Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban Institute of Technology, 2005. / The purpose of this study was to determine whether dry needling of myofascial trigger points (TrP's), found in the shoulder rotator myotatic unit, had an effect on the peak torque and total work parameters of the shoulder myotatic unit and by inference, the relative external rotation strength deficit in over-head throwing athletes. Athletes who perform overhead throwing sports such as: baseball, javelin, swimming/waterpolo and tennis, are susceptible to sustaining a micro-traumatic injury of the rotator myotatic unit of the shoulder, owing to repetitive high velocity mechanical stress placed on the shoulder at the extreme ranges of motion. The inherent structure of the shoulder, with three external rotators and five internal rotators, causes a muscle imbalance before an activity, such as throwing occurs, and this can predispose an athlete to Repetitive Stress Injuries (RSI) as a result of overuse or overload. The incidence and activation of TrP's in shoulder muscles can be accounted for on the basis of mechanical stress such as overuse / overload and thus could change muscle fiber co-ordination (muscle activity) and precipitate a painful lesion. It can be seen in current literature that TrP's produce a number of signs and symptoms such as: spasm of other muscles, weakness of involved muscle function, loss of co-ordination and decreased work tolerance of the involved muscle . Therefore the TrP's present in the shoulder rotator unit could contribute to changes in internal/external rotation ratios in over head athletes, and thus by deactivating or eliminating these TrP's, it is possible that these ratios may be / M

A factor analysis was performed on eleven variables derived from scores on the McGill Pain Questionnaire, Oswestry Activity Rating Scale, graphic rating scales designed to assess the average pain intensity, frequency of leg pain, back pain, numbness and tingling in legs, and weakness in legs, as well as bothersomeness of back pain, leg pain, numbness and tingling in legs and weakness of legs. A composite Pain Index was created on the basis of three factors: leg pain, back pain, and overall pain complaints. Extraclassificatory variables, such as negative affect including depression and anxiety, cognitions regarding health status and expectation of recovery, bodily awareness/somatization and demographic variables such as smoking or non-smoking, compensation status, litigation status, use of narcotic and non-narcotic medication, use of alcohol, and time off of work were analyzed in combination and independently in relationship to the Pain Index.

M.Tech.

Background: Pain management is a major issue in post-operative care. Little is known about the pain management experiences of parents and adolescents following discharge from inpatient surgery. Studies examining pain outcomes following day surgery suggest that children often experience severe pain and parents are challenged in providing pain care. Objective: To explore the pain management experiences of parents and adolescents following discharge from hospital after inpatient surgery. Results: Thematic analysis found that parents and adolescents were challenged in providing pain care. School return was more difficult than anticipated yet parents and adolescents were unsure how to navigate pain at school. Discharge education focused on analgesic management, leaving participants to discover non-pharmacological strategies on their own. Conclusions: Recovery from post-operative pain following inpatient surgery is challenging; nurses and healthcare professionals need to better prepare parents and adolescents to meet pain care needs following discharge.

