To understand pain processing requires the assessment of an individual’s perception of pain with temporal stimulation over different periods. Offset analgesia (OA), a phenomenon widely studied, refers to a disproportionate decrease in pain experience following a small reduction in temperature during noxious thermal stimulation. OA leads to skin desensitization, causing brief pain inhibition at the stimulation site and leading to adaptation and a decrease in pain scores. To avoid sensitization and habituation during thermal pain procedures, previous studies have utilized protocols in which the thermal stimulation is applied to different areas of the skin (e.g., upper forearm versus lower forearm). The reliability of this thermal pain calibration procedure in producing a nonadaptive effect has been previously tested using pain rating scales. The utilization of neuroimaging to further elucidate these relationships has not been widely studied, but it is likely an important tool to investigate these constructs. Functional near-infrared spectroscopy (fNIRS) is a noninvasive optical imaging technique that measures changes in hemoglobin (Hb) concentrations within the brain using the characteristic absorption spectra of Hb in the near-infrared range. This thesis investigated whether adaptation exists across four conditions of the OA paradigm using fNIRS. Introducing fNIRS to define significant differences in brain metrics (e.g., activated regions of interest) in participants who have undergone surgery and are experiencing chronic pain as well as healthy, pain-free controls could have implications for more accurate measures of OA and more reliable pain treatment options. In this study, noxious thermal stimulation was given to 19 participants on the forearm of the nondominant hand through a commonly used three-temperature OA paradigm with offset, constant, and control trials. Each OA paradigm consisted of four conditions (A, B, C, and D) with a pseudorandom sequence design of three trials. OA was implemented with the participant while real-time fNIRS data were obtained on the subject’s prefrontal and somatosensory cortices, regions known to be involved in pain processing. Hemoglobin responses during the four OA trials were evaluated and compared within experimental conditions. Repeated measures ANOVA was used to analyze the significant differences among conditions. Results showed no significant differences among the four OA trials. The findings of this thesis study indicated that brain response from the prefrontal and somatosensory cortices is not affected within the four OA trials. The consistent brain activation across multiple trials of stimulation suggests an absence of adaptive responses. In line with previous findings, these results imply the reliability of such thermal pain calibration procedures by fNIRS brain imaging. Further investigation with a larger sample size is likely for the verification of the findings from this study. / 2026-02-14T00:00:00Z

Bakgrund:Långvarig smärta definieras som smärta som kvarstår i över 3 månader. Det är vanligt förekommande i befolkningen och många söker vård för sina problem. Smärta är ett komplext begrepp som har inverkan på många olika faktorer hos individen men även en inverkan på samhället och dess resurser. Detta kan innebära utmaningar vid handläggning och framför allt vid val av behandling. Syfte:Syftet var att utforska kliniskt resonemang vid val av behandling för patienter med långvariga smärttillstånd hos en grupp fysioterapeuter i primärvården. Metod:Studien är en kvalitativ studie baserad på semistrukturerade intervjuer som analyserades med kvalitativ innehållsanalys.   Resultat:Det som ansågs spela stor roll för valet av behandling var behandlaren och patientens egenskaper och erfarenheter, relationen mellan dem samt analysen inför behandling. De riktlinjer som användes ansågs vara ett stöd men också svåra att applicera då behandlingen alltid behöver individanpassas i och med att patientgruppen är komplex. Möjlighet till samverkan ansågs vara viktigt för att bredda perspektivet och erbjuda patienten fler behandlingsalternativ. I behandlingsupplägget var målet alltid att öka funktionsnivå, vilket påverkade resonemanget kring val av behandling. Ökad kunskap hos patienten samt en ökad förmåga till smärthantering var ofta första steget. Slutsats:Många faktorer spelar in i det kliniska resonemanget för val av behandling för patienter med långvarig smärta. Erfarenhet hos behandlaren ansågs avgörande för beslutet och man kan därmed tänka sig att det är extra viktigt att nyexaminerade får möjlighet att samverka med kollegor med mer erfarenhet av patientgruppen. / Background:Chronic pain is defined as pain that remains in more than 3 months. Chronic pain is a widespread problem worldwide and there are many people who seek health care for their problems. Pain is a complex syndrome which impacts several aspects of the individual's life but also the society, which brings challenges in the assessment and the choice of treatment.  Purpose:The purpose of the study was to explore physiotherapists' clinical reasoning when choosing a treatment for patients with chronic pain in primary care.  Method:The study is a qualitative method based on semi-structured interviews which was analyzed with a qualitative content analysis.  Results:Factors that played a big part in the choice of treatment were the physiotherapist and the patient characteristics and experiences, the relationship between them and the significance of the examination. The guidelines that were used were considered to support the choice but were also seen to be difficult to apply, as the treatment always needs to be individualized because of the complexity in the patient group. The ability of cooperation was considered as a key factor to broaden the perspective and offer the patient different treatment alternatives. The treatments intended to increase function, knowledge and pain-management which had an impact on the clinical reasoning. Conclusion:Many factors play a part in the clinical reasoning for choosing treatment for patients with chronic pain. The physiotherapists experience was a crucial part of the decision and therefore it could be of importance that newly graduated physiotherapists get the possibility to cooperate with colleagues who have more experience of the patient group.

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.

No description available.

No description available.

No description available.

No description available.

No description available.

<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)