Two studies examined the hypothesis that acceptance and control-based interventions for pain have specific self-regulatory costs and benefits. Both studies consisted of volunteers from a sample derived from the pool of psychology students at the University of Manitoba. Relative to control-based coping, acceptance was predicted to be associated with: 1) Normalization of time distortion; 2) Faster post-stimulus pain recovery 3) Preservation of self-regulatory energy required for acts of self-control; 4) Stronger pain coping self-efficacy beliefs, relative to two control-based coping strategies: suppression and distraction, and 5) improved pain tolerance. Study I (N=180) showed no group differences for pain tolerance, retrospective duration judgments or self-efficacy ratings, and weak evidence of differential pain recovery effects. As predicted, temporal speed ratings were slower for the suppression condition relative to the distraction condition. In Study II the pattern of condition effects for temporal speed was replicated though the statistical main effect only approached significance. In Study II (N=190), between-group differences were detected for pain tolerance, pain recovery, retrospective duration judgments and self-efficacy belief variables. As predicted the distraction group showed higher pain tolerance than the suppression group. Contrary to prediction, the difference between distraction and acceptance for pain tolerance was not significant. Contrary to predictions the greatest normalization of retrospective duration distortion occurred in the distraction condition. As predicted, post-intervention self-efficacy ratings were higher for acceptance than suppression but the difference between acceptance and distraction was not significant. Predicted pain recovery effects were also detected in Study II such that pain ratings for the suppression and distraction conditions were higher than for the acceptance condition at 60 and 120 seconds post-tolerance. Hypothesized between-group differences for self-regulatory-strength depletion were not confirmed. Possible reasons for lack of difference between acceptance and distraction on pain tolerance ratings and ego depletion measures, as well as possible future research directions were discussed.

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Perioperative hypothermia (PH) is body temperature < 36°C and may occur in total knee arthroplasty (TKA) surgery. Planned hypothermia is necessary in a select number of surgical procedures but inadvertent hypothermia has deleterious consequences. TKA is a painful procedure and PH may enhance or diminish the effect of opioids and TKA pain – its effect is unclear. A new treatment for PH is a forced-air warming gown. A randomized control trial of 30 TKA patients compared the standard treatment of warm cotton blankets to a forced-air warming gown. Patients treated with the warming gown had higher temperatures (p < 0.001), used less opioid (p = 0.05) and had more satisfaction (p = 0.004) than the standard blanket group. This study suggests that warming gowns may be an effective alternative to averting PH and advocates for more research to explore the relationship between PH and its effect on pain and opioids.

Two studies examined the hypothesis that acceptance and control-based interventions for pain have specific self-regulatory costs and benefits. Both studies consisted of volunteers from a sample derived from the pool of psychology students at the University of Manitoba. Relative to control-based coping, acceptance was predicted to be associated with: 1) Normalization of time distortion; 2) Faster post-stimulus pain recovery 3) Preservation of self-regulatory energy required for acts of self-control; 4) Stronger pain coping self-efficacy beliefs, relative to two control-based coping strategies: suppression and distraction, and 5) improved pain tolerance. Study I (N=180) showed no group differences for pain tolerance, retrospective duration judgments or self-efficacy ratings, and weak evidence of differential pain recovery effects. As predicted, temporal speed ratings were slower for the suppression condition relative to the distraction condition. In Study II the pattern of condition effects for temporal speed was replicated though the statistical main effect only approached significance. In Study II (N=190), between-group differences were detected for pain tolerance, pain recovery, retrospective duration judgments and self-efficacy belief variables. As predicted the distraction group showed higher pain tolerance than the suppression group. Contrary to prediction, the difference between distraction and acceptance for pain tolerance was not significant. Contrary to predictions the greatest normalization of retrospective duration distortion occurred in the distraction condition. As predicted, post-intervention self-efficacy ratings were higher for acceptance than suppression but the difference between acceptance and distraction was not significant. Predicted pain recovery effects were also detected in Study II such that pain ratings for the suppression and distraction conditions were higher than for the acceptance condition at 60 and 120 seconds post-tolerance. Hypothesized between-group differences for self-regulatory-strength depletion were not confirmed. Possible reasons for lack of difference between acceptance and distraction on pain tolerance ratings and ego depletion measures, as well as possible future research directions were discussed.

Introduction: It is a well known fact that children suffer from pain due to treatment and procedures in health care and historically, their procedural pain due to medical treatment has been undertreated and under-recognized. Children’s understanding of pain and their ability to express their feelings depend on their stage of development and the nature and diversity of their prior pain experiences. The goal of pain management is to reduce pain, distress and anxiety, and the nurse is the key person to help and support the child in pain. Nurses’ professional competence form the foundation for pain management procedures, and there is a need to investigate whether the care and procedures nurses perform for children in pain lead to desired outcomes. Aim: The overall purpose was to describe nurses’ competence in pain management in children. The specific aims were to - identify and describe knowledge about and attitudes to pain and pain management - identify factors influencing pain management in children and - describe nurses’ experiences of caring for children in pain. Methods and material: Forty-two nurses participated in a survey on knowledge about and attitudes to pain management in children, and 21 nurses were interviewed about their experiences fromcaring for children in pain. All the data were analyzed using approved methods of analysis. Results: The results showed that the nurses had good knowledge about and positive attitudes to pain management in children. Collaboration with physicians was considered important in providing children with sufficient pain relief. Parents were regarded as a resource, and the nurses described communication with parents as important. The nurses’ own experience led to a better understanding of the children’s situation. The nurses stated that pain is a subjective experience and that if a child says he or she is in pain they should be believed. Pain was seen as a complex phenomenon, and the nurses had difficulty distinguishing between pain of different origins. In predictable situations, when the child had a clear medical diagnosis with physical pain and the child’s pain followed an expected pattern, the nurses trusted their knowledge and knew how to act. On the other hand, in unpredictable situations, when the child did not respond to the treatment despite all efforts, this created feelings of insufficiency, fear and abandonment, and even distrust. Conclusions: The conclusions of this thesis are that pain management in children is a challenge for clinical nurses in unpredictable situations. Professional competence in nursing deals with both personal abilities and the organization. Reflective practices and dialogues with colleagues would improve nurses’ work satisfaction, and guidelines and better routines would improve nurses’ pain management when caring for children.

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