Många äldre lider av långvarig smärta och får inte alltid den hjälp de behöver. Ökad kunskap inom området behövs då antalet äldre kommer att öka. Att utvärdera och lindra smärta hos äldre utgör en viktig del av sjuksköterskans ansvarsområde. Genomförd studie syftar till att undersöka vilka kunskaper som finns om utvärdering och lindring av smärta riktad till äldre boende i kommunen. Genom litteraturöversikt av både kvalitativa och kvantitativa artiklar redovisas resultatet i fyra teman: sjuksköterskans utvärdering av smärta, vårdtagarens utvärdering av smärta, sjuksköterskans lindring av smärta och vårdtagarens lindring av smärta. Hur smärta blev utvärderad stämde inte alltid överens med vårdtagarens upplevelse av smärtan. Smärtlindring sker oftast med läkemedel men alternativa behandlingar blir allt vanligare. Ökat samarbete mellan olika yrkeskategorier kan leda till att äldre med långvarig smärta får den vård de har rätt till. Mer studier behövs för att kunna utveckla vården inom området smärta hos äldre. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

I bakgrunden förklaras vad begreppen smärta, kronisk smärta, lindra, smärtbedömning och smärtlindring innebär. I sjuksköterskans dagliga arbete är en uppgift att lindra kronisk smärta hos patienter. Idag lever många människor med denna typ av smärta, och dessa patienter förekommer överallt inom hälso- och sjukvården. Patienter med denna smärta visar inte hela tiden att de har ont eftersom de ofta har lärt sig att leva med den. Därför finns det stor risk att sjuksköterskor undervärderar patientens värk. Viktigt är att patientens smärtupplevelser lindras eftersom kronisk smärta kan ge besvärande konsekvenser.Syftet är att studera hur patienter med kronisk smärta upplever otillräcklig smärtlindring.Studien är en litteraturstudie där 8 artiklar med kvalitativ ansats har analyserats och granskats utifrån syftet.I resultatet framkommer patienternas egna upplevelser av kronisk smärta och hur det är att inte bli tillräckligt smärtlindrad. Resultatet presenteras i fyra huvudteman med tillhörande subteman. Huvudtemana är: att bemästra kronisk smärta, barriärer till smärtlindring, brister i mötet och emotionella reaktioner. I diskussionen belyses resultatet utifrån annan forskning. Patientens egna strategier och sjukvårdens behandlingar diskuteras. Vidare diskuteras patientens upplevelse av att inte bli betrodd, brister i mötet mellan patient och vårdpersonal och patientens tankar kring att inte bli tillräckligt informerad. Sjuksköterskan bör ge bättre information till patienten om dennes smärttillstånd, lyssna till de strategier patienten använder sig av och integrera dessa i omvårdnadsarbetet, samt vara medveten om de barriärer som finns som förhindrar fullgod smärtlindring. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

Com o desenvolvimento tecnológico, cada vez mais, os neonatos têm sido expostos a procedimentos dolorosos. Atualmente, existem várias intervenções farmacológicas e não farmacológicas para o alívio da dor. Há escassez de estudos sobre a a exposição à dor dos recém-nascidos e as práticas para o seu manejo nas unidades neonatais brasileiras. Este estudo descritivo exploratório teve como objetivo dimensionar a exposição a procedimentos dolorosos de recém-nascidos pré-termo e as intervenções farmacológicas e não farmacológicas utilizadas para o alívio da dor, durante os primeiros 14 dias de vida em unidades neonatais de um hospital universitário de Ribeirão Preto - SP. Participaram do estudo 89 prematuros, após obtenção do consentimento livre e esclarecido dos responsáveis. Foi adicionado um questionário no prontuário dos neonatos para registro dos procedimentos dolorosos, intervenção analgésica, número de tentativas e profissional que realizou o procedimento. A coleta de dados foi realizada no período de outubro de 2012 a outubro de 2013. Também foi realizada busca nos prontuários dos prematuros para minimizar falha de registro e completar questionários que se encontravam incompletos. Realizada dupla digitação dos dados no Excel e para análise estatística foi utilizado o SPSS. Na análise quantitativa dos dados utilizou-se a estatística descritiva e para comparação das médias de distribuição dos procedimentos dolorosos foi testada a normalidade por meio do teste Kolmogorov-Smirnov (?