Chronic pain disorders are estimated to affect a significant proportion of the global population. These disorders are often debilitating and pose a substantial challenge to the everyday life of those affected. Modern medicine has made great strides in understanding the physiological processes involved in chronic pain. However, chronic pain is more than merely a physiological process. Chronic pain is an embodied mode of being-in-the-world that manifests in multiple aspects of lived experience, from the ability to perform day-to-day tasks to the relationship between body and self. Consequently, it is essential to cultivate a rich appreciation of chronic pain as a lived experience. To rely solely on physiological knowledge in conceptualizing chronic pain precludes the development of such an appreciation. This work examines the ways that phenomenology can be leveraged to broaden the current medical understanding of chronic pain to better incorporate subjective experience. As a rigorous methodology for studying embodied consciousness, phenomenology provides the theoretical and conceptual tools to form a rich description of chronic pain's lived experience. First, a brief history of theories of pain is presented to contextualize the development of modern medical understandings of chronic pain. Following this, the writings of three classical phenomenologists—Husserl, Heidegger, and Merleau-Ponty—are presented, and key phenomenological concepts are introduced. Phenomenology is then used to examine the lived experience of chronic pain. Finally, means of integrating phenomenology into the current medical framework are explored.

Background: Cannabis is increasingly used for management of chronic pain; however, the benefits and harms of this therapy remain uncertain. We conducted a systematic review to inform harms associated with inhaled cannabis for chronic pain. Methods: We searched MEDLINE, EMBASE, PsychInfo, and Web of Science for non-randomized studies reporting on harms associated with inhaled cannabis use, from inception to October 6, 2021. We used random-effects models for meta-analyses and assessed the certainty of evidence using the GRADE approach. Results: We identified 29 eligible studies enrolling 174,562 participants that reported 145 adverse events. Moderate certainty evidence suggests inhaled cannabis use is probably associated with dry mouth (prevalence: 56%; 95%CI 49 to 64), thirst (prevalence: 44%; 95% CI 33 to 55), fatigue (prevalence: 38%; 95%CI 31 to 45), nausea (prevalence: 17%; 95%CI 8 to 27), increased appetite (prevalence: 13%; 95%CI 9 to 18), dizziness (prevalence: 10%; 95%CI 6 to 14), diarrhea (prevalence: 9%; 95%CI 3 to 18), confusion (prevalence: 9%; 95%CI 5 to 13), mood changes (prevalence: 8%; 95%CI 4 to 15), hallucinations (prevalence: 7%; 95%CI 4 to 10), amnesia (prevalence: 6%; 95%CI 3 to 11), impaired coordination (prevalence: 5%; 95%CI 4 to 6), and disorientation (prevalence: 3%; 95%CI 1 to 7). Moderate certainty evidence shows that, compared to non-users, inhaling cannabis is probably associated with increased risk of shortness of breath (risk difference [RD]: 7%; 95%CI 4 to 10). Conclusions: Our review found moderate certainty evidence that dry mouth, thirst, and fatigue are probably frequently experienced with inhaled cannabis use. Several other adverse events are also probable associated with inhaled cannabis use but were less common. Rigorously conducted cohort studies are needed to inform harms associated with inhaled medical cannabis for chronic pain. / Thesis / Master of Science (MSc) / Increasing recognition of harms associated with long-term opioid therapy for management of chronic pain has generated enthusiasm for alternatives, including medical cannabis which is often consumed through inhalation. This review assesses the harms associated with the use of inhaled cannabis for management of chronic pain. Among serious adverse events, we found that inhaled cannabis is likely associated with amnesia, disorientation, impaired coordination, hallucinations, confusion, dizziness, chronic wheeze, and shortness of breath. Inhaled cannabis may be associated with palpitations, paranoia, anxiety, and cannabis dependence. The effects of inhaled cannabis on lung cancer, depression, and psychosis were uncertain. Among less serious adverse events, we found that inhaled cannabis is likely associated with thirst, fatigue, increased appetite, nausea, mood changes, diarrhea, and dry mouth. Inhaled cannabis may be associated with red eyes, vomiting, phlegm, asthma, and cough. The effects of inhaled cannabis on euphoria and irritability were uncertain.

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<p>Some individuals remain at risk for adverse outcomes such as chronic wrist/hand pain, falls, and fall-related osteoporotic fractures after distal radius fracture (DRF) remain. This thesis includes five studies that were conducted to establish prediction rules for assessing the risk of these adverse outcomes following DRF.</p> <p>The first manuscript outlines a theoretical framework (RACE - <strong>R</strong>educing pain, <strong>A</strong>ctivating, <strong>C</strong>ognitive reshaping, <strong>E</strong>mpowering) for managing the risk of adverse outcomes, mainly chronic pain, in individuals with DRF. The RACE is one of the first frameworks to suggest a risk-based management approach for individuals with DRF.</p> <p>The Patient-Rated Wrist Evaluation (PRWE) is a condition-specific measure for DRF used in research as well as clinical practice to measure pain and functions in individuals with different wrist/hand injuries. The second manuscript contributes to the literature by providing the first systematic literature review that synthesizes the evidence regarding the psychometric properties of the PRWE. The review determined that the PRWE has excellent reliability, construct validity, and responsiveness in individuals with DRF.</p> <p>The third manuscript indicates that the baseline pain intensity is an independent predictor of chronic pain in individuals with DRF. The results also suggest that the individuals who score ≥35/50 on the pain scale of the PRWE at baseline have 8 times greater risk for developing chronic wrist/hand pain compared to those who score < 35/50.</p> <p>The fourth and fifth manuscripts describe results of a two step study. The fourth manuscript is a structured literature synthesis that identified suitable measures for predicting the risk of falls and fall-related osteoporotic fractures following DRF. The fifth manuscript summarizes the results of preliminary analysis of psychometric properties of selected fall risk measures identified in the fourth manuscript. The fifth manuscript also provides feasibility and sample size requirements for conducting a fall prevention trial in individuals with DRF.</p> / Doctor of Philosophy (PhD)

