BAKGRUND: En av våra snabbast växande folksjukdomar i dagens samhälle är demens. Individer med demenssjukdom besitter olika hinder därav bl.a. kognitiv påverkan eller kognitiv svikt, vilket i sig medför svårigheter av kommunikationsart. Detta medför vidare problematik kring identifieringen av smärtsymtom. SYFTE: Att undersöka hur sjuksköterskor bedömer smärta hos äldre personer med en diagnostiserad demenssjukdom. METOD: Litteraturstudien utformades som en litteraturöversikt över förekommande forskning där syfte och frågeställningar besvaras utifrån resultat av tidigare vetenskapliga studier. Artikelsökningarna inriktades på de bibliografiska referensdatabaserna CINAHL samt PubMed där både kvantitativa och kvalitativa studier har granskats. RESULTAT: Tre huvudteman identifierades: Observation som instrument, självskattningsskalor som instrument samt sjuksköterskan som instrument. Observationsinstrumenten ADD, PACSLAC-D, PAINAD, DisDAT, NOPPAIN samt STI visade sig vara mest användbara för patienter med svår demens. För de individer med mild till måttlig demens lämpar sig självskattningsinstrument som VAS, VRS och FPS. Utöver instrumenten krävs även att sjuksköterskan har kunskap om såväl demens som individen bakom demensdiagnosen. Även riktlinjer, ett gott intraprofessionellt samarbete och anhörigas kunskap om individen är komponenter som har betydelse för att lindra smärta hos individer med demens. SLUTSATS: Konklusionen av resultatet visar att sjuksköterskans kunskap om demenssjukdom samt kunskap om individen bakom diagnosen utgör tillsammans med anhöriga en grund för att identifiera smärta. / BACKGROUND: One of our fastest growing endemic diseases in today's society is dementia. Individuals with dementia possess different series of obstacles including cognitive loss or cognitive impairment, which raises difficulties of communication. This causes further concerns relating to the relief of painful symptoms. OBJECTIVE: To investigate nurses' pain assessment in older people with diagnosed dementia. METHOD: The study was designed as a literature overview, research where the aim and questions answered on the basis of results of previous scientific studies. Searches for articles were focused on the bibliographic reference databases CINAHL and PubMed where both quantitative and qualitative studies have been reviewed. RESULTS: Three main themes were identified: Nurses knowledge as instruments, observation as an instrument and self- rating scales as instruments. Observation instruments ADD, PACSLAC -D, PAINAD, DisDAT, NOPPAIN and STI proved to be most useful for patients with severe dementia. For those individuals with mild to moderate dementia were self -report instrument such as VAS, VRS and FPS suitable. In addition to the instruments also requires that the nurse has knowledge of both dementia as the individual behind the dementia diagnosis. Although guidelines and a good knowledge of the individual is important to relieve pain in people with dementia. CONCLUSION: The results shows that the nurse's knowledge of dementia as a disease, and knowledge of the individual behind the diagnosis, together with relatives included a basis for identifying pain.

While chronic pain is an increasingly prevalent condition in the United States, it is twice as common among the military veteran population. As many Vietnam War era veterans are aging and experiencing comorbid medical conditions, their chronic pain is becoming increasingly complex. Policies enacted in response to the ‘opioid epidemic’ have in some ways made treatment of pain safer, but have also left remaining questions regarding how to properly provide care. There are three fields of complexity that interact within this topic: patients with a clear need for care and pain management, providers committed to helping patients, and structural barriers that unintentionally interfere with the provision of care. The lived experience of chronic pain and receiving care through the VA healthcare system combined with a common military culture exemplifies a lifeworld centered on pain—which I call a ‘painworld.’ This painworld is seen in the illness narratives of older, white, male veterans with chronic pain. Examining the way a single VA site provides pain care shows the providers are dedicated to treating veteran patients and offer a large number of treatment options. While the need for pain management services is clear from both the patient and provider perspectives, translating the lived experience of these veterans and their medical needs into a hierarchical bureaucratic structure is difficult. Furthermore, the bureaucratic nature of a large federal organization creates gaps in the healthcare system. This leads to the creation of informal systems through systems-correcting praxis to fill the gaps and attempt to prevent siloing and slippage throughout. Together, these fields of complexity are organized into three chapters, building the argument that the convergence of veteran painworlds, pain care, and bureaucracy can contribute to miscommunication, leading to unintended slippage through the system and inadequate care, despite good intentions of staff. Furthermore, the VA system and structure of providing pain care both influences and is part of the painworld, as are the interactions that occur between veteran patients and staff.