=0,05), e uso de estatística paramétrica para amostras independentes e estatística paramétrica para amostras dependentes, comparando as médias de procedimentos dolorosos segundo os grupos das variáveis peso ao nascer e idade gestacional com uso do teste ANOVA oneway (?=0,05); para as variáveis sexo e uso de ventilação invasiva utilizou-se o teste t-student não pareado (?=0,05) e para a variável período de internação utilizou-se o teste t-student para duas amostras em par (?=0,05). Obtiveram-se seguintes resultados: média de peso de 1384,1 ± 615,7g; média de idade gestacional de 30,6 ± 3,1 semanas; escore de risco SNAPPE II de 25,8 ± 20,2; parto cesáreo mais frequente (65,2%); média de tempo do uso de ventilação invasiva de 5,9 ± 5,5 dias; média total do tempo de internação 56,1 ± 50,4 dias. Foram realizados 6.687 procedimentos dolorosos, 65,5% registrados no questionário e 34,5% inseridos a partir do levantamento dos prontuários. A média diária foi de 5,37 procedimentos dolorosos por prematuro; na primeira e segunda semanas de internação as médias foram de 6,56 e 4,18 procedimentos dolorosos diários por prematuro (p<0,0001). Os procedimentos mais frequentes foram as aspirações nasal ou oral (35,85%) e traqueal (17,17%). Os prematuros que ficaram em ventilação invasiva foram os mais expostos a procedimentos dolorosos (71,2%). Apenas 44,9% dos procedimentos dolorosos tiveram alguma intervenção para o alívio da dor, sendo mais utilizada a sacarose (78,21%) e analgesia contínua (19,82%). Constata-se o subtratamento da dor aguda nessas unidades neonatais, recomendando-se maior sensibilização da equipe para o uso efetivo do protocolo existente e a implantação de outros para o manejo adequado e alívio da dor dos recém-nascidos / Due to technological development, neonates are increasingly exposed to painful procedures. Currently, there are many pharmacological and non-pharmacological interventions to relieve pain. Few studies address the exposure of newborns to pain and practices used to manage pain in Brazilian neonatal units. This exploratory descriptive study aimed to verify exposure of preterm newborns to painful procedures and pharmacological and non-pharmacological interventions used to relieve pain in the first 14 days of life in neonatal units of a university hospital in Ribeirão Preto, SP, Brazil. A total of 89 preterm infants participated in the study after their legal guardians signed free and informed consent forms. A questionnaire was added to the neonates\' medical files to record painful procedures, analgesic interventions, number of attempts, and the professional who performed the procedure. Data were collected from October 2012 to October 2013. The infants\' medical files were checked to minimize missing information and incomplete questionnaires. Data were double entered in Excel and SPSS was used for the statistical analysis. Descriptive statistics was used for the quantitative analysis and the Kolmogorov-Smirnov test (?=0.05) was employed to verify normality in order to compare the means of distribution of painful procedures. Parametric statistics was used for both independent and dependent samples. The means of painful procedures were compared according to groups of variables: for birth weight and gestational age one-way ANOVA (?=0.05) was used; t- student test (?=0.05) was used for sex and use of invasive ventilation; and finally, two sample matched t-student (?=0.05) was used for the variable period of hospitalization. The results indicated average weight of 1,384.1 ± 615.7g; average gestational age of 30.6 ± 3.1 weeks; SNAPPE II risk score of 25.8 ± 20.2; C-sections were more frequent (65.2%); average time invasive ventilation was used was 5.9 ± 5.5 days; and total average of length of hospitalization of 56.1 ± 50.4 days. A total of 6,687 painful procedures were verified: 65.5% was recorded in the questionnaire and 34.5% was included after checking the medical files. The daily average of painful procedures per infant was 5.37; the averages of daily painful procedures per infant in the first and second weeks of hospitalization were 6.56 and 4.18 (p<0.0001) respectively. The most frequent procedures were nasal or oral (35.85%) and tracheal (17.17%) aspirations. The infants receiving invasive ventilations were the ones most exposed to painful procedures (71.2%). Only 44.9% of the painful procedures included some pain relief intervention and the most used were sucrose (78.21%) and continuous analgesia (19.82%). Under treatment of acute pain was observed in the neonatal units and greater sensitization of the staff for effectively using the existent protocol and implementing other measures to appropriately manage and relieve pain among newborns is recommended