<p> Older adults with persistent pain experience reduced physical functioning, increased disability, and higher rates of depression. Previous research suggests that different types of positive and negative expectancies (e.g., optimism and hopelessness) may be associated with the severity of these pain-related outcomes. Moreover, different types of expectancies may interact with perceived control to predict these outcomes. However, it is unclear whether different types of expectancies are uniquely predictive of changes in pain-related outcomes over time in older adults and whether perceived control moderates these relationships. The primary aims of the current study were to 1) examine how the shared and unique aspects of optimism and hopelessness differentially predict changes in pain-related outcomes (i.e., pain severity, pain interference, disability, and depressive symptoms) in older adults experiencing persistent pain over a 10-year and 2-year timeframe and 2) examine whether perceptions of control over one’s health moderate these relationships. The present study sampled older adults with persistent pain who participated in a nationally representative, longitudinal study (i.e., The Health and Retirement Study) at three timepoints across a 10-year period. First, confirmatory factor analyses (CFA) were conducted to determine appropriate modeling of expectancy variables. Second, mixed latent and measured variable path analyses were created to examine the unique relationships between expectancy variables and changes in pain-related outcomes over both a 10- year and 2-year period. Finally, mixed latent and measured variable path analyses and PROCESS were used to test perceived control as moderator of the relationships between expectancy variables and changes in pain-related outcomes over time. CFA results suggested that measures of optimism and hopelessness were best understood in terms of their valence, as positive (i.e., optimism) or negative (i.e., pessimism and hopelessness) expectations. Results from path analyses suggested that only negative, not positive, expectancies were significantly associated with worsening pain severity, pain interference, disability, and depressive symptoms across both 10-year and 2-year periods. Moderation analyses demonstrated inconsistent results and difficulties with replication. However, post-hoc path analyses found that perceptions of control over one’s health independently predicted some changes in pain-related outcomes over time, even when controlling for expectancies. Altogether, the current findings expand our knowledge of the associations between expectancies and pain by suggesting that negative expectancies are 10 predictive of changes in mental and physical pain-related outcomes across years of time. The current study also suggests that positive and negative expectancies may be related, but distinct factors in older adults with persistent pain and that health-related perceived control may be predictive of changes in pain over time. The current discussion reviews these extensions of our current knowledge in greater detail, discusses the potential mechanisms driving these relationships through a theoretical lens, and identifies the implications of this work. </p>

In recent years vitamin D has gained popularity in the media, on the internet, and throughout alternative treatment practitioners as a cheap and effective option to treat many diseases. Research showing that vitamin D receptors are present in virtually all cells of the body, and the increasing data demonstrating a relationship of vitamin D metabolites to chronic diseases, have led to widespread treatment of medical conditions with vitamin D supplementation. Chronic pain and inflammatory conditions are increasingly linked to vitamin D deficiency. The question posed in this review is whether there is significant, quality research to recommend vitamin D supplementation for patients with chronic pain conditions. Utilizing publications from PubMed for the review, various search terms were entered for vitamin D (vitamin D; vitamin D2; vitamin D3; 1,25-dihydroxyvitamin D3; 1,25-dihydroxycholecalciferol; 25 hydroxycholecalciferol; 25-hydroxyvitamin D; alfacalcidol; calcidiol; calcitriol; calcifediol; calciferol; ergocalciferal; cholecalciferol); and "pain." The search was continued from the last day of the Straub et. al. review, September 8th, 2008. The last search was conducted on December 5, 2012. The search protocol from Straub et. al was followed as well. Also, added to this search protocol were the terms: vitamin D receptor; VDR and "pain." These terms enabled a search for genetic links between vitamin D and pain. The search criteria resulted in nine relevant articles (from the original 1,069 studies) with varying treatment protocols in each article making any statistical representation impossible. Results on the effectiveness of vitamin D correlation with chronic pain were extremely variable, with most papers drawing the conclusion that more quality research needs to be implemented on the subject. Due to the variability and lack of quality randomized controlled trials, the current literature can only suggest a possible link between vitamin D levels and pain. Also, recent research into Vitamin D Receptors (VDR) has opened up a possible connection between VDR polymorphisms and pain. So, after a comprehensive review of vitamin D, Vitamin D Receptors, and pain, there is still not enough evidence to recommend supplementation to treat chronic pain conditions. However, enough evidence is available to recommend future high quality, randomized controlled trials to help determine the influence vitamin D and VDRs have on pain issues. / Oral Biology