Chronic low back pain (CLBP) is one of the most prevalent and disabling health conditions in the US and worldwide. Biomedical explanations of acute injury fail to account for why some individuals experience remission of pain and restoration of physical function while others do not. Pain-related fear, accompanied by elevated appraisals of physical exertion and avoidance of physical activity, has emerged as a central psychosocial risk factor for transition from acute injury to chronic pain and disability. Research has indicated that these pain-related factors may be maintained through observational learning mechanisms. To date, no studies have experimentally examined the role of observational learning and pain-related fear in the context of actual musculoskeletal injury. Accordingly, the present study examined the impact of observational learning and pain-related fear on activity appraisals and exertion following experimentally- induced acute low back injury. Healthy participants' appraisal of standardized movement tasks along with measures of physical exertion were collected prior to and following a procedure designed to induce delayed onset muscle soreness (DOMS) to the lower back. Following induction of DOMS, participants observed a video prime depicting CLBP patients exhibiting either high or low pain behavior during similar standardized movements. In line with hypothesized effects, participants assigned to the high pain behavior prime demonstrated greater elevation in pain and harm appraisals as well as greater decrement in physical exertion. Further in line with hypotheses, significant changes in appraisal and physical performance following the high pain behavior prime were only observed among participants endorsing high pain-related fear during baseline assessment. Discussion of findings addresses potential mechanisms of action as well as study limitations and direction for future research.

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Recent advances in neuroimaging and electromagnetic measurement technology have permitted the exploration of structural and functional brain alterations associated with chronic pain. A number of cortical and subcortical brain regions have been found to be involved in the experience of chronic pain (Baliki et al., 2008; Jensen et al., 2010). Evidence suggests that living with chronic pain shapes the brain from both an architectural and a functional perspective, and that individuals living with chronic pain display altered brainwave activity even at rest. Quantitative EEG (qEEG) is a method of spectral analysis that utilizes a fast Fourier transform algorithm to convert analog EEG signals into digital signals, allowing for precise quantification and analysis of signals both at single electrode locations and across the scalp as a whole. An important advance that has been permitted by qEEG analysis is the development of lifespan normative databases against which individual qEEGs can be compared (Kaiser, 2006; Thatcher et al, 2000). Pilot data utilizing qEEG to examine brainwave patterns of individuals with chronic pain have revealed altered EEG activity at rest compared to age- and gender-matched healthy individuals (Burroughs, 2011). The current investigation extended the findings of the pilot study by utilizing qEEG to examine a larger sample of individuals with chronic pain. Individuals with chronic pain displayed significantly reduced slow wave activity in frontal, central, and temporal regions. Findings will be presented in terms of specific patterns of altered EEG activity seen in individuals with chronic pain.

TITLE: Association of Alcohol Use, Depression, and Pain among Cancer Patients AUTHOR INFO Nneoma Ubah Manik Ahuja Eugene Annor Author(s) Affiliations: College of Public Health, East Tennessee State University, Johnson City, TN 37614, United States Background: Cancer is often a chronic illness that evolves with pain. Studies have shown that 60% of patients with cancer are burdened with pain, and 25% to 30% have severe pain. Uncontrolled pain has been recognized as one of the significant causes of depression among cancer patients. Depression is a comorbid syndrome that affects 25% of cancer patients, but only 5% see a mental health professional. Major depressive disorders have very high rates of comorbidity, with substance use disorders ranging from 12% to 80%. However, there is limited data on the association of depression, alcohol use disorders, and pain among cancer patients. This study aims to identify this association. Methods: We used cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System, a nationally representative U.S. telephone-based survey of adults aged 18 and above. We also extracted data for cancer patients (n=8,963). Logistic regression analysis was conducted to test the association between pain associated with cancer and two outcomes, depression, and alcohol use. We controlled for income, race, educational status, health insurance status, race/ethnic minority status, and age. Results: Overall, 8.6% (n=843) of patients reported pain from their cancer, while 20.2% reported depression and 44.4% reported alcohol use. Pain from cancer was associated with significantly higher odds of depression (OR=1.75, 95% CI, 1.49, 2.05) along with low income (OR=1.93, 95% CI, 1.73, 2.16) and less than high school education (OR=1.30, 95% CI, 1.02, 1.65). Pain from cancer was not significantly associated with alcohol use, while male gender (OR=1.46, 95% CI, 1.34, 1.58) among cancer patients predicted higher odds of alcohol use. Conclusion: Depression and alcohol use have been identified as significant problems among cancer patients with pain. Among the cancer patients studied, pain from cancer was not significantly associated with alcohol use. However, cancer patients burdened with pain were more likely to suffer depression. This indicates a need to invest more effort in identifying cancer patients with depression and managing their pain appropriately to improve their outcomes. Proper pain management should also be prioritized in cancer care to prevent depression. Keywords: Pain management, Cancer Pain, Alcohol, Depression.

