Nurses are at increased risk for job burnout, which can lead to psychological and physical problems, decreased quality of care, and premature exit from the profession. Studies have found common predictors of burnout in multiple service occupations, but there are important differences across settings. The current study used embedded mixed-method analyses to explore burnout in a sample of nurses that work with patients with chronic abdominal pain. Thirty-two nurses participated in focus groups and data analyses revealed the following six themes: negative pain beliefs, barriers to effective pain management, nurse empathy/compassion, moral distress, coping methods, and burnout. These themes were evaluated with proposed theoretical frameworks and the extant literature to build the Pediatric Chronic Pain Nurse Burnout model. The constructs in this model were then evaluated quantitatively via measures completed by 41 nurses. Analyses provided partial support for the model and highlighted areas for further evaluation of burnout in nursing.

Cancer-induced bone pain (CIBP), due to bony metastases, is a major clinical problem, significantly reducing quality of life in cancer patients. Current therapies often provide inadequate analgesia or unacceptable side effects. The aim of this thesis was to characterise behaviours of a preclinical model of CIBP and test novel analgesic interventions in this model. A secondary aim was to investigate the involvement of the N-methyl-D-Aspartate (NMDA) receptors and TRP channels (TRPM8, TRPV1 and TRPV4) in CIBP. Investigation of CIBP in a preclinical model may lead to better pain management in CIBP patients. The results presented here demonstrate that this model of CIBP develops behaviours that may be indicative of mechanical allodynia, thermal sensitivity, movement-evoked pain, ongoing pain and spontaneous pain. This suggests that this model reflects the clinical condition of CIBP, where patients suffer from constant background pain with spontaneous and movement-related breakthrough pain. In this study it was found that radiotherapy significantly attenuated movement-evoked pain and thermal sensitivity to 20°C and 40°C. XRT also significantly reduced anxiety and risk assessment behaviours (grooming behaviour and number of protected stretch attends) compared to untreated CIBP. Duloxetine attenuated CIBP-induced mechanical allodynia, thermal sensitivity to 40°C and movement-evoked pain, whereas S,S-reboxetine attenuated thermal sensitivity to 40°C but did not effect CIBP-induced mechanical allodynia or movement-evoked pain. In addition, CB 65 attenuated movement-evoked pain and thermal sensitivity to 40°C. A single dose of gabapentin did not attenuate CIBP-induced mechanical allodynia, thermal sensitivity to 40°C or movement-evoked pain. These studies confirm that the CIBP model shows characteristics and pharmacological sensitivities consistent with known and predicted mechanisms and validate it as a useful model for assessing potential new treatments proposed for use in patients. Behavioural results suggest that NMDA receptors containing the NR2A subunit are involved in CIBP-induced movement-evoked pain. This suggests that NR2A antagonists may be useful for treating CIBP-induced movement-evoked pain. Additionally, results show that there is increased expression of NR2A in the laminae I, II and III in the dorsal horn of the spinal cord. XRT treated animals also showed increased expression of NR2A in laminae I and II. The selective involvement of NR2A in CIBP is different to other chronic pain states, for example, neuropathic pain states that appear to involve the NR2B subunit. The TRPV1 antagonist AMG 9810 did not attenuate mechanical allodynia, thermal sensitivity to 40°C or movement-evoked pain. Interestingly, the TRPM8 agonist icilin attenuated movement-evoked pain, which suggests that icilin might be useful in the treatment of movement-evoked pain. The TRPV4 antagonist RN 1734 attenuated mechanical allodynia, thermal sensitivity to 40°C and movement-evoked pain in CIBP. This suggests RN 1734 may be useful in the treatment of mechanical allodynia, thermal sensitivity to 40°C and movement-evoked pain in CIBP. Results show that the expression of TRPV4 is increased in DRG ipsilateral to the cancerbearing tibia. In conclusion, these results show that the preclinical model of CIBP investigated in this thesis is suitable for testing novel analgesic interventions. This thesis identified some useful targets for the analgesic treatment of CIBP and results suggest that many different mechanisms contribute to CIBP. A point to consider is that any robust effective treatment may need to target all (or at least several) of these mechanisms.

