Magister Scientiae (Physiotherapy) - MSc(Physio) / Evidence indicates that the current physiotherapy management of patients with chronic non-specific LBP only offers moderate benefit. Combined treatment programmes, addressing body as well as the mind, shows promising results in developed countries with adequate resources but low evidence in poorly-resourced countries and contexts. This is another gap in the existing knowledge. The study aimed to evaluate the effectiveness of a combined physiotherapy and cognitive-behavioral therapy treatment, compared to physiotherapy alone, in reducing pain, disability, mental health and fear-avoidance behavior, in adults with non-specific low back pain. The systematic review included articles published, in English only, between 1985-2018 (July) in the following databases available at the University of The Western Cape: EbscoHost, BioMedCentral, Cambridge Journals Online, CINAHL, Cochrane Library, Medline (EbscoHost), Medline (Pubmed), Sabinet Reference, SAGE Journals Online, ScienceDirect,SciFinder Scholar, SCOPUS, Wiley Online Library, Springerlink and PubMed.Two reviewers independently evaluated the methodological quality of full text articles, using a critical appraisal tool. Fourteen (14) articles were included based on methodological rigour. Five (5) articles were included in the narrative synthesis and nine (9) articles were included in the meta-analyses. Statistically significant improvements in pain, disability and mental health, in favour of combination therapy for patients with chronic lower back pain were found. A small but statistically significant cumulative effect size for mental health (g = -0.26, Z = -4.49, p <.01) , physical disability (g = -0.27, Z = -5.09, p <.01) and pain (g = -.27, Z = -5.05, p <.01) , in favour of a combination of cognitive behavioural therapy and physiotherapy in patients with chronic lower back pain was found. In addition, a medium but statistically significant cumulative effect size (g = -0.50, Z = -6.95, p <.01), in terms of fear avoidance, was found in favour of the combination therapy. In conclusion, physiotherapy in combination with cognitivebehavioral therapy was more effective than physiotherapy alone, in reducing pain, disability, mental health and fear-avoidance behaviour, in adults with non-specific low back pain. Ethics: Permission for the study was obtained from the university’s Biomedical Research Ethics Committee.

<p>Syftet med denna litteraturstudie var att beskriva äldre människors upplevelser av smärta och vilken smärtbehandling de fick. Metoden var en beskrivande litteraturstudie och för att besvara frågeställningarna genomfördes en litteratursökning i databaserna Cinahl, Science Direct och Medline (Pubmed). Resultatet visade att många av de äldre upplevde smärta på något sätt och ansåg att det var något de måste lära sig leva med. Aktiviteter i hemmet ökade ofta smärtan. Smärtan medförde att den fysiska aktiviteten minskade. Muskuloskeletal smärta var vanligast med smärta i rygg, ben, knän, fötter och höfter. Smärtan ledde till att livskvaliteten minskade och att de äldre blev mer beroende av hjälp. Kvinnor hade mer långvarig smärta och kände sig också mer deprimerade än männen. Äldre var ofta underbehandlade mot smärta och många med svår smärta använde inte smärtstillande läkemedel eller endast en låg dos. En bra läkemedelsbehandling förbättrade aktivitet och sömn. Många var intresserade av icke farmakologisk behandling och att delta i tränings- och avslappningsprogram för att hantera smärtan.</p> / <p>The aim of this study was to describe elderly people's experiences of pain and which treatment of pain they received. To answer the questions a descriptive literature review was made. The literature search was done in the following databases; Cinahl, Science Direct and Medline (Pubmed). The result showed that several of the elderly experienced pain in some way and believed it was something they had to live with. Most of the time activities at home increased the pain there the pain often decreased the physical activity.  The results showed also that musculoskeletal pain in back, legs, knees, feet and hips was most common. Pain resulted in reduced quality of life and the elderly became more dependent of support. Women experienced more chronic pain and were more depressed than men. The elderly was often undertreated against pain and many with difficult pain not used analgesics or only a low dose. A good pharmacological treatment improved activity and sleep. Majority of the elderly was interested of non-pharmacological treatment and to attend relaxation- and training's programs in order to handle the pain.</p>

<p><strong>Bakgrund: </strong>Den vanligaste faktorn till att människor söker vård idag är på grund av smärta. Sjuksköterskan har en viktig roll genom att kunna tillämpa de omvårdnadsåtgärder som krävs vid ett smärttillstånd på ett korrekt sätt. <strong>Syfte: </strong>Litteraturstudiens syfte var att beskriva sjuksköterskans tillämpning av omvårdnadsåtgärder vid smärta hos vuxna individer. <strong>Metod: </strong>En litteraturstudie genomfördes där kvalitativa och kvantitativa artiklar granskades. Analys gjordes av sjutton artiklar. <strong>Resultat:</strong> Analysen resulterade i tre teman, <em>Att smärtbedöma, Att smärtskatta och Att smärtlindra, </em>vilket innefattar faktorer som påverkar hur sjuksköterskan tillämpar omvårdnadsåtgärder vid smärta. <strong>Slutsats: </strong>Sjuksköterskors attityder och bristande kunskaper inom området leder till oförmågan att tillämpa åtgärder i sin helhet. Utbildning och fasta rutiner har visat sig ha en positiv inverkan på sjuksköterskors attityder och användandet av bedömningsinstrument.</p>

