Vaccinations provide protection against deadly diseases and children are scheduled to receive many immunization injections before the age of six. However, painful procedures, such as immunizations cause negative short- and long-term consequences for children. The Gate Control Theory of Pain suggests that physical interventions may be helpful, but they have not yet been validated as an effective intervention to manage children’s acute pain. This randomized trial examined the effectiveness of the ShotBlocker®, a physical intervention designed to decrease children’s injection pain, in a sample of 89 4- to 12- year-old children receiving immunizations at a pediatric practice. An ANOVA revealed no significant effect of treatment group (Typical Care Control, Placebo, and ShotBlocker®) on any measure of child distress. Clinical and theoretical implications are discussed.

Distraction is an effective pain management intervention and children’s coping styles are important to consider when designing interventions. The purpose of this study was to examine two movie distractions in children 3 to 11 years old receiving venipunctures and to evaluate the relations between the effectiveness of the interventions and coping styles. Results revealed no interaction and no main effects of condition or coping style. However, coping on caregiver-report of child pain approached significance. T-tests revealed significant differences between approach and avoidance coping styles, with children with an approach coping style experiencing significantly less pain compared to children with an avoidance coping style. Descriptive statistics revealed the presence of a mixed coping style, suggesting that children’s coping styles may be continuous. This study highlights the importance of examining coping styles in the context of pediatric painful medical procedures and the need to further examine the effectiveness of distraction interventions.

Pain in sport serves the adaptive functions of signalling impending or actual injury and signalling the achievement of optimum workload to produce a conditioning effect. It is important to be able to distinguish what pain is signalling in order to respond to it effectively. The different functions of pain present a challenge for athletes wanting to improve their skill and conditioning level in the most efficient manner without becoming injured. However, this challenge could prove dangerous to children who have only a partial understanding of the value of pain, or who believe that they must endure great amounts of pain in order to become successful in sport. Previous research with general populations has demonstrated that children have a naive understanding of pain causation and do not understand the value of pain. In addition, previous research demonstrated that social factors such as peer and parental pressure may lead to situations where child athletes suffer preventable injuries because they ignore the warning signals of pain. Because coaches and parents are often responsible for deciding what to do when children present with pain, it is important for these adults to be aware of the cognitive limitations of children regarding the causes and meaning of pain. To date, there is no research which examines what athletes know about sport-related pain. Participants for this research project were 68 gymnasts aged 6 to 13 years. Several questions were asked in this study: (a) can gymnasts of various ages distinguish different types of sport-related pain?; (b) do gymnasts respond differently to different types of sport-related pain?; (c) what reasons do gymnasts give for continuing or discontinuing gymnastics when they have pain?; (d) do gymnasts understand the concept of pain causality?; (e) do gymnasts understand the value of pain?; (0 do gymnasts use pain for secondary gain? These questions were investigated in the context of an interview designed for this study. Two subtests from the Stanford-Binet Intelligence Scale and tests of cognitive developmental level based on Piagetian theory were also administered. The effects of age, gender, level of cognitive development, experience with sport, and experience with pain and injury were examined for their influence on responses to the above questions. Results revealed age differences in the gymnasts' ability to distinguish types of pain such that older gymnasts identified more pain types. However, even the youngest participants were able to discuss more than one type of pain. There were age differences in gymnasts' understanding of pain causality. Contrary to previous research demonstrating children to be unable to identify a physiological cause of pain, 32% of the gymnasts aged 9 to 13 were able to describe the role of the brain and/or nerves in pain causality. Also contrary to previous research with general populations, the gymnasts were able to discuss the value of pain, especially as a signal of hard work and as a warning to stop what they are doing. Forty percent of participants reported using pain (sport-related and/or non sport-related) for secondary gain. Not a single gymnast reported using pain as an excuse for a poor performance. Six of them did, however, report pretending to be in pain to avoid something in the gym that caused them fear. Further demonstrating an appreciation of different types of pain, results showed the gymnasts to respond differently to various pain types. These young athletes demonstrated an awareness of the need to stop their sport in some cases and to continue gymnastics in other cases, depending upon the type of pain. When continuing gymnastics despite pain, participants usually justified their decision by saying that the pain was not harmful to them. When describing why they discontinued gymnastics because of pain, participants often stated that the pain or injury may worsen. Few participants stated a concern for their future functioning. No participant described pressure from coaches, parents or peers to continue gymnastics while experiencing pain. Results are discussed in a variety of contexts: (a) comparison of these results to those of similar research done with general populations of children; (b) implications for training practices, coach and athlete education. and sport policy in general; (c) support for a theory of cognition that encompasses both nativist and constructivist components; and (d) directions for future research.