Thoracic paravertebral block (TPVB) consists of an injection of local anaesthetic alongside the thoracic vertebra close to where the spinal nerves emerge from the intervertebral foramen. Clinically TPVB can be accomplished either as a single-injection or as a multiple-injection. It can also be used as a continuous paravertebral infusion through an indwelling catheter for continuous pain relief. However compared to an epidural block, TPVB is less well understood and not commonly used for anaesthesia and or analgesia in anaesthetic practice. I hypothesized that TPVB is effective for producing unilateral segmental thoracic anaesthesia and managing pain of unilateral origin from the thorax. / The objective of this thesis was to develop the technique of TPVB so that it becomes a useful technique for anaesthesia and pain management. So to test my hypothesis a series of clinical studies were performed on 416 patients (396 adults and 20 young infants), presenting for anaesthesia and or acute pain management, to evaluate various aspects of TPVB, namely; clinical application, anatomy of the thoracic paravertebral space, technique and safety, and pharmacology of local anaesthetic after TPVB. Also included are 9 published case reports and letters-to-editor (Appendix 1-9) based on my research that have provided new insights into the mechanism and applications of TPVB. The following section summarizes my research... / Karmakar, Manoj Kumar. / Thesis (M.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 270-285). / Appendix includes Chinese. / ABSTRACT --- p.v / PREFACE --- p.xxvii / STATEMENT OF WORK --- p.xxviii / ACKNOWLEDGEMENTS --- p.xxix / PUBLICATIONS AND PRESENTATIONS --- p.xxxii / LIST OF ABBREVIATIONS --- p.xxxviii / LIST OF TABLES --- p.xli / LIST OF FIGURES --- p.xliii / Chapter Part 1. --- Introduction --- p.1 / Chapter Chapter 1. --- Objective and Plan of Research --- p.2 / Chapter Chapter 2. --- Thoracic Paravertebral Block A Review of the Literature. --- p.7 / Chapter 2.1. --- Introduction --- p.7 / Chapter 2.2. --- History --- p.7 / Chapter 2.3. --- Anatomy: --- p.9 / Chapter 2.4. --- Techniques --- p.17 / Chapter 2.4.1. --- Anatomical Landmark Based Techniques --- p.20 / Chapter 2.4.1.1. --- Loss-of-resistance Technique --- p.20 / Chapter 2.4.1.2. --- Advancing the Block Needle by a pre-determined Distance --- p.23 / Chapter 2.4.1.3. --- Other Landmark Based Techniques --- p.24 / Chapter 2.4.2. --- Fluoroscopic Guidance or Injection of Radiopaque Contrast medium --- p.24 / Chapter 2.4.3. --- Peripheral Nerve Stimulation --- p.25 / Chapter 2.4.4. --- Pressure Measurement Technique --- p.26 / Chapter 2.5. --- Thoracic Paravertebral Catheter Placement --- p.27 / Chapter 2.6. --- Ultrasound Guided Thoracic Paravertebral Block --- p.32 / Chapter 2.6.1. --- Two Dimensional (2D) Sonoanatomy of the Thoracic Paravertebral Region --- p.32 / Chapter 2.6.1.1. --- Basic Considerations --- p.32 / Chapter 2.6.1.2. --- Transverse Scan of the Thoracic Paravertebral Region --- p.33 / Chapter 2.6.1.3. --- Sagittal Scan of the Thoracic Paravertebral Region --- p.42 / Chapter 2.6.2. --- Three Dimensional (3D) Sonoanatomy of the Thoracic Paravertebral Region --- p.46 / Chapter 2.6.3. --- Ultrasound Guided Thoracic Paravertebral Block - Techniques --- p.49 / Chapter 2.6.3.1. --- Transverse scan with short axis needle insertion (Technique 1) --- p.54 / Chapter 2.6.3.2. --- Paramedian Sagittal scan with in-plane needle insertion (Technique 2) --- p.56 / Chapter 2.6.3.3. --- Transverse scan with in-plane needle insertion or the Intercostal approach to the TPVS (Technique 3) --- p.58 / Chapter 2.7. --- Mechanism and Spread of Anaesthesia --- p.58 / Chapter 2.8. --- Indications --- p.65 / Chapter 2.9. --- Contraindications --- p.65 / Chapter 2.10. --- Drugs Used and Dosage --- p.68 / Chapter 2.11. --- Pharmacokinetic Considerations --- p.70 / Chapter 2.12. --- Failure Rate and Complications --- p.72 / Chapter 2.13. --- Clinical Applications of Thoracic Paravertebral Block --- p.76 / Chapter 2.13.1. --- Pain Relief after Thoracic Surgery --- p.76 / Chapter 2.13.2. --- Pain Relief after Multiple Fractured Ribs --- p.78 / Chapter 2.13.3. --- Anaesthesia and Analgesia for Breast Surgery --- p.80 / Chapter 2.13.4. --- Thoracic Paravertebral Block and Chronic Pain after Breast Cancer Surgery --- p.84 / Chapter 2.13.5. --- Thoracic Paravertebral Block and Cancer Recurrence after Breast Cancer Surgery --- p.85 / Chapter 2.13.6. --- Anaesthesia and Analgesia for Inguinal Herniorrhaphy --- p.87 / Chapter 2.13.7. --- Pain Relief after Cholecystectomy and Renal Surgery --- p.90 / Chapter 2.13.8. --- Anaesthesia and Analgesia for Liver and Biliary Tract Surgery --- p.91 / Chapter 2.13.9. --- Analgesia after Cardiac Surgery --- p.92 / Chapter 2.13.10. --- Thoracic Paravertebral Block and Chronic Pain Management --- p.94 / Chapter 2.13.11. --- Bilateral Thoracic Paravertebral Block --- p.94 / Chapter 2.13.12. --- Miscellaneous Applications --- p.95 / Chapter Part 2. --- Studies Evaluating the Efficacy of Thoracic Paravertebral Block in Adults. --- p.96 / Chapter Chapter 3. --- Prospective Randomized Evaluation of the Effects of Combining a Single-injection Thoracic Paravertebral Block with General Anesthesia in Patients Undergoing Modified Radical Mastectomy. --- p.97 / Chapter Chapter 4. --- Continuous Thoracic Paravertebral Infusion of Bupivacaine for Postthoracotomy Analgesia A Prospective, Randomized, Double Blind, Controlled Trial. --- p.120 / Chapter Chapter 5. --- Continuous Thoracic Paravertebral Infusion of Bupivacaine for Pain Management in Patients with Multiple Fractured Ribs. --- p.137 / Chapter Chapter 6. --- Thoracic Paravertebral Block and Its Effects on Chronic Pain and Health-related Quality of Life after Modified Radical Mastectomy. --- p.154 / Chapter Chapter 7. --- Right Thoracic Paravertebral Anaesthesia for Percutaneous Radiofrequency Ablation of Liver Tumours. --- p.186 / Chapter Part 3. --- Studies Evaluating The Efficacy Of Thoracic Paravertebral Block In Children. --- p.198 / Chapter Chapter 8. --- Continuous Extrapleural Paravertebral Infusion of Bupivacaine for Postthoracotomy Analgesia in Young Infants. --- p.199 / Chapter Part 4. --- Studies Evaluating The Anatomy Relevant For Thoracic Paravertebral Block. --- p.213 / Chapter Chapter 9. --- Thoracic Paravertebral Sonography - A Quantitative Evaluation of the Paramedian Sagittal Window for Visualizing the Anatomy Relevant for Thoracic Paravertebral Block. --- p.214 / Chapter Chapter 10. --- Volumetric 3D Ultrasound Imaging of the Anatomy Relevant for Thoracic Paravertebral Block. --- p.228 / Chapter Part 5. --- Pharmacokinetics of Ropivacaine after Thoracic Paravertebral Block. --- p.242 / Chapter Chapter 11. --- Arterial and Venous Pharmacokinetics of Ropivacaine With and Without Epinephrine after Thoracic Paravertebral Block. --- p.243 / Chapter Part 6. --- Summary and Conclusions --- p.266 / Chapter Chapter 12. --- Summary and Conclusions --- p.266 / Chapter Part 7. --- Bibliography --- p.270 / Chapter Part 8. --- Appendix --- p.296 / Chapter A. --- Published Case Reports and Letters-to-editor. --- p.297 / Chapter Appendix: 1.0. --- Variability of a Thoracic Paravertebral Block. Are we ignoring the endothoracic fascia? (Published Commentary) --- p.297 / Chapter Appendix: 2.0. --- Ipsilateral Thoraco-lumbar Anaesthesia and Paravertebral Spread after Low Thoracic Paravertebral Injection. (Published Case Report) --- p.301 / Chapter Appendix: 3.0. --- The Use of a Nerve Stimulator for Thoracic Paravertebral Block Reply. (Published Letter-to-editor) --- p.310 / Chapter Appendix: 4.0. --- Bilateral Continuous Paravertebral Block Used for Postoperative analgesia in an Infant having Bilateral Thoracotomy. (Published Case Report) --- p.312 / Chapter Appendix: 5.0. --- Thoracic Paravertebral Block: Radiological evidence of Contralateral Spread Anterior to the Vertebral Bodies. (Published Case Report) --- p.317 / Chapter Appendix: 6.0. --- Lymphatic Drainage of the Thoracic Paravertebral Space A Reply. (Published Letter-to-editor) --- p.325 / Chapter Appendix: 7.0. --- Thoracic Paravertebral Block for Management of Pain Associated with Multiple Fractured Ribs in Patients with Concomitant lumbar Spinal Trauma. (Published Case Report) --- p.328 / Chapter Appendix: 8.0. --- Right Thoracic Paravertebral Analgesia for Hepatectomy. (Published Case Report) --- p.340 / Chapter Appendix: 9.0. --- Resolution of ST-segment Depression after High Thoracic Paravertebral Block during General Anesthesia. (Published Case Report) --- p.348 / Chapter B. --- Medical Outcomes Study 36-Item Short-Form Questionnaire (SF-36) - Appendix 10. --- p.353 / Chapter C. --- Hospital Anxiety and Depression Scale - Appendix 11. --- p.362 / Chapter D. --- Postoperative Telephone Follow Up Questionnaire: Appendix 12. --- p.364

