published_or_final_version / Anaesthesiology / Doctoral / Doctor of Philosophy

Engaging in 150+ minutes of moderate to vigorous exercise is a recommended self-management strategy for arthritis. Considering the low levels of exercise among individuals with arthritis, national calls have been made for investigation of theory-based processes important for adherence. Self-regulation may be a key process important for persisting with exercise plans in the face of arthritis pain anxiety. The present study examined relationships based upon a known model (Fear Avoidance [FA] model) used to understand self-regulatory behavioral responses to pain anxiety – an unexamined relationship in the arthritis and exercise literature. Primary study purposes involved examination of predictors (pain, pain anxiety, and pain acceptance) of maladaptive and adaptive self-regulatory responses among adults with arthritis who exercise. The secondary purpose examined whether participants who met the recommended dose of exercise over a two-week period significantly differed in their pain cognitions and self-regulatory responses to pain anxiety compared to less active counterparts. Participants were 136 adults (Mage = 49.75 ± 13.88years) with self-reported medically-diagnosed arthritis. Online surveys of pain cognitions and demographics were completed at baseline, followed by self-reported exercise two weeks later. Hierarchical multiple regression analyses illustrated that: (a) pain anxiety was a significant, positive predictor of the use of maladaptive self- regulatory responses (p < .001) and (b) the interaction of pain anxiety x pain acceptance was a significant predictor of the adaptive self-regulatory responses relationship (p < .05). Follow-up analyses illustrated that pain acceptance was a moderator of the pain anxiety – adaptive self-regulatory responses relationship. Participants with higher pain acceptance used adaptive responses less frequently when anxiety was lower than participants with lower acceptance. When pain anxiety was higher, both higher and lower pain acceptance was associated with the more frequent use of adaptive self-regulatory responses. A MANOVA analysis illustrated that participants meeting the recommended exercise dose had significantly lower pain anxiety, higher pain acceptance, and used maladaptive self-regulatory responses less compared to the group not meeting the dose (p’s ≤ .01). Taken together, findings provide the first ever support for FA model predictions in the arthritis – exercise domain. The results of this observational study suggest a next step could be an extended longitudinal study design with multiple time periods of assessment (e.g., measures once a month over a six-month period). Observing the relationships over time would provide a better understanding of within-person changes in the psychosocial variables relative to exercise. Such research would provide a profile of individuals’ levels of anxiety, acceptance, and self-regulatory responses when they either decrease or completely avoid exercise and when they adhere. Obtaining a social cognitive profile of people at risk for exercise avoidance may be a useful tool in the future to identify those who are in need of intervention to deal with their pain anxiety.

Chronic pain is a major health problem affecting more than 1.5 billion people worldwide. Specifically, neuropathic pain and chronic post-surgical pain are debilitating clinical conditions with few efficacious treatments, warranting development of novel therapeutics. Starting with the hypothesis that dysregulated translation regulation pathways may underlie these pain states, we demonstrated that there is a major reorganization of translation machinery in the peripheral nervous system of rats and mice, including enhanced mTOR and ERK activity and increased phosphorylation of mTOR and ERK downstream targets in these persistent pain states. We also hypothesized that activators of AMP-activated protein kinase (AMPK) may represent a novel treatment avenue for the treatment of neuropathic and incision-induced pain because AMPK activators inhibit ERK and mTOR signaling, two important pathways involved in the sensitization of peripheral nociceptors. The AMP activated protein kinase (AMPK) activators, metformin, resveratrol and A769662, inhibited translation regulation signaling pathways in sensory neurons, eIF4F complex formation, nascent protein synthesis in injured nerves and sodium channel-dependent excitability of sensory neurons resulting in a resolution of neuropathic allodynia. We have further demonstrated that local injection of resveratrol, metformin or A769662 and topical application of resveratrol, a potent AMPK activator, into the hindpaw following plantar incision dose-relatedly reverses incision-mediated mechanical hypersensitivity as well as hyperalgesic priming induced by incision. In addition, co-treatment with systemic metformin and local resveratrol at individually sub-efficacious doses at the time of incision blocked acute hypersensitivity and hyperalgesic priming suggesting potential super-additive effects of combined AMPK activator use. These results highlight the importance of signaling to translation control in peripheral sensitization of nociceptors and provide further evidence for activation of AMPK as a novel treatment avenue for acute and chronic pain states.

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A dissertation presented to the Faculty of Health Sciences at the Durban University of Technology in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, 2009 / Introduction: The aetiology of Temporomandibular Joint Dysfunction (TMJD) is not fully understood and the treatment of TMJD is controversial. Most treatment plans are based on postulated aetiology. Treatment plans currently range from pharmacological to surgical and occasionally physical therapy is also used for any myofascial component. Myofacial Trigger Points (MFTP’s) in the head and neck region have similar pain referral patterns as TMJD and there is overlap in aetiology and epidemiology. If correlation can be proved to exist between the severities of TMJD and MFTP’s then the treatment of MFTP’s can potentially decrease the severity of TMJD and then the more radical treatments can be avoided. Objectives: To determine whether TMJD was present and establish severity. To locate any MFTP’s in the Sternocleidomastiod (SCM), Temporalis, Masseter, Posterior Cervical (PC), Lateral and Medial Pterygoid muscles and determine their severity. Methods: A random sample of 25 participants were evaluated. A p value <0.05 was considered as statistically significant. Quantitative variables were summarized using median, inter-quartile range and range due to skewness of distribution, while categorical variables were described using frequency distributions and bar charts. Spearman’s nonparametric correlation analysis, and curve estimation were used to determine the existence of a relationship between TMJ severity and MFTP severity. A scatterplot was used to graphically assess the relationship. Conclusion: The results suggested that the participants were actually chronic neck pain suffers that developed TMJD over the long term as a result of chronic neck pain changing the kinematic biomechanics or as a result of a completely different and independent event as suggested by Foreman and Croft (1995).

Stress can be defined as feelings of frustration or anxiety that arise when individuals face challenges that exceed their capabilities or resources. Consequences of stress generally result from a suppressed immune system and include headaches, sleep problems, and muscle pain. Music as an intervention for relieving pain has increased due to its non-invasive nature, ease of administration, low cost, and lack of adverse side effects. While prior research on music therapy and pain has primarily focused on pain related to surgery, disease, or accidents, there have been no studies to date examining the association between music therapy and stress-induced muscle pain. I have designed a study proposal to establish the relationship between music therapy and muscle pain related to stress. The proposed study will compare salivary cortisol levels, pain visual analogue scale (VAS) scores, the number of painkillers consumed, and the number of doctor visits of healthy individuals experiencing the same stressor (MCAT or GRE) over a 3 month period. One group of participants will be randomly assigned to listen to an additional 30 minutes of self-chosen calming music a day, whereas the other will not listen to any additional music. It is hypothesized that the participants that listen to the additional calming music will experience significantly lower levels of stress and therefore lower muscle pain levels than the participants that did not listen to music. This research is potentially useful for students who undergo constant stress due to the demands of college. Future studies could include whether music therapy allows students to study longer by relieving some of the muscle pain caused by stress.

<p>Uppsatsen godkänd i Februari i år (2012). Glömt reg. i DIVA...</p>