ABSTRACT Background: To serve the patients information and to relieve pain post-operatively is largely the nurse's responsibility. Studies suggest a correlation between the preoperative information and the pain and anxiety. Previous studies suggest that the preoperative information affect the postoperative pain in a positive direction. Aim: The aim of this study was to investigate the correlation between preoperative paininformation, anxiety and pain in patients who have undergone elective and acute orthopedic surgery. A further aim was to see if there was a difference between elective and acute orthopedic surgical wards and also investigate if there were something the patients were missing in the preoperative pain-information. Method: A quantitative survey was conducted with a descriptive correlative design. The study was carried out in two different orthopedic wards in a hospital in Sweden. The study included a total of 27 participants, 12 elective and 15 acute patients. Reslut: The result showed that there is a significant correlation between the patients preoperative anxiety and postoperative pain (r=0,398, N=27, p=0, 04). The result also showed a significant correlation between patient’s postoperative anxiety and postoperative pain (r=0,601, N=27, p=0,001). Patients with high anxiety also had high levels of pain. No significant difference was seen between the elective and acute group, but the elective group estimated the preoperative information higher (M=6, 17) than the acute group (M=4, 53). The study did not show evidence that preoperative information about the pain leads to lower postoperative painscores, however the preoperative information is important so the patient feel well prepared for the operation. A total of 6 (22%) patients did not obtain preoperative pain-information. Conclusion: Anxiety and pain are two factors that affect each other. To be responsive as a nurse and capture anxious patients, as well as alleviate this concern , the postoperative pain would be alleviated . Patients undergoing acute surgery do not receive preoperative information to the same extent as those undergoing elective surgery. To develop a quality document about how and when preoperative information about pain should be given , could ensure that patients are well informed before surgery. To share this information is largely the nurse's role, and it is important as it would lead to increased well-being and less suffering for the patients.

This study was designed to determine the effectiveness of a clinical intervention program for reduction of pain and concomitant symptoms of anxiety, depression and hostility in individuals experiencing chronic pain. The program consisted of 36 weeks of supportive group therapy, education and sessions of progressive muscle relaxation induced hypnosis. Single subject research design was used to analyze the clinical effectiveness of treatment. Data was collected and compiled weekly. Serial position curves were generated for a Reported Pain Index, SCL-90-R Symptom Indices for Anxiety, Depression, Hostility and the SCL-90-R Global Severity Index. The three subjects were adults whose ages ranged from 39 to 65, with five or more years of chronic pain due to orthopedic or arthritic conditions. Qualitative analysis of the data indicated dramatic reductions in pain and secondary symptoms. Reductions in reported pain ranged from 17% to 31% with the mean pain reduction for the group of 20.6%. Reduction in the SCL-90-R Global Severity Index ranged from 13.1% to 49.4% with the mean reduction for the group of 36.1%. Reduction in depression ranged from 12.7% to 50% with the mean reduction for the group of 32.6%. Anxiety was reduced for two subjects with a slight increase of .02% for the third subject. Range of anxiety change was .02% increase to 59% reduction with a group mean reduction of 36.3%. Reduction in hostility ranged from 29.5% to 54.4% with a group mean reduction of 39.9%. Progressive muscle relaxation induced hypnosis contributed to further reduction of pain and secondary symptoms with reductions ranging from 4 to 49%. The results of this study show dramatic reductions in pain, depression, hostility and anxiety in chronic pain patients. These findings are not meant to be generalized to other populations, but may point the way for future research utilizing long-term therapeutic approaches and single subject research design.

