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Four short-term interventions (relaxation instructions, cognitive imagery instructions, cognitive modeling, and vicarious modeling) were experienced by 105 first-trimester abortion patients, to determine their effects on abortion pain and self-efficacy in handling abortion pain, as measured by self-report. No significant differences were found among treatment group and controls. In fact, no significant increases were found among groups in the time the patients spent engaging in activities suggested by instructions. However, abortion patients were found to show significant differences in abortion pain and distress by whether they had experienced natural childbirth training. Also, a sensitivity to staff attitudes was revealed by the finding of differences among counselors on patient pain sensations. Abortion was found to. be more painful by the women in this experiment than has been previously reported. However, women were able to accurately predict how well they were I going to handle abortion pain and how distressed it was going to make them.

Background. Understanding how people adjust to living with chronic pain is paramount because of the negative impact of chronic pain on quality of life. Chronic pain integration has been proposed as a new construct that may enhance understanding of chronic pain adjustment. Integration, as defined by people living with chronic pain, is an ongoing process in which the person with chronic pain evolves becoming a mentally and physically stronger individual; creating a sense of harmony and control in one’s life. These positive outcomes of integration necessitate its continued investigation in chronic pain, especially if it may positively affect life quality. Objective. There were two overarching purposes of this study: (a) to further refine and test the psychometric properties of the Chronic Pain Integration Questionnaire (CPIQ); and (b) to examine four research hypotheses based on the proposed relationships between several constructs. Method and Results. Utilizing a quantitative, non-experimental design, the CPIQ demonstrated internal consistency reliability, test-retest reliability, and evidence of validity when tested in a sample of 201 adults living with chronic non-cancer pain. All four of the research hypotheses were confirmed and three domains of the CPIQ were identified through exploratory factor analysis: self-management, self-awareness, and intrinsic adjustment. The favourable psychometric results of the CPIQ provide support for its continued use to understand adjustment in chronic pain. Ultimately, the goal of future research with the CPIQ is to identify effective interventions that promote chronic pain integration; leading to improved life quality for the person with chronic pain. / Thesis / Doctor of Philosophy (PhD) / A questionnaire titled the Chronic Pain Integration Questionnaire (CPIQ) was developed and then given to 201 adults living with chronic pain in order to gain a better understanding of how these adults have adjusted to living with chronic pain. The responses that these adults gave on the CPIQ were then compared to responses they gave on additional questionnaires related to their physical and mental health, acceptance, and social support. These comparisons allowed for the detailed examination of people’s adjustment to living with chronic pain. It is hoped that the CPIQ, which has now been developed and tested, will continue to allow health care professionals to gather more information about the life of someone living with chronic pain. It is also hoped that the CPIQ could be used in future research to identify effective strategies that improve the overall quality of life of the person suffering with chronic pain.

There have been numerous studies of pain perception in humans using a variety of brain imaging methods. The majority of the past research has focused on the use of positron emission tomography (PET) as the primary imaging method. The present study examines the cortical mechanisms of pain perception in humans using a recently developed imaging technique called functional magnetic resonance imaging (fMRI). The primary interest in this study concerns how behavioural aspects of pain are reflected by cerebral cortical activity during noxious stimulation. As pain involves a combination of sensory, emotional, and cognitive responses, the extent and degree of activation in cortical areas associated with these responses can be affected. To address this issue, a behavioural experiment was first performed to assess the sensory, emotional, and cognitive components of tonic pain induced by a cold foam-pack (0°C). Subsequently, three subjects from the behavioural study pool participated in the imaging study of pain. In the imaging experiment, a cold foam-pack (0°C) and a non-cold foam-pack were applied to the left hands of these subjects. Activation produced by the noxious stimulus was compared with that produced by the innocuous stimulus. The results revealed inconsistencies in cortical activation among the three subjects and this could be related to each subject's behavioural measures. Individual and experimental variables may also account for the differences in results. / Thesis / Master of Science (MSc)