A dor é um fenômeno que está presente na assistência em saúde aos neonatos, e sua identificação, avaliação e tratamento pela equipe de saúde são ações relevantes para o bem estar do bebê, visto que interfere no restabelecimento de sua saúde e pode gerar consequências deletérias a curto, médio e longo prazo. O presente trabalho trata-se de um estudo quali-quantitativo, descritivo exploratório, cujo objetivo foi identificar o manejo da dor neonatal sob a perspectiva da equipe de saúde de uma maternidade de Ribeirão Preto - SP. Na etapa quantitativa do estudo, participaram 81 profissionais de saúde da maternidade: 12 pediatras, 1 técnica do laboratório, 22 enfermeiras e 46 auxiliares/técnicas de enfermagem, que responderam a um questionário de autopreenchimento com questões objetivas sobre dados pessoais, profissionais e dados específicos sobre o conhecimento e a prática da avaliação e manejo não farmacológico da dor neonatal. Na segunda etapa, profissionais considerados líderes de equipe foram convidados a participar, de forma individual, de uma entrevista semiestruturada gravada em áudio que após a transcrição foram submetidas à análise de conteúdo. Da análise dos dados quantitativos, constatou-se que todos os médicos, enfermeiras, técnica do laboratório e a grande maioria (89,1%) das auxiliares/técnicas de enfermagem referiram que o recém-nascido é capaz de sentir dor. 83,3% dos médicos, 77,3% das enfermeiras e 54,3% das auxiliares/técnicas de enfermagem, acreditam que procedimentos potencialmente dolorosos repetidos podem gerar alguma consequência ao neonato. A maioria dos profissionais afirmou que avaliam a dor do recém-nascido, tendo como parâmetros mais frequentes o choro, a mímica facial, e movimentos, construindo uma avaliação subjetiva sem o uso de escalas. As medidas não farmacológicas de alívio da dor mais citadas pelos profissionais foram: a oferta de sacarose a 25%, a sucção não nutritiva e a amamentação, com um predomínio da utilização da sacarose como principal método de escolha. Poucos profissionais de saúde se preocupam em realizar o registro adequado sobre a avaliação e o manejo da dor aguda do recém-nascido. Da análise dos dados qualitativos, 5 categorias e 15 subcategorias surgiram a partir das verbalizações das participantes: 1) \"Fatores facilitadores do manejo da dor neonatal\" (atuação dos profissionais; a utilização de métodos não farmacológicos; o uso sacarose como principal escolha para o alívio da dor neonatal; outras intervenções não farmacológicas), 2) \"Fatores dificultadores do manejo da dor neonatal\" (falhas em como lidar com a dor; excesso de procedimentos dolorosos; fluxo de trabalho e quantidade de recursos humanos), 3) \"Avaliação da dor\" (como e quando avaliar a dor; a importância da avaliação a dor), 4) \"Mudanças necessárias para melhorar o manejo da dor na instituição\" (treinamentos; protocolos e utilização de escalas para avaliação da dor; mudança na atitude dos profissionais e sensibilização da equipe), 5) \"Participação dos pais e/ou família no manejo da dor neonatal\" (vantagens e apoio ao manejo da dor neonatal com participação da família; dificuldades na participação da família no manejo da dor neonatal). Concluiu-se que há um conhecimento superficial dos profissionais de saúde quanto à avaliação e o manejo não farmacológico da dor neonatal aguda nesta maternidade, assim como há falta de protocolos clínicos formais, registros e capacitação dos profissionais de saúde. Considerando-se as propostas do cuidado atraumático, desenvolvimental e humanizado ao recém-nascido, torna-se imperativo mudanças de ações e condutas da equipe de saúde no que se refere ao manejo da dor neonatal, que deverá ser movida e estimulada a partir