O objetivo geral deste estudo foi avaliar a dor crônica advinda de diferentes tipos de cânceres. Os objetivos específicos foram descrever as características sociais dos participantes, caracterizar a dor percebida por meio de indicadores específicos e identificar os 10 descritores de dor crônica de maior e menor atribuição conforme a percepção da amostra. Participaram do estudo 45 mulheres com câncer de mama, 45 homens com câncer de próstata e 60 indivíduos de ambos os sexos com câncer de sistema digestivo. Para a mensuração da dor foram utilizados os 50 descritores de dor crônica que compõem a Escala Multidimensional de Avaliação de Dor (EMADOR), utilizando-se o método psicofísico de estimação de categorias. Os resultados da caracterização social das 3 amostras foram: a média de idade foi de 60 anos, 54% eram do gênero masculino, 58,7% casados, 65,3% pertencentes à religião católica e 50,6% tinham ensino fundamental completo. Na caracterização da dor foi evidenciado que, referente ao sítio primário do tumor, 30% estavam localizados na mama, 30% na próstata e 14,7% no estômago. O início da queixa dolorosa ocorreu em 40,7% dos participantes antes do diagnóstico da doença, 52,7% relataram somente 1 sítio de dor e 55,4% relataram que a mesma era intermitente. A intensidade da dor atribuída nas 3 amostras, considerando a média aritmética, demonstrou que os participantes com tumores de sistema digestivo reportaram os maiores escores (7,58 ± 2,59) e 26,6% desta amostra relataram escores acima de 8 para todos os descritores apresentados. Na avaliação dos descritores 10 descritores de maior atribuição foi observado que, 5 estavam presentes nas 3 amostras: -dolorosa?, -desconfortável?, -chata?, -desagradável? e o descritor -incômoda?, o qual foi o mais atribuído tanto pelos participantes com câncer de sistema digestivo quanto pelos participantes com câncer de próstata, demonstrando a similaridade da linguagem da dor nos diferentes grupos. Sobre a dimensão dos descritores de maior atribuição nas 3 amostras houve predomínio de descritores de dor crônica que caracterizaram a dimensão afetiva (50%), seguido pelos de dimensão cognitiva (26,6%) e pelos de dimensão sensitiva (23,3%). Concluímos que, mesmo sendo a dor oncológica um fenômeno considerado individual, multidimensional com comprometimento em diversos domínios da vida, a sua linguagem apresenta semelhança independente do sítio do tumor e do gênero e a dimensão afetiva da dor deve ser melhor explorada nas avaliações clínicas. / The aim general of this study was to evaluate chronic pain arising from different types of cancers. The specific objectives were to describe the social characteristics of the participants, to characterize the pain perceived by specific indicators and descriptors to identify the 10 major and minor award chronic cancer pain as perceived in the sample. The study included 45 women with breast cancer, 45 men with prostate cancer and 60 individuals of both sexes with cancers of the digestive system. For the measurement of pain were used 50 descriptors of chronic pain comprising the Multidimensional Pain Evaluation Scale (EMADOR), using the psychophysical method of category estimation. The results of the social characterization of the 3 samples were mean age was 60 years, 54% were male, 58.7% married, 65.3% belonging to the Catholic area and 50.6% had completed elementary education as schooling. The characterization of pain was evident that, for the primary tumor site 30% were located in the breast, prostate 30% and 14.7% in the stomach. The onset of pain complaint occurred in 40.7% of the participants before the diagnosis of disease, 52.7% reported only one site of pain and 55.4% reported that it was intermittent. Pain intensity given in three samples, considering the arithmetic mean, showed that participants with tumors of the digestive system report higher scores (7.58 ± 2.59) and 26.6% of this sample reported scores above average in 8 arithmetic mean of all the descriptors presented. In the evaluation of the descriptors was seen observed that among the 10 descriptors with higher scores, five were present in three samples: \"painful,\" \"uncomfortable\", \"boring,\" \"unpleasant,\" and the descriptor \"incommode? that was the longer assigned by both the participants with cancer of the digestive system and by the participants with prostate cancer, demonstrating the similarity of the language of pain in different groups. The dimension of descriptors with higher scores in three groups, there was a predominance of chronic pain descriptors that characterize the affective dimension (50%), followed by the cognitive dimension (26.6%) and size sensitive (23.3%). We conclude that even though cancer pain phenomenon considered an individual, multidimensional impairment in several areas of life, their language has similarities regardless of tumor site and gender, and affective dimension of pain should be further explored in the clinical ratings.