Syfte: Att utifrån litteratur beskriva hur sjuksköterskor kan identifiera smärta hos äldre personer med demenssjukdom, samt att undersöka vilka mätinstrument som finns att tillgå för att beskriva smärta. Metod: Litteraturstudien var av deskriptiv design. Litteratursökningen gjordes i databaserna PubMed och Cinahl. Resultat: Resultatet baserades på 14 vetenskapliga artiklar som visar att det finns många uttryck för smärta som sjuksköterskan kan använda sig av för att identifiera smärta hos äldre personer med demenssjukdom. Resultatet visade att det är mycket svårare att identifiera smärta vid omvårdnad av äldre demenssjuka, då de inte kan kommunicera som kognitivt intakta personer. Därför är det viktigt att sjuksköterskan känner patienten för att kunna notera avvikelser i beteendet och kroppsspråket, vilket kan tyda på smärta. Resultatet visade även att det finns en mängd olika mätinstrument för att skatta smärta hos äldre med demenssjukdom. Smärtskattningsinstrumenten delas in i självskattningsskalor och observationsskalor. Slutsats: Identifieringen av smärta hos denna patientgrupp kräver att sjuksköterskan är lyhörd, innehar kunskap och erfarenhet samt tar sig tid för bedömningen. Vid smärtskattning är observationsskalor att föredra då demenssjuka individer har svårare att självskatta sin smärta. / Aim: To describe from literature how nurses can identify pain in older people with dementia and to examine the instruments available to describe the pain. Method: The literature study was descriptive design. The literature search was done in PubMed and Cinahl databases. Results: The result was based on 14 scientific articles that show that there are many expressions of pain that nurses can use to identify pain in older people with dementia. The results showed that it is very difficult to identify pain in care of older persons with dementia, because they can not communicate as cognitively intact persons. It is therefore important that the nurse knows the patient to record deviations in behavior and body language, which may indicate pain. The results also showed that there are a variety of different sensors to estimate the pain in the elderly with dementia. Pain measurement instruments are divided into self-rating scales and observation scales. Conclusion: The identification of pain in this population requires that the nurse is attentive, have knowledge and experience and take the time for assessment. The pain assessment is observation scales to prefer demented individuals are less able to self-rate their pain.

Pain is common among women undergoing first trimester surgical abortions. At the postoperative unit, department of gynaecology, University Hospital, Uppsala, the goal is that 80 % of the women should rate pain as £ 3 on a numeric rating scale (NRS), when leaving the unit. The aim of the study was to investigate how rating was performed at the unit and to investigate patient’s perceptions of pain after having undergone first trimester surgical abortion. 20 patients (74%) participated in the study. Ninety percent of the patients rated their pain as NRS £ 3 when leaving the unit. Seven patients (35 %) rated their pain as NRS > 3 directly after operation, and 2 (10 %) patients NRS > 3 when leaving the unit. There were no correlations between patient’s age and ratings of pain. There was no difference in rating of pain between patients with prior vaginal delivery and patients who had no prior vaginal delivery. There were no correlations between ratings of pain and gestational age. Conclusion: It is important that patients undergoing first trimester surgical abortions receive adequate pain treatment. The unit’s goal for postoperative pain treatment is achived, 90 % of the patients rated their pain as NRS £ 3 when leaving the unit.