capacitações profissionais fundamentadas na transferência de conhecimento / Pain is a phenomenon that is present in the health care provided to neonates, and its identification, assessment and treatment by the health team are relevant actions for the welfare of the baby, since they interfere in the reestablishment of their health and may produce harmful consequences in the short, medium and long term. This is a quali-quantitative, descriptive and exploratory study with the aim to identify the management of neonatal pain from the perspective of the health team of a maternity hospital in Ribeirão Preto, São Paulo, Brazil. The quantitative stage of the study involved the participation of 81 health professionals from the maternity: 12 pediatricians, 1 laboratory technician, 22 nurses and 46 nursing technicians/aides, who answered a self-administered questionnaire containing objective questions regarding personal, professional and specific data on the knowledge and practice of the assessment and non-pharmacological management of neonatal pain. In the second stage, professionals who were considered to be team leaders were invited to participate, individually, in a semi-structured interview whose audio was recorded, transcribed and submitted to content analysis. The analysis of the quantitative data evidenced that all physicians, nurses, the laboratory technician and most of the nursing technicians/aides (89.1%) stated the newborn is capable of feeling pain. A total of 83.3% of the physicians, 77.3% of the nurses and 54.3% of the nursing technicians/aides believe that repetitive potentially painful procedures may bring some consequence to the neonate. Most of the professionals stated they assess the pain of the newborn, using their crying, facial mimics and movements as parameters, building a subjective assessment without the use of scales. The non-pharmacological measures for pain relief most commonly cited by the professionals were: offering a 25% sucrose solution, non-nutritional suction and breastfeeding, with prevalence for the use of sucrose as the main chosen method. Few health professionals care to make an appropriate record regarding the assessment and management of acute pain in the newborn. The analysis of the qualitative data generated 5 categories and 15 subcategories, based on the speeches of the participants: 1) \"Facilitating factors in the management of neonatal pain\" (performance of the professionals; use of non- pharmacological methods; use of sucrose as the main choice for relieving neonatal pain; other non- pharmacological interventions), 2) \"Complicating factors in the management of neonatal pain\" (failures in how to deal with the pain; excess of painful procedures; workflow and quantity of personnel), 3) \"Pain assessment\" (how and when to assess; the importance of pain assessment), 4) \"Necessary changes to improve pain management in the institution\" (trainings; protocols and the use of scales to assess pain; changing the attitude of professionals and making the team more sensitive), 5) \"Participation of the parents and/or family in the management of neonatal pain\" (advantages and support in the management of neonatal pain with the participation of the family; difficulties in the participation of the family for managing neonatal pain). In conclusion, health professionals have a superficial knowledge regarding the assessment and non-pharmacological management of acute neonatal pain in the studied maternity hospital. In addition, there is a lack of formal clinical protocols, records and qualification of health professionals. Considering the proposals for non-traumatic, developmental and humanized care to the neonate, it becomes imperative to make changes in actions and conducts of the health team in terms of neonatal pain management, as these professionals must be driven and encouraged based on professional qualifications grounded on knowledge transfer