O objetivo dessa tese foi avaliar alguns desses fatores, verificar a influência da ortodontia sobre alterações oclusais, limiares de dor à pressão da região orofacial, hábitos orais parafuncionais, e percepção de qualidade de vida. Foram selecionados 111 pacientes com idade entre 13 e 55 anos e ausência de sintomas de DTM que iniciaram terapia ortodôntica corretiva. O experimento foi dividido em três etapas: t1 (no momento da instalação do aparelho), t2 (2 meses após o início do tratamento), e t3 (6 meses após o início do tratamento). Em todas etapas os pacientes foram examinados clinicamente para avaliação oclusal e seus limiares de dor à pressão foram avaliados com um algômetro digital. Também foram aplicados questionários sobre hábitos orais parafuncionais (OBC) e percepção de saúde oral na qualidade de vida (OHIP-14br). Foram feitas comparações a respeito de cada variável quantitativa considerando os três tempos de avaliação por meio de Análise de variância (ANOVA) a um critério. O teste t foi utilizado para avaliar diferenças entre as médias das variáveis quantitativas no tempo inicial (t1) e tempo final (t3) de avaliação. Para avaliar o efeito da ortodontia sobre variáveis qualitativas oclusais foi utilizado o teste exato de Fisher. Foram considerados estatisticamente significantes aqueles resultados que apresentaram nível de significância igual ou menor que 0,05. Nenhum dos 111 pacientes desenvolveram sintomas de DTM até o momento final de avaliação. Não foram observadas mudanças oclusais quantitativas significativas (p>0,05) entre t1 e t3, no entanto os fatores qualitativos como mudanças nos padrões oclusais foram alterados significativamente (p<0,05). O tratamento ortodôntico não alterou os limiares de dor à pressão, mas foi observado um aumento significativo (p<0,05) nos escores de OHIP entre os períodos t1 e t3. O tratamento ortodôntico também não aumentou ou diminuiu a presença de hábitos orais parafuncionais, e não foram encontradas diferenças entre sexo e Limear de Dor a Pressão (LDP) nos indivíduos que possuíam mais ou menos hábitos. No entanto, pacientes mais velhos relataram maiores escores de OBC, e foi encontrada correlação entre pacientes com maiores escores de OBC e menores escores para o OHIP. O estudo concluiu que a movimentação ortodôntica não teve efeito sobre limiares de dor na região orofacial e não influencia na presença de hábitos orais parafuncionais. No entanto, o tratamento ortodôntico teve um efeito positivo sobre a percepção de saúde oral na qualidade de vida. / The aim of this thesis was to evaluate some of these factors, examining the influence of orthodontics on occlusal changes, pain pressure thresholds of the orofacial region, parafunctional oral habits, and the perception of quality of life. 111 patients aged 13 to 55 that showed no signs or symptoms of TMD and began orthodontic treatment were selected. The experiment was divided into three phases: t1 (when the orthodontic device was installed), t2 (two months after the installation), and t3 (six months after the start of the treatment). At all phases, the patients were examined clinically for occlusal evaluation and their pain pressure thresholds were assessed with an analog algometer. They were also applied questionnaires on parafunctional oral habits (OBC) and perception of oral health on the quality of life (OHIP-14br). Comparisons were made with respect to each quantitative variable considering the three phases of evaluation through a one-way analysis of variance (ANOVA) for each variable. The t test was used to assess differences between the means of quantitative variables at baseline (T1) and the final evaluation (t3). To evaluate the effect of orthodontics on occlusal qualitative variables Fisher\'s exact test was used. Statistical significance was considered for those results with a significance level equal to or less than 0.05. None of the 111 patients developed symptoms of TMD within the evaluation time. No significant occlusal quantitative changes were observed (p> 0.05) between t1 and t3, however the qualitative factors considered as occlusal patterns were significantly changed (p <0.05). Orthodontic treatment did not alter pain pressure thresholds but a significant increase (p <0.05) in scores of OHIP was observed between phases t1 and t3. Orthodontic treatment did not increase or decrease the pesence of parafunctional oral habits, and no differences were found between sex and LDP in individuals who possessed more/less parafunctional habits. However, older patients reported higher OBC scores, and correlation was found between patients with higher OBC scores and lower scores for OHIP. The study concluded that orthodontic treatment did not have an effect on orofacial pain hresholds, nor the presence of parafunctional oral habits. The perception of oral health on quality of life improved significantly with treatment and patients with lessparafunctional oral habits presented a better quality of life.