Pain from bone metastases is multifaceted with clinical descriptors including ongoing pain, hypersensitivity to external stimuli and intermittent episodes of breakthrough pain characterized as a sudden and abrupt onset of severe pain on a background of well-controlled pain. Moreover, cancer-induced bone pain remains inadequately managed due to a myriad of side effects associated with the current pain relieving regimens, which primarily rely on administration of opiates. Despite advances made in cancer therapeutics, these patients experience an inferior quality of life with incapacitating pain with limited daily activities. Development of long-term novel, non-opiate mechanism-based therapeutics with limited side effects is considered beneficial in elevating the patients' quality of life. First part of this dissertation encompasses the role of p38 MAPK in a mouse model of cancer-induced bone pain in which breast cancer cells were injected and sealed into the femur. Our data demonstrated that both acute and prolonged inhibition of p38 MAPK blocked cancer-induced spontaneous pain but had no effect on the evoked pain indicating important differences in mechanisms mediating ongoing pain as opposed to evoked pain. Undermanaged control of breakthrough pain is attributed to poor understanding of underlying mechanisms and how they may differ from ongoing pain due, in part, to lack of a pre-clinical model in which these mechanisms can be studied. We have established a rat model of cancer-induced bone pain to examine ongoing pain and pain relief using conditioned place preference paradigm as well as breakthrough pain using palpation-induced conditioned place aversion. We have shown that while peripheral afferent input from the tumor-bearing tibia mediates cancer-induced ongoing pain and initiation of breakthrough pain, it does not contribute to the maintenance of breakthrough pain. These data suggest that molecular targets mediating these two mechanisms may be different. This hypothesis was confirmed by our findings in this model that acute blockade of interleukin-6 blocked movement-evoked breakthrough pain in tumor-bearing rats, but failed to block tumor-induced ongoing pain. Hence, we provide a platform to manipulate treatments that can be given alone or in combination with opiates in such a way that patients receive adequate control of breakthrough pain.

Nursing care of patients with advanced cancer is challenging because it touches many dimensions of a patient’s life. The study of spiritual pain is relatively new although potentially very important in understanding how to help patients with advanced cancer achieve a sense of well-being. The purpose of this pilot study was to increase scientific knowledge from the participants‟ perspectives about experiences of spiritual pain and physical pain, and identify correlates of well-being from the participants‟ own perspectives in the context of advanced cancer. Four research questions were examined in this study: 1. What is the relationship between physical pain and spiritual pain, as perceived by participants who have advanced cancer? 2. What is the relationship between spiritual pain and existential well-being, as perceived by participants who have advanced cancer? 3. What is the relationship between spiritual pain and physical pain in the context of the demographic and health-related variables of age, gender, years of education, and months since diagnosis? 4. What factors do participants with advanced cancer identify as important to their existential well-being? A descriptive correlational design was used to study the research questions in a convenience sample of 30 adult participants from an outpatient oncology clinic in Southern Arizona. Quantitative data were obtained through interviews using the Providence Saint Vincent Medical Center Pastoral staff’s Spiritual Pain Assessment Tool and Paloutzian and Ellison’s (2009) Existential Well-Being Scale, and a Physical Pain Rating scale along with a demographic and health-related form. Qualitative data were also obtained from the participants. Descriptive, correlational, and content analyses generated results of a significant relationship between Spiritual Pain and Existential Well-Being, and a non-significant relationship between Physical Pain and Spiritual Pain. The following themes (with the first three being most frequently mentioned) were identified as important to the participants‟ well-being during their experience of advanced cancer: Meaningful activity, family and friends, and spiritual aspects, followed by health/nutrition, symptom management, and finances. Results warrant continued research into spiritual pain as it relates to existential well-being in persons with advanced cancer

No description available.

Chronic pain is recognized for its intra- and interpersonal stress, with greater social support being associated with better patient outcomes. Urologic Chronic Pelvic Pain Syndromes (UCPPS) are pain-associated conditions that are prevalent across genders and are strongly associated with diminished quality of life (QOL). To date, no gender-based research has examined such supportive behaviours in UCPPS samples. One model, the stress-buffering model of social support, suggests people with greater support within their proximal (e.g., marriage) and distal (e.g., physician) social environment may be protected from negative stressor impact (i.e., pain). Due to their strong associations with poorer QoL, I hypothesized catastrophizing and perceived pain control as important intrapersonal cognitive variables to also consider in such relations between pain and patient QoL. In this dissertation, I examined several research questions using two self-report studies: 1) Are there gender differences in social support for people with UCPPS?; 2) Does social support moderate the relationship between pain and patient outcome variables and are there gender differences in this effect?; and 3) If social support moderates the relationship between pain and outcomes, is this effect further moderated by cognitive variables and/or gender? In Studies 1 and 2, women with IC/PBS endorsed higher levels of solicitous and distracting spouse responses to pain behaviour than did men with CP/CPPS. Additionally, in Study 2 women reported greater support from friends than did men. In regard to moderation effects in Study 1, distracting spouse responses buffered the relationships between patient pain and mental QoL, and between pain and disability. However, spouse solicitousness had a detrimental effect on the relationship between patient pain and mental QoL but only at low levels of catastrophizing in the patient. The genders did not differ in the effect of spouse responses to pain behaviour in Study 1, and Study 1 results with respect to the stress-buffering role of distracting spouse responses were not replicated in Study 2. In Study 2, sources of social support from outside of the marriage also did not have a stress-buffering effect on the relationship between pain and patient outcome. Of the models reviewed, no one current model for understanding the role of social support or catastrophizing in chronic pain was sufficient to account for the findings reported in these studies. However, a dyadic emotion regulation perspective is suggested with implications for marital therapy with couples with chronic pain. / Thesis (Ph.D, Psychology) -- Queen's University, 2013-11-18 19:17:11.276