To understand pain processing requires the assessment of an individual’s perception of pain with temporal stimulation over different periods. Offset analgesia (OA), a phenomenon widely studied, refers to a disproportionate decrease in pain experience following a small reduction in temperature during noxious thermal stimulation. OA leads to skin desensitization, causing brief pain inhibition at the stimulation site and leading to adaptation and a decrease in pain scores. To avoid sensitization and habituation during thermal pain procedures, previous studies have utilized protocols in which the thermal stimulation is applied to different areas of the skin (e.g., upper forearm versus lower forearm). The reliability of this thermal pain calibration procedure in producing a nonadaptive effect has been previously tested using pain rating scales. The utilization of neuroimaging to further elucidate these relationships has not been widely studied, but it is likely an important tool to investigate these constructs. Functional near-infrared spectroscopy (fNIRS) is a noninvasive optical imaging technique that measures changes in hemoglobin (Hb) concentrations within the brain using the characteristic absorption spectra of Hb in the near-infrared range. This thesis investigated whether adaptation exists across four conditions of the OA paradigm using fNIRS. Introducing fNIRS to define significant differences in brain metrics (e.g., activated regions of interest) in participants who have undergone surgery and are experiencing chronic pain as well as healthy, pain-free controls could have implications for more accurate measures of OA and more reliable pain treatment options. In this study, noxious thermal stimulation was given to 19 participants on the forearm of the nondominant hand through a commonly used three-temperature OA paradigm with offset, constant, and control trials. Each OA paradigm consisted of four conditions (A, B, C, and D) with a pseudorandom sequence design of three trials. OA was implemented with the participant while real-time fNIRS data were obtained on the subject’s prefrontal and somatosensory cortices, regions known to be involved in pain processing. Hemoglobin responses during the four OA trials were evaluated and compared within experimental conditions. Repeated measures ANOVA was used to analyze the significant differences among conditions. Results showed no significant differences among the four OA trials. The findings of this thesis study indicated that brain response from the prefrontal and somatosensory cortices is not affected within the four OA trials. The consistent brain activation across multiple trials of stimulation suggests an absence of adaptive responses. In line with previous findings, these results imply the reliability of such thermal pain calibration procedures by fNIRS brain imaging. Further investigation with a larger sample size is likely for the verification of the findings from this study. / 2026-02-14T00:00:00Z

There is a growing literature supporting the idea that those who engage in non-suicidal deliberate self-harm (DSH) have altered pain perception compared to individuals who do not. For example, individuals who report a history of non-suicidal DSH behavior have a decreased sensitivity to transient pain during laboratory-based pain induction (e.g., Glenn et al., 2014). Research suggests that brief manipulations targeting individual beliefs can affect performance on subsequent tasks, including measures of pain sensitivity. To date, however, no study has examined the effects of experimentally manipulated pain perception on DSH behavior. The Self-Aggression Paradigm (SAP: Berman & Walley, 2003; McCloskey & Berman, 2003) allows for the prospective observation of the effects of experimental manipulations on a laboratory analogue of DSH. Therefore, the aim of the current study was to determine if experimentally manipulated false feedback about pain tolerance affects DSH behavior during the SAP, thus potentially providing evidence for a causal linkage between pain perception and DSH. Eighty participants were randomly assigned to one of three feedback groups: High pain tolerance, low pain tolerance, and a control condition with neutral feedback provided after completing the SAP. Participants were provided false feedback regarding their pain tolerance after a pressure algometer task. It was predicted that participants in the high pain tolerance feedback groupwould have the highest DSH on the SAP, with DSH defined as the level of shock self-administered during a series of reaction-time trials. No significant group differences, however, emerged based on group assignment. Men engaged in more DSH than women during the study independent of feedback group assignment. A secondary aim of the current study was to provide further validation for the SAP using multiple pain induction modalities. Implications of the current findings and future research directions are discussed.

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