Objetivo: Avaliar os efeitos da estimulação elétrica nervosa transcutânea (TENS) comparada com TENS placebo e grupo controle sobre a dor, função pulmonar, força muscular respiratória e medicações analgésicas no pós-operatório de cirurgias torácicas em uma Unidade de Tratamento Intensivo (UTI). Método: Pacientes entre 31 e 76 anos submetidos a toracotomia póstero-lateral, foram incluídos e alocados aleatoriamente em três grupos: TENS (GE), TENS placebo (GP) e controle (GC). O GE recebeu a aplicação da TENS (frequência=100 Hz, duração de pulso=100 μs, intensidade no nível sensorial, durante 30 minutos, três vezes ao dia, durante a internação na UTI), associada a fisioterapia convencional (respiratória e motora). No GP foi realizada a TENS placebo além de fisioterapia convencional; e o GC recebeu apenas a fisioterapia convencional. Os desfechos foram avaliados no pré-operatório, pós-operatório (PO), e 48 horas após a internação na UTI: dor através da Escala Visual Analógica, função pulmonar através de espirometria (VEF1 e CVF), força muscular respiratória através de manovacuometria (PImáx e PEmáx), e medicações através da análise dos prontuários. Resultados: Foram incluídos 45 pacientes, sendo 15 em cada grupo. Em relação a percepção dolorosa, não houve diferença entre os grupos (P=0,172), porém houve redução na dor após o término do primeiro atendimento no GE (4,7±3,2 vs. 3,3±2,6; P<0,05). Em relação a função pulmonar e força respiratória não houve diferença significativa entres os grupos nos momentos avaliados. Entretanto, nas avaliações intragrupo, observou-se melhora na CVF, todos os grupos apresentaram redução no momento PO e 48 horas comparado com o pré (P<0,001), e somente o GE promoveu um aumento na CVF nas 48 horas em relação ao PO (P<0,001). A PImáx e PEmáx diminuíram em todos os grupos comparando o pré com o PO e 48 horas (P<0,001). Não houve diferença entre os grupos em relação as medicações analgésicas, porém o GC apresentou maior consumo de morfina (p=0,037) e o GP maior consumo de paracetamol (p=0,035) 24 vs 48 horas, o que não foi alterado no GE. Conclusão: Não foi observado diferença entre os grupos em relação aos desfechos avaliados no pós-operatório de cirurgia torácica, porém, a TENS 13 promoveu redução da dor e aumento mais precoce da CVF, além disso, não promoveu aumento no consumo de medicação. / Objective: To evaluate the effects of transcutaneous electrical nerve stimulation (TENS) compared to placebo TENS and control group on pain, pulmonary function, respiratory muscle strength and analgesic medications in the postoperative period of thoracic surgery in an Intensive Care Unit (ICU). Methods: Patients between 31 and 76 years submitted to postero-lateral thoracotomy, were included and randomly allocated into three groups: TENS (GE), TENS placebo (GP) and control (GC). The GE received TENS (frequency = 100 Hz, pulse duration = 100 μs, intensity at the sensory level for 30 minutes, three times a day during ICU stay), associated with conventional physiotherapy (respiratory and motor). In GP, TENS was performed in addition to conventional physiotherapy; And GC received only conventional physiotherapy. The outcomes were evaluated in the preoperative, postoperative (PO) or 24 hours, and 48 hours after ICU admission: Pain through Visual Analog Scale, pulmonary function through spirometry (FEV 1 and FVC), respiratory muscle strength Through manovacuometry (MIP and MEP), and medications through the analysis of medical records. Results: 45 patients were included, 15 in each group. Regarding pain perception, there was no difference between the groups (P = 0.172), but there was a reduction in pain after the end of the first treatment in the GE (4.7 ± 3.2 vs. 3.3 ± 2.6; P <0.05). Regarding pulmonary function and respiratory force, there was no significant difference between the groups at the moments evaluated. However, in the intragroup evaluations, improvement in FVC, all the groups had a reduction at the time PO and 48 hours compared to the pre (P <0.001), and only the GE promoted an increase in FVC at 48 hours in relation to PO (P <0.001). The MIP and MEP decreased in all groups comparing the pre with PO and 48 hours (P <0.001).There was no difference between the groups in relation to analgesic medications, however, the CG had higher morphine consumption (p = 0.037) and the GP had a higher paracetamol consumption (p = 0.035) 24 vs 48 hours, which was not altered in the GE. Conclusion: No differences were observed between the groups in relation to the outcomes evaluated in the postoperative period of thoracic surgery, however, TENS promoted pain reduction and earlier increase in FVC, in addition, did not promote increase in medication consumption.

