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.

published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

Suffering is a fundamental experience of the human condition. Whereas the arts and humanities have struggled to make sense of this condition, no concerted effort has taken place in nursing. Suffering is painfully absent within the cancer nursing research literature, a place where suffering should be conspicuous. The purpose of this study was to explore suffering inherent in the cancer experience. The concurrent use of Travelbee's Human-To-Human Relationship Model and narrative theory provided the conceptual underpinning for this prospective ethnography. Narratives of suffering were explored among seven patients diagnosed with cancer (breast, n = 4; brain; malignant melanoma; and ovarian cancer). Five women and two men were interviewed weekly (N = 89 interviews) for a period of up to five months. Participant observation supplemented the interview data. Seven richly textured narratives revealed the suffering endured in the living-of-cancer. The narratives also detailed the informant as person, the cancer trajectory, and explanatory models of cancer causation. A second level analysis of the narratives provided an intra-group comparison of suffering. "Cascade of losses" was the overarching theme. The undermining of personhood, and a loss of faith and trust in the medical system characterized this cascade of losses. Losses were further encountered: the dismissal of symptoms presented to physicians, the failure of treatment as cure, the death of other cancer patients, and the false reassurance that "cancer can be beaten". The remaining themes were "cancer as torture" and "the work of suffering--the beauty of cancer". The findings of this study suggest that nurses may not be capable of alleviating patient suffering. Patients' lives intersect at the suffering experience; their suffering is shaped by the past, present, and future. Nurses may influence these intersections of suffering to some extent, however, it is the individual who ultimately determines the living and outcome (if any) of their suffering. In the lives of the informants, it was the love of spouses and children, faith and trust in God, and satisfaction with life's accomplishments which permitted the endurance of suffering. Competent, comfort-care provided by compassionate nurses is needed by patients who suffer with cancer.

No description available.

Pain has been described as the most complex human experience and most frequent reason patients seek medical treatment. Few people fail to experience the pain associated with disease, injury, or medical/surgical procedures. However, the impact of unemployment that results from chronic pain suffering has not been widely researched. To present a comprehensive view of the effect unemployment has upon the chronic pain experience, this study focused upon stress philosophy, chronic pain, employment, and coping effectiveness. The Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), and a Personal Data Questionnaire (PDQ) were administered to 96 persons (four groups of 24 subjects) representing either unemployed or employed and either chronic or non-chronic (acute) pain populations.

This study investigated the relationship between preferred coping strategies, and major stressors for nondepressed, and depressed chronic pain patients. The subjects for this study were 67 chronic pain patients who are participating in a pain/spinal rehabilitation program. The information collected from the individuals or their records included: (1) basic demographic information, (2) level of activity, (3) level of perceived pain, (4) medication usage, (5) therapist rating of level of stabilization, (6) scores on three inventories including the Coping Strategies Questionnaire, the Ways of Coping Checklist, and the Beck Depression Inventory. Analyses included an examination of the relationship between level of depression and (1) type of stressors, (2) coping strategies, and (3) level of perceived pain. Further analyses included multiple regression with outcome as defined by therapist ratings at the end of treatment, and patients' ratings at follow up as the criterion variables.

The purpose of the present study was to investigate cognitive functioning in a group of 30 chronic pain patients (CPG) as compared to a group of 39 acute pain patients (APG). In order to assess cognitive performance, certain subtests were selected from the McCarron-Dial System (MDS) of Neuropsychological Evaluation. Specifically, a measure of haptic discrimination was used along with the Bender Visual Motor Gestalt Test. As such, completion of these subtests required a cortically mediated, central nervous system processing of sensory information. This particular method of assessment was chosen because it provided a nonverbal measure of higher-order cognitive performance. Additionally, the haptic measure provided separate scores for right and left hemispheric functioning. Data analysis revealed significantly poorer Bender performance among CPG members (t(69) = -5.09, E - •0004, two tailed). Further data analysis revealed that the CPG performed significantly poorer on certain of the haptic discrimination subtests. Specifically, both texture and configuration scores for the right hemisphere were significantly lower among CPG members (texture, p = -042 and configuration, p = .002). Subsequent analyses were conducted to determine predictive relationships between important variables. These data are discussed in terms of their clinical significance and importance for future research.

Low back pain has long been estimated to be the most prevalent and debilitating source of chronic pain. The present study first reviews the literature addressing the various theories of pain, the physiological and psychological variables important in pain research, and the psychotherapeutic approaches that have been used to date to reduce pain. Thirty-seven hospitalized chronic back pain patients were administered the cold-pressor test and a medical pain stimulus procedure which was medically relevant to their back pathology. A card-sort method was utilized in order to assess the coping strategies employed by the patients during these two pain stimulus tasks. These procedures were repeated following treatment. Coping strategies used by patients during the two pain tasks were compared. Results demonstrated that there was a significant difference in the manner in which patients coped with the two types of pain. Cold-pressor measures of pain threshold and tolerance were not significantly different between pretreatment and post-treatment. These measures were also not positively correlated with treatment outcome. A multiple regression approach demonstrated that particular coping strategies were significantly predictive of treatment outcome. The medical pain stimulus procedure was found to provide more significant pedictor variables than the cold-pressor test. At pre-treatment assessment, patients who relied on dramatized coping strategies were less likely to be successful in treatment. Breathing activity and pain acknowledgement were positive coping techniques highly predictive of successful outcome in this study. The use of computers for assessment and other recommendations for future research were discussed.

Chan, Hoi Sze Gloria. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 204-241). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendixes also in Chinese.

Chan, Yuen Pik. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 29-33). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese.