The purpose of the study is to examine the relationship between the location of the initial onset of back pain as revealed by the subject's pain drawing and the site of maximum muscle tension at rest, while jaw-clenching and during a cold stressor, in men and women. Subjects were 30 males and 30 females divided into three groups of 10 males and 10 females each and designated according to back pain history as no back pain (NBP), upper back pain onset (UBP) and lower back pain onset (LBP). Six bipolar, bilateral electromyographic (EMG) recording sites were instrumented on each subject. EMG levels were recorded from the forehead, forearm, upper back, lower back, thighs and ankles under conditions of rest, jaw-clenching and a cold stressor. Seven hypotheses predicted that EMG levels would distinguish groups and gender of the subjects and that interactions would exist between site of pain onset and EMG elevations.

No description available.

A review of the literature identified that few research studies have been published which examined the post-operative pain of children, particularly those between the ages of 4 and 7 years. As a result, theoretical literature has been the major contributor to the understanding of the concept of children's post-operative pain. Therefore, the purpose of this study was to describe the post-operative pain of hospitalized children aged 4 to 7 years on the first postoperative day, through a self-reported measure of pain intensity levels as well as descriptions of the children's overt behaviours used to express pain. Data were gathered on the pain intensity levels (using the PCT) and overt behaviours of 11 children between the ages of 4 and 8 years on the first post-operative day between the hours of 0800 and 2000. In addition, data regarding parental presence and the administration of analgesics were also collected for these children. Findings related to pain intensity scores provided the basis for three important conclusions. First, all of the children were able to place a value on their pain using the PCT. Second, all of the children were experiencing some degree of post-operative pain possibly related to the lack of consistent administration of analgesia. Third, parental presence did not influence the pain intensity scores reported by the children. Findings related to the overt behaviours exhibited by children also provided the basis for three important conclusions. First, the most frequent behaviours identified were not those normally associated with feelings of pain. The researcher believed that this lack of expected response was as a result of the children's ability to adapt and cope with the pain. Second, behavioural measurement of pain may not be a reliable and valid measure of post-operative pain. Third, parental presence or absence did not influence the overt behaviours exhibited. / Applied Science, Faculty of / Nursing, School of / Graduate

This thesis deals with a potential interaction between the vestibular system and the phenomenon of central pain.  I provide behavioural and magnetoencephalographic (MEG) evidence that cold caloric vestibular stimulation (CVS) can alleviate central pain in some sufferers. I argue that activation of the parieto-insular vestibular cortex (PIVC) in central pain patients can act via the parabrachial nucleus in the brainstem to rebalance the integration of thermosensory input and suppress the perception of pain at the anterior cingulated cortex (ACC).  This is consistent with the thermosensory disinhibition hypothesis, which proposes that central pain is a thermoregulatory disorder which results from the loss of the central inhibition of pain by cooling.  I go on to propose that the PIVC and anatomically adjacent interoceptive cortex in the dorsal posterior insula (dpIns) share a number of similarities and that PIVC is best viewed as part of a wider interoceptive system. Based on the MEG data I suggest that low threshold C mechanoceptors may play a role in tactile allodynia in central pain.  I also use the MEG data to propose that the disruption of interoceptive input to the dpIns could lead to tactile afferents priming the primary motor cortex to respond more rapidly to subsequent ACC activation.  This effect may be mediated via a corollary branch of interoceptive input that runs not to the dpIns but to the fundus of the central sulcus. The final chapter contains additional research into the issue of body image, via investigations into apotemnophilia.  I provide MEG and other evidence suggesting that it is a disorder of the right parietal lobe.  I then propose a neurological explanation for a condition previously thought to be entirely psychological.

Introduction/Background: Chronic widespread pain (CWP) affects around 11% of the population and while aetiology is well documented it has been difficult to translate this into effective management strategies. Patients in clinical trials are known to be different from the patient populations that they represent and treatment preference is one area where they may differ. Treatment preference may also influence outcome, particularly when participants cannot be blinded to treatment allocation. Aims: To assess whether patient treatment preference has an influence on 1. Recruitment, 2. Outcome, and 3. Adherence In a clinical trial of interventions for CWP. Methods: In the MUSICIAN trial, a 2x2 factorial trial of exercise and telephone cognitive behavioural therapy (T-CBT) for CWP, treatment preferences were recorded when eligibility was assessed using a population postal survey. Eligible individuals who did and did not go on to enter the trial were compared to address aim 1. Trial participants were followed up after 6 months of treatment and outcomes were compared according to whether they received their preferred treatment to address aim 2 and T-CBT and exercise logs were used to assess adherence to examine aim 3. Results: Eligible individuals were more likely to be randomised into the MUSICIAN trial if they expressed a treatment preference in the screening questionnaire (Relative Risk 1.46, 95% confidence interval 1.19-1.79). Treatment preferences were also associated with prognostic factors (anxiety and fear of movement). At follow-up participants were more likely to achieve a good outcome (global assessment of change) if they had received their preferred treatment (Relative Risk 2.50, 95% confidence interval 1.54-4.03)and this may be due to those individuals being more likely to adhere to treatment programmes. Conclusions: Wherever possible participant treatment preferences should be recorded prior to randomisation in clinical trials. Additional benefit may be gained in clinical practice by tailoring treatment to patients’ preferences.