The thirteen essays in this collection center on the narrator's shifting relationship to opioid painkillers and other drugs. The narrator and protagonist, Amy, begins using opioids recreationally with her boyfriend Ryan, an opiate addict who initiates Amy's drug use. Years after the couple breaks up, Amy's childhood headaches return as migraines and transform into chronic daily headaches, which she relieves with oxycodone (and sometimes other drugs). The narrative chronicles Amy's relationship with Ryan and her iatrogenic dependence on narcotic painkillers, detoxification, return to opioids following a year spent "clean," and the ways in which her headache treatment regimen shapes her relationship to her family, friends, various medical personnel, and her own embodied subjectivity. / MFA

Background: In pain relief research, meta-analyses often combine continuous outcomes from various studies using mean differences. However, this approach can be difficult to interpret clinically. An alternative method involves aggregating the risk difference for patients who achieve a minimally important difference (MID) in pain reduction. The challenge is that many trials do not report responder analyses, necessitating continuous data conversion. Objective: To conduct a simulation study assessing the performance of four proposed methods for estimating the pooled risk difference (RD) of achieving the MID in meta-analyses of pain measured on a 10cm visual analogue scale (VAS). Methods: Individual patient data for VAS pain scores were simulated across 4,752 scenarios varying the treatment effect as change score in the intervention (-1.0 to 4.0) and control (-1.0 to 3.0) groups, study sample size (10-1000), number of studies per meta-analysis (3 to 30), shape of distribution (normal or skewed), and MID (1.0 or 1.5). The true pooled RD and 95% confidence interval (CI) were calculated from the simulated individual data. Four methods were evaluated: calculating RD based on pooled 1) median mean differences, 2) unweighted average differences, 3) weighted average differences, and 4) calculating RD for each individual study and then meta-analysing RDs. Bias, mean squared error, confidence interval (CI) coverage of true value, and empirical standard error (SE), and model-based SE were evaluated. Results: The median method showed the lowest bias (2.048; 95% CI: 1.759-2.338), while the individual method demonstrated the lowest RMSE (4.852; 95% CI: 4.661-5.044), empirical SE (0.148; 95% CI: 0.141-0.154), and model-based SE (2.198; 95% CI: 2.108-2.288), and highest CI coverage (55.717%; 95% CI: 53.185-58.250%). Differences between methods were minimal and not statistically significant. Performance was optimal when treatment effects were similar between groups and declined with increasing effect size differences. All methods performed poorly with skewed distributions. Conclusion: While the evaluated methods can provide useful estimates in many scenarios, they should be used cautiously, especially for large treatment effects or non-normal data. Researchers should prioritize conducting and reporting responder analyses in primary studies to reduce reliance on these estimation methods in meta-analyses. / Thesis / Master of Science (MSc) / Background: In pain relief research, meta-analyses often combine continuous outcomes from various studies using mean differences. However, this approach can be difficult to interpret clinically. An alternative method involves aggregating the risk difference for patients who achieve a minimally important difference (MID) in pain reduction. The challenge is that many trials do not report responder analyses, necessitating continuous data conversion. Objective: To conduct a simulation study assessing the performance of four proposed methods for estimating the pooled risk difference (RD) of achieving the MID in meta-analyses of pain measured on a 10cm visual analogue scale (VAS). Methods: Individual patient data for VAS pain scores were simulated across 4,752 scenarios varying the treatment effect as change score in the intervention (-1.0 to 4.0) and control (-1.0 to 3.0) groups, study sample size (10-1000), number of studies per meta-analysis (3 to 30), shape of distribution (normal or skewed), and MID (1.0 or 1.5). The true pooled RD and 95% confidence interval (CI) were calculated from the simulated individual data. Four methods were evaluated: calculating RD based on pooled 1) median mean differences, 2) unweighted average differences, 3) weighted average differences, and 4) calculating RD for each individual study and then meta-analysing RDs. Bias, mean squared error, confidence interval (CI) coverage of true value, and empirical standard error (SE), and model-based SE were evaluated. Results: The median method showed the lowest bias (2.048; 95% CI: 1.759-2.338), while the individual method demonstrated the lowest RMSE (4.852; 95% CI: 4.661-5.044), empirical SE (0.148; 95% CI: 0.141-0.154), and model-based SE (2.198; 95% CI: 2.108-2.288), and highest CI coverage (55.717%; 95% CI: 53.185-58.250%). Differences between methods were minimal and not statistically significant. Performance was optimal when treatment effects were similar between groups and declined with increasing effect size differences. All methods performed poorly with skewed distributions. Conclusion: While the evaluated methods can provide useful estimates in many scenarios, they should be used cautiously, especially for large treatment effects or non-normal data. Researchers should prioritize conducting and reporting responder analyses in primary studies to reduce reliance on these estimation methods in meta-analyses.