Liu, Xiaodong. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 135-155). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Complex Regional Pain Syndrome (CRPS) is a chronic neuropathic pain condition associated with significant alterations in the somatosensory and motor cortex brain regions. Cognitive-affective alterations have recently been recognized in patients suffering with CRPS, however, relatively little neuroimaging research has been done to examine these dimensions. Moreover, many children and adolescents suffer from CRPS, but very little is known about the impact of this condition on brain states in the pediatric population. The aim of this paper is to assess the structural brain differences between children with CRPS and healthy controls and to examine to what degree fear level influences such differences. This study is part of a larger investigation that integrates functional and structural brain differences to evaluate fear-related brain circuitry in patients with CRPS. Thirty-seven patients with CRPS were age and gender matched with 35 healthy controls. The two groups underwent structural magnetic resonance imaging (MRI) scans as well as completed the Fear of Pain Questionnaire, child report (FOPQ). To examine gray matter differences, voxel-based morphometry (VBM) and cortical thickness (CT) analysis was completed. Patients with CRPS in this study had an average age of 13.2 (SD=2.7) and were predominantly female (73%). Of the 35 patients who completed FOPQ, 49% reported clinically significant pain-related fear. Compared with healthy controls, CRPS patients had significantly less in gray matter (GM) volume in pain- and fear-related brain regions, including the dorsolateral prefrontal gyrus, motor and somatosensory cortex, anterior and posterior cingulate cortex, nucleus accumbens, putamen, amygdala, and hippocampus. Furthermore, gray matter decreases in regions such as anterior midcingulate cortex, nucleus accumbens, and putamen were associated with elevated pain-related fear in patients. Differences in gray matter volume in fear-circuitry areas could potentially be one mechanism by which abnormal fear learning and extinction develops in youth suffering with CRPS. Further research examining brain changes post-treatment is needed to determine if treatments that target improving pain and fear levels are associated with concomitant normalization of brain structures.

Within the livestock sector, farmers and veterinarians are two groups of people who play a pivotal role in maintaining the health and welfare of animals. How the different welfare needs of farm animals are perceived and prioritised by these two caretaker groups will have direct implications for the animals in their care. People’s perceptions and attitudes directly influence their behaviour, and research has demonstrated that positive attitudes towards animals are paramount to ensuring good animal welfare. The prevention and mitigation of pain is an important component to ensuring good animal welfare, as pain has the potential to negatively affect both physical and mental health. How pain in animals is perceived by farmers and vets will influence how it is managed. Therefore, understanding how farmers and vets: view the capacity of animals to experience pain, perceive the pain severity associated with different conditions and procedures, view the importance of pain mitigation in relation to other welfare needs, and deem the necessity of analgesic use in livestock, is vital. Four separate questionnaire based studies were conducted to assess these attitudes in farmers and veterinarians as well as in agriculture and veterinary students, as these students will be the next generation of farmers and veterinarians. Overall, farmers and vets were found to have positive attitudes towards pain in livestock. Although the capacity of cattle and sheep to feel pain was perceived to be lower than that of humans it was still rated highly. In addition, positive beliefs about the benefits of pain alleviation, the negative impacts of pain on production and welfare, and the importance of prompt treatment and pain management for good welfare were held. Cattle farmers had more positive attitudes towards pain and analgesic use than sheep farmers. This difference was most evident around areas of resource availability, such as time and labour, and the practicalities associated with pain identification and drug provision. Farmers, vets and students perceived lameness to be a painful condition, with the perceived severity of pain being closely related to the perceived severity of the disease. In addition, participants reported a greater emotional reaction in instances where they rated lameness and pain more highly. Furthermore, a positive relationship was found between lameness, pain and emotional reaction scores and the decision to catch a lame sheep for inspection. The majority of students had positive views towards pain in farm animals, believing that: farm animals were capable of experiencing pain, prompt treatment and the provision of pain relief were the two most important elements of welfare, and that farm animals benefit from pain alleviation. However, there was a perceived difference between a number of animal species in their capacity to feel pain, with livestock species being viewed as having a lesser capacity than companion animals and humans. In addition effects of gender were found, with females reporting higher levels of empathy and compassion towards lame sheep, and rating pain higher. Furthermore, female students had a stronger belief that animals were sentient beings than did males. These four studies found that views on pain and analgesic use in livestock were generally positive. However, differences between individuals and between groups were found in a number of areas including how observers perceived the severity of painful conditions and procedures and in the capacity of different animal species to experience pain. These differences in attitudes may affect the decisions farmers and vets make regarding the treatment of pain, which is likely to have implications for farm animal welfare.