The Southern Arizona Veterans Affairs Health Care System (SAVAHCS) Chronic Pain Rehabilitation Clinic (CPRC) is an interdisciplinary pain management team. The team consists of physicians, a psychologist, a kinesiotherapist, a nurse and a pharmacist, who work together, to manage pain. In order to monitor and improve the effectiveness of treatment at SAVAHCS CPRC, the team created a pain outcomes measure collection program. A pilot study of the pain outcomes data collection process was conducted. The purpose of this project was to evaluate the data collection procedure and identify areas for improvement. The program planned to collect outcomes data at a new patient education/orientation class using an intake questionnaire. After three months, a follow-up questionnaire was to be mailed to the patient. The patient would then return the questionnaire, by mail, to the clinic where responses would be entered into an electronic database. Eight items in the data collection process were recognized as needing improvement. Three of the most important items follow. (1) Mailing out questionnaires had a low response rate, which could be solved by administering the intake questionnaire during the pharmacist medication evaluation, and the follow-up questionnaire, 6 months later, during a provider appointment. (2) The investigational review board approval process took longer than anticipated but could be corrected through enforcement of a submission time line. (3) Data entry required a large amount of time but could be rectified through the use of volunteers. Overall, the data collection program could gather outcome measures, but procedural adjustments need to occur.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Science in Medicine in the branch of Anaesthesiology Johannesburg, 2014 / BACKGROUND: Chronic pain is a biopsychosocial phenomenon that can have a profound impact on people’s lives. Internationally, chronic pain is being recognised as a health priority. South Africa is a developing country with limited resources that are directed at catering for a growing population where life threatening conditions like Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS), violent crimes, and poverty predominate. Auditing the Helen Joseph Hospital Pain Management Unit (HJHPMU) is a step towards addressing the paucity of epidemiological data on chronic pain in South Africa. Clinical records are a basic clinical tool that also serves as a medicolegal document. It is essential that these records are legible and complete. AIM: The aim of this study was to describe the profile of chronic pain patients at the HJHPMU for 2011 and to determine the adequacy of record keeping. METHODOLOGY: A retrospective, contextual, descriptive study design was utilised. A consecutive sampling method was used and the study sample included the HJHPMU database and all files of adult patients that attended the HJHPMU during the period January 2011 to December 2011. Patient files were excluded from the audit if insufficient data were found. Descriptive statistics were used to analyse the data obtained during the study. Frequencies and percentages have been reported. A Chi-­‐squared test was utilised to analyse any association between gender and type of pain. RESULTS: There were 475 patients in the HJHPMU database for the year 2011 and 190 of these patients were excluded from the study due to illegible handwriting, duplication in the HJHPMU database, missing data such as no hospital number recorded, no initials to a surname, or the file not found. This resulted in a study sample of 285 patients. The HJHPMU had 215 (75,44%) pre-­‐existing patients and 70 (24,56%) new patients during the year 2011. The preponderance of patients were in the 41-­‐60 year age group, with 146 (51,23%) patients presenting in this age group. Of the 285 patients in the study, 91 (31,93%) patients were male and 194 (68,07%) were female. The most common complaint was of lower back pain (LBP). There were 97 (34,04%) patients with a diagnosis of spinal pain and 59 (20,70%) with Failed Back Surgery Syndrome (FBSS). There were 164 patients with a relevant surgical history. This included 46 (28,05%) patients that had been involved in a traumatic event, 47 (16,49%) patients that had surgery other than spinal surgery that was relevant to their pain diagnosis, and 71 patients (43,29%) that 4 had spinal surgery that was relevant to their diagnosis. A Chi-­‐squared test was performed on the relationship between gender and the type of pain, and a p value of 0.001 was found. When relating the type of pain with age, mixed pain and nociceptive pain was found to be most common in those aged >60 years (n=26), whereas neuropathic pain was found to be most common in the 41-­‐60 year age group (n=43). CONCLUSION: With the limited data from this study, the profile of patients with chronic pain in South Africa seems to not differ grossly from data collected internationally. The most pertinent finding of this study is the inadequacy of record keeping.

