No / Every year in England and Wales, 105,000 people sufferfrom uncontrolled cancer pain and are rarely offered community pharmacy medicine consultations (e.g. Medicines Use Reviews -MURs)[1]. Our aim was to examine how patients with cancer pain deal with their pain medication and to investigate their experiences of and attitudes towards community pharmacy.

Temporomandibular Disorder(s) (TMD), a common cause of chronic pain affecting the face and jaw, profoundly impacts interactions as fundamental to human existence as smiling, laughing, speaking, eating, and intimacy. Since landmark anthropological research on TMD in the 1990s, considerable changes have occurred in the way TMD is thought about and responded to. Knowledge about TMD among dentists and physicians has increased since publication of the Research Diagnostic Criteria (RDC-TMD), and a well-funded TMJ association now advocates for research and support of the condition. On the other hand, concerns in the medical world about increases in chronic pain and associated risks of misuse of pain medications have increased. Physicians are trained to perform a gatekeeper role, preventing those patients at-risk of becoming drug abusers from gaining access to opioid pain medications. These differing contextual factors and my focus on a group of participants drawn from a complementary and alternative medicine (CAM) trial, rather than from a pain clinic, provide an expanded and updated view of TMD. I present analyses of semi-structured, open-ended interviews with 44 participants interviewed multiple times over the course of their participation in an NIH-funded trial evaluating Traditional Chinese Medicine (TCM) for TMD. In contrast to earlier studies of participants who were consumed by an endless search for diagnosis and treatment, these participants were largely focused on coping and "just dealing with" the daily experience of severe pain. Three articles comprise the body of work presented in this dissertation. Topics include the Works of Illness, the Paradox of Hope, and the construction of moral identity through consumption of over-the-counter (OTC) medications. First, using a "works of illness" framework, I draw attention to the considerable work sufferers undertook to manage competing demands of social and physical risk imposed by chronic pain. I refer to these forms of work as the work of stoicism and the work of vigilance and identify double binds created in contexts that call for both. Multiple voices in the narratives of sufferers are highlighted as essential to the construction of a positive identity in the face of illness. In more in-depth exploration of the work of hope, hope is revealed as a fundamental and paradoxical aspect of autobiographical work. I describe multiple forms of hope in a typology of ways of hoping and raise as an issue the manner in which the paradox of hope--keeping hopes in check while also avoiding despair-- intersects with participant expectations in the trial. I suggest this may have an impact on the placebo effect. Trade-offs between physical harm reduction and reducing potential harm to one's identity produce narratives of harm justification as pain sufferers work to describe their use of OTC medications as minimal and responsible. Sufferers in this study, describing medications as "just over-the-counter" or "not real pain medication" distanced, themselves from association with the addictive potential of prescription pain medications. Participants avoided harm to their identities by consuming OTC pain medications as idioms of self-care. This case study provides important lessons about the experience of chronic pain in the USA. While much attention has been directed at overuse and addiction to pain medication, less has focused on the experience of those soldiering through pain and navigating paradoxes between social and physical demands. This study also directs attention to anthropology's potential contribution to drug trials, to the necessity of studying hope as well as expectations, and to how both impact the placebo response.

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Previous literature has indicated that nursing personnel face the second highest rate of occupational injury and illness. Assistive equipment, such as lift and transfer aids, has helped lower work task demands and reduce back stress on patient handlers. However, limited attention has been paid to the safety, comfort and dignity of the patient in postoperative care. Research on the efficacy of self-transfer aids for patients who require limited or no assistance by nursing personnel is insufficient. Ratings of comfort and security have only been evaluated for nursing home residents in a pilot field study, in which residents rated assistive devices as generally equal to or more secure and comfortable than manual transfer methods. The first study reports the laboratory evaluation of bed rising with the use of two self-transfer aids and bed rising unassisted. The objective was to determine muscle activity during bed rising tasks with and without the use of a bed assistive device using surface electromyography (EMG). Twenty male (n = 9; age, 33.7 ± 8.0 years) and female (n = 11; age, 34.5 ± 23.9 years) participants, with normal body mass index (BMI) ranging from 18.4 to 24.9, took part in the study. Mean and peak activity was recorded from three abdominal muscle sites. The results indicated bed rising with the use of a self-transfer device significantly reduced muscle activity compared to bed rising unassisted. Anchoring the devices at a higher height and elevating the torso further reduced muscle activity. Although no differences were observed between devices using EMG, results from the usability survey and final ranking indicated favorable ratings for the ABNOSTRAINTM prototype compared to the Bed Pull-up. A second study was conducted to determine the efficacy of a bed assistive device in a patient population. The objective was to compare self-perceived recovery measures and usage of pain medication between patients in the control (n = 8; age, 34.0 ± 6.3years) and device (n = 7; 40.7 ± 12.4) groups. A total of fifteen female participants undergoing either abdominal hysterectomy (n = 6) or Cesarean-section (n = 9) procedures were recruited for the study. Both groups completed a total of twelve questionnaires over a five-week recovery period. Responses to self-perceived recovery measures were significantly different. In general, the device group reported higher levels of energy, less pain interference, lower perceived pain, less reliance on pain medication and returned to activities of daily living faster than the control group. The results from the study provide clinicians or other practitioners information on the benefits of bed assistive devices for patients during postoperative recovery. Age and surgery differences should be considered when suggesting bed movement patterns with assistive intervention. / Master of Science

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