Background: Psychological research has consistently demonstrated the importance of cognitions in the form of thoughts and images on an individual’s wellbeing. Having pain-related verbal cognitions has been shown to lead to poorer outcomes for patients (McCracken & Turk, 2002). Research in other conditions has shown mental images have a more powerful impact on emotion than verbal cognitions (Holmes & Matthews, 2005). To date however, little work has explored the role of mental imagery in adjustment to chronic pain. Methods Fourteen semi-structured interviews were conducted with individuals with chronic pain. Interview transcripts were analysed according to grounded theory methods to construct a substantive theory of the impact spontaneously-invoked images of pain have on functioning. Results Eight participants reported pain-related imagery and three reported mental images associated with related symptoms. In line with previous findings (Gillanders et al., 2012; Gosden, 2008) the frequency and intensity of pain-related images influenced the degree of distress experienced. There was a distinction made between intrusive mental images and visual descriptions or metaphors of pain. The former being conceptualised as a visual cognition and playing a role in the aetiology and maintenance of distress in chronic pain and therefore an adverse impact on functioning. Conclusion Enhancing our understanding of pain related imagery and its impact on functioning could inform the design of interventions in clinical practice. Working systematically with patients’ idiosyncratic pain related images and the beliefs that are associated with them could be a helpful specific target for therapy.

A dissertation submitted in partial compliance with the requirements for a Master Degree in Technology: Chiropractic, Durban University of Technology, 2007. / The purpose of this research is to conduct a descriptive study of cases that presented with thoracic complaints to Durban University of Technology chiropractic Day Clinic from the 13 January 1995 to 30 November 2005. This is a retrospective, quantitative, non-experimental, clinical survey. The sample size for this study included 7111 cases obtained from the Durban University of Technology chiropractic day clinic. There were no thoracic cases recorded in the random sample for the year 1995, therefore the random sample allocated for this year was subtracted from the total sample. 249 Thoracic cases were included in this research. The overall prevalence for the time period 1996 - 2005 was 3.5%. Gender: 248 of the 249 patients had recorded gender information. The majority were female 54.8% while 45.2% were male. Age: The ages ranged from 11 to 73 years. The mean age was 33.3 years. Occupation: 241 patients had a recorded occupation. 21.6% of them were classified as active or non-sedentary while the majority had sedentary jobs. The main complaint was mid-back pain which was noted in 41.4% of the population. Thoracic facet syndrome was the primary diagnosis given in 74.7% of the population; myofasciitis was the second most diagnosed condition with 8.8% of the population having this primary diagnosis. The most common treatment was joint manipulation, which was used in 82.6% of the cases, followed by soft tissue therapy (79.4%) and stretches (44.9%). The facets that were most commonly found to be fixated were in the T5 toT8 region. The investigative procedure that was used most often in the sample was x-rays. Fourteen patients were sent for x-rays (5.6%). One patient was sent for a blood test (0.4%). No other investigative procedures were used in these patients. Even though the overall prevalence of thoracic pain sufferers was only 3.5% over the ten year period, it is still an area of pain that must be investigated. The thoracic spine has been overlooked as a major region for research. This study has proved that there is need for continuing research in this area, to assist chiropractors to treat the thoracic spine more effectively. / M