Syftet med denna litteraturstudie var att beskriva äldre människors upplevelser av smärta och vilken smärtbehandling de fick. Metoden var en beskrivande litteraturstudie och för att besvara frågeställningarna genomfördes en litteratursökning i databaserna Cinahl, Science Direct och Medline (Pubmed). Resultatet visade att många av de äldre upplevde smärta på något sätt och ansåg att det var något de måste lära sig leva med. Aktiviteter i hemmet ökade ofta smärtan. Smärtan medförde att den fysiska aktiviteten minskade. Muskuloskeletal smärta var vanligast med smärta i rygg, ben, knän, fötter och höfter. Smärtan ledde till att livskvaliteten minskade och att de äldre blev mer beroende av hjälp. Kvinnor hade mer långvarig smärta och kände sig också mer deprimerade än männen. Äldre var ofta underbehandlade mot smärta och många med svår smärta använde inte smärtstillande läkemedel eller endast en låg dos. En bra läkemedelsbehandling förbättrade aktivitet och sömn. Många var intresserade av icke farmakologisk behandling och att delta i tränings- och avslappningsprogram för att hantera smärtan. / The aim of this study was to describe elderly people's experiences of pain and which treatment of pain they received. To answer the questions a descriptive literature review was made. The literature search was done in the following databases; Cinahl, Science Direct and Medline (Pubmed). The result showed that several of the elderly experienced pain in some way and believed it was something they had to live with. Most of the time activities at home increased the pain there the pain often decreased the physical activity.  The results showed also that musculoskeletal pain in back, legs, knees, feet and hips was most common. Pain resulted in reduced quality of life and the elderly became more dependent of support. Women experienced more chronic pain and were more depressed than men. The elderly was often undertreated against pain and many with difficult pain not used analgesics or only a low dose. A good pharmacological treatment improved activity and sleep. Majority of the elderly was interested of non-pharmacological treatment and to attend relaxation- and training's programs in order to handle the pain.

Bakgrund: Den vanligaste faktorn till att människor söker vård idag är på grund av smärta. Sjuksköterskan har en viktig roll genom att kunna tillämpa de omvårdnadsåtgärder som krävs vid ett smärttillstånd på ett korrekt sätt. Syfte: Litteraturstudiens syfte var att beskriva sjuksköterskans tillämpning av omvårdnadsåtgärder vid smärta hos vuxna individer. Metod: En litteraturstudie genomfördes där kvalitativa och kvantitativa artiklar granskades. Analys gjordes av sjutton artiklar. Resultat: Analysen resulterade i tre teman, Att smärtbedöma, Att smärtskatta och Att smärtlindra, vilket innefattar faktorer som påverkar hur sjuksköterskan tillämpar omvårdnadsåtgärder vid smärta. Slutsats: Sjuksköterskors attityder och bristande kunskaper inom området leder till oförmågan att tillämpa åtgärder i sin helhet. Utbildning och fasta rutiner har visat sig ha en positiv inverkan på sjuksköterskors attityder och användandet av bedömningsinstrument.

Chronic pain in the aged is a widespread phenomenon, and morphine is the most commonly used narcotic analgesic for treatment. Despite that fact, there are relatively few published studies examining the impact of advanced age on morphine analgesia. We hypothesized that aged rats would be less sensitive to morphine than adults, and that aged animals would have reduced mu-opioid receptor (MOR) binding and expression in the ventrolateral periaqueductal gray, a brain region responsible for morphine analgesia. Using a model of persistent inflammatory pain, we found that morphine was significantly less effective in aged males compared to adult males, and that aged males and females experience a reduction in MOR binding and expression compared to adults. These results suggest that there are clear age differences in morphine efficacy, and that reductions in MOR binding and expression in the periaqueductal gray could underlie those differences.