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A central component of many psychological interventions is breathing training. Breathing training protocols based on a mindfulness or a cognitive behavioral therapy (CBT) have demonstrated value in the management of psychological and medical ailments. Yet, despite the wealth of literature examining each approach, little direct comparison exists. An additional concern is the proliferation of smart phone health (mHealth) applications (apps) providing breathing training with little empirical evidence to support their clinical use. A possible explanation for the interest in breathing and mHealth apps is the growing body of literature indicating breathing training provides wide ranging health benefits through improved stasis of the autonomic nervous system (ANS). As ANS dysregulation underlies many chronic health conditions such as persistent temporomandibular disorders (TMDs), there is a need for empirical research to identify the most effective modality of breathing training and validate the clinical efficacy of breathing based mHealth apps. Study One compared the effectiveness of a mindfulness breathing meditation (MB) and a CBT based protocol teaching diaphragmatic breathing (DB) to improve biomarkers of ANS stasis. An attention control approach based on the Nolen-Hoeksema task (C) was included as a comparison group. Ninety participants were randomly assigned to either the MB, DB, or C condition. Within each condition, 30 participants were provided skills training with practice time and completed a behavioral self-regulation task. Participants in the DB condition approach had significantly lower breathing rates than those in the MB and C conditions (p < .001). DB condition participants experienced improvements on high-frequency heart rate variability (p < .05) and the standard deviation in NN intervals (p < .001), which served as indicators for ANS stasis. No differences were found between conditions on the behavioral self-regulation task (p’s > .05). Given these results, the DB training protocol was converted into a mHealth app to facilitate a clinical trial with patients suffering persistent TMDs. Study Two examined the additive benefits of including the mHealth app with standard dental care (SDC+) versus standard dental care alone (SDC). Nineteen patients seeking care for persistent TMDs were recruited. All participants were asked to track daily ratings of pain (VAS), relaxation (RR), and complete weekly assessments on several comorbid psycho-social factors. Within the SDC+ condition participants were asked to track the proximate effects of each breathing practice on VAS and RR ratings. Given a high drop-out rate (nine participants) and low overall sample size (N = 10), results are exploratory at best. Within the SDC+ condition, results indicated reliable improvements in average VAS and RR ratings from before and after SDC+ participants used the mHealth app (p’s < .05). Within a one session training paradigm, results supported the use of a DB based intervention above the use of a MB or C intervention. Future research should consider the effects of having multiple training sessions. Study Two results were complicated by a limited sample size and failed to provide a clear picture of whether the conjunctive treatment in the SDC+ condition provided additional symptom relief above traditional dental care alone. Although exploratory results indicated the mHealth app provided temporary improvements in pain and feelings of relaxation, a well powered trial is needed to clarify whether the finding represents an enduring treatment effect.

Pain interferes with people's daily lives and often limits the extent to which they can pursue goals and engages in activities that promote well-being. The present study test how optimism affects and is affected by pain interference and activity among older women. Every three months for two years, middle- and older-age women (N = 199) complete daily diaries at home for a seven-day period, reporting their daily pain, pain interference, and activity. Optimism was measured at baseline and end-of-study. Multilevel models test the between- and within-person relationships among pain, optimism, pain interference and activity. Pain best predicted pain interference and optimism best predicted activity. Accumulated activity and pain interference across the study predicted longitudinal changes in optimism over two years. Optimism may play a protective role in disruptions caused by pain, leading to decreased pain interference and increased activity. In turn, less interference and more activity feed forward into increased optimism, resulting in a cycle that enhances optimism and well-being among older women.

Pain has caused innumerable suffering to countless individuals and has impacted their lives in profound ways. There are many detrimental effects of pain including decreased ability to work, depression, isolation, increased pharmaceutical use, and addiction. Pain, on a worldwide scale, remains ineffectively treated and alternative solutions for managing pain are needed. Pain is conventionally treated with pharmaceuticals, primarily narcotics. Continuation of medications for these painful conditions often causes dependence and addiction. The pain and narcotics cycle contributes to the opioid epidemic. The cost in human lives is immense. Pulsed Electromagnetic Field (PEMF) is a holistic modality used for various ailments. This exploratory descriptive research study focused on the experience of individuals using the Micro-Pulse, PEMF, for pain relief. The mind/body connection was a foundation of the holistic theoretical framework for this study. The theoretical grounding for this study was Watson’s (2018) theory of human caring, which is based on a foundation of holistic healing incorporating mind, emotional body, physical body, and spirit for treatment of pain. Understanding an individual’s experience of pain relief will potentially raise awareness and promote the exploration of holistic therapeutic approaches for patients in pain. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2019. / FAU Electronic Theses and Dissertations Collection