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Pain is the primary reason why patients seek medical care and there is a great unmet need for the development of pain relieving medications. The treatments that are currently available either have limited efficacy or are accompanied by a multitude of unwanted side effects. However, discovering novel therapeutics for the treatment of pain has been challenging. Part of the reason for this may be that that the ways in which pain is assessed in the preclinical setting are different from the way that it is evaluated clinically in human trials. The most common method for evaluating pain in preclinical models is to measure responses to evoked stimuli. However, a change in the threshold of response to evoked pain likely does not measure whether the unpleasant component of pain has actually been reduced. The most clinically relevant question for pain is whether the treatment actually makes the patients "feel better". Here, we demonstrate that the aversiveness of pain can be captured using motivated behavior to seek pain relief. We used conditioned place preference (CPP) to establish that animals with ongoing pain will seek a context that has been paired with effective pain relief, likely as a result of negative reinforcement. These studies allowed for mechanistic investigation. Our results show that: 1) effective pain relief can be achieved by either blocking noxious peripheral input or by directly attenuating pain related unpleasantness in the brain, and 2) pain relief is rewarding and activates the reward circuitry. These studies provide a basis for development of a future platform for drug discovery for pain.

Background: Altered autonomic nervous system (ANS) function has been proposed as a mechanism in the development of central sensitisation (CS) and visceral pain hypersensitivity (VPH). The contribution of the parasympathetic nervous system (PNS) and the factors that mediate differences in sensitisation to acid are unclear and their study will clarify risk factors for oesophageal pain hypersensitivity (OPH) in gastrooesophageal reflux disease. Aims: To investigate psychophysiological and pharmacological manipulation of PNS tone in the development of OPH, and to determine factors which predict the development of OPH to acid infusion in healthy volunteers in a validated model of acid induced OPH. Methods: Pain thresholds to electrical stimulation in the proximal oesophagus were determined before and after a 30-minute distal oesophageal infusion of 0.15 mol/L hydrochloric acid in subjects. Sympathetic (SNS) and PNS parameters were measured at baseline and continuously thereafter. Subjects underwent psychological profiling for anxiety, depression, attachment vulnerability and personality type. Using this model, five studies were undertaken: Study 1 a pilot study to trail modulation suitability for further study used. In Study 2, subjects who demonstrated secondary hyperalgesia in the proximal non-acid-exposed oesophagus performed deep or sham breathing. Study 3 subjects, who did not sensitise to acid, underwent a validated stress test to induce OPH. With Study 4, deep breathing with IV saline (placebo) or atropine (PNS antagonist) was used to evaluate deep breathing’s induced PNS tone in OPH reduction. Study 5, a genetic pilot study, exploring the role of the GCH-1 haplotype in VPH. Results: ANS control’s key role in CS was clarified. Deep breathing increased PNS tone and prevented acid-induced OPH in comparison to sham breathing and confirmed increased PNS tone’s reversal of OPH. Psychological factors of anxiety, alexithymia and attachment status influence ANS modulation of CS. Individuals’ predisposition to VPH due to psychogenetic profiles were clarified and their biopsychosocial role illustrated. Conclusions and Inferences: A mechanistic explanation for the analgesic effect of deep breathing is provided with potential therapeutic implications in the treatment of VPH syndromes. Further clinical study is warranted to develop cost-effective treatments for chronic VPH syndromes.