysis for accuracy in lower limb conditions versus healthy individuals showed a medium statistically significant effect size (0.59) with a significant 95% CI (0.11 to 1.07). Results for low back pain and cervical pain could not be pooled into a meta-analysis, as there were different methods of reporting the results in the studies. However, results from individual studies showed that laterality judgment impairments are present in the low back pain, complex regional pain syndrome 1 and the upper limb pain population. It was not been shown to be impaired in whiplash associated disorders. There is no consensus in the literature whether laterality is affected in chronic cervical pain. Conclusion Laterality judgment was shown to be impaired in CPRS 1, upper limb pain, carpal tunnel syndrome, and osteoarthritis of the knee and leg pain. Due to the lack of studies, low quality of evidence and differences in results between studies there are inconsistencies with regard to back pain and therefore no conclusions can be drawn from the literature. It was not been shown to be impaired in whiplash associated disorders and there is conflicting evidence in cervical pain. It is evident that the impairment of laterality judgment cannot be assumed amongst all chronic pain conditions. This systematic review can be used as a foundation for future research. Research studies can be designed to remediate laterality recognition in affected conditions and assess the effect hereof on levels of pain and functional abilities. This could solve the missing link in understanding chronic pain syndromes and its rehabilitation. Clinicians can also gain insight on incorporating techniques (e.g. graded motor imagery) to re-train the brain‘s neural plasticity, and to in turn decrease chronic pain. / MT2017

Background: The “gold standard” in chronic pain treatment is multidisciplinary care. With long wait times to receive appropriate care, there is a need for improved access to non-pharmacological treatments in the time gap between primary and specialist care. The Internet is emerging as a tool for delivery of healthcare information and intervention. Using this format to offer access to chronic pain therapies prior to specialist intervention may improve outcomes. Objective: To develop and test a guided Internet-based intervention for individuals with chronic pain waiting for specialty care. Method: A novel, Internet-based chronic pain intervention (ICPI) was developed, using evidence-based concepts proven effective in face-to-face interventions. This study was designed to assess feasibility of conducting larger-scale research and usability of the ICPI, and to collect preliminary data on effectiveness of the intervention. Data were collected at baseline, after each of the six intervention modules and 12 weeks after completion of the intervention. Results: Participants with chronic pain (n=41) reported satisfaction with the structure of the intervention, and ease of use at and away from their computers. Use of the Internet as a recruitment strategy aided in accrual of participants, making further large-scale study of the ICPI feasible. Preliminary data showed that the ICPI was effective in improving emotional function, had no demonstrable effect on physical function and produced a small but significant decrease in average and current pain intensity and pain interference. Most participants felt they benefited at least minimally overall as a result of using the ICPI. Conclusion: The newly-developed ICPI was well-received by participants and demonstrated some positive outcomes in this preliminary study. Further research with more participants is feasible and necessary, to fully assess the effect of this intervention. / Thesis (Ph.D, Nursing) -- Queen's University, 2014-01-31 11:54:25.7

Thesis (MNursing)--University of South Australia, 1996

Thesis (M. Phil)--University of Queensland, 2004. / Includes bibliographical references.

archives@tulane.edu / Opioids are the gold standard for treatment of severe pain, but long-term use of opioids has led to a crisis of addiction and overdose deaths in the US and abroad. Additionally, long-term use of opioids can lead to worse pain, dependence, and a host of other unfavorable side effects. ZH853 is a novel endomorphin analog that has reduced side effects, including abuse liability, and superior analgesia compared to morphine. The studies contained in this work examine the acute effectiveness of ZH853 in several pain states and whether chronic use prolongs and intensifies pain as morphine does. Two treatment paradigms were investigated. Either 1) chronic pain was induced followed by chronic treatment with morphine, ZH853 or vehicle, or 2) chronic drug was administered prior to pain induction. Neuropathic, inflammatory, and postoperative pain were induced using well-characterized methods. Drugs were administered by minipumps for 3-5 days at appropriate doses based on prior experiments. Animals were tested for mechanical allodynia and thermal hyperalgesia using von Frey filaments and the Hargreaves apparatus, respectively. Additionally, several gait parameters were measured using the CatWalk XT. At the end of experiments when animals had recovered to baseline, a naltrexone injection was administered to unmask latent sensitization (LS). Additional animals were used for immunohistochemistry (IHC) to assess several markers involving pain and inflammation. Morphine increased and prolonged inflammatory and postoperative pain while ZH853 reduced the overall time spent in pain and the severity of pain scores. Markers of inflammation were increased in morphine-treated animals but ZH853-treated animals consistently showed minimal inflammation. Finally, ZH853 protected against LS in all experiments, while vehicle- and morphine-treated animals showed hyperalgesia following naltrexone administration. ZH853 has a favorable side effect profile versus morphine, including greatly reduced abuse liability and a lack of respiratory depression, and it provides superior analgesia in a number of pain states. We now know that chronic use of this compound reduces time spent in a chronic pain state, the opposite of common opioids like morphine, making ZH853 an excellent candidate for clinical development in humans for chronic pain. / 1 / Amy K Feehan

Thesis (M.S.N.)--University of North Carolina at Greensboro, 2006. / Title from PDF title page screen. Advisor: Donald Kautz; submitted to the School of Nursing. Includes bibliographical references (p. 32-34).

Thesis (M.S.)--University of Michigan, 1993.

Thesis (Ph.D.)--Ohio University, November, 2004. / Includes bibliographical references (p. 145-172)