Even today, with modern medicine and technology, post-operative pain still exists as anmajor issue in modern treatment. A lot of research efforts have been made, in order toimprove pain outcome for patients that has undergone surgery[18][15].Even though physician's and doctors are well educated, the success rate is aboutapproximately 70 %, still there are patients that experience severe pain, after they haveundergone surgery. There could be several reasons to this, for example, lack of methods orsupport should be amongst other things, factors to consider[18].The problem has been to initiate a case-library and eventually create a tool, that could aidphycisians or doctors in their decision making, which hopefully would help in improvingpain outcome. The chosen method to do this, is a modified version of the CBR-algorithm,which is an artificial intelligence algorithm. The CBR-algorithm makes use of features,solution and outcome, and is implemented with a simple prototype, as a similarity function.The are several reasons for why this method was chosen, but using this method makes itpossible to easily create a web-based tool, so it can easily be accessed from anywhere, butstill be effective and work as a support tool.The algorithm works as a self learning mechanism, and is easy to implement, and theinterface has been constructed, allowing the phycisian or doctor to retrieve informationabout patients and run CBR. The desired results are as expected, it's possible to run theCBR, retrieve and compare cases, and get suggestion of solution or action that should beperformed.The conclusion that can be made, is that, although this is a very basic working medicalapplication, still an overall improvement is needed in order to be used as a medicalapplication. It's anyhow a start. For more details and information, check the appendicesplease. / The PainOut Project

BakgrundHemförlossningar är fortfarande vanligt förekommande internationellt och ofta enda alternativet för många kvinnor i låginkomstländer. Nederländerna är ett av få industrialiserade länder där planerade hemförlossningar fortfarande är norm för friska, gravida kvinnor. Forskning har visat att det är lika säkert för kvinnor med lågriskgraviditeter i Nederländerna att föda hemma som att föda på sjukhus. I dag är hemförlossningar i Sverige inte ett alternativ inom det officiella hälso- och sjukvårdssystemet. Om svenska kvinnor erbjuds fritt att välja var de skulle kunna tänkas föda, skulle hemförlossningarna vara 10 gånger fler. Kvinnor som väljer att föda hemma har en inställning till födandet som en naturlig process och att den kvinnliga kroppen har skapats för att kunna föda.SyfteSyftet med denna studie är att beskriva hur kvinnor hanterar värkarbetet vid en planerad förlossning i hemmet.MetodEn kvalitativ innehållsanalys av 118 slumpmässigt utvalda enkätsvar. Studien grundar sig på svaren på en öppen fråga, ur ett frågeformulär, riktad till kvinnor som fött eller planerade att föda i hemmet.ResultatI kvinnornas beskrivning av sin hemförlossning identifierades fyra huvudkategorier som beskriver hur kvinnorna hanterar värkarbetet vid planerad hemförlossning; Att vara kvar i vardagen och utföra vardagssysslor, genom fysisk och mental aktivitet, naturlig smärtlindring samt genom omgivande stöd. SlutsatsSlutsatsen är att kvinnorna stannar kvar i vardagen samtidigt som det sker ett mirakel och detta underlättar hanteringen av värkarbetet. Det finns ingen skiljelinje mellan graviditet och förlossning som det annars gör när kvinnorna föder på sjukhus.

<p>Based on a biopsychosocial model of mammography pain, the current study assessed if specific biological and psychosocial factors were associated with higher reported mammography pain in early stage breast cancer survivors. One hundred and twenty-seven women completed questionnaires assessing demographic information, cancer treatment history, ongoing breast pain, mammography-related anxiety, and social support immediately prior to receiving a mammogram. They then completed questionnaires assessing mammography pain and mammography-related pain catastrophizing immediately following the mammogram. Using path modeling and mediation analyses, relations among these variables were examined. Results revealed that mammography-related pain catastrophizing was related to higher mammography pain directly, while ongoing breast pain, lower social support quantity, and lower perceived quality of social support related to higher mammography pain indirectly through mammography-related pain catastrophizing. Moderated mediation analyses found that the mediation effects of mammography-related pain catastrophizing were significantly different at varying levels of perceived quality of social support, with more pronounced negative effects for those with higher quality support than those with lower quality support. The theoretical, clinical, and research implications of these findings are discussed.</p> / Dissertation

Thesis (M.S.)--West Virginia University, 2003. / Title from document title page. Document formatted into pages; contains ix, 57 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 43-46).

published_or_final_version / Medicine / Master / Doctor of Medicine