Introdução: A dor é o principal motivo de procura ao atendimento médico. Organizações internacionais de saúde indicam o alívio da dor como um direito humano básico. A literatura indica subutilização de opioides devido ao conhecimento insuficiente, o receio quanto ao potencial de adição, efeitos adversos e mitos persistentes sobre estes analgésicos por parte dos profissionais de saúde. Objetivo: Avaliar grau de conhecimento de profissionais de saúde no manejo da dor e no uso de opioides em três unidades pediátricas (Pediatria, UTI e Oncologia). Metodologia: Estudo transversal realizado em um hospital universitário do Sul do Brasil. Um questionário autoaplicável foi entregue para 182 profissionais (médicos, enfermeiros, farmacêuticos, técnicos e auxiliares de enfermagem), entre dezembro de 2011 e março de 2012. Resultados: A taxa de retorno foi de 67% (122). O percentual médio de acertos foi de 63,2 ± 1,4%. Os erros mais frequentes foram: um opioide não deve ser utilizado sem se saber a causa da dor (47%; 54/115); pacientes desenvolvem depressão respiratória frequentemente (42,3%; 22/52) e confusão entre os sintomas da síndrome de abstinência, tolerância e dependência (81,9%; 95/116). Apenas 8,8% (10/114) relataram o uso de escalas de dor para reconhecer a dor em crianças. A barreira para o controle da dor mais citada foi a dificuldade de medir e localizar a dor em pacientes pediátricos. Finalmente, 50,8% (62/122) não receberam nenhum treinamento sobre dor. Conclusões: Foram identificados problemas nos processos de identificação, mensuração e tratamento da dor. Os resultados sugerem a necessidade de investimento na formação continuada dos profissionais e no desenvolvimento de protocolos que busquem aperfeiçoar a terapia analgésica, impedindo um aumento desnecessário do sofrimento da criança. / Introduction: Pain is the main reason to seek medical care. Health international organizations indicate pain relief as a basic human right. The literature indicates underuse of opioids due to insufficient knowledge, fears about the potential for addiction, side effects and persistent myths about these analgesics by health professionals. Objective: To assess degree of knowledge and attitudes of health professionals about management of pain in three pediatric units (Pediatric, ICU and Oncology). Methods: Cross-sectional study in a teaching hospital in southern Brazil. A self-administered questionnaire was delivered to 182 professionals (doctors, nurses, pharmacists, technicians and nursing assistants), between December 2011 and March 2012. Results: The rate of return was 67% (122). The average percentage of correct responses was 63.2 ± 1.4%. The most frequent errors were: an opioid should not be used without knowing the cause of pain (47%, 54/115); patients often develop respiratory depression (42.3%, 22/52); and confusion between symptoms of the syndrome withdrawal, tolerance and dependence (81.9%, 95/116). Only 8.8% (10/114) reported using pain scales to recognize pain in children. The barrier to pain control most cited was the difficulty to measure and locate the pain in pediatric patients. Finally, 50.8% (62/122) received no training on pain. Conclusions: The study identified problems in the process of recognizing, measuring and treating pain. The results suggest the need for investment in training to health care team and development of protocols that seek to optimize analgesic therapy, preventing an unnecessary increase the suffering of the child.