Inflammation is an ubiquitous response of the body to cellular damage and injury. It not only leads to increased production of inflammatory molecules such as prostaglandins, bradykinins, histamine, and nerve growth factor (NGF) that sensitize the neurons, but is also associated with acidosis due to a local physiological decrease in extracellular pH, to as low as 5.3. The addition of protons to the sensitized area results in increased membrane conductance and depolarization in sensory neurons involving the acid sensing ion channels (ASICs), the capsaicin sensitive transient receptor potential vanilloid type 1 receptor (TRPV1), and blockade of background potassium conductance. Collectively, this combination heightens the pain state. As expression and activation of the NGF receptor tropomyosin-related kinase A (TrkA) are critically linked to inflammation-associated nociceptor sensitization, this led us to hypothesize that decreased pH may contribute to this process by depolarizing the neuron and mobilizing more TrkA to the cell membrane. This hypothesis is premised by previous experiments in other neuronal populations demonstrating that increased neuronal activity mobilizes more of the neurotrophin receptor TrkB to the membrane. We explored this question utilizing an in vitro model of acidosis akin to that observed with inflammation. Primary sensory neurons were grown on coverslips at a physiological pH of 7.4. The pH of the media was decreased to an acidic pH of 6.5 in half of the cultures for 30 minutes, followed by fixation under permeablizing or non-permeablizing conditions. Immunocytochemical analysis revealed a significant increase in the mobilization of TrkA to the plasma membrane in response to acidosis (confirmed using a biotinylation assay) and an enhanced level of TrkA activation in response to brief NGF challenge. This rapid mobilization of TrkA was attenuated with the addition of proton-sensitive channel blockers capsazepine and amiloride, for the TRPV and ASIC channels respectively. Unexpectedly, the amount of activated TrkA was also increased at pH 6.5 in the absence of NGF challenge. Taken together, the data suggests that sensory neurons can be rapidly sensitized to NGF in response to a decrease in pH and as such likely plays a role in the sensitization and hyperalgesia associated with an inflammatory state.

No description available.

Inflammation is an ubiquitous response of the body to cellular damage and injury. It not only leads to increased production of inflammatory molecules such as prostaglandins, bradykinins, histamine, and nerve growth factor (NGF) that sensitize the neurons, but is also associated with acidosis due to a local physiological decrease in extracellular pH, to as low as 5.3. The addition of protons to the sensitized area results in increased membrane conductance and depolarization in sensory neurons involving the acid sensing ion channels (ASICs), the capsaicin sensitive transient receptor potential vanilloid type 1 receptor (TRPV1), and blockade of background potassium conductance. Collectively, this combination heightens the pain state. As expression and activation of the NGF receptor tropomyosin-related kinase A (TrkA) are critically linked to inflammation-associated nociceptor sensitization, this led us to hypothesize that decreased pH may contribute to this process by depolarizing the neuron and mobilizing more TrkA to the cell membrane. This hypothesis is premised by previous experiments in other neuronal populations demonstrating that increased neuronal activity mobilizes more of the neurotrophin receptor TrkB to the membrane. We explored this question utilizing an in vitro model of acidosis akin to that observed with inflammation. Primary sensory neurons were grown on coverslips at a physiological pH of 7.4. The pH of the media was decreased to an acidic pH of 6.5 in half of the cultures for 30 minutes, followed by fixation under permeablizing or non-permeablizing conditions. Immunocytochemical analysis revealed a significant increase in the mobilization of TrkA to the plasma membrane in response to acidosis (confirmed using a biotinylation assay) and an enhanced level of TrkA activation in response to brief NGF challenge. This rapid mobilization of TrkA was attenuated with the addition of proton-sensitive channel blockers capsazepine and amiloride, for the TRPV and ASIC channels respectively. Unexpectedly, the amount of activated TrkA was also increased at pH 6.5 in the absence of NGF challenge. Taken together, the data suggests that sensory neurons can be rapidly sensitized to NGF in response to a decrease in pH and as such likely plays a role in the sensitization and hyperalgesia associated with an inflammatory state.

Pain is experienced in 30-50% of cancer patients during active antineoplastic therapy and in 60-90% of patients with advanced cancer. One of the root causes for inadequate medication is inadequate pain assessment. Therefore, a hospital-based quasi-experimental study was implemented to evaluate the effect of a continuing education and institutionalization program¡]CEI¡^on nurses¡¦ cancer pain assessment. There were 57 frequency-matched patient-nurse dyads were interviewed by the structured questionnaire at three different stages (pre-test, post-continuing education and post- institutionalization ). After these 171 patients were discharged, their charts were reviewed and abstracted. Chi-square test and ANOVA were used in the statistical analysis. The results showed that CE only made statistically significant improvement on patients¡¦ pain impact of relationship, pain impact of sleep, satisfaction, and hesitancy to report pain. Additionally, institutionalization made significant improvement on patient¡¦s now pain and average pain severity, nurses¡¦ accurate assessment of patient¡¦s pain ratings of mild pain and expected pain, and documentation of pain assessment. In conclusion, CE and institutionalization of cancer pain assessment were effective in cancer pain management in two different fields, one was the improvement of patient¡¦ pain severity and satisfaction and the other was the improvement of nurse¡¦s practices of cancer pain assessment. Quality comes from improving the process , not evaluating the output after fact. The suggestion was that the head nurse of the ward audited actively on unit and rewards for chart documentation. The management of good quality required the good administrator. To whom persisted endless of quality improvement , they can study the further analysis and comparison within five years after institutionalization.