ABSTRACT Pain is a subjective sensation and is difficult to measure. It is important to quantify pain as benefits are obtained from its quantification. The validity and reliability of pain outcome measures have been extensively researched in Europe, America and Asia. In Africa on the other hand, very few studies have been done. This study was a cross-sectional study to validate and test the reliability of pain scales.The aim of this study was to establish the validity and reliability of the Tswana translations of three pain scales, namely, the Visual Analogue scale (two versions), the Verbal Rating Scale and the Wong-Baker Faces Pain Measure. The validity of the study was determined by the face validity,criterion validity and construct validity.The statistical analysis of the results showed several significant p values (p< 0.05).However, none of the correlations illustrated a strong relationship as there were no r values in excess of 0.5 indicating a moderate correlation or greater than 0.7 indicating a good correlation. The statistical significance only indicated that the observed values were not due to chance.From the statistical analysis of the results, it became apparent that the subjects tested did not have an understanding of any of the three scales .This was seen in all the age groups and education levels selected for the purpose of this study. It is our recommendation therefore, that suitable, new scales be developed for our local population. The scales which have been used up until now are not being understood and hence are not being interpreted or used correctly in the South African context amongst Tswana speaking individuals. Future research needs to be done in developing entirely different scales for the South African scenario. More relevant and better understood scales should be developed for our local population to include persons of different languages and different education levels. This will assist in a better understanding of the health care process and will by so doing, improve their health care and management.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science in Nursing Johannesburg, 2014 / Discrepancies exist between how pain is assessed in ICU patients able and unable to self report. There are pain assessment scales and guidelines that have been developed over the years for pain assessment. However, little is known regarding ICU nurses’ knowledge and current practices in the provision of pain management in the critically ill. The purpose of this study was to investigate intensive care nurses’ knowledge and practices related to pain assessment for critically ill patients. A quantitative non-experimental, descriptive cross-sectional design was used to achieve the objectives. ICU nurse participants (n=79) were drawn from the five (5) adult ICUs in a public tertiary hospital. Data were collected using a self-administered questionnaire by Rose et al. 2011. Descriptive and inferential statistics were used to analyze the data.

Meng, Zhaoyu. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 61-74). / Abstracts in English and Chinese. / Declaration of Origination --- p.II / Abstract --- p.III / Acknowledgement --- p.VII / Table of Contents --- p.VIII / List of Tables --- p.XI / List of Figures --- p.XII / List of Abbreviations --- p.XIII / Chapter Chapter 1. --- Review of postoperative pain --- p.1 / Chapter Chapter 2. --- Candidate Genes --- p.6 / Chapter 2.1 --- μ Opioid Receptor Gene --- p.6 / Chapter 2.2 --- ATP-binding cassette B1 (ABCB1) / multiple drug resistance 1 (MDR1) gene --- p.10 / Chapter 2.3 --- Catechol-O-methyltransferase (COMT) gene --- p.10 / Chapter 2.4 --- βArrestin2 gene --- p.11 / Chapter 2.5 --- Transient receptor potential (TRP) gene --- p.11 / Chapter 2.6 --- GTP cyclohydrolase 1 (GCHl)gene --- p.12 / Chapter Chapter 3. --- Hypothesis and Experimental Design --- p.15 / Chapter 3.1 --- Hypothesis --- p.15 / Chapter 3.2 --- Objectives --- p.15 / Chapter 3.3 --- Experimental design --- p.15 / Chapter 4.4 --- Role in this study --- p.16 / Chapter Chapter 4. --- Methods --- p.17 / Chapter 4.1 --- Patients --- p.17 / Chapter 4.2 --- Anesthetic procedure --- p.17 / Chapter 4.3 --- Postoperative management --- p.18 / Chapter 4.4 --- Patient follow-up --- p.19 / Chapter 4.5 --- Definition of endpoints --- p.19 / Chapter Chapter 5. --- Genotyping --- p.22 / Chapter Chapter 6 --- Statistical Analysis and Sample Size --- p.24 / Chapter 6.1 --- Statistical analysis --- p.24 / Chapter 6.2 --- Sample size --- p.26 / Chapter Chapter 7. --- "Demographic, genotype and haplotype result" --- p.28 / Chapter 7.1 --- Patient characteristics --- p.28 / Chapter 7.2 --- Genotypes and haplotypes --- p.30 / Chapter Chapter 8. --- Acute postoperative pain --- p.35 / Chapter Chapter 9. --- Morphine consumption for early postoperative pain --- p.41 / Chapter 9.1 --- Patients using alternative analgesia --- p.41 / Chapter 9.2 --- Result in the patients using morphine alone --- p.41 / Chapter Chapter 10. --- Opioid-related Side Effects --- p.47 / Chapter Chapter 11. --- Chronic postoperative pain --- p.49 / Chapter 11.1 --- Patient characteristics --- p.49 / Chapter 11.2 --- Association of genetic polymorphisms and Chronic postoperative pain --- p.51 / Chapter Chapter 12. --- Discussion --- p.54 / Chapter 12.1 --- Acute postoperative pain --- p.54 / Chapter 12.2 --- Chronic postoperative pain --- p.57 / Chapter Chapter 13. --- Conclusion --- p.60 / References --- p.61 / Appendix I. Morphine Consumption and and Number of Demands for Patient Controlled Analgesia (PCA) in Patients with Different Genotypes --- p.75 / Appendix II. Opioid Related Symptom Distress Scale Score on Day 1 and Overall Score of Each Day in Patients with Different Genotypes --- p.79 / Appendix III. Opioid Related Symptoms Distress Scale Score in Patients with Different Genotypes --- p.83